Newsletter Volume 4, Issue 2
President’s Message
It’s been a busy summer for DSHP. In June, I
attended the Regional Chapter’s Presidents
Meeting (RCP) in Sacramento. The focus was
promoting grassroots legislative campaigns
within each local chapter. While in Sacramento,
I met with Senator Tom Torlakson and
Assemblyman Canciamilla’offices and provided
information on health-system pharmacists’
practice as well as offering DSHP/CSHP as
source of information for them in their
community regarding pharmaceutical issues. My
hope is that other pharmacists in our community
with ties to local and state representatives will
continue the start of this grassroots campaign to
allow DSHP/CSHP to add a knowledgeable
voice to the legislative process. Please contact
me if you have an interest in becoming active in
our chapter in this area. Jerry Gonzales attended
the September RCP meeting. (please see his
notes)
Consider attending Seminar 2006 this year in
Sacramento. It is being held October 12th-15th.
Topics include infectious disease, critical care,
oncology, diabetes, anticoagulation, ACLS
update, JCAHO, etc. Please join DSHP in
congratulating our President-Elect, Jerry
Gonzales at opening session where he will be
recognized as a new CSHP fellow.
Thank you to the many DSHP members who
have volunteered as moderator/monitors for one
CE room each day of Seminar.
DSHP is proud to sponsor final year pharmacy
students’ registrations at Seminar in order to
promote professionalism and further training in
residency programs. If you know of a final year
pharmacy student in our local chapter area
interested in attending Seminar, please have
Oct 2006
them contact Teresa Halperin at
tjhalperin@aol.com.
Night Out With Industry (NOWI) is Thursday,
October 26th from 5-10pm at the Embassy Suites
Hotel in Walnut Creek. This DSHP fundraising
annual event provides support for our
community outreach, continuing education and
student programming. We ask all members
support this event by attending and thanking our
drug industry attendees for supporting this event
through the drug fair. A one hour continuing
education dinner on diabetes will be provided in
addition to “faux”gambling, a raffle and 2007
DSHP officer installation.
DSHP ballots for 2007 officers have been mailed
and are due by October 17th. Thanks to the
nominees who have volunteered for leadership
positions. Board meetings are held the 3rd
Tuesday of each month (excluding June and
December) in Walnut Creek. Non-elected board
positions are also available.
Once again thanks for your continued
membership and support.
Teresa Halperin
For recent legislative and pharmacy law
information-see Capitol Notes at the CSHP
website. For local DSHP information:check out
our website at http://www.dshp.org
Seminar 2006 Delegates:, Johnny Wong, Teresa
Halperin, Denise Omen, Beckilyn Catali, Martin
Iyoya, Lucian Cheng)
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Communications from President-Elect
Regional Chapter Presidents Meeting September
16th in Ontario, Ca.
Highlights as reported by Jerry Gonzales,
President-Elect.
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The meeting was led by in coming
CSHP President, Alan Endo. He
announced the retirement of Claudia
Fouts, EVP effective September 11,
2006. CSHP Board of Directors will
begin a search for this position.
During her short tenure, Claudia has
energized the Board of Directors and
significantly improved the strategic
planning process and financial posture.
A key feature presentation related to
public relations, “Promoting Pharmacy
Practice was made by Jody JacobsonWedret and Thomas Pugh. The
presentation will be made again at
Seminar 06, with the additional support
of a representative from ASHP.
Review the process for regional
chapters to apply for a $1000 grant,
annually. The purpose of the grant is to
support materials for community
service or chapter advertisement.
Strategic Goals reviewed with key
points 1) of keeping members informed
of the CSHP governance process and
foster leadership development. 2)
Become a major force to support
regulatory and legislative changes
related to pharmacy practice. 3) Expand
relationships with external
organizations and increase the reach of
CSHP and regional chapter public
relations. 4) Increase member network
opportunities and provide activities that
provide relevance and value.
The balance of the meeting was
dedicated to up coming House of
Delegate agenda items.
o The chapter rebate model has
been remodeled in such a way
that there will be a more
consistent percentage-based
rebate for each member
category. E.g. pharmacist,
technician, student, etc. More
funds will be rebated back to
regional chapters and more
incentive to retain and renew
members.
Develop a professional policy
on the pharmacist’s
contribution and related to
Emergency Preparedness.
Establish a professional policy
regarding “off-label”
medication use.
Adopt a professional policy on
Pharmaceutical Care.
Resolution to appoint a Blue
Ribbon Committee to
determine an effective method
to insure “Geographical
Diversity” of CSHP Board of
Directors.
Continuing Education Chairs:
Debbie Sasaki-Hill and Donna Fitzgerald
2006 CE Events
January 12: 2006 Law Update, Board of
Pharmacy
February 23: COPD/Asthma, GSK
March 23: MRSA, Pfizer
April: TBD
May 11th: Metabolic Syndrome-Sanofi-Aventis
June 14th: Anemia of CKD Management in the
Elderly-Amgen
June 28th: Overactive Bladder-Watson
August 9th: ACS-Sanofi-Aventis
September 14th: Herpes Update-GSK
October 26th: NOWI- Diabetes
November 16th: Anemia Ortho Biotech(pending)
Dec or Jan 2007 Epilepsy by Eisai (pending)
DSHP Board Meetings: All members are
encouraged to become active volunteers within
our local association. Board meetings are held
the 3rd Tuesday of each month at Kaiser Walnut
Creek’s Walnut Bldg, 2nd floor conference
room. at 6:30pm-dinner provided. All members
are welcome to attend. Please RSVP to Teresa
Halperin at tjhaperin@aol.com or 925-935-9917
October 26th NOWI/Officer Installation
November 21st
Community Outreach Events
events every year.
American Heart Association Walk
Thank you for all participants and
donors.
Sunday, September 17, 2006 at the Danville
Livery and Mercantile.
Barbara Uenaka,chairperson Yelena Katkova .
and Priscilla Payne walked for DSHP. (Pictured
below)
National Pharmacy week is October 22- 28,
2006. Please watch out for future volunteer
events to highlight the important role of
pharmacists in ensuring safe and appropriate use
of medications! A tentative brown bag event is
being planned at the Concord Senior Center (and
possibly the Dublin Senior Center) during this
special week. We will communicate via email.
Contact Grace directly at gjcathome@yahoo.com
if you are interested in volunteering. We'd like
thank our membership for their generosity with
their time and energy and active participation in
community outreach programs.
More Community Past events:
DSHP team had 5 members, team Captain
Yelena Katkova, Barbara Uenaka, Priscilla
Payne, Denise Omen, and BeckiLynn Catalli.
Raised $600 up to date, late donations are
welcome.
The American Heart Association's online
fundraising website has a minimum donation
amount of $25.00. Follow this link to make a
secure credit card donation:
http://heartwalk.kintera.org/faf/r.asp?t=4
&i=158775&u=158775139970450&e=756026513
John Muir Women’s Health Fair:
Submitted by Grace Jone, PharmD
The annual Women's Health Faire was held at
the John Muir's Women's Center on September
16, 2006. A Second Year pharmacy student
volunteer Mandy ShuMin Guo from Touro
University volunteered along with DSHP
Community Co-Chair Grace Jone at this event.
We helped community members check their
blood pressures, discuss medications for
hypertension, diabetes and osteoporosis and
provided informative handouts. This was DSHP
first event at this venue. We had so much fun
that we will be adding it to our community
Submitted by Grace Jone, PharmD
On Friday April 21, 2006, DSHP attended the
annual Healthy Lifestyle and Resouce Fair at the
Concord Senior Center, an event we have been
participating in for several years now. The
DSHP members who participated were Kerri
Westmoreland, Teresa Halperin, Grace Jone and
CCPhA president Sarah Goldstein. John S., a
nursing student from Hayward State University,
also helped our booth by checking blood
pressures. We were on hand to help fill out vital
medication information for the ongoing Vial of
Life program for fair attendees, answer
medication-related questions, and disseminate
information regarding asthma, diabetes, arithritis,
hypertension and cholesterol. What a great
turnout for we were kept busy nearly the entire 4
hours! We would like to express appreciation to
John Muir Health, Teresa Halperin and Martin
Iyoya for preparing such a lovely healthy lunch!
Other Important Dates:
CSHP Regional Chapter Presidents Meeting:
CSHP Seminar 2006: 10/12-10/15 (Sacramento)
ASHP Mid-Year Meeting: 12/3-12/7 (Anaheim,
CA-Disneyland)
Membership Corner:
Submitted by Yelena Katkova
As of August , DSHP has 176 members.
Welcome packages have been sent to13
new members.
1. Lizett Battierez
2. Elizabeth Elledge
3. Daisy Arabelle Evangelista
4. Christine Gee
5. Chesi Ho
6. Eunice Lee
7. Kevin Leung
8. Maureen Long
9. Vinay Patel
10. Priscilla Payne
11. Rael Rufino
12. John Russilo
13. Nancy Stalker
National Poison Prevention Week:
BeckiLynn Catalli spoke to a lively group of first
graders at Green Valley Elementary on the topic
of poison prevention. The children tried their
hands of opening 3 different types of
“childproof” locks. Most first graders were able
to open 2 out of 3 of the containers. Colorful
Gatorade looking liquids were them presented to
the children. The kids agreed that they should
never drink anything found in the cabinet
without first asking an adult. They enjoyed
working on a poison crossword puzzle, along
with a word search, and a coloring book to take
home. The children also practiced identifying
items which should be kept out of reach of little
ones, such as aspirin, mouthwash, and vitamins.
The kids were encouraged to become official
Poison Detectives by going on a “Poison Jungle
Safari” with their parents to detect potential
poison problems in their own homes. The phone
number for public calls to the California
Poison Control System is 1-800-8764766 or 1-800-8POISON
Night Out With Industry 2006
Submitted by Denise Omen
Come Join us at our Annual Night Out With
Industry at teh Embassy Suites Hotel, in Walnut
Creek. This years theme is Mardi Gras, jeans, a
festive shirt with Mardi Gras mask and beads. A
best dressed prize will be awarded!
Our CE lecture will feature Dr. Pamela
Kerschner, MD Endocrinologist, Kaiser Walnut
Creek, she will be discussing: New Insulins.
Once again, this year we will have "faux"
gambling and raffle prizes. Please phone your
RSVP to Denise Omen at 925-295-5703 and
mail your payment to Denise Omen, 557 Heather
Grove Court, Walnut Creek, CA 94598. Cost per
person is $20. Officer Instillation will take place
during the evening, so don't forget to VOTE.
See you there.
Diablo Society of Health-System Pharmacists presents…
Come Join us!
October 26,
2006
Thursday
5:00 to 10:00
pm
at the
Embassy Suites
Hotel
in Walnut Creek
The Cost per
person is
$20
A limited number of
non-pharmacy guests
is allowed phone
ahead for approval
1345 Treat Blvd 6581100
Featuring
2 hr Drug Fair
New Officer
Instillation
1 Hr CE Lecture
“Faux” Gambling
Raffle Prizes
Please PHONE your
RSVP & mail your
payment to:
Denise Omen
557 Heather Grove Ct
Walnut Creek, CA
94598
Make checks payable to DSHP
Name(s):___________________________________
_
____________________________________
Pharmacist x ________(# tickets)
Pharmacy Technician x _________(#tickets)
Intern___________
Grad Intern_________
Pharmacy Resident__________
Technician Student____________
Email:___________________________________
Clinical Pearl
Medication Updates
by Amy Riedel, Pharm.D.
Anti-depressants and Pregnancy
The Food and Drug Administration (FDA) recently issued a public health advisory regarding the challenges
of treating depression in pregnancy. The advisory was issued in response to recently published studies. The
first study, performed by Cohen et al. (2006), described the risk of relapse of major depression in women
who discontinued their anti-depressant prior to or during the first 16-weeks of pregnancy. The second study
suggested an increased risk of persistent pulmonary hypertension of the newborn (PPHN) in mothers who
took selective serotonin reuptake inhibitors (SSRIs) late in pregnancy (Chambers et al. 2006).
In a prospective longitudinal study, Cohen et al. (2006) evaluated the risk of relapse of major depression in
201 women who maintained or discontinued their anti-depressant treatment during pregnancy. The majority
of patients received an SSRI. Women who discontinued their anti-depressant had a higher rate of relapse
compared to those who maintained their anti-depressant throughout pregnancy (68% vs. 26%). Antidepressant reintroduction did lower the risk of depressive relapse; however the risk of relapse was still
higher compared to the patients who maintained their anti-depressant treatment throughout pregnancy. Of
the women who experienced relapse, 51.2% did so in the first trimester, and 87.2% experienced relapse by
the end of the second trimester.
Chambers et al. (2006) performed a retrospective case-controlled study to assess the association between
PPHN and exposure to SSRI’s during late pregnancy. The relative risk of PPHN was significantly
increased in infants who were exposed to an SSRI after the 20 th week of gestation (adjusted odds ratio=6.1;
p=0.001). Fourteen of 377 (3.7%) infants with definite PPHN had been exposed to an SSRI compared to
six of 836 (0.7%) matched controls. The authors suggested that although the study was not designed to
establish causality, if causality is assumed, the absolute risk of PPHN in infants exposed to SSRI’s during
late pregnancy is still relatively low (~6-12 cases of PPHN, per 1000 women).
The study by Chambers et al. (2006) may be consistent with previous reports of neonatal complications
such as mild respiratory distress, transient tachypnea, failure to cry, and cyanosis in newborns exposed to
SSRI’s during late pregnancy. In addition, the paroxetine (Paxil) prescribing information was recently
revised based on two (unpublished) epidemiologic studies that demonstrated an increased risk of cardiac
congenital abnormalities in newborns who were exposed to paroxetine during the first trimester of
pregnancy (incidence of 1.5-2% in paroxetine exposed infants vs. 1% in infants not exposed to paroxetine).
Paroxetine is currently Pregnancy Category D; the remaining SSRI’s are currently Pregnancy Category C.
The FDA has requested all manufacturers of SSRI’s revise their labeling to describe the potential risk of
PPHN.
Given the potential risk of these rare events and their potential impact on the newborn, along with the
potential risk to the mother of depression relapse if anti-depressant treatment is discontinued, the treatment
of depression in pregnant women is especially challenging for health care professionals and patients. The
decision of whether or not to continue anti-depressants during pregnancy should be made after careful
consideration of the potential benefits and risk for each patient. If the health care professional and patient
choose to stop treatment with SSRIs before or during pregnancy, patients should be observed closely for
recurrence of depression.
References
Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL, et al. Selective
serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med
2006;354:579-587.
Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, et al. Relapse of major
depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA
2006;295:499-507.
FDA Public Health Advisory. Treatment Challenges of Depression in Pregnancy. July 19, 2006
http://www.fda.gov/cder/drug/advisory/SSRI_PPHN200607.htm
FDA Public Health Advisory. Paroxetine. December 8, 2005
http://www.fda.gov/cder/drug/advisory/paroxetine200512.htm
New Information on Angiotensin-Converting Enzyme (ACE) Inhibitors
Angioedema involving the extremities, face, lips, mucous membranes, tongue, glottis or larynx is a known
potential adverse effect with ACE inhibitors. Recently the Capozide (captopril/hydrochlorothiazide)
prescribing information was revised with reports of intestinal angioedema in patients treated with ACE
inhibitors. According to the Capozide prescribing information, patients presented with abdominal pain
(with or without nausea or vomiting); in some cases there was no prior history of facial angioedema and C1 esterase levels were normal. The angioedema was diagnosed by procedures including abdominal CT scan
or ultrasound, or at surgery, and symptoms resolved after stopping the ACE inhibitor.
In June 2006, the FDA issued a public health advisory regarding the use of ACE inhibitors during
pregnancy. The advisory was issued in response to an epidemiologic study published in the New England
Journal of Medicine. Investigators of the study reported an increased risk of major congenital
malformations (risk ratio=2.71) in infants exposed to ACE-inhibitors during the first trimester of pregnancy
(Cooper et al. 2006). Infants exposed to ACE-inhibitors were at increased risk for malformations of the
cardiovascular system (including atrial septal defect, patent ductus arteriosus, ventrical septal defect, and
pulmonic stenosis) and central nervous system (including hydrocephalus, microcephaly, spina bifida,
encephalocele). The risk of fetal abnormalities (especially related to the kidneys) associated with use of
ACE-inhibitors during the last six months of pregnancy has previously been established. The labeling for
all ACE-inhbitors currently includes a boxed warning regarding the potential harm when used during the
second and third trimester of pregnancy.
The FDA recommends the following:
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Healthcare providers who care for women of reproductive age should counsel those who are
treated with an ACE inhibitor about the potential risks of these drugs throughout pregnancy,
especially during the second and third trimesters.
Pregnant women should only be prescribed ACE inhibitors if the expected benefit clearly exceeds
the potential risk.
Women who become pregnant should have their ACE inhibitor changed to a different medication
as soon as possible.
Women who are taking ACE inhibitors to treat high blood pressure should tell their healthcare
professionals if they are planning a pregnancy or think they might be pregnant.
References
Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer S, Gideon PS, et al. Major congenital
malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006;354:2443-2451.
FDA Public Health Advisory. Angiotensin-Converting Enzyme Inhibitor (ACE inhibitor) Drugs and
Pregnancy. June 7, 2006 http://www.fda.gov/cder/drug/advisory/ACEI.htm
Capozide® (captopril and hydrochlorothiazide) Prescribing Information. Par Pharmaceuticals.
http://www.fda.gov/medwatch/SAFETY/2006/May_PIs/Capozide_PI.