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Pharmacists fonnally recognized for their role in public health
~~-------------------------------Pharmacists Fonnally Recognized for Their Role In Public Health The American Public Health Association (APHA) has adopted a major position statement recognizing pharmacy as a profession with major responsibilities for public health. Passed by the APHA governing council at its annual meeting in Detroit in late October, the statement proclaims that "the pharmacist's role is expanding beyond the traditional product-oriented functions of dispensing and distributing medicines and health supplies." And it called on the American Public Health Association and its members, • To support the inclusion of pharmacists in the composition of the team of primary care practitioners; • To support the inclusion of pharmacists in the definition of public health practitioners; • To encourage the inclusion of public health concepts in the curriculum of schools of pharmacy. The statement, written by a group of pharmacist-members of the APHA, recognizes many of the contributions to public health performed by pharmacists:
Many inpatient and ambulatory care programs have added a clinical pharmacy segment to the traditional distribution function. Pharmacists now function in medical screening clinics, in the medical management of chronic disease states, and in minor disease diagnosis and treatment ... In the community pharmacy, phar~cists provide rehabilitation support to Individuals and organizations by giving advice on the use and selection of ostomy and other surgical appliances and equipment. The literature is replete with examples of the pharmacist functioning in hypertensive and colorectal screening, venereal disease control and contraception P;ograms, and providing health educahon, not to mention the role in over-thecounter (OTC) drug choice and use. In rural areas, pharmacists have sup~rlcan Pharmacy Vol.
NS21, No. 1, January 1981/9
ported environmental programs such as water pollution control, sanitation and waste disposal. But, despite its positive thrust and implications for supporting the pharmacist's role in public health, the statement contained some contradictions and scored the profession in a number of areas. On health planning, for example, the APHA statement says,
In a few instances, pharmacists have asserted themselves and have established a functional capacity in public health, but these are the exceptions rather than the rule. And on health legislation and regulation, the statement says,
The promulgation of public health legislation and subsequent regulation is not a field generally associated with the pharmacist's public health role. Yet the statement goes on to cite a number of cases in which pharmacists are serving in vital positions with health planning agencies and health departments across the nation, including the National Center for Health Services Research, the Health Care Financing Administration, the Food and Drug Administration, the Veterans Administration, the U.S. Public Health Service, the Congressional Office of Technology Assessment, and the Bureau of Health Manpower. And it points out,
Pharmacists at the state and local levels are employed in administering the drug component of Medicaid programs, as well as regulating the practice of pharmacy. On the practice of pharmacy itself, the APHA statement says,
Although the pharmacist has the basic health knowledge on which to build and is often uniquely sited in the community
to provide public health services, there are historic reasons why the pharmacist rarely thinks of him or herself, or is thought of by others, in association with public health. Moreover, it says,
The community pharmacist who is involved in public health activities is so rare that relatively few pharmacists are available as public health role models. The APHA statement was particularly critical of schools of pharmacy for their failure to teach public health.
Pharmacy educators have failed to teach public health and to provide role models for pharmacy students in public health at either the macro or the micro level. There are few courses devoted solely to public health in pharmacy, and no textbook emphasizing the role of pharmacy in public health. Neither the American Council on Pharmaceutical Education Guidelines, nor the 1978 Report of the Committee for Establishing Standards for Undergraduate Education in Pharmacy Administration of the American Association of Colleges of Pharmacy have sections specifically devoted to public health. The statement made a special pitch for schools of public health to include pharmacy in their programs and to recruit pharmacists into advanced programs in public health. The position paper, one of two on pharmacy services approved by the American Public Health Association, was written primarily by pharmacists who are members of the Pharmacy Services Committee of APHA's Medical Care Section. They included: T. Donald Rucker of Ohio State University, Thomas L. Milne of Portland, OR, Patricia J. Bush of Washington, DC, Dale Christensen of the University of Washington, and Rosalyn C. King of Silver Spring, MD. o 9
Pharmacy Organizations Urge lnvolvetnent InWhiteHouse Conference.on Aging ''Pharmacy has a tremendous stake in the policy and legislative outcomes of the 1981 White House Conference on Aging (WHCOA)." That's the message that is coming loud and clear in missives to state pharmaceutical associations and colleges of pharmacies. The American Pharmaceutical Association and the American Association of Colleges of Pharmacy have teamed up to produce a "pharmacy participation kit" to help mobilize support for the conference scheduled for November 30 through December 3, 1981. The kit is a step-bystep guide for pharmacists who want to get involved and have their views made known to the new administration. The White House conference has actually begun. Since May 1980 there has been a series of activities
that will run through June 1981 to increase public awareness of the problems of aging and stimulate agenda items for the four-day conference next fall. Community forums and state conferences have been organized or are planned. Some 1,800 delegates to the national conference are being selected. Beginning in June, a number of hearings at the local and regional level are planned to elicit formal testimony on such questions as economic security, physical and mental health, social well-being, and the use of the elderly as a growing national resource. Pharmacists who want to get involved should contact their state pharmaceutical association executive, the dean of a nearby college of pharmacy, or AACP Task Force on Aging chairman Dr. Peter P. Lamy .
at the University of Maryland College of Pharmacy, Baltimore. o
Device Alert Proposed Medical device firms would be required to alert the government to any deaths, injuries or other safety problems associated with their products under a proposal made in November by the Food and Drug Administration. The requirement would apply, for example, to x-ray machines, pacemakers, hospital supplies, intrauterine devices, and contact lenses. Drug companies have long been required to inform FDA of problems with their products, but until now the agency has tried to rely on voluntary reporting for medical devices. A public hearing on the proposal will be held on January 22. o
'Buried in Paper'-The term may soon be out-
moded as pharmaceutical manufacturers turn to microfilm. Recently, the Warner-Lambert Company filed its New Drug Application (NDA) for Lopid, a lipid-modifying agent, with the Food and Drug Administration in microfiche form. Dr. T. N. T. Olson displays a single sheet in his left hand and holds three folders that represent 200 of the 279 volumes of paperwork stacked behind him. The folders can be stored in about six inches of file space, compared to 33 feet for the hard paper volumes.
10
1980 LOPID NDA
American Pharmacy Vol. NS21, No. 1, January 1981/1
New Hypertension Report Released The latest guidelines for the identification, confirmation and referral of patients with elevated blood pressure have just been published in the 1980 Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. The report stresses the need for treatment of even "mild" hypertension and the importance of patient education in maintaining compliance. It also reaffirms the steppedcare approach to treatment. Patients with mild hypertension (a diastolic blood pressure of 90104 mm Hg) have twice the risk of developing cardiovascular disorders as do normotensive patients. Overall risk is further increased when target organ damage or other independent risk factors exist. Therefore, all adults with diastolic blood pressures of 95 or above on first examination should have the elevation confirmed within a month. l Those with diastolic pressures of 90-95 should be remeasured within ' three months. When detection occurs outside a physician's office, a diastolic blood pressure of 115 or more warrants immediate referral. I, All adults who have systolic blood j pressure over 160 should be reeval. uated promptly, while those under age 35 should be reexamined if systolic pressure exceeds 150. i A positive diagnosis of hyperten( sion can be made when the average . of two subsequent blood pressure ( measurements is 90 or more. Diastolic pressure is used to make the diagnosis because although systolic pressure is as good a predictor of risk as diastolic pressure, the goals of treating elevated systolic pressure have not been established. Long-term control of blood press.ure requires time, effort and the active participation by the patient in making treatment decisions. In addition to knowing the benefits and ~· possible adverse effects of therapy, patients must know that: t Their blood pressure exceeds normal limits;
I
I 1
~rlcan Pharmacy Vol.
NS21, No.1, January 1981/11
• Hypertension is often asymptomatic and perceived symptoms do not reliably indicate blood pressure levels; • Uncontrolled hypertension has serious consequences; • Long-term therapy and followup are necessary; • Treatment will not cure hypertension but should control it.
Therapeutic Goals
Free copies of the committee's report may be obtained from the High Blood Pressure Information Center (HBPIC), Box IM, 120/80 National Institutes of Health, Bethesda, MD 20205.
with a diuretic. If that doesn't work at tolerable dosage levels, an adrenergic inhibiting agent-such as clonidine or propranolol-is added. If blood pressure remains elevated, a vasodilator is given. If all else fails, guanethidine is recommended.
Setting a therapeutic goal for each Improving Compliance patient is important. The initial goal Prolonged compliance with hyis to achieve and maintain a diastolic pertension therapy is a major probpressure of less than 90. A further lem. Pharmacists can help facilitate goal could be the lowest diastolic adherence by counseling patients, pressure consistent with safety and uncovering adherence problems tolerance. Patients with moderate and suggesting solutions, and mon(105-114) and severe (115 or above) itoring progress toward the goal hypertension may have to accept a blood pressure. more limited goal-perhaps 90-100 Besides ensuring that the patient -if side effects are intolerable at understands the consequences of doses needed to achieve lower poorly controlled high blood pressure, other steps may be taken to blood pressure levels. How is the therapeutic goal improve compliance including: reached? • Simplifying the medication Non-drug therapy in the form of schedule by having the patient take weight reduction and sodium con- a drug only once or twice a day; trol (daily intake of 5 g salt or 2 g • Providing the patient with simsodium) should be adjuncts to man- ple written instructions on dosage, agement for all hypertensive pa- common side effects and therapeutients. Dietary management is a rea- tic goals for the prescribed drug; sonable approach for young pa• Praising the patient when a tients with uncomplicated mild goal is achieved. hypertension and no additional carThe report notes the presence of diovascular risk factors. Non-drug isolated systolic hypertension in a management can be considered de- significant number of elderly pafinitive therapy if it maintains blood tients. The decision to treat isolated pressure at normal levels, but medi- systolic hypertension in these pacations should be added if levels re- tients is made on an individual basis because there are no data on the efmain elevated. Behavioral therapy such as bio- ficacy of treating systolic hypertenfeedback, psychotherapy and relax- sion. If the elderly are treated, howation is still considered experi- ever, they should start with smaller mental and can not be recom- than usual doses because they fremended for long-term control of hy- quently have impaired cardiovascular reflexes that make them more pertension, the report says. All patients with moderate and susceptible to hypotension. Insevere hypertension should re- creases in doses should be made in ceive antihypertensive drugs in a smaller increments and spaced over stepped-care fashion in which addi- longer intervals than for younger tional drugs are added one by one patients. Drugs that may cause when the drug in use fails to lower orthostatic hypotension-such as blood pressure to acceptable levels. guanethidine--should be used cauThe stepped-care regimen starts tiously, if at all. o 11
Caffeine in Drugs Caffeine has come under increased scrutiny recently, with concerns that the stimulant might have some teratogenic effects. And FDA Commissioner Jere E. Goy an has advised that pregnant women avoid or severely limit caffeine intake until further data on caffeine's effects can be gathered. Most discussions on caffeine avoidance have centered around caffeine-containing food products
Help for Africa The University of Minnesota College of Pharmacy and two pharmaceutical companies have launched a program to help improve pharmacy education in several developing African countries. According to Lawrence Weaver, dean of the college, the joint university-industry effort will furnish li-
PPI Compendium In an effort to help hospitals comply with the FDA's recently released final regulation on patient package inserts (PPis), the American Society of Hospital Pharmacists (ASHP) plans to publish a PPI Compendium covering the 10 drugs or drug classes included in the federal rule. The compendium will help hospitals meet the requirements of the long-fought-for institutional exemption for mandatory PPI distribution
Culpepper Honored The Mercer University School of Pharmacy recently dedicated its nuclear pharmacy laboratory in honor of the late Dr. William C. Culpepper, a long time active member of APhA. 12
such as coffee, tea, soft drinks, and chocolate, but FDA says that about 1,000 prescription drugs and 2,000 over-the-counter drugs also contain caffeine. Caffeine appears in a number of pain relievers and is often found in aspirin and propoxyphene preparations. It is also found in OTC weight control aids, alertness medications, headache and pain relief remedies, cold products, and diuretics. Often the amount of caffeine in medications exceeds that of a cup of tea (28-44 mg) or coffee (75-155 mg). For example, weight control tablets,
alertness tablets and diuretics can contain up to 200 mg caffeine. Anal· gesics and cold/allergy medications tend to contain less than 50 mg caf· feine. When caffeine is an ingredient of an OTC drug, the amount is listed on the label. The FDA stresses, however, that women should not assume that a non-prescription drug is safe to take during pregnancy if it does not contain caffeine and urges that women not take any medica· tions during pregnancy without a physician's advice.
brary resources to the University of Nairobi in Kenya, the University of the North in the Republic of South Africa and the University of Zimbabwe (formerly Rhodesia). Faculty members have donated nearly 200 volumes of research and scientific journals and the college has contributed 1,200 copies of the textbook, "Care and Treatment of the Diabetic." The text was developed by the Continuing Education in Pharmacy unit at the college.
Practicing pharmacists and students will also receive the text. Upjohn International and Lilly In· ternational are helping to finance the delivery of the material. Weaver also announced plans to send laboratory equipment to these countries. Equipment at the Minne· sota College of Pharmacy which has been made obsolete by new acquisi· tions will be donated to the African universities.
to inpatients. Under the FDA's final regulation, all health care institutions may establish a system "reasonably calculated" to notify patients on admission of the availability of PPis and to make these available on request. A copy of the PPI Compendium at each nursing station will meet the latter requirement. The compendium is expected to be available in early 1981 and will cover the approximately 300 shelf products encompassed by the 10 mandatory PPis. The compendium also will include PPis for heretofore
"voluntary" drug classes as well as for estrogens and oral contracep· tives. It will be published in a format~ that will allow for easy addition of future PPis. ASHP is planning a limited free distribution of the com· pendium, with single and multiple copies offered for sale. ASHP also is working with the American Society of Consultant Pharmacists (ASCP) to develop a PPI compendium directed toward the drug information needs of pa· tients residing in long-term care facilities.
A faculty member of the Atlanta school for 15 years, Culpepper held a BS degree in physics from North Georgia College and a BS in pharmacy from the University of Georgia. In 1962 he earned a MS degree in pharmaceutical chemistry from the University of Georgia and, in 1972, a PhD degree.
He was instrumental in setting up the nuclear pharmacy curriculum at Mercer and, in 1977, was appointed to APhA's Nuclear Pharmacy Com· mittee. He was also a member of Rho Chi, Phi Delta Chi, the Georgia Pharmaceutical Association, the American Association of Colleges of Pharmacy, and Sigma Xi. American Pharmacy Vol. NS21, No.1, January 1981/
Many inpatient and ambulatory care programs have added a clinical pharmacy segment to the traditional distribution function. Pharmacists now function in medical screening clinics, in the medical management of chronic disease states, and in minor disease diagnosis and treatment ... In the community pharmacy, phar~cists provide rehabilitation support to Individuals and organizations by giving advice on the use and selection of ostomy and other surgical appliances and equipment. The literature is replete with examples of the pharmacist functioning in hypertensive and colorectal screening, venereal disease control and contraception P;ograms, and providing health educahon, not to mention the role in over-thecounter (OTC) drug choice and use. In rural areas, pharmacists have sup~rlcan Pharmacy Vol.
NS21, No. 1, January 1981/9
ported environmental programs such as water pollution control, sanitation and waste disposal. But, despite its positive thrust and implications for supporting the pharmacist's role in public health, the statement contained some contradictions and scored the profession in a number of areas. On health planning, for example, the APHA statement says,
In a few instances, pharmacists have asserted themselves and have established a functional capacity in public health, but these are the exceptions rather than the rule. And on health legislation and regulation, the statement says,
The promulgation of public health legislation and subsequent regulation is not a field generally associated with the pharmacist's public health role. Yet the statement goes on to cite a number of cases in which pharmacists are serving in vital positions with health planning agencies and health departments across the nation, including the National Center for Health Services Research, the Health Care Financing Administration, the Food and Drug Administration, the Veterans Administration, the U.S. Public Health Service, the Congressional Office of Technology Assessment, and the Bureau of Health Manpower. And it points out,
Pharmacists at the state and local levels are employed in administering the drug component of Medicaid programs, as well as regulating the practice of pharmacy. On the practice of pharmacy itself, the APHA statement says,
Although the pharmacist has the basic health knowledge on which to build and is often uniquely sited in the community
to provide public health services, there are historic reasons why the pharmacist rarely thinks of him or herself, or is thought of by others, in association with public health. Moreover, it says,
The community pharmacist who is involved in public health activities is so rare that relatively few pharmacists are available as public health role models. The APHA statement was particularly critical of schools of pharmacy for their failure to teach public health.
Pharmacy educators have failed to teach public health and to provide role models for pharmacy students in public health at either the macro or the micro level. There are few courses devoted solely to public health in pharmacy, and no textbook emphasizing the role of pharmacy in public health. Neither the American Council on Pharmaceutical Education Guidelines, nor the 1978 Report of the Committee for Establishing Standards for Undergraduate Education in Pharmacy Administration of the American Association of Colleges of Pharmacy have sections specifically devoted to public health. The statement made a special pitch for schools of public health to include pharmacy in their programs and to recruit pharmacists into advanced programs in public health. The position paper, one of two on pharmacy services approved by the American Public Health Association, was written primarily by pharmacists who are members of the Pharmacy Services Committee of APHA's Medical Care Section. They included: T. Donald Rucker of Ohio State University, Thomas L. Milne of Portland, OR, Patricia J. Bush of Washington, DC, Dale Christensen of the University of Washington, and Rosalyn C. King of Silver Spring, MD. o 9
Pharmacy Organizations Urge lnvolvetnent InWhiteHouse Conference.on Aging ''Pharmacy has a tremendous stake in the policy and legislative outcomes of the 1981 White House Conference on Aging (WHCOA)." That's the message that is coming loud and clear in missives to state pharmaceutical associations and colleges of pharmacies. The American Pharmaceutical Association and the American Association of Colleges of Pharmacy have teamed up to produce a "pharmacy participation kit" to help mobilize support for the conference scheduled for November 30 through December 3, 1981. The kit is a step-bystep guide for pharmacists who want to get involved and have their views made known to the new administration. The White House conference has actually begun. Since May 1980 there has been a series of activities
that will run through June 1981 to increase public awareness of the problems of aging and stimulate agenda items for the four-day conference next fall. Community forums and state conferences have been organized or are planned. Some 1,800 delegates to the national conference are being selected. Beginning in June, a number of hearings at the local and regional level are planned to elicit formal testimony on such questions as economic security, physical and mental health, social well-being, and the use of the elderly as a growing national resource. Pharmacists who want to get involved should contact their state pharmaceutical association executive, the dean of a nearby college of pharmacy, or AACP Task Force on Aging chairman Dr. Peter P. Lamy .
at the University of Maryland College of Pharmacy, Baltimore. o
Device Alert Proposed Medical device firms would be required to alert the government to any deaths, injuries or other safety problems associated with their products under a proposal made in November by the Food and Drug Administration. The requirement would apply, for example, to x-ray machines, pacemakers, hospital supplies, intrauterine devices, and contact lenses. Drug companies have long been required to inform FDA of problems with their products, but until now the agency has tried to rely on voluntary reporting for medical devices. A public hearing on the proposal will be held on January 22. o
'Buried in Paper'-The term may soon be out-
moded as pharmaceutical manufacturers turn to microfilm. Recently, the Warner-Lambert Company filed its New Drug Application (NDA) for Lopid, a lipid-modifying agent, with the Food and Drug Administration in microfiche form. Dr. T. N. T. Olson displays a single sheet in his left hand and holds three folders that represent 200 of the 279 volumes of paperwork stacked behind him. The folders can be stored in about six inches of file space, compared to 33 feet for the hard paper volumes.
10
1980 LOPID NDA
American Pharmacy Vol. NS21, No. 1, January 1981/1
New Hypertension Report Released The latest guidelines for the identification, confirmation and referral of patients with elevated blood pressure have just been published in the 1980 Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. The report stresses the need for treatment of even "mild" hypertension and the importance of patient education in maintaining compliance. It also reaffirms the steppedcare approach to treatment. Patients with mild hypertension (a diastolic blood pressure of 90104 mm Hg) have twice the risk of developing cardiovascular disorders as do normotensive patients. Overall risk is further increased when target organ damage or other independent risk factors exist. Therefore, all adults with diastolic blood pressures of 95 or above on first examination should have the elevation confirmed within a month. l Those with diastolic pressures of 90-95 should be remeasured within ' three months. When detection occurs outside a physician's office, a diastolic blood pressure of 115 or more warrants immediate referral. I, All adults who have systolic blood j pressure over 160 should be reeval. uated promptly, while those under age 35 should be reexamined if systolic pressure exceeds 150. i A positive diagnosis of hyperten( sion can be made when the average . of two subsequent blood pressure ( measurements is 90 or more. Diastolic pressure is used to make the diagnosis because although systolic pressure is as good a predictor of risk as diastolic pressure, the goals of treating elevated systolic pressure have not been established. Long-term control of blood press.ure requires time, effort and the active participation by the patient in making treatment decisions. In addition to knowing the benefits and ~· possible adverse effects of therapy, patients must know that: t Their blood pressure exceeds normal limits;
I
I 1
~rlcan Pharmacy Vol.
NS21, No.1, January 1981/11
• Hypertension is often asymptomatic and perceived symptoms do not reliably indicate blood pressure levels; • Uncontrolled hypertension has serious consequences; • Long-term therapy and followup are necessary; • Treatment will not cure hypertension but should control it.
Therapeutic Goals
Free copies of the committee's report may be obtained from the High Blood Pressure Information Center (HBPIC), Box IM, 120/80 National Institutes of Health, Bethesda, MD 20205.
with a diuretic. If that doesn't work at tolerable dosage levels, an adrenergic inhibiting agent-such as clonidine or propranolol-is added. If blood pressure remains elevated, a vasodilator is given. If all else fails, guanethidine is recommended.
Setting a therapeutic goal for each Improving Compliance patient is important. The initial goal Prolonged compliance with hyis to achieve and maintain a diastolic pertension therapy is a major probpressure of less than 90. A further lem. Pharmacists can help facilitate goal could be the lowest diastolic adherence by counseling patients, pressure consistent with safety and uncovering adherence problems tolerance. Patients with moderate and suggesting solutions, and mon(105-114) and severe (115 or above) itoring progress toward the goal hypertension may have to accept a blood pressure. more limited goal-perhaps 90-100 Besides ensuring that the patient -if side effects are intolerable at understands the consequences of doses needed to achieve lower poorly controlled high blood pressure, other steps may be taken to blood pressure levels. How is the therapeutic goal improve compliance including: reached? • Simplifying the medication Non-drug therapy in the form of schedule by having the patient take weight reduction and sodium con- a drug only once or twice a day; trol (daily intake of 5 g salt or 2 g • Providing the patient with simsodium) should be adjuncts to man- ple written instructions on dosage, agement for all hypertensive pa- common side effects and therapeutients. Dietary management is a rea- tic goals for the prescribed drug; sonable approach for young pa• Praising the patient when a tients with uncomplicated mild goal is achieved. hypertension and no additional carThe report notes the presence of diovascular risk factors. Non-drug isolated systolic hypertension in a management can be considered de- significant number of elderly pafinitive therapy if it maintains blood tients. The decision to treat isolated pressure at normal levels, but medi- systolic hypertension in these pacations should be added if levels re- tients is made on an individual basis because there are no data on the efmain elevated. Behavioral therapy such as bio- ficacy of treating systolic hypertenfeedback, psychotherapy and relax- sion. If the elderly are treated, howation is still considered experi- ever, they should start with smaller mental and can not be recom- than usual doses because they fremended for long-term control of hy- quently have impaired cardiovascular reflexes that make them more pertension, the report says. All patients with moderate and susceptible to hypotension. Insevere hypertension should re- creases in doses should be made in ceive antihypertensive drugs in a smaller increments and spaced over stepped-care fashion in which addi- longer intervals than for younger tional drugs are added one by one patients. Drugs that may cause when the drug in use fails to lower orthostatic hypotension-such as blood pressure to acceptable levels. guanethidine--should be used cauThe stepped-care regimen starts tiously, if at all. o 11
Caffeine in Drugs Caffeine has come under increased scrutiny recently, with concerns that the stimulant might have some teratogenic effects. And FDA Commissioner Jere E. Goy an has advised that pregnant women avoid or severely limit caffeine intake until further data on caffeine's effects can be gathered. Most discussions on caffeine avoidance have centered around caffeine-containing food products
Help for Africa The University of Minnesota College of Pharmacy and two pharmaceutical companies have launched a program to help improve pharmacy education in several developing African countries. According to Lawrence Weaver, dean of the college, the joint university-industry effort will furnish li-
PPI Compendium In an effort to help hospitals comply with the FDA's recently released final regulation on patient package inserts (PPis), the American Society of Hospital Pharmacists (ASHP) plans to publish a PPI Compendium covering the 10 drugs or drug classes included in the federal rule. The compendium will help hospitals meet the requirements of the long-fought-for institutional exemption for mandatory PPI distribution
Culpepper Honored The Mercer University School of Pharmacy recently dedicated its nuclear pharmacy laboratory in honor of the late Dr. William C. Culpepper, a long time active member of APhA. 12
such as coffee, tea, soft drinks, and chocolate, but FDA says that about 1,000 prescription drugs and 2,000 over-the-counter drugs also contain caffeine. Caffeine appears in a number of pain relievers and is often found in aspirin and propoxyphene preparations. It is also found in OTC weight control aids, alertness medications, headache and pain relief remedies, cold products, and diuretics. Often the amount of caffeine in medications exceeds that of a cup of tea (28-44 mg) or coffee (75-155 mg). For example, weight control tablets,
alertness tablets and diuretics can contain up to 200 mg caffeine. Anal· gesics and cold/allergy medications tend to contain less than 50 mg caf· feine. When caffeine is an ingredient of an OTC drug, the amount is listed on the label. The FDA stresses, however, that women should not assume that a non-prescription drug is safe to take during pregnancy if it does not contain caffeine and urges that women not take any medica· tions during pregnancy without a physician's advice.
brary resources to the University of Nairobi in Kenya, the University of the North in the Republic of South Africa and the University of Zimbabwe (formerly Rhodesia). Faculty members have donated nearly 200 volumes of research and scientific journals and the college has contributed 1,200 copies of the textbook, "Care and Treatment of the Diabetic." The text was developed by the Continuing Education in Pharmacy unit at the college.
Practicing pharmacists and students will also receive the text. Upjohn International and Lilly In· ternational are helping to finance the delivery of the material. Weaver also announced plans to send laboratory equipment to these countries. Equipment at the Minne· sota College of Pharmacy which has been made obsolete by new acquisi· tions will be donated to the African universities.
to inpatients. Under the FDA's final regulation, all health care institutions may establish a system "reasonably calculated" to notify patients on admission of the availability of PPis and to make these available on request. A copy of the PPI Compendium at each nursing station will meet the latter requirement. The compendium is expected to be available in early 1981 and will cover the approximately 300 shelf products encompassed by the 10 mandatory PPis. The compendium also will include PPis for heretofore
"voluntary" drug classes as well as for estrogens and oral contracep· tives. It will be published in a format~ that will allow for easy addition of future PPis. ASHP is planning a limited free distribution of the com· pendium, with single and multiple copies offered for sale. ASHP also is working with the American Society of Consultant Pharmacists (ASCP) to develop a PPI compendium directed toward the drug information needs of pa· tients residing in long-term care facilities.
A faculty member of the Atlanta school for 15 years, Culpepper held a BS degree in physics from North Georgia College and a BS in pharmacy from the University of Georgia. In 1962 he earned a MS degree in pharmaceutical chemistry from the University of Georgia and, in 1972, a PhD degree.
He was instrumental in setting up the nuclear pharmacy curriculum at Mercer and, in 1977, was appointed to APhA's Nuclear Pharmacy Com· mittee. He was also a member of Rho Chi, Phi Delta Chi, the Georgia Pharmaceutical Association, the American Association of Colleges of Pharmacy, and Sigma Xi. American Pharmacy Vol. NS21, No.1, January 1981/