Preston Pharmacy News - October 2010

Influenza Vaccine

Influenza (flu) is a contagious disease caused by the influenza virus. The best way to prevent the flu is to get a flu vaccine each season. The flu virus changes every year; last season’s flu vaccine may not protect patients from newer viruses, therefore annual immunization is imperative. This season’s vaccine will protect against the 2009 H1N1 virus as well as other seasonal influenza viruses (an H3N2 virus and an influenza B virus).1 It takes up to two weeks for protection to develop and protection lasts about a year.2 There are two types of influenza vaccine: the flu shot and the intranasal vaccine. The flu shot is an inactivated, or killed, vaccine while the intranasal vaccine is a live, attenuated (weakened) virus.2 This year health experts are recommending that all people 6 months of age and older get the flu vaccine. Some people should not receive the flu vaccine: people who have a severe egg allergy, those who have had a severe reaction to the flu vaccine previously, people who developed Guillian-Barre syndrome within 6 weeks of a previous flu vaccine, children younger than 6 months, and those who are currently ill should wait to get vaccinated until after symptoms lessen.1,2 The nasal spray is only an option for healthy people 2-49 years of age who are not pregnant.3 Patients should inform their doctor if they have received any other vaccines in the past 4 weeks before getting the live vaccine.3 Side effects of the flu shot may begin soon after the injection and last 1-2 days; these may include injection-site reactions (redness, swelling, soreness), fever, and aches. Side effects of the nasal spray may include runny nose, or nasal congestion, cough, chills, fatigue, sore throat, or headache. It is important for patients to understand that the live, weakened virus does NOT cause the flu. This year there is a higher dose influenza vaccine available (Fluzone High Dose) indicated for people aged 65 or older. This vaccine contains 4 times the amount of antigen contained in standard flu shots. While the higher dose does provide a better immune response, there are no clinical trials at this time to prove better efficacy (protection) than the standard dose vaccine.4

Pneumococcal Vaccine

Pneumococcal disease is a vaccine-preventable disease caused by the Streptococcus pneumonia bacteria and is one of the leading causes of serious illness throughout the world. There are currently two vaccines available: a polysaccharide vaccine for adults and a conjugate vaccine for children. The pneumococcal polysaccharide vaccine (PPSV) protects against 23 of the most prevalent pneumococcal types.5 The Advisory Committee on Immunization Practices (ACIP) recommends that the following individuals receive the PPSV: all adults age 65 years and older; people age 2 through 64 who have a long-term health problem such as heart, lung, kidney, or liver disease, alcoholism, and diabetes; anyone 2 through 64 years of age who has a condition or is on medications which weaken the immune system; any adult age 19-64 who is a smoker or has asthma.5,6 The vaccine may be administered anytime of the year and can be given at the same time as the influenza vaccine. PPSV is generally given only once but some circumstances may require a second dose including adults who were vaccinated before age 65 or those at highest risk for serious disease.5,6 While the vaccine has been determined safe and effective, some people should not get the vaccine including those who have previously had an allergic reaction to PPSV, those currently receiving radiation or chemotherapy, people who are currently ill (vaccination should be postponed).6 Side effects of the vaccine are minimal, but may include injection-site reactions such as redness or pain. For more information regarding the influenza or PPSV, including special populations who should or should not receive the vaccines, please visit the CDC website at www.cdc.gov If a patient develops a severe reaction to the influenza or pneumococcal vaccine, healthcare providers are encouraged to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. This report can also be filed through the VAERS website at http://www.vaers.hhs.gov or by calling 1-800-822-7967.

Controlled Substance News You Can Use

Currently the DEA does not view nursing staff at a long term care facility (LTCF) as an agent of the physician. As such, a pharmacy cannot accept an order for a controlled substance from LTCF staff. In order to be considered valid, a prescription for a controlled drug (Classes II-V) must be dated and signed by the practitioner on the date it is issued and contain ALL of the following: 1) the full name and address of the patient 2) the drug name, strength, dosage form, quantity prescribed and directions for use, and 3) the name, address, and registration number of the practitioner or midlevel practitioner. A chart order can only be considered a valid written prescription for a controlled drug if it contains all of the information of a valid written prescription listed above. If any of those items are missing, the prescription drug order cannot be accepted and filled by the pharmacist and will require verification from the prescriber. Currently our pharmacy is contacting prescribers (via fax or phone) to verify orders for controlled substances that we receive, but you can help us in our process! Remind practitioners of the need to include a quantity and refills on controlled substance orders they are writing for your residents, or encourage them to call and give us the order verbally. We want nothing more than to assist you in caring for your residents!

New Drug Approvals

Prolia (Denosumab): subcutaneous injection administered every 6 months approved by the FDA for the treatment of postmenopausal women with osteoporosis at high risk for fracture.7

New Drug Formulations

Jalyn (Dutasteride and Tamsulosin): combination capsule containing Dutasteride 0.5mg and Tamsulosin 0.4mg has been approved for treatment of symptomatic BPH.8 Namenda XR: 28mg once daily tablet was approved for treatment of moderate to severe dementia of the Alzheimer disease type.9 Aricept 23mg/day has been approved by the FDA for moderate to severe Alzheimer’s disease.10 Dulera (Mometasone furoate and Formoterol fumarate): combination metered-dose inhaler approved by the FDA for the treatment of asthma in patients 12 years and older.11

Quote of the Month

“Attitudes are contagious. Is yours worth catching?” – Anonymous

References for October 2010 Issue

1. Centers for Disease Control and Prevention . Key facts about Influenza (Flu) & flu vaccine. Available at: http://www.cdc.gov/flu/keyfacts.htm. Accessed September 3, 2010.
2. Centers for Disease Control and Prevention. Inactivated influenza vaccine 2010-11. Available at: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flu.pdf. Accessed September 3, 2010.
3. Centers for Disease Control and Prevention. Live, intranasal influenza vaccine 2010-11. Available at: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flulive.pdf. Accessed September 3, 2010.
4. Centers for Disease Control and Prevention. Fluzone High-Dose seasonal influenza vaccine. Available at: http://www.cdc.gov/flu/protect/vaccine/qa_fluzone.htm. Accessed September 3, 2010.
5. National Foundation for Infectious Diseases. Facts about pneumococcal disease. Available at: http://www.nfid.org/factsheets/pneumofacts.shtml. Accessed September 10, 2010.
6. Centers for Disease Control and Prevention. Pneumococcal polysaccharide vaccine. Available at: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-ppv.pdf. Accessed September 3, 2010.
7. Pharmacy Today. 2010(Aug):16(8): 34-35.
8. GlaxoSmithKline Web site. FDA approves Jalyn, a fixed-dose combination of dutasteride and tamsulosin, for symptomatic BPH in men with an enlarged prostate. Available at: http://www.gsk.com/media/pressreleases/2010/2010_us_pressrelease_10035.htm. Accessed September 17, 2010.
9. Forest Laboratories, Inc. Web site. Forest and Merz announce FDA approval of Namenda XR for the treatment of moderate to severe dementia of the Alzheimer’s type. Available at: . Accessed Septemhttp://www.frx.com/news/PressRelease.aspx?ID=1440385ber 17, 2010.
10. Aricept Web site. Available at: http://www.aricept.com/23mg/Ariceptlanding.html. Accessed September 17, 2010.
11. Dulera Web Site. Available at: http://www.dulera.com/mometasone_formoterol/dulera/index.jsp. Accessed September 17, 2010.