Digitized by the Internet Archive
in 2011 with funding from
North Carolina History of Health Digital Collection, an LSTA-funded NC ECHO digitization grant project
http://www.archive.org/details/carolinajournalo671987
flE OIROLINk
JOURNN-OfPHN^MKGY
university of North Carolina
*- MAR 10 1987
S ^ea,th Sciences Library
o
>
The Adam's Mark Hotel, Charlotte, headquarters of the 1987 Annual Convention of the
North Carolina Pharmaceutical Association, the Traveling Members' Auxiliary and the
Woman's Auxiliary, April 22, 23, 24 and 25.
>-
D
<
Heal t h
2 23 I
Chapel Hill,
c i e n c e s Lib r a r y
This tablet represents
the successful treatment of
millions of patients.
(verapamil HCI/Knoll)
TABLETS
A product
of Knoll research
There's no substitute
for experience.
Wj#
-
80 nig sewed tablet
Also available
120 mg scored tablet
Knoll Pharmaceuticals j
A Unit of BASF K&F Corporation f
Whtppany. New Jersey 0798 1 m
BASF Group kn
© 1986, BASF K & F Corporation
Justice Drug Company
P.O. Box 22025
Greensboro, NC 27420
AN ALCO STANDARD COMPANY
Now in our 87th Year of Service to the North Carolina Pharmacists
1-800-632-1295
fills Partnership
For Profit
Family
Independent
Pharmacy
Total Retail Concept
The Family Independent Pharmacy program provides an
all-inclusive plan covering every aspect of marketing,
merchandising, and management of drug store opera-
tions. It is a wholesaler-sponsored voluntary, and it
embraces the total retail concept in all its forms.
IHHC
TOTAL HOME HEALTH CARE
Our Total Home Health Care™ Program offers Durable
Medical Equipment for Rent or Resale. Third Party Billing
for Medicare/Medicaid.
Additional
* Services & Programs Offered *
Store Plan-O-Gram: Complete Store Layout & Design
including Fixtures, Merchandise Plan-o-graming,
and Pricing Strategies
Specialty (Jift Departments including Arts & Crafts
Affordable Pharmacy Computer Systems
National Data Corporation
Merchandise Racking Service
Group Life
And Health
Insurance
Benefits
For Members Of
North Carolina
Pharmaceutical
Association
Pilot Life Insurance Company is pleased to have oeen
selected as the Group insurance carrier for the North
Carolina Pharmaceutical Association. It would be to
your advantage to become thoroughly acquainted with
the benefits of this program.
You can expect the best possible service from Pilot Life,
one of the nation's leading Group insurance carriers.
For full information, contact Mr. Al Mebane, Executive
Director, North Carolina Pharmaceutical Association.
Write or call:
Sam P. Stuart, CLU
P. O. Box 595
Winston-Salem, NC 27102
Telephone 919/723-8811
Pilot
Life
1HE GAROLINk
JOURNAL of PHrVRMkCY
JANUARY 1987
(USPS 091-280)
VOLUME 67
NUMBER 1
Officers
NORTH CAROLINA
PHARMACEUTICAL
ASSOCIATION
President
M. Keith Fearing, Jr.
P.O. Box 1048
Manteo, NC 27954
(919) 473-3463
Vice Presidents
Julian E. Upchurch
5201 Pine Way
Durham, NC 27712
(919)477-7325
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh, NC 27612
(919) 876-5600
W. Robert Bizzell
1007 Rhem Street
Kinston, NC 28501
(919) 527-6929
Executive Director
& Editor
A. H. Mebane, III
P.O. Box 151
Chapel Hill, N.C. 27514
NCPhA Office
(919) 967-2237
or
1-800-852-7343
CONTENTS
1987 Convention Highlights 5
Report of the Loan Fund/Endowment Fund Committee ... 8
International Leadership Conference 15
Pharmacist Allen Lloyd 17
Local News 18
Correspondence Course — Personal Hygiene 19
Dickinson's Pharmacy 30
Sleeping Pills 33
Classified Advertising 39
ADVERTISERS
APhA 16
Colorcraft 13
Justice Drug Company 1
Kendall Drug Company 28
Knoll Pharmaceuticals 2nd Cover; 36 & 37
Eli Lilly and Company 12
Owens & Minor, Inc 3rd Cover
Pilot Life 2
Dr. T.C. Smith Co./W.H. King Drug 4th Cover
Spear Associates 14
Store Fixtures & Planning, Inc 22
The Upjohn Company 6
USP 4
Washington National 32
The Carolina Journal of Pharmacy is published monthly by the
North Carolina Pharmaceutical Association, P. O. Box 151,
Chapel Hill, NC 27514. The Journal is provided to NCPhA
members through allocation of annual dues. Subscription rate to
non-pharmacists (continental US) $20.00. Single copy price
$2.00. Overseas rates on request. Second class postage paid at
Chapel Hill, NC.
THE CAROLINA JOURNAL OF PHARMACY
volume H
Advice*. |
the Patient ,.
Information
for the
Health Care
Provider
USPDI
^ntr>E«°n1'
USPDi
SeventhEdWom^
WHY BUY JUST A "BOOK"
when you can subscribe to USPDI®! This continually revised
drug information service will provide you with up-to-date, clinically
relevant drug data on virtually all drugs. Your subscription will also
include our unique corresponding patient drug information New
and revised information is issued through bimonthly Updates,
avoiding the inconvenience of replacing, or worse, losing pages.
Start your subscription to USPDI with the newly revised,
2-volume Seventh Edition at the special pre-publication price of
S64 95 (regularly S79.95) Continue your subscription at our low
renewal rates (billed annually) so that you are assured of receiving all
revised main volumes and a continuous flow of bimonthly Updates.
NEW IN THE SEVENTH EDITION
All new index by indications— for easy reference to drugs
used in the treatment of various disease states. Categorized
by agents used in diagnosis, prophylaxis, and treatment
Major new family monographs including: Adrenergic
Bronchodilators, Calcium Supplements, Citrates, Phosphates
Includes monographs on most of the major new drug
products recently approved by FDA such as: Enalapril,
Interferon, Muromonab-CD3, Ribavirin.
Over 100 new generic substances or combinations added.
I Get more than just a "book". Order your initial
subscription before January 31, 1987 and save $15.
| | Yes! I want to join the USP D\ subscription service at the pre-
publication price of $64.95 (S 1 5 off the regular price) for the
first year.
; | I want to continue to guarantee these low rates by
subscribing now for a two year period for $1 24.95.
FULL MONEY BACK GUARANTEE. It, for any reason, you are not
satisfied after receipt of your first subscription publication, return your
purchase (in resalable condition) within 30 days for a full refund.
□
Enclosed is my check payable to USPC for $_
(PA residents add 6% sales tax.)
| I Charge my
□ MasterCard Acct
□ VISA siiSS
about fords* sriio
The Seventh Ec
Send Order to:
L.
Zip
korbyrtK
North Carolina Pharmaceutical Association
PO. Box 151. 109 Church Street
Chapel Hill, North Carolina 27514
.J
Special Offer
Extended Through
February 27, 1987
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
1987 CONVENTION IN BRIEF
Adam's Mark Hotel
Charlotte, North Carolina
April 22, 23, 24 & 25
WEDNESDAY APRIL 22
Joint Management Seminar 9:00 - 5:00 pm
Sponsored by North Carolina Pharmaceutical Association
and North Carolina Society of Hospitals.
Convention Registration Desk Opens 3:00 pm
Opening Banquet 7:30 pm
Speaker: Michael Broome
Features: Presentation of NCPhA Coat of Arms, Don Blanton Award and Bowl of Hygeia
Award, Young Pharmacist of the Year and announcement of 1 987 Pharmacist of
the Year.
THURSDAY APRIL 23
Convention Registration Desk Opens 8:00 am
TMA Breakfast 8:00 am
PharmPac Breakfast 7:30 am. Guest speaker to be announced
Practitioner-Instructor Luncheon 1 :00 - 2:00 pm
Workshop — 2:00 - 5:00 pm
Watercolor Class — 3:00 - 5:00 pm
Golf and Tennis Tournaments
TMA Sponsored Dance 9:00 - 12:00 midnite
FRIDAY APRIL 24
Convention Registration Desk Opens 8:00 am
NCPhA 2nd Business Session 9:00 - 12:30 pm
TMA Business Session 1 1:00 am - 12:00 noon
Woman's Auxiliary Business Session 9:30 am
Exhibition Ribbon Cutting 12:30 pm
Complimentary Buffet Lunch in Exhibit Hall 12:30 pm
Exhibit Program 12:30 - 5:00 pm
Casino Night 8:30 - 11:00 pm
SATURDAY APRIL 25
Christian Breakfast 7:30 am
Convention Registration Desk Opens 8:00 am
NCPhA 3rd Business Session 9:00 - 12:30 pm
Awards Luncheon & Installation Ceremony
Speaker: Lonnie Hollings vorth, President, NARD
Induction into 50+ Club, Academy of Pharmacy, and other awards. Installation of
1987 1988 NCPhA Officers
Executive Committee Meeting 2:45 4:00 pm
January, 1987
This is
the only thing
a lot of prescriptions
will ever fill.
Sad, but true. Prescriptions written for 14% of
your customers never make it to your pharmacy
counter*. When asked for a reason, nearly 75% of
the noncompliant group said they didn't need the
medication ... or didn't want to take it.
Another 6% told tales of prescriptions lost,
prescriptions forgotten. . . or drugs that weren't
available.
But surprisingly enough in this age of tight
budgets, only one in ten persons said they canned
their prescriptions because of high cost.
Like to know more? Just contact your Upjohn
representative.
'According to the 1985 National Prescription Buyer Survey by Market Facts. Inc.
Upjohn
Sharing knowledge...sharing success.
1987. The Upjohn Company. Kalamazoo. Michigan 49001
THE CAROLINA JOURNAL OF PHARMACY
CONVENTION CHAIRMEN ^si Exhibitors
NCPhA Jonathan A. (Don) Hill
Woman's Auxiliary Mary Lou Davis
Traveling Members'
Auxiliary E. Delacy Luke
1987 Contributors
Ayerst Laboratories
Ciba-Geigy
Cooper Drug
Merrell-Dow
Ortho Pharmaceutical Corporation
Parke-Davis
Pfizer Pharmaceuticals
Smith Kline & French Laboratories
Roche Laboratories
Boehringer Ingelheim Pharmaceuticals, Inc.
Bristol Laboratories
Burroughs Wellcome Company
Carolina Medical Products Company
Companion Technologies
Eli Lilly Company
Goldline Laboratories
Kendall Drug Company
Knoll Pharmaceuticals
Marion Laboratories, Inc.
Mead Johnson Pharmaceutical Division
Pharmacy Network of North Carolina
PharmaSTAT, Inc.
QS/1 Pharmacy Systems
Spear Associates, Inc.
Store Fixtures & Planning, Inc.
The Upjohn Company
Rugby Laboratories, Inc.
Washington National Insurance Co.
Liberty Drug Systems, Inc.
SPECIAL UNIT FORMED TO COMBAT
HEALTH INSURANCE FRAUD
Fraud in the $425-billion-a-year health care
industry is reaching epidemic proportions and
Blue Cross and Blue Shield of North Carolina
(BCBSNC) is doing its part to fight it.
A special investigative unit was formed
January 1 to combat fraudulent and criminal use
of the health insurance system. Its function is to
identify and investigate suspected instances of
fraud, and when necessary, seek prosecution of
persons conducting fraudulent activities
involving BCBSNC benefits.
Examples of health insurance fraud include
using someone else's ID card to receive medical
services, falsifying medical records and receipts,
and billing for services not rendered.
"As the state's oldest and largest health insurer,
we are stewards of our subscribers' money and
we have the fiduciary responsibility to safeguard
that money," said Rose Carpenter, head of the
first-ever fraud unit.
"We won't be going on witch hunts, but we do
want people to know that we will aggressively
pursue and prosecute offenders," Carpenter said.
"There are no demographics to suggest that
fraudulent activities are conducted by just one
segment of society or the health insurance system.
We'll need help from everybody — our
subscribers, our employees and health care
providers — to put an end to the abuses."
Carpenter noted that pharmacists could assist
BCBSNC's fight against health insurance fraud
by making sure their signatures are stamped on
any drug records given to customers.
"One area of concern is that with the increased
use of computers for record keeping, it would be
quite easy for someone to falsify a drug record on
a home computer, print it out and submit it for
payment," Carpenter said. "Not only would a
stamped signature from the pharmacist on these
print-outs assure authenticity, but it would speed
up claims processing as well."
Persons suspecting fraudulent activity as it
relates to BCBSNC are encouraged to contact
Carpenter at (919) 489-7431. Confidentiality is
assured to all persons providing information.
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
106th ANNUAL CONVENTION
OF THE
NORTH CAROLINA PHARMACEUTICAL ASSOCIATION
APRIL 20-22, 1986
HOLIDAY INN FOUR SEASONS
GREENSBORO
COMMITTEE REPORT
OF THE COMMITTEE ON
CONSOLIDATED LOAN FUND/ENDOWMENT FUND
COMMITTEE MEMBERS
Jack K. Wier — Chairman, Chapel Hill
Laura G. Burnham, Winston Salem
Howard Q. Ferguson, Randleman
Robert L. Hall, Mocksville
Joseph L. Johnson, Jr., Greensboro
Donald V. Peterson, Durham
Russell K. Phipps, Chapel Hill
Ralph P. Rogers, Durham
B.R. Ward, Goldsboro
Jack G. Watts, Burlington
Ronald J. Winstead, Durham
CONSOLIDATED PHARMACY
LOAN FUND
The Consolidated Pharmacy Loan Fund is the
only regular source which can meet quickly the
needs of pharmacy students for emergency
financial aid. During calendar 1985 this fund
provided $39,900.00 in 133 loans to 65 students.
This represents approximately 6V2 percent of the
total documentable financial aid received by
students at the UNC-CH School of Pharmacy.
Total documentable financial aid to pharmacy
students from other sources for the 1985-86
academic year was $579,232.50 with approxi-
mately 69 percent of this amount coming from
the federal government. Of this total amount of
aid from other sources, 44 percent was in the
form of loans, 5.7 percent was in payments for
work performed by the students, and
approximately 50 percent was in the form of
grants and scholarships. School of Pharmacy
scholarships accounted for $18,600.00,
approximately 3 percent of the total of financial
aid from sources other than the Consolidated
Pharmacy Loan Fund. Pharmacy students
received about two times the financial support
from the Consolidated Pharmacy Loan Fund as
they did from School of Pharmacy Scholarships.
A summary table of 1985-86 financial aid to
pharmacy students is attached to this report.
A summary table of the financial activity of the
Consolidated Pharmacy Loan Fund is also
attached. This table reveals that 2 fewer loans
($600.00 less value) were made to pharmacy
students in 1985 than in 1984, but were still
almost $4,000.00 less than those of 1982 and
1983.
It is the opinion of this committee that the
trend toward frugality in federal expenditures
undoubtedly will reduce the monies available
from that source for grants and loan guarantees to
students in the near future. If such is the case, it
follows that there will be increased pressures on
all other sources of financial aid for students.
NCPhA to seek increased contributions to the
Consolidated Pharmacy Loan Fund.
This committee reported last year that it had
asked the NCPhA Executive Committee for
guidance on two subjects: the subject of
instituting an interest charge on loans made to
pharmacy students, and the subject of the
relationship of the Consolidated Pharmacy Loan
Fund to students who will become enrolled at the
new School of Pharmacy at Campbell
University. An ad hoc committee was appointed
by President Brown and charged by him with the
task of ascertaining, if possible, the intent of the
founders of the Consolidated Loan Fund as to the
clientele which the fund was to serve, and the
basis for their obvious intent not to charge interest
on loans made to pharmacy students. W. J. Smith
was chairman of the committee and duly made
his report to this committee. A copy of Mr.
Smith's report is attached to this report.
This committee met on February 23 this year.
The above subjects were considered, with Mr.
Smith's report as one source of input to
committee deliberations. The results of those
deliberations were as follows:
1 . Loans to students of pharmacy at Campbell
University — All monies in the Consolidated
Pharmacy Loan Fund at this time shall be
reserved for loans to NCPhA student members at
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
the UNC-CH School of Pharmacy. If, and only if,
the officials at Campbell University School of
Pharmacy wish to participate in such a loan fund,
future NCPhA solicitations of monies for the
Loan Fund will allow donors to stipulate whether
their donations should provide loan funds for
students at the UNC-CH School of Pharmacy, for
students at the Campbell University School of
Pharmacy, or for students at both schools.
The above recommendation was transmitted
to President Brown and the NCPhA Executive
Committee.
2. Interest charge on loans to students —
Discussion of this subject engendered lively
disagreement, as on previous occasions. Because
four of the eleven members of the committee
were not present for that discussion, chairman
Wier submitted the question to all members of
the committee by way of a mail ballot. A copy of
his letter to committee members and a copy of the
ballot which they received is attached to this
report. Six members of the committee voted to
maintain the policy of no interest on these loans,
which policy has been in effect since the inception
of the loan fund. Five members voted in favor of
charging interest on loans to students. Arguments
made by committee members for and against the
proposition are contained in the attached letter.
Because a bare majority of the committee
members favored continuing the policy of no
interest on loans, chairman Wier forwarded all
materials pertaining to the subject, and to the
vote, to President Brown and the NCPhA
Executive Committee. It is the opinion of the
chairman of this committee that such an
important monetary issue should be settled by the
Executive Committee rather than by this
committee.
ENDOWMENT FUND
The financial report of the Endowment Fund
and its several constituent funds is attached to this
report.
General Endowment Fund
The General Endowment Fund was increased
during 1985 by contributions of $633.75 to a
value of $78,796.59. Interest earned by the fund
was $7,241.91.00. $7,052.89 of that interest had
been transferred to the General Operating Fund
by December 31, 1985. The balance of the
interest was subsequently transferred to that fund.
Kappa Psi Fraternity Fund
The NCPhA owns a $5,000.00 bond issued by
the UNC-CH chapter of Kappa Psi Professional
Pharmacy Fraternity. The fraternity has made
annual payments of interest on that bond, but has
made no payments toward recovery of the bond.
This committee recommended that the Executive
Director of the NCPhA attempt to work with
Kappa Psi Fraternity, especially the alumni
members, to mount a fund drive to eliminate this
debt.
Ralph P. Rogers, Sr.,
Award Fund
The value of this fund increased during 1985
from $ 1 5,770.8 1 to $ 1 7,559.80. Expenses for the
Award and the Award Dinner were $872.08;
contributions were $1,113.30; interest earned
was $ 1 ,547.77. The award is made to a student at
the UNC-CH School of Pharmacy for
achievement in Pharmacy Administration course
work.
W. J. Smith Convention
Speaker Fund
With no expenditures, contributions of
$95.00, and interest earned of $588.43, the value
of this fund increased during 1985 to $6833.55.
Jesse S. Stewart Memorial
Scholarship Fund
During 1985, expenditures were $500.00 (the
scholarship) and interest earned was $748.16.
The balance of the fund at the end of 1985 was
$6,629.47.
CONSOLIDATED
PHARMACY LOAN FUND
1985
Number of Loans Made 133
Total Value of Loans $ 39,900.00
Average Value of Loans $ 300.00
Value of Loans Outstanding $ 1 08,800.00
Contributions to Fund $10,423.71
Total Assets of Fund $ 1 47,864.89
January, 1987
10 THE CAROLINA JOURNAL OF PHARMACY
SCHOOL OF PHARMACY — UNC-CH
1985-86 STUDENT FINANCIAL AID
January 13, 1986
TOTAL NEED $499,880.00
TOTAL FUNDS AWARDED $579,232.50
DIFFERENCE OF NEED AND FUNDS AWARDED $79,352.50
FUNDS OR GUARANTEES BY FEDERAL GOV'T.
Grants $155,831.00
Loans $236,510.00
Work-Study $7,250.00
Total Federal Support $399,59 1 .00
FUNDS OR GUARANTEES BY STATE GOVT.
Grants $23,410.50
Loans $10,440.00
Total State Support $33,850.50
UNC-CH FUNDS
Scholarships $65,775.00
Salaries $11,192.00
Total UNC-CH Support $76,967.00
SCHOOL OF PHARMACY SCHOLARSHIPS $ 1 8,600.00
MISCELLANEOUS SOURCES
Grants $25,465.00
Loans $9,875.00
Salaries $14,884.00
Total Miscellaneous Funds $50,224.00
TOTAL FINANCIAL SUPPORT $579,232.50
These funds were awarded to 196 students which is 40.7 percent of the
Pharmacy student body (48 1 ).
In addition to the funds provided through the Office of Student Aid and the
School of Pharmacy, $39,900.00 was provided as loans to students during
calendar 1985 by the Consolidated Loan Fund of the North Carolina
Pharmaceutical Association. These loans are provided at no interest and were
made to 65 students.
CONSOLIDATED PHARMACY LOAN FUND
Comparison of Selected Activities for 1980 through 1985
1980 1981 1982 1983 1984 1985
Number of Loans Made 76 110 119 136 135 133
Total Value of Loans $22,050.00 $32,820.00 $ 35,200.00 $ 40,600.00 $ 40,500.00 $ 39,900.00
Average Value of Loans $ 290.13 $ 298.36 $ 295.79 $ 300.00 $ 300.00 $ 300.00
Value of Loans Outstanding $64,875.00 $76,655.00 $89,233.33 $99,048.33 $103,395.00 $108,800.00
Contributions to Fund $6,359.63 $23,354.33 $14,638.68 $14,238.76 $ 9,548.39 $10,423.71
Total Assets of Fund $73,611.39 $97,489.52 $116,547.42 $128,962.03 $140,645.05 $147,864.89
NOTE: The maximum loan to a student each semester is $300.00. The maximum total loan to a student is $1,800.00.
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
11
ENDOWMENT FUND
1985
Balance 1/1/85
Balance 12/31/85
General Endowment Fund
$77,973.82
Interest
7,241.91
Interest Transferred to Gen. Fnd.
7,052.89
Contributions
633.75
$ 78,796.59
Kappa Psi Bond
$ 5,000.00
Interest
250.00
Interest Transferred to Gen. Fnd.
250.00
$ 5,000.00
Ralph P. Rogers, Sr. Fund
RESTRICTED FUNDS
$15,770.81
Interest
Expenses [Award and Dinner]
Contributions
1,547.77
(872.08)
1,113.30
$ 17,559.80
W. J. Smith Convention Spkr. Fund
$ 6,067.62
Interest
Contributions
Due from Gen. Fund (Contributions)
588.43
95.00
82.50
$ 6,833.55
J. S. Stewart Scholarship Fund
$ 6,381.31
Interest
Due to Gen. Fund (Scholarship)
748.16
(500.00)
$ 6,629.47
TOTAL
$114,819.41
To: Members, Consolidated Loan Fund
Committee, NCPhA
From: Jack K. Wier, Chairman
Date: February 25, 1986
Subject: Ballot — Should interest be charged
on loans?
1 . At the scheduled meeting of this committee
on February 23, the subject of instituting an
interest charge on loans made to Pharmacy
students from this fund was explored again.
Again, opinion was divided. Because four of
the eleven members of the committee were
not present, and because this is a matter of
considerable import, I chose to conduct a vote
on the subject by mail ballot. The
recommendation of this committee to the
Executive Committee of the NCPhA will be
determined by the results of this vote. Please
mark and return the ballots promptly. Please
sign your ballot. I will submit photocopies of
these ballots to the Executive Committee
along with the summary recommendation
from this committee.
2. Fact:
a. This loan fund was established circa
1945 with a sum of about one hundred and
seventy dollars.
b. The originators of the loan fund
specifically decided against charging interest
on the loans made.
c. The present value of the loan fund is
$147,864.89. In 1985, loan repayment plus
contributions exceeded money loaned by
$5,018.71.
(Continued on page 13)
January, 1987
Human insulin for all. Humulm
human insulin
[recombinant DNA origin]
Identical to human Insulin. Humulm is the only insulin not
derived from animal pancreases
Recombinant DNA technology makes the production of
Humulm possible and virtually assures every insulin user of a
lifetime supply
From Lilly . . . a dependable source of insulin lor
generations. Since 1922, when we became the first company
to manufacture insulin, we have led the search for the best
diabetes care products and, at the same time, maintained a
constant supply of insulin for all insulin users
Our 24 formulations of insulin— including Humulm and all
forms of lletm5 (insulin)— are available through the widest retail
distribution of insulin in the United States
Beyond that, we will continue to provide a wide range of
diabetes service and educational materials for use by physi-
cians, pharmacists, and diabetes educators,
« 1986 ELI LILLY AND COMPANY
Our Medical Division is on call. Our Medical Division staff
is only a phone call away Please contact them if you have any
questions about our diabetes care products
Any change of insulin should be made cautiously and
only under medical supervision. Changes in refinement,
purity, strength, brand (manufacturer), type (regular. NPH,
Lente ' , etc), and/or method of manufacture (recombinant DNA
versus animal-source insulin) may result in the need for a change
in dosage
Lilty Leadership
IN DIABETES CARE
For information on insulin delivery systems, contact CPI 1-(800)-2273422
3ky
Eli Lilly and Company
Indianapolis. Indiana 46285
THE CAROLINA JOURNAL OF PHARMACY
13
MEMBERS
(Continued from page 11)
d. The increase in value of the fund is
entirely from contributions to the fund. Any
bank interest earned has been transferred to
the General Fund.
e. As it stands now, repayment of loans
must begin within 6 months after graduation
from the School of Pharmacy, and payments
are to be no less than fifty dollars per month.
f. Bad-debt experiences have been
minimal. Never-the-less, beginning in 1983,
penalty interest of 6 percent is charged against
loans whose repayments are in default.
g. The monies available in the loan fund
have been sufficient for the past several years
to meet all requests for loans.
h. Loans from this fund account for
approximately six percent of the total
financial aid received by students at the
School of Pharmacy.
3. Speculation (probably valid):
a. Imminent decreases in federal funding
will reduce the financial aid available from
UNC-CH.
4. Arguments in favor of instituting an interest
charge on loans:
a. The general upward inflation trend will
make the total value of the loan fund decrease
in terms of future real dollars. A reasonable
interest charge will make the total value of the
fund grow with the inflation rate.
b. It is poor business practice to loan
money for any purpose without charging
interest.
c. The charging of interest will make the
borrowers regard the loans in a more serious
light.
d. Other private-source loan funds with
which some of the committee members are
associated do have an interest charge on
loans.
5. Arguments in favor of maintaining the
present "No Interest" policy:
a. These small emergency loans to
students at the School of Pharmacy engender
considerable good will toward the NCPhA
among the student body of the School of
Pharmacy. As these students always represent
the newest generation of pharmacists in the
state, this good will translates directly into
support of the NCPhA.
(Chairman's comment: There is no direct
evidence available to support or deny the
above contention. Some younger members of
this Committee have stated that these no
interest loans induced them to support the
Association and the Consolidated Loan
Fund.)
b. An interest charge on these loans will
give the borrower no more commitment to
the lender (the NCPhA) than he would have
to a commercial bank from which he
obtained a loan.
c. The fund has seen continuous growth
from contributions of members and friends of
the NCPhA. Because this growth is expected
to continue, and because the fund seems able
to meet all current loan requests, increased
fund growth from interest charged on loans is
not needed.
I will appreciate your prompt response. Time
is short if we are to submit a recommendation to
the Executive Committee prior to the
Convention.
Thank you for your assistance.
Respectfully submitted,
Jack K. Wier, Ph.D.,
Chairman
Remember the IDay
...in^Pictures
CXDLORCRAFT
North Carolina's Most Complete
Film Processing Service
There Is A Plant Located
Near You
For the Finest Quality Plus Fast
Dependable Service on All Your
Photo Needs, Contact the Plant
Nearest You.
CHARLOTTE WILMINGTON
KERNERSVILLE RALEIGH
FAYETTEVILLE DURHAM
If You Don't Know Photofinishing
Know Your Photographer
January, 1987
14 THE CAROLINA JOURNAL OF PHARMACY
WE ARE PLEASED TO ANOUNCE THAT
MR. PERRY TAYLOR
HAS JOINED OUR ORGANIZATION. A NATIVE
OF STATESVILLE, N.C., HE IS A GRADUATE
OF UNC CHAPEL HILL AND BRINGS WITH HIM
A WEALTH OF KNOWLEDGE IN GENERAL
MANAGEMENT AND ENGINEERING. IN OUR
TEAM APPROACH TO STORE DESIGN AND
INSTALLATION, PERRY WILL HAVE RESPON-
SIBILITIES IN GENERAL MANAGEMENT,
ENGINEERING, PROCUREMENT AND COM-
PONENT EVALUATION. PERRY WILL WORK
OUT OF OUR STATESVILLE OFFICES AND
SHOWROOM.
SPEAR ASSOCIATES INC.
SPEAR BUSINESS PARK
RT. 4, BOX 376AA
STATESVILLE, NC 28677
704 876 4153
DISTRIBUTORS OF STREATER STORE FIXTURES
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
15
INTERNATIONAL LEADERSHIP SYMPOSIUM:
THE ROLE OF WOMEN IN PHARMACY
A cooperative international effort has resulted
in the assembly of pharmacy leaders to present
the INTERNATIONAL LEADERSHIP SYM-
POSIUM: THE ROLE OF WOMEN IN
PHARMACY in London, June 2 1 -27, 1 987. To
open the program, the Baroness Trumpington of
Sandwich, Parliamentary Undersecretary for
Health, Department of Health and Social
Security (UK), will present the keynote address.
The week-long worldwide information
exchange will include plenary sessions of such
topics as:
• "The Economics of Health Care" presented
by Dr. Gail Wilensky (USA), Vice
President for Health Affairs, Project HOPE,
and Professor George Teeling Smith (UK),
Director, Office of Health Economics
• "The Pharmacist's Role in Health Care
Delivery" presented by Dr. Gloria Francke
(USA), Pharmacy Information Specialist,
and Mme. Jacqueline Surugue (France),
Hospital Pharmacist LaQueue enBrie
• "Pharmacy in the 21st Century" presented
by Dr. Joseph Oddis (USA), President,
Federation Internationale Pharmaceutique,
and Executive Vice President, ASHP and
Dr. Peter Noyce (UK), Deputy Chief
Pharmacist, Department of Health and
Social Security
• "Legislative and Regulatory Environment
for Pharmacy" presented by the Honorable
Don M. Newman (USA), Undersecretary,
Department of Health and Human Services
and Mr. Jan Winters (The Netherlands),
President, Section for Community Pharma-
cists, Federation Internationale Pharmaceu-
tique
• "Leadership in Pharmacy" presented by Dr.
Lucinda Maine (USA), Director of
Professional Relations, School of Phar-
macy, Samford University, and Ms. Cecilia
Claessen (Sweden), Apoteksbolaget A, The
National Corporation.
Additional topics and discussion groups will
be presented by representatives from Europe,
Australia, and North America. Proceedings will
be distributed.
For more information contact:
Mrs. Mary Grear
Correspondent
P.O. Box 981
Claremore, OK 74018
(919)342-1711
NEW CPE PROGRAM ON HYPOTHYROIDISM
AVAILABLE FROM FLINT LABORATORIES, INC.
A new home-study continuing pharmacy
education program on hypothyroidism is
available without charge from Flint.
The program is edited by R. Keith Campbell,
RPh, FAPP, Profesor of Clinical Pharmacy,
Washington State University College of
Pharmacy. Continuing education credits are
available from Washington State University
College of Pharmacy, which is approved by the
American Council of Pharmaceutical Education
as a provider of continuing education.
The new program, "Hypothyroidism Update,"
is issued in four sections: Hypothyroidism
Disorders: Diagnosis and Management, Hypo-
thyroidism in the Elderly, Hypothyroidism in
Middle Age, and Hypothyroidism in the Young.
January, 1987
A multiple-choice self-test accompanies each
section. Pharmacists wishing to enroll in the
program without charge may write to: CPE
Program Administrator, Flint Laboratories, Inc.,
1425 Lake Cook Road, Deerfield, IL 60015.
Pharmacists who wish to submit their
completed examination for grading and certifica-
tion of successful completion should send their
answer sheet with $5 to the Washington State
University College of Pharmacy, Weger Hall
147, Pullman, WA 99164-6501. A score of at
least 70% must be achieved in order to obtain
CPE credit.
For additional information, contact Char
Cary, Flint Laboratories, Inc., 1425 Lake Cook
Road, Deerfield, IL 60015.
16
THE CAROLINA JOURNAL OF PHARMACY
Join Us in
Chicago for
the Pharmacy
Event of
the Year!
APhA
American Pharmaceutical Association
134th APhA Annual Meeting
March 28-April 1, 1987
will be "reaching
new heights" In the big-thinking city that
invented skyscrapers, jazz, and big business.
Look what's In store:
♦ An all-new Saturday-to Wednesday format offering
you maximum value with the minimum number of
weekdays away from home and work- And the
Saturday night stayover qualifies you for the lowest
available airfares
♦ More than 200 hours of Continuing Education
presented in shorter, more concentrated sessions
permitting the greatest possible audience participa-
tion. Highly focused tracks make it easy to identify
sessions of special value in clinical, economic,
scientific, and policy areas
♦ The expanded Exhibit Hall featuring more
companies than ever before; and serving as the focus
of many exciting activities including the popular
Networking Exchange, Poster Sessions, and daily food
festivities celebrating Chicago's ethnic delicacies.
♦ Top name speakers, entertainment, new social
occasions, and fun!
♦ And, to cap the excitement, a full line-up of city
and industry tours presenting the sights, sounds, and
tastes of Chicago — one of the world's great cosmopoli-
tan cities.
Complete information on registration, housing, and
airlines is available from APhA Meetings and Exhibits,
2215 Constitution Avenue. NW, Washington, DC
20037; or call (202) 628-4410.
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
17
PHARMACIST MIXES CIVIC
PRIDE, PRESCRIPTIONS
by Andy Trincia
for The News and Observer
HILLSBOROUGH — Allen A. Lloyd keeps
going back to the clock in the old Orange County
Courthouse. Just like Hillsborough folks keep
going back to Lloyd.
Both are town institutions. As surely as the
clock spins, Lloyd will be in back of the
prescription counter at James Pharmacy.
Since 1937, Lloyd has been selling pills and
mixing potions for what ails his customers. Since
1 963, he has been winding the clock. At 7 1 years
old, he says he enjoys both jobs.
"We have a lot of loyal customers," Lloyd said
in an interview. "Some of my best customers are
the older people. But so many of them are getting
old and dying off."
Lloyd, a Hillsborough native and town
commissioner, said he liked being his own boss at
the pharmacy, where he supervises seven
employees. His pharmacist-daughter, Evelyn P.
Lloyd, joined him in 1965.
"Working at a smaller store is better than one
of these chain drug stores," he said. "You don't
have so many bosses."
He's largely on his own in his other job, too.
The town board appointed him in 1963 as the
official keeper of the clock, and he takes the job
seriously.
Every two or three days he climbs the spiral
staircase in the courthouse, built in 1846. He
winds the clock, built in England in 1766, with its
original crank.
He said he was glad to take on the chore, which
he does for free. The clock is a part of the town, a
fond memory of childhood, he said.
Lloyd, who is a graduate of the University of
North Carolina at Chapel Hill, also has fond
memories of the pharmacy, begun by a friend at
the 111 N. Churton St. location and still owned
by the friend's widow, Oma R. James.
He remembers the '40s and '50s, when it was a
popular teenage gathering spot, when couples
sipped on fountain sodas and milkshakes. People
still come for the refreshments, but teenagers
gather at fast food restaurants in Hillsborough,
Lloyd said.
But the soda fountain is still a place to catch
up on town gossip. One frequent customer is
Hillsborough Mayor Frank H. Sheffield, Jr.
"It's always a friendly atmosphere," Sheffield
January, 1987
said in a telephone interview. "It's just a real
institution in Hillsborough. It doesn't seem to
have changed in years."
Sheffield remembers when former Gov. James
B. Hunt Jr. visited Hillsborough in June 1984 to
dedicate the town cemetery.
"Governor Hunt made a reference in his
speech to James Pharmacy," Sheffield said. "He
said they had the best fountain Cokes in North
Carolina."
Hillsborough's history is another subject he
takes seriously. His interest in it has resulted in a
book, "History of the Town of Hillsborough,
1 754- 1 982," which he co-authored with his wife
Pauline O. Lloyd.
NARD LAUNCHES RX
EXPO '87
ALEXANDRIA, VA November 26, 1986
- Expanding on four consecutive years of
successful NARD Home Health Care Con-
ferences, the National Association of Retail
Druggists has announced that an exciting new
mid-year meeting — RxExpo — will be held
April 29-May 2, 1987 in New Orleans.
In addition to the in-depth programming on
home health care that has made NARD's Home
Health Care Conferences such huge successes in
years past, Rx Expo will offer attendees seminars
and workshops on a wide variety of disciplines
covering both the business and professional
practice of pharmacy.
Participants will be able to register for
educational tracks covering home health care and
long-term care, financial management, clinical
pharmacy, multiple locations pharmacy
ownership, and professional pharmacy manage-
ment. NARD's Geriatric Certificate Program,
unveiled at NARD's 1986 annual meeting in
Louisville, will be offered again during Rx Expo.
In addition, NARD has selected Rx Expo to
introduce an all-new program that offers
pharmacists a certificate in counseling ostomy
and incontinence patients. Rx Expo will also
serve as the site of NARD's 1987 PSAO
Conference, following up on the asociation's
much talked about First Annual PSAO
Conference held last May.
NARD's home health care trade exposition
will also be a part of Rx Expo '87, but this year
(continued on page 31)
18
THE CAROLINA JOURNAL OF PHARMACY
LOCAL NEWS
The Northeastern Carolina Pharmaceutical Society held their annual Christmas Party on Sunday,
December 7, 1 986 at the Holiday Inn in Williamston. Entertainment was provided by members of the
ECU School of Music. Distinguished guests were Mr. and Mrs. Al Mebane of the NCPhA.
Mr. Mebane swore in the 1987 officers of the Society. They are pictured above (left to right), Bill
Brown, past president, Al Mebane, Dean Bryan, president, Dana Outten, secretary-treasurer, and
Mike Adams, vice-president.
Dear State Pharmacy Association
Journal Editor:
We have learned that an operation calling
itself ANSWERS UNLIMITED is offering the
answers to CE correspondence courses for an
annual fee.
Perhaps you have already received a letter
from ACPE alerting you to that fact.
Please be aware that the repro proofs of CE
articles, tests included, which have been provided
to you on a complimentary basis from Merrell
Dow and Lakeside Pharmaceuticals, divisions of
Merrell Dow Pharmaceuticals, Inc. as a service to
pharmacy are copyrighted.
In our opinion, the provision of and utilization
of answers either in advance of, or concurrent
with the use of the post-tests:
• could possibly place the ACPE-approved
provider in non compliance with CE criteria
and guidelines
• is a violation of copyright laws
• may render the credit awarded to the
participant invalid
• is in clear contravention to the intent of
continuing education for pharmacists.
We strongly urge that you consider writing to
this person and tell him YOUR feelings about
this. James Brian, Answers Unlimited, Box 143,
Palos Park, IL 60464
It is our fervent hope that this dubious
operation will "dry up and blow away" from
economic nonsupport. At stake is the future
credibility of CE correspondence courses as well
as the integrity of the profession.
Sincerely,
Jack R. Statler, R.Ph.
Professional Relations Manager
The regular monthly meeting of the Guilford
County Society of Pharmacists was held Sunday,
January 1 8, 1 987 at the Ramada Inn Downtown
in Greensboro. Following the social hour and
dinner, our guest speaker for the evening, Mr.
Andrew Barrett, Executive Director of Pharmacy
Network of North Carolina, discussed the goals
and objectives of his organization. Mr. Barrett
also shared with us the progress PN/NC has
made thus far in negotiating some major
contracts for its member pharmacies, and what is
being done to increase the membership by
bringing in more of the chain pharmacies as well
as independents. During the short business
session that followed, members were reminded
that it is time to pay their 1987 dues, and that new
officers would be installed at the February
meeting. There being no further business, the
meeting was adjourned.
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
19
CORRESPONDENCE COURSE
ADVISING CONSUMERS ON
OTC PERSONAL HYGIENE PRODUCTS
by J. Richard Wuest, Pharm.D., R.Ph.
Professor of Clinical Pharmacy
University of Cincinnati, Cincinnati, OH
and
Thomas A. Gossel, R.Ph., Ph.D.
Professor of Pharmacology and Toxicology
Ohio Northern University, Ada, OH
Goals
The goals of this lesson are to:
1 . review the concepts of personal hygiene;
2. explain how to advise patients on the
selection of OTC personal hygiene products.
Objectives
At the completion of this lesson, the successful
participant will be able to:
1. recognize effective OTC personal hygiene
products;
2. identify the pharmacological actions of the
ingredients of these agents;
3. explain the proper technique for applying/
administering these OTC agents.
Introduction
Personal hygiene is truly big business in the
United States. It is estimated that Americans
spend more than $500,000 annually on
antiperspirants and deodorants alone. Advertis-
ing experts on Madison Avenue have successfully
sold the concept to Americans that perspiration
and body odor (which are normal body
functions) are socially unacceptable. This extrava-
gant spending and preoccupation with body odor
is not a new phenomenon, however. Egyptian,
Greek, and Roman historians all described
methods for masking body odor. For centuries
the French have made a significant name in the
Western world by perfecting and producing
perfumed oils and waters.
Deodorants developed in the 1 800's contained
zinc oxide. Simple solutions of aluminum
chloride and/or iron chloride came in the 1 900's.
But, the major problem with these deodorants
was that they were highly acidic, and irritated
underarm tissue or ruined clothing. Aluminum
chlorohydrate was introduced in the 1940's to
help solve these problems; it and its derivatives
have been the mainstay of commercial
antiperspirant products since that time.
Deodorants Versus Antiperspirants. There
are two types of products used for general
personal hygiene: antiperspirants and deodo-
rants. The basic difference between them is that
deodorants either directly mask body odor or
decrease the bacterial populations, in the
underarm area, that are responsible for producing
odor. They are considered by FDA to be
cosmetics because they do not directly affect
bodily activities.
Antiperspirants, as the name implies, inhibit
perspiration. They are legally classed as drugs
because they do affect normal body actions.
Antiperspirants will be the subject of this article.
(Continued on page 20)
inttiQ/orvico
of pharmacy
This continuing education for
Pharmacy article is provided
through a grant from
MERRELL DOW
PHARMACEUTICALS INC.
t Merrell Dow-
January, 1987
20
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
(Continued from page 19)
What Causes Sweating?
An explanation of sweat, its function, and
what produces it is in order before reviewing the
active ingredients of antiperspirants. There are
three secretion (exocrine) glands involved in
sweat production: the apocrine, the eccrine, and
the sebaceous glands (see Fig. 1). Sebaceous
glands produce sebum, an oily substance that
serves as a moisturizing agent for the skin. It holds
sweat on the outer dermal layer of the skin so that
the stratum corneum can be properly hydrated.
Sebum also serves as a nutritional source for
bacteria that live on the skin.
Both the sebaceous glands and the apocrine
sweat glands open into hair follicles and release
their secretions there. Most of the apocrine glands
are localized in the armpit (axillary), perianal and
nipple (areolar) areas. There is also a significant
number of apocrine-like glands in the inner eyelid
(conjunctiva) and ear canal (ceruminous); the
mammary gland is actually a modified apocrine
gland.
The exact function of the apocrine glands has
not yet been determined. Elevations in the
environmental temperature do not increase their
secretions. Instead, apocrine glands secrete a
slightly off-colored, low volume, viscous fluid
when they are stimulated by emotional stress
such as anger, fear, or pain. Direct mechanical
pressure such as stroking or petting also increases
their secretions. Bacteria on the skin metabolize
materials in apocrine fluids to produce an odor
characteristic to each individual. The current
leading theory is that apocrine secretions
somehow play a role in subconscious
communication between humans.
Interestingly, most other mammals (spe-
cifically the lower primates) have elaborate
means of communicating with each other via the
sense of smell. The fact that apocrine glands do
not fully develop and function until after puberty;
that they are located in warm, moist areas which
t" W.'MklV w-1
Sebaceous gland
O Q
J oo°
L:^^m&& &WSag£l
FIGURE 1. Glandular appendages of the skin.
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
21
are very susceptible to bacterial growth; that they
coexist with other (eccrine) glands which
produce a high volume of sweat that evaporates
and, therefore, spreads the bacteria-produced
odor adds substance to the theory that these
glands are involved in sexual attraction. The
reasoning that the hair growing out of the follicles
could serve as "wicks" for sending out the
secretions adds even more credence to this
theory.
The other types of sweat glands called eccrine
glands are present in nearly all areas of the skin.
They open directly onto the skin and occur to the
largest extent around hair follicles. Eccrine glands
consist of a deeply coiled ductwork system
located in the subcutaneous area that produces a
watery secretion from plasma which is modified
by the cells in the ductwork opening onto the
surface. Eccrine sweat is composed of sodium,
chlorine, potassium, urea, lactate, and glucose.
Concentrations of these various substances
differ from individual to individual and the
relative concentration of each constituent is
modified by the rate of sweat secretion. During
periods of rapid, profuse sweating, the
concentration of each of these components will
be much less than during periods of relative
dormancy. Unlike the apocrine secretions, which
rarely exceed a few milliliters, the eccrine glands
can turn out as much as 12,000 milliliters of fluid
in a twenty-four hour period. The average
volume, however, is approximately one liter per
day.
These eccrine glands are important in
maintaining the body's proper temperature and
electrolyte balance. Their activity is regulated by
at least three known factors: thermal, mental, and
gustatory response. The hypothalmus contains
the heat-regulating center. It, in turn, is activated
or deactivated by the volume and temperature of
blood circulating through its stem from the skin,
and by antipyretic drugs.
Other areas of the brain are also believed to be
involved in stimulation of eccrine glands,
although the exact site of activity has not yet been
determined. It is known, however, that mental
stress increases sweat production, especially on
the palms and soles of some individuals. The third
regulatory mechanism, gustatory, has not yet
been fully explained, but its existence is noted by
the sweating that occurs around the mouth and
on the forehead and nose after eating spicy foods.
There are various pathological disorders of the
sweat glands. The more common ones are listed
in Table 1 .
TABLE 1
Disorders of the Sweat Glands
Anhydrosis: scanty or nonexistent sweat
production. Results from CNS disorders or
disruption of the autonomic nervous system. It
is also a side effect of drugs with atropine-like
effects (e.g. anticholinergics, tricyclic
antidepressants, phenothiazines).
Bromhydrosis: bad smelling sweat. Usually the
result of improper hygiene but can be caused
by volatile substances being picked up from
the blood and secreted by the apocrine glands
(e.g., garlic).
Chromohydrosis: colored sweat. Can be caused
by metabolites and systemic disturbances (e.g.,
malfunction of the hypothalamus, hyper-
thyroidism, diabetes, menopause, cancer,
infections).
Hyperhydrosis: excessive sweating. Caused by
both mental and systemic disturbances (e.g.,
malfunction of the hypothalmus, hyper-
thyroidism, diabetes, menopause, cancer,
infections).
How Can Underarm Odor
Be Eliminated?
While it is known that skin bacteria are the
immediate cause of underarm odor, the exact
species responsible has not yet been determined.
Those that are undoubtedly involved include
Propionibacterium acnes, Propionibacterium
granulosum, various diphtheroids, and coagulase-
negative staphylococci. The relative proportions
of each of these vary from individual to
individual and none of them are pathogens. The
odor is known to result from bacterial
decomposition of apocrine secretions. This fluid
is somewhat sticky and thus adheres to the hair
growing out of the axillary area. This hair also
provides the bacteria with a greater surface area
on which to grow and come in contact with
apocrine secretions.
There are three methods for reducing
underarm odor with drugs, based upon what is
known about this condition. These include
inhibiting bacterial growth, reducing apocrine
secretions, and removing all sweat secretions
from the skin as quickly as possible. The primary
(Continued on page 22)
January, 1987
22 THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE the FDA advisory panel that reviewed tnem as
(Continued from page 21) being safe and effective, were felt to have a direct
bacterial action on organisms with which they
means, needless to say, is this third alternative, came in contact,
achieved by regular, effective washing of the area.
Many experts (and millions of "non-experts") Qq AntiperspirdntS
believe that shaving the hair from the underarms Roallu WorU-9
(a practice popular with women) is helpful in "
preventing axillary odor. Although this is usually Currently there are three proposed theories
done more for cosmetic reasons, it not only that are purported to explain the mechanism of
reduces the ability of bacteria to produce odor, it action of antiperspirants. None has been proven
also enhances the detergent and mechanical conclusively. One holds that metallic ions in the
action of soap when the area is washed. chemicals bind with anions in the keratin issue
Decreasing wetness by reducing sweat and form a functional closure of the sweat gland
production is another effective method for duct. This, -then, reportedly causes an
reducing underarm odor. This occurs because the intraluminal pressure head which stops glandular
three factors that enhance bacterial growth are secretion via a feedback mechanism,
the nutrients in apocrine secretions, the warm Another theory suggests that aluminum and
temperature, and the wetness supplied by the zirconium salts alter the permeability of water
water in both forms of sweat. Since the principle within the sweat duct and cause it to flow into the
source of wetness in the underarm area is eccrine tissue below the epithelial skin. This, then, is
sweat, limiting secretions by these glands will taken back up in the blood instead of being
reduce odor. Antiperspirants accomplish this. It deposited on the surface,
should also be noted that those agents cleared by The third theory is that the metallic ions
THE EXPERIENCE WE'VE GAINED FROM
OVER 200 PHARMACY INSTALLATIONS IS
AVAILABLE TO YOU . . .
AND, WE ARE THE ONLY STOCKING
DISTRIBUTOR OF DRUG STORE FIXTURES IN
THE CAROLINAS.
IF YOU NEED A SINGLE FIXTURE OR A
COMPLETE STORE, OUR PROFESSIONAL
STAFF IS READY TO SERVE YOU
"THE AREAS LARGEST DISTRIBUTOR OF
MODULAR DISPLAY FIXTURES"
RICHMOND, VIRGINIA CHARLOTTE, NORTH CAROLINA
7921 -A WEST BROAD ST. 3555 TRYCLAN DRIVE
(804) 740-0793 (704) 525-5300
TOM MARTIN ROLAND THOMAS RANDY BIVENS
"WE ARE MORE THAN A FIXTURE COMPANY— A TEAM OF PHARMACY
SPECIALISTS WITH OVER 60 YEARS COMBINED EXPERIENCE IN OVER
500 DRUG STORES"
0'4'»»u'0« O'
Sp
STORE FIXTURES E,-,—
& planning, inc. dSrSSS
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
23
decrease sweating by interfering with acetyl-
choline-induced nerve stimulation of the gland.
The proposed mechanism is that the metallic ions
in the antiperspirant have a direct effect on
acetycholinesterase (the enzyme that metabolizes
acetylcholine).
However, the panel that reviewed the anti-
perspirant drugs was not convinced that they
exert sufficient "anti-wetness" action to be the
only mechanism of action. Its members felt that
even though the resulting dryness is less suitable
for bacterial agents (especially the aluminum
chlorohydrates and aluminum chloride) possess
some antibacterial action in their own right. This
means that, in the panel's view, an effective
antiperspirant is also an effective deodorant
whether or not it has a "perfumy" odor.
Remember that the odor associated with
underarm perspiration is due to bacterial
breakdown of apocrine secretions. No OTC
product is known to cause an effect on apocrine
sweat production. Sweat produced by the
apocrine glands enhances bacterial growth and
the formation/evaporation of odor. Eccrine
sweat production is a normal part of the
biological function that helps regulate body
temperature and electrolyte balance. These
glands are located over the entire body (estimated
to exceed three million); they become active
under thermal stress. The eccrine sweat then
evaporates from most areas of the skin and cools
the blood circulating through the skin and,
therefore, the body itself.
The eccrine glands in the underarm area are
further unique in that they alone are stimulated
by emotional stress. This adds to odor produc-
tion. The net result is that, since the underarms
are not important in overall regulation of body
temperature, their sweat production can be
inhibited by antiperspirants without jeopardizing
body hemostasis. Therefore, they are safe and
effective for OTC use as antiperspirants. Table 2
lists those products that have been ruled by the
FDA's advisory panel to be safe and effective.
The basic components are aluminum chloride,
aluminum chlorohydrates, and aluminum
zirconium chlorohydrates.
Aluminum chlorohydrates are composed of
nine different salt forms. They vary in the ratio of
aluminum ions to chloride ions within the
molecule, and whether they are complexed with
propylene glycol or polyethylene (the glycols)
increase the alcoholic stability of the salts and
enhance their ability to form the various vehicles
used for commercial antiperspirants. They are,
TABLE 2
Safe and Effective OTC Antiperspirant Drug
Ingredients*
Aluminum chlorohydrates:
Aluminum dichlorohydrate
Aluminum sesquichlorohydrate
Aluminum chlorohydrex PG
Aluminum dichlorohydrex PG
Aluminum sesquichlorohydrex PG
Aluminum chlorohydrex PEG
Aluminum dichlorohydrex PEG
Aluminum sesquichlorohydrex PEG
Aluminum chloride
(aqueous solutions up to 15%)
Aluminum sulfate
(buffered with aluminum lactate)
Aluminum zirconium chlorohydrates:
Aluminum zirconium
trichlorohydrate
Aluminum zirconium
tetrachlorohydrate
Aluminum zirconium
pentachlorohydrate
Aluminum zirconium
octachlorohydrate
Aluminum zirconium
trichlorohydrex GLY
Aluminum zirconium
tetrachlorohydrex GLY
Aluminum zirconium
pentachlorohydrex GLY
Aluminum zirconium
octachlorohydrex GLY
PG = Propylene glycol complex
PEG = Polyethylene glycol complex
GLY = Glycine complex
*as determined by an FDA advisory panel
however, considered to be approximately equal
to each other in effectiveness.
Aluminum zirconium chlorohydrates are
somewhat similar to the aluminum chloro-
hydrates in that the basic differences between the
members of the group are their ratio of aluminum
to zirconium to chloride atoms, and whether or
not they are complexed with glycine. Glycine
enhances their formulation properties.
(Continued on page 25)
January, 1987
Give
your pharmacy
a physical.
Register for the Pharmacy Patron Survey
A service of the new Sandoz Consumer Health Care Group,
a combination of Dorsey Laboratories and Ex-Lax Pharmaceuticals
You believe in safeguarding your patron's health,
so why not do the same for your pharmacy? Like
you, it needs a periodic checkup to spot undetect-
ed problems that can lead to declining patronage.
Now, for the first time, you can take advantage
of this unique, cost-free survey of consumer at-
titudes — to help you keep your finger on your
pharmacy's pulse.
* Prepared by
a panel of professionals
This survey was developed by Sandoz Consumer
Health Care Group, manufacturers oi' the
Triaminic" brand of cold/cough products and the
Ex-Lax® brand of laxatives, in association with
the NARD Committee on Merchandising and
Management, plus a panel of experts on
pharmacy practice.
Streamlined kit
easy to set up
•
SANDOZ
CONSUMER
HEALTH CARE
GROUP
CARING
FOR YOUR
PHARMACY'S
HEALTH
SANDOZ
CONSUMER HEALTH
CARE GROUP
© 1987 Sandoz Consumer Health Care Group
The survey kit comes complete with everything
you need to conduct your own consumer poll, and
is easy to set up in any area of your store. Each
questionnaire takes approximately five minutes
for your patrons to complete while shopping or
waiting for their prescriptions.
^ Confidential report analyzes
your store's strengths
and growth potential
After a minimum of 60 surveys are completed and
returned, you will receive a confidential report
within eight weeks. This report will summarize
how your patrons rate your pharmacy and which
services are most important to them.
If you are interested in giving your pharmacy a
free physical, please complete the registration
form below, or call our Telemarketing Depart-
ment, toll-free, at 1-800-228-4575.
Register now for the Pharmacy Patron Survey
Please print or type, tor multiple pharmacy locations, please
include names and addresses on a separate sheet and enclose
with coupon.
Pharmacy
Owner. manager
Address
City Slate ZIP
Mail form to: Sandoz Consumer Health Care Group
P.O Box 83611, Lincoln. NE 6X501
THE CAROLINA JOURNAL OF PHARMACY
25
CORRESPONDENCE COURSE
(Continued from page 23)
When aluminum chloride hydrolyzes in
solution, it forms several compounds including
oxychloride and free hydrogen ions. These ions
lower the pH substantially and solutions greater
than 15% are not considered to be safe for OTC
use. Aluminum chloride reduces sweating to a
significantly greater degree than do the other
antiperspirants, but it also has a greater tendency
to irritate the skin.
While buffered aluminum sulfate is
considered to be a safe OTC antiperspirant, the
unbuffered form (cake alum) is not. The
unbuffered form produces a high degree of skin
irritation. Adding sodium aluminum lactate to
the product buffers the solution and significantly
decreases the irritation caused by aluminum
sulfate itself. Another complex, potassium
aluminum sulfate (i.e., medicinal alum), is
known to possess styptic and astringent activities,
but it has never been clinically tested for its
antiperspirant activity.
The panel concluded that two other agents
were definitely unsafe for OTC use. They are
zirconium-containing aerosols and alcoholic
solutions of aluminum chloride. As stated earlier,
some zirconium-containing formulations are
considered to be safe and effective, but not the
aerosols. The problems with them stem back to
evidence gathered a decade ago that chronic
inhalation of zirconium-containing aerosol
products might produce abnormal tissue growing
in the lungs. They were removed from the market
and will not be allowed back until adequate
testing is done. Aluminum chloride in alcoholic
solutions is barred from OTC sale because data
relating to its use have resulted from prescription
use under medical supervision. The FDA could
find no evidence that it is safe for self-use via the
more open OTC market.
Consumer Counseling
Since there are no significant differences
between the various ingredients, a major
determinant in choosing an antiperspirant is
whether or not a particular product irritates the
skin. Good advice is to use "whatever works for
you." Another factor is the product smell.
However, covering one odor with another is not a
substitute for proper hygiene.
Most often, repeated application of the
antiperspirant is needed before signficant wetness
reduction is seen. Also, the underarm area should
be dry before application and be allowed to dry
afterwards. Applying an antiperspirant when one
is sweating prevents the agent from penetrating
into the sweat gland ducts. Allowing the area to
dry after application, before putting on clothing,
will lessen the chance of the product hydrolyzing
to hydrochloric acid which induces skin
irritation. Irritation is also reduced by not
applying antiperspirants to abraded or freshly
shaven skin. Since all of us are biochemically
different, if one product fails to do the job,
another one with a different combination of
ingredients may do fine.
Feminine Hygiene
The question of whether or not to use douche
products and feminine deodorant spray stirs up a
great deal of controversy. Some gynecological
experts question the use of the latter agents,
stating that they may cause more harm than good
to sensitive vaginal tissue. Douching has both
proponents and opponents. Some experts believe
that proper douching enhances the health of
vaginal tissue, and that proper cleansing of the
perianal area is imperative to prevent vaginitis.
Others argue that the vagina is quite capable of
keeping itself clean and that adequate washing
will prevent the spread of organisms from the
anus to vagina.
Several factors contribute to the proper
function and health of the vaginal tract. These
include the thickness of the lining, pH, various
secretions, and the bacterial flora.
The thickness and consistency of the vaginal
epithelial lining is determined by the level of
estrogens in the body. During the years following
menses but before menopause, estrogen blood
levels are high and vaginal tissue cell height is
greatest. The chance for pathogenic invasion of
the vagina at this time is less likely than before or
after menstration.
Two other factors, vaginal pH and bacterial
flora, are interrelated. Again, there are major
differences in these during the childbearing years.
Before menses begins and after menopause
occurs, the pH of the vaginal tract is somewhat
alkaline. During the childbearing years, the pH
averages between 3.5 and 4.2 with a range of 3 to
6. It is known that keeping the vaginal tract acidic
aids the endogenous nonpathogenic bacteria/
flora to inhibit infection from occurring.
Whenever the pH becomes alkaline (as in
(Continued on page 27)
January, 1987
26
THE CAROLINA JOURNAL OF PHARMACY
TABLE 3
Representative OTC Douche Products
Product
Ingredients
Betadine
Povidone-iodine
Bo-Car-Al
Boric acid, eucalyptus, menthol, methyl salicylate, phenol,
potassium aluminum sulfate, thyn., »I
Demure
Benzethonium chloride
Dismiss
Cetearyl octate, citric acid
Femidine
Povidone-iodine
Gentle Spring
Sodium lauryl sulfate
Jeneen
Lactic acid, octoxynol
Massengill Disposable
Cetylpyridinium chloride, lactic acid, octoxynol
Massengill Liquid
Lactic acid, octoxynol
Massengill Powder
Ammonium aluminum sulfate, methyl salicylate, phenol, thymol
Massengill Medicated
Povidone-iodine
Massengill Vinegar
Citric acid, vinegar
New Freshness
Vinegar
Nylmerate II
Acetic acid, boric acid, nonoxynol
Operand
Povidone-iodine
Phenithyn
Benzethonium chloride
PMC
Ammonium aluminum sulfate, eucalyptus, menthol, phenol,
thymol
Povi-Douche
Povidone-iodine
Summer's Eve
Citric acid
Summer's Eve Medicated
Potassium sorbate
Summer's Eve Vinegar
Sorbic acid, vinegar
Stomaseptine
Eucalyptol, menthol, thymol
Trichotine
Sodium lauryl sulfate
Trivia
Alkyaryl sulfonate, oxyquinoline
V.A.
Boric acid, oxyquinoline, potassium aluminum sulfate, zinc
sulfate
Vagesic
Docusate, polyoxyethylene nonyl phenol
Zonite
Benzalkonium chloride, menthol, thymol
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
27
CORRESPONDENCE COURSE
(Continued from page 25)
pregnancy and during oral contraceptive use)
vaginal infections are more likely to occur.
A variety of secretions are produced in the
vaginal tract that cleanse and lubricate. They
include secretions from sebaceous, apocrine, and
eccrine glands (covered earlier), as well as from
other special glands. In themselves, they have no
odor, but if they remain on the external surface of
the vagina, bacterial decomposition can and will
produce odor. Two organisms that are especially
implicated in odor production are Trichomonas
and Gardnerella (previously called Haemophi-
lus) vaginale. They also cause inflammation as
does another pathogen — the yeast Candida
albicans.
When douching is indicated for medical
purposes, the most common reasons are to
alleviate itching or burning of the external vagina
(vulvar pruritis), to remove excessive vaginal
discharge (leukorrhea), to modify the infectious
vaginitis conditions mentioned above, and to
treat non-specific vaginitis (i.e., the cause is
unknown).
Much of the douching controversy centers on
the fact that there are no pain and itching
symptoms until the inflammation has spread to
the external genitalia. Therefore, a considerable
cadre of gynecologists believe that the question of
whether to douche or not is best answered by
consultation and discussion between physician
and patient rather than by heeding the
advertisements in ladies' magazines.
Needless to say, none of the above mentioned
conditions is amenable to self-medication.
However, there is a move to make anti-candidal
agents (e.g., nystatin) available OTC for women
who have had candidiasis (moniliasis), are able to
self-diagnose the condition, and can begin
treatment while waiting to see the physician, who
will determine whether other therapy is needed
later.
This has been suggested by the FDA Advisory
Panel on OTC Antifungal Drugs, and
representatives of OTC manufacturing com-
panies agree. At the time of writing this lesson,
however, FDA has not accepted the shift of anti-
candidal drugs to OTC status. While miconazole
and haloprogin were granted OTC status, their
manufacturers can promote them to the public
for treatment of ringworm but not candidal
infections.
While not taking sides in the argument of
whether it is beneficial to douche, we should
TABLE 4
Ingredients in OTC Douche Products
Ingredient
Claimed Action
Acetic Acid
Alkyaryl Sulfonate
Ammonium
aluminum sulfate
Benzalkonium
chloride
Benzethonium
chloride
Boric Acid
Cetearyl octate
Cetylpyridinium
chloride
Citric acid
Eucalyptus
Lactic acid
Menthol
Methylbenzethonium
chloride
Methylsalicylate
Nonoxynol
Octoxynol
Phenol
Polyoxyethylene
nonyl phenol
Potassium aluminum
sulfate
Potassium sorbate
Povidone-iodine
Sodium laryl sulfate
Sorbic acid
Thymol
Vinegar
Zinc sulfate
Acidifier
Surfactant
Astringent
Surfactant*
Surfactant*
Acidifier*
Surfactant*
Surfactant*
Acidifier
Analgesic
Acidifier
Analgesic
Surfactant*
Analgesic
Surfactant
Surfactant
Analgesic*
Surfactant
Astringent
Antimicrobial
Antimicrobial
Surfactant
Antimicrobial
Analgesic*
Acidifier
Astringent
*also claimed to have antimicrobial action
review the ingredients contained in OTC
products, and discuss how they act. Most OTC
douche products consist of one or more of the
following agents: acidifiers, antimicrobial agents,
astringents, counterirritants, and/or surfactants
(see Table 4). At this time, none of these has been
proven effective for its intended use.
The acidifiers contained in OTC douche
products include acetic acid (vinegar), boric acid,
citric acid, and lactic acid. While commercial
products are more convenient and expensive than
homemade vinegar solutions, there is no evidence
(Continued on page 28)
January, 1987
28
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
(Continued from page 27)
that any of them is more effective than a solution
made from two tablespoons of vinegar in a quart
of warm tap water. Acidifiers are used to lower
an elevated vaginal pH to a more infective-
resistant acidic pH.
Antimicrobials include the quaternary
ammonium compounds (QAC's), benzalkonium
chloride, benzethonium chloride, cetylpyri-
dinium chloride, and methylbenzethonium
chloride. These agents also serve as surfactants.
Other antimicrobials used are oxyquinoline,
phenylmercuric nitrate, povidoneiodine, and
potassium sorbate/sorbic acid. Boric acid is also
claimed to have antimicrobial activity. However,
most of these agents are present as preservatives,
rather than in concentrations likely to be
antimicrobial. None has been proven to be an
effective antimicrobial for this use.
Astringents are purported to reduce local
edema, inflammation, and discharge. Those
items claimed to exert this action when included
in douche preparations are ammonium and
potassium aluminum sulfate (alums) and zinc
sulfate. These agents exert beneficial effects on
skin and other mucous membrances so it can be
assumed they will do the same on vaginal tissue.
Eucalyptol, menthol, methyl salicylate,
phenol, and thymol are counterirritants which
are added to the products to provide anesthetic,
antipruritic, and antiseptic effects. Evidence of
these effects are lacking. Many feel that, at the
concentrations needed to provide counterirritant
effects, the products would be too irritating to the
sensitive membranes of the vaginal tract. In
reality, at the strength present in OTC douche
products, they are believed to provide a soothing,
"refreshing" deodorant effect.
Surfactants such as docusate salts (previously
called dioctyl sulfosuccinates), nonoxynol,
octoxynol, and sodium lauryl sulfate are included
to decrease surface tension and facilitate the
spread of the douche solution over the mucosa of
the vaginal tract. They are all effective for this
purpose as are the quarternary ammonium
compounds.
HERE COMES KENDALL
Here we come, and when you need us! When Hugh Chatham Memorial Hospital
needed drugs for a patient ASAP, the "K-Team" responded. The drugs were flown
to Elkin, N.C. almost immediately after the phone call.
In a life or death situation we will do our level best to deliver, regardless of the time
of day. Life or death -or day to day - you can rely on Kendall. After all, service is
our middle name!
(1-r: Cynthia Norman, Hugh Chatham Memorial Hospital; Dr. Joseph E
Walker, Ram Air; Gordon G Hamrick, Kendall Drug Co.)
W7 KEf\ID>XI_l_
PO Box 1060, Shelby, North Carolina 28150
TOLL FHK IN N ( 1 800 222 3856
IN S I Tt,NN VA (.A 1 800 438 5130
yi
X
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
29
CORRESPONDENCE COURSE QUIZ
Personal Hygiene
1 . Bacteria on the skin produce body odor by
metabolizing material secreted by which of
the following sweat glands?
a. Apocrine.
b. Eccrine.
2. The bacteria that cause underarm odor are:
a. nonpathogenic.
b. pathogenic.
3. Complexing the aluminum chlorohydrates
with propylene glycol or polyethylene
glycol accomplishes which of the following?
a. Increased water solubility
b. Increased effectiveness
c. Increased safety
d. Increased alcoholic stability
4. Vaginal infections are more likely to occur
when the vaginal pH is:
a. acidic
b. neutral
c. alkaline.
5. The leading theory holds that secretion from
which of the following glands plays the most
important role in subconscious communica-
tion between humans?
a. Apocrine
b. Eccrine.
6. All of the following are proposed theories
on the mechanism by which antiperspirants
act with the EXCEPTION of:
a. the metallic ions in the antiperspirant
bind with anions in the keratin tissue
and form a functional closure of the
sweat gland duct.
b. the aluminum and zinc salts of the
antiperspirants alter the permeability
of water within the sweat gland.
c. the metallic ions of the antiperspirants
interfere with nerve stimulation of the
sweat glands by acetylcholine.
d. the aluminum and zinc ions of the
antiperspirant chemically inactivate
the odor producing metabolism within
the causative organisms.
7. Solutions of aluminum chloride in
concentrations greater than 15% are not
considered to be safe for OTC use because:
a. they are ineffective.
b. they are insoluble.
c. they are too acidic.
d. they are too alkaline.
8. Vaginal "yeast" infections are caused by
which of the following organisms?
a. Candida.
b. Gardnerella.
c. Haemophilus.
d. Trichomonas.
9. The basic difference between an anti-
perspirant and a deodorant is that:
a. Antiperspirants decrease bacterial
count, deodorants do not.
b. Antiperspirants mask body odor,
deodorants do not.
c. Antiperspirants affect bodily action,
deodorants do not.
1 0. The type of sweat that is profuse, watery and
composed of sodium, chloride, potassium,
urea, glucose and lactate best describes that
produced by the:
a. apocrine gland.
b. eccrine gland.
11. All of the following formulations of
zirconium-containing products are con-
sidered safe and effective for OTC
antiperspirants EXCEPT the:
a. aerosols.
b. aqueous solutions.
c. creams.
d. lotions.
1 2. Which of the following is LEAST likely to
exert its purported effect when used as a
vaginal douche?
a. Boric acid as an antimicrobial
b. Octoxynol as a surfactant.
c. Vinegar as an acidifier.
d. Zinc sulfate as an astringent.
13. Apocrine gland secretion increases as a
result of all of the following stimuli with the
EXCEPTION of:
a. anger.
b. fear.
c. heat.
d. pain.
1 4. The tei m that refers to bad-smelling sweat
is:
a. anhydrosis.
b. bromhydrosis.
c. chromohydrosis.
d. hyperhydrosis.
15. The type of sweat gland that is most
involved in the regulation of body
temperature is the:
a. apocrine gland.
b. eccrine gland.
January, 1987
30
THE CAROLINA JOURNAL OF PHARMACY
DICKINSONS PHARMACY
by Jim Dickinson
Case study: Losing to the chains. How does a
firmly-established independent pharmacy lose a
reliable and active, chronic patient to a drug
chain in a prescription market that most experts
agree is moving from price to service as its
primary denominator?
This question goes right to the root of the
survivability of independent pharmacy, and to
the effectiveness of the PSAO (Pharmacy
Services Administrative Organization) move-
ment now sweeping the country. Because of this,
the following case study (disguised to protect
your columnist from lawyers but nonetheless
based on fact) is importantly instructive.
Paul M, 46, is a self-employed businessman
who's a well-stabilized chronic patient in a
community that has three independent
pharmacies and three chain drug stores. His drug
bill runs about $200 a month, at the largest of the
three independents, which has had his business
for years.
Because he's well-stabilized, and because his
life is orderly, the pharmacy's services have not
concerned Paul. It has never bothered him, for
instance, that the pharmacy is never open
Sundays, unlike Thrifty Drug, Rite Aid and
SupeRx.
Paul likes the convenience of charging his
hefty drug purchases, especially when slow
insurance reimbursements tie up his cashflow and
cause him to run his account past 30 days.
And he likes the pharmacy itself. Although it
does a heavy volume, it has managed to keep a
small and personal atmosphere; in short, it looks
like he thinks a pharmacy should look.
Emergency service, like Sunday service, had
never been important to Paul. And that's the focal
point of this case study — suddenly, both became
very important to him.
One Friday night, as he was packing for a
pre-dawn Saturday departure on a week-long
business trip, he realized that one of his medicines
would run out on Monday.
That's when he discovered that his
independent pharmacy did not have an after-
hours number. Not to worry, though — he'd
leave a note under the pharmacy door with a
completed Federal Express label on his way out
of town — the pharmacist could ship it across
country the next day, and it would be at his hotel
bright and early Monday morning.
Paul's weekend passed in travel and business
calls. So did an entire Monday — without his
medication. Alarmed, he called his pharmacy
during a break in a business meeting, to learn that
the medication was not shipped until that very
morning.
"But I need it now.r
"I sent it as soon as I saw your note," the
pharmacist said, defensively.
"But I put that note under your door on Friday
night — why didn't you send it Saturday? I even
made out the Federal Express label for you, on
my account."
"I don't know. The fellow who was here
Saturday is off for three days. I sent it as soon as I
saw your note."
Furious and frightened, Paul broke away from
the meeting and went to the nearest pharmacy,
which happened to be a Longs drug chain. He
explained his plight to the pharmacy, showing the
empty vial, and was dispensed enough to last him
through his crisis.
That made Paul think about the different kinds
of pharmacies, and what they do. Chains in his
home town, he realized, don't close at 6:00 PM
and all day Sundays, like his independent did.
And the chain pharmacist who helped him as a
total stranger was at least as personable and
understanding as his own pharmacist.
Paul suddenly realized how vulnerable his
independent pharmacy made him, lacking an
after-hours emergency service when his
expanding business would doubtless send him
out of town at short notice again and again, more
and more often. At the very least, he felt, his
pharmacist should have had an answering
service. The convenience of a charge account
suddenly paled next to after-hours service.
It's not important to this case study to record
what Paul did about his problem. What is
important is the realization that his problem is
symptomatic of a profound change in society's
thinking about health care. As more and more
people begin to work for themselves — and to
self-insure, in the case of employers — the
simplistic notion that price/convenience are
everything yields to notions such as cost-
effectiveness, drug utilization reviews, emergency
service for increasingly mobile patients, and
patient counseling.
The "S" in PSAO is the key, and it's
strategically placed exactly where it belongs —
right beside "Pharmacy." Paul paid twice for the
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
31
same drug, and used Federal Express at
additional cost to himself, simply because his
pharmacy could not respond to an emergency
situation before he left town; in short, it could not
be as helpful as a later-closing cnain drugstore
would have been.
"Service" isn't a big word. It can mean
different things to different people. It's over-
promoted and under-fulfilled. But it's what health
care buyers want. The pharmacy — chain or
independent — that fails to deliver it will likely
lose out to one that does.
This feature is presented on a grant from G.D. Searle &
Co., in the interests of promoting the open discussion of
professional issues in pharmacy. G.D. Searle & Co.,
accepts no responsibility for the views expressed herein
as they are those of the author and not necessarily those
of G.D. Searle & Co.
Nard Launches
(continued from page 17)
the exposition will be greatly expanded to also
include nonprescription drugs, health and beauty
aids, and general merchandise. NARD expects a
strong turnout of independent retail pharmacists
for Rx Expo's expanded program offerings — all
held in beautiful New Orleans — which means
this will be an important marketing opportunity
for exhibitors of home health care products, OTC
drugs, sundries, and the wide variety of other
products sold in independent pharmacies.
Promotion to exhibitors has already begun,
and registration information will be distributed to
the nation's independent retail pharmacists
during December as part of an aggressive
promotional campaign for Rx Expo '87.
Cut Out or Reproduce and Mail
CONTINUING PHARMACEUTICAL EDUCATION
Personal Hygiene
Attach Mailing label from The Carolina Journal of Pharmacy in space provided (or print
name and address) and mail completed questionnaire to: NCPhA, P.O. Box 151, Chapel Hill,
NC 27514.
You may submit completed questionnaires on a monthly, quarterly, or less frequent basis
depending on which procedure is most advantageous for you in your pharmacy practice.
NCPhA will maintain a record of your completed CE credit hours. Upon successful completion
of each program you shall receive a certificate for one hour of Board approved CE.
If the answers to more than two questions are incorrect, the questionnaire will not be acceptable
for CE credit. If your questionnaire is not accepted you will be notified within 1 0 days and given
an opportunity to submit a second questionnaire.
Please type complete address or attach mailing
label from The Carolina Journal of
Pharmacy here ►
Please circle correct answers
1. a b c d
2. a b c d
3. a b c d
4. a b c d
5. a b c d
6. a b c d
7. a b c d
8. abed
9. a b c d
10. abed
11. abed
12. abed
13. abed
14. a b c d
15. abed
Evaluation □ Excellent □ Good □ Fair
How long did it take you to read the article and complete the exam?
□ Poor
January, 1987
We're not
^^ strangers...
UJasninqjton
national
INSURANCE COMPANY
NCPhA-Endorsed Insurance Plans
Which Merit Member Participation
DISABILITY INCOME PLAN HOSPITAL INCOME PLAN
MAJOR MEDICAL EXPENSE PLAN TERM LIFE PLAN
RETIREMENT AND PROFIT SHARING PLANS
FOR DETAILS WRITE OR TELEPHONE:
HOYT W. SHORE, CLU and Associates
821 Baxter Street-Suite 316
O
Charlotte, North Carolina 28202
Telephone (704) 333-3764
UUasninQton
national
INSURANCE COMPANY
Evanston. Illinois 60201 • A Washington National Corporation Financial Service Company
THE CAROLINA JOURNAL OF PHARMACY
33
SLEEPING PILLS: WHEN ARE THEY
A SAFE ANSWER FOR THOSE WHO CAN'T SLEEP?
by J. Christian Gillin, M.D.
Professor of Psychiatry
University of California, San Diego
School of Medicine
La Jolla, CA
Methought I heard a voice cry, "Sleep no more!
Macbeth does murder sleep!"
Macbeth and his lady, it would seem, could
have used help with a sleep problem. In fact, a lot
of us could use help today.
A recent national survey found that one-third
of the population suffers from some degree of
insomnia, and half of that group considers it
serious, often leading to high levels of emotional
distress.
In treating insomnia, sleep medications are
sometimes appropriate, sometimes not. The ideal
hypnotic does not exist. If it did, it would:
• Help you fall asleep quickly and sleep soundly,
• Improve next-day alertness,
• Bring sleep stages and patterns closer to
normal,
• Not interact with other drugs,
• Be safe even when taken in large quantities,
• Be effective over a long period with no
increase in dosage,
• Have no side effects.
Nevertheless, the National Institutes of Health
reports that properly prescribed sleep medica-
tions can be safe and effective. And the new
shorter-acting hypnotics rarely produce the next-
day lethargy associated with earlier sleep
medications.
cases, physicians often recommend small doses of
a short-acting hypnotic, with treatment lasting no
more than one to three nights. Other physicians
consider drug therapy unnecessary for transient
insomnia. Just stick it out, they say; it happens to
everyone occasionally. But transient insomnia
can be disruptive or even dangerous if it is severe
and precedes an important daytime task or a long
drive.
Short-term insomnia can last up to three
weeks and may recur. It is often associated with
stress in work or family life, or with illness. In
such cases, low doses of a hypnotic agent may be
used intermittently for up to three weeks, along
with avoiding caffeine, alcohol and daytime naps.
The key to effective therapy is intermittent use,
since continuous long-term use of hypnotic drugs
can, paradoxically, lead to disruption of normal
sleep. A short-acting drug is preferable where
next-day alertness is desirable. A long-acting
drug, on the other hand, may help allay next-day
anxiety.
Long-term insomnia is more serious and calls
for a complete diagnostic workup. In the absence
of serious medical or psychiatric problems, long-
term insomnia may respond to a combination of
behavioral therapy, better sleep habits and, again,
intermittent use of sleep-promoting medications,
perhaps one night in three for a limited period of
time.
Type of Insomnia Determines
Type of Treatment
The key to proper use of the hypnotic agents
lies in determining the type of insomnia being
experienced. According to an NIH Consensus
Panel, there are three basic types: transient
insomnia, short-term insomnia and long-term
insomnia.
Transient insomnia is related to minor
situational stress such as long-distance jet travel
or hospitalization for elective surgery. In such
The Many Facets of Sleep
The usual amount of sleep obtained and the
timing of sleep vary between individuals. The
newborn may sleep up to 16 hours per day,
distributed in relatively short episodes more or
less evenly across the 24-hour day. As babies
grow older, total sleep time falls and gradually
becomes more consolidated at night. Napping
may continue for several years. On the other
(Continued on page 34)
January, 1987
34
THE CAROLINA JOURNAL OF PHARMACY
SLEEPING PILLS
(Continued from page 33)
hand, the clearcut sleep-wake periods
characteristic of adulthood often break down in
the elderly as sleep becomes more shallow and
broken, and wakefulness is interrupted by naps or
periods of drowsiness.
In addition, people vary in the amount of sleep
they require each night. Some people seem to
thrive on six hours per night, while others don't
feel well rested until they have obtained nine or
more hours. No one really knows how much
sleep is essential. The amount of sleep any
individual needs can be determined by the
Multiple Sleep Latency Test used by sleep
disorders centers around the country.
A practical approach is to ask how alert and
rested an individual feels during the day. A
chronically sleepy person is either not getting,
enough sleep or suffers from excessive daytime
sleepiness brought on by narcolepsy, sleep apnea,
sedating medications or other medical or
psychiatric disorders.
There are many reasons why such problems
should be investigated, among them the fact that
sleep loss accumulates, and the larger the sleep
debt becomes, the more likely it is to lead to a
potentially dangerous episode of drowsiness.
Because insomnia is so prevalent and
significant a problem, the medical community
has long sought effective and safe sleep-
promoting medications.
Approximately 20 million prescriptions for
sleeping pills are written in the United States each
year, making them the most widely used of all
drugs, according to Michael Baiter, Ph.D., former
chief of the Applied Therapeutics program of the
National Institute of Mental Health. For
example, about half of all patients in hospitals
receive sleep-promoting medications at some
time during their stay.
Nonprescription remedies for sleep are used in
even greater volume than prescription drugs,
even though their use can present problems. The
active ingredient in almost all "nighttime sleep
aids" is an antihistamine. Though antihistamines
do promote drowsiness, their side effects can
include disorientation, confusion, dizziness, ring-
ing in the ears, poor coordination, blurred vision
and irritability.
Alcohol is no help. Certainly a nightcap can
lull you to sleep, but it won't be a sound sleep.
Thomas Roth, Ph.D., director of the Sleep
Disorders and Research Center at Henry Ford
Hospital in Detroit, says alcohol in any
pharmacologically active dose disturbs overall
sleep.
Choosing the Best Hypnotic
For years, barbiturates were the drugs most
commonly used to overcome insomnia. But they
can be dangerous, even lethal in high doses.
Taken regularly, they lose their effectiveness as
tolerance develops. They can cause a cycle of
dependence and escalating doses. When
combined with alcohol, of course, barbiturates
can be deadly.
Chloral hydrate and its derivatives were also
prescribed regularly in the past, but their
effectiveness is soon lost. The risk of overdose is
high, and the drugs frequently cause gastric
irritation and can lead to internal bleeding. They
may also interfere with the effects of other drugs.
The benzodiazepines are currently the drugs of
choice to induce sleep. For the most part, they are
effective for both short-term and intermittent use
and are nontoxic and nonaddictive. Three of
them in the U.S. market today are specifically
intended for the treatment of insomnia: fluraze-
pam (Dalmane, Hoffman-LaRoche), temazepam
(Restoril, Sandoz) and triazolam (Halcion,
Upjohn).
They differ primarily in their rates of
absorption and duration of action. Flurazepam is
the longest acting, and triazolam is the shortest
acting.
For Benzodiazepines: A Wide
Spectrum of Use
According to the recommendations of a panel
of sleep experts convened by the National
Institutes of Health, the shorter-acting
benzodiazepine hypnotics are generally preferred
for transient and short-term insomnia. They are
also recommended for such groups as younger
patients with liver or kidney problems or geriatric
patients, who clear drugs more slowly and are
more sensitive to the effects of benzodiazepines.
Longer-acting drugs may be preferable, the panel
says, as adjunctive therapy in some chronic
insomnia or in cases where reduction of next-day
anxiety is desirable.
With some other patients, such as those who
have sleep apnea or a history of substance abuse,
the panel advises caution in the use of any sleep
medication.
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
35
PHARMACISTS RECOGNIZED BY
STATE SCHOOL BOARD ASSOCIATION
Two members of the North Carolina Pharma-
ceutical Association have been selected by the
N.C. School Board Association as 1986 All State
School Board Members.
Linda T. Taylor, Crossnore, and Richard
Dameron, Tabor City, were honored at the 1 986
North Carolina School Board Conference in
Winston-Salem along with six other school
board members from around the state.
The award is given for outstanding service to
the local Board of Education as well as the North
Carolina School Board Association.
Linda was a member of the Avery County
Board of Education for eight years and
chairperson for one year. Previously, she has been
selected as Avery Woman of the year for her
service to the community. She helped get a new
roof and paved parking lot for Avery High
School. She also helped plan for a new school in
the area.
Linda, together with her husband, Bob, owns
and operates the Crossnore Drugstore.
Richard is serving his third term on the
Columbus County Board of Education and is
current chairman. He has been president of the
Tabor City Chamber of Commerce, the Civitan
Club and the Columbus County Pharmaceutical
Association. In June of 1986, Dameron Drug
Store was presented the community service
award by Merck Sharpe and Dohme.
The staff of the NCPhA, faces behind the voices you get on the phone. Left to right, Al Mebane,
Executive Director; Betsy Mebane, financial secretary and administrative assistant; Erie Cocolas,
receptionist and membership records; and Laura Tate, secretary, CE records and liability
insurance.
January, 1987
INTRODUCING
NEW
ONCE-DAILY
ISOPTIN
(verapamil HCI/Knoll)
240 mg scored sustained-release tablets for hypertension
• Only calcium channel
blocker available in SR
form for once-a-day
fherapy
• New SR dosage form
allows greater patient
compliance
• Well documented safety
profile
• In miia to moderate
essential hypertension, a
more logical therapeutic
choice than beta
blockers or diuretics
HDC Mm- 1926.02
ISOPTIN
(verapamil HCI/Knoli)
240 mg
SUSTAINED-RELEASE TA8LETS j
tawion Federal law prohibits dispensing
wiflKwt prescription.
Koo« Pharmaceuticals /N
uppany. New Jersey 07981
• Economically packaged
in bottles of 100 tablets
• Liberal return-goods
policy
Supported by a
comprehensive
promotional
program, including:
• Extensive detailing
• Journal advertising
• Direct mail to
high-volume prescribers
Order today from your
wholesaler
A product of Knoll Research
6.
knoll
Serving the pharmacy profession for more than 80 years
Please see next page for brief summary.
© 1986 BASF K&F Corporation
2454B-11-86
January, 1987
NEW. . . ONCE DAILY B "" s™ma"
IN MILD TO MODERATE
HYPERTENSION
ISOPTIIf-SR
(verapamil HCI/Knoll)
240 mg scored, sustained-release tablets
CONTRAINDICATIONS: 1) Severe left ventricular dysfunction (see WARNINGS), 2) Hypotension (less than 90 mmHg systolic pressure) or cardiogenic
shock, 3) Sick sinus syndrome or 2nd or 3rd degree AV block (except in patients with a functioning artificial ventricular pacemaker).
WARNINGS: Heart Failure: ISOPTIN should be avoided in patients with severe left ventricular dysfunction (see DRUG INTERACTIONS). Patients with
milder ventricular dysfunction should, if possible, be controlled before verapamil treatment Hypotension: ISOPTIN (verapamil HCI) may produce
occasional symptomatic hypotension Elevated Liver Enzymes: Elevations of transaminases with and without concomitant elevations in alkaline
phosphatase and bilirubin have been reported. Periodic monitoring of liver function in patients receiving verapamil is therefore prudent Accessory
Bypass Tract (Wolff-Parkinson-White): Patients with paroxysmal and/or chronic atrial flutter or atrial fibrillation and a coexisting accessory AV pathway
have developed increased antegrade conduction across the accessory pathway producing a very rapid ventricular response or ventricular fibrillation after
receiving intravenous verapamil. While this has not been reported with oral verapamil, it should be considered a potential risk Treatment is usually
DC. -cardioversion Atrioventricular Block: The effect of verapamil on AV conduction and the SA node may cause asymptomatic 1st degree AV block and
transient bradycardia Higher degrees of AV block, while infrequent (0 8%), may require a reduction in dosage or, in rare instances, discontinuation of
verapamil HCI Patients with Hypertrophic Cardiomyopathy (IHSS): Although verapamil has been used in the therapy of patients with IHSS, severe
cardiovascular decompensation and death have been noted in this patient population.
PRECAUTIONS: Impaired Hepatic or Renal Function: Verapamil is highly metabolized by the liver with about 70% of an administered dose excreted in
the urine. In patients with impaired hepatic or renal function verapamil should be administered cautiously and the patients monitored for abnormal
prolongation of the PR interval or other signs of excessive pharmacological effects (see OVERDOSAGE)
Drug Interactions: Beta Blockers: Concomitant use of ISOPTIN and oral beta-adrenergic blocking agents may be beneficial in certain patients with
chronic stable angina or hypertension, but available information is not sufficient to predict with confidence the effects of concurrent treatment in
patients with left ventricular dysfunction or cardiac conduction abnormalities Digitalis: Clinical use of verapamil in digitalized patients has shown the
combination to be well tolerated if digoxin doses are properly adjusted. However, chronic verapamil treatment increases serum digoxin levels by 50 to
75% during the first week of therapy and this can result in digitalis toxicity Upon discontinuation of ISOPTIN (verapamil HCI), the patient should be
reassessed to avoid underdigitalization Antihypertensive Agents: Verapamil administered concomitantly with oral antihypertensive agents (e.g.,
vasodilators, angiotensm-convertmg enzyme inhibitors, diuretics, beta blockers, prazosin) will usually have an additive effect on lowering blood
pressure Patients receiving these combinations should be appropriately monitored Disopyramide: Disopyramide should not be administered within 48
hours before or 24 hours after verapamil administration Qumidme: In patients with hypertrophic cardiomyopathy (IHSS), concomitant use of verapamil
and qumidme resulted in significant hypotension There has been a report of increased quinidine levels during verapamil therapy Nitrates: The
pharmacologic profile of verapamil and nitrates as well as clinical experience suggest beneficial interactions Cimetidme: Two clinical trials have shown a
lack of significant verapamil interaction with cimetidme A third study showed cimetidme reduced verapamil clearance and increased elimination to 1 /2.
Anesthetic Agents: Verapamil may potentiate the activity of neuromuscular blocking agents and inhalation anesthetics. Carbamazepine Verapamil may
increase carbamazepine concentrations during combined therapy Rifampin Therapy with rifampin may markedly reduce oral verapamil bioavailability
Lithium: Verapamil may lower lithium levels in patient on chronic oral lithium therapy Carcinogenesis, Mutagenesis, Impairment of Fertility: There was
no evidence of a carcinogenic potential of verapamil administered to rats for two years Verapamil was not mutagenic in the Ames test. Studies in female
rats did not show impaired fertility. Effects on male fertility have not been determined Pregnancy (Category C): There are no adequate and well-
controlled studies in pregnant women ISOPTIN crosses the placental barrier and can be detected in umbilical vein blood at delivery This drug should be
used during pregnancy, labor, and delivery, only if clearly needed Nursing Mothers ISOPTIN is excreted in human milk, therefore, nursing should be
discontinued while verapamil is administered Pediatric Use Safety and efficacy of ISOPTIN in children below the age of 18 years have not been
established
ADVERSE REACTIONS: Constipation 8 4%, dizziness 3 5%. nausea 2 7%. hypotension 2.5%. edema 2 1%, headache 1 9%, CHF pulmonary edema
1.8%, fatigue 17%, bradycardia 1 4%, 3: AV block 0 8%. flushing 0.1%, elevated liver enzymes (see WARNINGS) The following reactions, reported in
less than 10% of patients, occurred under conditions (open trials, marketing experience) where a causal relationship is uncertain; they are mentioned
to alert the physician to a possible relationship angina pectoris, arthralgia and rash. AV block, blurred vision, cerebrovascular accident, chest pain,
claudication, confusion, diarrhea, dry mouth, dyspnea, ecchymosis or bruising, equilibrium disorders, exanthema, gastrointestinal distress, gingival
hyperplasia, gynecomastia, hair loss, hyperkeratosis, impotence, increased urination, insomnia, macules, muscle cramps, myocardial infarction,
palpitations, paresthesia, psychotic symptoms, purpura (vasculitis), shakmess, somnolence, spotty menstruation, sweating, syncope, urticaria
Treatment of Acute Cardiovascular Adverse Reactions: Whenever severe hypotension or complete AV block occur following oral administration of
verapamil, the appropriate emergency measures should be applied immediately, e.g., intravenously administered isoproterenol HCI, levarterenol
bitartrate, atropine (all in the usual doses), or calcium gluconate (10% solution) If further support is necessary, inotropic agents (dopamine or
dobutamine) may be administered Actual treatment and dosage should depend on the severity and the clinical situation and the ludgment and
experience of the treating physician
OVERDOSAGE: Treatment of overdosage should be supportive Beta-adrenergic stimulation or parenteral administration of calcium solutions may
increase calcium ion flux across the slow channel, and have been used effectively in treatment of deliberate overdosage with verapamil Clinically
significant hypotensive reactions or fixed high degree AV block should be treated with vasopressor agents or cardiac pacing, respectively Asystole
should be handled by the usual measures including cardiopulmonary resuscitation
Knoll Pharmaceuticals
A Unit of BASF K&F Corporation
Whippany, New Jersey 07981
A
BASF Group klK>ll
c1986. BASF K&F Corporation 2474 11 86 Printed in US A
38
THE CAROLINA JOURNAL OF PHARMACY
CLASSIFIED ADVERTISING
Classified advertising (single issue insertion) 25 cents a word with a minimum charge of $5.00 per
insertion. Payment to acompany order.
Names and addresses will be published unless a box number is requested.
In replying to "blind" ads, address Ad. No., Carolina Journal of Pharmacy, P.O. Box 151, Chapel
Hill, NC 27514. Telephone (919) 967-2237.
Pharmacist Needed: Looking for two
pharmacists in Charlotte area to work
together to cover store six days a week.
Saturday until 4:00 pm and NO SUNDAYS.
Very flexible hours, good benefits, profit
sharing, very competitive salary, hospital-
ization insurance, and paid vacation.
Send resume and phone number to: BJW-
NCPhA, PO Box 151, Chapel Hill NC
27514.
Weekend Pharmacy Coverage Needed:
Granville Hospital, a 66 bed community
hospital, requires Pharmacist coverage
on Saturdays and Sundays. Maintain unit
dose system and patient profiles. Contact
Joe Earnhardt, Director of Pharmacy,
Granville Hospital, College St. Extension,
Oxford NC 27565. (919) 693-5115.
Relief Pharmacist Available: Central
Eastern North Carolina. Contact Phar-
macy Relief, PO Box 2064, Chapel Hill NC
27515, or call 919-481-1272 evenings.
Pharmacist Wanted: Progressive inde-
pendent seeks motivated personable
pharmacist for permanent position.
Located within 30 minutes of Chapel Hill
and Greensboro. Buy in opportunity
available. Competitive salary and bonus
package. For more information send
resume to David Smith, Haw River
Discount Drug, PO Box 48, Haw River NC
27258
Independent Pharmacy For Sale: All or
part of Medicine Shoppe type set up.
Good hours. Excellent financing available
to the right party. Located in Durham. Call
(919)477-9455.
Pharmacist: to lease or operate new 6,000
sq/ft drugstore in ML Airy. Will be located
in new shopping center beside Food Lion
grocery store. Projected opening Febru-
ary, 1987. Contact Robert Lichauer
between 9 am - 4:30 pm, Monday-
Thursday. (919) 883-6131.
Clinical-Staff Pharmacist Position: Will be
working every 3rd weekend and will have
responsibilities in unit dose, IV admix-
tures, cancer chemotherapy, patient
education, nursing inservice, pharmacy
newsletter, pharmakinetic dosing, drug
use evaluation and other evolving clinical
applications. Some advanced training
and experience in clinical pharmacy
preferred. If interested and qualified
please send resume to: Director of
Personnel, Community General Hospital,
PO Box 789, Thomasville NC 27360. EOE.
Listings Needed For Good Profitable
Drug Stores: We have buyers. Bullock &
Whaley, Inc., PO Box 3783, Wilmington
NC 28406. (919) 762-2868.
Pharmacist Needed: Excellent opportun-
ity for young, aggressive pharmacist for
busy 3-man store. Buy-in potential,
excellent hours, profit sharing, and
insurance. Contact: Ron Ward (919) 692-
5258.
Pharmacist Needed: for professional
pharmacy in eastern North Carolina. Must
be people oriented and interested in
patient counselling. No Sundays or
holidays. Excellent salary and benefits for
highly motivated person. Call (919) 823-
2775 for appointment.
January, 1987
THE CAROLINA JOURNAL OF PHARMACY
39
Winthrop Pharmaceuticals
Adopted as New Name for
Winthrop-Breon Laboratories
On January 1, 1987, Winthrop-Breon
Laboratories became Winthrop Pharma-
ceuticals, it was announced today by Harry A.
Shoff, President of Winthrop. The division is the
ethical medical marketing unit of Sterling Drug
Inc., New York.
In making the announcement, Mr. Shoff
stated: "We changed the name to define more
concisely our interests and to bring us more
closely in line with our stated corporate mission
— to continue to provide high-quality
pharmaceuticals that best serve the needs of
patients and our customers. This name change,"
he said, "clearly defines this philosophy."
The name Winthrop has long been associated
with Sterling's prescription business, beginning
soon after World War I when the Winthrop
Chemical Company Inc. was established as a
Sterling subsidiary to market prescription
medicines. It became Winthrop-Breon in 1984
upon the consolidation of Sterling's two ethical
marketing divisions: Winthrop Laboratories and
Breon Laboratories.
PHARMACY NETWORK OF
NORTH CAROLINA
The Pharmacy Network of North Carolina is
off to a fast start. Executive Director, Andy
Barrett reports that two proposals have been
presented. One of these proposals was to an
insurance company and the other to a major
HMO. Response is expected from the insurance
company during the first quarter of 1987.
Negotiations are underway with the HMO.
Additionally, proposals are being prepared for
another HMO and two PPO's have requested the
development of a prescription drug program.
Membership in PN/NC is now over 550 stores
with the recent commitment by the Rite Aid
chain to join with all its stores. Inquiries
concerning membership have been received from
all the chains in North Carolina. Barrett expects
membership to increase dramatically as soon as a
contract is signed with a third party.
Barrett reports, "We are making an impact on
the third party sector. PN/NC has something of
value to sell to third party payers who are
marketing their services in a highly competitive
marketplace. We have convenient, quality, cost-
effective pharmacy services available from a
state-wide network of stores. We will make a
significant impact on pharmacy in North
Carolina. Individual pharmacists can help
themselves and PN/NC by communicating the
advantages of neighborhood pharmacies to their
customers."
Andy Barrett, Executive Director
Pharmacy Network of North Carolina
PHARMACIST PROFESSIONAL SER-
VICES/CONSULTATION: Temporary
and/or Continual. Contact: L.W. Mat-
thews, III (919) 967-0333 (or 929-1793).
1608 Smith Level Rd., Chapel Hill NC
27514.
PHARMACIST NEEDED: Kerr Drug
Stores has pharmacist positions available
in North Carolina. For more information
send resume to P.O. Box 6100, Raleigh,
NC 27661 or call Jackie Gupton at (919)
872-5710.
PHARMACIST NEEDED — Large, pro-
gressive independent is looking for a
pharmacist who enjoys consulting with
(continued on page 40)
January, 1987
40
THE CAROLINA JOURNAL OF PHARMACY
Shery! Brown, left, and Daniel Miller, right, Merck, Sharp and Dohme representatives,
are shown presenting the Pharmacy Recognition Award to Waits A. West and Thomas
L. West of Tart and West Druggists, Roseboro. The award is given for significant
achievements in continuous service to their community for 78 years.
CLASSIFIEDS
(Continued from page 39)
customers. Computerized prescription
department, excellent salary, hospital-
ization and life insurance, paid vacations.
Central North Carolina. Call Micky
Whitehead at R&M Mutual Discount
Drugs, Ramseur, 919-824-2151.
HOSPITAL PHARMACIST WANTED: The
Department of Pharmacy Services at
Sampson County Memorial Hospital has
opportunities available for hospital
pharmacy practice. Our 145 bed JCAH
approved hospital has excellent working
conditions with all ancillary departments
including active Medical Staff. Starting
salary in mid 30s plus comprehensive
benefit package. Activities: include
complete computerization, IV admixture,
unit dosage, patient profile and inventory
control. Patient Services: antibiotic
monitoring, TPN, aminoglycoside dosing
and support for continuing education.
Interested cadidates contact: Patricia R.
Britt, Director, Personnel 919-592-8511
EXT 477, Sampson County Memorial
Hospital, Clinton NC 28328.
PROFESSIONAL PHARMACIES: Several
small prescription-oriented pharmacies
are currently avaialbe for individual
ownership in North Carolina. These
opportunities provide the vehicle to
practice pharmacy the way you were
taught, while offering an attractive income
and more time to be with your family. In
some cases, financing is also available to
qualified candidates. For more informa-
tion write: Jan Patrick, 10121 Padget Dr.,
St. Louis MO 63132.
Pharmacist Wanted: Permanent full-time,
Pharm.D. preferred, to work as compre-
hensive farm worker health clinician,
education and consultation, protocol
development, inventory and formulary
maintenance. NC licensure and one year
experience required. Fluency in Spanish
a plus. Send resume or call: Mr. Baker,
Tri-County Community Health Center, PO
Box 537, Newton Grove NC 28366. (919)
567-6194.
January, 1987
Let us put
together a
HOME
HEALTH
CARE
program for you
A SERVICE OF
OWENS&MINORJNG
Serving The Health Care Industry Since 1S82
— Corporate Headquarters—
2727 Enterprise Parkway, Richmond, VA 23229
804/747 9794
A COMPLETE COMPREHENSIVE HEALTH CARE
PROGRAM FOR INDEPENDENT RETAILERS.
• DURABLE MEDICAL EQUIPMENT
Availability of a wide assortment of brand name
durable medical products including ambulatory and
non-ambulatory at competitive prices.
• CONSUMABLES
Due to our commitment and involvement with medi-
cal/surgical products, you can enjoy competitive
prices and a large assortment of disposable products
in stock. We will also be happy to locate special order
products in one of our medical/surgical branches and
drop ship them to your store.
• TRAINING
Complete home health care programs are conducted
for the retailer by our trained specialist initially and
on an on-going basis.
• FLOOR PLANNING
Floor plans, store fixtures, piano-grams, display
materials and merchandising assistance are available
to the retailer, for new locations or re merchandising
existing stores.
• ADVERTISING AND PROMOTION
A wide variety of advertising materials including signs,
decals, window banners, statement or bag stuffers,
brochures, patient education materials, newspaper ad
vertisements, catalogues, radio copy, letters, and cir
culars are available to assist the retailer in promoting
home health care products in the retail market.
• REPRESENTATION
A marketing specialist is available to and will assist
the retailer in the store on a regular basis in order to
provide continuous support in the home health care
market.
• COMPUTERIZED THIRD-PARTY BILLING
A service bureau to electronically submit third-party
claims to Medicare Part B will enhance the bottom
line profit through savings in time, personnel and
increased cash flow.
• CUSTOMER SERVICE
A customer service representative, fully trained in
third-party billing and medical/surgical products, is
available by telephone with the sole responsibility
of supplying the product to you as quickly as possible
and to answer questions relating to third-party claims.
Contact your Owens & Minor representative or call
a sales manager at one of the following locations:
1010 Herring Avenue, Wilson, NC 27893
919/237 1181
4825 Bethlehem Road, Richmond, VA 23230
804/355 0681
4500 Progress Road, Norfolk, VA 23502
804/857 5911
1175 N. W. 159th Drive, Miami, FL 33269
305/625 1321
ALLOW US
TO FILL YOUR
HOME HEALTH CARE
PRESCRIPTIONS!
FOR ALL OF YOUR
HOME HEALTH CARE NEEDS
ALLOW US TO ASSIST YOU
Leading Industrial Prod
ucts Available.
Next Day Delivery on li
Stock Products.
Discount Programs.
In Store Visits By Our
Trained Home Health
Services Representative
Phone Assistance By
Qualified Customer Sei
vice Personnel.
Product Literature Avai
able.
Third Party Reimburse-
ment Information Avail
able.
Complete Individualize*
and Customized Plan-C
Gram and Store Set Up
C.E.U. Accredited Worl
shops for N.C. Pharmacisl
HOME HEALTH SERVICES OF
CAROLINA SURGICAL SUPPLY
P.O. BOX 31207 • RALEIGH, N.C. 27622 • (919) 782-8400/(800) 662-7767 NC WATTS
SERVING CUSTOMERS OF:
Dr.T.C. Smith Co. / W.H.King Drug
1HE GJROLINk
JOURNN-OfPHN?MkCY
LU
O
>
1987 ANNUAL CONVENTION
NORTH CAROLINA
PHARMACEUTICAL ASSOCIATION
AND
AFFILIATED AUXILIARIES
Adam's Mark Hotel
Charlotte North Carolina
April 22, 23, 24 and 25
107th Annual Convention
North Carolina Pharmaceutical Association
Healtl
223-H
Chapel Hill, NC 27514
mm
mmmm
iiimiiiiiiiiii ijiiiiiiuiii
Looking for a
Dependable Wholesaler?
Look to Kendall.
Kendall customers choose us because
we know the pharmacy business and give
excellent service. Kendall offers evening
order-taking and fast delivery. Also look
to Kendall for Drug Store Designs and
Fixtures, Pricing Strategies, Microfiche,
Advertising Programs and Electronic
Order Entry.
Count On
Kendall also offers the Triad Pharmacy
Computer System, featuring Prescription
Processing, Drug Interactions, Accounts
Receivables, Third Party Billing and
Medi-Span Price Updates. Triad
increases efficiency and organization, is
easy to use, and is fully supported by
Kendall. Call Triad direct at
1-800-532-3087.
1[7K£I\IDAL.L
M\ > DRUG OOIVIFV\rMV
1305 Frederick St. • P.O. Box 1060 • Shelby, N.C. 28150
N.C. 1-800-222-3856
S.C. 1-800-438-5330
Justice Drug Company
P.O. Box 22025
Greensboro, NC 27420
AN ALCO STANDARD COMPANY
Now in our 87th Year of Service to the North Carolina Pharmacists
1-800-632-1295
SjJM Partnership
For Profit
Family
Independent
Pharmacy
Total Retail Concept
The Family Independent Pharmacy program provides an
all-inclusive plan covering every aspect of marketing,
merchandising, and management of drug store opera-
tions. It is a wholesaler-sponsored voluntary, and it
embraces the total retail concept in all its forms.
IHHC
TOTAL HOME HEALTH CAKE
Our Total Home Health Care" Program offers Durable
Medical EquipmentforRentorResale. Third Party Billing
for Medicare/Medicaid.
Additional
* Services & Programs Offered *
Store Plan-O-Gram: Complete Store Layout & Design
including Fixtures, Merchandise Plan-o-graming,
and Pricing Strategies
Specialty Cp if t Departments including Arts & Crafts
Affordable Pharmacy Computer Systems
National Data Corporation
Merchandise Racking Service
Group Life
And Health
Insurance
Benefits
For Members Of
North Carolina
Pharmaceutical
Association
Pilot Life Insurance Company is pleased to have oeen
selected as the Group insurance carrier for the North
Carolina Pharmaceutical Association. It would be to
your advantage to become thoroughly acquainted with
the benefits of this program.
You can expect the best possible service from Pilot Life,
one of the nation's leading Group insurance carriers.
For full information, contact Mr. Al Mebane, Executive
Director, North Carolina Pharmaceutical Association.
Write or call:
Sam P. Stuart, CLU
P. O. Box 595
Winston-Salem, NC 27102
Telephone 919/723-8811
Pilot
life
THE OIROLINk
JOURNAL of PHfvRMkCY
FEBRUARY 1987
Officers
NORTH CAROLINA
PHARMACEUTICAL
ASSOCIATION
President
M. Keith Fearing, Jr.
P.O. Box 1048
Manteo, NC 27954
(919)473-3463
Vice Presidents
Julian E. Upchurch
5201 Pine Way
Durham, NC 27712
(919)477-7325
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh, NC 27612
(919)876-5600
W. Robert Bizzell
1007 Rhem Street
Kinston, NC 28501
(919) 527-6929
Executive Director
& Editor
A. H. Mebane, HI
P.O.Box 151
Chapel Hill, N.C. 27514
NCPhA Office
(919) 967-2237
or
1-800-852-7343
(USPS 091-280)
VOLUME 67
ISSN 0528-1725
NUMBER 2
CONTENTS
1987 Convention Schedule 4
Association Lobbyist 7
Steroid Hormones 11
Pharmacy Policy Research Lab 17
State Board of Pharmacy 19
Correspondence Course, Contact Lenses 23
Dickinson's Pharmacy 31
Eckel Elected to Board 34
CE Course Quiz 35
Life Members 37
Classified Advertising 38
Births and Deaths 40
ADVERTISERS
Carolina Surgical Supply 24
Colorcraft 30
Justice Drug Company 1
Kendall Drug Company 2nd Cover
Knoll Pharmaceuticals 32 and 33
Lawrence Pharmaceuticals 20
Lilly/Dista 8
Owens & Minor 3rd Cover
Pilot Life 2
Roche 14 and 1 5
Savage Laboratories 16
Dr. T.C. Smith Co./W.H. King Drug 4th Cover
Spear Associates 10 and 18
Upjohn 6
USP 12
Washington National 22
The Carolina Journal of Pharmacy is published monthly by the
North Carolina Pharmaceutical Association, P. O. Box 151,
Chapel Hill, NC 27514. The Journal is provided to NCPhA
members through allocation of annual dues. Subscription rate to
non-pharmacists (continental US) $20.00. Single copy price
$2.00. Overseas rates on request. Second class postage paid at
Chapel Hill, NC.
THE CAROLINA JOURNAL OF PHARMACY
1987 ANNUAL CONVENTION
NORTH CAROLINA PHARMACEUTICAL ASSOCIATION AND
AFFILIATED AUXILIARIES
Adam's Mark Hotel
Charlotte, North Carolina
April 22 -25, 1987
8:00 am
9:00 am 4:00 pm
3:00 pm
7:30 pm
7:30
am
9:00
am
9:15
am
9:30
am
12:30
pm
1:00
pm
2:00
pm
2:00 pm
3:00 pm
9:00- 12:00 pm
WEDNESDAY April 22, 1987
Seminar Registration Desk opens
Seminar — "Substance Abuse: Disease, Pharmacology and
Treatment", sponsored by NCPhA and NCSHP with an educational
grant from Glaxo, Inc.
Convention Registration Desk Opens
Opening Session Banquet
Guest Speaker: Michael Broome
Features: Presentation of NCPhA Coat of Arms, Don Blanton Award
and Bowl of Hygeia Award, Young Pharmacist of the Year
and announcement of 1987 NCPhA Pharmacist-of-the-Year
THURSDAY April 23, 1987
PharmPAC Breakfast
NCPhA First Business Session
Buses start loading for Auxiliary Tour
Buses leave for Auxiliary Tour to Heritage USA and Marriott Hotel
Luncheon and Fashion Show Marriott Hotel, Tyvola Road
UNC Practitioner-Instructor Luncheon
Buses leave for Shopping at South Park
"Specialty Shoppes on the Park"
Golf Tournament, Larkhaven Golf Club
Sponsored by Owens-Illinois
Tennis Tournament, Freedom Park Courts
Sponsored by Jefferson-Pilot
Workshop on "Anti-dysrhythmic Drug Therapy"
Watercolor Class** — Joe Miller, Artist in Residence
Dinner on Your Own
TMA Sponsored Dance
Joyce Hawley and the Rhythm Section
Don Hill
NCPhA Convention Chairman
Mary Lou Davis
Woman's Auxiliary
Convention Chairman
February, 1987
THE CAROLINA JOURNAL OF PHARMACY
8:30 am
9:00 am
9:30 am
11:00 am
11:45 am
Noon
12:30 pm
2:00 pm
5:00 pm
8:30 pm
10:30 pm
FRIDAY April 24, 1987
Coffee and Goodies, Woman's Auxiliary Hospitality Room
NCPhA Second Business Session
Woman's Auxiliary Business Session
Traveling Members' Auxiliary Business Session
Buses start loading for Myers Park Country Club
Buses leave for Myers Park Country Club
Auxiliary Luncheon and Installation of Officers
Opening of Exhibit Program
Complimentary Buffet Luncheon in Exhibit Hall
Woman's Auxiliary Tour of Historic Mint Museum
Exhibit Program closes
Dinner on Your Own
Casino Night
Auction to benefit Woman's Auxiliary Consolidated Pharmacy Loan Fund
SATURDAY April 25, 1987
7:30 am Christian Pharmacists Breakfast
9:00 am NCPhA Third Business Session
12:30 pm Awards Luncheon & Installation Ceremony
Speaker: Lonnie Hollingsworth, President, NARD
Induction into 50+ Club, Academy of Pharmacy, and other
awards.
Installation of 1987-1988 NCPhA Officers
2:45 pm - 4:00 pm NCPhA Executive Committee meeting
**Pre-Registration required.
Woman's Auxiliary Hospitality Room will be open except during W.A. functions.
NOTE: Convention badges required for attendance at all functions.
President
First Vice President
Second Vice President
Third Vice President
1987-1988 NCPhA Officers To Be Installed
Julian E. Upchurch — Durham
Albert F. Lockamy, Jr. — Raleigh
W. Robert Bizzell — Kinston
Loni T. Garcia — Lumberton
Executive Committee Members-at-Large
Betty H. Dennis — Carrboro
Claude U. Paoloni — Chapel Hill
Donald V. Peterson — Durham
Joyce Hawley
February, 1987
This is
the only thing
a lot of prescriptions
will ever fill.
Sad, but true. Prescriptions written for 14% of
your customers never make it to your pharmacy
counter*. When asked for a reason, nearly 75% of
the noncompliant group said they didn't need the
medication. . . or didn't want to take it.
Another 6% told tales of prescriptions lost,
prescriptions forgotten. . . or drugs that weren't
available.
But surprisingly enough in this age of tight
budgets, only one in ten persons said they canned
their prescriptions because of high cost.
Like to know more? Just contact your Upjohn
representative.
'According to the 1985 National Prescription Buyer Survey by Market Facts. Inc.
Sharing knowledge...sharing success.
. The Upjohn Company, Kalamazoo. Michigan 49001
THE CAROLINA JOURNAL OF PHARMACY
NCPhA Legislative Lobbyist,
Virgil McBride
Virgil L. McBride
The North Carolina Pharmaceutical Associa-
tion is pleased to announce the selection of Virgil
L. McBride as our legislative agent (or lobbyist)
for this session of the North Carolina General
Assembly. We look forward to a long and
productive partnership and expansion of
pharmacy's visibility as an important force in
health related legislative issues.
Mr. McBride is a native of Mississippi. Born in
1933, he received his B.A. in Psychology and
Speech from Mississippi College, Clinton,
Mississippi and later his B.D. from Southeastern
Baptist Theological Seminary, Wake Forest. He
has done additional studies in business
administration, communications, personnel
administration and local government administra-
tion. He is a graduate of the Executive Program of
Professional Management Education, University
of North Carolina at Chapel Hill.
Mr. McBride has had a wealth of experience
which will benefit him in his work as a lobbyist in
the North Carolina General Assembly. He served
in the US Navy in the Bureau of Navy Personnel.
From 1961 to 1969, he was the Assistant to the
President of Chowan College and was Director
of Development. He was also Director of
Development at Wake Forest University, from
which he received a leave of absence to become
the first Executive Director of the North Carolina
Association of Independent Colleges and
Universities in 1970, a position he held for four
years. Since 1974, Mr. McBride has been
associated with R.J. Reynolds Industries, Inc. in
their public affairs department.
He was president of the Travel Council of
North Carolina, President of the Carolina Society
of Association Executives, a member of the
Advisory Committee on Assessment and
Accountability, North Carolina Board of
Education, Treasurer of the Governor's Business
Council on the Arts and Humanities and a
member of the NC Rural Development Advisory
Council, to list a few areas of his involvement in
North Carolina politics, state government and
service positions.
We hope you will meet Mr. McBride and get
to know him and let him get to know you, the
pharmacist he works for. You can contact him
through the NCPhA office in Chapel Hill or by
calling the General Assembly Legislative
Switchboard at (919) 733-4111 and leaving a
message. The NCPhA will try to have Mr.
McBride attend as many local association
meetings as possible. Your interest and personal
involvement with your legislators is as important
as anything one lobbyist can accomplish.
Trivia
For what was Richard Q. Peevy recognized
by NARD in 1951? First correct answer
will receive suitable prize and recognition.
February, 1987
Follow the arrows
to better cash flow management.
MtiM.
And they could lead you to greater profits.
With the help of the new Lilly Computerized
Pharmacy Management Series, you can learn key
cash management techniques that may Pe employed
for operating a more profitaPle pharmacy. But you
also earn as you learn. On satisfactory completion of
a test at the end of each unit, you receive 2 hours
(0.2 CEU) of continuing education credits.
With the aid of this "hands-on" program, you'll be
moving in the right direction . . .toward increased profits.
S%fyJ{
DISTA
YOUR PARTNERS IN HEALTH CARE
Service, support, and innovative products...
A tradition since 1876.
Y AND COMPANY
THE CAROLINA JOURNAL OF PHARMACY
APhA's EIGHTH EDITION OF
HANDBOOK OF
NONPRESCRIPTION DRUGS
NOW AVAILABLE
Handbook of Nonprescription Drugs, eighth
edition, prepared by the American Pharmaceutical
Association with the assistance of pharmacists,
physicians, other health care specialists, and the U.S.
Food and Drug Administration. Published by the
American Pharmaceutical Association, Washing-
ton, DC 20037; 1986. 768 pages, hardbound, SVi x
1 1 in. List price: $70.
Long recognized by pharmacy practitioners,
pharmacy students, and other health professinals
as the ultimate source of information on
nonprescription medications, the completely
revised and updated 8th edition of the American
Pharmaceutical Association's Handbook of
Nonprescription Drugs is now available.
The Handbook's 35 chapters are organized to
provide quick, practical information on
therapeutic groups of nonprescription products
and the conditions for which these products are
used. The 768 page reference provides detailed
information on virtually every aspect of
nonprescription medications, with discussion of
such topics as cold and allergy products, laxative
products, antacids, nutritional supplements,
weight control products, personal care products,
burn and sunburn products, sleep aids, internal
and external analgesics, and nonprescription
contraceptives.
A unique feature of the Handbook are the
product tables which provide at-a-glance
comparative information — including quanti-
tative amounts of active ingredients — on
virtually all nonprescription products. The more
than 100 tables have been completely updated
for the 8th edition
In addition, extensive illustrations and
anatomical drawings throughout the book are
complemented by a special eight-page section of
full-color photographs showing common
dermatological and dental/oral conditions. The
comprehensive index lists drugs by both trade
and generic names, and includes disease
conditions and symptoms.
Because nonprescription drugs, and the ways
in which people use them, have changed
enormously over the past few years, the 8th
edition features a number of important changes:
* Extensive revisions throughout to accu-
rately reflect product reformulations, new
product introductions, and changes in brand
name or manufacturer identification.
* New text discussions and product listings for
former prescription drugs now generally
available — including ibuprofen and
hydrocortisone.
* An entirely new chapter on antipyretic drug
products, reflecting professional and public
concern over Reye Syndrome.
* A completely new section on sports
medicine, with special emphasis on foot
injuries.
* New product information on calcium-rich
dietary supplements, reflecting the growing
public concern about osteoporosis.
* Extensive revision of contact lens
information, including four new product
tables for soft and gas-permeable contact
lenses — and a fifth table comparing the
different types.
* Expanded information on dentifrices and
oral health care products, including
abrasivity data.
* New separate product listings for inhalent
and orally-administered dosage form
asthma products.
After December 31,1 986, the price will rise to
$56 and $70, respectively. Student APhA
chapters and bookstores qualify for special rates.
For specific ordering information, contact the
Order Desk, APhA, 2215 Constitution Avenue,
NW, Washington, DC 20037.
PHARMACIST MOBILITY
According to the latest National Association of
Boards of Pharmacy Newsletter, North Carolina
ranked 5th on a list of pharmacists reciprocating
into the state for the period 1984 through 1986.
Ahead of North Carolina were Texas (715),
Virginia (642), Maryland (609), Pennsylvania
(601). North Carolina received 585 pharmacists
during that time. These figures reflect mobility by
reciprocity procedures and do not include
pharmacists who become licensed in other states
by examination.
The data also indicated which states had the
greatest difference in pharmacists reciprocating
into the state and out of the state. Arizona had the
greatest net gain (368), followed by Virginia
(367), Maryland (360) and North Carolina
(347). Hawaii had two pharmacists leave the
state and 77 reciprocate into the state, while
Alaska lost 9 pharmacists and gained 63.
February, 1987
10
THE CAROLINA JOURNAL OF PHARMACY
SURVEY FINDS WIDESPREAD
IGNORANCE ABOUT
ASPIRINS MANY USES
Most Americans don't know that aspirin may
be used to reduce the risk of heart attack and
stroke in high-risk persons.
In a recent national survey, it was learned that
only one in four Americans has heard about
aspirin therapy for vascular diseases — the
nation's Number One killer.
The survey was conducted by New World
Decisions, an opinion research firm in New
Jersey.
Last fall, the U.S. Food and Drug
Administration approved the use of aspirin to
help reduce the risk of heart attack in those who
have already had a heart attack, or who have
unstable angina. Aspirin has also been approved
by FDA to help reduce the risk of stroke in those
at risk.
Studies show that in those who have unstable
angina, one aspirin a day could reduce the
incidence of heart attack by almost one-half.
However, only 29 percent of those over 49 years
of age — the population most at risk for vascular
diseases — were familiar with this treatment.
The proportion of Americans who report
using aspirin to treat certain conditions parallels
the proportion of those who are aware of aspirin's
use for those conditions.
For example, the highest level of awareness
was for aspirin's usefulness in treating arthritis.
Aspirin for arthritis also had the highest
frequency of use — 11 percent.
Use of aspirin to reduce the risk of heart attack
and stroke was only 5 percent of those surveyed.
Will aspirin keep heart attacks away?
Researchers are now investigating whether
aspirin can be used by the general healthy
population to reduce the risk of vascular diseases.
A major study is expected to be released soon.
CONGRATULATIONS TO
LARRY STEEDELY
On the opening of his new store, Hamont Drugs in
Fayetteville. We are pleased to have helped Larry plan
and install the fixtures and equipment for this new store.
H Warren Spear R Ph
Pharmacy Design Specialist
415 Augusta Drive
Route 4, Box 376 AA
Statesville NC 28677
(704)876-4153
Spear Associates — planners, de-
signers and installers of pharmacy
fixtures & equipment
February, 1987
THE CAROLINA JOURNAL OF PHARMACY
11
STEROID HORMONES: WIDE
AVAILABILITY PROMOTES
RESEARCH, TREATMENT OF
MANY DISEASES
Imagine a scenario in which control of your
reproductive functions was dependent upon
tracking down and eating certain plants. The
California quail faces just such a predicament: In
years with little rain, its principal food source is
desert plants containing steroid hormones. These
inhibit quail reproduction, limiting the
population to a size the desert can feed.
The idea of humans in a similar situation is not
so farfetched. We use steroid hormones — in the
form of birth control pills — to control
reproduction. Today, these generally come not
from plants or animals, but from microbes.
Conversely, some people don't produce
enough of these hormones normally and are
dependent on external sources. Steroid deficiency
is linked to impotence in men, infertility and early
menopause in women, as well as a host of serious
medical conditions.
Steroid hormones — derived from cholesterol
and produced by the adrenal glands — control a
wide variety of biological processes in the body.
It wasn't until the 1930s that humans discovered
the potent hormonal and anti-inflammatory
properties of steroids. This finding attracted
widespread attention, and a team of researchers
soon applied it to the treatment of rheumatoid
arthritis. They won a Nobel Prize for that
discovery.
In 1949, cortisone, an anti-inflammatory
steroid hormone, was synthetically manufactured
for the first time by chemists at The Upjohn
Company, using a process that involved micro-
biological fermentation. Prior to this break-
through, cortisone was produced by a very costly
and tedious process requiring extraction of small
amounts of the hormone from tons of cow
adrenal glands or from exotic plants containing
cortisone precursors.
The successful synthesis of cortisone by
Upjohn made the hormone widely available and
affordable for the first time to people who
desperately needed it. Upjohn's technique
ushered in the era of steroidal anti-inflammatory
treatment.
Today a variety of synthetic steroidal drugs are
available for the treatment of arthritis, as well as
numerous other incapacitating illnesses.
Corticosteroid Sources in
Your Body
The key to appreciation of steroid hormone's
diversity lies in understanding their basic biology.
There are two types of natural corticosteroids (so
named because they come from the outer layers,
the cortex, of the adrenal glands), both naturally
produced from cholesterol. The mineralocorti-
coids help regulate sodium and potassium levels
and other body minerals. They promote proper
muscle and nerve functions as well as
maintenance of adequate blood volume and
pressure. The glucocorticoids regulate sugar and
protein metabolism and possess potent anti-
inflammatory and immunosuppressive prop-
erties.
Under ordinary conditions, the brain —
specifically, the hypothalamus and the "master
gland," the pituitary, (see figure #1) controls
corticosteroid (Cortisol) secretion. When blood
levels of Cortisol fall, the hypothalamus sends a
chemical messenger (called a releasing factor) to
the pituitary gland, signaling it to release another
chemical messenger, adrenocorticotropic
hormone (ACTH) into the bloodstream. ACTH
stimulates the adrenal gland to secrete Cortisol.
The hypothalamus monitors the blood levels of
Cortisol and turns off the signal to the pituitary
gland once Cortisol levels return to normal.
However, in adrenal insufficiency this
regulatory system fails, and specific diseases
develop. Addison's disease, characterized by
weakness, weight loss, irritability, lethargy and
low blood pressure, is associated with a
deficiency of adrenal hormones. Cushing's
syndrome, marked by hypertension, thin skin,
accumulation of abdominal fat, "moon face,"
osteoporosis (loss of bone substance) and red
cheeks, is linked to an excess in the production of
adrenal hormones.
Steroid Hormone Mechanism
of Action
"At the molecular level, corticosteroids bind to
specific steroid receptor molecules found within
most cells," says Susan Katz, M.D., assistant
professor of medicine at Albert Einstein College
of Medicine in New York City. Once bound, they
alter the cell's production of proteins.
Another group of potent, hormone-like
substances, the prostaglandis, appear to be
involved in inflammatory and allergic reactions
Continued on page 12
February, 1987
12
THE CAROLINA JOURNAL OF PHARMACY
as well. Steroids inhibit the formation of certain
prostaglandins by preventing the release of
prostaglandin precursors.
"It's not clear, however, how cellular changes
produced by steroids are related to their
therapeutic effects," adds Dr. Katz. "Steroids
stabilize the cell membrane and cause blood
vessels to constrict. These effects probably
underlie their most important clinical
properties."
Many Applications for
Steroid Therapy
The most widely exploited property of
corticosteroids is their ability to reduce localized
swelling, redness and tenderness — aspects of
inflammation. However, it is important to realize
that while corticosteroid therapy reduces
inflammation, it may mask the underlying
disease. So the underlying disease itself must be
aggressively treated at the same time that steroids
are administered.
Corticosteroids are also used therapeutically
for their immunosuppressive properties. They
reduce the individual's defense against infection.
Taking advantage of this, physicians use steroids
to suppress immunity in organ transplant patients
to prevent rejection of transplanted organs.
Another use for steroids is in the treatment of
autoimmune disorders, such as rheumatoid
arthritis, systemic lupus erythematosus, multiple
sclerosis and myasthenia gravis. In these diseases,
the body's immune system fails to distinguish
infecting foreign invaders from its own
components. And the body mistakenly produces
antibodies against itself. Steroids effectively
suppress this destructive cycle.
Steroids are also used to treat inflammation of
the eye and skin, hormone-dependent tumors of
the breast, leukemia, lymphoma and respiratory
disorders.
A Word About Steroid Toxicity
There is good reason to use steroids, reserving
them only for conditions that do not respond to
more moderate treatment. The prolonged use of
oral or injected steroids can result in suppression
of adrenal function, along with increased
susceptibility of infection, weakness, osteoporosis
and behavioral changes.
Abrupt withdrawal of long-term steroid
therapy may activate the condition for which
steroids were initiated. Antibiotic therapy is often
necessary to combat bacterial or fungal infection
WHY BUY JUST A "BOOK"
when you can subscribe to USPDI! ~> This continually revised drus
information service will provide you with up-to-date, clinically relevant
drug data on virtually all drugs New and revised information is issued
through bimonthly Updates
Start your subscription to U5PDI with the newly revised,
2-volume Seventh Edition at the special pre-publication price of S64.95
(regularly S79.95). Continue your subscription at our low renewal rates
(billed annually) so that you are assured of receiving all revised mam
volumes and a continuous flow of bimonthly Updates
NEW IN THE SEVENTH EDITION
All new index by indications— for easy reference to drugs
used in the treatment of various disease states.
Includes monographs on most of the major new drug
products recently approved by FDA.
Over 100 new generic substances or combinations added.
I Get more than just a "book".
| Yes! I want to join the USPDI subscription service at the pre-
publication price of S64 95 ($15 off the regular price) for the
first year
i | I want to continue to guarantee these low rates by
subscribing now for a two year period for $124 95
FULL MONEY BACK GUARANTEE • 'or any reason, you are not
satisfied after receipt of your first subscription publication, return your
purchase (in resalable condition) within 30 days for a full refund
|_] Enclosed is my check payable to USPC for $
(PA residents add 6% sales tax.)
| Charge my
□ MasterCard Acct »
Exp Date
□ VISA Sisnature
Name
Organization
Address
City State Zip
All orders must be paid in advance in U S dollar, drawn on a U S Dank or bv mone
Snipping costs of U S and Canadian order, are included m (he subscription price 1
sr—
Send North Carolina Pharmaceutical Association
Order to: P.O. Box 151, 109 Church Street
Chapel Hill, North Carolina 27514
February, 1987
THE CAROLINA JOURNAL OF PHARMACY
13
in patients treated with immunosuppressive
steroids.
In general, steroids should be administered in
what is determined to be the smallest effective
dose in an attempt to avoid these complications.
Treatment is usually tapered off gradually as the
crisis abates.
Pube-dosing — intermittent high doses of
steroids over short periods of time — may be
more effective in treating certain diseases than
long-term treatment with low doses. In the future,
novel drug delivery systems that target drugs
directly to the problem area will help to reduce
toxicity and improve effectiveness.
Sex Hormones Are Also
Steroids
The female ovaries and the male testes are
responsible for the production of another group
of steroids, the sex hormones — estrogen,
progesterone and testosterone. These hormones
are responsible for sexual development at
puberty and plan an important role through our
lives in shaping body and behavior.
The normal menstrual cycle in women is
governed by the cyclical production of estrogen
and progesterone. These hormones are some of
the most frequently prescribed drugs in the world
today. As many as 50 million women worldwide
are taking some form of oral contraception to
inhibit ovulation. Combined preparations of
estrogen and a progesterone-type agent
(progestin) are nearly 100 percent effective in
preventing pregnancy. The side "mini pill,"
containing only the latter, is about 98 percent
effective but avoids many of the side effects
related to estrogen.
In menopause, the ovaries gradually stop
producing hormones and menstruation ceases.
Replacement therapy with a combination of
estrogen and a progestin often provides relief
from hot flashes, vaginal thinning and
osteoporosis.
Replacement therapy with androgen (tes-
tosterone; Depo-Testadiol, Upjohn) is used
primarily to promote genital development and
normal growth in the deficient male.
Testosterone is an effective treatment for some
types of impotence as well.
Anabolic Steroids: How
Dangerous Is Their Use?
Androgens are also used by athletes who
exploit these drugs for their anabolic (body-
building) properties. The androgens can cause
dramatic weight gain in short periods by reducing
the body's ability to utilize protein.
It is believed that some athletes self-administer
high doses of a mixture of oral and injectable
steroids during training and taper them off prior
to competition to avoid detection.
In the few controlled studies addressing this
issue, anabolic steroids increased body weight
(apparently through water retention), but no
clear effect on muscle mass could be
documented.
Prolonged anabolic steroid use may result in
acquired masculinization in females, feminiza-
tion in males, insomnia, irritability and a variety
of serious blood disorders.
A Handful of Steroids Provide
an Abundance of Treatments
Steroid therapy has constituted a major
advance in clinical medicine in the past 35 years.
Armed with only a few of the many steroids
available, the physician can now bring about
remission of many chronic diseases and reduce
suffering that would otherwise be intractable.
HOW DO PATRONS RATE
THEIR PHARMACY?
The new Sandoz Consumer Health Care
Group, a combination of Dorsey Laboratories
and Ex-Lax® Pharmaceuticals, announces the
Pharmacy Patron Survey, a unique, cost-free
service to community pharmacies. Now, for the
first time, community pharmacies can evaluate
the attitudes of their clientele concerning the
quality of their pharmacy services. This survey
will also serve as a market research tool to help
pharmacies develop their future marketing
programs.
The survey was developed by Sandoz
Consumer Health Care Group in association
with The National Association of Retail
Druggists and a distinguished consultant panel.
The Pharmacy Patron Survey will be
announced in major national and state pharmacy
journals. Pharmacists wishing further infor-
mation about this program should contact Lon
D. Lowrey, 1-800-228-4575.
February, 1987
The Roche Community
Pharmacy Advisory Board j
Representing independent pharmacies nationwide, the Roche
Community Pharmacy Advisory Board is made up of community
pharmacists — just like you. The members are selected for their
leadership and outstanding commitment to their profession.
They help us by providing experienced input on Roche pharmacy
policies, programs and services. They help you by recommending
improvements and designing specific pharmacy oriented programs
which will ultimately benefit all community pharmacists and their
patients.
J. Harrison
Norwalk. California
Jerry Klimetz
Ft Lauderdale. Florida
W. A. Fitzpatrick
Ballwin. Missouri
G. E. Peterson
Long Beach, California
H. B. Hodgson. Jr.
Athens. Georgia
*
L. Feld
Rantan. New Jersey
jL
M. Rubin
San Antonio, Texas
Roche and Pharmacy...
Working Together for a
Healthier Tomorrow <H5k
His responsibility is to
do the best job possible. ..for you
...wherever you are in North Carolina.
How specially-trained
Savage professional representatives
can serve you and your business:
• Help maximize inventory turnover for greater
profitability
• Rapid-response order taking and delivery
...and a fair product-return policy
• Close liaison for you with wholesalers,
physicians, and headquarters customer
service at Savage
• Help to keep you informed about current
trends and competitive strategies
• Promotion specialist: Not only helps make the
deals, but helps build traffic
Savage products...
They help build customer traffic
for your pharmacy
22 high-quality products
from a single source
The right strengths, the right formulations,
the right quality, at the right price...
to help you serve your customers and
maintain your profits
^
Allergy: BREXIN* L A CAPSULES chlorpheniramine maleale 8mg,
pseudoephednne hydrochloride 120mg. •
Antiprotozoal: SATRIC '" TABLETS - 250mg (metronidazole USP) ■
SATRIC" - 500 TABLETS (metronidazole USP) •
Contrast Medium: ETHIODOL* (ethiodized oil lor miechon) ■
Hormone: DITATE" -DS (testosterone enanthate and
estradiol valerate injection) •
Bronchodilators: DILOR* ELIXIR (dyphylline) ■
DILOR* INJECTABLE (dyohylline) • DILOR*' TABLETS - 200mg (dyphylline) •
DILOR* -400 TABLETS (dyphylline) • DILOR-G" LIQUID
dyphylline 100mg, guaifenesin USP 100mg ■ DILOR-G" TABLETS
dyphylline 200mg. guaifenesin USP 200mg. •
Topicals: ALPHATREX* CREAM. OINTMENT AND LOTION 0 05%
(betamethasone dipropionale USP) ■
BETATREX" CREAM, OINTMENT AND LOTION 0 1%
(betamethasone valerate USP) • MYTREX* A* CREAM AND OINTMENT
(neomycin sulfate triamcinolone acetonide) •
MYTREX* F CREAM AND OINTMENT (nystatin - triamcinolone acetonide) •
NYSTEX'" CREAM AND OINTMENT (nystatin USP) •
NYSTEX'" ORAL SUSPENSION (nystatin oral suspension USP) ■
TRYMEX CREAM AND OINTMENT 0 025% (triamcinolone acetonide USP) •
TRYMEX CREAM AND OINTMENT 0 1 % (triamcinolone acetonide USP) •
Vaginal Preparations: TRYSUL" (triple sulfa vaginal cream)
(sulfathiazole 3 42%, sulfacetamide 2 86%, sullabenzamme 3 70%) •
Vitamins: CHROMAGEN* CAPSULES ferrous tumarate USP 200mg,
ascorbic acid USP 250mg, cyanocobalamm USP 10mcg, desiccated
stomach substance 100mg •
CHROMAGEN*1 OB CAPSULES a phosphorous-tree vitamin and mineral
dietary supplement lor use during pregnancy and lactation
"Introduction scheduled for July 19
SAVAGE
LABORATORIES
a division of Altana Inc • Melville. New York 1 1 747
People and products to serve your needs.
THE CAROLINA JOURNAL OF PHARMACY
17
DO MAIL ORDER PLANS
REALLY SAVE MONEY?
This question has been on the cutting edge of
our controversy over mail order, from the
beginning. Now there is a definite study carried
out by a reputable organization which establishes
that mail order Rx costs are 5% higher than
conventional drug plans!
The study titled "Actuarial Study of Mail
Order Drug Option Experience" was conducted
by Sieben and Associates on behalf of
McKesson's P.C.S. subsidiary. It did show that
while unit cost savings in mail order fills are
significant, they are more than eliminated by the
increased volume dispensed. In discrete numbers,
the 4% mail order savings in unit costs were
wiped out by the 9% higher utilization, resulting
in a mail order increased cost of 5% over non-
mail order group plans.
What was the cause or the problem? Well,
we're sure that in your mind you already knew
the answer before they conducted the
experiment. Wastage occurs. It occurs because
part, sometimes much, of many prescriptions
goes unused or medications are changed before
being finished and the leftovers are discarded (or
used by others who shouldn't consume them).
Also, prescriptions are lost and not renewed, or
individuals simply stop taking their medication
while many doses remain in the container.
The elderly represented the age group for
which mail order was least cost effective. This
was because the group did take a higher percent
of maintenance medications and there was a
greater increase in utilization than for other
groups. Subsequent study also showed this age
group also experienced a great deal of
prescription switching due to the large amount of
side effects encountered by the large number of
elderly people taking multiple prescriptions.
Some additional conclusions you can pass on
to your legislators are:
1. The more mail order was used, the higher
was additional cost of the plan due to
increased volumes of prescriptions
dispensed.
2. The mail order plans studied included both
90 and 1 80 day dispensing limitations. The
180 day maximums cost more than the 90
day plans, while the latter cost more than
non-mail order plans.
3. Drastic reductions in mail order ingredient
costs would not compensate for the
increased volumes dispensed.
Drugs Are Pittance
of U.S. Health Bill
Pharmaceuticals and related items accounted
for only 6.7 percent of the nation's health-care
bill in 1 985, according to figures compiled by the
Health Care Financing Administration.
HCFA statistics show that $28.5 billion of the
nation's $425 billion medical bill went for
prescription drugs, over-the-counter drugs and
other medical sundries purchased by consumers,
insurance plans and government programs.
In recent years, drugs and sundries have
accounted for less and less of the health-care
dollar. In 1960, they represented 13.7 percent of
total costs, while by 1980, they had dropped to
just 7.5 percent.
In 1985, consumers spent $21.7 billion on
drugs and related items, 77 percent of the total.
Insurance companies spent $4 billion, or 14
percent, while the government paid for the
remainder, $2.7 billion, or around 10 percent.
While about one-third of the nation's total
medical bill was channeled through private
insurance plans last year, consumers paid 28
percent of the total health-care bill, down from
29 percent in 1984.
The HCFA figures also indicate — to no one's
surprise — that federal spending for health care is
growing. Washington used 12.6 percent of its
entire budget for medical care last year. HCFA,
which administers the Medicare and Medicaid
programs, accounted for 22 percent of all
spending for health care in the United States.
February, 1987
THE CAROLINA JOURNAL OF PHARMACY
NARD LAUNCHES RX
EXPO '87
- Expanding on four consecutive years of
successful NARD Home Health Care Con-
ferences, the National Association of Retail
Druggists has announced that an exciting new
mid-year meeting — RxExpo — will be held
April 29-May 2, 1987 in New Orleans.
In addition to the in-depth programming on
home health care that has made NARD's Home
Health Care Conferences such huge successes in
years past, Rx Expo will offer attendees seminars
and workshops on a wide variety of disciplines
covering both the business and professional
practice of pharmacy.
Participants will be able to register for
educational tracks covering home health care and
long-term care, financial management, clinical
pharmacy, multiple locations pharmacy
ownership, and professional pharmacy manage-
ment. NARD's Geriatric Certificate Program,
unveiled at NARD's 1986 annual meeting in
Louisville, will be offered again during Rx Expo.
In addition, NARD has selected Rx Expo to
introduce an all-new program that offers
pharmacists a certificate in counseling ostomy
and incontinence patients. Rx Expo will also
serve as the site of NARD's 1987 PSAO
Conference, following up on the asociation's
much talked about First Annual PSAO
Conference held last May.
NARD's home health care trade exposition
will also be a part of Rx Expo '87, but this year
the exposition will be greatly expanded to also
include nonprescription drugs, health and beauty
aids, and general merchandise. NARD expects a
strong turnout of independent retail pharmacists
for Rx Expo's expanded program offerings — all
held in beautiful New Orleans — which means
this will be an important marketing opportunity
for exhibitors of home health care products, OTC
drugs, sundries, and the wide variety of other
products sold in independent pharmacies.
Promotion to exhibitors has already begun,
and registration information will be distributed to
the nation's independent retail pharmacists
during December as part of an aggressive
promotional campaign for Rx Expo '87.
CONGRATULATIONS TO
DEAN BRYAN
On the opening of his new store, Bryan Clinic Pharmacy,
Tarboro. We enjoyed being a part of the planning and
completion of this new store.
H. Warren Spear R. Ph.
Pharmacy Design Specialist
Route 4, Box 376AA
Statesville, North Carolina 28677
(704)876-4153
Spear Associates — planners, de-
signers and installers of pharmacy
fixtures & equipment
February, 1987
THE CAROLINA JOURNAL OF PHARMACY
19
STATE BOARD OF
PHARMACY
Members — W. R. Adams, Jr., Wilson; Harold V. Day, Spruce Pine; W. Whitaker Moose,
Mount Pleasant; W. H. Randall, Lllllngton; Evelyn P. Lloyd, Hillsborough; Joseph R. Roberts,
III, Gastonla; David R. Work, Executive Director, P. O. Box H, Carrboro, NC 27510
Telephone #(919) 942-4454
PERMITS ISSUED
Carlton Pharmacy
403 Fairview St.
Clinton, NC
Wm. Bruce Carlton, Jr., ph-mgr.
Issued 12/1/86
Rite Aid Discount Phcy.
Rt. 4, Hwy. 301
Four Oaks, NC
Wm. H. Lee, Jr., ph-mgr.
Issued 12/1/86
Superx Drugs
500 Randolph Mall, Hwy. 64E
Asheboro, NC
Livvie Vann, ph-mgr.
Issued 12/8/86 (T/O)
Superx Drugs
Watauga Village S/C
Boone, NC
Guy Lester Rippy, ph-mgr.
Issued 12/8/86 (T/O)
Superx Drugs
520 Church St.
Burlington, NC
Renee Taylor Lawson, ph-mgr.
Issued 12/8/86 (T/O)
Superx Drugs
2954 Church St. S.
Burlington, NC
Robert Wivagg, ph-mgr.
Issued 12/8/86 (T/O)
Superx Drugs
4007 W. Wendover Ave.
Greensboro, NC
Susan Apple, ph-mgr.
Issued 12/8/86 (T/O)
Superx Drugs
141 Greensboro Rd.
High Point, NC
Dewey Jordan, ph-mgr.
Issued 12/8/86 (T/O)
Superx Drugs
21 16 Roosevelt Blvd. W.
Monroe, NC
John Gregory Sligar, ph-mgr.
Issued 12/8/86 (T/O)
Superx Drugs
2001-2 Dixon Blvd. E
Shelby, NC
Allen Derrick Putnam, ph-mgr.
Issued 12/8/86 (T/O)
Superx Drugs
1410 US Hwy. 421(B)
Wilkesboro, NC
Rosemarie Zadlo, ph-mgr.
Issued 12/8/86 (T/O)
Superx Drugs
2810 University Pkwy.
Winston-Salem, NC
Deborah Cranfill, ph-mgr.
Issued 12/8/86 (T/O)
Superx Drugs
222 1 Cloverdale Ave.
Winston-Salem, NC
Larry Pope, ph-mgr.
Issued 12/8/86 (T/O)
Sloop Memorial Hospital Phcy.
P.O. Box 220
Crossnore, NC
Mary Katherine Phillips, ph-mgr.
Issued 12/12/86 (T/O)
(Con't)
February, 1987
Behind every good computer,
stands an even better employee*
The home office and warehouse of
Lawrence Pharmaceuticals are
models of automated efficiency.
Orders are received
electronically. Shelf labels, shipping
documents and invoices are quickly
prepared even as shipments are
being filled. Mechanized conveyor
systems smoothly carry products
from receiving to bulk storage to
order filling to shipping.
Everything runs with quiet
precision. Why then does Lawrence
need over 200 employees?
Because Lawrence still is a
people business. Computers can't
call on customers or help
pharmacists arrange their shelves
for better sales. Computers can't
prepare advertising programs for
participating members of True
Pharmacy. Computers can't
introduce new products or answer
questions when you call on
the phone.
Computers are invaluable in
much that we do. But when all of the
microchips are on the table, people
are still what we're all about. At
Lawrence we never forget that.
A FoxMeyer Company f***
^JLawrenee.^
rliariiKHH'iilH'aLs
6100 Phillips Highway • Post Office Box 5386
Jacksonville, Florida 32207-0386 • (904)731-4610
THE CAROLINA JOURNAL OF PHARMACY
21
BOARD OF PHARMACY
Continued from page 19
Mercy Hospital South Phcy.
10628 Park Rd.
Charlotte, NC
Kae A. Myers, ph-mgr.
Issued 12/15/86
Revco Discount Drug Center
807 East Roosevelt Blvd.
Monroe, NC
Donald G. Cameron, ph-mgr.
Issued 12/15/86
Kaiser Permanente Pediatric Phcy.
4505 Fair Meadows Ln., Suite 202
Raleigh, NC
Dawn Conti, ph-mgr.
Issued 12/17/86
Brown Drug Co., Inc.
102 S. Main St.
China Grove, NC
Gregory K. Bower, ph-mgr.
Issued 12/18/86 (T/O)
Crown Drugs, Inc.
New Market Plaza, 940 S. Main St.
Kernersville, NC
Barry Southern, ph-mgr.
Issued 1/5/87
Crisis Control Ministry, Inc. Phcy.
200 E. Tenth St.
Winston-Salem, NC
Albert Bruno, ph-mgr.
Issued 1/5/87 (LSP)
Kerr Drug Stores, Inc.
Northwoods Mkt., 945 N. Harrison Ave.
Cary, NC
Amy D. Boyce, ph-mgr.
Issued 1/5/87
Revco Discount Drug Ctr.
SEC Hanes Mall Blvd., The Pavilions at
Highland Oaks
Winston-Salem, NC
John R. Setzer, ph-mgr.
Issued 1/5/87
Kerr Drug Stores
Greystone Village, 7713-55 Leadmine Rd.
Raleigh, NC
Doris R. Clinkinbeard, ph-mgr.
Issued 1/6/87
Franklin Memorial Hosp.
North Main St.
Louisburg, NC
Joseph Sanzone, ph-mgr.
Issued 1/9/87 (T/O)
Skyland Phcy., Inc.
Hendersonville Rd.
Skyland, NC
Quay Harrison Beck, Jr., ph-mgr.
Issued 1/9/87 (T/O)
Allred Family Phcy.
2221 South 17th St.
Wilmington, NC
Michael L. Allred, ph-mgr.
Issued 1/9/87 (T/O)
Bryan Clinic Phcy.
101 Clinic Dr.
Tarboro, NC
Wendy W. Harrell, ph-mgr.
Issued 1/15/87 (T/O)
Gowan Drug Co.
124 Norwood St.
Wallace, NC
Wm. W. Richards, ph-mgr.
Issued 1/16/87 (T/O)
Johnson Drug Co., Inc.
714 New Bridge St.
Jacksonville, NC
Larry E. Denning, ph-mgr.
Issued 1/16/87 (T/O)
King's Pharmacy
107 Valley River
Murphy, NC
Dennis Woodcox, ph-mgr.
Issued 1/16/87 (T/O)
Jarvis Discount Drug
906 Connelly Springs Rd.
Lenoir, NC
R. Mack Jarvis, III, ph-mgr.
Issued 1/16/87 (T/O)
Parsons Bias, Inc.
100 S.Green St.
Wadesboro, NC
Thomas F. Taylor, ph-mgr.
Issued 1/16/87 (T/O)
Continued on page 34
February, 1987
We're not
^Y! strangers...
LUasninpcon
national
INSURANCE COMPANY
NCPhA-Endorsed Insurance Plans
Which Merit Member Participation
DISABILITY INCOME PLAN HOSPITAL INCOME PLAN
MAJOR MEDICAL EXPENSE PLAN TERM LIFE PLAN
RETIREMENT AND PROFIT SHARING PLANS
FOR DETAILS WRITE OR TELEPHONE:
HOYT W. SHORE, CLU and Associates
821 Baxter Street-Suite 316
O
Charlotte, North Carolina 28202
Telephone (704) 333-3764
UUasninqton
national
INSURANCE COMPANY
Evanston, Illinois 60201 • A Washington National Corporation Financial Service Company
THE CAROLINA JOURNAL OF PHARMACY
23
CORRESPONDENCE COURSE
ADVISING CONSUMERS ON
OTC EYE PREPARATIONS PART III: CONTACT LENSES
by J. Richard Wuest, R.Ph., Pharm.D.
Professor of Clinical Pharmacy
University of Cincinnati, Cincinnati, OH
and
Thomas A. Gossel, R.Ph., Ph.D.
Professor of Pharmacology and Toxicology
Ohio Northern University, Ada, OH
Goals
The goals of this lesson are to:
1 . discuss ocular problems that can be corrected
by wearing contact lenses;
2. compare contacts and spectacles, and hard
and soft contact lenses.
Objectives
At the completion of this lesson, the successful
participant will be able to:
1 . list the advantages and disadvantages of hard
and soft contact lenses;
2. counsel the consumer on proper contact lens
wear and care.
This is the third lesson in a series of articles on
OTC eye care products. In the first two articles,
the function of the eye and the proper use of OTC
eye preparations were reviewed. In this lesson,
we will discuss the background of contact lens
solutions beginning with contact lenses
themselves. Contact lens solutions and care
products will be described in the following lesson.
The marketplace for contact lenses and
solutions has become quite extensive. It is
estimated that Americans currently spend in
excess of $300,000,000 yearly on contact lenses
and their care, half of which is spent on contact
lens solutions. This figure is up over 50 percent
from 1979. However, it is also reported that less
than 60 percent of the total contact lens solution
market is based on pharmacy sales. Since more
than half of the approximately 15,000,000
contact lens wearers have soft lenses, and they
spend $75.00 a year on the average for their
solutions, the implications of providing a full line
of products and counseling becomes quite
evident.
Historical Background
Because there are major differences between
the types of materials used in the manufacture of
contact lenses and the types of solutions needed
to care for each, we will first review the lenses
themselves.
Even though the increased use of contact
lenses is a recent phenomenon (approximately
one-half of Americans need some type of eye
correction and an increasing percentage of them
now wear contacts), the concept is not new.
Contact lens technology goes back to Leonardo
da Vinci in the early 1500's. He theorized that
emerging one's head in a large glass bowl of water
could correct impaired vision. It is interesting to
note that hundreds of years before the retina and
its function were discovered, Leonardo drew
pictures of errors in accommodation. It was his
theory that people could not see clearly because
Continued on page 25
in the /of vice
of pharmacy
This continuing education for
Pharmacy article is provided
through a grant from
MERRELL DOW
PHARMACEUTICALS INC.
© Merrell Dow
February, 1987
ALLOW US
TO FILL YOUR
HOME HEALTH CARE
PRESCRIPTIONS!
FOR ALL OF YOUR
HOME HEALTH CARE NEEDS
ALLOW US TO ASSIST YOU
• Leading Industrial Prod-
ucts Available.
• Next Day Delivery on In
Stock Products.
• Discount Programs.
• In Store Visits By Our
Trained Home Health
Services Representatives.
• Phone Assistance By
Qualified Customer Ser-
vice Personnel.
• Product Literature Avail-
able.
• Third Party Reimburse-
ment Information Avail-
able.
• Complete Individualized
and Customized Plan-O-
Gram and Store Set Up.
• C.E.U. Accredited Work-
shops for N.C. Pharmacists.
HOME HEALTH SERVICES OF
CAROLINA SURGICAL SUPPLY
P.O. BOX 31207 • RALEIGH, N.C. 27622 • (919) 782-8400/(800) 662-7767 NC WATTS
SERVING CUSTOMERS OF:
Dr.T.C. Smith Co. / W.H.King Drug
ASHEVILLE. N C 28806 • 704/258 2645
RALEIGH. NC 27622*919/782 8400
THE CAROLINA JOURNAL OF PHARMACY
25
CORRESPONDENCE COURSE
Continued from page 24
the image of the objects they were looking at fell
somewhere in front of or behind the eye. His idea
never caught on possibly because while one can
see better with one's head in a bowl of water, it
makes for difficult breathing.
In the mid-1600's, a German physician
reportedly used a lens to correct a refractory error
by having his patients hold a tube full of water in
front of their eyes. Glass spectacles followed soon
after, but it wasn't until 1823 that someone
suggested taking a mold of the cornea and placing
a glass lens over it to correct vision.
In the late 1800's, an artificial eye maker
manufactured the first glass scleral contact lens.
From then until the 1 930's, the few contact lenses
made were produced by this long and tedious
method of fitting lens after lens until the correct
one was found. They were so heavy that very few
people could tolerate them, especially since the
tear fluids could erode them in about six months.
When plastics became available in the 1930's,
the door for contact lens technology opened. It
was an important breakthrough since a
chemically stable, unbreakable, transparent and
easy to work with lens was possible.
During World War II, an RAF surgeon
noticed that pilots with pieces of shot-out plastic
aircraft windows embedded in their eyes did not
exhibit a foreign particle rejection antibody/
antigen reaction. He and his associates were the
first to develop the external hard contact lens as
well as the artificial lens implant made of plastic.
More recently, soft plastic lenses, gas-
permeable hard lenses, and extended-wear soft
lenses have been developed. Each will be
discussed in turn.
Sales of soft lenses now dominate the
marketplace. It is reported that in 1982, soft
lenses represented 7 1 % of new fittings for contact
lenses, and the percentage is still increasing.
Contact Lenses vs. Spectacles
The answer to the question of which is better is
largely a matter of personal opinion.
Most people who wear contact lenses agree
that they have better and more natural vision
than they do with spectacles. One distinct
advantage of contacts is that however you move
your eyes, you are still looking through the center
of the lens. This does not occur with spectacles
because light is coming through the cornea and
the lens from all the different angles covered by
the spectacle. Therefore, there is less image
distortion with contacts.
Some prefer contact lenses because there are
no frames to block peripheral vision, pinch the
nose, head or ears, slide down a sweaty nose in
warm weather, and fog up when there are
changes in relative humidity. A major reason
people prefer contacts over spectacles is that
contacts are not visible to others.
However, not everyone can wear contacts. It is
reported that there is a 15% rejection rate with
hard lenses, but a much lower rate for the soft
lenses.
Some individuals experience burning and
redness due to the normal response of the eye to a
foreign object. Others experience problems with
excessive blinking which is a normal function of
the eye trying to take care of itself by removing a
foreign object. Others have problems with
excessive tearing which washes the lenses out.
Still others experience problems with the lenses
falling out although this is more common with
hard lenses than with the soft variety.
Some people are bothered by the glare of
fluorescent lights and others develop photo-
phobia. This is reported mainly with hard lenses.
It may be corrected with the use of tinted lenses.
Two other potential problems with contacts
are forgetting to take them out (one rarely does
this more than once because it is quite painful to
leave hard lenses in overnight) and lacking
confidence in inserting and removing them.
Another problem with the hard lenses is spectacle
blur. Some individuals have trouble seeing after
they take their hard contacts out, and the
difficulty is not corrected by the use of their
spectacles. This will be explained more fully later.
Contacts are difficult to wear for persons who
have hay fever, rose fever or other allergies.
Hormonal changes during pregnancy and the use
of oral contraceptives alter the fluid balance of
the cornea and interfere with the wearing. In
some individuals, anticholinergics, antihista-
mines, tricyclic antidepressants, decongestants,
and diuretics decrease tear secretion and interfere
with lens wear. This will be discussed later.
One authority claims that brown eyed
brunettes with dark complexion are the easiest to
fit with contacts, and the best wearers. Green-
eyed, fair-skinned redheads are reported to be the
hardest to fit and are most likely to discontinue
using contacts. There are certainly numerous
exceptions to this rule and the majority of people
fall between these two groups.
Continued on page 26
February, 1987
26
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
Continued from page 25
The overwhelming majority of individuals
who wear contacts prefer them over spectacles
and would not go back to wearing glasses.
What Ocular Problems Do
Contacts Correct?
The four major types of eye refractory errors
were discussed in the first lesson of this series. To
quickly review, hyperopia (farsightedness) is a
refractive problem with the crystalline lens
resulting from images being focused behind the
retina. Myopia (nearsightedness) is the direct
opposite in that the focal point of vision is in front
of the retina. Either of these conditions may be
corrected by hard or soft contact lenses.
Astigmatism is a condition in which the
cornea does not have a perfectly spherical shape.
Therefore, light rays entering through it are
distorted. The less spherical the cornea is, the
more blurred the vision. Since hard lenses are
rigid, they will serve as a new sphere. Hard lenses
can be used to correct nearly all degrees of
astigmatism.
Soft lenses are flexible and cannot correct all
astigmatisms. Until recently, they were rarely
effective in correcting this condition. However,
newer "toric" lenses are now available. There are
two types of corrective curves, one for correcting
nearsightedness or farsightedness, and another
called a cylinder correction that takes care of the
astigmatism. This form must be custom-made
and is quite expensive.
Presbyopia (literally, "old vision") is a
condition that requires bifocals. As we age, our
lenses become stiffer and it becomes more
difficult to focus on close-up objects. Presbyopia
invariably results in the need for reading glasses.
If the person is already nearsighted, bifocals are
necessary with the upper portion used to correct
distant vision and the lower for close-up vision.
Bifocal hard lenses have been available for
some time. They have two major drawbacks.
First, their fitting must be customized, a
procedure which is long, arduous, and expensive.
THE EXPERIENCE WE VE GAINED FROM
OVER 200 PHARMACY INSTALLATIONS IS
AVAILABLE TO YOU . . .
AND, WE ARE THE ONLY STOCKING
DISTRIBUTOR OF DRUG STORE FIXTURES IN
THE CAROLINAS.
IF YOU NEED A SINGLE FIXTURE OR A
COMPLETE STORE, OUR PROFESSIONAL
STAFF IS READY TO SERVE YOU. . . .
"THE AREAS LARGEST DISTRIBUTOR OF
MODULAR DISPLAY FIXTURES"
RICHMOND, VIRGINIA CHARLOTTE, NORTH CAROLINA
7921 -A WEST BROAD ST. 3555 TRYCLAN DRIVE
(804) 740-0793 (704) 525-5300
TOM MARTIN ROLAND THOMAS RANDY BIVENS
"WE ARE MORE THAN A FIXTURE COMPANY— A TEAM OF PHARMACY
SPECIALISTS WITH OVER 60 YEARS COMBINED EXPERIENCE IN OVER
500 DRUG STORES"
0'l'«'luiO« or
5?
STORE FIXTURES
& PLANNING. INC.
mrons rucTumew
February, 1987
THE CAROLINA JOURNAL OF PHARMACY
27
The second problem is that the up and down
movement of the lens can be troublesome. When
the person readjusts to the image, the distance
changes and the object goes in and out of focus.
However, some individuals wearing bifocal
spectacles have the same problem.
The authors have a friends who wears trifocals.
One day we asked, "How in the world can you
see through those?" He said that he just moves his
head up and down and whatever looks best, that's
what he pays attention to.
There are two other solutions for correcting
presbyopia without others knowing that you
need bifocals. One is to wear contacts for far
vision and half-glasses for reading.
Another concept that requires a great deal of
motivation is based on the fact that bilateral
organs have a dominant side. For example, some
people are right-handed while others are left-
handed. The same is true for vision. With
monovision, the individual wears a lens on the
dominant eye for far vision, and a different lens
with a refractory power on the other eye for near
vision. In a few weeks, the person learns to look
at far away objects with one eye and to read close
up with the other lens.
One major problem with monovision is that
depth perception is difficult. Those who use this
system (including a recent ex-president and
renown network news anchorman) have two
lenses available for the non-dominant eye. When
good depth perception is needed, they remove the
near vision lens and replace it with the one for
distance.
Soft lenses are also used for correcting several
other disorders. These include corneal dystrophy,
keratitis (inflammation of the cornea), corneal
ulcers, severely dry eyes and post-surgical
healing.
Hard Contact Lenses
Hard contact lenses are manufactured from a
plastic called polymethylmethacrylate (PMM A).
It is a material quite similar to Plexiglas® and
Lucite®. Hard lenses retain their shape in or out
of the eye, and they take on very little water.
The term "contact" lens is really a misnomer
for hard lenses because they do not actually make
contact with the eye. Hard lenses and the cornea
are hydrophobic so the lens floats on a layer of
lacrimal and ocular secretions over the top of the
cornea without touching it. A major difference
between hard and soft lenses is that the former
can be no larger than the cornea. If they were
larger, there would be inadequate transfer of
fluids between the cornea and the lens, and
inadequate oxygen to the cornea.
The cornea is unique in that it is not directly
supplied with blood vessels. Therefore, the
cornea does not receive oxygen directly from the
blood; instead it is nourished by the aqueous
humor, various other tear secretions, and to a
small extent, from the atmosphere.
Hard lenses block out oxygen that normally
enters the cornea osmotically from the air.
Therefore, when they are worn, the cornea must
rely on tear flow. The eyelid accomplishes this in
two ways. First, each time the eyelids close, they
press down slightly on the contact and force out
the "old tears" that were underneath. When the
eyelids open, the contact rises slightly and pumps
in "newer" tears.
Second, the lids cause the contact to rotate,
reportedly one full rotation every six to ten
blinks. This "whirlpool" action brings in more
tears. Individuals who wear contacts must blink
at least five times a minute to provide adequate
oxygen and to lubricate the eye.
In summary, the hard lens is a tough, acrylic
disc, smaller than the cornea, that is hydrophobic
(water-repellant). Soft lenses are flexible discs
that are larger than the cornea and are
hydrophilic (water-seeking).
Soft Contact Lenses
There are several kinds of soft contact lenses
made from a variety of chemicals. One of the
more commonly used plastics is hydroxyethyl-
methacrylate (HEMA).
Soft lenses are flexible, absorb water, and
conform to the shape of the eye. Many of them
have a water content exceeding 50 percent.
Earlier, we related the hard lenses to Plexiglas™
and Lucite™. Soft lenses are more like Saran
Wrap™ or Handiwrap™.
Soft lenses adhere directly to the cornea
through hydrophilic capillary attraction. They
must be larger than the cornea and fit slightly
underneath each eyelid. If they were smaller than
the cornea, the lenses could fall out with one
blink.
Soft lenses are manufactured in a manner
similar to hard lenses. They are lathe cut from
polymer buttons, molded into a spherical shape,
and hydrated in hot saline solution for several
days. In this procedure, they swell to the proper
size and impurities are extracted. To maintain
Continued on page 28
February, 1987
28
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
Continued from page 27
their shape, soft lenses must always be kept in an
isotonic solution, both before and after fitting.
Another major difference between hard lenses
and soft lenses is that the former must be form-
fitted to each individual's corneal shape. This
may require several days. Although soft lenses
differ in their refractory power, "a few sizes fit
all." Once the refractory power is determined,
soft lenses can be selected off the shelf and fitted
into the eye immediately.
As stated earlier, soft lenses must be hydrated
at all times and stored in an isotonic solution. If
the solution is hypotonic, the lens will swell. If it is
hypertonic, the lens will shrink. In either instance,
they will be less comfortable on the eye. The pH
is a factor for some lenses because certain plastic
polymers will shrink if the pH is below 6 and
swell if it is above 6.
Because they contain many hydroxyl,
carboxyl and lactam groups, all of which are
chemically reactive, soft lenses can be ruined by
absorbing chemicals. Therefore, it is unwise to
self-medicate with eye drops not specifically
labeled for use with soft contact lenses. In many
instances, both the preservatives and the active
ingredients will bind with the soft plastic
material. This is especially true of epinephrine
and phenylephrine which can actually turn the
lenses brown.
The irrigation and soaking solutions for soft
lenses contain a low concentration of
preservatives. If they are soaked in the more
concentrated solutions used for hard lenses, soft
lenses can take up the preservative and release it
into the eye leading to irritation.
The water in soft lenses can evaporate if the
lenses are left out of solution for any length of
time. If they become dry, they can be ruined.
Rehydrating a dry lens is difficult, and the
individual must closely follow the manufacturer's
instructions.
The water content in soft lenses can also
evaporate in excessively low relative humidity,
when there is inadequate tear production, under
the hair dryer, in high winds, or in dry climates.
When the lenses begin to dry, they shrink and
tighten on the cornea, thereby irritating the eye
and causing blurred vision.
Hard Lenses vs. Soft Lenses
There are pros and cons for both hard and soft
lenses. They are compared in Table 1 .
Those who prefer hard contact lenses claim
that they are less expensive, more durable, easier
to get in and out, and easier to take care of. In
most instances, soft lenses are more expensive
than the hard ones. The average life of a soft lens
is one and one-half to two years (they tear easily),
whereas hard lenses may last twenty to thirty
years. The daily care of soft lenses is more time
consuming, and the solutions more expensive
than those for the hard variety.
Proponents for soft lenses counter these claims
by stating that the softs are easier to fit, are more
comfortable, and allow for better peripheral
vision. They can also be worn "on and off' and
do not cause spectacle blur.
TABLE 1
Differentiation of Hard and Soft
Contact Lenses
Hard Soft
Composition
tough, acrylic disc flexible disc
smaller than cornea larger than cornea
hydrophobic hydrophilic
Indications
astigmatism aphakia
color blindness astigmatism
farsightedness eye bandage
nearsightedness farsightedness
nearsightedness
Advantages
easier to get in and out easier to get used to
easier to take care of more comfortable
more durable can wear "off and on"
tintable no spectacle blur
less expensive better peripheral vision
easier to fit
Disadvantages
take longer to break in takes longer to care for
pop out more easily more expensive
don't always follow cannot be marked right
eye movement or left
become scratched and absorb chemicals
warped
Solutions
wetting
cleaning
cleaning
disinfecting
soaking
chemical
lubricating
thermal
combinations
lubricant
Wearing soft lenses "on and ofF' means that
the wearer does not have to readjust if they aren't
February, 1987
THE CAROLINA JOURNAL OF PHARMACY
29
worn for awhile. This is not true for hard lenses.
After being properly fitted, a hard contact lens
wearer must gradually increase wearing time
over a period of days until he can tolerate them
for ten to twelve hours per day. Generally they
can be worn four hours the first day, and wearing
time can be increased an hour a day thereafter.
Hard lenses cannot be worn overnight as stated
earlier. Even though well-fitted hard lenses serve
as a pump for tears and each blink of the eyelid
brings in new tear fluid that is rich in oxygen, they
cannot accomplish this indefinitely. After several
hours, the amount of available oxygen for the
corneal cells is diminished somewhat and the
cells begin to swell. This leads to corneal edema
which makes the contact uncomfortable. Highly
motivated individuals can manage this. Others
cannot.
A bothersome effect for some hard lens
wearers is spectacle blur. This is a blurred, hazy
vision due to swollen cells in the cornea after a
number of hours of lens wear. In some
individuals, it takes awhile (sometimes
overnight) for eyesight to return to normal. For
these individuals, the wearing of regular
spectacles does not correct the problem. If hard
lenses are worn throughout the day, it is difficult
to watch television with spectacles.
Even though hard lenses pop out more readily
than soft lenses, they are easier to find, clean, and
replace into the eye. Hard lenses can be marked
"right" or "left," whereas soft lenses cannot be so
designated. The hard lens for the right eye has a
small black dot that does not interfere with
vision. If soft lenses get mixed up, it is difficult to
determine which is for the right eye and which is
for the left.
Gas-permeable and
Extended-wear Lenses
An indepth discussion of these lenses is beyond
the scope of this article. Basically they differ from
hard and soft lenses in that they can be worn
longer.
The gas-permeable lenses are similar to hard
lenses since they are about the same size, but they
are more flexible. Their major advantage is that
they allow the transfer of oxygen freely from
either side of the lens to the other. They are
composed of a plastic called cellulose acetate
butyrate (CAB), or a combination of PMMA and
silicone.
Gas-permeable lenses are just as durable as
hard lenses, but more wetable. They are
especially suited for those who cannot tolerate
the standard hard lenses but have a vision
problem that is not corrected by soft lenses.
The extended-wear lenses represent a more
recent development. They are made of varying
copolymers of HEMA and other hydrophilic
plastics. Most of them consist of a three-
dimensional network of copolymer chains joined
together by cross-links of chemical bonds. They
find extensive use in persons who have had
cataracts removed.
Cataracts are more than simply a film that
forms over the eye. The crystalline lens is
normally transparent. But with age, illness or
injury, the lens develops areas of opacity due to
precipitation of foreign materials within the lens.
This leads to a cloudiness in vision because it
blocks light from reaching the retina.
Cataracts can be removed surgically to restore
eyesight. The term aphakia refers to the absence
of the lens of the eye. If enough is removed,
however, it becomes extremely difficult to see
close-up. There are three procedures to correct
vision after cataract removal: wearing thick,
heavy, uncomfortable glasses, having an artificial
lens implanted, and wearing contact lenses.
While there is some controversy on the
subject, the artificial lens implant, barring
complications, is often best because it allows full
correction of vision when used with regular
glasses. In this procedure, the natural lens is
replaced with a plastic implant. It is much more
convenient to care for than contacts. Critics say
the procedure is too risky and if the lens is
defective or becomes contaminated, the patient
must return to surgery. However, the FDA
Advisory Panel on Ophthalmologicals has stated
that the benefits of the artificial lens implant
exceed the risks.
The third method for restoring eyesight after
lens removal is wearing extended-wear contacts.
It is claimed that they provide vision equal to an
artificial lens. If anything goes wrong, the contact
lenses can be removed. The biggest disadvantage
is that the patient's close-up vision may be so bad
that he cannot see well enough to insert or
remove the contact lenses.
Elderly people have even more problems with
contact lenses due to loss of manual dexterity.
Extended-wear soft lenses are beneficial because
they only need to be removed and cleaned every
two weeks or even less frequently. A list of "do's
Continued on page 30
February, 1987
30
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
Continued from page 29
and don'ts" for the care and wear of various types
of contact lenses is presented in Table 2.
TABLE 2
Do's and Don'ts for Contact Lens Care
and Wear
I. Do's
Wash and rinse hands thoroughly before
handling lenses.
Follow recommended procedures for lens
hygiene daily.
Adhere to your practitioner's instructions
and wearing schedules.
Avoid harmful and irritating vapors and
fumes.
Use extreme care when inserting or
removing lenses to avoid scratching the eye
with the lens or fingernail.
Always work with one lens first to avoid
mix-up.
Keep lenses and storage case clean at all
times.
Wear quality nonprescription sunglasses
outdoors.
Contact your eye specialist immediately if
you have difficulty.
Tell your other doctors that you wear
contact lenses.
Have eyes and lenses checked periodically.
Tell your doctor before using medications in
the eye.
II. Don'ts
Scrape lenses over any hard or rough
surfaces.
Allow soft lenses to dry out.
Expose lenses to extreme heat.
Swim with lenses in.
Rub lenses with cloth, tissues, cotton, or
paper lens cleaners.
Try to pick up lenses with tweezers or any
other utensil.
Clean lenses with household detergents,
chemicals or cleaning fluids.
Use saliva to wet lenses.
Lean over an open sink while inserting or
removing lenses.
Sleep with contact lenses on the eyes.
Rub eyes or eyelids while wearing contact
lenses.
Use aerosol products such as hair sprays
when wearing lenses.
III. If You Notice These:
• eyes sting, burn or itch (irritation)
• comfort is less than when lens was first
placed on your eye
• feeling of something in the eye (foreign
body, scratched area)
• excessive watering (tearing) of the eyes
• unusual eye secretions
• redness of the eyes
• reduced sharpness of vision (poor visual
acuity)
• blurred vision, rainbows, or halos around
objects
• sensitivity to light (photophobia)
• dry eyes
Do This:
• Remove your lenses.
• If the discomfort or problem stops, then look
closely at the lens.
• If the lens is damaged, DO NOT put the
lens back on your eye. Place the lens in the
storage case and contact your eye care
practitioner.
• If the lens has dirt, an eyelash, or other
foreign body on it, or the problem stops and
the lens appears undamaged, thoroughly
clean, rinse, and disinfect the lens; then
reinsert it.
• If the problem continues, DO NOT put the
lens back on your eye but IMMEDIATELY
consult your eye care practitioner.
Remember the "Day
...in^'ctures
COLORCRAFT
North Carolina's Most Complete
Film Processing Service
There Is A Plant Located
Near You
For the Finest Quality Plus Fast
Dependable Service on All Your
Photo Needs, Contact the Plant
Nearest You.
CHARLOTTE WILMINGTON
KERNERSVILLE RALEIGH
FAYETTEVILLE DURHAM
If You Don't Know Photofinishing
Know Your Photographer
February, 1987
THE CAROLINA JOURNAL OF PHARMACY
31
DICKINSONS PHARMACY
by Jim Dickinson
Winning against mail-order. It can be done. In
Alabama, pharmacists have wrested a B.F.
Goodrich employee benefits prescription
contract away from a mail-order operation.
To do it, they used a small, wholesaler-
operated local pharmacy service administrative
organization (PSAO) that includes chain drug
stores — Walker Drug's United Pharmacy
Services, Inc.
It was a winning tactic, because something else
was going for them as well: beneficiary
dissatisfaction.
Benefits managers and third-party programs
are slowly confronting this powerful new
ingredient all across the country. Sometimes
labeled "quality of care," it's being recognized as
the ultimate cost-containment device, and
handled correctly by pharmacy, it could be the
retail profession's biggest healer.
By combining beneficiary dissatisfaction with
a positive, patient-oriented determination, and
focusing on programs that have adopted the mail-
order option, the Alabama experience shows that
retail pharmacies can win that lost business back
when the contract comes up for renewal.
Indeed, in a perverse kind of way, if we can all
hang in there long enough, mail-order options
may be doing retail pharmacy a big favor —
they're providing the long-suffering public with
an uncomfortable "bench mark" against which
regular pharmacy service and convenience can be
measured with a sigh of relief!
It's a human frailty that we don't appreciate
what we've got until it's gone.
At the same time, that frailty is providing
lessons for the health bureaucracy, both private
and public.
This past December, federal Health Care
Financing (Medicare/Medicaid) Administrator
William L. Roper, M.D., informed the annual
Food & Drug Law Institute education
conference of a radical new strategy he's adopted
for Medicare: Quality of care!
As noted in this column previously, private-
sector studies have been predicting that health
managers would come to realize that quality of
care is the optimum form of cost-containment.
Now Dr. Roper tells Washington health-drug
lawyers at their annual meeting that he wants "to
further improve the quality of care under the
Medicare and Medicaid programs" by
developing a better measure of quality, a
measurable outcome. HCFA, he said, now wants
February, 1987
to know: Does the patient get better over time?
What stronger indicator could you want that
the cost-containment juggernaut is evolving to a
new, intelligent level of sophistication — a level
that cannot be attained by mail-order
prescriptions?
Being careful not to alarm and alienate the old
folk who feel they get good service from AARP
pharmacies, the time is now ripe for pharmacy to
pound away with its favorite message in the
employee benefit arena, cautioning against out-
of-state, anti-quality, bargain-basement prescrip-
tions for employees.
The distinction is tactically valid if you're
prepared to separate chronic maintenance
therapy for house-bound old people from all
other pharmaceutical care.
Ask your local employers if they really want
their employee benefits package to take money
and jobs out of your community and state.
Ask them what happens if their employee
forgets to get the prescription refilled just before a
holiday or weekend, or when they're going out of
town on business?
Ask what happens if the mail-order pharmacy
makes a mistake, and accidentally sends the
wrong prescription, or if the postal service delays
or loses the package?
Ask what happens if the employee develops an
unexpected sensitivity to the drug, and has to be
quickly switched to something else?
Ask how much absenteeism they can afford
when illnesses result from erroneous treatments
that local pharmacists can't help prevent or
correct.
The time has never been better to ask such
questions — and to keep on asking them.
This feature is presented on a grant from G.D. Searle &
Co. in the interests of promoting the open discussion of
professional issues in pharmacy. G.D. Searle & Co.,
accepts no responsibility for the views expressed herein
as they are those of the author and not necessarily those
of G.D. Searle & Co.
Jim Dickinson is President of Ferdic, Inc. a West
Virginia service corporation he owns with his wife.
Formerly associated with Drug Topics magazine, he is
widely read worldwide in health related publications.
Dickinson worked as special consultant to NARD, was
managing editor of the weekly Green Sheet and senior
editor of the weekly Pink Sheet, and has been
associated with the American Pharmaceutical
Association.
INTRODUCING
NEW
ONCE-DAILY
ISOPTIN
(verapamil HCI/Knoll)
240 mg scored sustained-release tablets for hypertension
• Only calcium channel
blocker available in SR
form for once-a-ciay
fherapy
• New SR dosage form
allows greater patient
compliance
• Well documented safety
profile
• In mild to moderate
essential hypertension, a
more logical therapeutic
choice than beta
blockers or diuretics
ISOPTINi
(verapamil HG '
240 mg
SUSTAiNEO-RELEASE TABLETS
Caution Federal lew prohibits dispensing
Whoul prescription.
A product of Knoll Research
, New Jersey 07981
A
• Economically packaged
in bottles of 100 tablets
• Liberal return-goods
policy
Supported by a
comprehensive
promotional
program, including:
• Extensive detailing
• Journal advertising
• Direct mail to
high-volume prescriPers
Order today from your
wholesaler
BASF Group lalOll
Serving the pharmacy profession for more than 80 years
Please see next page for brief summary.
s 1986 BASF K&F Corporation
2454B-11-86
NEW. . . ONCE DAILY Br,ef Summary
i IN MILD TO MODERATE
HYPERTENSION
ISOPTIIf-SR
(verapamil HCI/Knoll)
240 mg scored, sustained-release tablets
CONTRAINDICATIONS: 1) Severe left ventricular dysfunction (see WARNINGS), 2) Hypotension (less than 90 mmHg systolic pressure) or cardiogenic
shock, 3) Sick sinus syndrome or 2nd or 3rd degree AV block (except in patients with a functioning artificial ventricular pacemaker),
WARNINGS: Heart Failure: ISOPTIN should be avoided in patients with severe left ventricular dysfunction (see DRUG INTERACTIONS). Patients with
milder ventricular dysfunction should, if possible, be controlled before verapamil treatment Hypotension: ISOPTIN (verapamil HCI) may produce
occasional symptomatic hypotension. Elevated Liver Enzymes: Elevations of transaminases with and without concomitant elevations in alkaline
phosphatase and bilirubin have been reported Periodic monitoring of liver function in patients receiving verapamil is therefore prudent Accessory
Bypass Tract (Wolff-Parkinson-White): Patients with paroxysmal and/or chronic atrial flutter or atrial fibrillation and a coexisting accessory AV pathway
have developed increased antegrade conduction across the accessory pathway producing a very rapid ventricular response or ventricular fibrillation after
receiving intravenous verapamil While this has not been reported with oral verapamil, it should be considered a potential risk. Treatment is usually
DC. -cardioversion. Atrioventricular Block: The effect of verapamil on AV conduction and the SA node may cause asymptomatic 1st degree AV block and
transient bradycardia. Higher degrees of AV block, while infrequent (0.8%), may require a reduction in dosage or, in rare instances, discontinuation of
verapamil HCI Patients with Hypertrophic Cardiomyopathy (IHSS)' Although verapamil has been used in the therapy of patients with IHSS, severe
cardiovascular decompensation and death have been noted in this patient population
PRECAUTIONS: Impaired Hepatic or Renal Function: Verapamil is highly metabolized by the liver with about 70% of an administered dose excreted in
the urine. In patients with impaired hepatic or renal function verapamil should be administered cautiously and the patients monitored for abnormal
; prolongation of the PR interval or other signs of excessive pharmacological effects (see OVERDOSAGE)
l Drug Interactions: Beta Blockers Concomitant use of ISOPTIN and oral beta-adrenergic blocking agents may be beneficial in certain patients with
chronic stable angina or hypertension, but available information is not sufficient to predict with confidence the effects of concurrent treatment in
patients with left ventricular dysfunction or cardiac conduction abnormalities Digitalis: Clinical use of verapamil in digitalized patients has shown the
combination to be well tolerated if digoxin doses are properly ad|usted However, chronic verapamil treatment increases serum digoxin levels by 50 to
75% during the first week of therapy and this can result in digitalis toxicity Upon discontinuation of ISOPTIN (verapamil HCI), the patient should be
reassessed to avoid underdigitalization. Antihypertensive Agents: Verapamil administered concomitantly with oral antihypertensive agents (e.g.,
vasodilators, angiotensm-convertmg enzyme inhibitors, diuretics, beta blockers, prazosin) will usually have an additive effect on lowering blood
pressure Patients receiving these combinations should be appropriately monitored Disopyramide: Disopyramide should not be administered within 48
hours before or 24 hours after verapamil administration Quinidme: In patients with hypertrophic cardiomyopathy (IHSS). concomitant use of verapamil
and quinidme resulted in significant hypotension There has been a report of increased quinidme levels during verapamil therapy. Nitrates: The
pharmacologic profile of verapamil and nitrates as well as clinical experience suggest beneficial interactions Cimetidine: Two clinical trials have shown a
lack of significant verapamil interaction with cimetidine A third study showed cimetidine reduced verapamil clearance and increased elimination to 1/2,
Anesthetic Agents: Verapamil may potentiate the activity of neuromuscular blocking agents and inhalation anesthetics. Carbamazepine: Verapamil may
increase carbamazepine concentrations during combined therapy. Rifampin: Therapy with rifampin may markedly reduce oral verapamil bioavailability.
Lithium: Verapamil may lower lithium levels in patient on chronic oral lithium therapy Carcinogenesis, Mutagenesis, Impairment of Fertility: There was
no evidence of a carcinogenic potential of verapamil administered to rats for two years Verapamil was not mutagenic in the Ames test Studies in female
rats did not show impaired fertility Effects on male fertility have not been determined Pregnancy (Category C): There are no adequate and well-
controlled studies in pregnant women ISOPTIN crosses the placental barrier and can be detected in umbilical vein blood at delivery This drug should be
used during pregnancy, labor, and delivery, only if clearly needed Nursing Mothers ISOPTIN is excreted in human milk, therefore, nursing should be
discontinued while verapamil is administered Pediatric Use: Safety and efficacy of ISOPTIN in children below the age of 18 years have not been
established.
ADVERSE REACTIONS: Constipation 8.4%. dizziness 3.5%, nausea 2 7%, hypotension 2 5%, edema 2.1%, headache 1.9%, CHF pulmonary edema
1.8%, fatigue 1.7%. bradycardia 1.4%, 3J AV block 0.8%, flushing 0.1%, elevated liver enzymes (see WARNINGS) The following reactions, reported in
less than 10% of patients, occurred under conditions (open trials, marketing experience) where a causal relationship is uncertain, they are mentioned
to alert the physician to a possible relationship angina pectoris, arthralgia and rash, AV block, blurred vision, cerebrovascular accident, chest pain,
claudication, confusion, diarrhea, dry mouth, dyspnea, ecchymosis or bruising, equilibrium disorders, exanthema, gastrointestinal distress, gingival
hyperplasia, gynecomastia, hair loss, hyperkeratosis, impotence, increased urination, insomnia, macules, muscle cramps, myocardial infarction,
palpitations, paresthesia, psychotic symptoms, purpura (vasculitis), shakiness, somnolence, spotty menstruation, sweating, syncope, urticaria
Treatment of Acute Cardiovascular Adverse Reactions Whenever severe hypotension or complete AV block occur following oral administration of
verapamil, the appropriate emergency measures should be applied immediately, eg , intravenously administered isoproterenol HCI, levarterenol
bitartrate, atropine (all in the usual doses), or calcium gluconate (10% solution) If further support is necessary, inotropic agents (dopamine or
dobutamme) may be administered Actual treatment and dosage should depend on the severity and the clinical situation and the ludgment and
experience of the treating physician
OVERDOSAGE: Treatment of overdosage should be supportive Beta-adrenergic stimulation or parenteral administration of calcium solutions may
increase calcium ion flux across the slow channel, and have been used effectively in treatment of deliberate overdosage with verapamil Clinically
significant hypotensive reactions or fixed high degree AV block should be treated with vasopressor agents or cardiac pacing, respectively Asystole
should be handled by the usual measures including cardiopulmonary resuscitation
Knoll Pharmaceuticals
A Unit ol BASF K&F Corporation
Whippany. New Jersey 07981
6.
BASF Group knOll
■ 1986, BASF K&F Corporation 24741186 Printed in U.S.A.
34
THE CAROLINA JOURNAL OF PHARMACY
Board of Pharmacy
Continued from page 21
Medicine Shoppe
707 North Broad St.
Brevard, NC
John A. Boff, ph-mgr.
Issued 1/19/87
Revco Discount Drug Ctr.
2104 Statesville Blvd.
Salisbury, NC
Ronald C. Gobble, ph-mgr.
Issued 1/19/87
West Durham Drug
4709 Hillsborough Rd.
Durham, NC
Jeffrey Stillwagon, ph-mgr.
Issued 1/19/87
Beulaville Drug Co.
203 N. Jackson St.
Beulaville, NC
Roy Hoyt, ph-mgr.
Issued 1/23/87 (T/O)
Kroger Pharmacy
3508 High Point Rd.
Greensboro, NC
Hoover H. Hillard, Jr., ph-mgr.
Issued 1/28/87 (T/O)
Arbor Drugs, Inc.
2001 East 7th St.
Charlotte, NC
David Rizzi, ph-mgr.
Issued 2/2/87
Service Medical
The Mac-Lewis Blvd.
129 E. 3rd Ave.
Red Springs, NC
Thomas D'Andrea, ph-mgr.
Issued 2/2/87 (LSP)
Wal-Mart Phcy.
Suite 165/ White Oak Plaza
1175 Hwy. 74 Bypass
Spindale, NC
Mary S. Shaffer, ph-mgr.
Issued 2/2/87
Pharmacy Plus of New Bern
1204 S. Glenburnie Rd.
New Bern, NC
C. Stroud Tilley, III, ph-mgr.
Issued 2/3/87
Bunn Community Health Ctr. Phcy.
Main St.
Bunn, NC
Herbert P. Scoggin, ph-mgr.
Issued 2/9/87 (T/O)
ECKEL ELECTED TO
BOARD OF CHRISTIAN
PHARMACISTS FELLOWSHIP
INTERNATIONAL
Frederick M. Eckel, Associate Director of
Pharmacy Services at North Carolina Memorial
Hospital and Professor of Hospital Pharmacy at
the University of North Carolina at Chapel Hill,
N.C. has been elected to a three-year term on the
Board of Directors of the Christian Pharmacists
Fellowship International. Mr. Eckel's term began
January 1, 1987. The Board of Directors of the
Fellowship is made up of ten pharmacists from
various practice and academic settings
throughout the United States.
Mr. Eckel is a native of Philadelphia, Pa. and a
1961 B.S. graduate from the Philadelphia
College of Pharmacy and Science. He received
his M.S. in Hospital Pharmacy at Ohio State
University in 1963. After serving as Assistant
Director of Hospital Pharmacy at the Ohio State
University Hospitals and as Instructor in the
College of Pharmacy, in 1966 he became
Assistant Director of Pharmacy services at North
Carolina Memorial Hospital in Chapel Hill and
Instructor in Hospital Pharmacy. From 1968 to
1 975, he was Director of Pharmacy Services and
Director of Clinical Pharmacy Services from
1975 to 1978.
He has been recipient of many awards and
honors including the Harvey A.K. Whitney
Award in 1985. He has served as President of
numerous organizations, including the Central
Ohio Society of Hospital Pharmacists, the
Southeastern Society of Hospital Pharmacist, the
North Carolina Society of Hospital Pharmacists
and the American Society of Hospital
Pharmacists.
Continued on next page
February, 1987
THE CAROLINA JOURNAL OF PHARMACY
35
CORRESPONDENCE COURSE QUIZ
Contact Lenses
1 . The condition that is caused by the lenses of
the eye becoming stiffer and less able to
focus on close-up objects is called:
a. astigmatism.
b. hyperopia.
c. myopia.
d. presbyopia.
2. Which type of contact lens has the highest
reported rejection rate (i.e., inability of an
individual to wear them)?
a. Hard Lens.
b. Soft Lens.
3. Which of the following is a true statement
about hard contact lenses?
a. They are hydrophillic and adhere to
the cornea by capillary attraction.
b. They must be larger than the cornea to
prevent falling out when the eyelids
blink.
ECKEL
Continued from page 34
His memberships include the American
Association for the Advancement of Science,
American Association of Colleges of Pharmacy,
the American College of Apothecaries, the
American Institute of the History of Pharmacy,
the American Management Association, the
American Society of Consultant Pharmacists, the
American Society of Hospital Pharmacists, the
Canadian Society of Hospital Pharmacists, Rho
Chi Society, Sigma Xi and the North Carolina
Pharmaceutical Association.
The Christian Pharmacists Fellowship
International is a non profit trans denominational
Christian organization made up of pharmacists
with members in ten nations throughout the
world. Incorporated in 1984, it seeks to promote,
further and maintain fellowship among
pharmacists who believe the gospel of the Grace
of God, as taught by the Lord Jesus Christ and
recorded in the Bible. It is the only
interdenominational organization of its kind in
operation in pharmacy at this time. A Newsletter
is published quarterly. Mr. Robert J. Recobs of
Plainfield, N.J. and Dr. Warren E. Weaver of
Richmond, Va. is Executive Director. For more
information write CPFI at letterhead address or
call 804-285-0544.
c. They retain their shape in or out of the
eye.
d. They allow the transport of oxygen
from the atmosphere to the cornea.
4. Which type of lens has the greater number
of chemical reactive components and,
therefore, is more likely to absorb the
ingredients of eye medications?
a. Hard lens
b. Soft lens
5. As compared to spectacles, contact lenses
reportedly:
a. can prevent refractory problems from
getting worse.
b. correct a greater spectrum of vision
disorders.
c. have less tendency to cause "tired
eyes."
d. cause less image distortion.
6. Which type of contact lens must be fitted to
each individual's corneal shape?
a. Hard lens
b. Soft lens
7. Cataracts are caused by:
a. an opaque film that forms over the
cornea.
b. an opaque film that forms over the
crystalline lens.
c. precipitation of foreign materials
inside the cornea.
d. precipitation of foreign materials
inside the crystalline lens.
8. Persons with monovision wear contact
lenses with two different refractory powers
to correct:
a. astigmatism.
b. hyperopia.
c. myopia.
d. presbyopia.
9. Which type of contact lens causes the
greatest degree of spectacle blur?
a. Hard lens
b. Soft lens
10. When comparing hard and soft contact
lenses, which of the following is a true
statement?
a. Hard lenses require more care than soft
lenses.
b. Soft lenses correct more types of
astigmatism than hard lenses.
c. Hard lenses are larger in diameter than
soft lenses.
d. Soft lenses are more hydrophilic than
hard lenses.
February, 1987
36
THE CAROLINA JOURNAL OF PHARMACY
PHARMACY POLICY
RESEARCH LABORATORY
ESTABLISHED
A Pharmacy Policy Research Laboratory has
been established at the School of Pharmacy,
University of North Carolina, Chapel Hill. The
lab, created jointly by the Pharmacy Foundation
of North Carolina, Inc. and the School, began
operation in December, 1986 with Jane
Osterhaus as director.
The overall focus is to generate an awareness
of the available information and demonstrate its
usefulness in assessing the impact of economic,
social and demographic factors on drug
distribution within the health care environment.
Some of the functions of the laboratory include
organizing data bases of specific interest for those
involved with the production and distribution of
pharmaceuticals and pharmacy services;
collecting, maintaining and evaluating secondary
data bases; and providing critical information
needed for effective, efficient, short and long
range planning and forecasting.
Economic, social and administrative research
addressing drug distribution policy issues will
also be conducted by the Laboratory.
Individuals and organizations may contract
with the Laboratory to conduct unique studies.
The Laboratory is expected to provide a useful
service for planners and decision makers of
pharmacy associations, colleges and phar-
maceutical manufacturers, said Osterhaus.
Under the guidance of a Board of Directors
and Users Advisory Board, the Laboratory will
publish an annual report, summarizing and
interpreting the statistics presented in the
Laboratory's multiple data bases. Symposia or
seminars will be produced at regular intervals.
The projects undertaken by the Laboratory will
combine scholarly research techniques with clear
analyses to address the practical needs of business
and professional organizations.
Cut Out or Reproduce and Mail
CONTINUING PHARMACEUTICAL EDUCATION
Contact Lenses
Attach Mailing label from The Carolina Journal of Pharmacy in space provided (or print
name and address) and mail completed questionnaire to: NCPhA, P.O. Box 151, Chapel Hill,
NC 27514.
You may submit completed questionnaires on a monthly, quarterly, or less frequent basis
depending on which procedure is most advantageous for you in your pharmacy practice.
NCPhA will maintain a record of your completed CE credit hours. Upon successful completion
of each program you shall receive a certificate for one hour of Board approved CE.
If the answers to more than two questions are incorrect, the questionnaire will not be acceptable
for CE credit. If your questionnaire is not accepted you will be notified within 1 0 days and given
an opportunity to submit a second questionnaire.
Please type complete address or attach mailing
label from The Carolina Journal of
Pharmacy here ►
Please circle correct answers
1. a b c d
2. a b c d
3. a b c d
4. a b c d
5. a b c d
6. a b c d
7. a b c d
8. abed
9. abed
10. abed
11. abed
12. abed
IS. abed
14. a b c d
15. abed
Evaluation □ Excellent D Good □ Fair
How long did it take you to read the article and complete the exam?
□ Poor
February, 1987
THE CAROLINA JOURNAL OF PHARMACY
37
LIFE MEMBERS
Kevin Lee Almond, Sanford
John Parker Austin, Jr., Four Oaks
Michael David Barnes, Charlotte
Brainard M. Burrus, Canton
Samuel Brainard Burrus, Canton
Linda Lynch Butler, Chapel Hill
Clifford R. Butler, Chapel Hill
William Stewart Cameron, Sanford
Elizabeth Renee Cauley, Clayton
Robert M. Cheskis, Cary
Yvonne Faye Crawford, Covington VA
Bruce Edwin Dickerson, Elizabethtown
Charles Dermont Duffey, Winston Salem
Revis Radford Eller, Sparta
Marion Wilson Eubank, Jr., Jacksonville
Nancy Habrat Fagg, Charlotte
Julia E. Farris, Gastonia
Ann C. Frederiksen, Matthews
John Paul Garrison, Sylva
Timothy McRay Hinson, Whiteville
Lynette Campbell Hodgin, Danville VA
William Henry Houser, Cherryville
Alexander Byron Jarman, Jacksonville
Joseph Jarman, Jacksonville
Nellie Silver Jones, Raleigh
John Buren Kennedy, Jr., Andrews
Frances Rader Lena, Dallas TX
Sara F. Lore, Winston Salem
Debra Ellis McAulay, Raleigh
Arthur M. Mercier, Mocksville
John Agrippa Mitchener, HI, Edenton
William Whitaker Moose, Mount Pleasant
Lonnie Timothy Morgan, Buxton
Patsy Millar Myers, Winston Salem
Ruth Kannon Nassif, Wake Forest
Patricia Shook Price, Selma
Radford H. Rich, Fayetteville
Hearne Franklin Rickard, Kannapolis
Henry Baxter Ridenhour, Wilkesboro
Clarence B. Ridout, Morrisville
William Moss Salley, Jr., Asheville
Albert Hunter Smith, Fayetteville
James H. Smith, Fayetteville
June Richardson Standi, Greensboro
Charles L. Stevens, Benson
Susan Leonard Swepston, Charlotte
William J. Taylor, Burlington
William Hoyt Todd, Aulander
Marsha Barrow Tucker, Goldsboro
John Franklin Watts, Taylorsville
Jack Knight Wier, Chapel Hill
Welcome to the fifty-one pharmacists who
have become Life Members of the NCPhA by
paying ten times their annual dues. They have
been voted on and accepted by the Executive
Committee of the Association.
A recent FDA survey revealed this startl-
ing fact and went on to say that 70% of
surveyed patients also said they received
no counseling about drug precautions or
possible side effects.
So don't wait for patient questions. Take
the initiative. Give the answers . . .
1. The name of the medication and what
it is supposed to do.
2. How and when to take the medication
and for how long.
3. What foods, drinks, other drugs and
activities the patients should avoid
when taking the medication.
4. The possible side effects and what the
patient should do if they occur.
5. What written information patients can
take with them or consult to reinforce
professional counseling.
February, 1987
38
THE CAROLINA JOURNAL OF PHARMACY
CLASSIFIED ADVERTISING
Classified advertising (single issue insertion) 25 cents a word with a minimum charge of $5.00 per
insertion. Payment to acompany order.
Names and addresses will be published unless a box number is requested.
In replying to "blind" ads, address Ad. No., Carolina Journal of Pharmacy, P.O. Box 151, Chapel
Hill, NC 27514. Telephone (919) 967-2237.
PHARMACISTS NEEDED: Looking for
two pharmacists in Charlotte area to work
together to cover store 6 days a week.
Open until 4:00 pm on Saturday and NO
SUNDAYS. Very flexible hours. Good
benefits, profit sharing, very competitive
salary, hospitalization insurance, and
paid vacation. Please send resume and
phone number to: BJW, NCPhA, PO Box
151, Chapel Hill NC 27514.
RELIEF PHARMACIST AVAILABLE:
Central & Eastern North Carolina. Contact
Pharmacy Relief, PO Box 2064, Chapel
Hill NC 27515 or call 919-481-1272
evenings.
LISTINGS NEEDED FOR GOOD PRO-
FITABLE DRUG STORES: We have
buyers. Bullock & Whaley, Inc., PO Box
3783, Wilmington NC 28406. (919)
762-2868.
WORK IN JAPAN: Individuals with a
degree or experience in the phar-
maceutical industry interested in teach-
ing pharmaceutical English for one year in
Japan to employees of major corpora-
tions/government ministries should write
to: International Education Services, Shin
Taiso Bldg., 10-7 Dogenzaka 2-chome,
Shibuya-ku, Tokyo 150, JAPAN. Informa-
tion on the position will be sent after
receiving a detailed resume.
PHARMACIST to lease or operate new
6,000 sq/ft drugstore in Mt. Airy. Will be
located in new shopping center beside
Food Lion grocery store. Projected
opening February, 1987. Contact Robert
Lichauer between 9 am - 4:30 pm,
Monday - Thursday. (919) 883-6131.
Kerr Drug Stores has pharmacist
positions available in North Carolina. For
more information send resume to PO Box
61000, Raleigh NC 27661 or call Jackie
Gupton at (919) 872-5710.
PHARMACIST NEEDED: Large, pro-
gressive independent is looking for a
pharmacist who enjoys consulting with
customers. Computerized prescription
department, excellent salary, hospitaliza-
tion and life insurance, paid vacations.
Central North Carolina. Call Micky
Whitehead at R & M Mutual Discount
Drugs, Ramseur, 919-824-2151.
PHARMACY DIRECTOR: Angel Hos-
pital, an 81 bed community hospital, is
seeking a Pharmacist (RPH) with previous
experience in a hospital pharmacy.
Responsible for managing pharmaceu-
tical services and supervising activities of
non-professional staff. Competitive salary
and benefit package available in this
scenic section of the mountains of WNC.
Call for application or send resume to
Personnel Department, Angel Community
Hospital, PO Box 1209, Franklin NC
28734.(704)524-8411.
WEEKEND PHARMACY COVERAGE
NEEDED: Granville Hospital, a 66 bed
community hospital, requires Pharmacist
coverage on Saturdays and Sundays.
Maintain unit dose system and patient
profiles. Contact Joe Earnhardt, Director
of Pharmacy, Granville Hospital, College
St. Extension, Oxford NC 27565. 919-
693-5115.
CLINICAL-STAFF PHARMACIST POSI-
TION: Will be working every 3rd weekend
and will have responsibilities in unit dose,
IV admixtures, cancer chemotherapy,
patient education, nursing inservice,
pharmacy newsletter, pharmokinetic
dosing, drug use evaluation and other
evolving clinical applications. Some
February, 1987
THE CAROLINA JOURNAL OF PHARMACY
39
advanced training and experience in
clinical pharmacy preferred. If interested
and qualified please send resume to:
Director of Personnel, Community
General Hospital, PO Box 789, Thomas-
ville NC 27360. EOE.
PHARMACIST WANTED: Progressive
independent seeks motivated personable
pharmacist for permanent position.
Located within 30 minutes of Chapel Hill
and Greensboro. Buy in opportunity
available. Competitive salary and bonus
package. For more information send
resume to David Smith, Haw River
Discount Drug, PO Box 48, Haw River NC
27258.
PHARMACIST PROFESSIONAL SER-
VICES/CONSULTATION: Temporary
and/or Continual. Contact L. W.
Matthews, III, (919) 967-0333 (or 929-
1783) 1608 Smith Level Rd., Chapel Hill
NC 27514.
PHARMACIST NEEDED: Excellent
opportunity for young, aggressive
pharmacist for busy 3-man store. Buy-in
potential, excellent hours, profit sharing,
and insurance. Contact: Ron Ward, (919)
692-5258.
POSITION AVAILABLE: Apple Phar-
macy in Mocksville. Call Art Mercier (704)
634-2111. (1 week vacation every 4
months)
PROFESSIONAL PHARMACIES: Sev-
eral small prescription-oriented phar-
macies are currently available for
individual ownership in North Carolina.
These opportunities provide the vehicle to
practice pharmacy the way you were
taught, while offering an attractive income
and more time to be with your family. In
some of these cases, financing is also
available to qualified candidates. For
more information write: Jan Patrick,
10121 Paget Dr., St. Louis MO 63132.
PHARMACIST WANTED: Independent
store in Brevard. No Sundays or nights.
Good working conditions, salary, and
benefits. Call Paul Owenby after 6:30 pm
at (704) 883-2543.
PHARMACIST WANTED: Supervisory
position at Durham County General
Hospital. Contact Gerald Stahl at (919)
470-4169.
February, 1987
EXECUTIVE DIRECTOR OF PHAR-
MACY INDUSTRY ASSOCIATION: Seeks
results-oriented individual for position of
Executive Director. Requires strong skills:
working with elected, voluntary board to
implement policies, programs benefitting
the industry; developing membership
growth and alternative sources revenue;
effectively managing a staff headquar-
tered in Philadelphia. Minimum qualifica-
tions include bachelor's degree; five to 10
years exper. top-level mgmt.; expertise in
mbrshp. promo., pubs., conf. planning
highly desirable; familiarity regulatory
and ind. policies and issues; demon-
strated abilities to work effectively with
others. Salary commensurate qualifica-
tions and exper. Please submit resume to
Search Comm. c/o Parenteral Drug
Association, 1 346 Chestnut St., Ste. 1 407,
Philadelphia PA 19107.
HOSPITAL PHARMACIST WANTED:
Staff pharmacist position at Morehead
Hospital in Eden, NC. Call Robert Dever
(919)623-9711.
CHIEF PHARMACIST: opening at
McCain Hospital, McCain NC. Three-
person department; 2 RPh, 1 Tech. State
employment, Pay Grade 75, NC registra-
tion required. Serve 95-bed hospital with
additional 200 outpatients. Preparing for
expansion. Call Steve Dubay at (919)
944-2351.
MEDICINE SHOPPE FOR SALE: Don't
miss this excellent opportunity to be your
own boss in a professional atmosphere.
The Medicine Shoppe, a prescription
oriented pharmacy located in Raeford,
NC has been offered for immediate sale.
This fine opportunity offers clinic hours
and a positive cash flow from Day 1 . If you
have been considering owning your own
pharmacy, this could be an outstanding
opportunity for you! Financing available.
Contact John Aumiller, Medicine Shoppe
Intl., Inc. at 1-800-325-1397.
PHARMACY BUSINESS FOR SALE:
Small NC town, excellent location, high
traffic area, newly remodeled, attractive
building with option to purchase, good
established business, 159K. For pertinent
information contact CENTURY 21 Village
Joan Anderson (919) 467-0121.
40
THE CAROLINA JOURNAL OF PHARMACY
BIRTHS
CHARLES R. FENSKE and NANCY
COLTRAIN FENSKE of Louisburg, NC, both
1 976 graduates of the UNC School of Pharmacy
at Chapel Hill, announce the birth of their
daughter, Sarah Melissa, on December 1, 1986.
Sarah weighed 9 lbs. 9 oz. and has an older
brother, Lucas, who is 5.
Charles is pharmacist-manager of Revco
Drugs in Louisburg.
SUZANNE and ROBERT BIZZELL,
Kinston are happy to announce the birth of their
daughter Margaret Reams on December 29,
1986. Margaret weighed 7 pounds 15 ounces.
She has an older sister Beth.
MARRIAGES
DANA JOETTE LANGDON and Daniel
Lee McClure were married January 31, 1987 at
the bride's parent's home in Angier. The bride, a
1985 graduate of the UNC School of Pharmacy,
is employed by Revco Drug Stores. The couple
will live in Surf City.
DANA JOETTE LANGDON of Jackson-
ville and Daniel Lee McClure of Surf City were
married January 31 at the bride's parents' home
in Angier.
The bride, a graduate of the University of
North Carolina at Chapel Hill School of
Pharmacy, is a pharmacist at Revco.
The bridegroom, who attended Western State
College in Gunnison, Colorado, is a construction
supervisor with Venture Construction Co. The
couple live in Surf City.
DEATHS
William Allen Parks
Mr. William A. Parks, Davidson, died
December 1 , 1 986 at Mercy Hospital, Charlotte.
He was 84 years old. He attended Wofford
College and was a graduate of the UNC School of
Pharmacy and was licensed in 1938. Parks was
retired and former owner and pharmacist of
Parks Rexall Drugs in Davidson.
Robert Jackman Darden
Robert J. "Jack" Darden, Clinton, died Friday
March 7, 1 986 at a nursing home in Goldsboro at
the age of 74. Darden was a native of Sampson
County and operated Darden's Pharmacy in
Clinton until he retired. He was registered in
1 938 and was a partner in Butler's Pharmacy in
Clinton prior to opening Darden's Pharmacy.
Richard Furman Ponder
Richard F. Ponder, Mount Holly, died
Tuesday, January 13, 1987 at Gaston Memorial
Hospital at the age of 64. A native of Greenville,
SC, Ponder was a 1955 graduate of the
University of South Carolina School of
Pharmacy. He was a veteran of World War II
and co-owner of Charlie's Drugs and Sundries of
Mount Holly.
Wilbur Leon Hickmon
Wilbur L. Hickmon, Wilmington, died
Wednesday, February 25, 1987, in New
Hanover Hospital. He was 84 years old. He was a
1933 graduate of the UNC School of Pharmacy
and retired from Eli Lilly and Company in 1 975.
Both sons, James R. Hickmon and E. Edward
Hickmon are graduates of the UNC School of
Pharmacy.
David Foy McGowan, Sr.
David F. McGowan, Chapel Hill, died
Saturday, March 7, 1987, after an extended
illness, at Hillhaven Convalescent Center. He had
retired from Eli Lilly Company in 1979 after 33
years as a manufacturer's representative. A native
of Swan Quarter, McGowan attended Weaver
College and graduated in 1942 from the UNC
School of Pharmacy. He served in World War II
as a captain in the Marine Corps.
February, 1987
MANAGEMOtt
REPORTS
STAWO DESIGN
PHARMACY
, COMpyYpa
EVtCtBONtC- , -, , _/
ORDER E«*«*
COUPON '
I REDEEMPTIQ«
i\ PROGRAM ;
■WMi
Put all your eggs in one basket !
Being an independent pharmacist is like walking on egg shells.
The highly computerized systems and massive buying power
of the big chains make the competition tougher than ever.
The best way to meet this competition is to take advantage
of our buying power, computerized systems and our commit-
ment to a high level of service and quality products. So, if
you want a higher measure of return on your investment, put
all your eggs in our basket.
• Electronic Order Entry and Inventory Management • Pharmacy
Computer Systems • Cost Plus Purchasing • Special Deal Purchasing
• Automatic Price Updates • Home Health Care Products • Manage-
ment Reports • Store Planning and Design • Employee Training
• Merchandising and Programming • Advertising • Coupon Re-
deemption Program
Owens &Minor, Inc.
1010 HERRING AVENUE • WILSON, NORTH CAROLINA 27893 • 1-919-237-1181
THE CHOICE OF
THE FUTURE IS
YOURS TODAY
We give you the Future today! How? By provid-
ing computer software at a new plateau of so-
phistication. If you are looking at a first-time
purchase, or to replace an existing pharmacy
computer, examine this all-new PCI System.
This system features: Industry Standard
Hardware, IBM, AT&T, or NCR plus Standard
Operating Systems. User Memory (512KB up to
3MB RAM) and hard disk options (20MB to
72MB). "State of the Art Software" features pre-
scription processing, optional integrated Ac-
counts Receivable, Accounts Payable, General
Ledger, Institutional Processing, Nursing Home
packages and Word Processing.
PCI Systems prices start at $10,995. Leasing
plans available. For your performance require-
ments PCI can supply them all.
MULTI USER MULTIPLE TERMINALS
PHARMACY NEEDS
For additonal information and a closer look or personal demonstra-
tion, phone Chuck Rousseau, North Carolina Wats: 1-800-438-1062.
Dr.T.C.Smith Co. / W.H.King Drug
ASHEVILLE, N.C. 28806 • 704/258-2645
RALEIGH, N.C. 27622 • 919/782-8400
THE OIROUNK
JOURNN_ofPHN*MKCY
3 0 I98T
HEALTH i
Socio- Economic Seminar Participants: left to right; NCPhA First Vice President Julian
Upchurch, Under Secretary of HHS Donald M. Newman and John Mackowiak, UNC
School of Pharmacy
Health Sciences Libra- y
2 2 3 - H
UNC
Chapel Kill, H C 2 7 5 I 4
wimmmmmmmmmmmmm
Plagued by Back-Orders?
Kendall Has the Cure.
Kendall customers don't wait around
for their orders; in fact Kendall averages
a 95+% service level. Kendall customers
have relied on us for over 65 years to
provide a full line of pharmaceutical
services, including:
• Wholesale Pharmaceuticals
• Electronic Order Entry
• Drug Store Design and Fixtures
• Associated Druggist Advertising
Program
• Pricing Strategy
• Microfiche Service
• Per-Product Sales Analysis
• Next Day UPS Delivery in the
Carolinas
Kendall Drug also offers the
pharmacist a viable means of reducing
paperwork, while increasing efficiency
and profitability: The Triad In-Pharmacy
Computer System.
Triad handles your complete
prescription processing including labels,
instructions, drug interaction and receipts,
accounts receivable, third party billing,
and medi-span price updates. Triad is an
excellent pharmacy system, allowing you
to increase efficiency and productivity.
We put our name and service behind
Triad and you. Call Triad direct at
1-800-532-3087.
IK
IL-XDRLJG COIVIF>At\IY
1305 Frederick St. • P.O. Box 1060 • Shelby, N.C. 28150
NC 1-800-222-3856 SC 1-800-438-5330
Justice Drug Company
P.O. Box 22025
Greensboro, NC 27420
AN ALCO STANDARD COMPANY
Now in our 87th Year of Service to the North Carolina Pharmacists
|£Hs Partnership
For Profit
family
Independent
Pharmacy
Total Retail Concept
The Family Independent Pharmacy program provides an
all-inclusive plan covering every aspect of marketing,
merchandising, and management of drug store opera-
tions. It is a wholesaler-sponsored voluntary, and it
embraces the total retail concept in all its forms.
IHHC
TOTAL HOME HEALTH CARE
Our Total Home Health Care™ Program offers Durable
Medical EquipmentforRentor Resale. Third Party Billing
for Medicare/Medicaid.
Additional
* Services & Programs Offered *
Store Plan-O-Gram: Complete Store Layout & Design
including Fixtures, Merchandise Plan-o-graming,
and Pricing Strategies
Specialty Qift Departments including Arts & Crafts
Affordable Pharmacy Computer Systems
National Data Corporation
Merchandise Racking Service
Group Life
And Health
Insurance
Benefits
For Members Of
North Carolina
Pharmaceutical
Association
Pilot Life Insurance Company is pleased to have oeen
selected as the Group insurance carrier for the North
Carolina Pharmaceutical Association. It would be to
your advantage to become thoroughly acquainted with
the benefits of this program.
You can expect the best possible service from Pilot Life,
one of the nation's leading Group insurance carriers.
For full information, contact Mr. Al Mebane, Executive
Director, North Carolina Pharmaceutical Association.
Write or call:
Sam P. Stuart, CLU
P. 0. Box 595
Winston-Salem, NC 27102
Telephone 919/723-8811
Pilot
Lite
1HE OIROLINk
JOURNMofPHN^MkCY
MARCH 1987
Officers
NORTH CAROLINA
PHARMACEUTICAL
ASSOCIATION
President
M. Keith Fearing, Jr.
P.O. Box 1048
Manteo, NC 27954
(919) 473-3463
Vice Presidents
Julian E. Upchurch
5201 Pine Way
Durham, NC 27712
(919) 477-7325
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh, NC 27612
(919) 876-5600
W. Robert Bizzell
1007 Rhem Street
Kinston, NC 28501
(919) 527-6929
Executive Director
& Editor
A. H. Mebane, III
P.O. Box 151
Chapel Hill, N.C. 27514
NCPhA Office
(919) 967-2237
or
1-800-852-7343
(USPS 091-280)
VOLUME 67
ISSN 0528-1725
NUMBER 3
CONTENTS
Schering Report VII 5
Significant Patent Expirations 9
NC General Assembly Roster 12
Tom Holland-Mount Holly 27
Local News 31
Scenes from the Socio-Economic Seminar 32
Dickinson's Pharmacy 34
Classified Advertising 35
Personal Notes 36
ADVERTISERS
Carolina Surgical Supply 10
Colorcraft 27
Justice Drug Company 1
Kendall Drug Company 2nd Cover
Knoll Pharmaceuticals 28 & 29
Lilly 24
Marion Laboratories 14
Owens & Minor, Inc 3rd Cover
Pilot Life 2
Dr. T.C. Smith Co./W.H. King Drug 4th Cover
Spear Associates 6 & 20
Store Fixtures & Planning, Inc 4
Upjohn 26
Washington National Insurance Co 16
The Carolina Journal of Pharmacy is published monthly by the
North Carolina Pharmaceutical Association, P. O. Box 151,
Chapel Hill, NC 27514. The Journal is provided to NCPhA
members through allocation of annual dues. Subscription rate to
non-pharmacists (continental US) $20.00. Single copy price
$2.00. Overseas rates on request. Second class postage paid at
Chapel Hill, NC.
THANKS N.C. PHARMACISTS!
For selecting us Co assist you with your new pharmacies
expansions, or store improvements during 1986 !!!!!!!!!
Ron Holland
Truman Hudson
3ill Forrest
AKERS PHARMACY
Gastonia , N.C.
Arnold Britt
^A.T.C. Pharmacy
Reidsville,N. C.
Don Weathers
'CITY PHARMACY
Newton, N.C.
John Bennett
Jim Powers
CLINIC DRUG
Glen Alpine, N.C.
Jerry Norvell
Paul Walker
CORNWELL DRUG STORES
Davidson, N.C.
Lincolnton, N.C. (2)
Morganton, N.C.
Stanley, N.C.
Bill Allen
Frank Allen
--FALLSTON PHARMACY
Fallston, N.C.
Mr Andy Hunter
•-MONROE FAMILY PHARM.
Monroe, N.C.
Chuck Westmoreland
Ronald Watts
^FAMILY PHARMACY
Walnut Cove, N. C.
Lewis Summers
FOREST HEIGHTS PHARMACY
Statesvil le , N.C.
Steve & Charlene Wilson
^GUILFORD COLLEGE DRUGS
Greensboro, N.C.
Ken Hardin
Marshall Hardin
HARDIN'S DRUGS
Forest City, N.C.
Charles & Sylvia Adams
^JOHNSON'S DRUGS
Fuquay Varina, N.C.
John & Linda Kennedy
KENNEDY'S DRUG CENTER
Andrews , N.C.
W. W. (Bill) Howie
Steve Howie
Tom McMahan
Freddy Rabon
-'MED-PARK PHARMACY
Marion, N. C.
Pete & Mary Milliones
MEDICAL PHARMACY
Charlotte, N.C.
Russell Mitchell
MITCHELL'S DISCOUNT DRUG #2
MITCHELL'S DISCOUNT DRUG #3
Eden, N. C.
Raleigh Putnam
^PUTNAM'S PHARMACY
Clemmons, N.C.
Rick Brame
RED CROSS PHARMACY
North Wilkesboro, N.C.
Jim Prevo
L. Stan Haywood
Thomas Ward
•-SEAGROVE DRUGS
Seagrove, N. C.
Dan Hayes
''STEADMAN DRUG
Steadman, N. C.
Samuel Powell
''THOMASVILLE DRUGS
Thomasville, N.C.
C. E. (Ted) Green, III
Ben Suttle
''WHITE STAR DISCOUNT PHARMACY
Haw River, N.C.
and
The Many Other Pharmacies
that purchased fixtures from
us during the Year'!
"•''Represents NEW Pharmacies or NEW LOCATIONS
WE CONGRATULATE YOU AtlD WISH YOU A PROSPEROUS 1987!!
Roland G. Thomas - Randy M. Bivens
SH
STORE FIXTURES
& PLANNING, INC.
3555 TRYCLAN DRIVE • CHARLOTTE, NORTH CAROLINA 28210 • PHONE 704-525-5300
"Over 300 Drug Store Installations in the Carolinas"
THE CAROLINA JOURNAL OF PHARMACY
SCHERING REPORT VIII UNDERSCORES PHARMACISTS'
SATISFACTION WITH PROFESSION AND PERSONAL LIFE
A major finding of an independent nationwide
survey commissioned by Schering Laboratories
reveals that pharmacists are generally well
satisfied with their professional and personal
lives, although there are different perceptions by
age, sex and work setting, with "burnout"
emerging as a significant problem.
"Pharmacy is a dynamic and increasingly
important health care profession, so it's not
surprising that pharmacists — whether they
practice in independent, chain or hospital
pharmacies — are highly introspective and
increasingly concerned about their relationships
with customers, physicians, their families and
fellow practitioners," said Dr. Jack Robbins,
director — pharmacy affairs, Schering
Laboratories.
"What emerges from the survey is a clear
picture of pharmacists as caring health
professionals," he added. "They prefer using their
professional expertise where it's needed most and
where they get the greatest personal satisfaction
— meeting the needs and demands of patients for
advice and counsel on health matters."
Schering Report VIII — "Inside Pharmacy:
The Anatomy of a Profession" — also explored
the growing impact of women in the profession,
the pharmacist's evolving self-esteem as a health
care provider, and the relationship between
prestige and work satisfaction as revealed
through membership in national, state and local
pharmacy associations.
The 1986 survey was based on over 300 in-
depth interviews with male and female
pharmacists across the country in large and small
cities, towns and rural communities. "To get a
good look at the profession from the inside out,
researchers interviewed pharmacists practicing in
independent, chain and hospital pharmacies,"
Robbins said.
Highlighting the survey, he reported that
pharmacists, when asked to rank their five "most
preferred" professional activities, named
counseling patients about prescriptions as
number one, followed by filling prescriptions,
advising patients about over-the-counter
medications, consulting with physicians, and
advising patients about non-drug related matters.
"It seems evident," he observed, "that activities
related to the patient's welfare rank high with
pharmacists. The only significant difference arose
with hospital pharmacists, who as you might
March, 1987
expect, listed conferring with physicians as the
activity they preferred most."
"The pharmacist's age and sex also showed up
in the results. "Women pharmacists felt even
stronger than men did about counseling patients
as their first choice (74 percent versus 68
percent)," Robbins pointed out. "By age, 65
percent of pharmacists over 40 listed filling
prescriptions as their number-one preference
against 45 percent for the under-40 group."
Pharmacists seemed equally clear about what
they consider routine or mostly business matters.
"They don't like clerical activities or keeping
prescription records, stocking shelves, handling
cash and credit card transactions, speaking with
sales representatives or addressing non-medical
groups, such as PTAs," he added.
"On the other hand," Robbins pointed out,
"pharmacists would like more personal
interaction, not only with patients, but with
doctors, nurses and other medical personnel.
They also want to be more active professionally,
maintaining patient profiles and serving on
professional committees.
"Education, their own and that of others, was
also a forefront issue," he observed. "They want
to continue their education through lectures and
seminars, as well as teach, give lectures and
participate in public education — in particular,
helping teenagers learn about proper use of
pharmaceuticals and the dangers of drug abuse."
What work experiences do pharmacists find
very satisfying in a personal or professional way?
They reported being very satisfied with
relationships involving fellow workers (63
percent) and happy with work in general (44
percent). Pharmacists also enjoyed contacts with
other pharmacists outside their immediate work
environment (42 percent), got great satisfaction
from delivering patient care (34 percent), and
were very satisfied with the prestige of their
profession (34 percent). Finally, 32 percent said
they were very satisfied with their ability to meet
their patients' needs.
However, some sharp differences in degree of
satisfaction emerged in analyzing the responses
by where the pharmacist practices, and whether
the pharmacist was a man or woman:
• Respondents in independent drug stores were
much more satisfied with their work
Continued on page 6
THE CAROLINA JOURNAL OF PHARMACY
SCHERING REPORT
Continued from page 5
experiences than those in chains or hospital
pharmacies. Why? Robbins speculated that
"pharmacists in independent practice have
closer personal contacts with patients, thereby
reinforcing their self-image as nurturing health
care professionals."
• More men than women (37 percent versus 26
percent) derive great satisfaction in the status
and prestige associated with pharmacy. Also,
men get greater satisfaction in meeting
patients' needs and demands (35 percent
against 26 percent).
• However, more women pharmacists reported
being satisfied with their current salaries (24
percent versus 1 8 percent).
Factoring in the respondents' age and
membership in a national pharmacy association
also revealed some striking differences. Overall,
older pharmacists are considerably more satisfied
than their younger counterparts with work
experiences, relationships with fellow employees,
and the intangible rewards from patient care and
professional prestige.
"On the question of satisfaction with work
experiences, pharmacists who belonged to a
national pharmacy group indicated that they
were very satisfied with work in general (52
percent), compared with non-joiners (31
percent)," Robbins observed. "And that response
pattern also emerged in questions involving
satisfaction in dealing with patients, and status
and pride as pharmacists."
When asked if they were "very dissatisfied
with anything," very few respondents — less
than 10 percent — cited as reasons for their
dissatisfaction lack of opportunities for
promotion; current salary and periodic increases;
or unhappiness over management policy
decisions.
"From these findings," he said, "pharmacists
seem fairly satisfied with their work."
The survey also focused on the pharmacist-
physician relationship, with some notable
CONGRATULATIONS TO
LARRY and JOHN THOMAS
On the remodeling of their store, Thomas Drug Store,
Dunn. We are pleased to have been a part of this exciting
project.
H Warren Spear R Ph.
Pharmacy Design Specialist
415 Augusta Drive
Route 4, Box 376 AA
Statesville NC 28677
(704)876-4153
Spear Associates — planners, de-
signers and installers of pharmacy
fixtures & equipment
March, 1987
THE CAROLINA JOURNAL OF PHARMACY
differences arising. Two-fifths of the respondents
(41 percent) said that doctors treat them as
equals, but a larger proportion (57 percent) felt
they did not.
How is that sense of "equality" perceived?
More than half of the respondents (53 percent)
recall friendly relations with doctors; 3 1 percent
cited instances where doctors sought their advice
on drugs, dosages and side effects; and 20 percent
said that doctors "respect my opinion and
knowledge, and accept my recommendations."
The survey also probed the impact on
pharmacy of the trend toward shifting many
prescription drugs to over-the-counter status.
Some 57 percent of the respondents believe
that the OTC switch is having a "decided"
impact, while 43 percent said that the switch has
left the profession unchanged. Of pharmacists
who felt that the switch is affecting the profession,
29 percent said that the pharmacist himself had
been impacted for the better, citing "greater
freedom to counsel patients more frequently on
OTC medications and to use their professional
knowledge in making recommendations."
Some respondents (23 percent) noted that the
shift also is impacting patients, freeing them to
choose among several OTC drugs. They reported
that "patients need new knowledge and more
counseling by pharmacists to help them select an
OTC medication." Only three percent felt that
the shift would mean fewer prescriptions for
pharmacists.
Interviewed about their personal lives,
pharmacists seem to be happy with most aspects
of their lifestyles. Robbins reported that "they
were very satisfied with immediate family
relationships, their mental and physical health,
their friendships and life in general."
On the less positive side, less than half (41
percent) were very satisfied with their leisure
activities, and only 26 percent reported being
very satisfied with their financial status.
In exploring any friction between work and
social and family obligations, the Schering
Report uncovered only a small degree of conflict.
Relatively few respondents (17 percent)
identified working on weekends as presenting
problems with family life, and fewer still torn
between the demands of work and personal life.
Some pharmacists (25 percent) noted that
work-home conflicts came with the job, and they
accept them as part of practicing pharmacy.
Pharmacists also were questioned about the
increasing number of women in the profession.
More than half (56 percent) believed that the
entry of women would make no difference — "a
pharmacist is a pharmacist regardless of gender."
More than a third (35 percent) said that more
women will have a positive impact, citing
qualifications and education comparable to those
of men, and greater compassion and
understanding.
"Asking pharmacists why they belonged to
professional associations, and what benefits they
expected to derive from them, turned up a wide
range of responses," Robbins reported.
"Almost half of the respondents (48 percent)
were members of national professional
associations," he added. "Hospital pharmacists
dominated among the three groups (67 percent),
compared with 50 percent for pharmacists in
independent practice, and 28 percent for
pharmacists in chain drug stores."
In addition, among the members, there were
more women than men (58 percent versus 45
percent), more pharmacists with advanced
degrees than with B.S. degrees (65 percent versus
40 percent), and more city than suburban
pharmacists (55 percent to 40 percent).
"Touching on the sensitive issue of
pharmacist-physician relationships, pharmacists
who reported that they were treated as equals by
doctors are more apt to belong to professional
associations (55 percent versus 42 percent) than
those who felt they were not treated as equals,"
Robbins pointed out.
As for the benefits of belonging, pharmacists
mentioned — in order of importance —
educational advantages (70 percent); financial
benefits, such as insurance plans (19 percent);
social benefits ( 1 2 percent); and influence upon
legislation (six percent).
"Pharmacists had similar responses when
asked about membership in state or local
pharmacy groups, and there were more women
than men, and more urban than suburban
pharmacists."
One of the most profound findings in the
Schering study came to light on the topic of
"burnout." "This appears to be a significant
problem," Robbins noted, "with more than
three-quarters of the respondents (78 percent)
saying 'yes', burnout is a problem.
"Again, differences in perception appear to be
related to the different work settings. Chain and
hospital pharmacists (81 and 79 percent,
respectively) were emphatic about burnout as a
major concern, while only 73 percent of
Continued on page 8
March, 1987
THE CAROLINA JOURNAL OF PHARMACY
SCHERING REPORT
Continued from page 7
independent pharmacists saw it as a problem," he
added.
Further, women pharmacists reported more
burnout than men (83 percent to 76 percent).
"This may indicate that women, in some
pharmacies, may feel they are under extra
pressures to prove their competence," Robbins
observed. "Also, younger pharmacists, those
under 40, reported an 84-percent incidence of
burnout compared with 68 percent for those over
40 years of age."
How to avoid burnout? "Make life behind the
counter less boring and more creative," the
respondents said. Suggestions included more
flexible work hours, hiring more technicians to
reduce pharmacists' workload, varying duties,
and greater opportunities to use their professional
training in direct contact with physicians and
patients.
Summarizing the 1986 Schering Report,
Robbins underscored the dynamic nature of the
pharmacy profession today, citing its problems
and emphasizing its expanding opportunities in
serving the health care needs of Americans.
CALL FOR PAPERS
The NCSHP Program Committee is calling for
papers to be presented in poster format at the
NCSHP Winter Meeting in February 1988.
Summaries of papers should be prepared
according to the guidelines outlined in the
January 1987 issue of American Journal of
Hospital Pharmacy and submitted to Dennis
Williams, Pharm.D., Program Committee
Chairman, Beard Hall 200H, UNC, Chapel Hill,
NC 27514.
The deadline for receipt of papers is August 3,
1987. Notification of acceptance will be sent by
September 14, 1987.
Papers submitted for presentation at national
meetings are welcome. Please participate and
share your work with your North Carolina
colleagues.
The Upjohn Research award will also be
selected from papers submitted. The award
consists of a plaque and a cash award from the
Upjohn Company. Each paper will be evaluated
by at least two NCSHP members. Papers
submitted for consideration of this award do not
necessarily have to be presented at the poster
session, but the author should clearly state
his(her) intent upon submission.
N.C. Pharmacists at the NARD's 19th Annual Conference on National Legislation and Public
Affairs, Washington, March 24. Left to right: Jesse Pike, NARD Past President; W.W. Moose, NARD
5th Vice President; Congressman H. Martin Lancaster, D-3rd District; Al Mebane, NCPhA
Executive Director; Betsy Mebane; Lib Fearing and NCPhA President M. Keith Fearing, Jr.
March, 1987
THE CAROLINA JOURNAL OF PHARMACY 9
BRANDED DRUGS WHOSE PATENTS WILL EXPIRE BY 1994
Brand Name Generic Name Branded Manufacturer Sales (000)*
Patent expired in 1986
Advil
Ibuprofen
Amer. Home Prods.
$200,000
Haldol
Haloperidol
McNeil
87,814
Catapres
Clonidine HC1
Boehringer Ingelheim
86,395
Alupent
Metaproterenol sulfate
Boehringer Ingelheim
51,651
Sinequan
Doxepin HC1
Roerig
39,381
Carafate
Sucralfate
Marion
38,628
Zyloprim
Allopurinol
Burroughs Wellcome
34,070
Centrax
Prazepam
Parke-Davis
33,600
Velosef
Cephradine
Squibb
32,368
Visken
Pindolol
Sandoz
16,800
Cephulac
Lactulose
Merrell Dow
N/A
Patent expires in
1987
Ancef
Cefazolin sodium
Smith, Kline & French
97,303
Tranxene
Clorazepate dipotassium
Abbott
88,674
Cleocin
Clindamycin HC1
Upjohn
83,488
Duricef
Cefadroxil
Mead Johnson
47,956
Bactrim DS
Trimethoprim
w/sulfamethoxazole
Roche
34,000
Septra
Trimethoprim
w/sulfamethoxazole
Burroughs Wellcome
17,000
Unipen
Nafcillin sodium
Wyeth
N/A
Patent expires in
1988
Feldene
Piroxicam
Pfizer
240,234
Timoptic
Timolol maleate
Pfizer
119,710
Adriamycin
Doxorubicin HC1
Adria
66,445
Nalfon
Fenoprofen calcium
Lilly
46,545
Pavulon
Pancuronium bromide
Organon
16,000
Patent expires in
1989
Keflex
Cephalexin
Lilly
237,585
Clinoril
Sulindac
Merck
134,861
Nebcin
Tobramycin sulfate
Dista
74,942
Platinol
Cisplatin
Bristol-Myers
63,115
Proventil
Albuterol sulfate
Schering
54,675
Ventolin
Albuterol
Glaxo
47,206
Lotrimin
Clotrimazole
Schering
22,400
Mutamycin
Mitomycin
Bristol-Myers
20,720
Blenoxane
Bleomycin sulfate
Bristol-Myers
19,824
Asendin
Amoxapine
Lederle
17,000
Blocadren
Timolol Maleate
Merck
16,800
Patent expires in
1990
Dolobid
Diflunisal
Merck
48,346
Tolectin
Tolmetin sodium
McNeil
46,818
Parlodel
Bromocriptine mesylate
Sandoz
34,450
Imodium
Loperamide HC1
Janssen
17,920
Retin-A
Tretinoin
Ortho
12,910
Amikin
Amikacin sulfate
Bristol
N/A
Continued
on page 1
March, 1987
ALLOW US
TO FILL YOUR
HOME HEALTH CARE
PRESCRIPTIONS!
FOR ALL OF YOUR
HOME HEALTH CARE NEEDS
ALLOW US TO ASSIST YOU
• Leading Industrial Prod-
ucts Available.
• Next Day Delivery on Ir
Stock Products.
• Discount Programs.
• In Store Visits By Our
Trained Home Health
Services Representative,
• Phone Assistance By
Qualified Customer Ser
vice Personnel.
• Product Literature Avai
able.
• Third Party Reimburse- 1
ment Information Avail- ?
able.
• Complete Individualizec
and Customized Plan-O
Gram and Store Set (Jr.
• C.E.U. Accredited Wort-
shops for N.C. Pharmacist.
HOME HEALTH SERVICES OF
CAROLINA SURGICAL SUPPLY
P.O. BOX 31207 • RALEIGH, N.C. 27622 • (919) 782-8400/(800) 662-7767 NC WATTS
SERVING CUSTOMERS OF:
Dr.T.C.Smith Co. / W.H.King Drug
ASHEVILLE.NC 28806 • 704/258-2645
RALEIGH. N C 27622 • 919/782-8400
THE CAROLINA JOURNAL OF PHARMACY
11
BRANDED DRUGS
Continued from page 9
Brand Name
Generic Name
Patent expires in 1991
Procardia Nifedipine
Sinemet Carbidopa-levodopa
Ovral
Stadol
Monistat
Norgestrel
w/ethinyl estradiol
Butorphanol tartrate
Miconazole
Patent expires in
1992
Naprosyn
Ceclor
Naproxen
Cefaclor
Flexeril
Lorelco
Cyclobenzaprine HC1
Probucol
Spectrobid
Bacampicillin HC1
Patent expires in
1993
Tenormin
Atenolol
Lopressor
Xanax
Corgard
Dobutrex
Metoprolol tartrate
Alprazolam
Nadolol
Dobutamine HC1
Patent expires in
1994
Tagamet
Mezlin
Cimetidine HC1
Mezlocillin sodium
Bricanyl
Terbutaline sulfate
Branded Manufacturer
Pfizer
Merck
Wyeth
Bristol
Ortho
Syntex
Lilly
Merck
Merrell Dow
Roerig
Stuart
Ciba-Geigy
Upjohn
Squibb
Lilly
Smith, Kline & French
Miles
Lakeside
Sales (000)*
180,302
72,708
55,650
13,000
N/A
249,061
132,148
51,139
N/A
N/A
210,807
160,072
147,476
103,320
N/A
481,967
N/A
N/A
*1985 sales, some estimated.
N/A = not available.
MOVING? Help us keep your Carolina Journal of Pharmacy and other NCPhA mailings
coming to your correct address. Please complete the address change form and send to the
NCPhA, P.O. Box 151, Chapel Hill 27514, as soon as you know your new address.
Name
Old Address
City
State Zip Code
New Address
Effective Date
City
State Zip Code
March, 1987
12
THE CAROLINA JOURNAL OF PHARMACY
N.C. GENERAL ASSEMBLY
SENATE
(District and Counties
Represented)
Marc Basnight
Box 1025
Manteo NC 27954
Senate #1
Beaufort, Camden, Currituck, Pasquotank,
Perquimans, Tyrrell, Washington, Dare, Hyde
J.J. Harrington
P.O. Drawer 519
Lewiston-Woodville NC 27849
Senate #2
Bertie, Edgecombe, Gates, Halifax, Hertford,
Martin, Northampton, Warren
William H. Barker
P.O. Box 52
Oriental NC 2857186
Senate #3
Cartaret, Craven, Pamlico
A.D. Guy
511 New Bridge Street
Jacksonville NC 28540
Senate #4
Onslow
Harold W. Hardison
1001 West Vernon Avenue
Kinston NC 28501
Senate #5
Duplin, Jones, Lenoir, Pender
R.L. Martin
P.O. Box 387
Bethel NC 27812
Senate #6
Edgecombe, Martin, Pitt, Wilson
Franklin Block
1 1 08 Seapath Towers
Wrightsville Beach NC 28480
Senate #7
New Hanover, Pender
Henson P. Barnes
P.O. Drawer 7
Goldsboro NC 27530
Senate #8
Wayne, Greene
Thomas F. Taft
P.O. Box 588
Greenville NC 27834
Senate #9
Beaufort, Martin, Pitt
James E. Ezzell, Jr.
201 Forest Hill Avenue
Rocky Mount NC 27801
Senate #10
Edgecombe, Halifax, Nash, Warren, Wilson
James D. Speed
Route 6, Box 542
Louisburg NC 27549
Senate #1 1
Franklin, Vance, Wake
Anthony E. Rand
P.O. Box 1239
Fayetteville NC 28302
Senate #12
Cumberland
Lura Tally
3 1 00 Tallywood Drive
Fayetteville NC 38303
Senate #12
Cumberland
Ralph A. Hunt
1005 Crete Street
Durham NC 27707
Senate #13
Durham, Granville, Orange, Person
Kenneth C. Royall, Jr.
P.O. Box 8766
Forest Hills Station
Durham NC 27707
Senate #13
Durham, Orange, Granville, Person
March, 1987
THE CAROLINA JOURNAL OF PHARMACY
13
Joseph E. Johnson
P.O. Box 750
Raleigh NC 27602
Senate #14
Wake, Harnett, Lee
J. K. Sherron
3329 Julian Drive
Raleigh NC 27604
Senate #14
Wake, Lee, Harnett
William W. Staton
605 Palmer Drive
Sanford NC 27330
Senate #14
Wake, Lee, Harnett
Robert D. Warren
Route 3, Box 25
Benson NC 27504
Senate #15
Johnston, Sampson
Wanda H. Hunt
P.O. Box 1335
Pinehurst NC 28374
Senate #16
Chatham, Moore, Orange, Randolph
Russell G. Walker
1004 Westmont Drive
Asheboro NC 27203
Senate #16
Chatham, Moore, Orange, Randolph
J. Richard Conder
1401 Carolina Drive
Rockingham NC 28379
Senate #17
Anson, Montgomery, Richmond, Scotland,
Stanley, Union
Aaron W. Plyler
2170 Concord Avenue
Monroe NC 281 10
Senate #17
Anson, Montgomery, Richmond, Scotland,
Stanley, Union
R.C. Soles, Jr.
P.O. Box 6
Tabor City NC 28463
Senate #18
Bladen, Brunswick, Columbus, Cumberland
Robert G. Shaw
P.O. Box 8101
Greensboro NC 27419
Senate #19
Forsyth, Guilford
Ted Kaplan
P.O. Box 5128
Winston Salem NC 27113
Senate #20
Forsyth
Marvin M. Ward
641 Yorkshire Road
Winston Salem NC 27106
Senate #20
Forsyth
George B. Daniel
P.O. Box 179
Yanceyville NC 27379
Senate #21
Alamance, Caswell
James C. Johnson, Jr.
29 Church Street, South
Concord NC 28025
Senate #22
Cabarrus, Mecklenburg
Robert Vance Somers
240 Confederate Avenue
Salisbury NC 28144
Senate #23
Davidson, Rowan, Davie
Continued on page 15
March, 1987
YOU WANT YOUR
"USUAL AND
CUSTOMARY"
DISPENSING FEE.
c
c
K?3
Marion thinks
you deserve it.
Pharmacists deserve a dispensing fee that
reflects the degree of professional service
required when filling a prescription. That's
why Marion reimburses pharmacists for their
"usual and customary" dispensing fee, no
matter what it is, when filling prescriptions
for Marion associates.
To us, it's simply a matter of principle:
pharmacists perform a valuable service, so
they should be reimbursed accordingly.
We believe that an arbitrarily fixed fee
is inconsistent with the reality of costs,
associated with filling prescriptions, varying
from one pharmacy to the next. The positive
response to our reimbursement program indi-
cates that our philosophy is shared by most
pharmacists.
As a result, Marion is currently working
with state and national pharmacy organiza-
tions to provide information about the suc-
cess of our reimbursement program so that
they may benefit from our experience when
negotiating with third-party insurers.
Reimbursing for the "usual and custom-
ary" dispensing fee— just one more way that
Marion demonstrates its commitment to
pharmacy through action, not words.
Service to Pharmacy
M
PHARMACEUTICAL DIVISION
MARION
LABORATORIES INC
THE CAROLINA JOURNAL OF PHARMACY
15
N.C. GENERAL ASSEMBLY
Continued from page 13
Paul S. Smith
P.O. Box 916
Salisbury NC 28144
Senate #23
Davie, Davidson, Rowan
William D. Goldston, Jr.
P.O. Box 307
Eden NC 27288
Senate #24
Alleghany, Ashe, Rockingham, Stokes, Surry,
Watauga
A.P. Sands, III
908 Oakhurst Drive
Reidsville NC 27320
Senate #24
Alleghany, Ashe, Rockingham, Stokes, Surry,
Watauga
J. Ollie Harris
P.O. Box 627
Kings Mountain NC 28086
Senate #25
Cleveland, Gaston, Lincoln, Rutherford
Helen Rhyne Marvin
119 Ridge Lane
Gastonia NC 28054
Senate #25
Cleveland, Gaston, Lincoln, Rutherford
Marshall A. Rauch
Box 609
Gastonia NC 28054
Senate #25
Cleveland, Gaston, Lincoln, Rutherford
Austin M. Allran
515 6th Avenue NW
Hickory NC 28601
Senate #26
Alexander, Catawba, Iredell, Yadkin
William W. Redman, Jr.
Route 2, Box 43
Statesville NC 28677
Senate #26
Alexander, Catawba, Iredell, Yadkin
Daniel Reid Simpson
P.O. Box 1329
Morganton NC 28655
Senate #27
Avery, Burke, Caldwell, Mitchell, Wilkes
Donald R. Kincaid
P.O. Box 988
Lenoir NC 28645
Senate #27
Avery, Burke, Caldwell, Mitchell, Wilkes
Robert S. Swain
Route 5, Box 1112
Asheville NC 28803
Senate #28
Buncombe, McDowell, Madison, Yancey
Dennis J. Winner
81-B Central Avenue
Asheville NC 28801
Senate #28
Buncombe, McDowell, Madison, Yancey
Charles William Hipps
505 N. Main Street, Suite 305
Waynesville NC 28786
Senate #29
Cherokee, Clay, Graham, Haywood,
Henderson, Jackson, Macon, Polk, Swain,
Transylvania
R.P. Thomas
P.O. Drawer 220
Hendersonville NC 28739
Senate #29
Cherokee, Clay, Graham, Haywood,
Henderson, Jackson, Macon, Polk, Swain,
Transylvania
David Russell Parnell
P.O. Box 100
Parkton NC 28371
Senate #30
Hoke, Robeson
William N. Martin
P.O. Box 21363
Greensboro NC 27420
Senate #3 1
Guilford
Continued on page 17
March, 1987
o
We're not
strangers...
LUasninpcon
national
INSURANCE COMPANY
NCPhA-Endorsed Insurance Plans
Which Merit Member Participation
DISABILITY INCOME PLAN HOSPITAL INCOME PLAN
MAJOR MEDICAL EXPENSE PLAN TERM LIFE PLAN
RETIREMENT AND PROFIT SHARING PLANS
FOR DETAILS WRITE OR TELEPHONE:
HOYT W. SHORE, CLU and Associates
821 Baxter Street-Suite 316
Charlotte, North Carolina 28202
Telephone (704) 333-3764
UJastiinQCon
national
INSURANCE COMPANY
Evanston. Illinois 60201 • A Washington National Corporation Financial Service Company
THE CAROLINA JOURNAL OF PHARMACY
17
N.C. GENERAL ASSEMBLY
Continued from page 15
Mary Seymour
1105 Pender Lane
Greensboro NC 27408
Senate #32
Guilford
James F. Richardson
1739 Northbrook Drive
Charlotte NC 28216
Senate #33
Mecklenburg
James D. McDuffie
819 Eastway Drive
Charlotte NC 28205
Senate #34
Mecklenburg
Laurence A. Cobb
3022 Sharon Road
Charlotte NC 28211
Senate #35
Mecklenburg
N.C. GENERAL ASSEMBLY
HOUSE OF
REPRESENTATIVES
(District and Counties
Represented)
R. M. (Pete) Thompson
Queen Ann Drive
Edenton NC 27932
House #1
Camden, Chowan, Currituck, Dare, Pasquotank,
Gates, Perquimans, Tyrrell, Washington
Vernon G. James
Route 4, Box 265
Elizabeth City NC 27909
House #1
Camden, Chowan, Currituck, Dare, Pasquotank,
Gates, Perquimans, Tyrrell, Washington
Howard B. Chapin
212 Smaw Road
Washington NC 27889
House #2
Beaufort, Hyde, Washington
Gerald L. Anderson
P.O. Box 568
Bridgeton NC 28519
House #3
Craven, Lenoir, Pamlico
Daniel L. Lilley
P.O. Box 824
Kinston NC 28501
House #3
Craven, Pamlico, Lenoir
Beverly M. Perdue
211 Wilson Point Road
New Bern NC 28560
House #3
Craven, Lenoir, Pamlico
J. Paul Tyndall
414 Woodhaven Drive
Jacksonville NC 28540
House #4
Cartaret, Onslow
W. Bruce Ethridge
Route 2, Box 27
Swansboro NC 28584
House #4
Onslow, Cartaret
Robert Grady
107 Jean Circle
Jacksonville NC 28540
House #4
Onslow, Cartaret
Brewster W. Brown
P.O. Box 527
Winton NC 27986
House #5
Northampton, Bertie, Gates, Hertford
Continued on page 18
March, 1987
11
THE CAROLINA JOURNAL OF PHARMACY
N.C. GENERAL ASSEMBLY
Continued from page 17
Eugene Rogers
908 Woodlawn Drive
Williamston NC 27892
House #6
Bertie, Hertford, Martin, Pitt
Thomas C. Hardaway
207 McDaniel Street
Enfield NC 27823
House #7
Halifax, Martin, Warren
Josephus L. Mavretic
Route 3, P.O. Box 1984
Tarboro NC 27886
House #8
Edgecombe, Nash
Walter B. Jones, Jr.
302 Hillcrest
Farmville NC 27828
House #9
Greene, Pitt
Edward N. Warren
227 Country Club Drive
Greenville NC 27834
House #9
Greene, Pitt
Wendell H. Murphy
Route l.Box76-E
Rose Hill NC 28458
House #10
Duplin, Jones
John Tart
Route l,Box 125-A
Goldsboro NC 27530
House # 1 1
Wayne
John Kerr
232 Ridgewood Drive
Goldsboro NC 27530
House #11
Wayne
Edd Nye
P.O. Box 8
Elizabethtown NC 28337
House #12
Bladen, Pender, Sampson
Ed Bowen
Route 1, Box 2
Harrells NC 28444
House #12
Bladen, Pender, Sampson
Harry E. Payne, Jr.
P.O.Box 1147
Wilmington NC 28402
House #13
New Hanover
A.M. Hall
223 Ashford Avenue
Wilmington NC 28405
House #13
New Hanover
E. David Redwine
P.O. Box 1238
Shallotte NC 28459
House #14
Brunswick, New Hanover, Pender
Richard Wright
P.O. Box 457
Tabor City NC 28463
House #15
Columbus
Daniel H. DeVane
Drawer N
Raeford NC 28376
House #16
Hoke, Robeson, Sampson
John C. Hasty
P.O. Box 338
Maxton NC 28364
House #16
Hoke, Robeson, Sampson
March, 1987
THE CAROLINA JOURNAL OF PHARMACY
19
Sidney A. Locks
P.O. Box 290
Lumberton NC 28358
House #16
Hoke, Robeson, Sampson
C.R. Edwards
1502BorosDr.
Fayetteville NC 28303
House #17
Cumberland
Luther R. Jeralds
319 Jasper Street
Fayetteville NC 28301
House #17
Cumberland
R.D. Beard
2918 Skye Drive
Fayetteville NC 28303
House #18
Cumberland
Joe Raynor
2198 Morganton Road
Fayetteville NC 28305
House #18
Cumberland
Alex Warner
3713 Hillcrest Street
Hope Mills NC 28348
House #18
Cumberland
Bob R. Ethridge
Box 295
Lillington NC 27546
House #19
Harnett, Lee
Dennis A. Wicker
1201 Burnes Drive
Sanford NC 27330
House #19
Harnett, Lee
George R. Brannon
309 Maplewood Drive
Smithfield NC 27577
House #20
Franklin, Johnston
Barney Paul Woodard
P.O. Box 5
Princeton NC 27569
House #20
Franklin, Johnston
Daniel Blue, Jr.
2541 Albemarle Avenue
Raleigh NC 27610
House #21
Wake
William T. Watkins
P.O. Box 247
Oxford NC 27565
House #22
Caswell, Granville, Halifax, Person, Vance,
Warren
James W. Crawford, Jr.
509 College St.
Oxford NC 27565
House #22
Caswell, Granville, Halifax, Person, Vance,
Warren
John T. Church
420 Woodland Road
Henderson NC 27536
House #22
Caswell, Granville, Halifax, Person, Vance,
Warren
H.M. Michaux
1722 Alfred Street
Durham NC 27713
House #23
Durham
Anne Barnes
3 1 3 Severin Street
Chapel Hill NC 27514
House #24
Orange, Chatham
Joe Hackney
104 Carolina Forest
Chapel Hill NC 27514
House #24
Orange, Chatham
Continued on page 20
March, 1987
20
THE CAROLINA JOURNAL OF PHARMACY
N.C. GENERAL ASSEMBLY
Continued from page 19
Robert L. McAllister
Route 1, Box 336
Ruffin NC 27326
House #25
Alamance, Rockingham, Stokes
Bertha B. Holt
P.O. Box 1 1 1 1
Burlington NC 27215
House #25
Alamance, Rockingham, Stokes
R. Samuel Hunt, HI
1218 W.Davis Street
Burlington NC 27215
House #25
Alamance, Rockingham, Stokes
J. Fred Bowman
814 N. Graham-Hopedale Road
Burlington NC 27215
House #25
Alamance, Rockingham, Stokes
Herman C. Gist
442 Gorrell Street
Greensboro NC 27406
House #26
Guilford, Randolph
Albert S. Lineberry, Sr.
300 Meadowbrook Terrace
Greensboro NC 27408
House #27
Guilford
Margaret Keesee-Forrester
204 N. Mendenhall St.
Greensboro NC 27403
House #27
Guilford
CONGRATULATIONS TO
DIANE and HARRY BROGDEN
On their beautiful new store, The Drug Store, in
Lincolnton. It was a pleasure to help design and supply
fixtures for this showplace pharmacy.
H Warren Spear R Ph
Pharmacy Design Specialist
415 Augusta Drive
Statesville, North Carolina 28677
(704)873-9993
Spear Associates — planners, de-
signers and installers of pharmacy
fixtures & equipment
March, 1987
THE CAROLINA JOURNAL OF PHARMACY
21
Frank J. Sizemore
711 Greene Street
Greensboro NC 27401
House #27
Guilford
Mary Jarrell
1010 Wickliff Avenue
High Point NC 27260
House #28
Guilford
Richard E. Chalk
427 Wright Street
High Point NC 27260
House #28
Guilford
Michael Decker
6011 Bexhill Drive
Walkertown NC 27051
House #29
Guilford, Forsyth
William T. Boyd
1315 N. Shore Drive
Asheboro NC 27203
House #30
Chatham, Randolph
James M. Craven
P.O. Box 358
Asheboro NC 28379
House #31
Moore
Donald M. Dawkins
Route 3, Box 358
Rockingham NC 28379
House #32
Richmond, Scotland
Foyle Hightower, Jr.
715 E. Wade Street
WadesboroNC 28170
House #33
Anson, Montgomery
William G. Alexander
1589 Daybreak Ridge Road
Kannapolis NC 28081
House #34
Cabarrus, Stanley, Union
Coy C. Privette
306 Cottage Drive
Kannapolis NC 28081
House #34
Cabarrus, Stanley, Union
Bobby H. Barbee, Sr.
P.O. Box 656
Locust NC 280973
House #34
Cabarrus, Stanley, Union
Timothy N. Tallent
210 Corban Ave. SE
Concord NC 28025
House #34
Cabarrus, Stanley, Union
Brad V. Ligon
Route 12, Box 460
Salisbury NC 28144
House #35
Rowan
Charlotte A. Gardner
1500 West Colonial Drive
Salisbury NC 28144
House #35
Rowan
Raymond Warren
10003 Grand Junction Road
Charlotte NC 28212
House #36
Mecklenburg
Betsy L. Cochrane
Box 517
Bermuda Run
Advance NC 27006
House #37
Davidson, Iredell, Davie
Charles L. Cromer
Route 4, Box 362
Thomasville NC 27360
House #37
Davidson, Iredell, Davie
Continued on page 22
March, 1987
22
THE CAROLINA JOURNAL OF PHARMACY
N.C. GENERAL ASSEMBLY
Continued from page 21
Joe H. Hege
1 526 Greensboro Street
Lexington NC 27292
House #37
Davidson, Iredell, Davie
Harold J. Brubaker
138 Scarboro Street
Asheboro NC 27203
House #38
Randolph
Ann Q. Duncan
4237 Mashie Drive
Winston Salem NC 27040
House #39
Forsyth
Frank E. Rhodes
4701 Whitehaven Road
Winston Salem NC 27106
House #39
Forsyth
Theresa H. Esposito
207 Stanaford Road
Winston Salem NC 27104
House #39
Forsyth
David H. Diamont
P.O. Box 784
Pilot Mountain NC 27041
House #40
Alleghaney, Ashe, Stokes, Surry, Watauga
Wade F. Wilmoth
209 Crest Drive
Boone NC 28607
House #40
Alleghaney, Ashe, Stokes, Surry, Watauga
Judy Hunt
P.O. Box 1526
Blowing Rock NC 28605
House #40
Alleghaney, Ashe, Stokes, Surry, Watauga
John Walter Brown
Route 2, Box 87
ElkinNC 28621
House #41
Alexander, Wilkes, Yadkin
George M. Holmes
P.O. Box 217
Yadkinville NC 27055
House #4 1
Alexander, Wilkes, Yadkin
Lois S. Walker
611 Woods Drive
Statesville NC 28677
House #42
Iredell
C. Robert Brawley
P.O. Box 1322
MooresvilleNC28115
House #43
Alexander, Catawba, Iredell
David W. Bumgardner, Jr.
209 Peachtree Street
Belmont NC 28012
House #44
Gaston, Lincoln
Walter H. Windley
1531 Shady Bark Drive
Gastonia NC 28054
House #44
Gaston, Lincoln
J. Vernon Abernethy
P.O. Box 381 Avenue
Gastonia NC 28054
House #44
Gaston, Lincoln
Johnathan L. Rhyne, Jr.
P.O. Box 832
Lincolnton NC 28092
House #44
Gaston, Lincoln
March, 1987
THE CAROLINA JOURNAL OF PHARMACY
23
W. Stine Isenhower
505 2nd Avenue, NE
ConoverNC 28613
House #45
Burke, Catawba
Doris R. Huffman
Route 4, Box 81
Newton NC 28650
House #45
Burke, Catawba
Edgar Vance Starnes
P.O. Box 425
Granite Falls NC 28630
House #46
Alexander, Avery, Burke, Caldwell, Mitchell,
Watauga
Charles F. Buchanan
Route 1
Green Mountain NC 28740
House #46
Alexander, Avery, Burke, Caldwell, Mitchell,
Watauga
James F. Hughes
P.O. Box 277
Linville NC 28656
House #46
Alexander, Avery, Burke, Caldwell, Mitchell,
Watauga
Ray C. Fletcher
P.O. Box 68
Valdese NC 28690
House #47
Burke
John J. Hunt
P.O. Box 277
Lattimore NC 28089
House #48
Cleveland, Polk, Rutherford
Edith L. Lutz
Route 3
Lawndale NC 28090
House #48
Cleveland, Polk, Rutherford
Charles D. Owens
P.O. Box 610
Forest City NC 28043
House #48
Cleveland, Polk, Rutherford
Robert C. Hunter
565 Forest Heights
Marion NC 28752
House #49
McDowell, Yancey
Larry T. Justus
P.O. Box 2396
Hendersonville NC 28739
House #50
Henderson
Marie W. Colton
392 Charlotte Street
Asheville NC 28801
House #5 1
Buncombe, Transylvania, Henderson
Narvel J. Crawford
15 Edgemont Road
Asheville NC 28801
House #51
Buncombe, Transylvania, Henderson
Gordon H. Greenwood
P.O. Box 487
Black Mountain NC 28711
House #51
Buncombe, Transylvania, Henderson
Martin L. Nesbit
Suite 814
Northwestern Bank Building
Asheville NC 28801
House #51
Buncombe, Transylvania, Henderson
Continued on page 25
March, 1987
Human insulin for all. Humuliri
human insulin
[recombinant DNA origin]
Identical to human Insulin. Humulin is the only insulin not
derived from animal pancreases.
Recombinant DNA technology makes the production of
Humulin possible and virtually assures every insulin user of a
lifetime supply
From Lilly ... a dependable source of insulin for
generations. Since 1922, when we became the first company
to manufacture insulin, we have led the search for the best
diabetes care products and, at the same time, maintained a
constant supply of insulin for all insulin users
Our 24 formulations of insulin— including Humulin and all
forms of lletinl? (insulin)— are available through the widest retail
distribution of insulin in the United States
Beyond that, we will continue to provide a wide range of
diabetes service and educational materials for use by physi-
cians, pharmacists, and diabetes educators
© 1986 ELI LILLY AND COMPANY
Our Medical Division is on call. Our Medical Division staff
is only a phone call away Please contact them if you have any
questions about our diabetes care products
Any change of insulin should be made cautiously and
only under medical supervision. Changes in refinement,
purity, strength, brand (manufacturer), type (regular, NPH,
Lente- , etc), and/or method of manufacture (recombinant DNA
versus animal-source insulin) may result in the need for a change
in dosage
titty Leadership
IN DIABETES CARE
For information on insulin delivery systems, contact CPI 1(800)227 3422
S&fy
Eli Lilly and Company
Indianapolis, Indiana 46285
THE CAROLINA JOURNAL OF PHARMACY
25
N.C. GENERAL ASSEMBLY
Continued from page 23
Charles Beall
Route 3, Box 322
Clyde NC 28721
House #52
Graham, Haywood, Jackson, Madison, Swain
Liston B. Ramsey
P.O. Box 337 322
Marshall NC 28753
House #52
Graham, Haywood, Jackson, Madison, Swain
Jeff H. Enloe
Route 1, Box 38
Franklin NC 28734
House #53
Cherokee, Clay, Graham, Macon
John B. McLaughlin
P.O. Box 158
Newell NC 28126
House #54
Mecklenburg
C. Ivan Mothershead
1815 Queens Road
Charlotte NC 28205
House #55
Mecklenburg
Jo Graham Foster
1520 Maryland Avenue
Charlotte NC 28209
House #56
Mecklenburg
Harry Grimmer
4000 Highridge Road
Matthews NC 28105
House #57
Mecklenburg
Ruth M. Easter ling
811 Bromley Road #1
Charlotte NC 28207
House #58
Mecklenburg
W. Pete Cunningham
3121 Valleywood Place
Charlotte NC 28216
House #59
Mecklenburg
Howard C. Barnhill
2400 Newland Road
Charlotte NC 28216
House #60
Mecklenburg
Casper Holroyd
1401 Granada Drive
Raleigh NC 27612
House #61
Wake
William M. Freeman
502 Burton Street
Fuquay-Varina NC 27526
House #62
Wake
Margaret Stamey
6201 Arnold Road
Raleigh NC 27607
House #63
Wake
Betty H. Wiser
404 Dixie Trail
Raleigh NC 27607
House #64
Wake
Aaron E. Fussell
1201 Briar Patch Lane
Raleigh NC 27609
House #65
Wake
Annie Brown Kennedy
3727 Spaulding Drive
Winston Salem NC 27105
House #66
Forsyth
Continued on page 30
March, 1987
(jM^g.v^^
More than 50,000 pharmacists know these men
and use their wisdom to solve everyday problems.
Dave Schmidt and Harles Cone, Ph.D., gave
them a better understanding of human nature
and improved their ability to communicate.
And many have profited from the good dollar
sense of Allan Hurst and his lectures on financial
planning, cash flow and store management:
We're proud to have brought their Professional
Development programs to your association meet-
ings and conventions during the past 12 years.
We hope they made your world better
,*4R%5Uifr
1 Upiohn Company, I
THE CAROLINA JOURNAL OF PHARMACY
27
STILL GOING STRONG
AFTER 1 MILLION
PRESCRIPTIONS
MOUNT HOLLY — Thomas Holland became
a pharmacist simply because it seemed the
natural thing to do. After all, his family had been
in the business since 1893.
"I just kind of fell into it," says Holland, 66,
who owns the Holland Drug Co. at the corner of
Main Street and Central Avenue. "I didn't feel a
deep calling for it, like a minister or a
schoolteacher would. I worked at the soda
fountain as a teenager and went from there to
pharmacy school."
With the growth of chain drugstores, there
aren't as many customers getting prescriptions at
Holland's corner drugstore as before. Still, he
reached a milestone by filling the store's one
millionth prescription on Oct. 28.
Holland's was started by Washington Holland,
Thomas's grandfather, in 1893 across the street
from its present location at 100 N. Main St.
Washington Holland's son, Willis, joined the
store in 1910 and Thomas followed in 1945,
three years after graduating from the UNC
School of Pharmacy and passing his state boards.
He would have come to work sooner, but
World War II got in the way. "The draft board
was breathing down my neck, so I enlisted in the
Navy," he says.
The Navy put his pharmacy skills to work right
away, assigning him first to a hospital in
Newport, R.I., then to another in England and
eventually to a destroyer.
When Holland returned from military service,
he immediately started working with his father.
"We worked together until he died in 1971," he
says.
Holland now runs the pharmacy alone except
for Wednesdays, when he gets help from Charlie
Yandell, a retired drug salesman and licensed
pharmacist who also works for Caldwell Drug
Co. in Gastonia. Yandell also fills in when
Holland takes a vacation, usually for about two
weeks a year.
Holland hasn't had competition from any of
the big chain drugstores around Mount Holly, but
a Revco will open in a new shopping center off
N.C. 27 in April. He acknowledges that Eckerds
and a new Rite-Aid store down N.C. 273 in
Belmont have cut into his market share over the
years.
"We don't fill as many prescriptions, but they
are more expensive," he said. "That's not good
for the customers, but we can't help it. It's one of
the facts of life."
Still, Holland has survived because his store
has kept the old-fashioned, small-town way of
doing business intact, he says. It still has a soda
fountain where townspeople gather to trade the
latest news, and the service from the pharmacy
has a personal touch.
"We have old family ties," he says. "We are
smaller than the other stores, and we know a lot
of our customers by name."
Holland's legacy will end whenever he decides
to retire. His son opted for a career in banking
rather than continuing with the family business.
"He's got his degree in accounting and works
for the S.C. National Bank in Columbia," he said.
"When he went to Chapel Hill, he declared his
major in pharmacy, but switched to accounting."
That means Holland probably would have to
sell his store to another pharmacist looking to
enter business for himself. But he hasn't really set
a date for doing that.
"I've thought about it," he says. "But I'm not a
golfer or fisherman, so I'm not in a hurry."
The Drug Enforcement Administration (DEA)
is intensifying its drug diversion surveillance by
expanding its diversion staff from 190 to nearly
400 investigators. One thrust of this activity will
be to ensure that manufacturers are actively
monitoring for excessive orders.
Remember the ^Day
...in'D'ctures
COLORCRAFT
North Carolina's Most Complete
Film Processing Service
There Is A Plant Located
Near You
For the Finest Quality Plus Fast
Dependable Service on All Your
Photo Needs, Contact the Plant
Nearest You.
CHARLOTTE WILMINGTON
KERNERSVILLE RALEIGH
FAYETTEVILLE DURHAM
If You Don't Know Photofinishing
Know Your Photographer
March, 1987
INTRODUCING
NEW
ONCE-DAILY
ISOPTIN
(verapamil HCI/Knoll)
240 mg scored sustained-release tablets for hypertension
• Only calcium channel
blocker available in SR
form for once-a-day
therapy
• New SR dosage form
allows greater patient
compliance
• Well documented safety
profile
• In mild to moderate
essential hypertension, a
more logical therapeutic
choice than beta
blockers or diuretics
WC04M 1826.02
isoptinM
(verapamil HCI/Knoll)
240 mg
SUSTAINED-RELEASE TABLETS j
Caution: Federal law prohibits dispensing
"fitotil prescription. ?:s-
Xnoli Pharmaceuticals /\
* ' ■ 8*Sf KSf .,;>. My i i
A product of Knoll Research
Whippany. New Jersey C
• Economically packaged
in bottles of 100 tablets
• Liberal return-goods
policy
Supported by a
comprehensive
promotional
program, including:
• Extensive detailing
• Journal advertising
• Direct mail to
high-volume prescribers
Order today from your
wholesaler
6.
knoll
Serving the pharmacy profession for more than 80 years
Please see next page for brief summary.
© 1986 BASF K&f Corporation
2454B-11-86
NEW. . . ONCE DAILY Bnef Summary
IN MILD TO MODERATE
HYPERTENSION
ISOPTIN-SR
(verapamil HCI/Knoll)
240 mg scored, sustained-release tablets
CONTRAINDICATIONS: 1) Severe left ventricular dysfunction (see WARNINGS). 2) Hypotension (less than 90 mmHg systolic pressure) or cardiogenic
shock, 3) Sick sinus syndrome or 2nd or 3rd degree AV block (except in patients with a functioning artificial ventricular pacemaker).
WARNINGS: Heart Failure: ISOPTIN should be avoided in patients with severe left ventricular dysfunction (see DRUG INTERACTIONS). Patients with
milder ventricular dysfunction should, if possible, be controlled before verapamil treatment. Hypotension: ISOPTIN (verapamil HCI) may produce
occasional symptomatic hypotension. Elevated Liver Enzymes: Elevations of transaminases with and without concomitant elevations in alkaline
phosphatase and bilirubin have been reported. Periodic monitoring of liver function in patients receiving verapamil is therefore prudent. Accessory
Bypass Tract (Wolff-Parkinson-White): Patients with paroxysmal and/or chronic atrial flutter or atrial fibrillation and a coexisting accessory AV pathway
have developed increased antegrade conduction across the accessory pathway producing a very rapid ventricular response or ventricular fibrillation after
receiving intravenous verapamil. While this has not been reported with oral verapamil, it should be considered a potential risk. Treatment is usually
DC. -cardioversion. Atrioventricular Block: The effect of verapamil on AV conduction and the SA node may cause asymptomatic 1st degree AV block and
transient bradycardia Higher degrees of AV block, while infrequent (0.8%), may require a reduction in dosage or, in rare instances, discontinuation of
verapamil HCI. Patients with Hypertrophic Cardiomyopathy (IHSS): Although verapamil has been used in the therapy of patients with IHSS, severe
cardiovascular decompensation and death have been noted in this patient population.
PRECAUTIONS: Impaired Hepatic or Renal Function: Verapamil is highly metabolized by the liver with about 70% of an administered dose excreted in
the urine In patients with impaired hepatic or renal function verapamil should be administered cautiously and the patients monitored for abnormal
prolongation of the PR interval or other signs of excessive pharmacological effects (see OVERDOSAGE).
Drug Interactions: Beta Blockers: Concomitant use of ISOPTIN and oral beta-adrenergic blocking agents may be beneficial in certain patients with
chronic stable angina or hypertension, but available information is not sufficient to predict with confidence the effects of concurrent treatment in
patients with left ventricular dysfunction or cardiac conduction abnormalities. Digitalis: Clinical use of verapamil in digitalized patients has shown the
combination to be well tolerated if digoxm doses are properly adjusted. However, chronic verapamil treatment increases serum digoxin levels by 50 to
75% during the first week of therapy and this can result in digitalis toxicity Upon discontinuation of ISOPTIN (verapamil HCI), the patient should be
reassessed to avoid underdigitalization. Antihypertensive Agents: Verapamil administered concomitantly with oral antihypertensive agents (e.g.,
vasodilators, angiotensin-converting enzyme inhibitors, diuretics, beta blockers, prazosin) will usually have an additive effect on lowering blood
pressure. Patients receiving these combinations should be appropriately monitored. Disopyramide: Disopyramide should not be administered within 48
hours before or 24 hours after verapamil administration Quinidine: In patients with hypertrophic cardiomyopathy (IHSS), concomitant use of verapamil
and quinidine resulted in significant hypotension. There has been a report of increased quinidine levels during verapamil therapy. Nitrates: The
pharmacologic profile of verapamil and nitrates as well as clinical experience suggest beneficial interactions Cimetidine: Two clinical trials have shown a
lack of significant verapamil interaction with cimetidine. A third study showed cimetidine reduced verapamil clearance and increased elimination to 1 12.
Anesthetic Agents: Verapamil may potentiate the activity of neuromuscular blocking agents and inhalation anesthetics. Carbamazepine: Verapamil may
increase carbamazepine concentrations during combined therapy. Rifampin Therapy with rifampin may markedly reduce oral verapamil bioavailability
Lithium: Verapamil may iower lithium levels in patient on chronic oral lithium therapy. Carcinogenesis, Mutagenesis, Impairment of Fertility: There was
no evidence of a carcinogenic potential of verapamil administered to rats for two years Verapamil was not mutagenic in the Ames test. Studies in female
rats did not show impaired fertility. Effects on male fertility have not been determined Pregnancy (Category C): There are no adequate and well-
controlled studies in pregnant women ISOPTIN crosses the placental barrier and can be detected in umbilical vein blood at delivery. This drug should be
used during pregnancy, labor, and delivery, only if clearly needed. Nursing Mothers: ISOPTIN is excreted in human milk, therefore, nursing should be
discontinued while verapamil is administered Pediatric Use: Safety and efficacy of ISOPTIN in children below the age of 18 years have not been
established
ADVERSE REACTIONS: Constipation 8.4%, dizziness 3.5%, nausea 2.7%, hypotension 2.5%, edema 2.1%, headache 1.9%, CHF/pulmonary edema
1.8%, fatigue 1.7%. bradycardia 1.4%, 3° AV block 0.8%, flushing 0.1%, elevated liver enzymes (see WARNINGS) The following reactions, reported in
less than 1.0% of patients, occurred under conditions (open trials, marketing experience) where a causal relationship is uncertain: they are mentioned
to alert the physician to a possible relationship angina pectoris, arthralgia and rash, AV block, blurred vision, cerebrovascular accident, chest pain,
claudication, confusion, diarrhea, dry mouth, dyspnea, ecchymosis or bruising, equilibrium disorders, exanthema, gastrointestinal distress, gingival
hyperplasia, gynecomastia, hair loss, hyperkeratosis, impotence, increased urination, insomnia, macules, muscle cramps, myocardial infarction,
palpitations, paresthesia, psychotic symptoms, purpura (vasculitis), shakiness, somnolence, spotty menstruation, sweating, syncope, urticaria.
Treatment of Acute Cardiovascular Adverse Reactions: Whenever severe hypotension or complete AV block occur following oral administration of
verapamil, the appropriate emergency measures should be applied immediately, e.g., intravenously administered isoproterenol HCI, levarterenol
bitartrate, atropine (all in the usual doses), or calcium gluconate (10% solution). If further support is necessary, inotropic agents (dopamine or
dobutamine) may be administered Actual treatment and dosage should depend on the severity and the clinical situation and the ludgment and
experience of the treating physician.
OVERDOSAGE: Treatment of overdosage should be supportive Beta-adrenergic stimulation or parenteral administration of calcium solutions may
increase calcium ion flux across the slow channel, and have been used effectively in treatment of deliberate overdosage with verapamil Clinically
significant hypotensive reactions or fixed high degree AV block should be treated with vasopressor agents or cardiac pacing, respectively Asystole
should be handled by the usual measures including cardiopulmonary resuscitation
Knoll Pharmaceuticals
A Unit of BASF K&F Corporation
Whippany, New Jersey 07981
A.
BASF Group knOll
i 1986, BASF K&F Corporation 2474,11-86 Printed in U.S.A.
30
THE CAROLINA JOURNAL OF PHARMACY
Triazolobenzodiazepines:
New and Improved
Antidepressants?
"A relatively new class of drugs — triazolo-
benzodiazepines — may represent a major
breakthrough in safety and efficacy for the
treatment of depression," says Jay B. Cohn,
M.D., Ph.D., clinical professor of psychiatry,
department of psychology and biobehavioral
sciences. University of California College of
Medicine in Los Angeles.
Unlike earlier benzodiazepines, triazoloben-
zodiazepines show considerable promise for
treating depression, according to Karl Rickels,
MD., professor of psychiatry at the University of
Pennsylvania School of Medicine in Philadel-
phia. Although benzodiazepines relieve anxiety,
they can worsen depression. Unfortunately, the
two conditions often coexist.
Now, a preliminary report by Rickels has
developed new and encouraging evidence that
triazolobenzodiazepines such Xanax, unlike
earlier benzodiazepines, are effective in relieving
both depression and anxiety. The study involving
504 outpatients with a variety of depressive
symptoms compared the effectiveness of Xanax
with two TCA antidepressants, amitriptyline and
doxepin.
Xanax was equal to the TCAs in producing
clinical improvement of patients, but superior
when 12 adverse side effects were compared:
drowsiness, dry mouth, tachycardia (accelerated
heartbeat), constipation, blurred vision,
hypotension, nervousness, headache, faintness,
nausea or vomiting, light-headedness, and
diarrhea. Drowsiness was produced equally by
the three medications, but Xanax showed fewer
cardiovascular effects.
"At Upjohn," says Robert P. Purpura, M.D.,
medical manager, psychopharmacology medical
research, "we are presently evaluating a new
drug, Deracyn (adinazolam), another triazolo-
benzodiazepine, in patients suffering from
neurotic depressive disorders. We hope this drug
will prove safer than presently available
antidepressants, with fewer cardiotoxic effects."
Anxiety and depression together afflice many
millions of Americans. For them, the successful
outcome of the search for safer medications
without adverse effects on the heart will be an
important and significant event.
Additional Readings
1. Alexander B., "A Review of Psychotropic
Drugs, Part 2: Antidepressants," Journal of
Pharmacy Technology, 1:3, May/ June 1985,
pp. 104-107.
2. Brody, J. The New York Times Guide to
Personal Health, Times Books, New York,
1982, pp. 146-151,678-680.
3. Rickels, K., et al., "Alprazolam, Amitri-
ptyline, Doxepin, and Placebo in the
Treatment of Depression," Archives of
General Psychiatry, 42, February 1985, pp.
134-141.
N.C. GENERAL ASSEMBLY
Continued from page 25
Logan Burke
3410 Cumberland Drive
Winston Salem NC 27105
House #67
Forsyth
Sharon Thompson
1809Glendale
Durham NC 27701
House #68
Durham
George W. Miller, Jr.
3862 Sommerset Drive
Durham NC 27707
House #69
Durham
Milton F. Fitch, Jr.
516 S. Lodge Street
Wilson NC 27893
House #70
Edgecombe, Nash, Wilson
Larry E. Ethridge
1 124 Delano Avenue
Wilson NC 27893
House #71
Nash, Wilson
Roy (Coop) Cooper III
50 1 6 Netherwood Road
Rocky Mount NC 27803
House #72
Nash, Edgecomb
Keep this for your records
March, 1987
THE CAROLINA JOURNAL OF PHARMACY
31
CHARLOTTE WOMAN'S
PHARMACEUTICAL
AUXILIARY
The Members of the Charlotte Woman's
Pharmaceutical Auxiliary have been experienc-
ing some different types of meetings than we have
previously attended. These have been planned by
Mrs. Johnie Bennick (Marguerite), First Vice
President and Program Chairperson.
In January we changed the day and time of the
regular meeting in order to secure the Two
Decker Fun Bus that WBT schedules, free of
charge, to community and religious groups. (Of
course, the Organization may tip the driver!)
A tour of the N.C. University at Charlotte was
our destination for the day. By pre-arrangement
the Director of Development joined the group on
board the bus to first tour the Campus and the
surrounding grounds and various important
buildings, such as: the Memorial Hospital,
University Research Park and University Place, a
"newtown" center adjacent to the Campus. After
the Bus tour we walked through some of the
Buildings. We enjoyed a delicious Lunch in the
Cafeteria, visited the Library, the Special
Collection of Books and Art, the Mary and Harry
L. Dalton Rare Book Room.
We were pleased at the growth of the
University and quite proud that it is such an
important part of Charlotte.
In February the Charlotte Woman's
Pharmaceutical Auxiliary had a learning session
on an important subject — "Personal Legal Plans
— Wills and Estates." This Company was
created to act as Consultants between Client and
Lawyer.
This is a service that through talks to groups,
through Seminars, visits to one's home — if
needed — gives information on many legal
questions, helps one formulate questions one may
need to ask the Attorney. It could be questions
about Wills, Children or Spousal Trusts, Power
of Attorney, Living Wills, Tax Advice, Personal
Income Tax Preparation. Information on these
subjects is to help one formulate the questions
one may need to ask an Attorney.
This Group will send a person to one's home,
will answer your questions by phone. This is a
service that saves time and expense making one's
visit to the Attorney's Office more fruitful in less
time. Also can cut down on number of calls one
may have to make to an Office. With such
preparation on questions one needs to know one
will not so often leave the Attorney's Office with
some important question thought about much
later necessitating another visit to the Attorney's
Office.
In March the Charlotte Woman's Pharma-
ceutical Auxiliary celebrated the Annual Fun
Day and visit of the State President in a different
way. As a group we visited the WBTV Station at
One Julian Price Place.
We were met by the Station Hostess who gave
us a guided tour of the Station. Since "Top of the
Day" Program was out on location, the Auxiliary
Members were allowed a brief visit in the Control
Room. This was exciting! We found the tour of
the various sets and activities fascinating.
We had Lunch in the Station Cafeteria. Each
one enjoyed their special selection of food . . .
and recognizing some of the T.V. personalities.
Also it was fun to see how many of the pictures,
lining the walls, of Radio and T.V. personalities
we could recognize. We were quite excited when
we recognized Johnie and Marguerite Bennick's
picture taken in New York, several years ago,
when they were contestants on a T.V. Show . . .
They had won Funds for a Special Charity.
After lunch we had a brief business session. A
gift was presented the State President, Jewel
Oxendine, one of our own members!
A Special Meeting was set for later in March in
order to correlate and complete the plans of the
Auxiliary for the Annual Convention of the N.C.
Pharmaceutical Association and the Auxiliaries
Meeting in Charlotte in April 22, 23, 24 and 25.
LOCAL NEWS
THE GUILFORD COUNTY SOCIETY
OF PHARMACISTS
GREENSBORO, NC
The regular monthly meeting of the Guilford
County Society of Pharmacists was held on
Sunday evening, February 1 5, 1 987, at Moses H.
Cone Memorial Hospital in Greensboro. Our
speaker was David R. Work, J.D., R.Ph.,
Executive Director of the North Carolina Board
of Pharmacy. The program consisted of a review
of current Board of Pharmacy activities, and a
slide presentation on the licensure examination.
Those in attendance were certainly enlightened
as to some of the "interesting" results obtained by
candidates for licensure on the practical portion
of the examination. Following the program, there
was a short business, then the meeting was
adjourned.
J. Frank Burton
Sec.-Tres.
March, 1987
32
THE CAROLINA JOURNAL OF PHARMACY
SOCIO ECONOMIC SEMINAR
Holiday Inn Four Seasons
Greensboro, February 25, 1987
John W. Hasty, coordinator of the Virginia Impaired Pharmacists program and President
of the Virginia Pharmaceutical Association.
Virgil McBride, NCPhA Legislative Agent
March, 1987
THE CAROLINA JOURNAL OF PHARMACY
SOCIO ECONOMIC SEMINAR
33
Recie Bomar, Professional Operations Representative, Revco Drug Stores.
Dennis Moore, Chairman, North Carolina Impaired Pharmacist Committee
March, 1987
34
THE CAROLINA JOURNAL OF PHARMACY
DICKINSONS PHARMACY
by Jim Dickinson
"The Doctor's Pharmacy. " Dear Pharmacy
School: I have a new health care facility in
Connellsville, Pa. and plan to open a new
pharmacy called the DRx's Pharmacy. I believe
under the new state laws I as a physician may own
such a facility. But if that might not appear ethical
in any manner, I would be happy to help get anew
pharmacist established in this facility.
So wrote Dr. Mark S. Fremd, 32, recently. His
response was bleak — and it should not have
been. Pharmacy schools are overflowing with
bright, eager, soon-to-graduate pharmacists
whose shoulders are stooped under the burden of
student loan payback obligations, and whose
eyes are filled with dollar signs put there by chain
drugstore recruiters.
The Dr. Fremds of this world — and surely
there are many, as the medical profession tightens
its belt in adverse economic circumstances —
want young, energetic pharmacists to take a
chance with them.
Dr. Fremd's situation is intriguing. He has a
practice of nearly 2,000 "active" patients, many
of whom are elderly, and two large apartment
buildings nearby. Beyond Connellsville (48 miles
southeast of Pittsburgh) is an immediate
population catchment of some 12,000 people
and 8-12 prescribing physicians.
In a two-mile radius of his Family Health Care
Center, Dr. Fremd has three chain drugstores and
one Medicine Shoppe — and he says his patients
are always badgering him about when is he going
to get a pharmacy for them? Many of them are
old, and they don't want to walk 8-10 blocks to
the nearest pharmacy.
He is a bright, volatile entrepreneur and he
wants to help them as he helps himself. But where
are the bright, entrepreneurial pharmacists?
Sadly, he's frustrated. The chains are taking
them all, at starting salaries around $30,000-plus,
and they don't see his neighborhood as easy
pickings (that's all that inefficiently big
corporations seem to want these days: easy
pickings. Possibly it has something to do with
excessive price-cannibalism in the mass-
merchandise market and a consequent reluctance
to risk threadbare profit margins on ventures that
constitute less than a sure thing).
Anyway, Dr. Fremd could not have the
interactive kind of health care relationship with a
chain and his patients that he could with a
pharmaceutical entrepreneur. And he isn't sure
he wants to get into bed with a chain, anyway; he
says one tough, street-wise chain operator he
approached gave him some friendly advice —
"Hey, doc, you don't want to get into this. It's a
dirty business."
So, what does he do? He frankly admits that
he's explored the dispensing-physician option. It
would solve his patients' problem, but he doesn't
like the ethical aspects, and the suspicions he fears
that the dual role could arouse in his patients.
But Dr. Fremd has other ideas. He wants his
pharmacist partner (if he ever finds one) to help
him launch a DRx's Pharmacy chain that would
promote patient-interactive good health, home
health care, home oxygen service, and all the
spin-off goods and services that could follow.
But he's only 32. He hasn't amassed the fortune
and the savvy that all this could take to start. He
needs the help of an enterprising pharmacist.
And the best thing of all about this is that there
has to be thousands of Dr. Fremds out there.
The truly sad thing is: Where are the young,
risk-taking, energetic pharmacists? They're "out
there," too, but their debt burdens seem to be too
big to allow them to answer the call of this unmet
market.
This feature is presented on a grant from G.D. Searle &
Co. in the interests of promoting the open discussion of
professional issues in pharmacy. G.D. Searle & Co.,
accepts no responsibility for the views expressed herein
as they are those of the author and not necessarily those
of G.D. Searle & Co.
NC BOARD OF PHARMACY
APRIL MEETING
This Memo shall serve as notice to all
interested parties that the North Carolina Board
of Pharmacy will hold its regular monthly
meeting on Tuesday and Wednesday, April 21st
and 22nd in Charlotte, North Carolina. The
meeting on Tuesday, April 21st will consist of a
hearing which is scheduled in the County
Commissioners Hearing Room, Room 400,
County Office Building, Charlotte, North
Carolina. The Board will continue its meeting to
consider other business on Wednesday, April
22nd in the Adams Mark Hotel, 555 South
McDowell Street in Charlotte.
The North Carolina Pharmaceutical Associa-
tion is meeting in Charlotte at that time.
March, 1987
THE CAROLINA JOURNAL OF PHARMACY
35
CLASSIFIED ADVERTISING
Classified advertising (single issue insertion) 25 cents a word with a minimum charge of $5.00 per
insertion. Payment to acompany order.
Names and addresses will be published unless a box number is requested.
In replying to "blind" ads, address Ad. No., Carolina Journal of Pharmacy, P.O. Box 151, Chapel
Hill, NC 27514. Telephone (919) 967-2237.
MEDICINE SHOPPE FOR SALE: Don't
miss this excellent opportunity to be your
own boss in a professional atmosphere.
The Medicine Shoppe, a prescription
oriented pharmacy located in Raeford,
NC has been offered for immediate sale.
This fine opportunity offers clinic hours
and a positive cash flow from Day 1 . If you
have been considering owning your own
pharmacy, this could be an outstanding
opportunity for you! Financing available.
Contact John Aumiller, Medicine Shoppe
Intl., Inc. at 1-800-325-1397.
PHARMACISTS WANTED: Kerr Drug
Stores has pharmacist positions available
in North Carolina. For more information
send resume to PO Box 61000, Raleigh
NC 27661 or call Jackie Gupton at (919)
872-5710.
WEEKEND PHARMACY COVERAGE
NEEDED: Granville Hospital, a 66 bed
community hospital, requires Pharmacist
coverage on Saturdays and Sundays.
Maintain unit dose system and patient
profiles. Contact Joe Earnhardt, Director
of Pharmacy, Granville Hospital, College
St. Extension, Oxford NC 27565. (919)
693-5115.
PHARMACIST PROFESSIONAL SER-
VICES/CONSULTATION: Temporary and
or Continual. Contact: L. W. Matthews, III,
(919) 967-0333 or 929-1783. 1608 Smith
Level Rd., Chapel Hill NC 27514.
RELIEF PHARMACIST AVAILABLE:
Central and Eastern North Carolina.
Contact Pharmacy Relief, PO Box 2064,
Chapel Hill NC 27515, or call 919-481-
1272 evenings.
PHARMACY FOR SALE: Coastal NC.
Sales greater than $400,000.00; 60%
prescriptions. 10 miles from the ocean.
Contact Bullock & Whaley (919) 762-
2868; PO Box 3783, Wilmington NC
28406.
PHARMACIST WANTED: Independent
pharmacy in Concord seeks a full time
pharmacist. Good salary, excellent
benefits. Call Mickey Watts (704)
782-2194.
PHARMACIST WANTED. Full-time
position on coast. Excellent working
conditions. Competitive salary and
benefits. Contact T01, NCPhA.
HOSPITAL PHARMACIST WANTED:
Staff position available in a 68 bed acute
care hospital in Siler City NC. Hospital
experience desirable. Salary commensu-
rate with experience. For more informa-
tion, contact Sandra McKinney, Chatham
Hospital, Inc., PO Box 649, Siler City NC
27344.(919)663-2113.
INDEPENDENT PHARMACY: needs
warm, friendly, civic-minded pharmacist.
In return have flexible hours, plus one
weeks vacation every four months, plus
3-day weekends during summer. Call
Apple Pharmacy, (704) 634-2111.
CHIEF PHARMACIST: opening at
McCain Hospital, McCain NC. Three-
person department; 2 RPh, 1 Tech. State
employment, Pay Grade 75, NC registra-
tion required. Serve 95-bed hospital with
additional 200 outpatients. Preparing for
expansion. Call Steve Dubay at (919)
944-2351.
Continued on page 36
March, 1987
36
THE CAROLINA JOURNAL OF PHARMACY
PERSONAL NOTES
HARGETT JOINS
NC DIVISION OF FACILITY
SERVICES
On March 2, 1987, Mr. Ernest Hargett began
employment as a pharmacist consultant to the
Licensure Section of the North Carolina Division
of Facility Services. His duties will focus
primarily on pharmaceutical services in the long
term care environment by offering consultation
to facilities, as well as performing compliance
surveys.
One of Hargett's goals is to support the North
Carolina Pharmaceutical Association in
expanding the services provided by the Academy
of Consulting Pharmacists. He was formerly
associated with the Pharm Save store in
Hookerton which provides both dispensing and
consulting services to approximately 3500 long
term beds. Hargett is a 1973 graduate of the UNC
School of Pharmacy and makes his home in
Raleigh.
DEATHS
DIANE HARRIS FINK
Diane Fink, Graham, a 1977 graduate of the
UNC School of Pharmacy, died March 1 1, 1987.
Mrs. Fink was born in Hickory and had worked
with Revco Drug Store in Graham before
entering UNC graduate school in Medicinal
Chemistry.
LEONIDAS JACKSON
Leonidas Jackson, Erwin, died Thursday,
April 2, 1987. He was 87 years old. He was the
first mayor of Erwin after it was incorporated in
1967. Jackson was graduated from the UNC
School of Pharmacy in 1925 with a Ph.G degree.
He was associated with Thomas Drug Store in
Erwin and lived in the town for more than 65
years.
WILLIAM LEWIS JOHNSON, JR.
William L. Johnson, Jr., Franklinton, died
Thursday, March 5, 1987 at the age of 58. First
licensed in 1961, he was associated with Corner
Drug Store, Inc. in his home town for more than
twenty years. Johnson ran unopposed for mayor
of Franklinton in the November 1977 election.
BIRTH
Frances Rader Lena and Manuel Lena, Jr.
announce the birth of their first child, Charles
Manuel Lena, born March 23, 1987 in Dallas,
Texas. Frances received her B.S. in Pharmacy in
1979 and her M.S. in Pharmacy Practice in 1982,
both from the UNC School of Pharmacy. She
worked as Director of Continuing Education for
the Texas Pharmaceutical Association in Austin
before moving to Dallas where Manuel, also a
pharmacist, is attending law school.
CLASSIFIED ADVERTISING
Continued from page 35
CLINICAL-STAFF PHARMACIST PO-
SITION: Will be working every 3rd
weekend and will have responsibilities in
unit dose, IV admixtures, cancer chemo-
therapy, patient education, nursing
inservice, pharmacy newsletter, pharma-
kinetic dosing, drug use evaluation and
other evolving clinical applications. Some
advanced training and experience in
clinical pharmacy preferred. If interested
and qualified please send resume to:
Director of Personnel, Community
General Hospital, PO Box 789, Thomas-
ville NC 27360. EOE.
PROFESSIONAL PHARMACIES: Sev-
eral small prescription-oriented phar-
macies are currently available for
individual ownership in North Carolina.
These opportunities provide the vehicle to
practice pharmacy the way you were
taught, while offering an attractive income
and more time to be with your family. In
some of these cases, financing is also
available to qualified candidates. For
more information write: Jan Patrick,
10121 Paget Dr., St. Louis MO 63132.
PHARMACIST NEEDED: Large, pro-
gressive independent is looking for a
pharmacist who enjoys consulting with
customers. Computerized prescription
department, excellent salary, hospital-
ization and life insurance, paid vacations.
Central North Carolina. Call Mickey
Whitehead at R & M Mutual Discount
Drugs, Ramseur, (919) 824-2151.
March, 1987
Put all your eggs in one basket !
Being an independent pharmacist is like walking on egg shells.
The highly computerized systems and massive buying power
of the big chains make the competition tougher than ever.
The best way to meet this competition is to take advantage
of our buying power, computerized systems and our commit-
ment to a high level of service and quality products. So, if
you want a higher measure of return on your investment, put
all your eggs in our basket.
• Electronic Order Entry and Inventory Management • Pharmacy
Computer Systems • Cost Plus Purchasing • Special Deal Purchasing
• Automatic Price Updates • Home Health Care Products • Manage-
ment Reports • Store Planning and Design • Employee Training
• Merchandising and Planogramming • Advertising • Coupon Re
deemption Program
Owens sJMHnor, Inc.
1010 HERRING AVENUE • WILSON, NORTH CAROLINA 27893 • 1-919-237-1181
THE CHOICE OF
THE FUTURE IS
YOURS TODAY
We give you the Future today! How? By provid-
ing computer software at a new plateau of so-
phistication. If you are looking at a first-time
purchase, or to replace an existing pharmacy
computer, examine this all-new PCI System.
This system features: Industry Standard
Hardware, IBM, AT&T, or NCR plus Standard
Operating Systems. User Memory (512KB up to
3MB RAM) and hard disk options (20MB to
72MB). "State of the Art Software" features pre-
scription processing, optional integrated Ac-
counts Receivable, Accounts Payable, General
Ledger, Institutional Processing, Nursing Home
packages and Word Processing.
PCI Systems prices start at $10,995. Leasing
plans available. For your performance require-
ments PCI can supply them all.
PHARMACY NEEDS
For additonal information and a closer look or personal demonstra-
tion, phone Chuck Rousseau. North Carolina Wats 1-800-438-1062.
Dr.T.C. Smith Co. / W.H.King Drug
ASHEVILLE, N.C. 28806 • 704/258-2645
RALEIGH, N.C. 27622 • 919/782-8400
ROLINk
JOURNN-OfPH^RMkCY
or
LU
GO
:!VERSiTY OF NORTH C;*0LSi':l
JUN - 5 1987
1^.
:::. :::'"> %:lf:- ""■'
o
v
LU
^
fl/^b ^'
~1
\MKk
o
* sm^H / i
>
1
Julian E. Upchurch
1987-1988 President
North Carolina Pharmacy Association
r^.
oo
Health
Sciences Library
o
2 2 3 - H
^~
UNC
or
Chapel
Hill, NC 27514
<
Lost in the Computer Jungle?
Kendall Can Help!
Kendall can help you make an
informed decision about an in-pharmacy
computer system. We've served the
industry for over 65 years; we know the
pharmacy business. That's why we offer
the Triad Pharmacy Computer System.
We recommend Triad because of its
varied functions, ease of operation, and
Kendall's continued service to you once
the Triad System is in place. Triad
features:
• Complete Prescription Processing
• Accounts Receivable Program
• Third Party Processing
• Nursing Home Package
• Medi-Span Price Updates
We put our good name behind Triad,
and our continued service behind you.
17
^1 > DRUG COIVIFVXIMV
1305 Frederick St. • P.O. Box 1060 • Shelby, N.C. 28150
NC 1-800-222-3856 • SC 1-800-438-5330
A Triad Direct 1-800-532-3087
Justice Drug Company
P.O. Box 22025
Greensboro, NC 27420
AN ALCO STANDARD COMPANY
Now in our 87th Year of Service to the North Carolina Pharmacists
1-800-632-1295
HTjv Partnership
** For Profit
Family
Independent
Pharmacy
Total Retail Concept
The Family Independent Pharmacy program providesan
all-inclusive plan covering every aspect of marketing,
merchandising, and management of drug store opera-
tions. It is a wholesaler-sponsored voluntary, and it
embraces the total retail concept in all its forms.
IHHC
TOTAL MOKE HEALTH CARE
Our Total Home Health Care" Program offers Durable
Medical EquipmentforRentorResale. Third Party Billing
for Medicare/Medicaid.
Additional
* Services & Programs Offered *
Store Plan-O-Gram: Complete Store Layouts Design
including Fixtures, Merchandise Plan-o-graming,
and Pricing Strategies
Specialty Qift Departments including Arts & Crafts
Affordable Pharmacy Computer Systems
LIBERTY DRUG SYSTEMS, INC.
QS/1 PHARMACY SYSTEMS
Merchandise Racking Service
Group Life
And Health
Insurance
Benefits
For Members Of
North Carolina
Pharmaceutical
Association
Pilot Life Insurance Company is pleased to have been
selected as the Group insurance carrier for the North
Carolina Pharmaceutical Association. It would be iO
your advantage to become thoroughly acquainted with
the benefits of this program.
You can expect the best possible service from Pilot Life,
one of the nation's leading Group insurance carriers.
For full information, contact Mr. Al Mebane, Executive
Director, North Carolina Pharmaceutical Association.
Write or call:
Sam P. Stuart, CLU
P. O. Box 595
Winston-Salem, NC 27102
Telephone 919/723-8811
Pilot
Life
THEOIROUNk
JOURNUofPHNWIkCY
APRIL 1987
Officers
NORTH CAROLINA
PHARMACEUTICAL
ASSOCIATION
President
Julian E. Upchurch
5201 Pine Way
Durham, NC 27712
(919) 477-7325
Vice Presidents
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh, NC 27612
(919) 876-5600
W. Robert Bizzell
1007 Rhem Street
Kinston, NC 28501
(919) 527-6929
Loni T.Garcia
5210 McLeod Road
Lumberton, NC 28358
(919) 738-6441, Ext. 7317
Executive Director
& Editor
A. H. Mebane, III
P.O. Box 151
Chapel Hill, N.C. 27514
NCPhA Office
(919) 967-2237
or
1-800-852-7343
(USPS 091-280)
VOLUME 67
ISSN 0528-1725
NUMBER 4
CONTENTS
Keith Fearing-Manteo Pharmacist 5
Report of the Third Annual Pharmacy Leaders Forum 9
Undercover Pharmacist Receives Award 19
CE Course — OTC Vaginal Douche Products 20
Dickinson's Pharmacy 31
CE Test 38
Births and Deaths 39
Classified Advertising 40
ADVERTISERS
Carolina Surgical Supply 4
Colorcraft 29
Dr. T. C. Smith Co./W.H. King Drug Back Cover
Eli Lilly and Company 16
Geer Drug Company 32
Justice Drug Company 1
Kendall Drug Company Inside Front Cover
Knoll Pharmaceuticals 36 & 37
Lawrence Pharmaceuticals 22
Marion Laboratories 12
Owens & Minor Inside Back Cover
Pilot Life 2
Renlar Systems 30
Savage Laboratories 6
Spear Associates 8 & 26
Store Fixtures & Planning, Inc 10
Upjohn 24
USPDI 34
Washington National Insurance Co 18
The Carolina Journal of Pharmacy is published monthly by the
North Carolina Pharmaceutical Association, P. O. Box 151,
Chapel Hill, NC 27514. The Journal is provided to NCPhA
members through allocation of annual dues. Subscription rate to
non-pharmacists (continental US) $20.00. Single copy price
$2.00. Overseas rates on request. Second class postage paid at
Chapel Hill, NC.
ALLOW US
TO FILL YOUR
HOME HEALTH CARE
PRESCRIPTIONS!
FOR ALL OF YOUR
HOME HEALTH CARE NEEDS
ALLOW US TO ASSIST YOU
• Leading Industrial Prod-
ucts Available.
• Next Day Delivery on In
Stock Products.
• Discount Programs.
• In Store Visits By Our
Trained Home Health
Services Representatives.
• Phone Assistance By
Qualified Customer Ser-
vice Personnel.
• Product Literature Avail-
able.
• Third Party Reimburse-
ment Information Avail-
able.
• Complete Individualized
and Customized Plan-O-
Gram and Store Set Up.
• C.E.U. Accredited Work-
shops for N.C. Pharmacists.
HOME HEALTH SERVICES OF
CAROLINA SURGICAL SUPPLY
P.O. BOX 31207 • RALEIGH, N.C. 27622 • (919) 782-8400/(800) 662-7767 NC WATTS
SERVING CUSTOMERS OF:
Dr.T.C. Smith Co. / W.H.King Drug
ASHEVIl LE N C 28806 • 704/258-2645
RALEIGH. N C 27622 • 919/782 8400
THE CAROLINA JOURNAL OF PHARMACY
KEITH FEARING: MANTEO'S
MANY-SIDED PHARMACIST
Back in 1947, when Keith Fearing opened
Dare County's first permanent pharmacy in
Manteo, things were quite a bit different from the
way they are today.
For example, there were only two doctors in
Dare County, and as Fearing admits, "there
weren't a lot of prescriptions to write."
You could get an ocean-front lot for $1,000
and a good hot meal for a quarter.
But despite the simpler times, Dare County's
first pharmacy was a place where things
invariably happened.
If the doctor couldn't be found, sick or injured
folks were usually brought into the pharmacy for
medical attention. Fearing can remember doctor-
ing victims of heart attacks, knife and gunshot
wounds, and accidents, to name only a few.
But Fearing's pharmacy was not just a place of
medicines and healing, the pharmacy also
occupied a special place in the life of the
community. Here, people gathered to swap tall
tales, gossip, dream, or just pass the time talking
about the weather.
Fearing's 38 years experience in pharmacy
certainly qualifies him as an expert on the role the
pharmacy plays in the life of a community.
And despite the recent trend toward market
domination by drug store chains, it's refreshing to
hear him say that small-town, individually
owned pharmacies are still as valuable today as
they were back in 1947.
Through his family-owned corporation,
Fearings Inc., Fearing managed his Manteo
pharmacy until 1980. By then he had branched
out into other business enterprises, including
insurance and real estate.
From 1981 until 1985 he was co-owner of The
Island Pharmacy. And although he sold out his
share of the business, he has remained actively
involved in pharmacy.
As president of the N.C. Pharmaceutical
association, Fearing has worked tirelessly to
improve the laws governing pharmacy, with an
aim toward making the laws safer for both
pharmacists and patients.
Fearing attended Campbell College and
graduated from the University of North Carolina
at Chapel Hill in 1944. He then served as a
medical corpsman in the U.S. Navy.
Fearing and his wife, Mary Elizabeth, have
two children. Their daughter, Dean, lives in
M. Keith Fearing, Jr.
Roanoke, Va. And their son, Malcolm, lives in
Manteo.
Campbell University recently named Fearing
"Distinguished Alumnus of the Year."
This interview was conducted by Current
reporter Stephen March.
What was it like around here, when you first
opened your pharmacy?
I was the only pharmacist in Dare County, and
at that time there weren't many prescriptions.
When I opened the store. Dr. Hoggard had
moved here and opened an office, and he stayed
here a year. Dr. Johnston was practicing here
— he was the man who delivered me.
But we had periods of times when there wasn't
a doctor. We had a Dr. Harris who moved here,
on the retirement of Dr. Johnston, and he wrote
good prescriptions. Great old fellow. He was a
very good doctor, but he had one failing, and that
was arm-bending too much. He'd go off on a toot
now and then, and when he was gone, a lot of the
medical information came from the pharmacy
here. And a lot of the happenings were there. I
had them brought in — people who had been
shot and cut, people who had heart attacks.
Isn 't there a trend away from the individually-
owned drug store, toward domination of the
market by big chains? If so, how do you feel about
this trend?
Continued on page 7
April, 1987
His responsibility is to
do the best job possible... for you
...wherever you are in North Carolina.
How specially-trained
Savage professional representatives
can serve you and your business:
• Help maximize inventory turnover for greater
profitability
• Rapid-response order taking and delivery
...ancfafair product-return policy
• Close liaison for you with wholesalers,
physicians, and headquarters customer
service at Savage
• Help to keep you informed about current
trends and competitive strategies
• Promotion specialist: Not only helps make the
deals, but helps build traffic
Savage products...
They help build customer traffic
for your pharmacy
The right strengths, the right formulations,
the right quality, at the right price . . .
to help you serve your customers and
maintain your profits
22 high-quality products
from a single source
^
Allergy: BREXIN® LA CAPSULES chlorpheniramine maleale 8mg,
pseudoephednne hydrochloride 120mg •
Antiprotozoal: SATRIC'" TABLETS - 250mg (metronidazole USP) •
SATRIC '" - 500 TABLETS (metronidazole USP) •
Contrast Medium: ETHIODOL* (ethiodized oil tor injection) •
Hormone: DITATE*-DS (testosterone enanlhate and
estradiol valerate injection) •
Bronchodilators: dilor* elixir (dyphylline) •
DIL0R«' INJECTABLE (dyphylline) • DILOR* TABLETS - 200mg (dyphylline) •
DILOR*- 400 TABLETS (dyphylline) • DILOR-G* LIQUID
dyphylline 100mg, guaifenesin USP 100mg. • DILOR-G* TABLETS
dyphylline 200mg, guailenesm USP 200mg ■
Topicals: ALPHATREX*' CREAM, ointment AND LOTION 0 05%
(betamethasone dipropionate USP) •
BETATREX'" CREAM, OINTMENT AND LOTION 01%
(betamethasone valerate USP) • MYTREX* A* CREAM AND OINTMENT
(neomycin sulfate - triamcinolone acelonide) ■
MYTREX* F CREAM AND OINTMENT (nystatin - triamcinolone acelonide) ■
NYSTEX'" CREAM AND OINTMENT (nystatin USP) ■
NYSTEX™ ORAL SUSPENSION (nystatin oral suspension USP) ■
TRYMEX CREAM AND OINTMENT 0 025% (triamcinolone acelonide USP) ■
TRYMEX CREAM AND OINTMENT 0 1% (triamcinolone acelonide USP) ■
Vaginal Preparations: TRYSUL* (triple sulfa vaginal cream)
(sultalhiazole 3 42%. sulfacetamide 2 86%, sulfabenzamme 3 70%) ■
Vitamins: CHR0MAGEN* CAPSULES ferrous fumarale USP 200mg,
ascorbic acid USP 250mg, cyanocobalamin USP 10mcg, desiccated
stomach substance 100mg. •
CHROMAGEN* OB CAPSULES a phosphorous-tree vitamin and mineral
dietary supplement lor use during pregnancy and lactation
'Introduction scheduled lor July 1986
SAVAGE
LABORATORIES
a division of Altana Inc • Melville. New York 1 1 747
People and products to serve your needs.
THE CAROLINA JOURNAL OF PHARMACY
KEITH FEARING
Continued from page 5
There is that trend, but that does not prevent a
community pharmacy from being a viable part of
a community — if a pharmacist had the initiative
and financial backing to open his or her store.
The big chains cannot give the kind of service that
a pharmacist in an independently owned
pharmacy can give.
Medications today are so much more
complicated, and patients need advice on how to
take it. Some medicines can kill, for example, if
taken with cheese.
There's a lot of technical information that
pharmacists need to pass on to the patient. You
know there are many people in North Carolina
who are functionally illiterate. Someone had to
take the time to make sure patients understand
how to take their medication.
/ imagine that you 've seen some big changes on
the Outer Banks since you were a boy. How has it
changed since then?
I remember when we didn't have electricity.
Around 1929 my dad and uncle bought the first
power system that was here. The electricity was
on from 6 in the morning until 1 1 at night. Later
on they turned it on all the time. We generated
the power right here. The first current ever
generated on the island came from a generating
plant on a ship that had come ashore. I believe it
was "The Leviathan."
Most of us had spotlights on our vehicles. If the
power went off, restoring it became the number
one priority. If the lights went out, during the
middle of a meal, we'd get up and go to the power
plant.
When I was a small child I remember when
everyone came and left here by boats. The mail
came in from Elizabeth City on the "Trenton."
Smaller boats would take it over to Hatteras
Island. Back then, if you wanted to get land on the
beach, you could often get if it you'd pay taxes on
it.
I remember when they built the beach road in
the 1 930s, and when the bridge to Nags Head was
built. It was a single-lane toll bridge, with a draw
span.
The Outer Banks really started changing in
1937, with "The Lost Colony," it began
attracting more people. Then, after World War
II, Wayland Sermons, Guy Lennon and some
others built the Carolinian Hotel, and promoted
that. The Carolinian became a popular place, and
from then on the beach started developing.
You could get an ocean front lot then from
$750 to $1,000. Of course the advent of the new
bridges helped, too. People started finding the
beauty and enjoyment in the area.
I think if an area is going to progress, you've
got to have people moving in, buying property
and building things. If you don't have that, you're
going to regress. There's no standing still.
What are your duties and responsibilities as
president of the N.C. Pharmaceutical Associa-
tion?
To try and guide the fortunes of the
association. I've been interested in several things.
I've felt there's a great need to strengthen our
lobbying efforts for pharmacy, so I appointed a
strong legislative committee. I appointed people
— friends of pharmacy — who know the
leadership in the House and Senate. And we
hired a former lobbyist who represented R.J.
Reynolds, Virgil Mcbride. We feel we're making
progress.
What are your specific objectives regarding
these lobbying efforts?
We have several concerns. Physician
dispensing is one concern. Doctors write their
prescriptions and then they go to a pharmacy
— this gives a check and a balance. As
pharmacists, we feel that check and balance is
very important. But when doctors dispense
medicines, they don't always do it themselves,
they turn it over to somebody in their office, to
pass the medication out, and many times that
person might not have the right technical
knowledge about the medication.
So we think it would be well if doctors
restricted their practice to medicine, and
provided prescriptions to their patients. We
would like to see this formalized. If doctors are
going to dispense, they should meet the same
requirements that pharmacists do in handling
medications.
What other concerns to you have?
We also have a concern about the mail order
prescriptions coming into the state. North
Carolina has laws governing pharmacy, but we
need to strengthen the rules that allow mail order
prescriptions coming in. For instance, any
medicine that you dispense in North Carolina has
to have a logo on the pill so that it's easy to
identify. Medicines coming in through the mail
don't have that requirement.
So that's a concern, and we're working on that.
Another thing, there's no registration of
Continued on page 8
April, 1987
THE CAROLINA JOURNAL OF PHARMACY
KEITH FEARING
Continued from page 7
wholesalers or the repackers of drugs, who buy it
in bulk and repack it. In North Carolina no one
knows who's handling the drugs — and there's
no official place for them to register. It's
important to have that.
There's also no place in North Carolina —
sanctioned by state government — that
commemorates pharmacy. So I appointed a
committee to see about getting space in the
Museum of History building. We've had a couple
of meetings with John Ellington, and we've had a
promise of maybe as much as 1 ,500 feet of space
— to establish a pharmacy in the Museum of
History building in Raleigh, that will be built. It
will be four years or so before it will be ready. But
he has told us we will have space. We will
establish all the artifacts of a 1 925 era pharmacy.
John Ellington said, "I'd like for the soda
fountain to be in there, where you could get a
brown cow."
NETWORK SIGNS FIRST
CONTRACT
Mickey Watts, president of Pharmacy
Network of North Carolina, has announced that
a contract has been signed with Maxicare/
Health America for their 60,000 enrollees in
North Carolina. Start up date is June 1 .
This is a "capitated" contract which means
that PN/NC will receive a set payment per
enrollee each month. These monies will be
distributed to pharmacies who fill scripts for
Maxicare members utilizing an AWP plus fee
formula. This dispensing fee will vary depending
on utilization and percentage of generics used.
Plan specifics are being finalized. Information
will be mailed to members hopefully by May 15.
There will be a series of workshops across the
state conducted by Executive Director, Andrew
Barrett, to explain the plan operation and answer
questions. Members will be notified of the dates
and locations of these workshops.
CONGRATULATIONS TO
HERMAN MEDLIN
On the remodeling of his store, Medlin Rx Drug, Dunn.
We are pleased to have been a part of the planning and
execution of this project.
H Warren Spear R Ph
Pharmacy Design Specialist
415 Augxista Drive
Statesville, North Carolina 28677
(704)873-9993
Spear Associates — planners, de-
signers and installers of pharmacy
fixtures & equipment
April, 1987
THE CAROLINA JOURNAL OF PHARMACY
REPORT OF THE THIRD PHARMACY LEADERS FORUM
February 7, 1987
Southern Pines, N.C.
The Third Annual Pharmacy Leaders Forum
was held in Southern Pines at the Mid Pines
Resort February 6, 7 and 8, 1 987. The forum is a
roundtable discussion of issues expected to affect
pharmacy, with representatives of pharmacy
organizations bringing their respective view-
points and background information.
Agenda
I. Health Department Regulations
II. Status of Continuing Education
III. Specialization in Pharmacy
IV. Impaired Pharmacists
V. Recruiting Pharmacy Students in High School
VI. Manpower Report
VII. Legislation
VIII. Physician Dispensing
IX. Pharmacist Prescribing
X. Prescriptions by Mail
XI. Campbell University
XII. UNC
XIII. Home Health Care Regulations
XIV. Third Party Regulations
XV. Penalty for Steroid Possession
I. Health Department
Regulations
Reference was made to NCAC .2202 and
.2203 (attached) pertaining to the dispensing of
certain drugs by health department nurses.
Hearings were held last August and
September, and the bill was adopted in
November. There has been some criticism of the
bill, but the opportunity to challenge the bill has
passed.
To date, no health department nurses have
been trained. Charles Reed has informed all
health department nurses and directors. The
Division of Facility Services contracted with
Kathy D'Achille to prepare training packets (by
April, 1987). The packet is designed to train a
nurse and pharmacist team to be trainors through
a self-instructional module (for home use), to be
followed by a half day workshop.
Dispensing in Health Departments has
occurred (overlooked) for years in NC (and in
many other states). Few (if any) other states have
PAs and NPs prescribing and dispensing as in
NC. There were few (if any) model pieces of
legislation in other states.
The Board attempted to move expeditiously
on this and did not want to be perceived as "foot
draggers."
NO ACTIONS NEEDED.
II. Status of Continuing
Education
There has been some difficulty (trouble) in
approving some proposed CE programs. For
example: "What are vitamins and how to sell
them", "How to use an in-house computer
system", and Inservice (in-house) programs. The
committee has said no to journal clubs. Most such
requests come from local groups. One
requirement is to submit applications 30 days
prior to the program.
Is the regulation accomplishing what it is
supposed to? The question is very difficult to
answer. The issue is not whether CE is good or
bad, but how to improve it. One attendee
admitted 180 degree turn from his original
opposition to the requirement stating, "We need
CE to survive, to provide services needed in the
community. We have had some good programs
. . . and some bad ones . . . but not 5 more
hours!"
Practitioner input is important. The AHEC
advisory group accomplishes this.
Glaxo is preparing to make a major new move
in CE. There is a need to create or achieve a
balance in the CE programs offered to recognize
practitioner needs and wants. Rather than
disjointed, independent offerings there should be
continuity . . . real programs . . . with tracks and
targeted end points and certificates. We should
look at substance and purpose rather than just
numbers. How can CE providers provide
pharmacists with meaningful (certificate or
degree) programs 3 to 5 years from now, 3 to 5
years out from pharmacy school?
Some pharmacists think programs intended
for other professionals (e.g., cardiovascular
program for nurses, by nurses) are legitimate.
(There was some discussion about this.) The
regulation says this is OK if "reasonably related."
Several attendees felt that it may be time for the
Board of Pharmacy to rethink the regulation and
accept only ACPE approved.
Continued on page 10
April, 1987
10
THE CAROLINA JOURNAL OF PHARMACY
LEADERS FORUM
Continued from page 9
Are all programs apropos for all people?
Some feel there is a need to pre and post test.
What factors move people to learn? Pressure,
tests (assessment).
There is a seminar in May at the UNC School
of Pharmacy on the future of CE (Jane Osterhaus
and Betty Dennis). Refer also to agenda item XII.
If and when participants are ever surveyed,
they should be asked to list one thing learned
from CE that you have put into practice.
NO SPECIFIC ACTIONS REQUIRED
SINCE A COMMITTEE ALREADY EX-
ISTS. COMMITTEE AND BOARD APPRE-
CIATE GUIDANCE AND DISCUSSION.
HI. Specialization in Pharmacy
The group discussed the BPS petition on
Clinical Pharmacy as a specialty. The BPS came
into existence in the 1960s. They have developed
7 criteria for recognition of specialty practice in
pharmacy. Nuclear pharmacy is the only
recognized specialty.
The Florida Board of Pharmacy licenses
pharmacists AND consultant pharmacists. Some
states license hospital pharmacists separately.
Certification is needed as a (surrogate)
designation or recognition of specialization.
Certification should be through examination and
specialized continuing education. CE is needed to
assist pharmacists in attaining "board certifica-
tion". Boards of pharmacy should continue to
grant licenses. Other groups (like BPS) should
offer certification.
Several members of the group expressed
concern over the continued use of the term
"Clinical Pharmacist", stating that it turns people
off, and it's time we found a new term.
NO SPECIFIC ACTIONS NEEDED.
IV. Impaired Pharmacists
Dennis Moore is chairman of the joint
NCSHP/NCPhA program for impaired
pharmacists. The committee should consider
THE EXPERIENCE WE'VE GAINED FROM
OVER 200 PHARMACY INSTALLATIONS IS
AVAILABLE TO YOU . . .
AND, WE ARE THE ONLY STOCKING
DISTRIBUTOR OF DRUG STORE FIXTURES IN
THE CAROLINAS.
IF YOU NEED A SINGLE FIXTURE OR A
COMPLETE STORE, OUR PROFESSIONAL
STAFF IS READY TO SERVE YOU
"THE AREAS LARGEST DISTRIBUTOR OF
MODULAR DISPLAY FIXTURES"
RICHMOND, VIRGINIA CHARLOTTE, NORTH CAROLINA
7921 -A WEST BROAD ST. 3555 TRYCLAN DRIVE
(804) 740-0793 (704) 525-5300
ROLAND THOMAS RANDY BIVENS
"WE ARE MORE THAN A FIXTURE COMPANY — A TEAM OF PHARMACY
SPECIALISTS WITH OVER 60 YEARS COMBINED EXPERIENCE IN OVER
500 DRUG STORES"
Sp
STORE FIXTURES
& PLANNING, INC.
April, 1987
THE CAROLINA JOURNAL OF PHARMACY
11
changing the name of the program to something
with a more positive connotation, e.g.,
Pharmacists Assisting Pharmacists, or PHARM-
ASSIST.
KEY QUESTIONS INCLUDE; WHERE IS
THE PROGRAM? WHERE IS THE PRO-
GRAM GOING? It was noted that the program
is active.
There remains some question of liability in
cases (e.g.) when a member of the joint
committee approaches a pharmacist who claims
not to be impaired. Al Mebane has brought
Virginia's liablity law to the attention of Joe
Whitehead.
A member mentioned that the nursing
profession tends to revoke a license rather than
rehabilitate. Some feel that our joint program
may serve as a prototype in NC for serving other
impaired professionals.
In June (each year) there is a one week
program offered by the University of Utah
School of Alcoholism and Other Drug
Dependencies. D. Teat has attended and rates it
very high.
The Socioeconomic Seminar in April deals
with this subject.
Kathy D'Achille has consulted with the UNC
School of Pharmacy, and prepared a video tape
and participant's work guide on the impairment
problem.
Employee's AND employers need support
systems in attempting to deal with the issue of
impairment.
ACTION: BETTY DENNIS WILL WORK
WITH DAN TEAT TO DEVELOP C.E.
V. Recruiting Pharmacy
Students in High School
George Cocolas showed a video tape (film) to
be used as a recruitment and teaching tool. It was
well received. Prepared with SKF/GAPS grant.
There is a possibility of doing something like this
with the subject of "drug abuse."
VI. Manpower Report
Chris Rudd presented information from her
survey, a report of which is to be published in the
NCPhA journal.
Flexible scheduling is a problem. People do
not want to work weekends and other "off
hours. There is increased pressure in some
communities for pharmacists to work much
longer hours. Outpatient clinics and "emergi-
centers" are staying open longer.
There are about 1 900 active pharmacy permits
in NC today. There were several comments re the
nature of pharmacy in 1997; more robotics, more
clinical services, more informational and consul-
tative roles. Pharmacy will be still more removed
from a PRODUCT. One member noted that the
proliferation of automatic teller machines does
not seem to have decreased the number of tellers.
Another member stated, "Pharmacy will exist as
long as the public wants us to exist. One of our
profession's biggest attractions to patients is our
accessibility. We need to maintain close patient
contact . . . COMMUNICATION."
We need to consider more ways to cut costs
and provide more services.
There is much concern about the increased
role and the number of technicians.
Pharmacy must convince (appeal to) several
audiences: Patient, Payor, Legislator, Physician,
Administrator, Pharmacist, and other health
professionals.
Pharmacy must provide a product (service)
that no one else provides.
Joe Whitehead suggested the need for a task
force ("perhaps Pharmacy in NC in the year
2000") to deal with pertinent questions,
perceptions, desired roles, etc. and report back to
this forum in 1988. There is a need to recognize
and assess patient needs AND to increase public
awareness of pharmacy services. (See Action
below). Bill Edmundson noted that the pharmacy
industry/profession project in Florida was an
outgrowth of the Pharmacy vs Industry battle
over the issue of generic substitution. It might be
useful to also cultivate awareness in NC on the
role of pharmaceuticals in health care. Tapes,
PSAs, books and brochures are available. Use
resources of the National Council on Patient
Information and Education (NCPIE).
Other members noted:
"There is a 25% illiteracy problem in NC. A
fact that dictates more patient counselling."
"There is a need to focus on caring for geriatric
patients."
"Pharmacists have a role (opportunity) to deal
with the big problems for noncompliance and
adverse reactions."
"Who is willing to pay the pharmacist for this
intervention service? Pharmacists have always
been looked on as providing free advice."
ACTION: THE GROUP (BOARD)
IMPANELED A TASK FORCE ON
PHARMACY TO COLLECT, FORMU-
Continued on page 13
April, 1987
YOU WANT YOUR
"USUAL AND
CUSTOMARY"
DISPENSING FEE.
- -■•"
S
C
v^
Marion thinks
you deserve it.
Pharmacists deserve a dispensing fee that
reflects the degree of professional service
required when filling a prescription. That's
why Marion reimburses pharmacists for their
"usual and customary" dispensing fee, no
matter what it is, when filling prescriptions
for Marion associates.
To us, it's simply a matter of principle:
pharmacists perform a valuable service, so
they should be reimbursed accordingly.
We believe that an arbitrarily fixed fee
is inconsistent with the reality of costs,
associated with filling prescriptions, varying
from one pharmacy to the next. The positive
response to our reimbursement program indi-
cates that our philosophy is shared by most
pharmacists.
As a result, Marion is currently working
with state and national pharmacy organiza-
tions to provide information about the suc-
cess of our reimbursement program so that
they may benefit from our experience when
negotiating with third-party insurers.
Reimbursing for the "usual and custom-
ary" dispensing fee— just one more way that
Marion demonstrates its commitment to
pharmacy through action, not words.
Service to Pharmacy
M
PHARMACEUTICAL DIVISION
MARION
LABORATORIES INC
THE CAROLINA JOURNAL OF PHARMACY
13
LEADERS FORUM
Continued from page 11
LATE AND DISSEMINATE MATERIAL
RELATING TO PHARMACY WITH A
GOAL OF EDUCATING THE PUBLIC,
AND OTHER PROFESSIONS AND
PAYORS ABOUT THE ROLE OF PHAR-
MACISTS IN HEALTH CARE. (See
attached memorandum from D. Work,
February 9, 1987)
VII. Legislation
Keith Fearing reported that Mr. Virgil
McBride was being considered as a possible
NCPhA lobbyist. (Subsequent to the meeting he
was appointed.) There is a potentially very strong
lobbying effort in NC by Pharmacy. NCPhA is
soliciting funds. PharmPAC CANNOT
contribute to that fund, and cannot lobby.
Members need to know the difference (re what
PharmPAC can and cannot do).
NCSHP and NCPhA should invite local
legislators to meetings. There is a need for a
legislative or lobbying plan or program. Right
now it appears to be undirected, disjointed. We
need to know what kind of lobbying efforts we
can be effective at. Our lobbyist needs to be in
Raleigh to scope seemingly insignificant and
unrelated bills. NCPhA issues include drug
samples (more a national issue), physician
dispensing (national) and patient freedom of
choice, registration of suppliers and manufac-
turers, "pass throughs", and increase in
examination expense.
NO SPECIFIC ACTIONS REQUIRED.
VIM. Physician Dispensing
This item was discussed within the content of
several other agenda items.
Attempted "stumbling blocks" in other states
have been torn down. Recent FTC rulings
(advice) in Maryland and Georgia have been
particularly disturbing. Pharmacy may not be
able to prevent this from happening, but may
find a way to control MD dispensing by requiring
the same labeling and record keeping as of
pharmacists. Such control could only occur by
pharmacy working cooperatively with the
medical societies.
Pharmacy should try to present arguments in a
nonconfrontational way. If physicians are to
dispense, they should do so in a way that is in the
patient's best interest.
If the Board of Pharmacy granted permits to
dispensing physicians, they could possibly
regulate this activity. How to enforce? Would
rules and regs have to come as part of the medical
practice act? It seems that the Board of Pharmacy
now has no power (authority) over physician
dispensing.
Freedom of choice is an important issue if the
physician does not give the patient a prescription.
NO SPECIFIC ACTION TAKEN.
IX. Pharmacist Prescribing
Essentially a dead issue.
Not considered to be an equal trade with
"physician dispensing." The experiment in
Florida has not been a huge success. The
formulary is very limited.
NO ACTION TAKEN.
X. Prescriptions by Mail
2% of prescriptions filled in the US are now
filled by mail. The AARP lobby is very strong.
Arguments of cost-effectiveness are very strong.
(One study showed pharmacist dispensing is 5%
cheaper.)
This is a particular problem in light of the
problem of functional illiteracy in the US (and
esp in NC).
The public must be educated. Ads should
show dangers and problems. Pharmacists should
document the incidence of problems (damages).
APhA apparently feels that legislation is more
likely at the state level. Use NCPIE (Paul Rogers,
Executive Director).
If it is a public health problem, it should be
brought to the attention of the Attorney General.
Is it possible to take legal action (legislation) to
prevent employers from requiring employees to
use mail order services? Some major employers
require this.
The Board of Pharmacy has had a problem
with jurisdiction.
NACDS and NARD issued a joint statement
of major concern.
NO ACTION TAKEN.
XI. Campbell University
Ron Maddox presented a report form
Campbell (attached).
Dan Teat mentioned that as a CE provider,
CU is anxious to sponsor and cosponsor CE
Continued on page 14
April, 1987
14
THE CAROLINA JOURNAL OF PHARMACY
LEADERS FORUM
Continued from page 13
programs with other groups. CU plans to work
with other schools of pharmacy in neighboring
states.
Keith Fearing stated that 100% of CU
pharmacy students are members of NCPhA.
NO ACTION TAKEN.
XII. UNC
George Cocolas presented the UNC report.
There are 501 undergraduate students, 65%
(326) of whom are female. The graduating class
will be about 155. There are 24 PharmD
students, 75 graduate students and 50 FTE
faculty. The applicant pool is increasing.
The school is trying to stimulate minority
student interest in pharmacy. About 50% of
present students made their decision re pharmacy
in high school.
The Pharmacy Policy Research Laboratory is
attempting to assemble NC data for individuals
and businesses.
The new computer lab is now open.
Betty Dennis thanked the Board for mailing
the school's CE calendar. She reminded the
group of the May conference on "Strategies for
Continuing Professional Competence."
NO ACTION TAKEN.
XIII. Home Health Care
Regulations
Some other states have laws and regulations
pertaining to home care and home care
pharmacy services. The issue is potentially
similar to that of mail order prescriptions. The
Board should develop regulations to protect the
public.
Representatives of the home care industry
have expressed the desire and willingness to work
on this within the framework of laws and regs.
Concern was expressed about home care
providers from out of state. The group was
cautioned re potential antitrust issues.
The Department of Medical Assistance (Medi-
caid) is concerned about who is reimbursed and
how the activity is regulated.
Texas developed an addendum to their
Pharmacy Practice Act. The Board of Pharmacy
has the statutory authority to do this.
NO SPECIFIC ACTIONS WERE TAKEN.
XIV. Third Party Regulations
B. Rideout led much of this discussion. CIP
and PIP proposals will probably not work. The
number of MAC drugs will probably increase.
The federal government has been trying to do
something about this for more than three years
without much success. The issue involves more
than Medicaid.
We will probably see an increase in the use of
plastic cards for this and similar programs.
DMA will continue to investigate (step up?)
pharmacies re the amount they bill Medicaid and
the amount they accept as usual and customary
from other third party payors. Pharmacy hurts
pharmacy by accepting fees that are lower than
what Medicaid allows.
The consensus amoung the group seemed to be
that B. Rideout and DMA should be strict about
this. DMA has provided the mechanism, but is
surprised that pharmacists have taken the risky
strategy of accepting lower fees from some third
party programs, and higher fees from Medicaid.
NO SPECIFIC ACTIONS.
XV. Penalty for Steroid
Possession
There is significant concern about the illegal
use of steroids. Ads in weight lifting magazines,
and the availability of some products in health
food stores are a sign of the nature of the problem.
The USFDA may work through the NCFDA
(Bob Gordon) in such matters.
Some members felt human growth hormone
could be classified as a controlled substance
during the next year.
NO SPECIFIC ACTIONS.
Campbell University
School of Pharmacy
February 1987
Students:
Charter Class — 53 students
54% females
3.2 GPA
90% N.C. Residents
55 Prepharmacy students at Campbell
Faculty:
Currently 9 — projected 26
Ronald W. Maddox, Pharm.D.
Area of Interest: Cardiology
Harry Rosenberg, Pharm.D., Ph.D.
Area of Interest: Biochemistry
Thomas Wiser, Pharm.D.
Area of Interest: Ambulatory Medicine
Daniel W. Teat, Pharm.D.
April, 1987
THE CAROLINA JOURNAL OF PHARMACY
15
Area of Interest: Emergency Medicine
Paula Thompson, M.S.
Area of Interest: Physiology
Steve Weaver, M.L.S.
Area of Interest: Library Science
Edward E. Soltis, Ph.D.
Area of Interest: Pathophysiology
Alan Richards, Ph.D.
Area of Interest: Immunology
Robert Greenwood, Ph.D.
Area of Interest: Pharmaceutics
Advancement:
We have had over $250,000 in equipment and
funds donated to the School of Pharmacy. The
following companies have made major
contributions: Rite Aid Corporation, Dupont,
Hoechst-Roussel, Glaxo, Burroughs Wellcome
C. E. Provider:
We were approved as a provider of continuing
education by ACPE at their January meeting.
Dr. Teat will discuss.
MEMORANDUM
To: Leaders Forum Attendees
FROM: D.R. Work
DATE: Februarys 1987
SUBJECT: Task Force on Pharmacy
One of the main products of our meeting this
past weekend was the formation of a Task Force
on Pharmacy which consists of representatives
from the various groups which attended the
Forum. President Moose issued a charge to the
Task Force to collect, formulate and disseminate
material relating to Pharmacy with a goal of
educating the public, other professions and
payors about the role of pharmacists in health
care.
Members of this Task Force are: Ronald W.
Maddox, Chairman, Dean, School of Pharmacy,
Campbell University; Joe Whitehead, Director
of Government Affairs, Burroughs Wellcome;
Frances Gualtieri, NCMH; Keith Elmore,
Bellamy Drug; Betty Dennis, Director of
Continuing Education, UNC School of
Pharmacy; Chris Rudd, Assistant Director,
Poison Control Center, Duke University Medical
Center; Bill Randall, Lafayette Drug, Lillington
& Member, Board of Pharmacy; Al Lockamy,
NCPhA Officer and Revco Pharmacist; William
Whitaker Moose, Moose Drug, Mt. Pleasant &
Board of Pharmacy Member
This Task Force is to pursue its charge and
report back to the Leaders Forum at the next
meeting. Members of the Forum expect that this
effort will produce a better understanding of the
merits of pharmacy services by everyone
involved with health care.
LIST OF ATTENDEES
Representing North Carolina Board of
Pharmacy
William R. Adams, Jr.
PO Box 3161
Wilson, NC 27895
Member
Harold V. Day
Day's Drug
309 Oak Avenue
Spruce Pine, NC 28777
Member
Wm. Whitaker Moose
Moose Drugs
PO Box 67
Mt. Pleasant, NC 28124
President
William H. Randall, Jr.
Lafayette Drugs
PO Box 999
Lillington, NC 27546
Member
Joseph B. Roberts, III
PO Box 2335
Gastonia, NC 28053
Public Member, Attorney
Vice President
David R. Work
PO Box H
Carrboro, NC 27510
Executive Director
Representing the UNC School of Pharmacy
Steve Caiola, Pharmacy AHEC Director
George Cocolas, Associate Dean
Betty Dennis, Director of Continuing Education
Wayne Pittman, Associate Professor
Beard Hall 200H
Chapel Hill, NC 27514; 919/966-1 121
Representing the North Carolina
Pharmaceutical Association (1-800-852-7343)
Keith Fearing, President
Al Lockamy, NCPhA Officer & Revco
Pharmacist
Continued on page 1 7
April, 1987
Human insulin for all. Humuliri
human insulin
[recombinant DNA origin]
Identical to human insulin. Humulin is the only insulin not
derived from animal pancreases
Recombinant DNA technology makes the production of
Humulin possible and virtually assures every insulin user of a
lifetime supply
From Lilly ... a dependable source of insulin for
generations. Since 1922, when we became the first company
to manufacture insulin, we have led the search for the best
diabetes care products and, at the same time, maintained a
constant supply of insulin for all insulin users
Our 24 formulations of insulin— including Humulin and all
forms of lletm* (insulin)— are available through the widest retail
distribution of insulin in the United States
Beyond that, we will continue to provide a wide range of
diabetes service and educational materials for use by physi-
cians, pharmacists, and diabetes educators,
! 1986 ELI LILLY AND COMPANY
Our Medical Division is on call. Our Medical Division staff
is only a phone call away Please contact them if you have any
questions about our diabetes care products
Any change of insulin should be made cautiously and
only under medical supervision. Changes in refinement,
purity, strength, brand (manufacturer), type (regular, NPH,
Lente", etc), and/or method of manufacture (recombinant DNA
versus animal-source insulin) may result in the need for a change
in dosage
mLmeBm
For information on insulin delivery systems, contact CPI 1(800)227 3422
3key
Eli Lilly and Company
Indianapolis, Indiana 46285
THE CAROLINA JOURNAL OF PHARMACY
17
LEADERS FORUM
Continued from page 15
Al Mebane, Executive Director, PO Box 151,
Chapel Hill, NC 27514; 919-967-2237
Julian Upchurch, NCPhA Officer & Upchurch
Drugs
Representing Chains
Ron Fulmer, Eckerd Drugs; Pharmacy
Professional Services & Operations Manager;
704-371-8243
Jimmy Jackson, Kerr Drugs, Raleigh;
919/872-5710
Representing Hospitals
Steve Dedrick, Duke University Medical
Center; 919-681-2414
Fred Eckel, Head-Division of Pharmacy
Practice, UNC School of Pharmacy
919/966-1121
Tom Hughes, Director of Pharmacy, North
Carolina Memorial Hospital, Chapel Hill;
919/966-2374
Pam Joyner, NCSHP Officer & Wake AHEC
Chris Rudd, Assistant Director, Poison Control
Center, Duke University Medical Center
Representing Campbell University School of
Pharmacy
Ronald W. Maddox, Dean
Daniel Teat, Director of Admissions &
Continuing Education
Tom Wiser, Chairman-Department of
Pharmacy Practice
Buies Creek, NC 27506; 919-893-41 1 1
Representing Wholesalers
Keith Elmore, Bellamy Drug, Wilmington;
799-3320
Rusty Hamrick, Kendall Drugs, Shelby;
704/482-2841
Representing Manufacturers
Bill Edmondson, Vice President-Government
Affairs, Glaxo, Inc, RTP; 919-248-2295
Joe Whitehead, Director of Government
Affairs, Burroughs Wellcome Company,
RTP; 919-248-4459
Other
Benny Rideout, Medicaid Drug Program, Dept.
of Human Resources, Raleigh; 919-733-2833
Ginger Lockamy, Pharmacist
Report submitted by Tom Hughes, President,
NCSHP, February 27, 1987
UPJOHN EXECUTIVES PRESENT CHECK TO CAMPBELL — Officials of the Upjohn Company
recently made a check presentation to the Campbell University School of Pharmacy. Pictured at the
presentation are (I. to r.) J. T. Mathis, pharmacy sciences liaison; Jimmy Jordan, director,
Pharmaceutical Sales; DeLacy Luke, district manager; Dr. Norman A. Wiggins, president of
Campbell University; Dr. Ron Maddox, dean of the School of Pharmacy at Campbell; and Vincent
Candela, pharmacy relations manager.
April, 1987
We're not
O strangers...
uuasninpeon
national
INSURANCE COMPANY
NCPhA-Endorsed Insurance Plans
Which Merit Member Participation
DISABILITY INCOME PLAN HOSPITAL INCOME PLAN
MAJOR MEDICAL EXPENSE PLAN TERM LIFE PLAN
RETIREMENT AND PROFIT SHARING PLANS
FOR DETAILS WRITE OR TELEPHONE:
HOYT W. SHORE, CLU and Associates
821 Baxter Street-Suite 316
Charlotte, North Carolina 28202
O
Telephone (704) 333-3764
uuasninqeon
national
INSURANCE COMPANY
Evanston. Illinois 60201 • A Washington National Corporation Financial Service Company
THE CAROLINA JOURNAL OF PHARMACY
19
FORMER "UNDERCOVER"
PHARMACIST RECEIVES
NATIONAL AWARD
David Wheaton Hall — a pharmacist whose
undercover activities for drug enforcement
authorities led to the 1985 convictions of seven
medical doctors, five medical clinic owners, three
independent drug dealers and a pharmacy owner
— was presented with the 1987 American
Society for Pharmacy Law President's Award.
The award, sponsored by Merrell Dow
Pharmaceuticals Inc., recognizes an individual
who has made a significant contribution to the
legal system in relation to the practice of
pharmacy.
Hall spent approximately one year as a civilian
turned undercover operative in a two-year state
and federal investigation of prescription drug
trafficking in the Los Angeles area, where he
worked as a pharmacist during 1983. Govern-
ment agents involved in the investigation credit
Hall for the "sting" operation that resulted in the
filing of criminal and civil charges against 34
people.
The investigation involved officials from the
U.S. Drug Enforcement Administration, the
Bureau of Narcotic Enforcement in the
California Attorney General's office, and the
California Board of Pharmacy.
The investigation has resulted in the largest
number of doctors and pharmacists simul-
taneously indicted for illegal diversion of drugs in
the history of drug enforcement.
"Hall came forward and literally put himself
out there working on our behalf," California
Attorney General John K. Van de Kamp said at
the time of the arrests. "It was a tremendous
sacrifice in regard to his time and a tremendous
public service."
A native of Seattle, Washington, Hall earned a
bachelor's degree in Pharmacy from Idaho State
College. Throughout various periods, he owned
and operated two pharmacies in small California
towns, in one of which he served terms as
president and member of the local school board.
Hall also served as board member and president
of the Fresno-Madera Regional Occupational
Program, and received two community service
awards.
Presenting the award are Jack R. Statler (left), Manager of Professional Relations for Merrell Dow
Pharmaceuticals Inc., and David B. Brushwood (right), ASPL President.
20
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
ADVISING CONSUMERS ON
OTC VAGINAL DOUCHE PRODUCTS
by Thomas A. Gossel, R.Ph., Ph.D.
Professor of Pharmacology and Toxicology
Ohio Northern University, Ada, OH
and
J. Richard Wuest, R.Ph., Pharm.D.
Professor of Clinical Pharmacy
University of Cincinnati, Cincinnati, OH
Goals
The goals of this lesson are to:
1. outline the FDA/OTC advisory panel's
recommendations on douching solution
ingredients and douching equipment;
2. explain the factors involved in maintaining a
healthy vaginal tract,
3. outline the proper method for douching.
Objectives
At the completion of this lesson, the successful
participant will be able to:
1. explain the relationship of various factors
important for maintaining a healthy vaginal
environment;
2. cite specific recommendations of the
FDA/OTC advisory panel that reviewed
data on the safety and effectiveness of OTC
douching ingredients;
3. exhibit an understanding of the various
methods for using a douche solution;
4. differentiate between drug and cosmetic
claims for OTC douche ingredients;
5. specify potential dangers involved with
douching during pregnancy.
Over-the-counter douche products are big
business in the U.S. Sales of solutions and
powders for making solutions to rinse the vaginal
tract were reported to be nearly $20,600,000
during 1 983. Various surveys state that over one-
half of all American women douche regularly.
While some douche products are intended to be
used solely for cosmetic purposes, others are
indicated for therapeutic purposes.
Although many women douche regularly,
factual information on the correct procedure is
difficult to find. Few articles have appeared in the
medical/pharmaceutical literature or consumer
magazines that illustrate the proper method for
douching.
Whether or not a woman should douche in the
first place, and the correct procedure to follow
when it is indicated are the topics of this month's
lesson. Additionally, the recommendations of an
FDA advisory panel that reviewed OTC vaginal
drug products are presented.
Vaginal Physiology
The normal pH range of vaginal fluids is 3.0 to
5.5 during the reproductive years. Fluctuations
are normal and coincide with various phases of
the menstrual cycle. For example, the pH is less
acidic around ovulation and during menstruation
than at other times.
The pH of the vaginal tract is controlled, in
part, by the indigenous microflora which consist
of numerous microorganisms including cocci,
coliform, diphtheroids, anaerobes, fungi, lacto-
bacilli, and trichomonads. Acidity is maintained
by bacteria, notably the lactobacilli which
initio /or vice
of pharmacy
This continuing education for
Pharmacy article is provided
through a grant from
MERRELL DOW
PHARMACEUTICALS INC.
t Merrell Dow-
April, 1987
THE CAROLINA JOURNAL OF PHARMACY
21
produce lactic acid. They do this by converting
glycogen contained in vaginal epithelial cells to
lactic acid. An acidic media is necessary for the
preservation of normal growth of the vaginal
flora and to confer some protection against over-
growth and invasion by pathogenic micro-
organisms.
At times, certain microorganisms may over-
grow and cause infections resulting in vaginal
odor, discharge, and irritation. Since so many
different microorganisms normally inhabit the
vagina, it is difficult to casually determine which
one is responsible when these symptoms are
present. Thus, it is also difficult to assess which
therapy, if any, is best.
Another important point about the vaginal
lining is that many drugs can be absorbed through
it into the general circulation. The amount
absorbed may be sufficient to cause toxicity to the
woman, or to her fetus if she is pregnant.
Vaginal Douches
The term "douche" means to cleanse. There-
fore, a vaginal douche is a liquid preparation
used to irrigate the vaginal tract. It is intended for
one or more of the following purposes: 1.
cleansing, 2. producing a soothing or "refreshing"
sensation, 3. deodorizing, 4. relieving minor
irritations, 5. reducing the number of pathogenic
microorganisms, 6. altering the pH to encourage
growth of normal bacterial flora, 7. causing an
astringent effect, 8. lowering the surface tension,
9. inducing a mucolytic effect, and 10. producing
a proteolytic effect. Vaginal suppositories are
used for the same purposes.
Certain applications of vaginal douches and
suppositories may be more cosmetic than
medicinal. Since the Food, Drug and Cosmetic
Act specifically defines drugs as ". . . articles
intended for the use in the diagnosis, cure,
mitigation, treatment, or prevention of disease,"
most of the uses for vaginal products are intended
for drug use, rather than cosmetic application.
The classification of whether a product is a
drug or cosmetic is dependent to a great extent on
the nature and concentration of its ingredients. If
an ingredient is present in a therapeutic
concentration, even though no therapeutic claims
are made, the product is classed as a drug. The
FDA advisory panel that reviewed vaginal
products concluded that uses 1 -3 listed above are
cosmetic rather than therapeutic claims.
Therefore, vaginal products making only these
claims are not required to undergo rigid scientific
testing to prove their effectiveness.
When the term "deodorant" is used in
conjunction with a douche product, the panel
advised that it should be labeled to state the mode
of action of the deodorant. A deodorant may be
effective in reducing offensive odors because it: 1 .
removes vaginal secretions, seminal fluid, and
contraceptive products from the vagina, 2.
decreases the number of microorganisms that
cause odors, or 3. masks offensive odors. The
panel stated that OTC douche products do not
actually destroy odors, but diminish a person's
perception to them. So the designation "destroys
odor" cannot be used on the labeling of these
products.
Douching Techniques
Douching must be properly performed to
maximize benefits and minimize risks of damage
to the vaginal tissue. The vagina is lined with a
mucous membrane that is highly susceptible to
irritation. This membrane is actually an extension
of the internal reproductive organs (i.e., uterus
and fallopian tubes) and the abdominal cavity.
The blood supply and lymphatic drainage system
are shared by all these sites. Improper douching
techniques and equipment may directly injure the
vagina and introduce pathogenic microorgan-
isms which can cause upper reproductive tract or
abdominal infection. Some reproductive tract
infections can result in sterility.
Currently there are no data to prove that
routine douching is necessary for a normal,
healthy woman. At the same time, there is no
contraindication for the procedure in these
women as long as they are pregnant.
Some manufacturers advise against douching
more frequently than twice a week. However,
there are no definitive toxicity data that support
this restriction. The frequency of douching does
not appear to exert an adverse effect on the
vaginal flora, cause vaginitis, or produce injury
resulting from excessive dryness of the vaginal
mucosa. The FDA advisory panel recommended
against any restriction on the frequency of
douching with OTC products.
Douching may cause pain, redness, swelling or
itching within the vagina due to sensitivity to one
or more of the product's ingredients. Vaginal or
abdominal pain may also be indicative of
improper use of douches, excessively hot
solutions, or presence of a serious pathologic
disorder in the pelvic region.
Continued on page 23
April, 1987
Now you don't Now you
see it...
Customers won't buy what
they don't see. And when the
merchandise in the front of your
pharmacy is poorly arranged,
you're doing your customers a
disservice as well as yourself.
That's why the professionally
trained Merchandising Specialists
at Lawrence are so important. At
no cost to you, they will survey
your store and then work with
you in rearranging shelves and
displays to market your products
most effectively. They'll also
provide you with the latest
information about special product
promotions, couponing, adver-
tising and trial size merchandise.
This helps you run a more
successful store. And your
customers find the products at
the best available price.
To arrange an appointment
with a Lawrence Merchandising
Specialist, call our Sales/Service
Department at the number below.
A FoxMeyer Company
rhmniacHHitirals
6100 Phillips Highway • Post Office Box 5386
Jacksonville, Florida 32207-0386 • (904)731-4610
Toll Free 800/682-2270
THE CAROLINA JOURNAL OF PHARMACY
23
CORRESPONDENCE COURSE
Continued from page 21
Some product labeling directs that the douche
solution be instilled into the vagina with the
vaginal opening occluded around the douche tip
until a sensation of fullness is felt. There are
numerous reports in the literature that warn
against any procedure which occludes fluid
outflow because the fluid may enter the uterus
and fallopian tubes. Therefore, vaginal occlusion,
or using a high intravaginal hydrostatic douching
pressure (explained later) is potentially danger-
ous and should be discouraged. One report
confirmed that 90% of women with salpingitis
(inflammation of the fallopian tubes) or pelvic
inflammatory disease douched frequently,
whereas the condition appeared only half as often
in women who did not douche.
Douching During Pregnancy. There are no
data to substantiate the safety of douching during
pregnancy. One survey of 510 pregnant women
indicated that 12% of them continued to douche,
with no harmful effects to mother or child.
However, the procedure is not without danger.
During pregnancy, the uterine vasculature is
increased. This large blood supply increases the
woman's risk for vascular problems and systemic
absorption of drugs. There are reports of fatal
embolism following vaginal insufflation with
powders and with air forcefully blown into the
vagina. Soap and disinfectant solutions have also
led to fatal intravascular hemolysis following
attempts at self-induced abortion. Complications
such as severe bleeding due to placental
detachment, rupture of the chorionic membrane,
or introduction of microorganisms have been
recorded. As mentioned earlier, the fetus may
also absorb chemicals which can produce
deleterious effects.
The bottom line is that the risks of douching
during pregnancy outweight any possible
benefits. Unless a physician specifically directs it,
douching during this period should be avoided.
Ingredients Of OTC Douching
Solutions
The FDA Advisory Review Panel on OTC
Contraceptives and Other Vaginal Drug
Products reviewed the ingredients listed in Table
1 and assigned the classifications shown. A brief
review of important findings follows.
Calcium and Sodium Propionate. The panel
found these salts to be safe and effective in
concentrations up to 20% for use in vaginal drug
products claimed to relieve minor vaginal
irritation. The panel also noted that propionates
are safe and effective for physician-supervised
treatment of infections caused by Candida
albicans. But FDA responded that there was too
much consumer uncertainty about the use of drug
products to self-treat vaginal irritation that could
be caused by this organism. Because calcium and
sodium propionate salts have not previously been
available except on prescription, they may not be
marketed OTC until further studies are
conducted to prove their safe use without direct
physician supervision.
Potassium Sorbate. According to the
advisory panel, potassium sorbate is safe and
effective in concentrations of 1% to 3% for self-
medication of minor vaginal irritation. It has
demonstrated significant beneficial activity in
treating various yeast infections. However, as
with calcium and sodium propionates, FDA
indicated that further studies on self-medication
are needed.
Povidone-iodine. The panel concluded that
povidone-iodine in a concentration of 0.15% to
0.3% is safe and effective to relieve minor vaginal
irritation. Povidone-iodine has shown little local
or systemic toxicity, and few sensitivity reactions.
It can be absorbed and cause an increase in the
serum protein-bound iodine level, but this has no
significant effect on thyroid activity. However,
several citations suggest possible mutagenic and
carcinogenic actions. Povidone-iodine can
modify the DNA structure of both bacterial and
animal cells. But the few studies that report these
actions are inconclusive. The panel, therefore,
placed little significance on them. FDA agreed,
but indicated it would continue to monitor safety
reports on the drug for possible future action.
Anionic Surface Active Agents (docusate
sodium, sodium lauryl sulfate). Used in
concentrations of 0.002% and 0.02% respectively,
docusate sodium and sodium lauryl sulfate are
considered to be safe and effective for self use to
produce a mucolytic action on vaginal fluids.
These agents also lyse trichomonads and bacteria,
and are used in prescription products for treating
Trichomonas vaginalis. However, this claim
cannot be made for OTC products since FDA
believes that treatment of vaginal infections
requires physician intervention.
Nonionic Surface Agents (nonoxynol 9 and
octoxynol 9). These are safe and effective in
concentrations of 0.0176% and 0.088%
Continued on page 25
April, 1987
More than 50,000 pharmacists know these men
and use their wisdom to solve everyday problems.
Dave Schmidt and Harles Cone, Ph.D., gave
them a better understanding of human nature
and improved their ability to communicate.
And many have profited from the good dollar
sense of Allan Hurst and his lectures on financial
planning, cash flow and store management.
We're proud to have brought their Professional
Development programs to your association meet-
ings and conventions during the past 12 years.
We hope they made your- world better
B<>-M^Uifr
1985 The Upjohn Company, Kalamazoo, M
THE CAROLINA JOURNAL OF PHARMACY 25
TABLE 1
FDA Classifications of Active Ingredients of Vaginal Products
LOWER SURFACE
RELIEF OF MINOR
ALTERS
TENSION AND
ACTIVE INGREDIENT
IRRITATION
pH
ASTRINGENT
MUCOLYTIC
Acetic acid
III(E)
111(E)
Alkyl aryl sulfonate
III(E)
Allantoin
III(E)
Aloe Vera, stabilized
III(E)
Alum
III(E)
Benzalkonium chloride
III(S.E)
Benzethonium chloride
III(S,E)
Benzocaine
III(E)
Boric acid
III(S,E)
III(S,E)
III(S,E)
III(S,E)
Boroglycerin
III(S,E)
III(S,E)
IH(S,E)
III(S,E)
Calcium and sodium
propionate*
I
Citric acid
III(E)
Docustate**
I
Edetate disodium
III(S,E)
Edetate sodium
III(S,E)
Hexachlorophene
II
Lactic acid
III(E)
Nonoxynol 9
HI(E)
I
Octoxynol 9
III(E)
I
Papain
Oxyquinoline citrate
III(S,E)
Oxyquinoline sulfate
III(S,E)
Phenol
II
111(E)
Phenolate
II
Potassium sorbate*
I
Povidone-iodine
I
Sodium bicarbonate
IH(E)
Sodium borate
III(S,E)
III(S,E)
III(S,E)
III(S,E)
Sodium carbonate
III(S,E)
Sodium lactate
III(E)
Sodium lauryl sulfate
I
Sodium perborate
III(S,E)
HI(S,E)
III(S,E)
III(S,E)
Sodium salicylate
II
Sodium salicylic acid
phenolate
II
Tartaric acid
III(E)
Zinc sulfate
III(E)
*FDA will not allow marketing in OTC products at this time.
**Dioctyl sodium sulfosuccinate
Category I: safe and effective for OTC use; Category II: neither safe nor effective for OTC use; Category III: safe and
or effectiveness for OTC use not yet established
(E) — safety established, effectiveness in question
(S,E) — both safety and effectiveness need to be established
April, 1987
26
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
Continued from page 23
respectively for use in vaginal douches to produce
a mucolytic action. In larger concentrations,
nonoxynol 9 and octoxynol 9 are also safe and
effective spermicides.
Unproven Ingredients And
Claims
Treatment of Minor Irritations. The ingredi-
ents in Table 1 designated as "Category III" have
been used in vaginal preparations for the specific
actions shown. Some have been proven safe.
Others have questionable safety. None has been
proven effective for the specific indication(s)
listed.
Manufacturers may conduct the clinical
studies necessary to establish effectiveness of
these ingredients until FDA promulgates its final
"official" monograph on a particular drug group.
If safety or effectiveness cannot be established by
that time, these substances will not be permitted
as active ingredients of OTC products, nor will
their manufacturers be allowed to make the listed
claims.
Allantoin has a long history of medical use. Its
medicinal properties were discovered during
World War I when it was noticed that maggot-
infested wounds healed more quickly than
noninfested wounds. Maggots produce a
considerable amount of allantoin.
Allantoin has been used for years in many
topical products and there are no specific toxicity
problems documented. It has also been found by
other FDA/OTC advisory panels to be safe for
use on injured skin and on the oral mucosa.
Aloe is another interesting substance. Leaves
of the aloe vera plant can be cut and squeezed to
obtain an exudate. The exudate is not stable in
air, and deteriorates within several hours.
However, the commercially available forms are
claimed by manufacturers to be stable.
The OTC panel reviewed more than 100
reports describing vaginal application of aloe
vera. While no report cited specific toxicities,
CONGRATULATIONS TO
JEFF STILLWAGON and NED GRIFFIN
On their new store, West Durham Pharmacy, Durham.
It was our pleasure to help design and supply fixtures for
this beautiful new store.
H. Warren Spear R Ph
Pharmacy Design Specialist
415 Augusta Drive
Route 4, Box 376 AA
Statesville NC 28677
(704)876-4153
Spear Associates — planners, de-
signers and installers of pharmacy
fixtures & equipment
April, 1987
THE CAROLINA JOURNAL OF PHARMACY
27
none of them substantiated proof of effectiveness
either.
Quaternary ammonium compounds (ben-
zalkonium CI and benzethonium CI) have been
employed for a number of uses over the years.
However, a critical assessment of the literature
casts doubt on their safety and effectiveness for
use in vaginal douche products.
There are no clinical studies dealing
specifically with safety of using benzocaine on
the vaginal mucosa. However, this local
anesthetic has a long history of safe use on other
mucous membrances. The advisory panel
thereby concluded that benzocaine was also safe
for vaginal use. While its effectiveness for
alleviating vaginal irritation can be inferred from
its use on other mucous membranes, such action
will nevertheless require substantiation by studies
using it on vaginal tissue.
Boron compounds (boric acid, boroglycerine,
sodium borate, sodium perborate) have been
instilled into various body cavities and applied
topically for antiseptic uses for over a century.
Boric acid has mild astringent action so it has also
been used for its anti-inflammatory and
antipruritic actions. There is insufficient evidence
to establish that boron compounds are actually
effective for these uses.
The safety of these compounds is also
questionable. Reports of poisonings from boric
acid resulting from ingestion, application of
ointments and powder, and irrigation of closed
body surfaces confirm the potential for toxicity.
The review panel looked specifically for toxicity
related to use in the vagina. In one review, three
cases of boric acid intoxication following
application were cited. But the studies were
poorly conducted, and their outcomes were
considered unreliable.
Edetate salts (edetate disodium, edetate
sodium - EDTA) are thought to act on vaginal
microorganisms by binding with calcium on their
surface, thus interfering with metabolism and
leading to their death. However, edetate salts also
chelate other essential metal ions such as zinc
from vaginal tissues. As a result, the panel felt
they might be injurious. The panel suggested that
edetate salts be limited to 4.4% concentration,
and that they continue to be tested both for safety
and effectiveness before a final ruling is made.
Nonoxynol 9 and octoxynol 9 are safe and
effective mucolytics and spermicides, but there
are insufficient data to show they are effective in
relieving minor vaginal irritation. The drugs have
been noted to reduce the number of pathogenic
vaginal microorganisms such as Trichomonas
vaginalis, but the data are inadequate to
substantiate use in OTC products.
Oxyquinoline compounds (oxyquinoline
citrate and sulfate) have been used for over 50
years to treat gonorrhea and other vaginal
infections. The compounds form complexes with
essential metal ions of microbes such as zinc and
copper, and this is presumed to be their
mechanism of action.
There have been no specific notations of
adverse effects. However, animal studies have
suggested possible carcinogenic activity. Because
of a lack of specific data to show both safety and
effectiveness, the panel recommended that
further studies on oxyquinoline be initiated.
Agents that alter vaginal pH. A douching
solution can change and maintain the pH of the
vaginal fluids only as long as the solution remains
inside the vagina. Within thirty minutes of
cessation of douching with an acidic solution, the
vaginal pH will return to its pre-douche level. In
fact, it may become even more alkaline than
before. This occurs because douching can remove
glycogen, lactic acid, and other acids that
normally maintain an acid environment.
Acetic acid, in a concentration of 4% to 6%
when properly diluted, is safe when used in the
vagina. Vinegar is approximately 5% acetic acid,
and is also safe for intravaginal use when properly
diluted (1.5 teaspoonfuls per quart of water).
However, the data fail to show that it is effective
in lowering the pH long enough to encourage
growth of normal vaginal flora. Its use as a
cleansing, "refreshing" douche is a cosmetic
application. Therefore, this claim was not
evaluated by the panel, nor is it affected by these
regulations.
Other acids that are safe include citric acid
(0.1% to 0.5%), lactic acid (0.4% to 1.3%), and
tartaric acid (0.047%). However, none of these
have yet been proven to be effective.
The alkaline substance, sodium bicarbonate,
is safe in concentrations used in most douching
solutions. The rationale for using it as a douche is
presumably in its action to neutralize vaginal
secretions. Such action is only temporary. Dilute
solutions of baking soda labeled to produce a
cleansing, "refreshing," or soothing effect are
cosmetics rather than drugs.
Astringent Effects. Astringents are locally
acting drugs that precipitate protein on the
surface of cells. They cause constriction of
Continued on page 28
April, 1987
28
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
Continued from page 27
mucous membranes, resulting in reduced local
edema, inflammation, and exudation. Cellular
permeability is altered, but the cell remains
viable. Alum compounds in a concentration
range of 0.037% to 0.06% and zinc sulfate in a
concentration of 0.02% are safe. Neither has been
proven effective. On the other hand, zinc sulfate
in a conentration of 0.2% to 1.0% is an effective
astringent, but has unproven safety for use in the
vagina.
Alkyl aryl sulfonate, lactic acid, and papain
are all safe for human use. None has undergone
the testing needed to prove effectiveness in
vaginally applied drug products.
Douching Equipment
The advisory panel reviewed douching
equipment as well as drug products. It specifically
warned against using any douching device with a
nozzle that had a single, unshielded opening. This
apparatus could force drugs or air into the uterus
and fallopian tubes, and the abdominal cavity.
The panel recommended that only nozzles with
multiple openings be used. If a nozzle with a
single opening is employed, the opening should
be shielded so that the douche solution does not
emerge in a steady, forceful stream. The panel
also recommended that nozzles have a blunt end
to minimize injuring the vaginal wall.
Some bulb-type syringes contain a device that
occludes the vagina after insertion of the
douching solution to prevent its drainage. The
panel recommended against their use for the
reasons expressed earlier.
Types of Douching Equipment. Two basic
forms of douching equipment are available. The
douche bag (fountain syringe or combination
water bottle-fountain syringe) holds one to two
quarts of fluid. It is supplied with tubing and a
shut-off valve. The bag is suspended approxi-
mately two feet above the vagina and the fluid
flow pressure is regulated by gravity. Increasing
the distance of the bag above the vagina results in
a greater hydrostatic pressure. The greatest height
recommended is three feet.
The bag can also be used with a rectal tip to
administer enemas. A rectal tip is shorter than a
vaginal tip. It should not be used to administer
douches because it has only a single, unshielded
opening. The panel recommended that these
nozzles be labeled for their respective uses to
prevent consumer confusion, and it asked the
industry to follow-up on this recommendation.
Bulb douche syringes hold eight to sixteen
ounces of fluid. The nozzle is attached directly to
the bulb and the flow rate is regulated by the
amount of pressure exerted when squeezing the
bulb. The currently marketed prepackaged
disposable douche units are of this design, but
hold three to nine ounces of fluid.
The advisory panel raised a question concern-
ing the volume of douche solution needed.
Douche volume usually ranges from 250 to 2000
ml, with the average quantity approximately
1000 ml. The disposable units deliver much less,
and this may not be a sufficient quantity of fluid
to remove cellular material from the vagina. The
panel believed that these smaller volumes were
adequate for cosmetic purposes, but when a
therapeutic claim is made, the manufacturer must
prove that the volume is sufficient to achieve the
desired effect.
Patient Advice
Whether or not routine douching is beneficial
is controversial. Some gynecologists believe that
a normal, healthy vagina cleanses itself. Others
state that if douching is done properly, it will help
promote healthy vaginal tissues. One important
fact is that douching will not prevent pregnancy.
Another controversial topic concerns precoital
douching to influence the sex of the offspring.
Reports since the early 1970's have claimed the
X-bearing sperm (female determinant) is more
resistant to acid destruction than the smaller,
Y-bearing (male determinant) sperm. Since the
cervical mucous is most alkaline immediately
prior to, or at the time of ovulation, the theory is
that conception at this time is likely to result in a
male. Shortly after ovulation when the pH is
more acidic, fertilization is more likely to result in
a female offspring. If coitus were timed to coin-
cide with periods more favorable to development
of either male or female, the fetal sex might be
influenced.
This viewpoint has been extended to employ
acidic or alkaline (e.g., vinegar or sodium
bicarbonate) douches precoitally to alter the pH
and, therefore, facilitate the desired results. While
some investigators have confirmed that the sex of
the offspring can be affected in this manner,
others have denied it. However, douching
precoitally does not appear to detrimentally
affect the health of the mother or fetus should
conception occur.
Women should be sure they understand the
correct procedure of douching. Table 2 provides
April, 1987
THE CAROLINA JOURNAL OF PHARMACY
29
specific points to aid in consumer counseling.
Table 3 lists representative OTC douche
products. One key point is that the proper
method of douching is perhaps more important
than the formula used. For example, physicians
usually recommend douching in a reclined
position, with the knees flexed and the hips
slightly raised. It has been reported that only 30%
of women follow this advice. When sitting or
standing, only the outer one-third or one-fourth
of the vagina will be reached by the douching
fluid, even if the nozzle is fully inserted.
It should also be kept in mind that the
symptoms caused by a wide variety of vaginal
disorders are similar. While many conditions are
mild and of no serious consequence, others can be
severe. Whenever symptoms are severe or
persistent, or worsen when a douche is being
used, a physician should be consulted.
TABLE 2
Consumer Information on OTC Douche
Products
Do not use this product if you are pregnant,
except on the advice of and under the
supervision of a physician.
If minor irritation has not improved after
one week of use, or if you notice
development of redness, itching, swelling or
pain in or around the vagina after douching,
consult a physician.
This product is not intended to be used for
birth control. It does not prevent pregnancy.
Mix solution thoroughly according to
manufacturer's directions just before use.
Rinse all equipment well after each use.
Keep it clean and dry between uses.
Keep this product out of the reach of
children.
CE TEST ON P. 38
Remember the ^Day
...incPicturts
COLORCRAFT
North Carolina's Most Complete
Film Processing Service
There Is A Plant Located
Near You
For the Finest Quality Plus Fast
Dependable Service on All Your
Photo Needs, Contact the Plant
Nearest You.
CHARLOTTE WILMINGTON
KERNERSVILLE RALEIGH
FAYETTEVILLE DURHAM
If You Don't Know Photofinishing
Know Your Photographer
TABLE 3
Representative OTC Douch Products
Product
Form
Betadine
Solution
Betadine Medicated
Disposable solution
Dismiss
Disposable solution
Femidine
Solution
Feminique
Disposable solution*
Gentle Spray
Powder
Massengill
Powder
Massengill
Disposable solution*
Massengill Concentrate
Solution
Massengill Medicated
Disposable solution
New Freshness
Disposable solution
Nylmerate II
Concentrate
Solution
Sorbex
Granules
Stomaseptine
Powder
Summer's Eve
Disposable solution*
Summer's Eve
Medicated
Disposable solution
Trichotine
Powder
Trichotine
Solution
Trichotine-D
Powder
Triva
Powder
Vagisec
Solution
Vanite
Powder
Zonite Concentrate
Solution
*available with different ingredients
April, 1987
I'M RENLAR'S
SYSTEM. ..WITH
EXTENSIVE STORAGE
BLAZING SPEED
AND DOZENS
OF FEATURES.
- - ,y:. ■:y*~~~r3Z^r , .ST
loooeojoooooa ooo
The technical brilliance of RenLar's new
system speaks for itself. It boasts all the power of a
RenLar system in a PC configuration. It offers full-
featured hardware,* not the "bare-bones" minimum
found on other systems. Blazing speed with the
80286 processor and superior storage are at your
fingertips. Like all RenLar Systems, it's command-
driven for efficiency, but the option of using a menu-
driven format makes it instructional to beginners.
S INCLUDING
COMMAND-DRIVEN
PHARMACY SOFTWARE?
fNATURALLY.
f I'M A
I RENLAR
R SYSTEM.
You also get one-vendor support from a
company that's an authorized distributor for both
Digital Equipment Corporation and NEC, two of
the finest names in computing today. And there's
the almost unparalleled benefit of RenLar's eight
years of software research and enhancements.
All for $6,995. Or lease it for under six
dollars a day. RenLar's new system. Listen to what
it can do for your business.
renIar
SySTEMS
2640 Palumbo Drive, Lexington, Kentucky 40509 (606) 266-5414
'Full-featured software, too. — Natural name lookup for patients, physicians and drugs — Recording and maintaining of
patient profile along with Rx label, hardcopy and receipt — Rx pricing — Third parry insurance billing — State medicaid
billing — Extensive business reporting — Superior inventory control features — Accounts receivable package — And
literally dozens of other features often optional on systems costing twice as much.
Mail to: Renlar Systems, 2640 Palumbo Drive, Lexington, Kentucky 40509
□ Send me additional information Name TMv
on RenLar's new system. store
□ I already have an IBM PC-AT or
compatible system and am
interested in software only.
Add ii
t it} Si Zip
Phone
THE CAROLINA JOURNAL OF PHARMACY
31
DICKINSON'S PHARMACY
by Jim Dickinson
Pharmacy power. Sometimes, in the pharmacy
you can be too close to the wood to see the trees.
Take dispensing physicians, for example. The
pharmacy press will tell you it's the hottest issue
around, with giant repackaging companies
picking up physicians right, left and center.
That's true.
Then you'll read that the Federal Trade
Commission is on their side, and pharmacy has its
back to the wall — a matter of "grave concern,"
as the American Pharmaceutical Association
puts it.
That's only a little bit true.
Dispensing physicians are so much of a
menace — not just to pharmacy, but especially to
the public as a whole — that this is a very
winnable fight. And better yet, it will be an
interesting fight, because of the weirdness of the
forces that are lined up against pharmacy.
It's a fight that every pharmacist can pitch into,
with relish.
The weirdest part of this is the FTC scenario.
On two occasions, it has publicly spoken out
against pharmacy efforts to make physician-
dispensing illegal. In one, an FTC letter to the
Maryland Board of Medical Examiners rendered
an opinion that physician-dispensing is no more
hazardous a practice than other medical
practices, and that pharmacists often do not
safety-check prescriptions. In another, the
somewhat flaky, far-right Republican chairman
of the FTC ("extremism in the pursuit of
competition is no vice" [apologies to Barry
Goldwater, 1964]) Daniel Oliver told the
National Health Lawyers' Association in
January that physician-dispensing is a
"traditional aspect of medical practice" offering
the consumer increased convenience and more-
competitive prices.
These utterings have been widely misinter-
preted in pharmacy as signaling: Throw-in-the-
tcwel-unless-you-like-bleeding-to-death-in-
battles-you-can't-win.
Nothing could be further from the truth!
As National Association of Retail Druggists
executive vice president Charles M. West put it
on February 9, the glint of fire in his usually quiet
eyes: "We can turn FTC around on this, because
it is right."
That same day, NARD and its arch-enemy,
the National Association of Chain Drug Stores
(!) joined forces in a vigorously worded news
release saying they represented "virtually every
retail pharmacy in the U.S.," they'd agreed on a
single legislative strategy to protect the present
system of medical checks and balances, and
declaring that physician-dispensing "is not in the
best interest of the public health, in part, because
it denies the patient the advantage of a personal
consulting relationship with a pharmacist."
This is where the ordinary, individual, most-
respected-professional pharmacist comes in.
Hours before NARD and NACDS issued that
joint statement, they had met with the FTC staff
people responsible for fighting pharmacy moves
to make physician-dispensing illegal or damn-
near-impossible. Most significantly, they heard
FTC Bureau of Competition acting assistant
director Charles Corddry (write him at 6th and
Pennsylvania Avenue N.W., Washington, D.C.
20580) claim, "we know pharmacists aren't
consulting — we read their journals."
However, Corddry and other FTC staffers
claim also their opinion to the Maryland Medical
Examiners Board is being overplayed in
pharmacy — the letter was not volunteered, but
requested by the board; as such, it does not reflect
deep FTC concern, or a commitment to
campaign in favor of dispensing physicians.
FTC's real, internal, staff-level concern (as
opposed to the high-flying rhetoric of its political
game-players like Oliver) is whether state
licensing boards of all kinds over-reach their real,
legislated authorities. When a state board asks
FTC for an opinion on something that might
over-reach, FTC gives it. Period.
Deep down in their institutional memories,
FTC, the U.S. Justice Department antitrust
division, the American Medical Association, the
pharmacy associations, and all the other
organizations with a long-established stake in this
issue, are pretty much agreed. Checks and
balances in health care are like checks and
balances in government — fundamental to the
American way of life. Freedom of choice is
preserved if patients aren't cut off by a
prescriber's own conflict-of-interest.
Insurance companies increasingly require
second opinions before elective medical expenses
are undertaken. That's at least partly because the
physician's judgment, alone, isn't sufficient.
Continued on page 33
April, 1987
WE BRING YOU THE BEST
CHARLESTON, S.C.
GREENVILLE, S.C.
THE CAROLINA JOURNAL OF PHARMACY
33
DICKINSON'S PHARMACY
Continued from page 31
News item: "The state Attorney General's
Office has charged five Michigan doctors with
having their patients' tests done at a laboratory
they partly owned. They are the first cases under
a provision of the state Public Health Code that
prohibits doctors, dentists and other health
professionals from sending their patients to
facilities in which the health professionals have a
financial interest." (Detroit Free Press)
Then there is the decidedly seedy character of
the people who are pressing physicians to get into
this business. Many look like used-car salesmen
types, glib of tongue and sleek of dress, who hire
freshly minted pharmacists, out-of-work medicos
and others at better-than-average salaries to
exploit the financial worries of prescribes in an
overcrowded, and worsening marketplace.
They know no more about health and checks
and balances than they do about that little beauty
that was only driven to church on Sunday
mornings by a little old lady in Pasadena.
That's worrying the AMA, too. Their
members are finding it harder to make a good
living, and pharmaceuticals can offer them,
according to the hucksters' brochures, $30,000 or
more year income on the side. Not to be sneezed
at!
Nothing worth doing is easy. Pharmacists who
try to regulate state bans on physician-dispensing
will attract FTC and other scrutiny. But there's
nothing wrong with trumpeting the checks-and-
balances system (I have 50-sheet bagstuffer pads
that do it, P.O. Box 848, Morgantown, WV
26507), and giving your patients the value-added
medical care that comes from one-on-one
consulting.
And lend your support to the pharmacy
associations that are fighting this menace for you.
We don't often get a "motherhood" issue like this
one!
This feature is presented on a grant from G.D. Searle &
Co. in the interests of promoting the open discussion of
professional issues in pharmacy. G.D. Searle & Co.,
accepts no responsibility for the views expressed herein
as they are those of the author and not necessarily those
of G.D. Searle & Co.
(FOOTNOTE: You remember those letters we asked
you to write to HHS Under Secretary Don Newman,
R.Pk, about Medicaid discounts? It worked! Federal
Medicaid has put discounts on the backburner.)
Pete T. Milliones, owner of Medical Center Pharmacy in Charlotte, is presented the Merck Sharp &
Dohme Pharmacy Recognition Award by Keith Tinkham and Judoth Dellinger, Senior Professional
Representatives of MSD, for continuous service to the community for 31 years. Milliones is a
graduate of the University of South Carolina School of Pharmacy and was licensed in 1955.
April, 1987
34
THE CAROLINA JOURNAL OF PHARMACY
dviccfor
e Patient
n**—1
rUW"«
Information
for the
Health Care
Provider
WHY BUY JUST A "BOOK"
. . . when you can subscribe to USP Dl'? This continually revised
drug information service will provide you with up-to-date, clinically
relevant drug data on virtually all drugs Your subscription will also
include our unique corresponding patient drug information volume.
New and revised information is issued through bimonthly Updates,
avoiding the inconvenience of replacing, or worse, losing pages.
Start your subscription now with the newly revised, Seventh
Edition two-volume set for only S7995
Continue your subscription at our low renewal rates, currently
S60.00(billed annually), so that you are assured of receiving all revised
mam volumes and a continuous flow of bimonthly Updates
NEW IN THE SEVENTH EDITION
All new index by indications — for easy reference to drugs
used in the treatment of various disease states. Categorized
by agents used in diagnosis, prophylaxis, and treatment.
Get more than just a "book.''
Subscribe to USP Dl\
Subscription to the new USP Dl (2-volume set and its Updates)
□ first year $79.95 (Annual renewal S60 00)
Subscription to Volume I only of USP Dl
□ first year $59.95 (Annual renewal: $45.00)
Subscription to Volume II only of USP Dl
□ first year $29.95 (Annual renewal $24 00)
FULL MONEY BACK GUARANTEE. If, for any r
□ Enclosed is my check payable to USPC for S
□ Charge my
□ MasterCard
□ VISA
Major new family monographs including: Adrenergic
Bronchodilators, Calcium Supplements, Citrates, Phosphates.
Includes monographs on most of the major new drug
products recently approved by FDA such as: Enalapril,
Interferon, Muromonab-CD3, Ribavirin.
Over 100 new generic substances or combinations added.
The Seventh Editi
Send Order to:
North Carolina Pharmaceutical Association
P.O Box 151. 109 Church Street
Chapel Hill. North Carolina 27514
J
April, 1987
THE CAROLINA JOURNAL OF PHARMACY
35
REVISED EDITION OF
PATIENT GUIDE TO
HIGH BLOOD PRESSURE
MEDICINES PUBLISHED
BYUSP
About Your High Blood Pressures Medicines,
a lay-language guide to medicines used to treat
high blood pressure, has been published in a
revised and updated edition.
The USP, a non-profit organization of health
professionals working together in the public
interest, publishes this consumer guide with the
cooperation of the National High Blood Pressure
Education Program of the National Institutes of
Health in a move to encourage proper use of and
compliance with the medicines used to treat
hypertension. High blood pressure, or
hypertension, afflicts more than 60 million
Americans, yet only an estimated 5 million
properly treat and control the condition.
About Your High Blood Pressure Medicines
provides profiles of the medicines most
frequently prescribed for hypertension, including
thiazide diuretics, captopril, methyldopa and
others. Each profile details the brand and generic
names, the proper use of the medicine,
precautions to consider, possible side effects, drug
interactions, storage directions and notes
information that should be considered before the
drug is taken. The book is indexed by brand and
generic names for easy reference.
Special chapters include a general introduction
to the use of high blood pressure medicines and
information on the importance of patient
participation in treatment. It also discusses
common misconceptions about high blood
pressure. A "medication calendar" is included as
an easy-to-use chart for recording daily
medication doses. A wallet diary is provided for
the patient to list his or her physician's name,
appointment dates and prescribed medicines.
About Your Medicines is sold in an attractive
display case to health care facilities, such as
pharmacies for resale to consumers. Display
cases of 1 2 copies may be purchased through the
North Carolina Pharmaceutical Association.
HOSPITAL DISTRIBUTORS
OF AMERICA ANNOUNCES
NEW MEMBERS
The Board of Directors of Hospital
Distributors of America (HDA), Meeting March
19, 1987, in New Orleans, announce the election
of five additional wholesale drug ownerships to
the hospital distribution network. The new
members, operating eight divisions, are:
Gulf Distribution, Inc., Miami, FL
Humiston-Keeling Inc., Calumet City, IL;
Grand Rapids, MI; Madison, WI
Dr. T.C. Smith Co., Inc., Asheville, NC;
W.H. King Drug, Raleigh, NC
Ohio Valley/Clarksburg Drug Companies,
Wheeling, WV
Smith Drug Company, Spartanburg, SC
(Division of J M Smith Corporation)
According to Edward S. Albers, Jr., President,
"The group was formed to provide hospital
purchasing mega-groups with a unified
distribution and data reporting system for their
member hospitals who may be dispersed over a
wider area than any one wholesaler prime vendor
could serve. It is composed of respected, strong
locally-owned regional wholesale drug dis-
tributors with substantial group hospital business
and expertise. The new members enhance the
network coverage with locations distributing to
the majority of population served by the major
hospital groups today."
James E. Kleinheinz, Vice President, added
"HDA provides a network capability necessary
for the independent wholesalers to compete with
larger wholesalers with many divisions spread
over wider regional or national areas. Also, the
hospitals have the advantage of continuing to be
served by their preferred local prime vendor who
is linked with other HDA members supplying the
rest of the mega-group. HDA then gives the
hospitals, their groups, and the manufacturers an
alternative to utilize local independent prime
vendors who are linked together by the HDA
Continued on page 38
April, 1987
INTRODUCING
NEW
ONCE-DAILY
ISOPTIN
(verapamil HCI/Knoll)
240 mg scored sustained-release tablets for hypertension
• Only calcium channel
blocker available in SR
form for once-a-day
therapy
• New SR dosage form
allows greater patient
compliance
• Well documented safety
profile
• In mild to moderate
essential hypertension, a
more logical therapeutic
choice than beta
blockers or diuretics
KSCOOU- 1 926.03
ISOPTIN
(verapamil HQ/Knoii)
i'U
SUSTAINED-RELEASE TABLETS
Caution: federal law prohibits dispensing
witnout prescription W
Knoll Pharmaceuticals
A product of Knoll Research
a
• Economically packaged
in bottles of 100 tablets
• Liberal return-goods
policy
Supported by a
comprehensive
promotional
program, including:
• Extensive detailing
• Journal advertising
• Direct mail to
high-volume prescribers
Order today from your
wholesaler
basf g.oup knoll
Serving the pharmacy profession for more than 80 years
Please see next page for brief summary.
1986 BASF K&F Corporation
2454B-11-86
NEW. . . ONCE DAILY Bnef Summary
IN MILD TO MODERATE
HYPERTENSION
ISOPTIN SR
(verapamil HCI/Knoll)
240 mg scored, sustained-release tablets
CONTRAINDICATIONS: 1) Severe left ventricular dysfunction (see WARNINGS), 2) Hypotension (less than 90 mmHg systolic pressure) or cardiogenic
shock, 3) Sick sinus syndrome or 2nd or 3rd degree AV block (except in patients with a functioning artificial ventricular pacemaker).
WARNINGS: Heart Failure: ISOPTIN should be avoided in patients with severe left ventricular dysfunction (see DRUG INTERACTIONS), Patients with
milder ventricular dysfunction should, if possible, be controlled before verapamil treatment. Hypotension: ISOPTIN (verapamil HCI) may produce
occasional symptomatic hypotension. Elevated Liver Enzymes: Elevations of transaminases with and without concomitant elevations in alkaline
phosphatase and bilirubin have been reported. Periodic monitoring of liver function in patients receiving verapamil is therefore prudent. Accessory
Bypass Tract (Wolff-Parkinson-White): Patients with paroxysmal and/or chronic atrial flutter or atrial fibrillation and a coexisting accessory AV pathway
have developed increased antegrade conduction across the accessory pathway producing a very rapid ventricular response or ventricular fibrillation after
receiving intravenous verapamil. While this has not been reported with oral verapamil, it should be considered a potential risk. Treatment is usually
D.C. -cardioversion. Atrioventricular Block: The effect of verapamil on AV conduction and the SA node may cause asymptomatic 1st degree AV block and
transient bradycardia. Higher degrees of AV block, while infreguent (0.8%), may require a reduction in dosage or, in rare instances, discontinuation of
verapamil HCI. Patients with Hypertrophic Cardiomyopathy (IHSS): Although verapamil has been used in the therapy of patients with IHSS, severe
cardiovascular decompensation and death have been noted in this patient population.
PRECAUTIONS: Impaired Hepatic or Renal Function: Verapamil is highly metabolized by the liver with about 70% of an administered dose excreted in
the urine, in patients with impaired hepatic or renal function verapamil should be administered cautiously and the patients monitored for abnormal
prolongation of the PR interval or other signs of excessive pharmacological effects (see OVERDOSAGE).
Drug Interactions: Beta Blockers: Concomitant use of ISOPTIN and oral beta-adrenergic blocking agents may be beneficial in certain patients with
chronic stable angina or hypertension, but available information is not sufficient to predict with confidence the effects of concurrent treatment in
patients with left ventricular dysfunction or cardiac conduction abnormalities. Digitalis: Clinical use of verapamil in digitalized patients has shown the
combination to be well tolerated if digoxin doses are properly adjusted. However, chronic verapamil treatment increases serum digoxin levels by 50 to
75% during the first week of therapy and this can result in digitalis toxicity Upon discontinuation of ISOPTIN (verapamil HCI), the patient should be
reassessed to avoid underdigitalization. Antihypertensive Agents: Verapamil administered concomitantly with oral antihypertensive agents (e.g.,
vasodilators, angiotensin-converting enzyme inhibitors, diuretics, beta blockers, prazosin) will usually have an additive effect on lowering blood
pressure. Patients receiving these combinations should be appropriately monitored. Disopyramide: Disopyramide should not be administered within 48
hours before or 24 hours after verapamil administration. Quinidine: In patients with hypertrophic cardiomyopathy (IHSS), concomitant use of verapamil
and quinidine resulted in significant hypotension. There has been a report of increased quinidine levels during verapamil therapy. Nitrates: The
pharmacologic profile of verapamil and nitrates as well as clinical experience suggest beneficial interactions. Cimetidine: Two clinical trials have shown a
lack of significant verapamil interaction with cimetidine. A third study showed cimetidine reduced verapamil clearance and increased elimination to 1/2.
Anesthetic Agents: Verapamil may potentiate the activity of neuromuscular blocking agents and inhalation anesthetics. Carbamazepine: Verapamil may
increase carbamazepine concentrations during combined therapy Rifampin: Therapy with rifampin may markedly reduce oral verapamil bioavailability.
Lithium: Verapamil may lower lithium levels in patient on chronic oral lithium therapy. Carcinogenesis, Mutagenesis, Impairment of Fertility: There was
no evidence of a carcinogenic potential of verapamil administered to rats for two years. Verapamil was not mutagenic in the Ames test. Studies in female
rats did not show impaired fertility. Effects on male fertility have not been determined Pregnancv (Category C): There are no adequate and well-
controlled studies in pregnant women. ISOPTIN crosses the placental barrier and can be detected in umbilical vein blood at delivery. This drug should be
used during pregnancy, labor, and delivery, only if clearly needed Nursing Mothers: ISOPTIN is excreted in human milk, therefore, nursing should be
discontinued while verapamil is administered. Pediatric Use: Safety and efficacy of ISOPTIN in children below the age of 18 years have not been
established
ADVERSE REACTIONS: Constipation 8.4%, dizziness 3.5%, nausea 2.7%, hypotension 2.5%, edema 21%, headache 1.9%, CHF/pulmonary edema
1 .8%, fatigue 1.7%, bradycardia 1 .4%, 3° AV block 0.8%, flushing 0.1%, elevated liver enzymes (see WARNINGS). The following reactions, reported in
less than 1 .0% of patients, occurred under conditions (open trials, marketing experience) where a causal relationship is uncertain: they are mentioned
to alert the physician to a possible relationship: angina pectoris, arthralgia and rash, AV block, blurred vision, cerebrovascular accident, chest pain,
claudication, confusion, diarrhea, dry mouth, dyspnea, ecchymosis or bruising, equilibrium disorders, exanthema, gastrointestinal distress, gingival
hyperplasia, gynecomastia, hair loss, hyperkeratosis, impotence, increased urination, insomnia, macules, muscle cramps, myocardial infarction,
palpitations, paresthesia, psychotic symptoms, purpura (vasculitis), shakiness, somnolence, spotty menstruation, sweating, syncope, urticaria.
Treatment of Acute Cardiovascular Adverse Reactions: Whenever severe hypotension or complete AV block occur following oral administration of
verapamil, the appropriate emergency measures should be applied immediately, e.g., intravenously administered isoproterenol HCI, levarterenol
bitartrate, atropine (all in the usual doses), or calcium gluconate (10% solution). If further support is necessary, inotropic agents (dopamine or
dobutamine) may be administered. Actual treatment and dosage should depend on the seventy and the clinical situation and the |udgment and
experience of the treating physician.
OVERDOSAGE: Treatment of overdosage should be supportive. Beta-adrenergic stimulation or parenteral administration of calcium solutions may
increase calcium ion flux across the slow channel, and have been used effectively in treatment of deliberate overdosage with verapamil. Clinically
significant hypotensive reactions or fixed high degree AV block should be treated with vasopressor agents or cardiac pacing, respectively. Asystole
should be handled by the usual measures including cardiopulmonary resuscitation
Knoll Pharmaceuticals
A Unit of BASF K&F Corporation
Whippany, New Jersey 07981
&,
BASF Group knOll
c 1986, BASF K&F Corporation Printed in USA
38
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE QUIZ
Vaginal Douche Products
1. The FDA advisory panel that reviewed
OTC vaginal douche products reported that
all of the following are legitimate claims to
be permitted on the labeling of deodorant
products with the EXCEPTION of:
a. decreases the number of micro-
organisms.
b. destroys odors.
c. masks offensive odors..
d. removes vaginal secretions.
2. Which of the following has demonstrated
effectiveness as an astringent in a 0.2 to 1 .0%
concentration, but has not been proven safe
for use in OTC vaginal products?
a. Edetate disodium
b. Oxyquinoline citrate
c. Sodium borate
d. Zinc sulfate
3. During the reproductive years, the normal
pH of vaginal fluid is:
a. acidic.
b. neutral.
c. alkaline.
4. The FDA advisory panel that reviewed
OTC vaginal douche products found that
which of the following is safe and effective
for self-treatment of minor vaginal
irritation?
a. Acetic acid
b. Benzalkonium chloride
c. Boric acid
d. Povidone-iodine
5. All of the following are indigenous micro-
flora for the vaginal tract EXCEPT:
a. diphtheroids.
b. lactobacilli.
c. spirochetes.
d. trichomonas.
6. Which of the following statements is true?
a. Drugs introduced into the vaginal tract
cannot be absorbed.
b. It has been proven that routine
douching is necessary for normal,
healthy vaginal mucosa.
c. When douching, the woman should
occlude her vaginal opening so that the
irrigation fluid remains within for at
least five minutes.
d. The mucous membrane of the vaginal
tract is an extension of the uterus,
fallopian tubes and abdominal cavity.
7. The FDA panel that reviewed OTC vaginal
douches products found that all of the
following are safe and effective for self
medication as a mucolytic agent EXCEPT:
a. docusate.
b. nonoxynol 9.
c. sodium borate.
d. sodium lauryl sulfate.
8. The major question that the FDA panel that
reviewed OTC vaginal douche products
had concerning commercially available
OTC disposable douches was whether they:
a. contain a sufficient quantity of fluid to
effectively achieve their therapeutic
claims.
b. are adequately labeled for cosmetic
purposes.
c. are supplied with the proper tubing
and shut-off valve.
d. are safe for OTC sale.
9. When contained in OTC vaginal douche
products, potassium sorbate is classified by
the FDA advisory panel as being safe,
effective, and useful for:
a. altering vaginal pH.
b. astringent activity.
c. mucolytic action.
d. relief of minor irritation.
10. As far as the FDA is concerned, which of
the following uses for OTC vaginal douche
products is a therapeutic claim rather than a
cosmetic application?
a. Cleansing action
b. Deodorization
c. Mucolytic effect
d. Soothing effect
NEW MEMBERS
Continued from page 35
data collection and distribution services
network."
The new members join the charter founding
wholesalers who are:
Albers Inc., Knoxville, TN; Bristol, VA
Behrens, Inc., Waco, TX; Lubbock, TX
Commons Bros., Inc., Elmsford, NY
J. E. Goold & Company, Portland, ME
Northwestern Drug Co., Auburn, WA
Solomons Company, Savannah, GA
Twin City Wholesale Drug Company,
Minneapolis, MN
Walker Drug Company, Birmingham, AL
Louis Zahn Drug Companv, Melrose Park,
IL
Total membership consists of 14 ownerships
with 19 distribution centers.
April, 1987
THE CAROLINA JOURNAL OF PHARMACY
39
BIRTHS
Born to Mr. & Mrs. Bruce MacLeod, Raleigh
on March 26 at Wake Memorial Hospital, a son
named Robert Paul. Mrs. MacLeod is the former
Joy Woodard, class of 1977 School of
Pharmacy. Barney Paul and Anne Woodard of
Princeton are the proud grandparents.
Timothy and Mary Fuller Morgan of Buxton,
announce the birth of their daughter, Mary
Shanley Morgan on April 6 at 8 lbs. 2 oz.
DEATH
John D. Mitchell
John D. Mitchell, Kannapolis, died December
15, 1986 at the age of 73. Born in Concord,
Mitchell was a 1935 graduate of the UNC School
of Pharmacy, and in 1986 was inducted into the
NCPhA Fifty Plus Club, symbolizing fifty years
as a pharmacist. Mitchell was associated with
pharmacies in the Charlotte, Concord,
Kannapolis area before purchasing Martin's
Drug in Kannapolis in 1948.
MARRIAGE
SHERRY GAIL CREECH, Selma and
Dennis Harold Holloman, Princeton were
married on Saturday, March 21, at Fairview
Presbyterian Church, Selma. Elder D.B. Stokes
officiated at the 3:00 pm ceremony.
The bride is a 1986 graduate of the University
of North Carolina at Chapel Hill School of
Pharmacy, and is employed as a pharmacist at
Johnston Memorial Hospital in Smithfield. The
bridegroom is a 1977 graduate of North
Johnston High School and is employed with
Harris Teeter, Inc. of Raleigh. The couple live in
Selma.
1987 B.W. CO® PHARMACY
EDUCATION PROGRAM
Burroughs Wellcome Co. is pleased to
announce the continuation of the Burroughs
Wellcome Co. Pharmacy Education Program
through 1987. This year, we will distribute
$ 1 56,000 toward the program, bringing the total
amount of awards over the past fourteen years to
more than $1,600,000.
The objective of the Burroughs Wellcome Co.
Pharmacy Education Program is to bring all
segments of pharmacy (retail — chain and
independent, hospital, academic, and industry)
together for the basic support of the future of
pharmacy; i.e., to aid deserving students in
completing their education.
Each year, pharmacists from every state, plus
the District of Columbia and Puerto Rico, are
invited to participate in the Burroughs Wellcome
Co. Pharmacy Education Program. Pharmacists
who participate have the opportunity to compete
for educational grants which are presented to
pharmacy schools and the educational
foundations of six national pharmacy associa-
tions of their choice. Upon receipt, the pharmacy
school involved establishes a Burroughs
Wellcome Co. Scholarship which will be
awarded to an outstanding student to aid in the
completion of his/her education.
When the program started in 1974, 52
students received grants of $250. In subsequent
years, the program has gradually expanded to its
present format of 1 56 winning pharmacists given
the opportunity to donate: (1) $500 to the
pharmacy school of his/her choice for the
establishment of a Burroughs Wellcome Co.
Scholarship; and (2) an additional $500 grant,
issued in his/her name, and presented to the
educational foundation of one of the following
national pharmacy associations; American
College of Apothecaries (ACA), American
Pharmaceutical Association (APhA), American
Society of Hospital Pharmacists (ASHP),
National Association of Chain Drug Stores
(NACDS), National Association of Retail
Druggists (NARD), or the American Society of
Consultant Pharmacists (ASCP). Again, the
choice of national pharmacy association is up to
the winners.
Pharmacists become eligible for the drawing
(scheduled for July 17, 1987) by filling out and
mailing an entry form to B.W. Co.® by the June
15 deadline. To be valid, the entry form must
include both the pharmacy school and the
national pharmacy association of their choice.
Each of the 156 pharmacists will receive a
suitably inscribed plaque in recognition of their
being a winner. And everyone who enters will
receive a free gift — a replica of a 17th century
pill tile.
In 1986, over 48,600 entries were received,
truly a testimonial to the interest within the
pharmacy profession for the Burroughs
Wellcome Co. Pharmacy Education Program.
April, 1987
40
THE CAROLINA JOURNAL OF PHARMACY
CLASSIFIED ADVERTISING
Classified advertising (single issue insertion) 25 cents a word with a minimum charge of $5.00 per
insertion. Payment to acompany order.
Names and addresses will be published unless a box number is requested.
In replying to "blind" ads, address Ad. No., Carolina Journal of Pharmacy, P.O. Box 151, Chapel
Hill, NC 27514. Telephone (919) 967-2237.
PHARMACIST NEEDED: Crown Drug
has pharmacist positions open in central
North Carolina due to planned expansion
in 1 987, We offer excellent starting salary,
40 hour week, paid vacation, insurance,
and many other benefits. Come grow with
us. Send resume to: Doug Sprinkle,
Crown Center, 400 Commerce Place,
Advance, NC 27006.
RELIEF PHARMACIST NEEDED: For
weekend work. Professional pharmacy in
Garner. Computerized excellent working
conditions. Contact Tom Jones Drug, PO
Box 271, Garner, NC 27529. (919) 772-
4737.
HOSPITAL PHARMACIST WANTED:
Staff position available in a 68 bed acute
care hospital in Siler City, NC. Hospital
experience desirable. Salary commen-
surate with experience. For more
information, contact Sandra McKinney,
Chatham Hospital, Inc., P.O. Box 649,
Siler City, NC 27344. (919) 663-2113.
PHARMACIST FOR HIRE: Mature
Pharmacist, active in excellent health
wants work with small town pharmacy or
relief work. Call Craig, (919) 673-1368.
PHARMACIST WANTED: Full-time
position on coast. Excellent working
conditions. Competitive salary and
benefits. Contact T01, NCPhA.
PHARMACY FOR SALE: Coastal NC.
Sales greater than $400,000.00; 60%
prescriptions. 10 miles from the ocean.
Contact Bullock & Whaley (919) 762-
2868; PO Box 3783, Wilmington NC
28406.
INDEPENDENT PHARMACY (Triad):
Needs warm, friendly, civic-minded
pharmacist. In return have flexible hours,
plus one week's vacation every four
months, plus 3-day weekends during
summer. Call Apple Pharmacy, 704-634-
2111.
RELIEF PHARMACIST AVAILABLE:
Central & Eastern North Carolina. Contact
Pharmacy Relief, PO Box 2064, Chapel
Hill NC 27515 or call 919-481-1272
evenings.
PROFESSIONAL PHARMACIES: Sev-
eral small prescription-oriented pharma-
cies are currently available for individual
ownership in North Carolina. These oppor-
tunities provide the vehicle to practice
pharmacy the way you were taught, while
offering an attractive income and more
time to be with your family. In some of
these cases, financing is also available to
qualified candidates. For more informa-
tion write: Jan Patrick, 10121 Paget Dr.,
St. Louis MO 63132.
CLINICAL-STAFF PHARMACIST POSI-
TION: Will be working every 3rd weekend
and will have responsibilities in unit dose,
IV admixtures, cancer chemotherapy,
patient education, nursing inservice,
pharmacy newsletter, pharmokinetic
dosing, drug use evaluation and other
evolving clinical applications. Some
advanced training and experience in
clinical pharmacy preferred. If interested
and qualified please send resume to:
Director of Personnel, Community
General Hospital, PO Box 789, Thomas-
ville NC 27360. EOE.
PHARMACIST PROFESSIONAL SER-
VICES/CONSULTATION: Temporary and
or Continual. Contact: L. W. Matthews, III,
(919) 967-0333 or 929-1783. 1608 Smith
Level Rd., Chapel Hill NC 27514.
April, 1987
Digger
CHRISTMAS^
Saturday, July 11
1 p.m.- 9 p.m.
Sunday, July 12
9 a.m.- 6 p.m.
at the
Arthur Ashe Athletic Center
3017 North Boulevard • Richmond, Virginia
Owens &Minor, Inc.
1987 GIFT SHOW
• Spectacular array of top quality
goods in one location.
• Over 100 major manufacturers
represented.
• Everyday drug store items.
• The convenience of one stop
shopping.
• New products and traditional
gifts.
• Household products, personal
and electrical appliances.
• Main brand cosmetic lines.
• Toys, games and plush items.
Owens &Minor, Inc.
1010 HERRING AVENUE • Wl LSON, NORTH CAROLINA 27893 '919/237-1181
Dr.T.C. Smith Co. / W.H.King Drug
ASHEVILLE, N.C. 28806 • 704/258-2645
RALEIGH, N.C. 27622 • 919/782-8400
TOTAL
HOMESPUN
SERVICE
In today's business rush we take the time to help
you with your management decisions . . . whether its
over coffee or part of a regular sales call. We will fill
your order with care and with dispatch today. Just as
we did in 1869.
We use advanced technology to lead in service to our
customers.
Some of our available programs are Electronic Order
Entry • Merchandising and Programming • Valurex
Advertising & Promotion • Retail Pricing • Micro-
fiche • Pharmacy Computer Systems • Home
Health Care and much more.
Whether you take your coffee
black or with cream,
call us to find
out more details. i-ffl
VALUREX INDEPENDENT
vmm
PHARMACY
ADVERTISING & PROMOTIONAL
PROGRAMS
TO HELP YOUR BUSINESS IS OUR BUSINESS'
A =- ^> l*
THE OIROUNk
JOURNMofPHN?MkCY
iJ^LlH SLEW
UBR
LU
CO
:
JUN
1987
O
>
Presented their 50+ Certificates and pins and inducted into the NCPhA Fifty Plus
Club at the Annual Convention, having been licensed for fifty years were: left to right
Rupert E. Bullard, Fayetteville; Loy M. McCombs, Creedmoor; John A. Mitchener,
Jr., Edenton; Herbert T. Taylor, Goldsboro; Charles M. Crowell, Jr., Mooresville; W.J.
Smith, Chapel Hill.
oo
i
Health
223 -H
UNC
Chapel HiU
Sciences L i b r a r y
NC 2 7514
JMIIIIIlun ' ■nnilllll
Looking for a
Dependable Wholesaler?
Look to Kendall.
Kendall customers choose us because
we know the pharmacy business and give
excellent service. Kendall offers evening
order-taking and fast delivery. Also look
to Kendall for Drug Store Designs and
Fixtures, Pricing Strategies, Microfiche,
Advertising Programs and Electronic
Order Entry.
Kendall also offers the Triad Pharmacy
Computer System, featuring Prescription
Processing, Drug Interactions, Accounts
Receivables, Third Party Billing and
Medi-Span Price Updates. Triad
increases efficiency and organization, is
easy to use, and is fully supported by
Kendall. Call Triad direct at
1-800-532-3087.
IK
Count On
ILXDFOJO COIVIF>A»MY
1305 Frederick St. • P.O. Box 1060 • Shelby, N.C. 28150
N.C. 1-800-222-3856
S.C. 1-800-438-5330
Justice Drug Company
P.O. Box 22025
Greensboro, NC 27420
AN ALCO STANDARD COMPANY
Now in our 87th Year of Service to the North Carolina Pharmacists
1-800-632-1295
fills Partnership
For Profit
Family
Independent
Pharmacy
Total Retail Concept
The Family Independent Pharmacy program provides an
all-inclusive plan covering every aspect of marketing,
merchandising, and management of drug store opera-
tions. It is a wholesaler-sponsored voluntary, and it
embraces the total retail concept in all its forms.
1HHC
TOTAL HOME HEALTH CARE
Our Total Home Health Care™ Program offers Durable
Medical Equipmentfor Rentor Resale. Third Party Billing
for Medicare/Medicaid.
Additional
* Services & Programs Offered *
Store Plan-O-Gram: Complete Store Layouts Design
including Fixtures, Merchandise Plan-o-graming,
and Pricing Strategies
Specialty Qift Departments including Arts & Crafts
Affordable Pharmacy Computer Systems
LIBERTY DRUG SYSTEMS, INC.
QS/1 PHARMACY SYSTEMS
Merchandise Racking Service
Group Life
And Health
Insurance
Benefits
For Members Of
North Carolina
Pharmaceutical
Association
Pilot Life Insurance Company is pleased to have oeen
selected as the Group insurance carrier for the North
Carolina Pharmaceutical Association. It would be to
your advantage to become thoroughly acquainted with
the benefits of this program.
You can expect the best possible service from Pilot Life,
one of the nation's leading Group insurance carriers.
For full information, contact Mr. Al Mebane, Executive
Director, North Carolina Pharmaceutical Association.
Write or call:
Sam P. Stuart, CLU
P. 0. Box 595
Winston-Salem, NC 27102
Telephone 919/723-8811
Pilot
life
THE OIROLINk
JOURNN.ofPHN?MKCY
MAY 1987
Officers
NORTH CAROLINA
PHARMACEUTICAL
ASSOCIATION
President
Julian E. Upchurch
5201 Pine Way
Durham, NC 27712
(919)477-7325
Vice Presidents
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh, NC 27612
(919) 876-5600
W. Robert Bizzell
1007 Rhem Street
Kinston, NC 28501
(919)527-6929
Loni T.Garcia
5210 McLeod Road
Lumberton, NC 28358
(919) 738-6441, Ext. 7317
Executive Director
& Editor
A. H. Mebane, III
P.O.Box 151
Chapel Hill, N.C. 27514
NCPhA Office
(919)967-2237
or
1-800-852-7343
(USPS 091-280)
VOLUME 67
ISSN 0528-1725
NUMBER 5
CONTENTS
Report of the Resolution Committee 4
Report of the Ethics, Grievance and Practice Committee ... 9
Woodard Receives Distinguished Pharmacy
Alumnus Award 15
Report of the NCPhA Endowment Fund Committee 16
The NCPhA Endowment Fund 17
Dickinson's Pharmacy 20
Cocaine and "Crack" 21
CE Course — Hard Contact Lens Solutions 23
CE Course Quiz 32
Classified Advertising 35
ADVERTISERS
Colorcraft 5
Dr. T. C. Smith Co./W.H. King Drug Back Cover
Eli Lilly and Company 30
Justice Drug Company 1
Kendall Drug Company Inside Front Cover
NARD Calendar 26
Owens & Minor Inside Back Cover
Pilot Life 2
Spear Associates 18
Store Fixtures & Planning, Inc 10
Upjohn 8
Washington National 12
The Carolina Journal of Pharmacy is published monthly by the
North Carolina Pharmaceutical Association, P. O. Box 151,
Chapel Hill, NC 27514. The Journal is provided to NCPhA
members through allocation of annual dues. Subscription rate to
non-pharmacists (continental US) $20.00. Single copy price
$2.00. Overseas rates on request. Second class postage paid at
Chapel Hill, NC.
[ THE CAROLINA JOURNAL OF PHARMACY
REPORT OF THE RESOLUTIONS COMMITTEE
Presented and Adopted at the 107th Annual meeting of the North Carolina
Pharmaceutical Association, April 22-25, 1987, Charlotte
I. Source — Mental Health Committee
Whereas the Mental Health Committee is
concerned about the dispensing of drugs
in Mental Health Centers, and
Whereas there is insufficient information
currently available on this practice,
Now therefore be it Resolved that
A survey be conducted by the Committee to
determine how mental health centers in
the 100 counties of North Carolina are
handling medications for their clients.
Recommendation — Do Pass
II. Source — Employer/Employee Relations
Committee
Whereas polygraph test results are not
accepted as evidence in a court of law
and results are subject to misinterpre-
tation and variation in testing techniques,
and
Whereas polygraph testing is stressful and
degrading to professionals,
Now therefore be it Resolved that
The North Carolina Pharmaceutical
Association recommends that pre-
employment and routine polygraphing
of pharmacists be discontinued/and be
it further resolved that the North
Carolina Pharmaceutical Association
supports federal and state legislation to
limit polygraph testing.
Recommendation — Do Pass
III. Source — Employer/Employee Relations
Committee
Whereas due to changes in federal income
tax laws, employed pharmacists (will)
be unable to deduct such items as
association dues, convention expenses,
continuing education, etc., therefore
Be it resolved that
Employers be urged to offer pharmacists a
"Professional Expense Account" and
reimburse said employees for these
miscellaneous expenses up to a
reasonable dollar limit, on a case-by-
case basis
Recommendation — Do Pass
IV. Source — Employer/Employee Relations
Committee
Whereas many pharmacists who are
covered by company pension plans are
affected by changes in the tax law
Now therefore be it Resolved that
Employers be urged to offer alternate tax-
sheltered retirement plans to their
pharmacists.
Recommendation — Do Pass
V. Source — Ethics, Grievance & Practice
Committee
Whereas disciplinary action by the Ethics,
Grievance and Practice Committee as
authorized by the Constitution of the
North Carolina Pharmaceutical Asso-
ciation can have substantial impact on
the disciplined member, and
Whereas all disciplinary action by the
Ethics, Grievance and Practice Com-
mittee should be administered in a
consistent and equitable manner, and
#TC WUHfy J
David Work, Chairman, Resolutions Committee
May, 1987
THE CAROLINA JOURNAL OF PHARMACY
Whereas variation in disciplinary action can
be minimized by staggered four year
terms of Committee members, therefore,
Be it Resolved that
The North Carolina Pharmaceutical Asso-
ciation submit the following constitu-
tional amendment to be considered at
the 1988 annual meeting.
Article HI, Section 2 of the Consitution is
amended to read:
The Ethics, Grievance and Practice
Committee is the judicial division of the
Associtaion and shall be composed of
five members, one of whom shall be the
current Second Vice-President of the
Association. The first year, the President
of the Association shall appoint four
committee members and shall designate,
one, two, three, or four year terms,
respectively. Thereafter, one new
member shall be appointed by the
President annually for a four year term.
The Executive Director of the Associ-
ation shall serve as an exofficio member
of the Committee. It shall be the primary
responsibility of the Ethics, Grievance
and Practice Committe to develop
written criteria for membership and
interpret and enforce the Association's
Code of Professional Ethics according to
the provisions of the Bylaws and
procedures duly adopted by the
Committee. The Committee shall also
serve to advance the practice standards
of the profession of pharmacy.
(Changed wording appears in italics)
Recommendation — No Recommendation
VI. Source — Committee on Community
Pharmacy
Whereas it is not in the patient's best
interests to limit freedom of choice, and
Whereas a limitation on freedom of choice
of pharmaceutical services can interfere
with the pharmacist/physician/patient
relationship
Now therefore be it Resolved that
The North Carolina Pharmaceutical
Association encourages freedom of
choice of pharmaceutical services in all
managed health care plans.
Recommendation — Do Pass
VII. Source — Committee on Community
Pharmacy
Whereas the Pharmaceutical Manufac-
turers Association finished products
index has increased approximately 10%
annually over the last five years, and
Whereas this does not compare favorably
with other economic data such as the
1 986 Consumer Price Index increase of
2%,
Now therefore be it Resolved that
The North Carolina Pharmaceutical
Association urge pharmaceutical
manfacturers to use restraint in price
increases, and
Be it further Resolved that
A copy of this Resolution be mailed to all
Pharmaceutical Association members.
Recommendation — Do Pass
VIII. Source — Committee on Community
Pharmacy
Whereas single tiered pricing of pharma-
ceuticals is in the best interest of the
public,
Therefore be it Resolved that
The North Carolina Pharmaceutical
Association commend those pharma-
ceutical manufacturers who have
implemented single tier pricing plans
Continued on page 6
Remember the ^Day
...incPictures
COLORCRAFT
North Carolina's Most Complete
Film Processing Service
There Is A Plant Located
Near You
For the Finest Quality Plus Fast
Dependable Service on All Your
Photo Needs, Contact the Plant
Nearest You.
CHARLOTTE WILMINGTON
KERNERSVILLE RALEIGH
FAYETTEVILLE DURHAM
If You Don't Know Photofinishing
Know Your Photofinisher
May, 1987
THE CAROLINA JOURNAL OF PHARMACY
RESOLUTIONS COMMITTEE
Continued from page 5
and encourage other manufacturers to
adopt such plans, and
Be it further Resolved that
A copy of this Resolution be forwarded to
the members of the Pharmaceutical
Manufacturers Association.
Recommendation — Do Pass
IX. Source — Members of Board of Pharmacy
Whereas the orientation process for New
Members of the Board of Pharmacy
takes a substantial period of time and
can consume most of one term, and
Whereas the current limit of two terms of
three years each is uniformly considered
by present and past Board Members as
insufficient for maximum benefit to the
public and the profession, and
Whereas under the current statutory
provision it is possible for five of the six
Board Members to be replaced within a
12 month period, and
Whereas the five elected Board Members
would be replaced at a more steady and
reasonable rate if the Members terms
were staggered and five years in length,
thus insuring continuity and fairness in
hearings and disciplinary matters,
Now therefore be it Resolved that
The North Carolina Pharmaceutical
Association go on record supporting a
maximum of two terms of five years
each for Members of the Board of
Pharmacy.
Recommendation — Do Pass
X. Source — Resolutions Committee
Whereas W.J. Smith has expended much
effort to obtain space for a 1 920's drug
store exhibit in the North Carolina
Museum of History, and
Whereas W.J. Smith is continuing a diligent
search for pharmaceutical fixtures, items
and other support, and
Whereas this activity will provide an
invaluable asset for pharmacy and the
people of this state.
Now therefore be it Resolved that
W.J. Smith and the Committee for
Installation of 1 925 Exhibit at the North
Carolina Museum of History, Raleigh
be commended for this leadership.
Recommendation — Do Pass
XI. Source Northwest Pharmacists' Association
NONPHARMACIST DISPENSING
Whereas, there is a current trend toward
increased dispensing activity by
nonpharmacists, and
Whereas, patients receiving prescription
medications are entitled to comprehen-
sive pharmaceutical services, including,
but not limited to patient counseling,
maintenance of patient profiles and the
provision of the "check and balance"
system with other health professionals to
prevent prescriber errors and adverse
drug interations, and
Whereas, patients typically do not receive
these comprehensive services from
nonpharmacist dispensers, and
Whereas, twenty-five states now have
legislation which either prohibits
nonpharmacist (including physician)
dispensing or imposes the same labeling,
packaging and recordkeeping require-
ments as apply to pharmacists, and
Whereas, the American Pharmaceutical
Association has seen fit to adopt a policy
in opposition to dispensing by
nonpharmacists,
Be it resolved that, the North Carolina
Pharmaceutical Association oppose the
dispensing of prescription medications
by nonpharmacists, and
Be it further resolved that, the North
Carolina Pharmaceutical Association
propose and support legislation which
would 1) prohibit the dispensing of
prescription medications except under
the supervision and control of a
pharmacist, and 2) require that all
persons who dispense prescription
medications (including medication
samples) be required to obtain a
pharmacy permit and to comply with
the same laws and regulations governing
dispensing by pharmacists, and
Further be it resolved that the North
Carolina Pharmaceutical Association
report on the status of the above
legislative activity to the membership at
the 1988 Annual Meeting
Recommendation — Do Pass
XII. Source Northwest Pharmacists' Association
May, 1987
THE CAROLINA JOURNAL OF PHARMACY
Campbell University Student Chapter of the
NCPhA
PRESCRIPTION MAIL ORDER
PHARMACY SERVICES
Whereas, a direct, personal and interactive
pharmacist-patient relationship is
essential in the provision of compre-
hensive pharmaceutical services, and
Whereas, patients should not be penalized
by third party contractual agreements
which limit their selection of providers
of pharmacy services, and
Whereas, studies have shown mail order
prescription services do not save money
for the payers of health care benefits, and
Whereas, community pharmacists are
called upon to deal with problems
experienced by patients using mail order
prescription services,
Be it resolved that the North Carolina
Pharmaceutical Association oppose
mail order prescription services which
circumvent the traditional primary
pharmacist-patient-physician relation-
ship, and
Be it further resolved that the North
Carolina Pharmaceutical Association
educate payers of prescription benefits
abou the lack of cost-effectiveness and
other problems associated with mail
order prescription services, and
Be it further resolved that the North
Carolina Pharmaceutical Association
propose and support legislation which
would require that all providers of
pharmaceutical services in North
Carolina meet the North Carolina
pharmacy practice standards, laws and
regulations, and
Further be it resolved that the North
Carolina Pharmaceutical Association
report on the status of the above
legislative activity to the membership at
the 1988 Annual Meeting
Recommendation — Do Pass
XIII. Source Resolutions Committee
Whereas this Annual Convention has been
served by a dedicated group of Local
Convention Chairmen, and
Whereas this Annual Convention could not
occur without the invaluable assistance
of many individuals,
Now, there be it Resolved that the Members
of the North Carolina Pharmaceutical
Association hereby adopt this resolution
of appreciation for the efforts of Don
Hill, Mary Lou Davis, DeLacey Luke,
Exhibitors, Contibutors and all others
who have helped make this convention a
success.
Recommendation — Do Pass
Committee Members
David R. Work, Chairman
James L. Creech
Kathleen M. D'Achille
Truman Hudson
John R. Setzer, Jr.
Left to Right: John C. Hood, 1 987 Pharmacist of
the Year and M. Keith Fearing, Jr., 1986-1987
NCPhA President. The Mortar and Pestle
Dinner in Kinston will be announced soon.
The Pharmacy Trivia question in the
February issue of the Carolina Journal of
Pharmacy has gone unanswered. The
question was "For what was Richard Q.
Peevy recognized by NARD in 1951".
Jesse Pike, Concord, was close, but not
correct. Peevy was the pharmacist on the
radio show "The Great Gildersleeve" and
received a plaque honoring him as
"American's Favorite Neighbor Druggist".
May, 1987
These days,
your customers want more
than medicine in hand.
They want answers.
"today's pharmacists have some explaining
to do. In fact a recent study by The Upjohn
Company showed that 65% of your customers
want to talk with you about their prescriptions.
That's a 22% increase in nearly 10 years!
The reason is consumer awareness. Todays
customer is better informed, better educated
— with many more questions about concerns
like side effects and drug interactions. So take
time out to talk with your customers. In today's
competitive environment it might be one of the
best things you can do to earn repeat business.
The Upjohn Company has many more facts
on the trends affecting your business. If you'd
like to know more, just contact your Upjohn
representative.
Sharing knowledge... sharing success.
, C 1M7. Th. Up**" Comfany. K4unuoo, Mtttogvi 49001
THE CAROLINA JOURNAL OF PHARMACY
REPORT OF THE ETHICS, GRIEVANCE
AND PRACTICE COMMITTEE
Presented at the 107th Annual meeting of the North Carolina
Pharmaceutical Association, April 22-25, 1987, Charlotte
The work of the 1986-87 Ethics, Grievance
and Practice Committee was two-fold;
1) develop written criteria for membership and
administrative procedure for grievances as called
for in the Association's Constitution and
2) provide an interpretation of the Code of
Professional Ethics and to advance the practice
standards of the profession.
Written Criteria For Membership
Article IV, Section 1 of the NCPhA
Constitution states that an active member must
satisfy written criteria developed by the Ethics,
Grievance and Practice Committee. Pursuant to
this requirement, the committee adopted the
following criteria for active membership.
To become an Active Member, an individual
must meet the following criteria:
1. be a pharmacist licensed to practice
pharmacy under the laws of this state or a
graduate of an accredited School of
Pharmacy,
2. pay annual dues, and
3. subscribe to the Association's Code of
Professional Ethics (to be indicated by
signing the application for membership and
renewal applications)
It will be apparent to the membership that the
Committee is requiring of potential members
nothing that the Constitution does not already
require.
Administrative Procedure For
Disciplinary Action
In considering the procedure to be folowed
when disciplining its members, many salient
issues were raised. These are presented in this
report to provide a greater perspective to the
membership regarding the work of this
Committee. The document outlining the
procedure to govern disciplinary action as
adopted by the Committee follows the
presentation of these issues.
1 . What are the tangible repercussions to an
individual if his membership is terminated?
a. Denial of renewal of professional
liability insurance.
b. No loss in health insurance benefits.
North Carolina Laws prohibit an
organization from dropping a member's
(former member's) health insurance.
2. Shouldn't there be some way for the
Committee to discipline a member without
taking away their membership? i.e.
something less severe
— The committee should be able to reduce
membership privileges. This may include
prohibiting the member from committee
membership or serving/being nominated
for an Association office. This suggestion
was incorporated in "II. Disciplinary
Actions" of the Administrative Procedure.
3. What should this Committee's role be in
helping the grieved parties?
— An attempt at arbitration should occur
prior to any formal action by the
committee. This consideration was
incorporated in paragraph three of the
introduction to the Administrative
Procedure.
4. How can consistency and fairness in
committee actions against members be
assured?
— It was proposed that the committee
members serve extended terms with only
one member rotating off each year. A
constitutional amendment will be requried
to change the committee's composition and
will be presented as a resolution at this
1987 Convention.
5. How will the Committee learn of the
conviction of a member by the Board of
Pharmacy or the Courts?
— The Association should obtain the
public record of the Board of Pharmacy
proceedings as well as any court cases
involving members. It is the feeling of this
Committee that a genuine effort should be
made to routinely peruse these documents
in order to fairly administer its
responsibilities. The mechanism for
obtaining this information is left to the
discretion of the Committee and the
Association staff. This issue was
Continued on page 10
May, 1987
10 THE CAROLINA JOURNAL OF PHARMACY
ETHICS, GRIEVANCE identified? What media should be used to
Continued from page 9 identify disicplined members?
— A subcommittee recommended that the
incorporated in paragraph three of the actions of the Committee be published in
introduction to the Administrative the Carolina Journal of Pharmacy. The
Procedure. Committee took no final action on this
6. Does the responsibility of this Committee recommendation,
duplicate the responsibilities of the Board
of Pharmacy? Administrative Procedure For
— This Committee is the judicial branch Disciplinary Action
of the North Carolina Pharmaceutical The Ethics, Grievance and Practice
Association and as such should be Committee (hereinafter referred to as the
responsible for the self regulation of its Committee) is authorized to hear, mediate and
membership. The Board of Phrmacy does advise on matters with respect to the Code of
not adress ethical issues; and this fact alone Professional Ethics of the North Carolina
differentiates the actions of the two. It is Pharmaceutical Association. The power of the
also apparent that the Association is not Committee is solely to hear representations by
well served by endorsing as members the persons directly involved in grievances, to
convicted te\ons (pharmacy related or other mediate voluntary adjustments and to advise
wise) or others serving active sentences adjustments or disciplinary action when
imposed by the Board of Pharmacy. appropriate. The Committee may act as a whole
7. Should the names of disciplined members or as designated by the Chairman in panels of two
be published, or should just the town, area or more for consideration of particular
of the state, and/or practice type be grievances.
THE EXPERIENCE WE VE GAINED FROM
OVER 200 PHARMACY INSTALLATIONS IS
AVAILABLE TO YOU . . .
AND, WE ARE THE ONLY STOCKING
DISTRIBUTOR OF DRUG STORE FIXTURES IN
THE CAROLINAS.
IF YOU NEED A SINGLE FIXTURE OR A
COMPLETE STORE, OUR PROFESSIONAL
STAFF IS READY TO SERVE YOU
"THE AREAS LARGEST DISTRIBUTOR OF
MODULAR DISPLAY FIXTURES"
RICHMOND, VIRGINIA CHARLOTTE, NORTH CAROLINA
7921 -A WEST BROAD ST 3555 TRYCLAN DRIVE
(804) 740-0793 (704) 525-5300
ROLAND THOMAS RANDY BIVENS
"WE ARE MORE THAN A FIXTURE COMPANY— A TEAM OF PHARMACY
SPECIALISTS WITH OVER 60 YEARS COMBINED EXPERIENCE IN OVER
500 DRUG STORES"
5?
STORE FIXTURES
& PLANNING. INC.
BTonc rucrvnew
May, 1987
THE CAROLINA JOURNAL OF PHARMACY
11
"Grievances" within the jurisdiction of the
Committee include matters directly related to
violations by any member of the Association of
any section of the Code of Professional Ethics; of
the phramacy laws of the State of North
Carolina, the Rules and Regulations of the North
Carolina Board of Pharmacy or the federal laws
relating to the practice of pharmacy; or actively
serving a conviction for a felony.
No grievances based on violation of the Code
of Professional Ethics may be considered except
on the basis of a prior written statement of its
nature by the aggrieved member(s) and until
determination is made that an unsuccessful
attempt has been made to resolve the grievance
with member or members directly concerned. All
other grievances will be considered on the basis of
the public record reporting said grievance. A
grievance need not be presented by a member of
the North Carolina Pharmaceutical Association.
I. CONDUCT SUBJECT TO
DISCIPLINE
A member may be disciplined by the
Committee for:
1 . violating the Code of Professional Ethics
of the North Carolina Pharmaceutical
Association,
2. having been convicted of violating the
pharmacy laws of the State of North
Carolina, the Rules and Regulations of
the North Carolina Board of Pharmacy,
or the federal laws relating to the practice
of pharmacy, or
3. having been convicted of a felony.
II. DISCPLINARY ACTIONS
A member may be reprimanded, have his
membership privileges reduced, be sus-
pended or be expelled from membership for
any of the offenses enumerated in Section I.
(NCPhA Constitution Article III, Section 3)
III. DISCIPLINARY PROCEEDINGS
Upon the receipt of a written, signed
complaint or other notification, the
Committee shall determine whether the
allegations are true and correct requiring
disciplinary action. If so, the committee may
then: 1 ) seek voluntary compliance with the
Code of Professional Ethics, 2) schedule a
formal hearing, or 3) delay action pending
further information. If the committee
determines that the allegation would not
constitute unprofessional conduct, it will
dismiss the complaint.
A. Hearing: The accused member shall be
entitled to a hearing at which he shall be
given the opportunity to present his
defense to all charges brought against
him.
B. Notice: The accused member shall be
notified in writing of charges brought
against him and of the time and place of
the hearing.
C. Charges: The written charges shall
include a statement of the alleged
conviction in law or determination of
legal guilt, or a specification of the ethical
provisions alleged to have been violated,
as the case may be, and a description of
the conduct alleged to have been
violated, as the case may be, and a
description of the conduct alleged to
constitute each violation.
D. Decision: Every decision which shall
result in reprimand, suspension or
expulsion shall be reduced to writing and
shall specify the charges made against the
member, the facts which substantiate any
or all of the charges, the decision
rendered, the action imposed and a notice
shall be mailed to the accused member
informing him of his right of appeal.
Within ten ( 1 0) days of the date on which
the decision is rendered a copy thereof
shall be sent by registered mail to the last
known address of each of the following
parties: 1) the accused member 2) the
president of the Association, and 3) the
Executive Director of the Association.
The Executive Committee of the North
Carolina Pharmaceutical Association
(hereinafter referred to as the Executive
Committee) shall be notified of all
decisions affecting membership status.
IV. APPEALS
Before any disciplinary action is imposed,
an accused member shall have the right to
appeal from a decision of the Committee to
the Executive Committe by filing an appeal
with the Executive Director of this
Association and chairman of the the
Committee. An appeal from any decision
shall not be valid unless filed within sixty
(60) days from the date on which the
member received notification of the
decision by the Committee. No decision
Continued on page 13
May, 1987
o
We're not
strangers...
LUasninpcon
national
INSURANCE COMPANY
NCPhA-Endorsed Insurance Plans
Which Merit Member Participation
DISABILITY INCOME PLAN HOSPITAL INCOME PLAN
MAJOR MEDICAL EXPENSE PLAN TERM LIFE PLAN
RETIREMENT AND PROFIT SHARING PLANS
FOR DETAILS WRITE OR TELEPHONE:
HOYT W. SHORE, CLU and Associates
821 Baxter Street-Suite 316
Charlotte, North Carolina 28202
Telephone (704) 333-3764
UJasninqeon
national
INSURANCE COMPANY
Evanston, Illinois 60201 • A Washington National Corporation Financial Service Company
THE CAROLINA JOURNAL OF PHARMACY
13
ETHICS, GRIEVANCE
Continued from page 11
shall become final while an appeal there
from is pending or until the sixty (60) day
period for perfecting an appeal has elapsed.
(NCPhA Constitution Article III, Section
3). The following procedure shall be used in
processing appeals:
A. Hearing on Appeal: The accused
member shall be entitled to a hearing on
an appeal, provided that such appeal is
taken in accordance with, and satisfied
the requirements of Section IV.
B. Notice: The accused member and the
chairman of the Committee shall be
notified of the time and place of the
hearing, such notice to be sent by
registered mail to the last known address
of the parties to the appeal and mailed not
less than thirty (30) days prior to the date
set for the hearing.
C. Briefs: Every party to an appeal shall be
entitled to submit a brief in support of his
or its position. The party initiating the
appeal shall submit his or its brief to the
Executive Director of the Association
within ninety (90) days of the date upon
which the decision appealed from was
rendered.
D. Record of Disciplinary Proceedings:
Upon notice of an appeal, the chairman
of the Committee shall furnish to the
Executive Director of this Association
and to the accused member a transcript
of, or an officially certified copy of the
minutes of the hearing accorded the
accused member. The transcripts or
minutes shall be accompanied by
certified copies of any affidavits or other
documents submitted as evidence to
support the charges against the accused
member or submitted by the accused
member as part of this defense.
E. Appeals Jurisdiction: The executive
committee shall be required to review the
decision appealed from to determine
whether the evidence before the
Committee supports that decision or
warrants the disciplinary action imposed.
The majority decision of the executive
committee of cases on appeal shall be
final and binding (NCPhA Constitution
Article III, Section 3).
F. Decision on Appeals: Every decision on
appeal shall be reduced to writing and
shall state clearly the conclusion of the
executive committee and the reasons for
reaching that conclusion. The executive
committee shall have the discretion to:
1 . uphold the decision of the Committee,
2. reverse the decision of the Committee,
3. deny an appeal which fails to satisfy
the requirement of Section IV,
4. refer the case back to the Committee
for a new proceedings, if the rights of
the accused member under all
applicable bylaws were not accorded
him, or
5. refer the case back to the Committee
with a recommendation for less
severe disciplinary action.
Within ten (10) days from the date on which a
decision on appeal is rendered, a copy thereof
shall be sent by registered mail to the last known
address of each of the following parties: 1 ) the
accused member, 2) the chairman of the
Committee, 3) the Executive Director of the
Association.
Committee Membership
As stated above, the Committee was
concerned with the likelihood of substantial
variation in the nature of disciplinary action
should the entire committee membership be
changed each year as in the current practice. The
Committee further believes that membership in
the Association is important enough that an
attempt should be made to provide consistency
and fairness in the Committee's deliberations.
The following consitutional change is therefore
being submitted in the form of a resolution at this
1987 Convention. (Proposed changes appear in
italics)
ARTICLE III, SECTION 2 — ETHICS,
GRIEVANCE AND PRACTICE
COMMITTEE
The Ethics, Grievance and Practice
Committee is the judicial division of the
Association and shall be composed of five
members, one of whom shall be the
current Second Vice-President of the
Association. The first year, the President
of the Association shall appoint four
committee members and shall designate
one, two, three or four year terms,
respectively. Thereafter, one new member
Continued on page 14
May, 1987
14
THE CAROLINA JOURNAL OF PHARMACY
ETHICS, GRIEVANCE
Continued from page 13
shall be appointed by the President
annually for a four year term. The
Executive Director of the Association shall
serve as an ex officio member of the
Committee. It shall be the primary
responsibility of the Ethics, Grievance and
Practice Committee to develop written
criteria for membership and interpret and
enforce the Association's Code of
Professional Ethics according to the
provisions of the Bylaws and procedures
duly adopted by the Committee. The
Committee shall also serve to advance the
practice standards of the profession of
pharmacy.
Interpretation of The Code of
Professional Ethics
This committee did not feel that a written
interpretation of the Code of Professional Ethics
was required by the Constitution. Rather the role
of the Committee is to provide an interpretation
when grievances are brought before the
Committee.
Advancement of the Practice of
the Profession
This Committee should actively strive to
advance the practice standards of the pharmacy
profession. A first step has been taken by the
adoption of the Code of Professional Ethics last
year and the adoption by this Committee of an
equitably procedure for dealing with grievances.
Repectfully submitted,
Loni T. Garcia, Chairman
Committee Members
Loni T. Garcia, Chairman
C. Yvonne Blackmon Laura G. McLeod
Ronald C. Gobble
Margaret D. LeDoux
Virginia L. Lockamy
Wallace E. Nelson
A. Wayne Pittman
Kevin Almond
Clifford E. Hemingway
Evelyn P. Lloyd
Albert F. Lockamy, Jr.
Claude U. Paoloni
Thomas R. Thutt
The Convention voted to distribute the Report
of the Ethics, Grievance and Practice Committee
along with the Code of Professional Ethics to the
membership in a special mailing. This has been
done. To further disseminate the committee
report, this Journal is being sent to ALL
pharmacists practicing in North Carolina, both
members and non-members. We encourage every
pharmacist to read this report carefully and will
appreciate any comments, written or called in.
While we would prefer names, comments do not
have to be signed
APhA TO AGAIN
COSPONSOR AMA
IMPAIRMENT CONFERENCE
The American Pharmaceutical Association
(APhA) for the second consecutive year will
cosponsor the American Medical Association
(AMA) National Conference on the Impaired
Health Professional, which will be held October
8-1 1, 1987 at the Drake Hotel in Chicago.
Cosponsorship of the conference is a natural
extension of APhA's 1982 policy encouraging
the establishment of programs to assist
pharmacists and pharmacy students whose
ability to practice has been impaired due to the
use of alcohol and/or other drugs.
The theme of the conference, "Impaired
Health Professionals: Educating Ourselves . . .
Educating Others," will stress the need for
increased educational activities in the area of
impairment of health professionals. Topics that
will be addressed include:
• Design, Implementation and Assesment of
Programs in Varied Settings
• Strategies for Non-Chemical Impairment
• Current Trends in Chemical Dependence
• The "Politics" of Impairment
• The Family of the Health Professional
• Suicide Prevention
• Intervention Training Sessions (Beginner
and Advanced)
• Evening Self-Help Support Groups
A unique feature of this year's conference will
be the presentation of original research on topics
related to impairment and well-being. Abstracts
are now being sought, with deadline for
submission being August 1 , 1 987.
This is the only national conference of its kind
that provides a forum for the exchange of ideas
and approaches that aim to help current
Continued on next page
May, 1987
THE CAROLINA JOURNAL OF PHARMACY
15
WOODARD NAMED RECIPIENT OF 1987 PHARMACY
ALUMNI DISTINGUISHED SERVICE AWARD
Pharmacy, was cited for his contributions to
pharmacy and the community during a recent
ceremony in Chapel Hill.
Woodard has represented District 20, which
includes Wayne and Johnston counties, for eight
consecutive terms. During that time, he has
served on committees dealing with issues in
human resources, state personnel, aging,
agriculture and health.
In addition to his political activities, Woodard
has contributed to his community as well. He
bought a pharmacy in his native Princeton in
1943. Three years later, he bought Peele Drug
Co. In 1954 he built a new drug store, which has
continued to grow.
He was elected to the Princeton Board of
Commissioners in 1948, when he helped the
town build its first City Hall, organize its first fire
department and build and equip its first fire
station.
When the Princeton Community Building and
gymnasium were destroyed by fire in 1977, he
helped replace the building with a Community
Center that houses a library and meeting space
for civic groups.
Woodard has been a member of the Princeton
Lions Club for 35 years and has served in all its
offices, a member of the Masonic Lodge #3 1 7 for
38 years and a member of the Johnston County
Shriner's Club. He was a Princeton school board
member for 1 6 years, including four as chairman.
Barney Paul Woodard
N.C. Rep. Barney Paul Woodard, D-
Johnston, has been named the recipient of the
1987 Pharmacy Alumni Distinguished Service
Award by the University of North Carolina at
Chapel Hill School of Pharmacy.
Woodard, a 1938 graduate of the School of
ETHICS, GRIEVANCE
Continued from page 14
programs function more effectively and aid in the
establishment of new programs, particularly
those involving a collaborative effort among
disciplines.
The conference is the eighth in a series of AM A
impairment conferences, originally dealing only
with impaired physicians. In 1 986, the focus of
the conference was broadened to include other
health professions. Besides APhA, other
cosponsors are: the American Dental Associa-
tion, the American Nurses' Association, the
American Podiatric Medical Association and the
American Veterinary Medical Association, along
with AMA and the AMA Auxiliary.
For further information, contact: Janice J.
Robertson, Department of Substance Abuse,
American Medical Association, 535 N.
Dearborn Street, Chicago, IL 60610; telephone
(312)645-5083.
The American Pharmaceutical Association is
the national professional society of pharmacists,
representing the third largest health profession
that comprises more than 150,000 pharmacy
practitioners, pharmaceutical scientists and
pharmacy students. Since its founding in 1852,
APhA has been a leder in the professional and
scientific advancement of pharmacy and in
safeguarding the well-being of the individual
patient.
May, 1987
1 6 THE CAROLINA JOURNAL OF PHARMACY
REPORT OF THE NCPhA ENDOWMENT FUND COMMITTEE
Presented at the 107th Annual meeting of the North Carolina
Pharmaceutical Association, April 22-25, 1987, Charlotte
The Endowment Fund Committee met in the
Institute of Pharmacy November 26, 1986 and
after reviewing the financial position of the Fund
and the past history, the Committee recom-
mended that a more formal document be written
and approved by the Executive Committee of the
Association. This document would establish a
Board of Trustees for the Fund.
The duties of the Trustees will be the
following:
1 . Solicitation of gifts
2. Investments
3. Administrations
A document establishing the Board of Trustees
was written and presented to the Executive
Committee of the Association during the
February 8, 1987 meeting. After discussion, the
Executive Committee of the Association
approved and signed the document.
The Board of Trustees of the Endowment
Fund consist of:
1 . The President of the Association
— Keith Fearing
2. The President Elect of the Association
— Julian Upchurch
3. The Immediate Past President of the
Association
Shelton Brown
4. Four (4) appointed members
— L. M. Whaley
— Howard Ferguson
— Albert Rachide
— Robert Hall
5. Executive Director of the Association
— Ex-Officio — A. H. Mebane
The Board of Trustees of the Endowment
Fund met at the Institute of Pharmacy March 1 2,
1987. L. M. Whaley was elected chairman and
Howard Ferguson, vice chairman. A. H. Mebane
will act as secretary to the Trustees.
Whaley suggested a fund raising dinner be held
and it was approved by the Trustees for the
Kenan Center in Chapel Hill, Saturday, October
17, 1987.
A copy of the endowment fund financial
condition as of March 1, 1987 is attached for
your information.
NCPhA Endowment Fund
Fund Title March 1, 1987
W.J. Smith Speaker Fund $ 7,087.26
Ralph P. Rogers Sr.
Scholarship Fund 17,903.33
Jesse Stewart Scholarship Fund 7,225.05
Kappa Psi Bond (@ 5%) 5,000.00
General Endowment Fund 1 17,887.44
Total 155,103.08
Committee Members
L.M. Whaley, Chairman
Howard Q. Ferguson A.H. Mebane, III
Vice Chairman
H. Shelton Brown, Jr.
M. Keith Fearing, Jr.
Robert Hall
Ex Officio
Albert Rachide, Sr.
Julian E. Upchurch
•
L. M. Whaley, Chairman, NCPhA Endowment
Fund Committee
May, 1987
THE CAROLINA JOURNAL OF PHARMACY
17
State of North Carolina County of Orange
THE NORTH CAROLINA PHARMACEUTICAL ASSOCIATION
ENDOWMENT FUND
WHEREAS, The North Carolina Pharma-
ceutical Association of North Carolina
(hereinafter referred to as the ASSOCIATION)
is a duly organized and operating association of
the state of North Carolina; and
WHEREAS, the personal property of said
Association is vested in and owned by the North
Carolina Pharmaceutical Association; and
WHEREAS, the Executive Committee of the
Association has determined that it would be in
the best interest of the ASSOCIATION for
bequests, designated gifts, and trust funds to be
held and managed within an endowment fund for
the purposes of administration, investment and
distribution, said endowment fund to be
established in such a way as to restrict the use of
the property transferred thereunder for the
purposes and uses as expressed herein; and
WHEREAS, this Resolution and Declaration
is executed for the purpose of establishing the
North Carolina Pharmaceutical Association
Endowment Fund, hereinafter referred to as the
FUND.
NOW, THEREFORE, in order to accomplish
such purpose, the Executive Committee of the
North Carolina Pharmaceutical Association does
hereby adopt the following Resolution and
Declaration.
1 . Name. The fund herein provided for shall be
known as "The North Carolina Pharmaceutical
Association Endowment Fund."
2. Grant. The Executive Committee of the
Association has assigned, transferred and set over
to the FUND the property described in Schedule
A hereof, which properties together with
investments, reinvestments and such other
property as may from time to time be added
thereto shall be held in the FUND in perpetuity
upon the terms and conditions contained herein.
3. Additions to the Fund Additions may be
made to the FUND at any time and from time to
time of any money and property whatsoever,
including but not limited to cash, real property,
tangible and intangible personal property,
insurance proceeds and any other form of or
interest in property. Such additions may be made
by inter vivos or testamentary transfer. Property
added to this FUND becomes a part of the
FUND and shall be held, managed, administered
and distributed upon the same uses as if
constituting original assets hereof. The Trustees
of the Endowment Fund (hereinafter referred to
as the TRUSTEES) may in their sole discretion
refuse to accept any property for any reason
whatsoever. The TRUSTEES are authorized to
place in the FUND any sums or property made
payable, assigned, or transferred in such a way as
to show an intent on the part of the donor or
testator to give such property to the FUND.
4. Purposes of the Fund. The purposes for
which this FUND is organized and shall be
operated are:
(a) To provide for capital improvements to the
ASSOCIATION property, including but
not limited to construction of new
ASSOCIATION facilities and improve-
ment or renovation of existing ASSO-
CIATION facilities; to provide for the
acquisition of real property for the
ASSOCIATION; and to provide for the
purchase of furniture, fixtures, and
equipment.
(b) To provide a resource for the operating
budget of the ASSOCIATION.
Not withstanding the above, the use of FUND
monies is restricted to the income from the
general endowment fund unless voted on and
approved by the Executive Committee of the
Association. Designated gifts and income
therefrom shall be used as requested by the
donor.
5. Management of Fund Property. The
TRUSTEES shall hold, invest and reinvest the
property of the FUND for the purposes expressed
herein and shall collect and receive the interest
and income thereon and shall distribute said
income and principal as follows:
(a) The TRUSTEES may, at their option and
in their discretion, use all or any part of the
income and principal of the FUND
property to pay assessments, taxes,
charges, and expenses incurred in the
collection, care, administration, manage-
ment, protection and distribution of
FUND property or income.
(b) After payment of the charges under
subparagraph (a) above, the net income of
the FUND shall be added to principal or
shall be paid over for the purposes and
Continued on page 18
May, 1987
li
THE CAROLINA JOURNAL OF PHARMACY
ENDOWMENT FUND
Continued from page 17
subject to the restrictions of Article 4
above,
(c) Notwithstanding the foregoing, if a gift,
devise or bequest is made to the FUND
with directions from the donor or testator
as to the purpose for which the income or
principal shall be retained or distributed,
then if such gift, devise, or bequest is
accepted, the income or principal
therefrom shall be retained or disbursed as
directed by the donor or testator.
6. No Individual Beneficiary. No individual or
person shall have any right or interest in the trust
property nor shall any part of the property of the
FUND or the net earnings therfrom enure to the
benefit of any individual except as provided in
Paragraphs 4 and 5 above.
7. TRUSTEES. The governing body of the
FUND shall be the TRUSTEES. The
TRUSTEES shall consist of the following seven
persons:
( 1 ) The President of the Association
(2) The President-elect of the Association
(3) The Immediate Past President of the
Association
(4) The remaining four members shall be
active members of the Association with business
and/or investment expertise. These four
individuals shall be appointed by the President of
the Association and ratified by the Executive
Committee of the ASSOCIATION. They will
serve terms of four years. (The original members
shall be appointed for one, two, three, and four
year terms respectively.)
The Executive Director of the Association
shall serve as a non-voting ex officio member of
the TRUSTEES. Any member of the
TRUSTEES other than the President-elect,
President, and immediate Past President of the
Association may be removed from office by a
two-thirds vote of the Association Executive
Committee for any reason deemed to be in the
interest of the FUND. Any vacancy occurring on
the TRUSTEES, other than that of President-
elect, President, or immediate Past President of
CONGRATULATIONS TO
EVELYN and ALLEN LLOYD
On the opening of their new store, Lloyd's Pharmacy in
Hillsborough. We are pleased to have assisted with this
plan and wish them much success.
H Warren Spear R Ph.
Pharmacy Design Specialist
415 Augusta Drive
Statesville, North Carolina 28677
(704)873-9993
Spear Associates — planners, de-
signers and installers of pharmacy
fixtures & equipment
May, 1987
THE CAROLINA JOURNAL OF PHARMACY
19
the Association, by death, resignation or
otherwise shall be filled by appointment by the
Association President and approved by the
Association Executive Committee.
A quorum for the transaction of business by
the TRUSTEES shall consist of four members;
one of which must be the Chairman or the Vice
Chairman. The TRUSTEES shall annually elect
a chairman, vice chairman and secretary. Either
the Chairman or the Vice Chairman shall have
authority to execute any authorized documents
and to certify official action of the TRUSTEES.
8. Annual Report. The TRUSTEES shall
present a financial report annually to the
Executive Committee of the Association.
9. Liability. The TRUSTEES shall not be held
personally liable for any act or omission to act in
administering the trust, including the retention of
original assets, except for bad faith.
10. Amendment of Resolution and Declara-
tion. Amendments of this instrument may be
made by the Executive Committee of the
ASSOCIATION. Amendments shall be made as
may be necessary to qualify this FUND as
exempt under Internal Revenue Code §50 1(c) or
§170 or to secure non-private foundation status
under the provisions of Internal Revenue Code
§509(a) or corresponding laws, from time to time
in effect. Such amendment shall be made by the
execution by the Executive Committee of the
Association and the TRUSTEES of a written
instrument amending this document.
Notwithstanding the provisions of this
document, the TRUSTEES shall not conduct or
carry on any activity which shall adversely affect
the FUND'S exempt status under §50 1(c)(3) and
its non-private foundation status under §509(a)
of the Internal Revenue Code as they may now
exist or may hereafter be in force or in effect. If
any provisions contained in this document shall
in any manner be construed to adversely affect
the tax exempt status of the FUND, the same
shall be null and void and of no further course
and effect and severable from the provisions of
this document without affecting the vitality or
enforceability of any of the provisions remaining
herein.
1 1 . Law Governing FUND. The Executive
Committee of the Association shall at all times
have all the rights under law to enforce the terms
of this document including accountability for the
funds thereof.
IN WITNESS WHEREOF, the Executive
Committee of the North Carolina Pharmaceu-
tical Association has caused these presents to be
executed by each of the individual members of
the Executive Committee of the Association and
their seals attached.
Max Reece, Jr., is the latest member of the NC Academy of Pharmacy. His wife, Susan, and NCPhA
President M. Keith Fearing, Jr. view with pride.
May, 1987
20
THE CAROLINA JOURNAL OF PHARMACY
DICKINSON'S PHARMACY
by Jim Dickinson
Employer power. A recent column entitled
"Pharmacy Power" addressed dispensing
physicians and ways that pharmacy will win that
fight.
Now let's focus on another, even bigger fight,
and who will win it. It's the hot war between
corporate employers on the one hand and their
soaring health costs on the other, paid either
through (a) insurance premiums or (b) their own
in-house programs.
The employers' dilemma was well-put at the
American Pharmaceutical Association annual
meeting in Chicago by consultant Laird Miller
(Health Systems Management Inc., 612-729-
1733), who until recently ran the employee
benefits programs of Honeywell, Inc.
"Corporate actuaries worry us with their
projections of life expectancies in the 85-90
range and better," he said, referencing the
burgeoning number of retirees getting health and
drug benefits. "Our chief concern is that we aren't
getting value for our money from the health
programs we use; we can't pass on an 11%
increase in the health cost index, when our
customers are holding us to 2% in the price
increases they're willing to pay us."
And if you think pharmacists are fed up with
third-party payors and insurance programs that
(eventually) pay them, corporate employers who
buy their programs are even more fed up, Miller
says.
Pharmacists formed PSAOs to get the kind of
combined clout they need with the programs, and
that's what Miller says employers are doing, too.
Small employers, especially, "can buy better
when they network with each other."
But listen to what a few large employers did,
when they ran up against insurance company
arrogance and unresponsiveness.
Without naming names, Miller said he knew
of one corporate employer that got so frustrated
trying to find out why its health premiums kept
rising so much that it did some detective work
until it found out the identities of some other
customers of that same arrogant insurance
company.
They formed an ad hoc "user's group" among
themselves, and went in a body to the insurance
company, which suddenly became very attentive.
Now the members of the user's group are in the
driver's seat with the insurance company, which
has agreed to tailor specific health programs for
each of them, instead of persisting with its usual
all-too-common attitude of "here's-what-we've-
got, take-it-or-leave-it."
This tactic is completely turning the tables on
how health benefits are paid for, and is in essence
turning the employer into the main regulator of
health care today, Miller says.
Now employers can design their own health
packages, and dictate the individual provider
specifications within those health packages.
Such employers will be more responsive to
quality-based arguments than aloof, distant
insurance companies and HMOs could be. They
will want to deal with local pharmacies — not
mail-order (although they will look at all
options). They will find employee satisfaction a
persuasive argument in establishing program
specifications.
And if they get too much resistance from
HMOs and other third parties on the adoption of
their specifications, they will self-insure, keeping
costs down with controllable employee
incentives not to overuse services.
Smaller employers will network among
themselves — Miller calls it "linkage" — so that
they can bring leverage to bear against third
parties, HMOs and, yes, even against PSAOs.
"I know if I walked up to you with a quarter-
million lives in our pocket, you'd do handsprings
to get our business," Miller told his pharmacy
audience at APhA.
But with all that leverage and clout and
muscle, the employers have a great weakness, he
admitted. "They don't know enough about the
delivery system, and they need your help."
Sounds like a match made in heaven!
This feature is presented on a grant from G.D. Searle &
Co. in the interests of promoting the open discussion of
professional issues in pharmacy. G.D. Searle & Co.,
accepts no responsibility for the views expressed herein
as they are those of the author and not necessarily those
of G.D. Searle & Co.
May, 1987
THE CAROLINA JOURNAL OF PHARMACY
21
COCAINE AND CRACK'
Pharmacists can be the secret weapon in
this war against drug abuse.
by Joseph Scar lata, R.Pk
Like millions of others during the past few
months, I have become increasingly aware of
— and concerned about — the rapidly spreading
use within our nation's "drug abuse subculture"
of cocaine and its deadly derivative, crack.
The more I have learned about crack, the more
I have found myself pondering what we, as
pharmacists, should — or can — do about the
situation.
Crack, as everyone knows by now, is the "free
base" derivative of cocaine. But, unlike cocaine,
crack is smoked rather than snorted.
The problems associated with addiction to
heroin and other hard drugs seem to pale in
comparison with the problems of those who fall
prey to the enticements of crack.
With crack, addiction can be instantaneous.
Most users are hooked after their first try. Crack
users do not experience a "break in" period
during which addiction develops gradually.
Unlike the other illicit drugs that plague our
society, crack — or "rock" or "base" as it is also
known — is relatively inexpensive. A single fix
sells on the streets for about $ 1 0 to $ 1 5 — putting
it within financial reach of the very young. Crack
is also plentiful and easily obtainable.
Law enforcement officials estimate that each
day some 2000 Americans try cocaine or crack
for the first time. Most of them are teenagers.
Crack is more addictive than heroin — and it
produces a greater high than heroin does. Addicts
say that their cravings for crack far exceed their
desires for food or oxygen.
As the most addictive drug now known to
man, crack has the capacity to transform the
occasional cocaine user into a desperate, fanatical
addict.
Atom Bomb
One narcotic officer has declared that crack is
to cocaine what an atomic bomb is to an ordinary
bomb.
Cocaine and crack constitute the fastest-
growing drug abuse problem in our nation today.
And it is a problem among adults and
schoolchildren.
To those of us who have been educated in the
actions and effects of drugs, it is particularly
horrifying to see cocaine use glorified as trendy
and fashionable among show business
personalities and the rich. It is appalling to see
athletes, who should be role models, use cocaine
with what seems to be almost unimpeded
regularity.
As pharmacists, we are well aware of the
hazards cocaine poses to mind and body. It
accelerates heart rate, increases blood pressure,
interferes with performance and produces sudden
— and fatal — seizures.
This is a time for us to consider what we
pharmacists, as society's most visible and readily
accessible authorities on drugs, can do about the
burgeoning epidemic of cocaine use.
For years, we have heard that we have a
responsibility to become active in our
communities, to speak out against the ravages of
drug abuse and to try to educate young people
about the hazards of illicit drugs.
But even though a number of our professional
colleagues have taken part in such efforts, most of
us have not. The pressures of business and family,
we have no doubt rationalized, leave us no time
to participate in programs of durg abuse
education. "Someday," we have all promised
ourselves, we will have the time. And then we'll
become active.
Toll Rises
Meanwhile, as we await the arrival of the
"someday" when our time will be freed up, the
clock goes on ticking. The toll of people falling
victim to drugs like crack and cocaine continues
to rise.
Government and law-enforcement agencies
can only do so much. Reducing the supply of the
drugs is only part of the solution. As long as there
is a demand for the drugs, ways will be found to
supply them.
It is up to us to help reduce the demand
through education. I think we can do it.
As pharmacists — the health professionals
who possess the greatest expertise in drugs — we
must not shirk our responsibilities to help
counteract the continuing onslaught of illicit drug
use. We have a thorough knowledge of the effects
of drugs. We are accessible. We have respect and
credibility in our communities.
All of us in the profession of pharmacy —
practitioners, educators, industry personnel,
Continued on page 22
May, 1987
22
THE CAROLINA JOURNAL OF PHARMACY
COCAINE AND CRACK
Continued from page 21
students, scientists — have a role to play in trying
to rid society of drug abuse problems.
Reprinted with permission of American Druggist.
Obligation
As professionals who have gained much from
society, don't we have an obligation to "put
something back" that will help improve that
society? Of course we do!
Perhaps each of us has an obligation to tithe a
portion of time to fight drug abuse. Even if this
tithing amounts to only a few hours per year per
pharmacist, just think of how much could be
accomplished through our collective efforts!
We pharmacists can be especially effective by
visiting elementary schools and speaking to the
children about the hazards of using drugs.
For pharmacists who want to get involved in
drug abuse education, there are many sources to
turn to for information and instructional
materials. One of the most useful sources is an
organization known as Pharmacists Against
Drug Abuse or PADA.
PADA offers three items that you will find
helpful: (1) The Pharmacist's Guide to Drug
Abuse, a manual for pharmacists; (2) The Kinds
of Drugs Kids Are Getting Into, a manual for
parents; and (3) a speech kit for helping
pharmacists make effective presentations in their
communities.
Toll- Free
You may obtain these materials from PADA
by phoning toll-free to 1-800-222-PADA.
Let us not lose sight of the fact that the fight
against drug abuse must be waged as a full-scale
war. We pharmacists are among the most
important combatants in this war. We are the
community drug experts with the know-how to
educate children and parents.
Once we are properly deployed, we can be the
secret weapon in this war — the secret weapon
that will lead our society to victory!
I urge you to become involved! Today
Joseph Scarlaia, senior vice-president, Pharma-
ceutical Group, Sterling Drug, Inc., received his
bachelor's degree in pharmacy from Brooklyn College
of Pharmacy in 1954.
Convention hospitality rooms often require strange dress codes. Obviously abiding by this maxim
in the Woman's Auxiliary Hospitality Room is Len Phillipps, to the delight of Lib Fearing, Stella
Paoloni and Eloise Watts.
May, 1987
THE CAROLINA JOURNAL OF PHARMACY
23
CORRESPONDENCE COURSE
ADVISING CONSUMERS ON
HARD CONTACT LENS SOLUTIONS
by J. Richard Wuest, R.Ph., Pharm.D.
Professor of Clinical Pharmacy
University of Cincinnati, Cincinnati, OH
and
Thomas A. Gossel, R.Ph., Ph.D.
Professor of Pharmacology and Toxicology
Ohio Northern University, Ada, OH
Goals
The goals of this lesson are to:
1 . discuss solutions used in the care and wear of
hard contact lenses;
2. explain how to advise contact wearers on the
proper use of these solutions.
Objectives
At the completion of this lesson, the successful
participant will be able to:
1 . identify solutions intended for use with hard
contact lenses;
2. explain the proper techniques for using these
solutions.
The purpose of this SCOPE lesson is to discuss
the various solutions intended for use with hard
contact lenses. There are five major subheadings
of hard contact lens solutions. These include
wetting solutions, cleaning solutions, soaking
solutions, lubricants and combinations of the
above. These solutions are defined, and their uses
categorized. Specific consumer advice is also
presented. Solutions for use with soft contact
lenses will be discussed in next month's lesson.
The term "contact lens" is a misnomer. These
lenses do not actually come in contact with the
cornea. Instead, they float on a layer of tears (or
commercial lubricating solution if tear secretion
is inadequate). Therefore, contact lens solutions
provide comfort for individuals who choose to
wear lenses rather than spectacles.
A potential problem associated with hard
contact lens use is decreased oxygen supply to the
cornea which may cause corneal irritation.
Unless measures are taken to correct this in
susceptible lens wearers, they may experience
intense physical discomfort. To alleviate this
problem, a variety of solutions specifically
developed for the care for these lenses and their
preparation for insertion into the eye are
available.
The Lens Solution Market
The OTC contact lens solution market is
extremely competitive and highly subjective.
Various manufacturers of contact lens products
have successfully created strong brand loyalty to
their solutions. Contact lens wearers have been
taught to rely heavily on the advice of their lens
fitters.
Manufacturers have attempted to acquire
customers by supplying samples of contact lens
solutions to ophthalmologists, optometrists and
opticians who are the key advisors on which
products are best suited to specific applications.
Most contact lens wearers receive an intro-
ductory package of sample materials and
products when their lenses are initially fitted.
They generally will continue to use those brands.
Continued on page 24
W
intho/QfvicQ
of pharmacy
This continuing education for
Pharmacy article is provided
through a grant from
MERRELL DOW
PHARMACEUTICALS INC.
t Merrell Dow
May, 1987
24
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
Continued from page 23
There is very little difference between com-
mercially available products from within the
same class. After individual bias is removed,
products in each class are basically interchange-
able with others intended for the same purpose.
However, products intended specifically for hard
or soft lenses are not interchangeable with each
other.
Most manufacturers are now working to
develop products that can be used interchange-
ably for both hard and soft lenses. Several have
been marketed that are useful for soft and hard
lenses, and the newer gas permeable lenses.
However, the two basic categories of contact lens
solutions that are currently available are those
primarily for hard lenses, and those that are used
for soft lenses.
Legal Guidelines
Legally, contact lens solutions are regulated by
the Device Section (rather than the Drug
Section) of the Pure Food, Drug and Cosmetic
Act. Manufacturers are required to test all their
products on the various commercially available
soft contact lenses before they can claim that the
product is safe. They must also list the names of
the specific types of lenses on the label. Before a
consumer selects a brand of soft contact lens
solutions, he can readily determine if the product
is safe for his type of lens.
Contact Lens Care
The care of hard contact lenses begins when
they are removed from the eye. The wearer must
first clean and rinse the lenses. Plain tap water can
be used for cleaning and rinsing hard lenses, but
not soft lenses. After the cleaning solution and
debris have been rinsed off, the lenses are soaked
overnight. The lenses are then wetted before
insertion into the eye. A list of ingredients
contained in various contact lens solutions
appears in Tables 1 and 2.
Wetting Solutions
Wetting solutions are agents that facilitate the
spread of fluid over the surface of a solid material.
Cohesion and adhesion are two physical
properties which determine whether an item is
hydrophobic (water-repelling) or hydrophilic
(water-attracting).
Cohesion is the force of attraction between
two molecules of the same substance. For
TABLE 1
Ingredients in Contact Lens Solutions and
Their Functions
BUFFERS:
Boric Acid (BA)*
Sodium bicarbonate (NaHC03)
Sodium borate (NaB)
Sodium hydroxide (NaOH)
Sodium phosphate(s) (NaP)
CHELATING AGENT:
Ethylenediamine tetraacetic acid (EDTA)
DETERGENTS:
Octylphenoxyethanol (OCT)
Tyloxapol (TYL)
ISOTONICITY AGENTS:
Boric acid (BA)
Potassium chloride (KG)
Sodium chloride (NaCl)
PRESERVATIVES:
Benzalkonium chloride (BC1)
Chlorhexidine (CH)
Phenylmercuric nitrate (PMN)
Sorbic acid (SA)
Thimerosal (TH)
SURFACTANTS
Bis-2-hydroxyethyl tallow ammonium
chloride (BTA)
Nonoxyl 15 (N15)
Polyoxyl 40 (P40)
Polysorbate (Polyoxyethylene) 21 (P21);
80 (P80)
Poloxamer 407 (P407); 188 (PI 88)
Polyvinyl alcohol (PVA)
Povidone (polyvinylpyrolidine) (PPP)
Tris-2-hydroxyethyl tallow ammonium
chloride (TTA)
VISCOSITY AGENTS:
Hydroxyethylcellulose (HEC)
Hydroxypropyl methylcellulose (HPM)
Methylcellulose (MC)
Polyethylene glycol (PG)
Polyvinyl alcohol (PVA)
Propylene glycol (PRG)
The abbreviations within parentheses are to
simplify Table 2. They are not the chemical
formulae for the compounds listed.
May, 1987
THE CAROLINA JOURNAL OF PHARMACY
25
TABLE 2
Commercially Available Hard Contact Lens
Solutions
WETTING
INGREDIENTS*
Barnes Hind
PVA, BC1, EDTA
Contique
PVA, BC1, EDTA, HPM
hy-FLOW
PVA, BC1, EDTA
Liquifilm
PVA, BC1, EDTA, HPM
Visalens
PVA, BC1, EDTA, HPM
CLEANING
Boston Lens Cleaner
surfactant/friction agent
Clens
?, BC1, EDTA
Contique
?, BC1
d-film
?, BC1, EDTA, P407
Gel Clean
?,TH
LC-65
?, TH, EDTA
Lensine
?, BC1, EDTA
Miraflow
?, P407
Opti-Clean
?, P21, TH
Titan
?, BC1, EDTA
SOAKING
Boston Lens
PVA, HEC, CH, EDTA
Conditioning
Solution
Contique
BC1, EDTA
Soakare
BC1, EDTA
Soquette
PVA, BC1, EDTA
WETTING AND SOAKING
Barnes Hind
PVA, PPP, BC1, EDTA,
HEC, OCT
Contique Dual-Wet
PVA, BC1, EDTA
Soaclens
TH, EDTA
Wet-N-Soak
PVA, BC1, EDTA
CLEANING AND SOAKING
Barnes Hind
?, BC1, EDTA
Clean-N-Soak
?, PMN
Contique
?, BC1, EDTA
duo-Flow
PI 88, BC1, EDTA
Visalens
?, BC1, EDTA
WETTING, CLEANING AND SOAKING
Contactisol
BC1, EDTA, HPM, N15
Lensine 5
PVA, BC1, EDTA, P407,
HEC, PG
Lens-Mate
PVA, BC1, EDTA, HPM
One Solution
?, BC1, EDTA
Total
PVA, BC1, EDTA
ADJUNCT SOLUTIONS (for use directly into
the eye)
Adapt
PPP, TH, EDTA
Adapettes
PPP, TH, EDTA
Aqua-Flow
BC1, EDTA
Blink-N-Clean
P40, PG, CHL
Clerz 2 P407, EDTA, SA, HEC
Comfort drops ?, BC1, EDTA
Lens Lubricant (B&L) PPP, TH, EDTA
Lens- Wet PVA, TH, EDTA
Pre-Sert PVA, BC1
*See Table 1 for explanation of ingredients.
? = contains unidentified ingredient(s)
example, iron molecules are strongly cohesive
with other iron molecules, and water molecules
are strongly cohesive with other water molecules.
But iron molecules are not cohesive with water.
The second physical factor, adhesion is the
force of attraction between molecules of different
substances. If the force of adhesion between
molecules on the surface of a drop of water and
molecules on the surface of another substance is
greater than the force of cohesion, the water will
wet the substance and render it hydrophilic. If
not, water will bead up on the surface (like rain
drops on the hood of a freshly waxed auto-
mobile) and the substance is said to be hydro-
phobic. This occurs with hard contact lenses and
the cornea, both of which are hydrophobic.
Wetting solutions make the hydrophobic
contact lens surface more hydrophilic. This
increases the lubricating and cushioning effect
between the cornea and the lens, and between the
lens and the eyelid.
Wetting solutions provide a viscous coating
over the lens surface so that it does not come in
direct contact with the finger during insertion.
This prevents oily sebaceous deposits of the skin
from transferring to the lens. These solutions also
help to stabilize the lens on the fingertip to
promote easier insertion. Without a wetting
solution, water would not wet the lens and the
lens would cause pain and discomfort when
placed on the eye.
Tears contain various protein and poly-
saccharide complexes that assist in wetting
contact lenses. But this is not adequate until five
to fifteen minutes after the lens is inserted.
Wetting solutions accomplish this until the tears
take over.
Wetting solutions also serve as a cushion
between the lens and the cornea, and prevent
sudden movements of the lens when the
individual turns his head quickly.
Continued on page 27
May, 1987
The calendar that brings customers
to you for products & information on:
• CHILD CARE
• CHOLESTEROL
• SECRETS OF PAIN
• ALZHEIMERS
• DIET
tout
• CANCER PREVENTION
• ALCOHOLISM
• HEALTHY HEARTS
• FITNESS
• VITAMINS
• OSTEOPOROSIS
darf<#
-its**-*
1988
THE CALENDAR,
PUBLISHED BYNARD, THAT
TELLS MORE THAN DATES!
Hundreds of thousands of customers and potential customers are now using the
Good Health calendar to help them cope with everyday life. And they'll be looking
for next year's information-packed edition, too!
In addition to providing them with answers to their questions it also provides
them with the rrcosr valuable piece of good health advice: To come to you, their family
pharmacist, for products and services, instead of depending upon brand-name
promotions and advertisements.
These useful calendars are teaching customers that you are their first line of defense
against illness and their first and most valuable resource if illness occurs.
Put your name and phone number in front of potential customers all year long,
on a calendar theyll refer to again and again... for more than just the date!
To order, fill out and mail the handy coupon on the next page to NARD with your
check today!
SPECIAL BONUS: 100 Calendars FREE with each order of 1,000.
i
6 7 •
13 M IS
ana
VOIR IMPRINT HERE
THE CAROLINA JOURNAL OF PHARMACY
27
CORRESPONDENCE COURSE
Continued from page 25
The most common ingredients used in wetting
solutions are polyvinyl alcohol, methylcellulose,
and other cellulose derivatives which increase the
viscosity and aid in the cushioning effect. The
most commonly used preservative has been
thimerosal. Manufacturers are moving toward
sorbic acid which is less irritating and sensitizing.
To review, wetting solutions are used prior to
inserting hard lenses. They provide a hydrophilic
surface to the lens, promote the spread of tears,
and prevent the initial discomfort that would be
experienced with hard lenses. They also serve as a
cushion between the cornea and the lens, and
between the lens and the eyelid.
Cleaning Solutions
Human tears consist of a number of substances
secreted by various glands from within the
structures of the eye and eyelid. These include
hydrophic oils and proteinaceous residues which
adhere to lenses. While they serve a useful
purpose, they also provide a media for bacterial
growth. Over time, they harden on the lens
surface into rough deposits that irritate the cornea
and the eyelids. If allowed to accumulate, they
may cause corneal abrasion and increase chances
for infection. The lenses may become cloudy,
decreasing visual acuity.
Cleaning solutions contain detergents as their
main ingredient, most commonly nonionic
surfactants. These agents emulsify fats and oils
and help solubilize other substances. Most
cleaning solutions are used when the lens is out of
the eye. There are a few solutions that are
indicated specifically for application to the lens
while it is inserted. Products not labeled
specifically for such use should not be placed
directly into the eye.
Cleaning solutions enhance the removal of
debris through their detergent activity. Those
intended for use after the lens is removed must be
thoroughly rinsed off before the lens is reinserted
to avoid irritation.
Continued on page 28
Simply fill out and mail the coupon below to NARD with your check. Can be ordered with or
without imprints. All orders in units of 100. Minimum order of 100 for calendars without
imprints, rninimurn order of 300 for imprinted copies. Will be shipped to arrive on or before
October 1, 1987.
SPECIAL BONUS! 100 Calendars FREE with each order of 1,000.
r—
1988 GOOD HEALTH CALENDAR ORDER BLANK
(All ordcn in umu ol 100.)
Please print in ink or type the following information:
NCI
100 FREE WITH EACH 1.000 CALENDARS ORDERED
copies with no imprints @ 38<
(minimum order 100 copies)
.imprinted copies @ 42«
(minimum order 300 copies)
Printers Handling Charge
TOTAL ENCLOSED
IMPRINTED ORDER
Print the following only if you wish to order imprinted
copies. Complete exactly as you wish imprints to appear—
imprints limited to four lines.
□ Please use same impnnt as we had on our 1987 calendars.
1.
Enclosed is mv $75 deposit Shipment October 1. 1987 DEPOSIT IS
NOT REFUNDABLE. Calendars will be shipped freight collect
I wish to pay:
D through the enclosed check or money order payable to NARD
□ through the credit card specified at right
Deposit Must Accompany Order.
Make check payable to: NARD
Mail to: National Association of Retail Druggists
205 Daingerfield Road, Alexandria, VA 22314
2.
3
4
VISA*
F.xp Datp
MasterCard
MasterCard Inter Bank Number
Signature
May, 1987
28
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
Continued from page 27
The two most widely used nonionic detergents
are octylphenoxyethanol and tyloxapol. Other
ingredients include surfactants such as bis-2-
hydroxyethyl tallow ammonium chloride (BT A),
polyoxyl 40, polysorbate 80, polyoxamer 407,
polyvinyl alcohol, povidone, and tris-2-
hydroxyethyl tallow ammonium chloride.
Buffering agents include boric acid, sodium
borate, and the sodium phosphates. Isotonic
agents are sodium and potassium chlorides.
Some cleaning solutions contain agents that
increase their viscosity. These include the
cellulose derivatives, polyethylene glycol, and
propylene glycol. All cleaning solutions contain a
preservative. Benzalkonium chloride, thimerosal
and sorbic acid are the mainstays. Sorbic acid
reportedly causes less irritation than thimerosal
and its use is increasing, especially in solutions
intended for soft lenses. The remaining ingredient
in hard lens cleaning solutions is the chelating
agent, ethylenediamine tetraacetic acid (EDTA).
This will be discussed shortly.
Benzalkonium chloride is a cationic, surface
active, quaternary ammonium germicide
effective against many gram-positive organisms
and a few gram-negative varieties. The exact
mechanism for the antimicrobial action of
benzalkonium chloride has not been determined.
It is theorized that its surface active property
interferes with the membrane integrity of suscep-
tible organisms, or alternatively, that it interferes
with respiration and glycolysis (carbohydrate
breakdown) in susceptible organisms. In either
instance, bacterial growth cannot proceed and
replication is inhibited.
Benzalkonium chloride can also serve as a
wetting agent because it lowers the surface
tension of water. However, quaternary
ammonium compounds have both a hydrophilic
(cationic) portion and a hydrophobic (nonpolar)
portion. When the hydrophilic end aligns with
the water in tears, it can actually form another
hydrophobic layer between the water molecule
and the hydrophobic hard lens, making the lens
even less wettable. Benzalkonium chloride is,
therefore, contained in contact lens solutions only
for its germicidal activity. It is used at the lowest
effective strength, 0.12% (1:750).
EDTA is a calcium chelater. This means that it
binds with calcium ions. However, it is used in
contact lens solutions because it slightly decreases
the integrity of microorganism cell walls, and
increases their permeability for penetration by
benzalkonium chloride. This enhances the
germicidal activity of the quaternary ammonium
compound, benzalkonium chloride.
Hard lenses may be cleaned by different
techniques. Spray cleaning involves placing the
lenses in a perforated holder that is held under
running water which dislodges accumulated
debris. Hydraulic cleaning utilizes a plastic
holder containing separate baskets. A plunger
device is pushed up and down, forcing a cleaning
solution over and around the lenses.
Most hard lens wearers use friction cleaning.
This involves rubbing the lenses between two
fingers in a rotating manner, or placing the lens in
the palm and rubbing with a finger from the other
hand. Either way, a cleaning solution or gel is
used on both sides of the lens at the same time.
A fourth method, ultrasonic cleaning, is the
best but most expensive. It is done in the fitter's
office rather than at home. The lenses are placed
in a water bath and ultrasonic waves are passed
over them which dislodge and remove debris.
In summary, cleaning solutions are used after
removal of hard lenses to enhance elimination of
mucus, protein, oils and debris, and to keep
foreign material from adhering to the lenses. To
lessen irritation, the individual must rinse the
solution off completely before reinserting the
lenses. Because cleaning solutions must be rinsed
off, many manufacturers market cleaning
solutions that are appropriate for both hard lens
and soft lens use. This mainly involves lowering
the concentration of the detergent.
Soaking Solutions
For the most part, soaking solutions consist of
preservatives. They are used for holding the
lenses between wearings. They are intended to
prevent bacterial contamination of the lenses
during storage, to dilute any remaining cleaning
solution, and to leach out protein and mucus that
the cleaning solution did not remove. Mucus and
debris left on lenses overnight may also harden if
the lenses become dry. Soaking solutions prevent
this. They also help maintain the wetability of
hard lenses and aid them in retaining their shape
during storage.
Even though they are hydrophobic, hard
lenses can absorb 1 to 3% of their weight in fluids.
They dehydrate slightly when exposed to air,
then rehydrate when placed in a soaking solution
or back into the eye. If they are reinserted in
dehydrated form, they may extract fluid from the
cornea. This can cause discomfort and increase
the chance for bacterial infection. Dehydrated
May, 1987
THE CAROLINA JOURNAL OF PHARMACY
29
lenses are also flatter, so vision may be impaired
until the lenses become rehydrated.
Soaking solutions should be poured fresh each
time they are used. Any solution remaining in the
storage chamber after the lenses have been
removed should be flushed out before new
solution is added. Reusing soaking solutions
negates their effectiveness.
Lubricants And Viscosity
Agents
These agents are similar to wetting solutions.
Some are used prior to insertion for cushioning
the lens against the cornea. Others are used to
increase comfort while the lenses are being worn.
It is claimed that these solutions clean and rewet
the lens while it is still in the eye. Since hard lenses
can absorb mucus and salts onto their surface to
possibly cause blurred vision and enhance the
chance for infection, these agents prevent
potential build-up from occurring.
Most authorities and manufacturers prefer
polyvinyl alcohol to the cellulose derivatives for
both their lubricating and wetting solutions. The
cellulose derivatives reportedly may interfere
with regeneration of corneal epithelium in a few
individuals. Polyvinyl alcohol is also considered
to be a more effective wetting agent.
Multipurpose Hard Lens
Solutions
Because of the large number of solutions
involved in the care of hard lenses, there has been
a trend in recent years toward developing
multipurpose products. However, there is some
controversy associated with the use of these
solutions. Their proponents argue that they save
the consumer money and are more convenient to
use. Opponents advise against their use claiming
that good lens cleaning solutions must contain
enough surfactant and detergent to do the job.
Trying to make soaking and wetting solutions of
them requires lowering the concentrations of
ingredients to the point that they do not contain
appropriate amounts of cleaner. To do so will
result in a solution that will irritate the eye.
There is less controversy associated with
combination soaking and wetting solutions
because these are basically similar. Opponents to
their use state that the ingredients must perform
divergent functions. The high concentration of
perservatives in soaking solutions needed to kill
bacteria can be irritating when used as wetting
May, 1987
agents or lubricants. The high concentration of
viscosity agents needed for wetting and
lubricating can cause lenses to become "gummy,"
and result in discomfort if used for overnight
storage. The anionic detergents needed for
cleaning can cause irritation if they are placed
directly into the eye. Millions of individuals
disagree with these objections and have no
problems with multipurpose solutions.
Adjunct Solutions
Pre-insertion solutions are intended to be
used directly into the eye to prepare it for lens
insertion. Most are highly viscous substances that
decrease corneal sensitivity to lens application.
Consumers should be reminded that the viscous
solutions may cause blurred vision until they are
diluted by tears. They should, therefore, not be
applied to the eye immediately before driving or
other events which require visual acuity.
Conditioners are used directly in the eye when
tears are unable to sufficiently wet or cushion the
lenses. They can be applied periodically, three to
four times a day.
Consumer Advice
Contact lens wearers should inform their fitter
if they experience sharp eye pain, excessive
watering, persistent irritation or inflammation of
the eye, sudden changes in vision, or spectacle
blur that does not clear overnight. Spectacle blur
is a phenomenon in which hard lenses worn for a
number of hours cause corneal edema. This
changes visual acuity for several minutes to
several hours after lens removal until the eye
returns to normal.
Since the air supply to the cornea is reduced
during sleep, it is best to not insert hard lenses
immediately upon awakening. When the eyelids
are closed for a period of time, the cornea may
become slightly swollen. Therefore, persons
should wait ten to fifteen minutes before inserting
the lenses. Occasionally during the day, they
should blink hard and hold the eyes closed for
several seconds to enhance better tear flow.
Placing a lens into the mouth to wet it before
inserting it should not be done because the oral
cavity is laden with bacteria. There is a possibility
that pathogenic organisms will be introduced into
the eye. Also, the person might swallow the lens.
Continued on page 31
Human insulin for all. Humulin
human insulin
[recombinant DNA origin]
Identical to human insulin. Humulin is the only insulin not
derived from animal pancreases
Recombinant DNA technology makes the production of
Humulin possible and virtually assures every insulin user of a
lifetime supply
From Lilly ... a dependable source of insulin for
generations. Since 1922. when we became the first company
to manufacture insulin, we have led the search for the best
diabetes care products and, at the same time, maintained a
constant supply of insulin for all insulin users
Our 24 formulations of insulin— including Humulin and all
forms of lletm- (insulin)— are available through the widest retail
distribution of insulin in the United States
Beyond that, we will continue to provide a wide range of
diabetes service and educational materials for use by physi-
cians, pharmacists, and diabetes educators
e 1986 ELI LILLY AND COMPANY
Our Medical Division is on call. Our Medical Division staff
is only a phone call away Please contact them if you have any
questions about our diabetes care products
Any change of insulin should be made cautiously and
only under medical supervision. Changes in refinement,
purity, strength, brand (manufacturer), type (regular, NPH,
Lente5", etc), and/or method of manufacture (recombinant DNA
versus animal-source insulin) may result in the need for a change
in dosage
Littv Leadership
IN DIABETES CARE
For information on insulin delivery systems, contact CPI 1-(800)-227-3422
2%%
Eli Lilly and Company
Indianapolis, Indiana 46285
THE CAROLINA JOURNAL OF PHARMACY
31
CORRESPONDENCE COURSE
Continued from page 29
The largest group of contact lens wearers is
women between the ages of eighteen and twenty-
four. Most of these women are also good
cosmetic customers. It is estimated that they
spend more money on cosmetics than non-
wearers, so one topic of importance to consumer
counseling regards restrictions on cosmetic use.
Aerosol hairsprays should be used before
inserting contact lenses, and preferably should be
applied in another room to avoid particles of the
spray from attaching to the lenses.
Wearers should wash their hands thoroughly
before handling the lenses, regardless of whether
the lenses are the soft or hard variety. The hands
should be thoroughly rinsed because soap can
leave a residue on the lens.
Lenses should be inserted before applying
makeup because oily substances in these
preparations can stick to the fingers and smudge
the lenses when they are handled. Conversely,
lenses should be removed before removing
makeup. Many ophthalmologists advise lens
wearers to purchase makeup in the smallest
containers. Once opened, the longer it sits
around, the greater is the chance for bacterial
contamination which can be transferred to the
lenses.
Mascara and pearlized eye shadow should be
avoided by women wearing hard lenses. Particles
from these types of makeup can easily flake into,
the eye and cause considerable irritation and,
possibly, corneal damage. It is less of a problem
with the soft lenses, because soft lenses adhere to
the cornea and particles do not readily penetrate
underneath them.
Contact lens wearers who notice that their eyes
are bloodshot should not use OTC vasoconstric-
tors without checking with their physician.
Vasoconstrictors may mask a symptom that
should be evaluated by a physician and treated. A
summary of other important points of consumer
advice for contact lens wearers is presented in
Table 3.
This series on contact lenses and their solutions
will conclude next month. Products intended
specifically for soft lenses, and questions about
lens solutions that are asked of pharmacists will
be presented.
TABLE 3
Consumer Advice
Do not use dishwashing detergents to clean
hard lenses. (They may cause physical
changes in the surface of the lens.)
Do not use saliva to re-wet contact lenses.
(The mouth is laden with bacteria which can
be transferred to the lens.)
Do not wipe hard lenses dry with tissue. (This
may cause scratching.)
Keep the contact lens solution tightly sealed
between uses, and do not touch the dropper
tip to any surface. (This reduces the chance of
contaminating the solution.)
Clean hard lenses as soon as they are removed
from the eye. (This prevents deposits from
becoming difficult to remove.)
Follow proper sanitary procedures while
inserting, removing, or caring for contact
lenses. (This increases their life and reduces
the chance for contaminating the eye.)
Do not re-use any contact lens solution.
Always use fresh solution. (This prevents
growth of microorganisms in the solution and
transfer to eye.)
Do not use any contact lens solution beyond
the expiration date on the bottle. (It may be
decomposed or contaminated.)
Contact your fitter if any of the following
become persistent or excessively irritating:
— Burning, itching, stinging or watering of the
eye
— Redness or dryness of the eye
— Reduced ability to see clearly
— Spectacle blur that does not clear up
overnight.
Any of these may be signals of eye damage or
corneal hypoxia
CE TEST ON P. 32
May, 1987
32
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE QUIZ
Hard Contact Lenses
1. Polyvinyl alcohol is contained in contact
lens solutions for which of the following
functions?
a. Buffer and/or isotonicity agent
b. Chelating and/or enzyme cleaner
c. Detergent and/or preservative
d. Surfactant and/or viscosity agent
2. All of the following are multipurpose
solutions indicated for wetting, cleaning and
soaking hard contact lenses EXCEPT:
a. Contactisol.
b. Lens-Mate.
c. Titan.
d. Total.
3. Which of the following is intended for use
directly into the eye of a person wearing
hard contact lenses?
a. Blink-N-Clean
b. duo-Flow
c. Lensine
d. Visalens
4. Which of the following statements is true?
a. Hard lenses are called contacts because
they come in actual contact with the
cornea.
b. Hard lenses allow the transfer of tear
secretions and oxygen to the cornea.
c. Hard lens solutions, within each
category of products, are basically
interchangeable with others intended
for the same purpose.
d. Hard lenses must be heat sterilized
between each wearing.
5. A person requesting an adjunct contact lens
solution for use directly into the eye, who is
known to be hypersensitive to thimerosal,
should be advised to purchase:
a. Adapettes
b. Clerz 2
c. Lens-Wet
d. LC-65
6. The force of attraction between molecules
of different substances is called:
a. adhesion.
b. capacity.
c. cohesion.
d. tonicity.
7. The phenomenon of spectacle blur caused
by hard lenses is due to:
a. corneal edema induced by the lenses.
b. deposits that cake and harden on the
lenses.
c. placing the lenses in the wrong eyes.
d. wearing spectacles over the lenses.
8. The basic purpose of wetting solutions is to
make:
a. hydrophobic contact lenses more
hydrophilic.
b. hydrophilic contact lenses more
hydrophobic.
9. The unsupervised use of OTC vaso-
constrictors in the persistently bloodshot
eyes of a person wearing hard lenses is
unwise, because vasoconstrictors:
a. will discolor the hard lens.
b. will alter the optics of the lens.
c. will adhere to or ruin hard lenses.
d. may mask a symptom that requires
more appropriate therapy.
1 0. Which of the following is a chelating agent
that reportedly enhances the action of
benzalkonium chloride?
a. BTA
b. EDTA
c. PVA
d. TTA
NETWORK BUYING GROUP
FORMED
Rugby Laboratories has been selected as the
exclusive provider for the Pharmacy Network of
North Carolina buying group. This plan,
available through wholesalers or direct from
Rugby, will be available on May 1. All drug
wholesalers are expected to participate and
should have program details by May 1.
This program includes the following:
• Special pricing on approximately 350
SKU's.
• An allowance of 15% on 150 high volume
prescription items plus 100 O-T-C items
which carry the Good Housekeeping Seal of
Approval, plus 60 comparable vitamin
products and an additional 75 single entity
and combination vitamin products.
• A 5% quarterly discount on the entire Rugby
line of products.
May, 1987
THE CAROLINA JOURNAL OF PHARMACY
33
APhA OFFERS RETROVIR
MONITORING ASSISTANCE
The American Pharmaceutical Association
(APhA) is urging its members to assist the
Burroughs Wellcome Company in monitoring
the effectiveness of the unique distribution system
it has established for its new drug Retrovir
(zidovudine), the first drug approved by the Food
and Drug Administration for treatment of
Acquired Immune Deficiency Syndrome
(AIDS).
The distribution system, that requires patient
certification and patient designation of
pharmacies which will distribute the drug, has
been put into place because Burroughs Wellcome
anticipates a somewhat limited supply of
Retrovir for "a period of time in the near future."
The system is designed to direct the drug to those
patients at greatest need and those who are most
likely to benefit from therapy.
Physicians wishing to prescribe Retrovir must
submit an enrollment application for each new
patient who is a candidate for the drug. These
applications will be reviewed by medical
specialists against a set of pre-established criteria.
If the patient is enrolled, the physician will
receive a patient enrollment number which must
accompany the patient's Retrovir prescription.
Pharmacists will be able to dispense
prescriptions only for those patients who have an
enrollment number. A special toll-free number,
(800) 332-1887, may be used by pharmacists to
order Retrovir. Patient enrollment numbers will
be verified prior to the acceptance of an order.
Once an order is placed, a one-month supply of
the drug will be shipped to the pharmacy for that
patient. An additional quantity for that patient
may not be ordered for 25 days.
Continued on page 34
Cut Out or Reproduce and Mail
CONTINUING PHARMACEUTICAL EDUCATION
Hard Contact Lens Solutions
Attach Mailing label from The Carolina Journal of Pharmacy in space provided (or print
name and address) and mail completed questionnaire to: NCPhA, P.O. Box 151, Chapel Hill,
NC 27514.
You may submit completed questionnaires on a monthly, quarterly, or less frequent basis
depending on which procedure is most advantageous for you in your pharmacy practice.
NCPhA will maintain a record of your completed CE credit hours. Upon successful completion
of each program you shall receive a certificate for one hour of Board approved CE.
If the answers to more than two questions are incorrect, the questionnaire will not be acceptable
for CE credit. If your questionnaire is not accepted you will be notified within 1 0 days and given
an opportunity to submit a second questionnaire.
Please circle correct answers
1. a b c d
2. a b c d
3. a b c d
4. a b c d
5. a b c d
6. a b c d
7. a b c d
8. abed
9. a bed
10. a b c d
11. abed
12. abed
13. abed
14. a b c d
15. abed
Evaluation □ Excellent □ Good □ Fair
How long did it take you to read the article and complete the exam?
□ Poor
May, 1987
34
THE CAROLINA JOURNAL OF PHARMACY
APHA OFFERS
Continued from page 33
During the period of limited supply,
Burroughs Wellcome will drop-ship Retrovir to
pharmacies and bill through the wholesaler.
Because of the uniqueness of the distribution
system, APhA is asking its members who will be
dispensing Retrovir to report either to Burroughs
Wellcome or to APhA any problems
encountered or any suggestions for improvement
in the system.
April 8, 1987
Greensboro News and Record
200 E. Market St.
Greensboro, NC 27401
To the editor:
As a practicing community pharmacist in
Greensboro for many years, I feel I must take
strong exception with Joe Graedon's implied
recommendation of AARP's mail order
prescription service in his column of April 7th.
Mr. Graedon, although not a pharmacist himself,
usually writes a very informative and generally
accurate column, but this time he is failing to
advise the prescription-buying consumer in his
best interest. I share his concern about the soaring
costs of prescription drugs, and the difficulty this
causes for those on fixed incomes, but let us
examine why mail order prescriptions, while
perhaps cheaper, are really no bargain at all!
When you order your prescriptions by mail,
you are giving up the personalized service of your
community pharmacist, a drug expert who
knows you and your family, and who often
makes himself available to you on an emergency
or 24 hour basis, either to fill your prescription or
just to answer your questions. Because he keeps a
patient profile on you, he knows what other drugs
you may be taking that could interact
dangerously with your new prescriptions and
whether you might be allergic to the medication.
With mail order prescriptions, what do you do
if the medicine is lost or stolen? What do you do
until the medicine arrives in the mail? What if
you need a new prescription filled at once or if
your medicine runs out and you need a refill right
away? Is it really a good idea to receive larger
than normal quantities of medicine, which can
lead to abuse and waste?
In view of all the potential health hazzards of
mail order prescriptions, I cannot agree with Mr.
Graedon's apparent opinion that these risks are
outweighed by the "savings".
Sincerely,
J. Frank Burton, R.Ph.
Secretary, Guilford Co. Society of Pharmacists
Mrs. Lib Fearing is presented the Geigy "Pharmacist's Mate" Award by Gary Allman of Geigy
Laboratories as President M. Keith Fearing looks on.
May, 1987
THE CAROLINA JOURNAL OF PHARMACY
35
CLASSIFIED ADVERTISING
Classified advertising (single issue insertion) 25 cents a word with a minimum charge of $5.00 per
insertion. Payment to acompany order.
Names and addresses will be published unless a box number is requested.
In replying to "blind" ads, address Ad. No., Carolina Journal of Pharmacy, P.O. Box 151, Chapel
Hill, NC 27514. Telephone (919) 967-2237.
INDEPENDENT PHARMACY (Triad)
Needs warm, friendly, civic-minded
pharmacist. In return have flexible hours,
plus one weeks vacation every four
months, plus 3-day weekends during
summer. Call Apple Pharmacy, 704-634-
2111.
HOSPITAL PHARMACIST WANTED:
Staff position available in a 68 bed acute
care hospital in Siler City, NC. Hospital
experience desirable. Salary commensu-
rate with experience. For more informa-
tion, contact Sandra McKinney, Chatham
Hospital, Inc., P.O. Box 649, Siler City, NC
27344.(919)663-2113.
NEED PHARMACIST MANAGER —
Belwood Pharmacy Incorporated. Salary
Negotiable, Benefits, Retirement, Vaca-
tion. Rural Piedmont, North Carolina. Call
Dr. Cecil L. Barrier at (704) 538-7891
(Office) or (704) 538-7673 (Residence).
RELIEF PHARMACIST AVAILABLE:
Central & Eastern North Carolina. Contact
Pharmacy Relief, PO Box 2064, Chapel
Hill NC 27515 or call 919-481-1272
evenings.
PHARMACY FOR SALE: Coastal NC.
Sales greater than $400,000.00; 60%
prescriptions. 10 miles from the ocean.
Contact Bullock & Whaley (919) 762-
2868; PO Box 3783, Wilmington NC
28406.
PHARMACIST FOR HIRE: Mature
Pharmacist, active in excellent health
wants work with small town pharmacy or
relief work. Call Craig, (919) 673-1368.
PHARMACIST WANTED. Full-time
position on coast. Excellent working
conditions. Competitive salary and
benefits. Contact T01, NCPhA.
PHARMACIST NEEDED: Crown Drugs
has pharmacist positions open in central
North Carolina due to planned expansion
in 1 987. We offer excellent starting salary,
40 hour week, paid vacation, insurance,
and many other benefits. Come grow with
us. Send resume to: Doug Sprinkle,
Crown Center, 400 Commerce Place,
Advance, NC 27006.
PROFESSIONAL PHARMACIES: Sev-
eral small prescription-oriented pharma-
cies are currently available for individual
ownership in North Carolina. These oppor-
tunities provide the vehicle to practice
pharmacy the way you were taught, while
offering an attractive income and more
time to be with your family. In some of
these cases, financing is also available to
qualified candidates. For more informa-
tion write: Jan Patrick, 10121 Paget Dr.,
St. Louis MO 63132.
CLINICAL-STAFF PHARMACIST POSI-
TION: Will be working every 3rd weekend
and will have responsibilities in unit dose,
IV admixtures, cancer chemotherapy,
patient education, nursing inservice,
pharmacy newsletter, pharmokinetic
dosing, drug use evaluation and other
evolving clinical applications. Some
advanced training and experience in
clinical pharmacy preferred. If interested
and qualified please send resume to:
Director of Personnel, Community
General Hospital, PO Box 789, Thomas-
ville NC 27360. EOE.
MEDICINE SHOPPE FOR SALE: Don't
miss this excellent opportunity to be your
own boss in a professional atmosphere.
The Medicine Shoppe, a prescription
Continued on page 36
May, 1987
36
THE CAROLINA JOURNAL OF PHARMACY
CLASSIFIEDS
Continued from page 35
oriented pharmacy located in Raeford,
NC has been offered for immediate sale.
This fine opportunity offers clinic hours
and a positive cash flow from Day 1 . If you
have been considering owning your own
pharmacy, this could be an outstanding
opportunity for you! Financing available.
Contact John Aumiller, Medicine Shoppe
Intl., Inc. at 1-800/325-1397.
PHARMACIST PROFESSIONAL SER-
VICES/CONSULTATION: Temporary and
or Continual. Contact: L. W. Matthews, III,
(919) 967-0333 or 929-1783. 1608 Smith
Level Rd., Chapel Hill NC 27514.
PHARMACIST WANTED: Independent
pharmacy in Concord seeks a full time
pharmacist. Good salary, excellent
benefits. Call Mickey Watts (704)
782-2194.
STAFF PHARMACIST WANTED: Posi-
tion at Kings Mountain Hospital. Modern
102-bed facility with computerized unit
dosage. Hospital experience preferred
but not necessary. Will consider a May
graduate. Contact Jerry McKee at (704)
739-3601 Ext. 472.
PHARMACIST WANTED: Opportunity
for pharmacist interested in progressive
independent practice. Opportunities for
patient counseling, hypertensive screen-
ing, diabetes screening and home health
care. Excellent salary and benefits. No
nights or Sundays. Contact Box ZZZ, c/o
North Carolina Pharmaceutical Associa-
tion, P.O. Box 151, Chapel Hill, NC 27514.
PHARMACIST WANTED: We are
seeking ambitious and professional
career-minded individuals for pharmacist
positions in High Point, Greensboro and
Winston Salem. We offer excellent salary,
stock ownership, educational subsidy,
extensive benefits, retirement plan, 401 K
tax deferment plan, and annual salary
merit reviews. "Pure pharmacy setting."
Call Lew Thompson at 1-800-233-7018 or
send resume' to the Kroger Company,
Attn: Personnel, P.O. Box 14002,
Roanoke VA 24038. EOE
PHARMACIST — Full-time in Eastern
North Carolina. Excellent schedule and
benefits. Salary commensurate with
experience. Contact Danny Yates at 1-
800-682-0062 for details/interview.
We are seeking an ambitious and
professional career-minded individual for
Pharmacy-manager position in south-
eastern North Carolina near the coast.
Computerized prescriptions, excellent
salary, hospitalization and life insurance,
paid vacations. Small professional
pharmacy located in the center of a
medical complex. Contact Box CDD, c/o
NCPhA, P.O. Box 151, Chapel Hill, NC
27514.
Special Thanks
The Student Branch of the NCPhA at the
UNC School of Pharmacy would like to thank
the following pharmacists for their thoughtful
contributions and words of encouragement.
Their assistance helped make our trip to the
American Pharmaceutical Association Annual
Convention in Chicago a huge success. Thank
you!.
E.A. Brecht
Robert Lewis
Larry Denning
John Lowder
W.H. Randall
Bob Taylor
May, 1987
Dinner
Saturday, July 11
1 p.m.- 9 p.m.
Sunday, July 12
9 am. -6 p.m.
at the
Arthur Ashe Athletic Center
3017 North Boulevard • Richmond, Virginia
Owens &Minor, Inc.
1987 GIFT SHOW
• Spectacular array of top quality
goods in one location.
• Over 100 major manufacturers
represented.
• Everyday drug store items.
• The convenience of one-stop
shopping.
• New products and traditional
gifts.
• Household products, personal
and electrical appliances.
• Main brand cosmetic lines.
• Toys, games and plush items.
Owens &Minor, Inc.
1010 HERRING AVENUE • Wl LSON, NORTH CAROLINA 27893 • 919/237-1 181
Toll Free 800/682-2270
£(
y\
She'scountingonyou.
Your patients count on you for consistent quality
care. At QS/1, we know that you need the full service
of your computer system every minute of every day.
Your patients' depend on it. When you get
a QS/1 computer system, we walk you
through every step until you are thoroughly
comfortable with the system. But more
important, if you ever have a problem or >•
a question we're only a phone call away.
To find out more about the pharmacy system you can count
call today: 1-800-845-7558.
Dr.T.C. Smith Co. / W.H.King Drug
ASHEVILLE. N.C 28806 • 704/258-2645
RALEIGH, N.C. 27622 • 919/782-8400
"HE QUROUNk
He a I th £
I ... u
. . H
inces — . o ■ « i' y
77c ■
JOURNN.ofPHN?MkCY
LU
CO
O
>
00
University of North Carolina
FEB 15 1988
Health Sciences Library
COAT OF ARMS OF THE
NORTH CAROLINA
PHARMACEUTICAL ASSOCIATION
(SEE STORY ON PAGE 5)©
Q^
m}
/ < — *
1 i
U
^
\
I
Plagued by Back-Orders?
Kendall Has the Cure.
Kendall customers don't wait around
for their orders; in fact Kendall averages
a 95+% service level. Kendall customers
have relied on us for over 65 years to
provide a full line of pharmaceutical
services, including:
• Wholesale Pharmaceuticals
• Electronic Order Entry
• Drug Store Design and Fixtures
• Associated Druggist Advertising
Program
• Pricing Strategy
• Microfiche Service
• Per-Product Sales Analysis
• Next Day UPS Delivery in the
Carolinas
Kendall Drug also offers the
pharmacist a viable means of reducing
paperwork, while increasing efficiency
and profitability: The Triad In-Pharmacy
Computer System.
Triad handles your complete
prescription processing including labels,
instructions, drug interaction and receipts,
accounts receivable, third party billing,
and medi-span price updates. Triad is an
excellent pharmacy system, allowing you
to increase efficiency and productivity.
We put our name and service behind
Triad and you. Call Triad direct at
1-800-532-3087.
H
DRUG COIVlF>AI\IV
1305 Frederick St. • P.O. Box 1060 • Shelby, N.C. 28150
NC 1-800-222-3856 SC 1-800-438-5330
Justice Drug Company
P.O. Box 22025
Greensboro, NC 27420
AN ALCO STANDARD COMPANY
Now in our 87th Year of Service to the North Carolina Pharmacists
m
Hxfs Partnership
For Profit
Family
Independent
Pharmacy
Total Retail Concept
The Family Independent Pharmacy program provides an
all-inclusive plan covering every aspect of marketing,
merchandising, and management of drug store opera-
tions. It is a wholesaler-sponsored voluntary, and it
embraces the total retail concept in all its forms.
1HHC
TOTAL HOME HEALTH CAKE
Our Total Home Health Care1" Program offers Durable
Medical Equipment for Rent or Resale. Third Party Billing
for Medicare/Medicaid.
Additional
* Services & Programs Offered *
Store Plan-O-Gram: Complete Store Layout & Design
including Fixtures, Merchandise Plan-o-graming,
and Pricing Strategies
Specialty Gift Departments including Arts & Crafts
Affordable Pharmacy Computer Systems
LIBERTY DRUG SYSTEMS, INC.
QS/1 PHARMACY SYSTEMS
Merchandise Racking Service
Group Life
And Health
Insurance
Benefits
For Members Of
North Carolina
Pharmaceutical
Association
Pilot Life Insurance Company is pleased to have oeen
selected as the Group insurance carrier for the North
Carolina Pharmaceutical Association. It would be to
your advantage to become thoroughly acquainted with
the benefits of this program.
You can expect the best possible service from Pilot Life,
one of the nation's leading Group insurance carriers.
For full information, contact Mr. Al Mebane, Executive
Director, North Carolina Pharmaceutical Association.
Write or call:
Sam P. Stuart, CLU
P. O. Box 595
Winston-Salem, NC 27102
Telephone 919/723-8811
■iflffepsnn
PilOI
INSURANCE / FINANCIAL SERVICES
HE OIROLINk
JOURNMofPHN^MkCY
JUNE 1987
Officers
NORTH CAROLINA
PHARMACEUTICAL
ASSOCIATION
President
Julian E. Upchurch
5201 Pine Way
Durham, NC 27712
(919) 477-7325
Vice Presidents
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh, NC 27612
(919) 876-5600
W. Robert Bizzell
1007 Rhem Street
Kinston, NC 28501
(919) 527-6929
Loni T.Garcia
5210 McLeod Road
Lumberton, NC 28358
(919) 738-6441, Ext. 7317
Executive Director
& Editor
A. H. Mebane, III
P.O. Box 151
Chapel Hill, N.C. 27514
NCPhA Office
(919)967-2237
or
1-800-852-7343
(USPS 091-280)
VOLUME 67
ISSN 0528-1725
NUMBER 6
CONTENTS
Coat of Arms Presented to Association 5
The Devisal of Arms 6
Report of the UNC School of Pharmacy and
the Pharmacy Foundation of NC II
Report of the UNC Student Branch 17
1987-1988 NCPhA Executive Committee 19
Invitation to Mortar-and-Pestle Dinner 20
State Board of Pharmacy 21
1 942 Alumnus Address 23
Report of the National Legislative Committee 25
Local News 27
Report of the Mental Health Committee 29
Report of the Social & Economic Relations Committee 31
Report of the Community Pharmacy Committee 32
Report of the Women in Pharmacy Committee 35
Weddings and Births 37
Classified Advertising 39
ADVERTISERS
Burroughs Assets Management Company 14
Colorcraft 35
Dr. T. C. Smith Co./W.H. King Drug Back Cover
Eli Lilly and Company 4
Geer Drug 30
Jefferson-Pilot 2
Justice Drug Division 1
Kendall Drug Company Inside Front Cover
Knoll Pharmaceuticals 33 & 34
Lawrence Pharmaceuticals 12
Owens & Minor Inside Back Cover
PharmaSTAT, Inc 10
Savage Laboratories 28
Store Fixtures & Planning, Inc 22
The Upjohn Company 24
Washington National Insurance Company 16
The Carolina Journal of Pharmacy is published monthly by the
North Carolina Pharmaceutical Association, P. O. Box 151,
Chapel Hill, NC 27514. The Journal is provided to NCPhA
members through allocation of annual dues. Subscription rate to
non-pharmacists (continental US) $20.00. Single copy price
$2.00. Overseas rates on request. Second class postage paid at
Chapel Hill, NC.
Follow the arrows
to better cash flow management.
J-ttWftMftiriw-Tr--? ■ ttAaJiMd
And they could lead you to greater profits.
With the help of the new Lilly Computerized
Pharmacy Management Series, you can learn key
cash management techniques that may be employed
for operating a more profitable pharmacy. But you
also earn as you learn. On satisfactory completion of
a test at the end of each unit, you receive 2 hours
(0.2 CEU) of continuing education credits.
With the aid of this "hands-on" program, you'll be
moving in the right direction . . .toward increased profits.
£&+J(
DISTA
YOUR PARTNERS IN HEALTH CARE
Service, support, and innovative products...
A tradition since 1876.
t AND COMPANY
THE CAROLINA JOURNAL OF PHARMACY
COAT OF ARMS PRESENTED
TO ASSOCIATION
At an impressive ceremony highlighting the
Opening Session Banquet of the 107th Annual
Convention of the North Carolina Pharmaceu-
tical Association, the Coat of Arms devised for
the Association was presented to President M.
Keith Fearing, Jr.
John P.B. Brooke-Little, Esquire, Norroy and
Ulster King of Arms, the agent for the Devisal
made the presentation and explained the various
components of the Devisal. The North Carolina
Pharmaceutical Association is the first
professional association in the United States to
have a coat of arms. Other corporate bodies in the
US to have Arms devised for them include the
City of Kinston, NC, the Town of Manteo, NC,
the Commonwealth of Virginia, the Senate of
Virginia, Barclays Bank of California and the
City of Williamsburg, VA.
The original document, hand drawn and
lettered on sheepskin, will be framed and
mounted in the office of the Association in the
Institute of Pharmacy in Chapel Hill where
visitors are welcome to examine it. Proper use of
the Arms is explained in detail in the
accompanying article.
John P.B. Brooke-Little, Norroy and Ulster of
Arms, assisted by Colonel Robert R. Jeter, Jr.,
Chief of Staff, 108th Division, US Army
Reserves.
Mr. and Mrs. Brooke-Little and M. Keith Fearing display the Devisal of Arms at the Opening
Banquet of the Annual Convention.
June, 1987
THE CAROLINA JOURNAL OF PHARMACY
THE DEVISAL OF ARMS
by John P.B. Brooke-Little, Esqre.
C.V.O., M.A., F.S.A.
Norroy and Ulster King of Arms
Treasurer and Librarian
The College of Arms
London
"What Is a Devisal
of Arms?"
In the 1950's one or two American corporate
bodies expressed an interest in heraldry and a
desire to have English arms granted to them. This
was flattering and was something which the
English heralds would have liked to do, but the
granting of arms is a facet of the royal prerogative
and the Queen's writ does not run in the United
States.
After much thought, and as a result of inquiries
made at the diplomatic level, it was agreed that
the English Kings of Arms of the College of
Arms, London, might grant to American towns,
but in making these grants, they would be acting
on their own and not in pursuance of an Earl
Marshal's Warrant, nor with the authority of the
Crown. The arms so granted would be treated in
every way as an ordinary grant. The Officers of
arms would act as agents for their clients in the
usual way, the fees would be the same as on other
grants of arms; the arms would have to be unique
and would be placed on record as is the case with
other grants, thus they would become part of the
whole corpus of English heraldry.
Just two conditions were laid down; the
Governor of the State in which the body
requesting arms was situated must signify his
approval and the grant was to be called a Devisal,
so as to indicate that it differed slightly from, but
was in no way inferior to, an ordinary grant.
Naturally, the usual decoration at the head of a
Patent of Arms (the arms of the Queen, the Earl
Marshal and the College of Arms) was not
appropriate, so a Devisal would be headed by
paintings of either the crowns of the three
devising kings, or their arms. The Patent could be
embellished with a decorative border and initial
letter, and could be written in an italic, or
foundational hand, rather than the usual
copperplate but, as with a grant of arms, the cost
of such embellishments would have to be
underwritten by the grantee.
The devising of arms to American Towns was
instituted by an Earl Marshal's Warrant dated
25th July 1960. By a further Warrant dated 1st
February 1962, the devising of arms was
extended to embrace other worthy, respectable
and eminent corporations, such as banks,
colleges, ecclesiastical foundations, commercial
firms and, of course, various types of local
authority.
Why a Devisal?
There is no law of arms in the United States,
nor is there any authority, except the Army
Institute of Heraldry officially concerned with
military heraldry and insignia, which can assign
arms. This means that any corporate body in
America can assume, bear and copyright a device
which can be in the form of arms. Why then
should corporations turn to the English Heraldic
Authority for a Devisal?
I think the reasons are many and various and
although I shall list them seriatim, they are in no
particular order of precedence as the only
precedence there can be is in the reckoning of the
devisee.
1 . America was once, for better or for worse, a
collection of English colonies. The ties of the
motherland have long been severed and nationals
of many other countries have planted their roots
in the United States, yet the historical fact and the
feeling of national kinship remain. In some states,
where the names of cities, towns, counties and
townships reflect colonial days, the feeling is
stronger than in others. This is understandable,
yet even in what might be called non-British
areas, the common language forms a common
bond. I believe that the American colonies broke
away from Britain as a grown child will break
away from its family if kept in too strict tutelage
for too long. After the fight for freedom, there
remain no really hard feelings; nothing can
permanently sever the old family ties and after a
while all is forgotten and forgiven. This is what
has happened; the emancipated child has grown
and become more cosmopolitan and much richer
June, 1987
THE CAROLINA JOURNAL OF PHARMACY
than its parents, as children the world over often
do; yet it retains a lingering affection for its
parents, just as parents cannot but love and
admire those who have flown the nest. That
political conditions make reciprocal affection
very desirable should not blind us to the fact that
such closeness is natural and sincere and that
jealousies and criticisms are an unhappy but
inevitable concommittant of mutual admiration
and affection, and never should be considered as
more than one of the ephemera of human nature.
2. Heraldry is an ancient and accepted form of
ordered symbolism not just in Britain but
throughout Europe. For this reason, there is a
natural reluctance for anyone, whether an
individual or a corporate body, to assume arms
unless such arms are authoritative. This poses a
problem for those American corporate bodies
who think this way, for to whom can they turn to
give their arms that authority and cachet which,
perhaps almost subconsciously, they seek? The
English heralds have supplied an answer. It is not
a perfect one, but I believe it is a good one and
certainly the best possible.
3. The officers of arms have been designing
arms in the English tradition for almost eight
hundred years. They are professionals and know
the true meaning and purpose of heraldry; they
understand its intricacies, its limitations and its
possibilities. They know that a well designed coat
of arms should be simple, easily recognizable and
timeless. It is the timeless quality of the design and
symbolism of heraldic emblems which is where
its true value lies. The modern logo is a
contemporary, immediate rival to heraldry, for it
is not a permanent recorded device; today it is
new, bright and fresh but tomorrow it is out of
date, and it is usually so expensive. A public
relations firm could easily charge $20,000.00 for
what is called the "development" of a logo, yet
the fees on a grant or devisal of arms are laid
down by the Earl Marshal (the Duke of Norfolk)
and may not be altered.
4. Thus the cost could be another reason why
English heraldry is preferred to modern logos.
"How," the Americans ask, "can the heralds
produce a super design enshrined in a beautiful
document for such a relatively small price when
design firms charge from $20,000.00 upwards for
a simple logo?" The answer is relatively simple;
the Crown, through the Earl Marshal, ordains the
fees which are paid on a grant or devisal of arms.
In essence these bear no relation either to the fees
charged by so-called rival enterprises or to
current commercial rates. Work has to be paid
June, 1987
for, but heavy overheads do not have to be
covered nor large profits made.
5. Good heraldry is versatile and full of
possibilities. The heraldric artist and designer has
far more freedom than is generally supposed. For
instance, if a town were devised a coat of arms
consisting of three red eagles displayed on a gold
shield, the conventions of heraldry ordain that the
shield shall be recognizably gold or yellow and
the eagles a reasonably bright red; that the eagles
be disposed two at the top of the shield and one at
the bottom and that they be "displayed", that is as
if flung against a wall, with wings outspread and
heads facing the heraldic right, (the left as you
observe a shield). What heraldic convention does
not demand is that the eagles shall be fat or thin,
have a full complement of wing feathers or a
symbolic fan, look happy, miserable or fierce. It
does not mind whether they are painted flat or
shaded to suggest moulding. It is not concerned
with the size of the birds as long as they can be
seen to be what they are. Furthermore, although
on the actual document devising the arms the
artist will show the eagles on a shield whose
shape pleases him, this is of no significance. The
arms may be borne on any shape or type of shield
as long as it is a shield. This means that if the arms
were to be carved in stone, in order to adorn a
modern rectangular edifice, they would probably
be depicted on a shield shaped like a flat-iron
whose simple, severe lines would best harmonise
with those of the building; but, if the arms were to
head the menu of an 18th century bi-centennial
dinner, they would probably look better in an
ornate shield of the period with gold piecrust
edges. Heraldry should not be a cross to a
designer, but a challenge and an inspiration.
What Is a Coat of Arms?
Strictly speaking, a coat of arms consists of a
shield on which are displayed, in an orderly and
symbolic form, various devices arranged
according to time honoured conventions and
which form a unique, attractive and easily
recognizable mark of identity. Such devices were
first used in the early 13th century by Norman
knights and nobles on their shields and also on
their coat armour, a long surcoat worn over their
mail. It was from this latter custom that the term
"coat of arms", or more briefly, just "arms",
became current. About a century later crests,
devices modelled onto the helmet became
popular and were shown, together with the
Continued on page 8
THE CAROLINA JOURNAL OF PHARMACY
DEVISAL OF ARMS
Continued from page 7
helmet and short cloak or mantling attached to it,
over the shield of arms in pictorial representa-
tions. Still later, in the late 15th century, some
coats of arms were supported on either side by
creatures or human beings which, with
devastating logic, were called supporters.
Supporters were sparingly granted and devised
but counties, cities and towns are entitled to
them. A motto may always be depicted on a
scroll beneath the arms but this does not form
part of the actual grant or devisal. This means that
a motto does not have to be unique; indeed, many
families and corporations share such classic
mottoes such as Dum spiro spew. When all these
various devices are shown together they form
what is sometimes called a complete coat of arms
although the proper term is an achievement of
arms.
There is also a subsidiary device called a
badge. Badges were originally used by great
nobles to mark their retainers, and articles of
property and were also sometimes used as a motif
in decoration and on standards. Today, some of
these early uses of badges are still pertinent but
corporations find another and perhaps even more
important use for a badge. It is this: a person or
corporation which bears arms may neither
license nor permit any other person or body to
use their arms. Arms are essentially personal
devices; ensigns of honour peculiar to their
owner. However, it often happens that, from the
very best of motives, people may want to use the
arms of another. For example, a local historical
society, sports group or similar organization may
want to use a symbol of the town or county
whose name it bears. In such cases it would be
quite proper for the town or county to license the
use of its badge, but it would be contrary to the
love and tradition of heraldry for it to permit the
use of its arms. Badges can also be used on ties,
blazer pockets, buttons, souvenirs and the like.
The illustration at the end details the component
parts of an achievement of arms.
How Can Arms Be Used?
The short answer to this question is "anywhere
where they can beautify and identify dignity and
propriety", but obviously over the centuries,
certain uses have become traditional and
acceptable, whilst others are considered offensive
or vulgar. For example, the use of the American
flag as a motif in articles of clothing is not only
considered bad taste by loyal Americans but their
feelings are supported by a Federal law. So it is, to
a slightly lesser degree, with coats of arms. I have
listed below a few of the chief ways in which a
corporation to which arms have been devised
may properly use them.
1 . ON A BANNER. This is a rectangular flag
(the dimensions will be dictated by the weather
conditions and height of the mast) on which the
arms on the shield will be shown throughout. If
the corporation has a badge, a standard may be
flown. This is a long tapering flag (say 1:3) with
the arms in the hoist and the badge, motto and, if
desired, crest, displayed on the fly.
2. ON THE COMMON SEAL. This is one of
the most ancient uses for arms. It is quite correct
to have the full achievement engraved on the seal
but this argues a heavy and expensive press. For
this reason, many corporations use just the arms,
or the arms with the crest, sans helm and
mantling on their seals.
3. ON STATIONERY. While it is considered
vulgar for an individual to have his full
achievement of arms on his stationery (a crest or
badge is all that propriety permits) it is usual for a
corporation to display the achievement on
writing paper, envelopes, invitations, proformas
and so forth.
4. ON CORPORATE PROPERTY. Either
the full achievement, shield alone, or badge may
be used to mark the property of the corporation.
The nature of the display will dictate what
insignia shall be employed. Thus, the badge
would be used on buttons and cuttlery but the full
achievement on vehicles, or carved in stone over
the entrance to a school.
5. ON SOUVENIRS. The citizens who live
under the jurisdiction of a corporation or, if it is
an incorporated company, those who work for it,
should be encouraged to use the badge. This they
may do on ties, head scarves, blazer pockets and
small flags. Souvenirs such as post cards, ash trays
and mugs can properly be emblazoned with the
full achievement, as long as the name of the
corporation appears in conjunction with the
arms.
There are, of course, many other ways in
which the achievement or parts of it can be
displayed and used and I shall be happy to advise
on such uses, as indeed on any aspect of
acquiring, using and enjoying a properly devised
coat of arms. Heraldry is a noble, dignified and
ancient art or science, but it is also and essentially
fun; it is there to be enjoyed by as many people as
possible.
June, 1987
THE CAROLINA JOURNAL OF PHARMACY
CREST
DESCRIPTION OF
THE COAT OF ARMS
(from the Devisal Document)
DEXTER
SUPPORTER
HELM
ON WHICH
THE CREST
IS BORNE
MANTLING
OR
LAMBREQUIN
SINISTER
SUPPORTER :
SHIELD
ON WHICH
THE ARMS
ARE BORNE
0mm*mx
MOTTO SCROLL
CONTAINING
THE MOTTO
The design of the Devisal of Arms for the North
Carolina Pharmaceutical Association is as
follows: For Arms; per pale Azure and Gules a
Mortar therein a Pestle bendwise within an Orle
of four Sassafras Flowers Or alternating with as
many Dogwood Flowers Argent and for the
Crest upon a Helm with a Wreath Argent Azure
and Gules Issuant from Clouds a dexter Hand
proper grasping an Unicorn's Horn erect Or
environed by a Serpent Argent Mantled Parted
Gules and Azure doubled Argent and for
June, 1987
BADGE
(IN THIS CASE
COMPOSED OF
ELEMENTS FROM
ARMS & CREST)
Supporters on either side an Unicorn Argent
armed unguled and crined Or sejeant on a Book
Sable the spine manifest garnished gold and for a
Device or Badge A Mortar Or within a Circlet
composed of four Dogwood Flowers Argent and
as many Sassafras Rowers Gold.
Editor's note. Translation of the Motto "Herbarum
Subjecta Potentia Nobis" is 'With knowledge of herbs,
we have the potential to cure. "
Pharmst&WV, Inc.
Pharmacy Relief Service
P.O Box 24973, Winston-Salem, NC 27114,(919)777-8366
PharmaSTAT, Inc.
We are looking for pharmacists interested in
traveling in North Carolina wanting new and
challenging pharmacy experiences. Now hiring
full and part-time pharmacists to provide
pharmacy relief. Work the hours you choose in
hospital or retial. Competitive salary and benefits.
Pharmacist owned and operated. Call (919) 777-
8366 or write: P.O. Box 24973, W-S, NC 2711 4.
Employee Information
The benefits of full time employment, with the scheduling flexibility of an
independent consultant.
Hours you choose, whether full or part time employee
Professional liability insurance: $1,000,000/53,000,000 malpractice
coverage, as well as general liability
Paid membership in the North Carolina Pharmaceutical Association
Paid health care benefits for full time employees (Policy includes
$10,000.00 life insurance)
The opportunity to purchase health care coverage at group rates for part
time employees
Paid vacation days for all employees
Paid personal leave days for full time employees
Competitive salary and regular increases
Travel outside the city limits paid at the hourly wage rate
A variety of practice settings — independent, retail and hospital
The opportunity to practice pharmacy in a professional manner, using all
your skills and training
FICA and unemployment insurance provided for all employees
THE CAROLINA JOURNAL OF PHARMACY
11
REPORT OF
THE UNC AT CHAPEL HILL SCHOOL OF PHARMACY
AND
THE PHARMACY FOUNDATION OF NORTH CAROLINA, INC.
PRESENTED TO
THE NORTH CAROLINA PHARMACEUTICAL ASSOCIATION
ANNUAL MEETING
Charlotte, NC
April 24, 1987
by Tom S. Miya, Ph.D., Dean, School of Pharmacy,
Secretary, Pharmacy Foundation of North Carolina, Inc.
It is a pleasure for me to present this report to
this, the 107th convention of the North Carolina
Pharmaceutical Association. Before discussing
the past year's activities of the School I want to
remind you of its history and some of the changes
which have recently occurred.
Pharmacy education at UNC began in 1880
with ten students in medicine and pharmacy. The
School was officially established in 1 897. During
the period 1 897- 1 959 the School was housed in
Old West, Person and Howell Hall and from
1959 in Beard Hall. In recent years considerable
fiscal resources have been expended and continue
to be expended for renovations of Beard Hall to
accommodate changing needs and growth.
Table I shows the growth pattern in just the last
ten years. The table, however, does not reflect the
knowledge explosion and attending techno-
logical advances with which we have had to
cope.
TABLE I
Ten- Year Quantitative Growth Comparisons
1976-77 through 1986-87
1976-77
1985-86
1986-87
Faculty
32
54
AHEC Faculty
3
18
B.S. Students
581 (1-4
501 (2-3
prog)a
prog)b
Pharm.D. Students
24 (2 yrs)
Graduate Students
35
72
Visiting Scholars,
Residents/ Fellows
5
18
Support Staff
20
26
Non-State Funds
$281,334°
$1.2 Milliond
(1st 3 qtrs)
Scholarly
Publications
60
110
^lass size 145
"Class size 166
Tom S. Miya, Dean, UNC School of
Pharmacy
includes Capitation Grant of $197,266
"No Capitation funds
An interesting demographic observation is that
we have gone from 49% women in the student
body in 1976-77 to 65% in 1985-86.
Neither time nor space allows for a detailed
report of all of the School's activities. However,
several significant activities are brought to your
attention. Our Strategic Planning Process
(Planning for Excellence) and the resulting report
were completed and will be distributed shortly.
Continued on page 13
June, 1987
True Pharmacy
helps you celebrate
Independence Day
everyday.
In this era of mergers, consolidations,
conglomerates and chains, there's still a lq
to be said for independence.
If you're a pharmacist in business for
yourself, you know all about it. Along with
the long hours and endless decisions, there is
still the joy of personally serving your
customers and the pride that comes only
from doing things the way you want them
done.
Lawrence Pharmaceuticals had
all of this in mind when it -^
formed its True
Pharmacy cooperative
program.
True Pharmacy i
designed to
preserve-^ahd
enhance — your
independence by
iding you with year-round advertising
Promotional material for a small fraction
Phat it would cost you to prepare the
material on your own. And True Pharmacy
backs this up by guaranteeing 100 percent
sales of all health and beauty items it
delivers.
As more than 200 independent
pharmacists from Tennessee to Florida will
attest, True Pharmacy is every bit
as good as its name. If you're not
a participating member and
would like more information,
write or call Tom Koenig at
(904) 731-4610 today.
It's our way of helping you
celebrate your independence
1 every day of the year.
A FQ-xNHry+r Company >_
Pharmaceuticals
61 00 Phillips Highway
Post Office Box 5386
Jacksonville, Florida 32207-0386
(904)731-4610
THE CAROLINA JOURNAL OF PHARMACY
13
REPORT
Continued from page 11
Many of you were involved in its development
and members of the Practitioner-Educator
Advisory Committee have had an opportunity to
react to it. The significance of the report is two-
fold. The process itself has informed and
sensitized all of us involved to the rapidly
changing environment. Secondly, the Plan is a
working document with many specific recom-
mendations with suggested timetables to
accomplish them. I will shortly be appointing an
oversight committee to keep the School moving
in the direction of our Strategic Plan. The Plan is
geared to what is happening to U.S. demography
and the health care system and what is projected
to happen. Unless we prepare our students and
faculty to meet the challenges of change, we will
indeed be in great difficulty.
With financial support from the Pharmacy
Foundation of North Carolina, Inc. the School
established a Pharmacy Policy Research
Laboratory, the first of its kind in the nation. The
Laboratory is designed to organize and monitor
economic, social and demographic factors vital to
pharmacy. It will combine scholarly research
techniques with objective analyses to meet the
needs of decision-makers and planners in
industry, associations and colleges. Dr. Jane
Osterhaus of the Division of Pharmacy
Administration will direct the activities of the
Laboratory. The creation of this unit follows on
the heels of the University-unique Radiosynthesis
Laboratory directed by Dr. Steven Wyrick and
the Natural Products Laboratory directed by Dr.
K. H. Lee. Both of these laboratories reside in the
Division of Medicinal Chemistry and have been
highly successful.
There have been unprecedented Continuing
Education activites directed by Dr. Betty Dennis.
I would be remiss if I did not mention all of our
AHEC pharmacists who have contributed to CE
programs. On May 19-20 1987 the School will
be hosting an invitational symposium/workshop
on continuing education with selected national
leaders participating. Special funds from the Vice
Chancellor's Office were made available to
mount this program. With a competitive William
S. Apple Pharmacy Practitioner Management
Award, the Division of Pharmacy Administra-
tion in collaboration with the School of Business
will be hosting a group of 20 practitioners for a
week-long workshop in June. The participants
were selected by the American Pharmaceutical
Association from a nationwide pool.
Among many faculty activities was the
development of an educational film on
pharmacist impairment funded by the Pharmacy
Foundation of North Carolina, Inc. and a
recruitment film targeted to high school chemis-
try classes developed through a grant from the
American Association of Colleges of Pharmacy.
Both films are so well done that we anticipate
nationwide distribution and recognition.
The Office of Academic Program Develop-
ment, directed by A. Wayne Pittman, has made
significant contributions to the School's
educational mission. These range from improved
Continued on page 14
TABLE II
Selected Financial Data 1976-77 — 1985-86
Pharmacy Foundation of North Carolina, Inc.
Total
Total
Period
Additions2
Expenses
1976-77
$ 58,244
$42,017
1977-78
26,272
37,601
1978-79
37,270
39,066
1979-80
68,250
39,084
1980-81
81,584
33,893
1981-82
75,967
28,177
1982-83
122,349
45,709
1983-84
233,112
47,978
1984-85
423,305
73,477
1985-86
296,779
98,974
aGifts and investment income
June, 1987
Value
Book
Market
525,872
$ 495,479
514,543
481,209
512,747
484,127
541,913
503,294
589,604
556,861
637,394
567,987
714,034
884,158
899,168
981,614
1,248,996
1,515,374
1,446,801
2,038,967
14
THE CAROLINA JOURNAL OF PHARMACY
REPORT
Continued from page 13
course/instructor evaluation to computers for
classroom use to plans and implementation of
more effective means of instruction. These
activities, we believe, are not only cost-effective,
but a necessity. Your continuing support makes
this possible.
The second Hollingsworth Scholar was
selected to receive $5,000/year until completion
of the first professional degree. The Scholar is
selected from the incoming third-year class. The
Scholar award was made possible by a bequest
from Mary Hollingsworth of Mt. Airy in memory
of Joe Hollingsworth. This year's recipient was
Laura Elizabeth Hundley of Boone who joins
Patricia Leigh Parker of West Jefferson as a
Hollingsworth Scholar.
There are many items untouched. I could
report to you all of the national honors and
recognition of our faculty, the numbers of papers
and book chapters published and about the
highly successful annual meeting of the
Pharmacy Alumni Association where the 50-
year graduates were specially recognized and
where Barney Paul Woodard received the
Distinguished Alumni Award. It will suffice now
to report to this convention that I have never been
more excited about the future progress of your
school.
Pharmacy Foundation of
North Carolina, Inc.
The Foundation completed 40 years of
operation in 1 986. It had its beginning in the early
1940s, an initiative of this Association. It was
incorporated in 1946 as the North Carolina
Pharmaceutical Research Foundation and
underwent a name change to the Pharmacy
Foundation of North Carolina, Inc. in 1982.
From the initial personal contributions of
almost $7,000 by the Board of Directors of the
Foundation in 1947 the assets have grown
steadily from contributions, bequests and
industry support and investments. Table II shows
a year-by-year financial statement from 1976
through June 30, 1986. The current market value
of the Foundation's assets is significantly greater
than shown at the close of our fiscal year.
It should be noted that the expenses, with the
exception of two years, have been significantly
lower than the total additions. Together with a
prudent but aggressive investment policy and
excellent fund management, the Foundation is
becoming an even greater force in the School's
pursuit of excellence.
The 40th Annual Meeting of the Board of
Directors was held on September 24 and chaired
Burroughs Assets Management Company
Specializing in health care and small business consulting.
Serving pharmacists with new or existing stores by performing:
* Business plans for startup
operations or expanding
operations
* Feasibility studies
* Market planning
Efficiency studies that
detail financial analysis
Terrence B. Burroughs, M.B.A., R.Ph.
President
(919)481-4439
226 Adams Street
Cary NC 27511
June, 1987
THE CAROLINA JOURNAL OF PHARMACY
15
by President Ralph P. Rogers. The luncheon was
highlighted by a presentation by Vice Chancellor
for Health Affairs, H. Garland Hershey.
The Directors elected Ralph Rogers and Ed
Brecht to serve additional terms to expire in
1991. Four additional members will be elected
by the NCPhA membership. The officers for the
year are: President, Ralph P. Rogers; Vice
President, Ed Brecht; Secretary, Tom Miya. The
Executive Committee members are: Paul
Bissette, Charles Blanton, Pam Joyner, and ex
officio members Rogers, Brecht and Miya. The
Investment Committee members are: Ed Brecht,
Tom Burgiss, William Edmondson, Ralph
Rogers and Tom Miya.
President Rogers also appointed a committee
to make a comprehensive study of the
Constitution and By-Laws of the Foundation.
The members are: W. J. Smith, Chairman; James
Creech, and C. M. Whitehead.
In other significant action, the Directors
approved start-up funds of $15,000 for a
Pharmacy Policy Research Laboratory, the first
of its kind in the nation. It is designed to organize
and monitor economic, social and demographic
factors vital to pharmacy. The Laboratory is
expected to be self-sufficient. Dr. Jane Osterhaus
of the Division of Pharmacy Administration is its
Director. Continuing annual expenditures of
$ 1 0,000 for the establishment of a Hollings worth
Faculty Scholar was also approved.
As it was when it was created, the Pharmacy
Foundation of North Carolina, Inc. continues to
be a driving force for progress not only for the
UNC School of Pharmacy but for the profession
of pharmacy.
The current Directors are:
Term
Directors
Expires
P. B. Bissette, Jr.
1988
C. D. Blanton, Jr.
1990
E. A. Brecht, Vice President
1991
T. R. Burgiss
1989
Laura G. Burnham
1989
J. L. Creech
1988
D. R. Davis
1987
H. V. Day
1987
W. H. Edmondson
1990
H. Q. Ferguson
1988
Sara J. Hackney
1990
J. C. Hood
1989
Pamela U. Joyner
1990
H. W. Lynch
1988
W. W. Moose
1990
Jean B. Provo
1987
E. J. Rabil
1989
R. P. Rogers, Jr., President
1991
W. J. Smith
1987
J. P. Tunstall
1989
W. A. West
1990
L. M. Whaley
1989
C. M. Whitehead
1988
J. D. Whitehead III
1988
F. F. Yarborough
1987
The Directors were saddened by the report of
the passing of three past Directors: W. Thomas
Boone. Ahoskie; Thomas Reamer, Durham; and
John T. Stevenson, Elizabeth City. Memorial
funds have been established should friends wish
to make contributions.
MOVING? Help us keep your
coming to your correct address
NCPhA, P.O. Box 151, Chapel
Carolina Journal of Pharmacy and other NCPhA mailings
Please complete the address change form and send to the
Hill 27514, as soon as you know your new address.
Name
Old Address
City
State Zip Code
New Address
Effective Date
City
State Zip Code
June, 1987
We're not
O strangers...
UJasnincjcon
national
INSURANCE COMPANY
NCPhA-Endorsed Insurance Plans
Which Merit Member Participation
DISABILITY INCOME PLAN HOSPITAL INCOME PLAN
MAJOR MEDICAL EXPENSE PLAN TERM LIFE PLAN
RETIREMENT AND PROFIT SHARING PLANS
FOR DETAILS WRITE OR TELEPHONE:
HOYT W. SHORE, CLU and Associates
821 Baxter Street-Suite 316
Charlotte, North Carolina 28202
O
Telephone (704) 333-3764
uuasninqeon
national
INSURANCE COMPANY
Evanston, Illinois 60201 • A Washington National Corporation Financial Service Company
THE CAROLINA JOURNAL OF PHARMACY
17
UNC STUDENT BRANCH REPORT
REPORTED AT THE 107TH ANNUAL NCPHA CONVENTION
Charlotte, North Carolina
April 22-25, 1987
by Allison Uzzell, President
I feel that the Student Branch has had a very
productive and successful year. This year we have
made it our goal to get as many students involved
in our organization as possible. I believe that we
have done a good job in attaining this goal. The
year began with a pig pickin' for the students and
faculty. It gave everyone the chance to visit with
old friends and get to know some of the incoming
Ys's. Once classes started, we kicked off our
membership drive. As an extra incentive for
joining the Student Branches, we staged a class
competition. The class with the highest
percentage of membership received a $50 prize.
The membership drive lasted until the first of
November, and we ended up with 350 members
which is about 71% of our student body.
As usual we held several clinics during the
year. Among them were screening clinics for
diabetes, hypertension, and osteoporosis. These
clinics are very important for the public as well as
the students. For many it is the first opportunity
to find out what the profession of pharmacy is
about. The clinics give the students a chance to
apply what they learn in the classroom while
enabling them to practice their counseling
techniques.
One of our major projects for the fall semester
really picked up on the idea behind these clinics.
This project was the patient counseling
competition. The competition was started at
UNC last year and was further expanded this
year. Twenty five students participated in this
program. Students first compete on a local level
and then the winner goes on to compete at the
national level. On the local level there are two
rounds. In each round students were given
prescriptions and then counseled their patients on
their medication. These scenarios were
videotaped and then judged by the faculty and
participating pharmacists. The top 12 winners
received USP-DI's and went on to compete in the
final round. The top 4 winners were announced
at an awards ceremony held at the Institute of
Pharmacy. They were each awarded cash prizes.
The winner of the competition, Susan Chitty, also
received a trip to Chicago to compete in the
national competition. She did an outstanding job
in representing our school.
Allison Uzzell, President
Last fall eight of our members attended the
regions midyear meeting in Memphis, TN.
Everyone who attended learned a lot from the
meeting, not to mention the fun we had meeting
the students from other schools in our region. I
think everyone left Memphis really appreciating
the good program we have at UNC. Several of
the proposals that came from our region went on
to be approved at the national convention in
Chicago. Delegates from our region were also
elected at this meeting. Hopefully in the near
future we will have members of our branch to run
for offices at the regional or national level.
Well, in December we had a short break, but
things started back in full swing at the beginning
of January. The Student Branch along with
pharmacy school senate sponsored an ice skating
party at Hillsborough for the student body. We
had a large turnout, and everyone especially
enjoyed the lessons that our advisor, Dr. Dennis
Williams, gave on the proper way to fall.
Continued on page 18
June, 1987
THE CAROLINA JOURNAL OF PHARMACY
UNC STUDENT
Continued from page 17
During the spring semester a major emphasis
was placed on a new program which we hope to
put in action next fall. The program will be to
educate ourselves and elementary school students
on drug abuse. This semester students contacted
various resources and gathered information for us
to use in our program. We also had a speaker
from the Orange County Mental Health
Association come to one of our meetings to help
us in developing this program. She had several
interesting ideas (i.e., puppet shows and skits)
which we plan to use.
A few short weeks ago 1 7 students represented
UNC at the national APhA convention in
Chicago. Again we attended some very
important meetings on our policy proposals, and
this time elected national officers. All of our hard
work really paid off in Chicago. Our chapter was
one of 17 to receive a chapter achievement
award. At the awards ceremony we were
presented a plaque to hang in our school.
The officers of the Student Branch are already
working hard on our plans for the summer and
next year. During the summer we will be
publishing an orientation handbook for the
incoming %'s, and we are planning a picnic for
the students and faculty of both UNC and
Campbell University.
Finally, I would like to thank a few people
who have been very important to our
organization: Dean Miya; Dr. Cocolas; Dennis
Williams, and the Institute of Pharmacy staff; Mr.
and Mrs. Mebane, Mrs. Cocolas, and Laura who
were always there with new ideas when we ran
short.
WRITTEN ORDERS WITH
STRANGE SOUNDING NAMES
(Thanks to W.J. Smith)
One of the interesting facets of Pharmacy is the
occasional opportunity to decipher a written
order with unusual spelling of an over-the-
counter drug product. Generally, the customer
can supply some basic information, such as
tablet, liquid or ointment, treatment use, etc.,
which are helpful in identifying the product
desired.
A request for a bottle of building and loan
tonic presented a problem until the customer
stated the label had pictured drops of blood. A
bottle of BLOOD LIFE filled the bill. The label,
in addition to the red blood drops, included BL in
large type.
Some pharmacists maintain collections of
these unusual written orders. For years,
Pharmacist Haywood Jones maintained such a
collection in an album at Zebulon Drug
Company. Recently, Pharmacist Jones permitted
us to screen the album which includes several
hundred orders compiled over a twenty year
period.
Here is a sample of 20 orders. See page 22 for
proper identification. If you identified all 20
products, go to the head of the class.
1. GODCORDIE
2. OIL COCK PLASTER
3. SCOTCH MULTION
4. KAMFER
5. PRORIZE
6. DUE EASE
7. LITTY PINKHENEY
8. TETREAM GREASE
9. ASIE FIZET
10. SUSAN SYRUP
11. MAY LOCK
12. CAFERVENL LINKER
13. BARKING WORM KILL
14. 3 BEES BLOOD TONIC
15. DOOR BELL SOLUTION
16. LAKAT TATE PEPS
17. PNEUMONIA QUE
18. SULPH CAMEL
19. WINECORUDIA
20. BANADE
June, 1987
THE CAROLINA JOURNAL OF PHARMACY
19
NORTH CAROLINA
PHARMACEUTICAL
ASSOCIATION
Executive Committee
1987-1988
Mr. Julian E. Upchurch, President
5201 Pine Way
Durham NC 27712
Mr. Albert F. Lockamy, Jr., First Vice President
6708 Candlewood Drive
Raleigh NC 27612
Mr. W. Robert Bizzell, 2nd Vice President
1007 Rhem Street
Kinston NC 28501
Mrs. Loni T. Garcia, Third Vice President
5210 McLeod Road
Lumberton NC 28358
Mrs. Betty H. Dennis, Executive Committee
104 Calumet Court
CarrboroNC 27510
Mr. Claude U. Paoloni, Executive Committee
300 Spruce Street
Chapel Hill NC 27514
Mr. Donald V. Peterson, Executive Committee
917 Kimball Drive
Durham NC 27705
Mr. H. Shelton Brown, Jr., Past President
2516 Fillmore Road
Richmond VA 23235
Mr. M. Keith Fearing, Jr., Past President
P.O. Box 1048
Manteo NC 27954
Mr. W. Artemus West, P.D., Past President
Tart & West Druggists
P.O. Box 248
Roseboro NC 28382
Mr. W.J. Smith, Consultant
908 Arrowhead Road
Chapel Hill NC 27514
Mr. A.H. Mebane, III, Executive Director
P.O.Box 151
Chapel Hill NC 27514
Mr. Fred M. Eckel, Ex Officio
713 Churchill Drive
Chapel Hill NC 27514
Mr. Thomas F. Hughes, Ex Officio
Route 5, Box 325E
Chapel Hill NC 27514
Newly installed officers of the North Carolina Pharmaceutical Association are: (left to right) Julian
E. Upchurch, President; Albert F. Lockamy, Jr., First Vice President; W. Robert Bizzell, Second
Vice President; Loni T. Garcia, Third Vice President; Betty H. Dennis, Claude U. Paoloni and
Donald V. Peterson, Executive Committee.
June, 1987
20
THE CAROLINA JOURNAL OF PHARMACY
You are most cordially invited to attend
The 1987 Mortar-and-Pestle Award Dinner
Honoring
John C. Hood, Jr.
1987 North Carolina Pharmaceutical Association
PHARMACIST-OF-THE-YEAR
Friday Evening
August 14, 1987
Vermillion's Buffet
Kinston
7:00 pm Reception
8:00 pm Dinner
$16.00 per person
The Mortar-and-Pestle Award is the most coveted award
presented by the North Carolina Pharmaceutical Association and
the recipient is chosen because of outstanding service to
Pharmacy and the community over many years.
PROGRAM
At the dinner, friends and colleagues of the recipient will relate
some of his activities which led to his selection. NCPhA President
Julian Upchurch will preside and the Mortar-and-Pestle Award
will be presented by Immediate Past President M. Keith Fearing,
Jr. Program participants include Representative Daniel T. Lilly,
NC General Assembly; Roland L Paylor, Jr., Executive Director,
Kinston Housing Authority; W. Robert Bizzel, Pharmacist; David S.
Clift, Minister, Westminister United Methodist Church; and J.
Marshall Tetterton, President, Peoples Bank. John T. Capps, III
will serve as Master of Ceremonies.
Dinner reservations may be ordered from the NCPhA office in
Chapel Hill or the Lenoir County Chamber of Commerce in
Kinston.
Overnight accommodations are available at the Sheraton Kinston
(91 9) 523-1 400. Reduced rates have been obtained for this event.
THE CAROLINA JOURNAL OF PHARMACY
21
STATE BOARD OF
PHARMACY
Members — W. R. Adams, Jr., Wilson; Harold V. Day, Spruce Pine; W. Whltaker Moose,
Mount Pleasant; W. H. Randall, Lilllngton; Evelyn P. Lloyd, Hillsborough; Joseph R. Roberts,
III, Gastonla; David R. Work, Executive Director, P. O. Box H, Carrboro, NC 27510
Telephone #(919) 942-4454
PHARMACY PERMITS
RECENTLY ISSUED
Bunn Community Health Ctr. Phcy.
Main St., Bunn
Herbert P. Scoggin, Ph-mgr.
Issued 2/9/87 (T/O)
Kaiser Permanente
New Bern Ave., Raleigh
Linda Riggs Burke, ph-mgr.
Issued 2/18/87
Service Drug Store
Pinetops
Johnny L. Hogg, ph-mgr.
Issued 2/20/87 (T/O)
Tar Heel Drug Co. of Robbins, Inc.
N. Middleton St., Robbins
Robert H. Reynolds, Jr., ph-mgr.
Issued 2/24/87 (T/O)
Guilford Co. Family Planning Phcy.
312 N. Eugene St., Greensboro
Myra J.W. Southerland, ph-mgr.
Issued 3/2/87 (LSP)
Big Value Discount Drug Ctr.
Hwy. 258-Academy St., Richlands
Ralph B. Hunter, ph-mgr.
Issued 3/9/87 (T/O)
Lewis Drug Co.
128 N. Center St., Mt. Olive
Wilson K. Lewis, ph-mgr.
Issued 3/9/87 (T/O)
Belmont Phcy., Inc.
1309 Coach Rd., Reidsville
John Allen, ph-mgr.
Issued 3/1 1/87 (T/O)
Forest Lawn Phcy.
Hwy. 19-23, Enka
Wilbur S. Ward, ph-mgr.
Issued 3/16/87 (LSP)
Hardin's Drug Store #5, Inc.
Suite 130-1 175 Hwy. 74 Bypass, Spindale
J. Laine Hawkins, ph-mgr.
Issued 3/16/87
Charter Northridge Hosp.
400 Newton Rd., Raleigh
Robert J. Fuentes, ph-mgr.
Issued 3/16/87 (LSP) (T/O)
Foothills Pharmacy
202 A Harper Ave. NW, Lenoir
David A. Ayers, ph-mgr.
Issued 3/16/87 (T/O)
Massey Hill Drug Co., Inc.
1072 Southern Ave., Fayetteville
Albert H. Smith, ph-mgr.
Issued 3/16/87 (T/O)
Sampson Co. Health Dept.
Rowan Rd., Co. Complex, Clinton
Sharman C. Leinwand, ph-mgr.
Issued 3/17/87 (LSP)
Med Center I of Greenville
507 E 14th St., Greenville
Carol A. Crew, ph-mgr.
Issued 3/17/87 (LSP)
Metrolina Comprehensive Health Ctr., Inc.
3333 Wilkinson Blvd., Charlotte
Milton McCoy, ph-mgr.
Issued 4/2/87 (LSP)
Drugco Discount Phcy.
107 Smith Church Rd., Roanoke Rapids
Gene W. Minton, ph-mgr.
Issued 4/6/87
Continued on page 22
June, 1987
THE CAROLINA JOURNAL OF PHARMACY
PERMITS
Continued from page 21
Kerr Drug Stores, Inc.
Ashton Sq., 4020 North Blvd., Raleigh
Jeanne L. Berray, ph-mgr.
Issued 4/6/87 "
Blackwelder Memorial Hospital
1 1 1 Boundary St., Lenoir
Linda S. Cole, ph-mgr.
Issued 4/7/87 (T/O)
Standard Drug Store #2
100 S. Queen St., Kinston
Joseph D. Eudy, Jr., ph-mgr.
Issued 4/1/87 (T/O)
Gamewell Drug Store
Rt. 6, Box 242, Morganton Blvd., Lenoir
Barry V. Watson, ph-mgr.
Issued 4/7/87 (T/O)
PROPER IDENTIFICATION OF
STRANGE SOUNDING NAMES
Continued from page 18
1. GODFREY'S CORDIAL
2. ALCOCKS POROUS PLASTER
3. SCOTTS EMULSION
4. CAMPHOR
5. PEROXIDE
6. DEWEES CARMINATIVE
7. LYDIA E. PINKHAM VEGETABLE
COMPOUND
8. TETTERINE SALVE
9. ASAFETIDA
10. WINSLOW'S SOOTHING SYRUP
11. MAALOX
12. CAMPHO-PHENIQUE LIQUID
13. BOYKIN WORM SYRUP
14. BBB TONIC
15. DOBELL'S SOLUTION
16. ELIXIER LACTATED PEPSIN
17. VICK'S SALVE
18. SULFUR CANDLE
19. CARDUI
20. BAND AID
THE EXPERIENCE WE'VE GAINED FROM
OVER 200 PHARMACY INSTALLATIONS IS
AVAILABLE TO YOU . . .
AND, WE ARE THE ONLY STOCKING
DISTRIBUTOR OF DRUG STORE FIXTURES IN
THE CAROLINAS.
IF YOU NEED A SINGLE FIXTURE OR A
COMPLETE STORE, OUR PROFESSIONAL
STAFF IS READY TO SERVE YOU
"THE AREAS LARGEST DISTRIBUTOR OF
MODULAR DISPLAY FIXTURES"
RICHMOND, VIRGINIA CHARLOTTE, NORTH CAROLINA
7921 -A WEST BROAD ST 3555 TRYCLAN DRIVE
(804) 740-0793 (704) 525-5300
ROLAND THOMAS RANDY BIVENS
"WE ARE MORE THAN A FIXTURE COMPANY— A TEAM OF PHARMACY
SPECIALISTS WITH OVER 60 YEARS COMBINED EXPERIENCE IN OVER
500 DRUG STORES"
0'»T«i»u TO* O'
5p
STORE FIXTURES
& PLANNING. INC.
mrone rurnjnew
June, 1987
THE CAROLINA JOURNAL OF PHARMACY
23
EDITORS CHOICE
1942 ALUMNUS EXPLAINS
DIFFERENCE
by Rush Hamrick
Editor's Note: The information and humorous
remarks below were delivered by Rush Hamrick
at the 45 th reunion of the class of 1942. While an
undergraduate at UNC, Hamrick wrote for the
Daily Tar Heel. During one summer he edited
The Blowing Rocket, a newspaper published in
Blowing Rock only during the summer months.
Later, along with his wife, Grace, he established
the Cleveland Times in Shelby, a weekly
newspaper that still operates. Early in life,
Hamrick discovered there was more money to be
made in pharmaceuticals. Grace is the first and
only woman to be president of UNC's General
Alumni Association (1976-77).
Most of my time at UNC was spent on The
Daily Tar Heel and the Buccaneer. We used to
crusade to "keep off the grass" and today students
are urged to "not smoke the grass."
I met wife Grace at the Tar Heel and we were
both in the newspaper business until I got out in
1946 and started pushing drugs . . . legitimate,
that is, pharmaceuticals. Grace continued writing
... for the last few years a weekly column in the
Shelby Daily Star. She has written about some of
her reunions. Lifting from some of her columns,
borrowing from others and adding some of my
own . . . listen to this . . .
There are three ages of men and women:
youth, middle age, and "You haven't changed a
bit." But change is the name of the game.
Consider this. Members of the class of 1 942 were
before the pill and the population explosion,
which went hand in hand. We got married first
and then lived together. How quaint can you be?
We were before TV, penicillin, polio shots,
antibiotics and frisbees. Before frozen food,
nylon, dacron, Xerox, Kinsey and Grandma
Moses. We were before radar, fluorescent light,
credit cards, ballpoint pens and "M.A.S.H." For
us, time-sharing meant togetherness, not
something to do with computers or part
ownership in condominiums. A chip was a piece
of wood; hardware meant hardware, and
software wasn't even a word.
UNC coeds didn't wear slacks . . . they wore
skirts and saddle shoes. That was before
pantyhose and drip-dry clothes. Before ice-
makers and dishwashers, clothes dryers, freezers,
electric blankets, the 40-hour week and the
minimum wage. Before men wore long hair and
earrings, and women wore jeans.
In our time, closets were for clothes, not for
coming out of, and a book about two young
women living together in Europe could be called
"Our Hearts Were Young and Gay." We were
before Playboy and bunnies were small rabbits,
and rabbits were not Volkswagens. Girls wore
Peter Pan collars, and thought a deep cleavage
was something butchers did.
When we were in school, pizzas, Cheerios,
frozen orange juice, instant coffee and
McDonald's were unheard of. We thought fast
food was what you ate during Lent. We were
before FM radio, CB radio, stereo, tape recorders,
video recorders, electric typewriters, word
processors, personal computers, Muzak,
electronic music and disco dancing . . . and that's
not all bad. We knew whom we were dancing
with, and held on to them.
We were before Boy George, the Beatles,
Madonna, Jim and Tammy Bakker, Rudolph the
Red-Nosed Reindeer, and Snoopy . . . before
DDT and vitamin pills, vodka and the white
wine craze and before disposable diapers and
Jeeps.
We didn't talk about medicare, menopause,
Continued on page 26
Rush Hamrick was voted a life
membership in the TMA at the Annual
Convention.
June, 1987
These days,
your customers want more
than medicine in hand.
They want answers.
"today's pharmacists have some explaining
to do. In fact a recent study by The Upjohn
Company showed that 65% of your customers
want to talk with you about their prescriptions.
That's a 22% increase in nearly 10 years!
The reason is consumer awareness. Today's
customer is better informed, better educated
— with many more questions about concerns
like side effects and drug interactions. So take
time out to talk with your customers. In today's
competitive environment it might be one of the
best things you can do to earn repeat business.
The Upjohn Company has many more facts
on the trends affecting your business. If you'd
like to know more, just contact your Upjohn
representative.
Sharing knowledge. ..sharing success.
C 1M7. Th. Uptown Compwiy. Kilimuoo. MteNoax 48001
THE CAROLINA JOURNAL OF PHARMACY 25
REPORT OF THE NATIONAL LEGISLATIVE COMMITTEE
Presented at the 107th Annual meeting of the North Carolina
Pharmaceutical Association, April 22-25, 1987, Charlotte
North Carolina Pharmaceutical Association
National Legislative Committee
January 23, 1987
Pharmacy Institute, Chapel Hill, North Carolina
Those present: Jesse Pike, Bill Edmondson,
Jerry Gaylord, William Randall, Dan Teat,
Seymour Holt, Milton Skolaut and Jonathan
Hill.
Those absent due to weather and travel: Jean
Gagnon, Jonathon Hill, Jerry Brunson, Fred
Eckel.
Guests: Jane Osterhaus, pharmacy intern
Allison Jones.
The meeting started promptly at 9:00 a.m. and
ended at 3:00 p.m. Following is a report of each
area:
• Prescription drug prices — Jesse Pike
Jesse Pike provided an overview of this
issue indicating that the topic was applicable
to all others being discussed.
• Discriminatory Pricing —
The focus of the issue is the disparity of
prices. Needed changes in the Robinson-
Patman Act would avoid discrimination;
the future of pharmacy is in the balance in
that the pharmacy community is pressed
with discounters and chains.
Third party issues are impacting on drug
prices, retail pharmacy in North Carolina
has not been registered adequately via
Medicaid pricing. Jesse referenced NARD
network program where 32 states signed up
and felt that the program will not be
effective until all states sign up.
• Drug Pricing Trends —
Jane Osterhaus provided an thorough
overview of drug pricing trends in the
pharmaceutical industry including a multi-
source category containing branded and
generic products, generics compete on basis
of price, and brands prefer non-price
competition. She summarized her presen-
tation by indicating the durg prices have
been increasing more rapidly in the last 5
years, increasing primarily from branded
manufacturers.
Branded manufacturers increase prices of
single-source and multi-source products;
generics use price competition where brands
prefer non-price competition. Explaining
these changes is the climbing productivity,
dollar flucuations, a few significant new
products, research and development
expenditures, government intervention and
product liability. The outlined drug issues
for Congress that are related include drug
diversion, pharmaceutical marketing,
AIDS/cancer/biomedical research and
Medicare drug coverage along with anti-
generic campaigns, vaccine compensation,
and drug diversion.
Drug Diversion — Chairman Bill
Edmondson provided an overview of the
drug diversion issue H.R. 4820, the
Prescription Drug Marketing Act of 1986,
whose function is to protect consumers,
benefit manufacturers and allow retailers
and wholesalers to compete in the free
market.
Report included subcommittee findings,
legislative content with key recommenda-
tions, the purpose of sampling from a
physician's point of view, alternatives to
sample delivery including samples to mail to
physicians, coupons distributed to phy-
sicians, the discontinuance of samples
altogether, sampling of new products.
Industry positions from FDA, the PMA,
physicians, the American Pharmaceutical
Association, National Association of Retail
Druggists, the American Society of Hospital
Pharmacists, American Academy of Family
Practice were provided.
Mentioned were alternatives such as patient
rebates and consumer advertising. Jerry
Gaylord provided an overview of review
letters from practitioners and reaction from
APhA and NARD. In some instances,
consumer complaints indicate that samples
were given to patients illegally and issues in
Continued on page 26
June, 1987
26
THE CAROLINA JOURNAL OF PHARMACY
LEGISLATIVE COMMITTEE
Continued from page 25
the future are designer drugs of the 1 990's
that will need to be addressed.
• Tort Reform — Bill Randall and Dan Teat
indicated that North Carolina is recom-
mending tort changes like those at the
federal level. The objective of restricting
total limits of liability indicated in North
Carolina the number of cases are increasing
but to a small degree and the Bar feels that
no changes are needed.
The point was raised that insurances costs
for pharmacists are still quite low and the
AMA is using tort reform to say that foreign
doctors are responsible for liability suits
therefore they want to curtail foreign
graduates.
• Drug Voucher System — Seymour Holt
indicated that the test voucher in Alabama is
used as an example of cost reduction with
Delaware Blue Cross Blue Shield. The
system works and the pharmacist is
reimbursed quickly. Insurance companies
and the government is against the system.
The North Carolina legislative committee
recommended the following:
"The Federal legislation committee
recommends a demonstration pro-
ject that would utilize the ways to
reduce the administrative costs and
associated costs to reduce pharmacy
processing, examining techniques
such as voucher electronic transfer of
funds etc. It was indicated that it cost
78 cents to process a claim. The
voucher system could reduce this
considerably."
• Drug reimbursement schemes — Milton
Skolaut provided an overview of PHIP,
CIP, MAC, EAC, the Alabama voucher
system and usual and customary fees as
issues being examined for reimbursement
by HCFA.
• Pharmaceutical Exports — Shelton
Brown and Fred Eckel were absent. Brief
overiew of its status was provided to the
committee. In preparation for the North
Carolina Pharmaceutical Associations visit
to Washington on March 22-23, the
following were identified as key issues to
discuss with representatives in Washington:
drug reimbursement, voucher, diversion,
tort reform, Robinson-Patman Act review,
physician dispensing and mail order
prescription business.
Committee Members
William W. Edmondson, Chairman
G.N. "Jerry" Brunson
Jean Paul Gagnon
Jonathan A. "Don" Hill
W.H. Randall, Jr.
Daniel W. Teat
H. Shelton Brown, Jr.
Fred M. Eckel
Jerry T. Gaylord
W. Seymour Holt
Milton W. Skolaut
RUSH HAMRICK
Continued from page 23
mini-skirts, maxi-pads, condos, contras and
condoms. The coeds didn't need living bras . . .
they just needed one that hung around.
In our day cigarette smoking was fashionable,
grass was mowed, Coke was something you
drank, and pot was something you cooked in. We
were before day-care centers, house husbands,
baby sitters, computer dating, dual careers, and
live-in partners. "Made in Japan" meant junk,
and "making out" referred to how you did on an
exam.
In our time there were five-and-ten cent stores
where you could buy things for five and 10 cents.
For just one nickel you could make a phone call,
or buy a Coke, or mail one letter and two post
cards. For 25 cents we could go to the 1:30 class
at E. Carrington Smith's Carolina Theatre or
have a meat, two vegetables and a drink at the
College Cafe. You could buy a new Pontiac
convertible for less than $900 or a Chevy coupe
for less than $700, but who could afford them?
Not many! A pity, too, with gas at 11 cents per
gallon. If anyone has asked us in those days to
explain CIA, Ms., NATO, NFL, SAT, JFK,
BMW, PTL, or IUD, we would've said
"Alphabet soup."
We were not before the difference between the
sexes was discovered, but we were before sex
changes. We just made do with what we had, and
we were the last generation that was so dumb that
we thought a girl had to have a husband to have a
baby.
My, how things have changed!
The Chapel Hill Newspaper
Sunday, May 17, 1987
June, 1987
THE CAROLINA JOURNAL OF PHARMACY
LOCAL NEWS
27
FOUR COUNTY
PHARMACEUTICAL
ASSOCIATION INSTALLS
OFFICERS
On Wednesday evening, March 25, 1987, the
Four County Pharmaceutical Association held its
Annual Officer Installation Banquet at the
Holiday Inn in Henderson. In addition to
members' spouses, attending as guests were Mr.
Andrew Barrett, Executive Director of the
Pharmacy Network of North Carolina and Mr.
Julian Upchurch, President-Elect of the North
Carolina Pharmaceutical Association.
Following dinner, featured speaker Barrett
shared with the group some of the progress being
made in the Network, including pending
contracts for services for Network members, as
well as his expectations and insights for the future
of pharmacy in this state.
President-Elect Upchurch echoed his support
for the Network and the accomplishments that
have been made in its short existence. He briefly
expressed his hopes for the up-coming NCPhA
year and their legislative lobbying efforts, and
accepted on behalf of the Lobby Fund a check in
the amount of $250.00 from the Four County
Pharmaceutical Association.
Installed as officers by Upchurch for the
1987-88 year for the local Association were as
follows:
John Standi, Henderson, President
Woody King, Norlina, First Vice-President
Steve Potter, Henderson, Second Vice-
President
Charles Creech, Oxford, Secretary-
Treasurer
Out-going President J.B. Clay of Oxford was
recognized and presented an engraved plaque for
his past year of dedicated leadership, as well as his
role in the initial planning and organization of the
Association itself. The Four County Pharmaceu-
tical Association was formed in early 1985 and is
made up of member pharmacists from Vance,
Granville, Warren and Franklin counties.
RANDOLPH COUNTY
PHARMACEUTICAL SOCIETY
The first meeting of the Randolph County
Pharmaceutical Society was held Sunday night,
May 24, 1987, in the conference room of the
Randolph Hospital. Charter officers installed by
NCPhA Executive Director Al Mebane are Neill
Wilson, President; Charles F. Owen, Vice
President; and Kim Farrington, Secretary-
Treasurer. Jack Watts, Secretary-Treasurer of
the Alamance County Pharmaceutical Associa-
tion received special thanks for his help in
establishing the Society through his position as
CE Coordinator for the Greensboro AHEC.
THE GUILFORD COUNTY
SOCIETY OF PHARMACISTS
Greensboro, North Carolina
by J. Frank Burton, Sec./Tres.
The regular monthly meeting of the Guilford
County Society of Pharmacists was held Sunday
evening, May 10, 1987, at Moses H. Cone
Hospital in Greensboro. Guest speaker for the
meeting was Dr. John A. Lusk, a Greensboro
internest specializing in oncology, a highly
respected authority in the field of cancer and its
treatment. Dr. Lusk's topic was "An Update on
Breast Cancer", and his talk proved very
interesting and informative. After the program, a
short business session was held and the meeting
adjourned.
BLUE RIDGE
PHARMACEUTICAL
ASSOCIATION
The first meeting of the Blue Ridge
Pharmaceutical Association was held Sunday,
February 22, 1987, at the Sheraton Hotel in
North Wilkesboro. Officers installed by NCPhA
Executive Director Al Mebane were: Steve Critz,
President; Don Beam, Vice President and
Secretary; Jim Worley, Treasurer.
TO LOCAL ASSOCIATION
SECRETARIES
The activities of local/regional pharmaceuti-
cal associations are of interest to all pharmacists
of the state. To have your association reports
printed in the Carolina Journal of Pharmacy,
please send your condensed minutes to: The
Editor, Carolina Journal of Pharmacy, P.O. Box
151, Chapel Hill NC 27514.
June, 1987
Dan Hinson
Winston-
Salem •
His responsibility is to
do the best job possible. ..for you
...wherever you are in North Carolina.
How specially-trained
Savage professional representatives
can serve you and your business:
• Help maximize inventory turnover for greater
profitability
• Rapid-response order taking and delivery
...ancfa fair product-return policy
• Close liaison for you with wholesalers,
physicians, and headquarters customer
service at Savage
• Help to keep you informed about current
trends and competitive strategies
• Promotion specialist: Not only helps make the
deals, but helps build traffic
Savage products...
They help build customer traffic
for your pharmacy
The right strengths, the right formulations,
the right quality, at the right price...
to help you serve your customers and
maintain your profits
22 high-quality products
from a single source
^
Allergy: BREXIN® LA. CAPSULES chlorpheniramine maleale 8mg,
pseudoephednne hydrochloride 120mg •
Antiprotozoal: SATRIC™ TABLETS - 250mg (metronidazole USP) ■
SATRIC '" - 500 TABLETS (metronidazole USP) •
Contrast Medium: ETHIODOL® (ethiodized oil lor injection) •
Hormone: DITATE®-DS (testosterone enanlhate and
estradiol valerate injection) ■
Bronchodilators: DILOR® ELIXIR (dyphylline) •
DILOR® INJECTABLE (dyphylline) • DILOR® TABLETS- 200mg (dyphylline) •
DILOR® - 400 TABLETS (dyphylline) • DILOR-G® LIQUID
dyphylline 100mg. guaifenesin USP 100mg • DILOR-G® TABLETS
dyphylline 200mg, guailenesm USP 200mg •
Topicals: ALPHATREX® CREAM. OINTMENT AND LOTION 0 05%
(betamethasone dipropionale USP) •
BETATREX'" CREAM. OINTMENT AND LOTION 0.1%
(betamethasone valerate USP) • MYTREX® A* CREAM AND OINTMENT
(neomycin sulfate - triamcinolone acetonide) •
MYTREX® F CREAM AND OINTMENT (nystatin - triamcinolone acetonide) •
NYSTEX'" CREAM AND OINTMENT (nystatin USP) ■
NYSTEX'" ORAL SUSPENSION (nystatin oral suspension USP) ■
TRYMEX CREAM AND OINTMENT 0.025% (triamcinolone acetonide USP) •
TRYMEX CREAM AND OINTMENT 0 1% (triamcinolone acetonide USP) •
Vaginal Preparations: TRYSUL® (triple sulfa vaginal cream)
(sullathiazole 3 42%, sulfacetamide 2 86%, sultabenzamine 3 70%) •
Vitamins: CHROMAGEN® CAPSULES ferrous lumarate USP 200mg,
ascorbic acid USP 250mg, cyanocobalarnin USP 10mcg, desiccated
stomach substance 100mg. •
CHROMAGEN* OB CAPSULES a phosphorous-tree vitamin and mineral
dietary supplement lor use during pregnancy and lactation
'Introduction scheduled lor July 1986
SAVAGE
LABORATORIES
a division of Altana Inc. • Melville, New York 1 1 747
People and products to serve your needs.
THE CAROLINA JOURNAL OF PHARMACY
29
REPORT OF THE NCPhA MENTAL HEALTH COMMITTEE
Presented at the 107th Annual meeting of the North Carolina
Pharmaceutical Association, April 22-25, 1987, Charlotte
The North Carolina Pharmaceutical Association
MENTAL HEALTH COMMITTEE
Meeting Minutes
March 12, 1987
The Mental Health Committee of the NCPhA
met in Chapel Hill at the Institute of Pharmacy
from 2:00-3:00 pm on March 12. The following
members were present:
Julian Baker, Chairman, Neal Jennings, John
Myhre, Horace Steadman, Robert Worley,
Robert Allen, Advisor, Martha Johnson,
Richard Sessions, Paul Stevenson
Members absent were:
Edward Durand, Jerry McKee, Mary
Ledbetter, Dennis Moore, Advisor
Chairman Baker called the meeting to order
and thanked everyone for taking time from their
busy schedule to attend this committee meeting.
Each member introduced themselves and
indicated why they had an interest in mental
health.
The committee had many concerns which
were ultimately expressed in a proposed
resolution to be presented at the annual meeting
in Charlotte. The recommendations made in the
resolution are as follows:
1 . a survey to be conducted by the Committee
to:
(A) determine how mental health centers
in the 100 counties of North Carolina
are handling medications for their
clients,
(B) determine to what extent community
pharmacists are participating in this
effort and
(C) recommend actions community
pharmacists can take to help the
Division of Mental Health, Mental
Retardation and Substance Abuse
Services improve medication com-
pliance for mentally ill North Carolina
citizens.
2. an article describing the results of the above
mentioned survey be published in the
Carolina Journal of Pharmacy;
3. the scope of the Committee's concerns,
activities and recommendations be
expanded to include the mentally ill and
the substance abuser;
4. the name of Committee be changed to be
the NCPhA "Mental Health, Mental
Retardation and Substance Abuse
Committee";
5. the membership be expanded to include an
AHEC pharmacist.
The committee further agreed that it is not
possible to perform the work of this committee
by meeting only once per year. It was
recommended and agreed upon by consensus
that the committee meet at least two or more
times per year. It was recommeded that the
committee retain its same composition for
another year and that persons to be added to the
committee as designated by Chairman Baker to
represent the interests of mentally retarded
citizens and substance abusers.
The committee decided to review the results of
the study Bob Allen agreed to conduct
(recommendation #1 above) at the next meeting.
Chairman Baker will call a meeting when the
study results are tabulated. In addition, the
committee agreed they would like to have
someone representing the mentally ill or mentally
retarded speak to the group about the needs of
these disability areas at a future meeting.
With no further business, the committee
adjourned at 3:30 PM.
Respectfully submitted
Bob Allen, Secretary
March 25, 1987
Committee Members
Julian Baker, Chairman
Dennis Moore, Advisor Robert J. Allen, Advisor
R. Neal Jennings
Mary W. Ledbetter
John H. Myhre
Horace D. Steadman, Jr.
Robert W. Worley, Jr.
Edward M. Durand
Martha P. Johnson
Jerry McKee
J. Richard Sessions
Paul A. Stevenson
June, 1987
WE BRING YOU THE BEST
CHARLESTON, S.C.
GREENVILLE, S.C.
THE CAROLINA JOURNAL OF PHARMACY
31
REPORT OF THE SOCIAL AND
ECONOMIC RELATIONS COMMITTEE
Presented at the 107th Annual meeting of the North Carolina
Pharmaceutical Association, April 22-25, 1987, Charlotte
The Social and Economic Relations
Committee of the North Carolina Pharmaceu-
tical Association met march 1, 1987 at 2:00 p.m.
at the Institute of Pharmacy, Chapel Hill, N.C.
The chairman asked the members of the
committee present to express themselves as to the
areas of concern the pharmacists of the state have
in order that the association may work to help
improve the social and economic well-being of
the pharmacist.
There were several areas identified and
discussed. They were as follows:
I. Third Party Contracts
While there is still much work to be done,
the committee wanted to go on record
commending Mickey Watts and the Board
of Directors of the Pharmacy Network for
the work it is doing to secure third party
contracts for our pharmacists.
II. Physician Dispensing
The committee was concerned for the safety
of the citizens of North Carolina in the
manner in which drugs are being dispensed
in some physicians offices. The committee
was in favor of legislation for the physicians
to be required to adhere to the same
pharmacy laws for dispensing drugs (i.e.,
proper labeling and proper and complete
record keeping, etc.) as the pharmacist.
III. Pharmacist Prescribing
After much discussion, the committee was
in favor of legislation to allow pharmacists
to prescribe and dispense certain types of
drugs. The pharmacist is prepared by
education and experience to assume this
role.
IV. Mail Order Prescriptions
The committee discussed this problem at
length. The conclusion was that in order to
protect the public, anyone that is filling
prescriptions for residents of North Carolina
should be required to be licensed by the
North Carolina Board of Pharmacy and
abide by the same regulations as other
pharmacies in the state.
V. Public Relations
The Pharmaceutical Association should
consider hiring a public relations firm to
help inform the public about the problems
of concern, i.e., HMO dispensing, mail
order prescriptions, physicians dispensing,
pharmacists prescribing, etc., in order to
bring about favorable changes for our
pharmacists.
This report is being made to the Executive
Committee of the Pharmaceutical Association. It
is hoped that the leadership of the association will
be able to implement the suggestions.
Committee Members
L. Milton Whaley, Chairman
L. Stuart Booker Ida N. Keetsock
L. Irvin Graham William L. Marsh
Abraham G. Hartzema Sheila Whitehead
Richard J. Hendrix
WOMAN'S AUXILIARY
BOARD MEETING
The Board Meeting of the North Carolina
Pharmaceutical Association Auxiliary was held
at the Institute of Pharmacy in Chapel Hill on
Thursday, June 25, 1987 at 1:30 p.m. Board
members present were: Dollie Corwin, Jewell
Oxendine, Eloise Watts, Jean Morse, Gladys
Jones, Peggy Jackson, Frances Jones, and Mary
Lou Davis.
The President, Mary Lou Davis, called the
meeting to order. For our devotion, our president
gave us Albert Schweitzer's Rx for continued
success. It consisted of so many parts of
Inspiration, Aspiration, Determination, Devo-
tion and Elbow Grease. The minutes were read,
corrected, and approved.
Eloise Watts gave the treasurer's report. We
had a balance on hand of $4,544.59. She made a
motion that we put $2,000.00 in the Reserve
Fund to draw interest and give $500.00 to the
Continued on page 37
June, 1987
32 THE CAROLINA JOURNAL OF PHARMACY
REPORT OF THE COMMUNITY PHARMACY COMMITTEE
Presented at the 107th Annual meeting of the North Carolina
Pharmaceutical Association, April 22-25, 1987, Charlotte
Committee on Community Pharmacy
The NCPhA Committee on Community
Pharmacy met Sunday, February 22, 1 987 at the
Institute of Pharmacy in Chapel Hill. Chairman
Ralph Ashworth conducted the meeting.
Agenda Items
l.
Possible Continuing Pharmaceutical
Education (CPE) credits for NCPhA
committee meetings.
2. Physician dispensing for profit
3. Mail order prescription drug programs
4. Computers in pharmacy
5. Third party prescription drug plans
6. The rise in health care costs as compared to
the Consumer Price Index increases.
The committee discussed the possibility and
feasibility of obtaining CPE credit for NCPhA
committee meetings, recognizing the limitations
that should be imposed. The committee
postponed any official recommendations until
further study could be done.
To determine the scope of the problem of
physician dispensing and resulting reduction in
the patient's perceived freedom of choice
regarding where the prescriptions must be
dispensed, the committee recommended a survey
of the membership be undertaken in March. This
survey should solicit specific information
regarding possible exploitation and/or incon-
venience of patients resulting from physician or
clinic dispensing. The committee also proposed a
resolution addressing freedom of choice be
introduced at the annual convention.
The committee discussed mail order
prescription drug programs and encourages the
Legislative Committee and Executive Com-
mittee to pursue any and all approaches to limit
or end this practice. The committee felt the
patient is best served when the professional
services of a pharmacist are immediately and
personally available to the patient or the patient's
agent. Efforts should be started to document and
substantiate pharmacy's opinion that local
pharmacy services are more cost effective than
mail order programs.
The increase in manufacturers' cost of drug
products concerned the committee as did the
multi-tiered pricing policies of many manufac-
turers. The committee suggested resolutions be
presented commending those manfacturers who
have initiated a single tiered pricing policy, and
recommending restraint in price increases to the
Pharmaceutical Manufacturers Association.
While pharmacy computers have expanded
the information available to the pharmacist, such
as patient profiles, drug interactions, multi-
prescriber, multi-drug user habits, insurance and
Medicaid information, etc., the committee
expressed concern about the lack of standardiza-
tion in the industry. The committee also felt it was
important for gradutes to be computer literate
and yet retain the proficiency to operate without
the services of a computer should it be necessary.
Committee Members
Ralph H. Ashworth, Chairman
Thomas M. Allison
Barry L. Carpenter
Connie L. Daughtry
Stephen Y. Jones
Randy N. Lawson
Radford H. Rich
Carl D. Taylor
Ronald J. Winston
Terri Bostick
David N. Cox
Charles F. Delaney
Susan Ladd
Ruth W. Mitcham
M. Keith Stewart
Marianne K. White
|#Mfl^|
Ralph Ashworth, Community Pharmacy
Committee Chairman
June, 1987
INTRODUCING
NEW
ONCE-DAILY
ISOPTIN
(verapamil HCI/Knoll)
240 mg scored sustained-release tablets for hypertension
• Only calcium channel
blocker available in SR
form for once-a-day
therapy
• New SR dosage form
allows greater patient
compliance
• Well documented safety
profile
• in mild to moderate
essential hypertension, a
more logical therapeutic
choice than beta
blockers or diuretics
«0C(ffl44-l8J6.a2
A'xr
(verapamil HCI/Knoli)
240 mg
SUSTAINED-RELEASE TABLETS
Caution Federal law prohibits dispensM
wtttout prescription. ?<:8»
KnoH Pharmaceuticals
A product of Knoll Research
. New Jersey 07981
a
• Economically packaged
in bottles of 100 tablets
• Liberal return-goods
policy
Supported by a
comprehensive
promotional
program, including:
• Extensive detailing
• Journal advertising
• Direct mail to
high-volume prescribers
Order today from your
wholesaler
basf coup knoll
Serving the pharmacy profession for more than 80 years
Please see next page for brief summary.
1986 BASF K&F Corporation
2454B-11-86
NEW. . . ONCE DAILY Bnef Summay
IN MILD TO MODERATE
HYPERTENSION
ISOPTIN SR
(verapamil HCI/Knoll)
240 mg scored, sustained-release tablets
CONTRAINDICATIONS: 1) Severe left ventricular dysfunction (see WARNINGS), 2) Hypotension (less than 90 mmHg systolic pressure) or cardiogenic
shock, 3) Sick sinus syndrome or 2nd or 3rd degree AV block (except in patients with a functioning artificial ventricular pacemaker).
WARNINGS: Heart Failure: ISOPTIN should be avoided in patients with severe left ventricular dysfunction (see DRUG INTERACTIONS). Patients with
milder ventricular dysfunction should, if possible, be controlled before verapamil treatment Hypotension: ISOPTIN (verapamil HCI) may produce
occasional symptomatic hypotension. Elevated Liver Enzymes: Elevations of transaminases with and without concomitant elevations in alkaline
phosphatase and bilirubin have been reported Periodic monitoring of liver function in patients receiving verapamil is therefore prudent. Accessory
Bypass Tract (Wolff-Parkinson-White): Patients with paroxysmal and/or chronic atrial flutter or atrial fibrillation and a coexisting accessory AV pathway
have developed increased antegrade conduction across the accessory pathway producing a very rapid ventricular response or ventricular fibrillation after
receiving intravenous verapamil While this has not been reported with oral verapamil, it should be considered a potential risk. Treatment is usually
D C. -cardioversion Atrioventricular Block: The effect of verapamil on AV conduction and the SA node may cause asymptomatic 1st degree AV block and
transient bradycardia. Higher degrees of AV block, while infrequent (0.8%), may require a reduction in dosage or, in rare instances, discontinuation of
verapamil HCI. Patients with Hypertrophic Cardiomyopathy (IHSS): Although verapamil has been used in the therapy of patients with IHSS, severe
cardiovascular decompensation and death have been noted in this patient population.
PRECAUTIONS: Impaired Hepatic or Renal Function: Verapamil is highly metabolized by the liver with about 70% of an administered dose excreted in
the urine In patients with impaired hepatic or renal function verapamil should be administered cautiously and the patients monitored for abnormal
prolongation of the PR interval or other signs of excessive pharmacological effects (see OVERDOSAGE).
Drug Interactions: Beta Blockers: Concomitant use of ISOPTIN and oral beta-adrenergic blocking agents may be beneficial in certain patients with
chronic stable angina or hypertension, but available information is not sufficient to predict with confidence the effects of concurrent treatment in
patients with left ventricular dysfunction or cardiac conduction abnormalities. Digitalis: Clinical use of verapamil in digitalized patients has shown the
combination to be well tolerated if digoxin doses are properly adjusted. However, chronic verapamil treatment increases serum digoxm levels by 50 to
75% during the first week of therapy and this can result in digitalis toxicity. Upon discontinuation of ISOPTIN (verapamil HCI), the patient should be
reassessed to avoid underdigitalization. Antihypertensive Agents: Verapamil administered concomitantly with oral antihypertensive agents (e.g.,
vasodilators, angiotensm-converting enzyme inhibitors, diuretics, beta blockers, prazosin) will usually have an additive effect on lowering blood
pressure Patients receiving these combinations should be appropriately monitored. Disopyramide: Disopyramide should not be administered within 48
hours before or 24 hours after verapamil administration. Quinidine: In patients with hypertrophic cardiomyopathy (IHSS), concomitant use of verapamil
and quinidine resulted in significant hypotension. There has been a report of increased quinidine levels during verapamil therapy. Nitrates: The
pharmacologic profile of verapamil and nitrates as well as clinical experience suggest beneficial interactions. Cimetidine: Two clinical trials have shown a
lack of significant verapamil interaction with cimetidine. A third study showed cimetidine reduced verapamil clearance and increased elimination to 1/2.
Anesthetic Agents: Verapamil may potentiate the activity of neuromuscular blocking agents and inhalation anesthetics. Carbamazepine: Verapamil may
increase carbamazepine concentrations during combined therapy Rifampin: Therapy with rifampin may markedly reduce oral verapamil bioavailability
Lithium: Verapamil may lower lithium levels in patient on chronic oral lithium therapy. Carcinogenesis, Mutagenesis, Impairment of Fertility: There was
no evidence of a carcinogenic potential of verapamil administered to rats for two years Verapamil was not mutagenic in the Ames test Studies in female
rats did not show impaired fertility Effects on male fertility have not been determined. Pregnancv (Category C): There are no adequate and well-
controlled studies in pregnant women ISOPTIN crosses the placental barrier and can be detected in umbilical vein blood at delivery. This drug should be
used during pregnancy, labor, and delivery, only if clearly needed Nursing Mothers: ISOPTIN is excreted in human milk, therefore, nursing should be
discontinued while verapamil is administered Pediatric Use: Safety and efficacy of ISOPTIN in children below the age of 18 years have not been
established
ADVERSE REACTIONS: Constipation 8.4%, dizziness 3.5%, nausea 2.7%, hypotension 2.5%, edema 2.1%, headache 1.9%, CHF/pulmonary edema
1 8%, fatigue 17%, bradycardia 1.4%, 3° AV block 0.8%, flushing 0.1%. elevated liver enzymes (see WARNINGS). The following reactions, reported in
less than 1.0% of patients, occurred under conditions (open trials, marketing experience) where a causal relationship is uncertain: they are mentioned
to alert the physician to a possible relationship: angina pectoris, arthralgia and rash, AV block, blurred vision, cerebrovascular accident, chest pain,
claudication, confusion, diarrhea, dry mouth, dyspnea, ecchymosis or bruising, equilibrium disorders, exanthema, gastrointestinal distress, gingival
hyperplasia, gynecomastia, hair loss, hyperkeratosis, impotence, increased urination, insomnia, macules, muscle cramps, myocardial infarction,
palpitations, paresthesia, psychotic symptoms, purpura (vasculitis), shakmess, somnolence, spotty menstruation, sweating, syncope, urticaria
Treatment of Acute Cardiovascular Adverse Reactions: Whenever severe hypotension or complete AV block occur following oral administration of
verapamil, the appropriate emergency measures should be applied immediately, e.g., intravenously administered isoproterenol HCI, levarterenol
bitartrate, atropine (all in the usual doses), or calcium gluconate (10% solution). If further support is necessary, inotropic agents (dopamine or
dobutamine) may be administered. Actual treatment and dosage should depend on the severity and the clinical situation and the |udgment and
experience of the treating physician
OVERDOSAGE: Treatment of overdosage should be supportive Beta-adrenergic stimulation or parenteral administration of calcium solutions may
increase calcium ion flux across the slow channel, and have been used effectively in treatment of deliberate overdosage with verapamil Clinically
significant hypotensive reactions or fixed high degree AV block should be treated with vasopressor agents or cardiac pacing, respectively Asystole
should be handled by the usual measures including cardiopulmonary resuscitation
Knoll Pharmaceuticals
A Unit of BASF K&F Corporation
Whippany. New Jersey 07981
6.
BASF Group ICMOH
c1986, BASF K&F Corporation Printed in U SA.
THE CAROLINA JOURNAL OF PHARMACY
35
REPORT OF THE WOMEN IN PHARMACY COMMITTEE
Presented at the 107th Annual meeting of the North Carolina
Pharmaceutical Association, April 22-25, 1987, Charlotte
The number of women entering phrmacy has
been on the increase. While most of the
pharmacists now practicing in North Carolina
are men, the UNC School of Pharmacy student
population is currently over 50% female. Even
though the number of women pharmacists is
increasing their representation as managers has
not kept pace.1 It is for this reason that the
Women in Pharmacy Committee this year
focused its attention on career management.
However, in researching career management
we found that men as well as women have a
disadvantage because they are "baby boomers."
All young practitioners may find it harder to
advance in their career. Minimal advancement
potential is one of the greatest causes of job
dissatisfaction.2 This is true regardless on the
setting, i.e. hospital, chain-store, or independent
pharmacy practice sites. Take for instance
hospital pharmacies. Two thirds of hospital
pharmacists are less than 40 years old. The
majority of pharmacy directors are less than 40
years old.3 Few pharmacists leaving for
retirement may be a reason why hospital
pharmacists feel a lack of opportunity.4 Limited
personal growth may be what pharmacists are
expressing as they complain of a lack of career
advancement opportunities.5
Young pharmacists entering the profession
may have difficulty seeing beyond a staff "job"
and focusing on the profession of pharmacy as a
lifetime career. We, as a committee, wanted to do
something to help analyze their career choices
and not let salary or benefit packages lure them
into a "job" and fail to consider how their choice
of practice position will contribute to the
achievement of their career goals.
We sponsored a panel discussion jointly with
Kappa Epsilon to present different pharmacy
career opportunities. The speakers were:
1) Laura Burnham, Director of Pellcare
Nursing Home Pharmacy
2) Omega Dean, owner Omega's Medicine
Shoppe
3) Gigi Fredrich, Veterinary Pharmacist,
North Carolina State University School of
Medicine.
4) Jane Hall, Clinical Research Pharmacist,
Burroughs-Wellcome Company
June, 1987
5) Chris Rudd, Pharm. D., Assistant Director
of Pharmacy, Clinical Services, Duke
University Medical Center
6) Joy Southerland, Director of Pharmacy
Services, Guilford County Department of
Public Health
The discussion provided excellent information
on different career opportunities. We hope that
this will become an annual event and attract both
male and female pharmacy students.
The committee has also tried in past years to
conduct a survey in North Caroilina to help
determine the status of women pharmacists.
Since the percentage of women pharmacists
continues to increase each year, we would like to
see where their interests and future committments
lie. We are happy to say that this survey will be
done in conjunction with Dr. Gagnon's NCPhA
salary survey. Dr. Jan Phillips from the UNC
School of Pharmacy is formulating the survey
and expects to conduct the survey this spring. The
Committee forwarded our ideas and suggestions
for the survey to Drs. Gagnon and Phillips and
Continued on page 36
Remember the ^Bay
...in^'ctures
OTLORCRAFT
North Carolina's Most Complete
Film Processing Service
There Is A Plant Located
Near You
For the Finest Quality Plus Fast
Dependable Service on All Your
Photo Needs, Contact the Plant
Nearest You.
CHARLOTTE WILMINGTON
KERNERSVILLE RALEIGH
FAYETTEVILLE DURHAM
If You Don't Know Photofinishing
Know Your Photofinisher
36
THE CAROLINA JOURNAL OF PHARMACY
WOMEN IN PHARMACY
Continued from page 35
eagerly await the results of the survey. We hope
this will provide useful information and help us
focus on future areas of concern.
The committee also supports continuing
education. It is for this reason that we wanted to
sponsor a speaker at this gathering of pharmacists
throughout the state.
We invited Dr. Randal Von Seggern to
participate in an afternoon workshop. He
presented a lecture on "Electrophysiologic
Studies and Selecting Antidysrhythmic Drug
Therapy."
As the lifestyles of pharmacists change and we
enter different life cycles, or seek opportunities
for advancement, or learn to manage as a two-
career couple, we hope that what we try to do as a
committee will bring out the best in the change
while focusing on professional growth.
Footnotes
1) Nice FJ, Schondelmeyer SW, Bootman JL.
"Women in Pharmacy Management — Why
Not?' Am. Pharm 1984: NS24:214-9.
2) Curtiss AR. "Psychological Strain and Job
Dissatisfaction in Pharmacy Practice:
Institutional Versus Community Practioner."
Am J. Hosp. Pharmacy. 1978:35:516-20.
3) Oakley RS, Bradham DD. "Factors Affecting
the Salaries of Pharmacy Directors in Large
Hospitals." Am J. Hosp. Pharm. 1983;
40:591-7.
4) Posey LM, "Managing Baby Boom
Pharmacists in the Information Age." Am. J.
Hosp. Pharm 1984: 41:890. Editorial.
5) Mackowiak J, Eckel FM. "Career Manage-
ment: Understanding the Process." Am J.
Hosp. Pharm 1985, 45:297-303.
Committee Members
Nancy R. Hardie, Chairman
Kim H. Deloatch Marilyn A. McConnell
Sonja P. Estes Donna S. Roberts
Elizabeth Farrington Joy W. Sutherland
Debbie Ladd
THE CHARLOTTE WOMAN'S
PHARMACEUTICAL
AUXILIARY
by Lurlene G. Barnhardt
The Charlotte Woman's Pharmaceutical
Auxiliary met for Lunch at the Elk's Club for the
Annual April Business Meeting.
Prior to the April Luncheon Meeting the
Board of the Auxiliary had met in the home of
Jewel Oxendine (Mr. Jesse). From the Board
meeting several recommendations were brought
to the Auxiliary for vote. The recommendation to
give $ 1 00.00 to Mission Air toward the challenge
gift offered them by a couple — that is to match
each $100.00 gift up to $50,000.00 — was
approved.
The Treasurer reported that the Auxiliary is in
fairly good condition after some special gifts had
been received.
The President, Mary Lou Davis (Mrs. Leslie
H.) was elected as our delegate to the N.C.
Pharmaceutical Convention.
The Nominating Committee brought in a full
Slate of Officers. These to be installed at the May
Meeting of the Auxiliary.
President Mary Lou Davis, also General
Convention Chairman for the Woman's
Auxiliary NCPA, discussed the plans for the
Convention. Each local chairperson reported for
her particular assigned duties. All plans seem to
be in order and ready to serve as Hostesses for the
Woman's Auxiliary of the N.C. Pharmaceutical
Association meeting in Charlotte, April 22-25,
1987. The Adam's Mark Hotel is Convention
Headquarters. We are hoping to have a large
number of women attending from over the State
of North Carolina.
J'-i#v
June, 1987
THE CAROLINA JOURNAL OF PHARMACY
37
WEDDINGS AND BIRTHS
Greg and Debbie Southern of King, announce
the birth of a son, Kyle Gregory, on April 17,
1987. Greg is a 1979 graduate of the UNC
School of Pharmacy at Chapel Hill.
Myra Raine Hawkins of Cary and William
Dodd Lindsay of Carrboro were married March
7 at St. Paul's Episcopal Church in Cary.
The bride and groom both graduated from the
University of North Carolina School of
Pharmacy. She is employed by Treasury Drug
and he is employed by Revco DS, Inc. They
make their home in Chapel Hill.
WIER AND CHAMBERS
RETIRE FROM UNC SCHOOL
OF PHARMACY
Melvin A. Chambers, professor and former
dean of the School of Pharmacy, and Jack K.
Wier, professor of pharmacognosy, retire at the
end of the current school year. Chambers, a
native of Garrett, Indiana, received his degrees
from Ohio State University. He taught pharmacy
administration and was a general college advisor.
He served on the UNC faculty for 28 years. Wier
was a native of Cairo, Nebraska, and received
degrees from the University of Nebraska, the
University of Washington and the University of
Wisconsin. He specialized in natural substances
used by North Carolinians and prepared several
programs on the subject of the UNC Center for
Public Television. Wier taught at UNC for 26
years.
REPORT OF THE ELECTIONS
COMMITTEE
The NCPhA Election Committee met
Thursday, June 25th to open and count the
ballots in the mail election. Results are:
1 st Vice President — Ralph Ashworth, Cary
2nd Vice President — Frank Burton,
Greensboro
3rd Vice President — Robert Worley,
Goldsboro
Executive Committee Members-at-Large
Phillip Crouch, Asheville
Steve Dedrick, Durham
Logan Womble, Plymouth
These officers will be installed in Asheville at
the conclusion of the 1988 Annual Convention at
the Grove Park Inn and will serve in their
respective offices for the 1988-1989 Association
year.
Elected to the Board of Directors of the
Pharmacy Foundation of NC:
James Creech, Smithfield
Banks Kerr, Raleigh
Harold Day, Spruce Pine
W.J. Smith, Chapel Hill
Members of the Elections Committee:
E.A. Brecht, Betty Dennis, Abraham
Hartzema and Haywood Jones
WOMAN'S AUXILIARY
Continued from page 31
Consolidated Loan Fund. This was seconded by
Jean Morse and agreed to by the board.
Peggy Jackson gave her final report from the
membership committee. We have a total of 187
members, 1 7 of these being life members. A total
of $1313.00 was collected in dues.
The president announced that Pharmacy
Week will be observed Oct. 1 1th - 17th. It will
be Talk About Rx Month. The theme is
"Medicine — Ask About Your Medicine Before
You Take It".
Jewell made a motion to keep the VIAL OF
LIFE our State Service Project, under the
leadership of Jerry White. This was seconded by
Peggy Jackson.
Concerning our Service Project for the year
(considering taking on something for substance
abuse) a motion was made by Jean Morse and
seconded by Peggy Jackson for each member of
the Board to find whatever information they
could and pass it on to the President.
The Fall Convocation will be on Wed. Oct 7th
at the Institute. Partial plans were made for the
Convocation. Jean and Peggy were asked to
check on American Airlines concerning a
program.
The president, in closing, read from "In My
Own Back Yard".
June, 1987
38
THE CAROLINA JOURNAL OF PHARMACY
OFFICE PRACTICE OF
PHARMACY
Louis Ferguson has been practicing pharmacy
in an office setting in Taylorsville, North Carolina
since 1981. When you walk into his pharmacy,
the first thing that becomes obvious is the absence
of bottles. Louis prefers it that way and is
convinced that many people in the community
like it that way also. In 1980 he sold a pharmacy
that he and a classmate from the University of
North Carolina had bought and operated in
Taylorsville since 1 956. Louis says it took him 25
years to see that pharmacy was changing and he
was ready to make significant changes in his own
practice. What caused Louis to consider making
major changes in his professional life?
Louis says it all started in 1 976, shortly after he
suffered a myocardial infarction. During the
three months that he was away from the
pharmacy, Louis began to evaluate the way he
had been practicing. He felt that he needed a
more "professional" approach. He says that he
felt he should begin devoting more of his time and
energy to the compounding of prescriptions and
to counseling patrons about their medications.
He began to read articles written by and about
Eugene White, recipient of the Remington
Award for his work in developing the office
practice concept. Louis and his wife later visited
White's practice in Berryville, Virginia. Eugene
suggested that Louis also visit Carl Emswiller in
Leesburg, Virginia. He secured a piece of
property in Taylorsville, built a new building, and
in May of 1981 opened his office practice. The
rest, according to Louis, is history.
The most gratifying aspect of office pharmacy,
according to Louis, is the one-to-one contact with
people. He says, "This type of practice places you
in direct contact with many people and that's the
part I like the best." He prefers a low key
approach to patrons and feels that word-of-
mouth is his best promotion. He is quick to point
out, however, that this is only one of many
different ways to practice the profession. Louis
Ferguson also believes that one of the greatest
myths under which most pharmacists operate is
that people are only interested in pharmacies
which offer the cheapest products and services.
He says, "There is a better way . . . and I think I
may have found it."
from "Voice of the Pharmacist"
Donald W. Arthur, Chairman, Executive Committee of the National Association of Retail Druggists,
presents the NARD Leadership Award to incoming NCPhA President Julian E. Upchurch.
June, 1987
THE CAROLINA JOURNAL OF PHARMACY
39
CLASSIFIED ADVERTISING
Classified advertising (single issue insertion) 25 cents a word with a minimum charge of $5.00 per
insertion. Payment to acompany order.
Names and addresses will be published unless a box number is requested.
In replying to "blind" ads, address Ad. No., Carolina Journal of Pharmacy, P.O. Box 151, Chapel
Hill, NC 27514. Telephone (919) 967-2237.
We are seeking an ambitious and
professional career-minded individual for
Pharmacy-manager position in south-
eastern North Carolina near the coast.
Computerized prescriptions, excellent
salary, hospitalization and life insurance,
paid vacations. Small professional
pharmacy located in the center of a
medical complex. Contact Box CDD, c/o
NCPhA, P.O. Box 151, Chapel Hill, NC
27514.
PHARMACIST WANTED: We are
seeking an ambitious, and professional
career-minded individual for a pharmacist
position in Greensboro, High Point and
Winston-Salem, NC. We offer excellent
salary, stock ownership, educational
subsidy, extensive benefits, retirement
plan, 401 K tax plan, annual salary merit
reviews. "Pure pharmacy setting". If
interested call Lew Thompson 1 -800-233-
7018 or send resume to: The Kroger
Company, Attn: Personnel, PO Box
14002, Roanoke VA 24038. EOE.
PHARMACIST POSITION: Reynolds
Health Center Pharmacy in Winston-
Salem. Pharmacy hours 8-5, Monday
through Friday. Salary negotiable,
excellent benefits. Contact Forsythe
County Personnel at (919) 727-2851 or
Janet Foster at (919) 727-8264 for further
information.
PHARMACIST WANTED: Opportunity
for pharmacist interested in progressive
independent practice. Opportunities for
patient counseling, hypertensive screen-
ing, diabetes screening and home health
care. Excellent salary and benefits. No
nights or Sundays. Contact Box 777, c/o
North Carolina Pharmaceutical Associa-
tion, P.O. Box 151, Chapel Hill, NC 27514.
PHARMACY FOR SALE: Coastal NC.
Sales greater than $400,000.00; 60%
prescriptions. 10 miles from the ocean.
Contact Bullock & Whaley (919) 762-
2868; PO Box 3783, Wilmington NC
28406.
INDEPENDENT PHARMACY (Triad)
Needs warm, friendly, civic-minded
pharmacist. In return have flexible hours,
plus one week's vacation every four
months, plus 3-day weekends during
summer. Call Apple Pharmacy, 704-
634-2111.
MEDICINE SHOPPE FOR SALE: Don't
miss this excellent opportunity to be your
own boss in a professional atmosphere.
The Medicine Shoppe, a prescription
oriented pharmacy located in Raeford,
NC has been offered for immediate sale.
This fine opportunity offers clinic hours
and a positive cash flow from Day 1 . If you
have been considering owning your own
pharmacy, this could be an outstanding
opportunity for you! Financing available.
Contact John Aumiller, Medicine Shoppe
Int'l., Inc. at 1-800/325-1397.
HOSPITAL PHARMACIST WANTED:
Staff position available in a 68 bed acute
care hospital in Siler City, NC. Hospital
experience desirable. Salary commen-
surate with experience. For more
information, contact Sandra McKinney,
Chatham Hospital, Inc., P.O. Box 649,
Siler City, NC 27344. (919) 663-2113.
PHARMACIST FOR HIRE: Mature
Pharmacist, active in excellent health
wants work with small town pharmacy or
relief work. Call Craig, (919) 673-1368.
Continued on page 40
June, 1987
40
THE CAROLINA JOURNAL OF PHARMACY
CLASSIFIEDS
Continued from page 39
STAFF PHARMACIST WANTED: Posi-
tion at Kings Mountain Hospital. Modern
102-bed facility with computerized unit
dosage. Hospital experience preferred
but not necessary. Will consider a May
graduate. Contact Jerry McKee at (704)
739-3601 Ext. 472.
PHARMACY DIRECTOR: Angel Hos-
pital, an 81 bed community hospital in
Weestern North Carolina, is seeking a
Pharmacist (RPH) with previous experi-
ence in a hospital pharmacy. Responsible
for managing pharmaceutical services
and supervising activities of non-
professional staff. Competitive salary and
benefit package available in this scenic
section of the mountains of WNC. Call for
aplication or send resume to Personnel
Department, Angel Community Hospital,
P.O. Box 1209, Franklin, NC 28734. (704)
369-4266.
PHARMACIST WANTED: Independent
pharmacy in Concord seeks a full time
pharmacist. Good salary, excellent
benefits. Call Mickey Watts (704) 782-
2194.
PROFESSIONAL PHARMACIES: Sev-
eral small prescription-oriented phar-
macies are currently available for
individual ownership in North Carolina.
These opportunities provide the vehicle to
practice pharmacy the way you were
taught, while offering an attractive income
and more time to be with your family. In
some of these cases, financing is also
available to qualified candidates. For
more information write: Jan Patrick,
10121 Paget Dr., St. Louis MO 63132.
PHARMACIST: Professional Services/
Consultation — Temporary and/or
Continual. Contact: L. W. Matthews at
(919) 967-0333 or 929-1783. 1608 Smith
Level Road, Chapel Hill, NC 27514.
RELIEF PHARMACIST AVAILABLE:
Central & Eastern North Carolina. Contact
Pharmacy Relief, PO Box 2064, Chapel
Hill NC 27515 or call 919-481-1272
evenings.
PHARMACIST WANTED. Full-time
position on coast. Excellent working
conditions. Competitive salary and
benefits. Contact T01, NCPhA.
PHARMACIST NEEDED: Crown Drugs
has pharmacist positions open in central
North Carolina due to planned expansion
in 1 987. We offer excellent starting salary,
40 hour week, paid vacation, insurance,
and many other benefits. Come grow with
us. Send resume to: Doug Sprinkle,
Crown Center, 400 Commerce Place,
Advance, NC 27006.
CLINICAL-STAFF PHARMACIST POSI-
TION: Will be working every 3rd weekend
and will have responsibilities in unit dose,
IV admixtures, cancer chemotherapy,
patient education, nursing inservice,
pharmacy newsletter, pharmokinetic
dosing, drug use evaluation and other
evolving clinical applications. Some
advanced training and experience in
clinical pharmacy preferred. If interested
and qualified please send resume to:
Director of Personnel, Community
General Hospital, PO Box 789, Thomas-
ville NC 27360. EOE.
This issue of the Carolina Journal of Pharmacy is being mailed to all
pharmacists registered in North Carolina as well as out-of-state members of
the NCPhA and other friends of pharmacy. Non-members are receiving
this issue only as an introduction to some of the areas in which the NCPhA
is working to improve the profession. We hope non-members will find
enough worth-while activities to consider joining or re-joining their state
pharmacy association. A letter of invitation will soon be mailed.
MANAGEM«#£ >•
REP0Rt$-"4/ -S?
\
0R0EB ENTW
AND INVENT^,,
MANA&tMEWf."
COUPON '
REDEEMPTtG«<
PROGRAM
Put all your eggs in one basket !
Being an independent pharmacist is like walking on egg shells.
The highly computerized systems and massive buying power
of the big chains make the competition tougher than ever.
The best way to meet this competition is to take advantage
of our buying power, computerized systems and our commit-
ment to a high level of service and quality products. So, if
you want a higher measure of return on your investment, put
all your eggs in our basket.
• Electronic Order Entry and Inventory Management • Pharmacy
Computer Systems • Cost Plus Purchasing • Special Deal Purchasing
• Automatic Price Updates • Home Health Care Products • Manage-
ment Reports • Store Planning and Design • Employee Training
• Merchandising and Planogramming • Advertising • Coupon Re
deemption Program
Owens &Minor;Inc.
1010 HERRING AVENUE • WILSON, NORTH CAROLINA 27893 • 1-919-237-1181
"Toll Free 1-800-682-2270"
Dr.T.C.Smith Co. / W.H.King Drug
ASHEVILLE, N.C. 28806 • 704/258-2645
RALEIGH, N.C. 27622 • 919/782-8400
TOTAL
HOMESPUN
SERVICE
In today's business rush we take the time to help
you with your management decisions . . . whether its
over coffee or part of a regular sales call. We will fill
your order with care and with dispatch today. Just as
we did in 1869.
We use advanced technology to lead in service to our
customers.
Some of our available programs are Electronic Order
Entry • Merchandising and Programming • Valurex
Advertising & Promotion • Retail Pricing • Micro-
fiche • Pharmacy Computer Systems
Health Care and much more.
Whether you take your coffee
black or with cream,
call us to find
out more details.
VALUREX INDEPENDENT
PHARMACY
ADVERTISING & PROMOTIONAL
PROGRAMS
"TO HELP YOUR BUSINESS IS OUR BUSINESS
1HE QUROUNk
JOURNN-OfPHN^MKCY
LU
CO
1^
o
LU
§
x Ym
:
111
1
iC:5
■jH i
■ -'Sj
i jS^Sr^wT^
A iS
ilneliKfll
oo
o
Melinda Kay Steele, /eff and Lori Lee Wilkins accept the cash
awards for the Ralph Peele Rogers Memorial Pharmacy
Administration Award from Ralph Rogers, Jr. Story on
page 12.
n^ - 7 J987
Health Sciences Library
223-H
UNC
Chapel Hill, NC 27514
Thank You,
Kendall Customers!
For over 65 years, Kendall has been
serving pharmacists in the Southeast.
Your changing needs and ideas have
helped us grow into the service
oriented wholesaler we are today.
We appreciate your loyalty and
support, and we strive to provide
Kendall Staff:
continued excellent service. This
includes evening order taking, accurate
order filling, fast delivery, and a 95+%
service level.
Thanks again, Kendall customers,
for making us your full-line
pharmaceutical wholesaler.
Front Row:
Billy Hawkins (Shipping); Sarah Owens (Warehouse); Linda Towery (Receiving)
Back Row:
Sherry Goforth (Accounting); Sherry Barrett (Data Processing); John Wortman
(Purchasing); Scott Helms (Receiving); Bobby McDaniel (Sales)
IK
ILXDRLJG COIVIF>AIMV
1305 Frederick St. • P.O. Box 1060 • Shelby, N.C. 28150
NC 1-800-222-3856 • SC 1-800-438-5330
Justice Drug Company
P.O. Box 22025
Greensboro, NC 27420
AN ALCO STANDARD COMPANY
Now in our 87th Year of Service to the North Carolina Pharmacists
1-800-632-1295
fOlff Partnership
For Profit
Family
Independent
Pharmacy
Total Retail Concept
The Family Independent Pharmacy program provides an
all-inclusive plan covering every aspect of marketing,
merchandising, and management of drug store opera-
tions. It is a wholesaler-sponsored voluntary, and it
embraces the total retail concept in all its forms.
Thhc
TOTAL HOME HEALTH CARE
Our Total Home Health Care ™ Program offers Durable
Medical Equipmentfor Rent orResale. Third Party Billing
for Medicare/Medicaid.
Additional
* Services & Programs Offered *
Store Plan-O-Gram: Complete Store Layout & Design
including Fixtures, Merchandise Plan-o-graming,
and Pricing Strategies
Specialty (Jift Departments including Arts & Crafts
Affordable Pharmacy Computer Systems
LIBERTY DRUG SYSTEMS, INC.
QS/1 PHARMACY SYSTEMS
Merchandise Racking Service
Group Life
And Health
Insurance
Benefits
For Members Of
North Carolina
Pharmaceutical
Association
Jefferson-Pilot Life Insurance Company is pleased to
have been selected as the Group insurance carrier for
the North Carolina Pharmaceutical Association. It would
be to your advantage to become thoroughly acquainted
with the benefits of this program.
You can expect the best possible service from
Jefferson -Pi lot, one of the nation's leading Group
insurance carriers. For full information, contact Mr. Al
Mebane, Executive Director, North Carolina
Pharmaceutical Association.
Write or call:
Sam P. Stuart, CLU
P. O. Box 595
Winston-Salem, NC 27102
Telephone 919/723-8811
Jefferson
Pilot
INSURANCE / FINANCIAL SERVICES
THE OIROLINk
JOURNMofPHN^MkCY
JULY 1987
Officers
NORTH CAROLINA
PHARMACEUTICAL
ASSOCIATION
President
Julian E. Upchurch
5201 Pine Way
Durham, NC 27712
(919)477-7325
Vice Presidents
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh, NC 27612
(919) 876-5600
W. Robert Bizzell
1007 Rhem Street
Kinston, NC 28501
(919) 527-6929
Loni T.Garcia
5210 McLeod Road
Lumberton, NC 28358
(919) 738-6441, Ext. 7317
Executive Director
& Editor
A. H. Mebane, III
P.O. Box 151
Chapel Hill, N.C. 27514
NCPhA Office
(919) 967-2237
or
1-800-852-7343
(USPS 091-280)
VOLUME 67
ISSN 0528-1725
NUMBER 7
CONTENTS
President's Page 4
UNC School of Pharmacy Strategic Plan 5
Trends Affecting Pharmacy Education & Practice 7
Report of the Employer/Employee Relations Committee ... 9
Two Students Win Rogers Award 12
Giving the Consumer a Say j 14
CE Course — Soft Contact Lens Solutions 1 18
Dickinson's Pharmacy '25
Pharmacists Help Medic Alert Save Lives 1 27
How To Avoid Poisoning 31
Classified Advertising 34
Births, Deaths and Weddings 36
ADVERTISERS
Colorcraft -32
Dr. T. C. Smith Co./W.H. King Drug Back Cover
Eli Lilly and Company 28
Geer Drug 22
Gene Minton Consulting Services 24
Jefferson-Pilot 2
Justice Drug Division 1
Kendall Drug Company Inside Front Cover
Owens & Minor, Inc Inside Back Cover
Store Fixtures & Planning, Inc 6
The Upjohn Company 10
Washington National Insurance Company 30
The Carolina Journal of Pharmacy is published monthly by the
North Carolina Pharmaceutical Association, P. O. Box 151,
Chapel Hill, NC 27514. The Journal is provided to NCPhA
members through allocation of annual dues. Subscription rate to
non-pharmacists (continental US) $20.00. Single copy price
$2.00. Overseas rates on request. Second class postage paid at
Chapel Hill, NC.
THE CAROLINA JOURNAL OF PHARMACY
PRESIDENT'S PAGE
What is your most important possession?
Think about this question for 60 seconds before
you continue to read this article — 56-57-58-59-
60. OK, I am sure that you came up with some
really important things in your life that are very
dear to you. Let's consider a few; your health,
family, friends, house, car, freedom, church, etc.
The list could go on and on. There is one thing
that I did not name that I hope you did, as this is
the subject I would like to share with you.
I hope that you named your profession of
pharmacy, and your job in this profession as
being one of your most important possessions. To
discover just how important your pharmacy
profession is to you, let's take 60 more seconds
and think of all the things your job and profession
allows us to do. Our profession has a very direct
relationship to all of the important possessions
that we have listed; our house, family, car,
church, friends, and even our health. I think that
you will have to agree with me that pharmacy is
important to you! I also want to tell you
something that many of you do not know. YOU
are important to the profession of pharmacy and
its survival as one of our most respected
professions! YOU are the face of pharmacy to the
public and you've done a good job!
At this point, I would like to ask your help in
continuing to help your profession, so that your
profession can continue to serve you. I would like
to establish a $ 10 Club for Pharmacy in our state.
This is not a new idea. The Methodist Church
uses this method of raising necessary funds very
successfully. All we need is for you to commit to a
$10 gift to the profession of pharmacy on a
maximum of two times a year. If we all pool our
$10's, we can have the money to work with on
projects needed for the support and survival of
pharmacy as a profession. We need the money
for legislative activity, eg. "Doctor-prescribing",
mail order prescriptions, third class of drugs,
lobbying, student loans, NCPhA Endowment
Fund, needed repairs to the Institute, and many,
many more good causes. We need money with
no strings attached, that can be used for any
purpose that will help or further our professional
goals. Let's look at it this way. Today $ 1 0 is about
the price of a meal in a restaurant. Will you take
your profession out to eat a couple of times a year
so that your profession can feed your family the
rest of the year?
Please do not procrastinate on this $10 Club.
We need each of you! You may not have the time
to devote to the furtherance of pharmacy as a
Julian E. Upchurch
NCPhA President
profession other than your daily activity, but your
$ 10 gift will give others the tools to work with for
you and for pharmacy.
We all know that there is strength in unity! We
are all pharmacists whether we are in a hospital,
retail, teaching, or manufacturing. I ask for the
full support of your time, talent, and money. If
you let down your profession, you are only
hurting yourself!
Please join me today and become a charter
member in the NCPhA Ten Dollar Club. Mail
your check to NCPhA Ten Dollar Club, P.O.
Box 229, Chapel Hill NC 27514. Thanks and
you'll be glad you did.
ERRATA for May issue.
The advertisement for Dr. T.C. Smith
Co./W.H. King Drug which appeared in
the May issue (Volume 67, #5) was the
result of a printing error in the reference to
QS/1 Computer System. Dr. T.C. Smith
Company and W.H. King Drug are not
agents or distributors for the QS/ 1 System
which is handled by other drug
wholesalers advertising in this journal.
The editor apologizes for any incon-
venience or misunderstanding resulting
from this mistake.
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
UNC
SCHOOL OF PHARMACY
STRATEGIC PLAN
Executive Summary
Significant changes in the health care delivery
system and rapid advances in technology will
clearly impact the pharmacy profession.
Recognizing this changing environment, the
School of Pharmacy has been engaged in a
strategic planning initiative, and has developed
the school's first strategic plan. The planning
process involved significant input from the
faculty, pharmacy practitioners, business and
industry leaders, pharmaceutical association
representatives, and other health professionals.
Thoughtful consideration was given to some of
the emerging trends in the health care delivery
system, such as: the rapidly increasing numbers of
elderly, the declining numbers of small rural
hospitals providing traditional hospital services,
the increasing amount of health care being
delivered through outpatient service centers and
in the home, the growth in the use of alternate
forms of drug distribution, such as through
individual physicians and via the mail, the
increasing use of self-administered testing to
detect disease, the emerging physician surplus,
rapid advances in technology that bring about
new forms of drug therapy, the increasing use of
computers in diagnosis and management of
disease, the increasing use of HMO insurance
plans and decline of the traditional fee for service
reimbursement system.
In light of these changes, consideration was
given to the future role of the pharmacist and how
these omnipresent trends might effect pharmacy
education. The following areas have been
identified as deserving of special attention:
The Need to Allow for Specialization
The Need to Expand Computer Expertise
The Need to Focus on Teaching Strategies
The Need to Acquire Modern Equipment
The Need to Foster Business and Industry
Relations
The Need to Stress Fund Raising Goals
The subject of specialization directs attention
to the manpower needs in North Carolina and to
the educational programs required to meet those
needs. It has been determined that the school
should continue to graduate at least 165 students
a year in the BS and Doctor of Pharmacy
programs combined; beginning in the Fall of
1987, the school plans to gradually increase the
Doctor of Pharmacy enrollment by between 5
and 10 students per year, with comparable
decreases in Baccalaureate enrollment. Plans also
call for increasing the numbers of graduate
students who hold professional pharmacy
degrees. The school will continue to closely
monitor the changing environment to determine
the extent these gradual programmatic changes
are addressing the needs of the marketplace. In
addition, the school will continue to address the
needs of the practicing professional, the school's
most visible product and a stalwart of the
pharmacy profession, and begin to develop new
educational opportunities for them.
Undeniably, computerization is having an
impact on all aspects of pharmacy education and
professional practice. To sustain its leadership
position, the school must define the role of
computers in both pharmacy practice and
education, and fully implement their use by both
students and faculty. The strategic plan calls for
increasing the number of personal computers by
15 to 20 per year, through targeted fund raising
and grant requests. Faculty are being encouraged
to incorporate computer use into the curriculum
and also focus on teaching techniques that will
enhance students' skills in the areas of
communications, problem solving and manage-
ment. The plan calls for the school's curriculum
committee to survey the faculty to determine
what innovative teaching techniques are
presently being used, examine their effectiveness
and, where appropriate, encourage their broader
application.
To maintain its leadership position in graduate
education and research, the school recognizes the
need to upgrade its equipment and laboratories.
There is an urgent need to replace its 90 MHZ
NMR and develop a practical "space needs" plan
that will assure continued research progress. A
key strategic element that is intended to further
enhance research opportunities is the creation of
an "Industry Advisory Committee" and
continued dedication to the enhancement of
business and industry relations.
Recognizing that striving for continued
excellence inherently requires increasing funds,
and that State resources are likely to remain
limited, the school plans to look towards
specialized fund raising efforts to reach its goals,
that will be targeted towards specific needs, such
as computer acquisition and faculty develop-
ment. The development of a strong and
Continued on page 6
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
STRATEGIC PLAN
Continued from page 5
comprehensive public relations plan is also a key
element in this strategy.
In addition to the areas highlighted above, the
strategic planning document sets forth very
specific objectives and strategies in each of the
following areas:
Pharmacy Manpower Needs
The Doctor of Pharmacy Issue
Achieving Educational Excellence
Enhancing Faculty Development
Enhancing Business and Industry
Relations
Marketing the School and the Profession
Attracting Financial Support
Addressing Facility Requirements
Promoting Service to the Community
Promoting Research
Continued Planning
In conclusion, the School of Pharmacy is very
pleased with the progress it has made towards
achieving academic excellence. As one of the
nation's leaders in pharmacy education, the
school has now clearly reaffirmed its
commitment to excellence for the future, by
incorporating into its plans the continuation of a
strategic planning initiative that will assure its
continued dedication, clear programmatic
direction, and resolute success.
from "The School of Pharmacy, A Strategic Plan,
Planning for Excellence" The University of North
Carolina at Chapel Hill
THE EXPERIENCE WE'VE GAINED FROM
OVER 200 PHARMACY INSTALLATIONS IS
AVAILABLE TO YOU . . .
AND, WE ARE THE ONLY STOCKING
DISTRIBUTOR OF DRUG STORE FIXTURES IN
THE CAROLINAS.
IF YOU NEED A SINGLE FIXTURE OR A
COMPLETE STORE. OUR PROFESSIONAL
STAFF IS READY TO SERVE YOU
"THE AREAS LARGEST DISTRIBUTOR OF
MODULAR DISPLAY FIXTURES"
RICHMOND, VIRGINIA CHARLOTTE, NORTH CAROLINA
7921 -A WEST BROAD ST. 3555 TRYCLAN DRIVE
(804) 740-0793 (704) 525-5300
ROLAND THOMAS RANDY BIVENS
"WE ARE MORE THAN A FIXTURE COMPANY— A TEAM OF PHARMACY
SPECIALISTS WITH OVER 60 YEARS COMBINED EXPERIENCE IN OVER
500 DRUG STORES"
5p
STORE FIXTURES
& PLANNING, INC.
mroRe rucnjmew
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
TRENDS THAT WILL EFFECT
PHARMACY EDUCATION
AND PRACTICE
Approximately 1000 individuals were directly
involved in providing information for the
strategic planning process. To provide specific
background information that sets the stage for the
strategic plan's thrust, a brief summary of the
trends that is expected to affect pharmacy
education and practice now and in the future are
provided below, along with a summary of what
these trends imply for pharmacy education.
(Please refer to Exhibit A for a graphic depiction
of these trends.)
The Growing Number of Elderly
The percentage increases in the elderly
population are growing at an even greater rate in
North Carolina than in the nation. By the year
2000, there will be more than one million North
Carolinians over the age of 65, up from
approximately 695,000 individuals over the age
of 65 in 1 986. The population over the age of 80
will increase by more than 90 percent in 75 of
North Carolina's 100 counties by the year 2000.
The Changing Role of Hospitals
Many small primary care hospitals will close
or significantly alter their focus to an outpatient
service orientation.
Larger hospitals will become centers of high
technology, and as a result of consolidations and
closings there will be fewer larger acute care
facilities of this genre. A relatively small number
of major "for-profit" chains will dominate the
hospital market.
The Focus on Outpatient Services
More health care services will be delivered on
an outpatient basis in specialized outpatient
service centers, such as ambulatory surgery
centers and freestanding diagnostic and therapy
clinics.
More health care services will be provided by
and through commercial enterprises such as
shopping malls, department stores, and business
worksites.
More health care will be delivered through
community services; by home-based service
providers and through schools in varying degrees
at various levels.
New Forms of Drug Distribution
The traditional forms of drug distribution,
through community based pharmacies and
through hospital in-patient services will be facing
new competition. Drug distribution through mail
order services and direct physician dispensing has
already begun. As hospitals increase their
emphasis on outpatient services, hospitals will
consider expanding and altering their distribution
functions.
The Increasing Use of Self- Administered
Testing
More health care will be self-administered or
administered by a family member. Self-adminis-
tered blood tests, pregnancy tests, and cancer tests
are current examples of what is on the horizon.
The Emerging Physician Surplus
The number of physicians is continuing to
grow at rates three times greater than the general
population and is projected to increase more than
50 percent between 1980 and the year 2000.
The incidence of drugs being dispensed by
physicians is increasing and expected to continue
with the rise in the commercialization of
physician practices.
The Rapid Advances in New Technologies
Rapid advances in technology and science will
bring about revolutionary changes in diagnosis
and delivery of health care. Examples of recent
advances include the use of nuclear magnetic
imaging devices, lithotriptors, digital subtraction,
robotics and monoclonal antibodies.
Many of today's experimental and high cost
medical miracles will become routinely
performed in specialized centers. New forms of
drug therapy will become commonplace in the
treatment of problems related to the aging
process.
Computerization of the Health Care Industry
Computers will be involved in every aspect of
health care delivery, from the business opera-
tions, to patient diagnosis and treatment.
Continued on page 8
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
TRENDS
Continued from page 7
The Increasing Number of HMO Insurance
Plans
There have been estimates that by the year
2000, more than 25 percent of the population
may be enrolled in HMO plans, a dramatic
increase from today's approximately 8 percent.
Expanded federal incentives for financing care
for the elderly and poor could further accelerate
this trend.
Immediate Implications These
Trends Have for Pharmacy
Education
The trends that have been identified have
important and immediate implications for the
Pharmacy profession. The School of Pharmacy
has considered the implications identified below
in the development of its strategic plan and has
begun and will continue to address all of the
following implications through specific
curriculum changes, through new teaching
approaches, and through additions to the
experiential and "hands on" components of the
curriculum:
The Need for Specialization
Hospital and community pharmacists will
require a greater degree of sophistication and
specialization to deal with further technological
advances, and to interact with, or "treat," a
generally sicker patient population.
The Need for Computer Expertise
Pharmacy Professionals will experience an
increasing need to be well versed in computer
technology applications, in both the health care
service delivery areas and in the business and
management area of pharmacy practice.
The Need for Enhanced Business Skills
Pharmacy Professionals will increasingly find
it necessary to have strong marketing and
management skills in order to evaluate and
appropriately respond to the new markets that
will be created for selling and distributing health
care products, equipment and services, and for
the provision and packaging of these services for
individual home use.
The Need for Continuing Education
Pharmacy Professionals will find it necessary
to keep abreast of changes in the entire health
care delivery system and will need to consider the
direct and indirect implications of such changes
on pharmacy practice and pharmacy prac-
titioners.
The Need for Effectively Communicating the
Rapidly Increasing Quantities of Drug
Information
Pharmacy Professionals should and must be
highly knowledgeable "drug and medication
experts" and become effective "communicators"
of their expertise to health care providers and
consumers. These skills will require not only a
comprehensive knowledge of drug use and drug
interactions, but will demand enhanced
proficiency in communication skills.
The results of a comprehensive statewide
survey, which was undertaken as part of the
strategic planning process, helped to highlight
and further confirm for the school that the
following areas in the School of Pharmacy's
program need to be given greater attention:
Programmatic Areas Needing Greater
Attention
• Practical Experience
• Problem Solving Skills
• Business and Management Skills
• Communications Skills
• Product Information
• Computer Use and Application
The UNC-CH School of Pharmacy has
already begun to make adjustments in the
School's programs so that students who will be
graduating over the next five years will be
prepared for the changes that will be taking place
in the health care system.
From Planning for Excellence, A Strategic Plan,
The University of North Carolina at Chapel Hill
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
REPORT OF THE EMPLOYER/EMPLOYEE
RELATIONS COMMITTEE
Presented at the 107th Annual meeting of the North Carolina
Pharmaceutical Association, April 22-25, 1987, Charlotte
Minutes of the NCPhA Employer-Employee Relations Committee
Institute of Pharmacy, Chapel Hill
January 7, 1987
Members Present: Charles D. Blanton, Chairman, Stanley A. Biedney, John Mackowiack, Roy B.
Smith, Jr., John F. Watts, Al Mebane
I. After discussion, members voted unani-
mously to recommend that the NCPhA
initiate and fund a survey of pharmacists to
determine, among other things, salary
compensation, fringe benefits, and working
conditions.
A. The Committee specifically wanted
questions touching the following areas
1. Male vs. Female — employment
terms
2. New pharmacist vs. those with 10
or more years experience
3. Overtime policies
4. Hospital and institutional pharma-
cists compensation and fringe
benefits
5. Professional liability insurance
II. Polygraph and Urine Testing
A. The Committee agreed upon the
following
1 . Doubtful accuracy of polygraph
2. Variance due to testing conditions
and administrations of tests
3. Degrading to professionals such as
pharmacists
4. Should be limited to investigation of
problems such as money loss,
control substance loss or abuse, or
merchandise disappearance.
B. Therefore, the Committe voted to
submit a resolution urging the
following
1. Elimination of pre-employment
and routine polygraph testing
2. Substitution of written profile tests
to screen prospective employees
3. Support of any federal or state
legislation to ban these questionable
and controversial electronic testing
procedures
C. The Committee expressed concern
about urine testing in the following
areas
1. False positives
2. Laboratory errors
3. Range of substances to be tested for
4. Some ethical questions as with
polygraph
5. A watchful stance is recommended
to the NCPhA
III. Professional Expenses — should employers
pay Association Dues, CE expenses, license
renewal, etc? NOTE: Tax Reform Act of
1986 severely limits these items as tax
deductions to individual pharmacists.
A. The Committee wishes to submit a
resolution to the annual meeting
suggesting that employers provide an
optional expense account (with set
dollar limit) to be used at employed
pharmacist's discretion in meeting these
expenses. These to be reimbursed on a
case-by-case basis up to dollar limit.
IV. Professional Liability Insurance
A. Questions were raised about true
protection provided to employed
pharmacists. It is possible that
insurance company can reimburse
corporation for liability loss, then sue
the individual pharmacist to recoup the
loss.
B. Also concern was expressed about
unavailability of personal professional
liability insurance in North Carolina.
C. Recommendations
1 . Incorporate questions about this in
proposed survey
2. Inform pharmacists of availability
of coverage through NCPhA master
policy.
V. Employment Conditions and Contracts
A. After discussion for need of defining
responsibilities of both employer and
Continued on page 11
July, 1987
10
THE CAROLINA JOURNAL OF PHARMACY
We think
special
achievement
is worth a little
The philosophy that "good enough" will do, simply
isn't acceptable anymore.
We must locate and encourage the young
men and women who consistently do more than is
expected of them.
This is why we established our Upjohn
Achievement Award program in 1972.
Each year plaques and stipends are received
by outstanding seniors in the nation's colleges
of pharmacy. Men and women who are chosen by
their faculties to be honored for community
service or scholastic achievement.
Future pharmacists who will "go for the gold"
because they can do no less.
1985 The Upiohn Company, Kalamazoo, Ml
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
11
RELATIONS COMMITTEE
Continued from page 9
employee, the Committee asked the
NCPhA to develop and distribute a
model pre-employment form (to be
adopted for individual or employer
use).
B. Also suggest article be published in the
Carolina Journal of Pharmacy
featuring this form and stressing items
to be determined at time of em-
ployment.
VI. Retirement Plans
A. Since many employed pharmacists
who are part of "2 earner" families will
no longer be eligible for tax-deductible
IRA contributions, the Committee
would like to submit a resolution urging
employers to offer alternate tax
sheltered plans to pharmacist, such as
Keogh and 401 K.
Minutes recorded and interpreted by
Charlie Blanton, Chairman
Employer/Employee Relations Committee
Committee Members
Charlie D. Blanton, Jr., Chairman
Robert S. Beddingfield Olen Clyde Naylor, Jr.
Stanley A. Biedney Roy B. Smith, Jr.
Larry D. Cole, Jr. John F. Watts
Woodson B. Fearing Lee D. Werley, Jr.
DRUG ABUSE BY
PHARMACISTS AND
PHARMACY STUDENTS
A study published in the February issue of the
American Journal of Hospital Pharmacy reports
that almost half of 312 pharmacists and two
thirds of 287 pharmacy students who responded
to a questionnaire on drug use had used
controlled substances at some time without
prescriptions. The drugs most commonly used
were marijuana, stimulants, tranquilizers, and
opiates. Authors of the report, all of whom are on
the faculty of the Harvard School of Public
Health, Boston, conclude that the extent of use
was "usually quite small in light of the many
years of drug access, and use was often for self-
treatment." Nonetheless, they recommend that
more drug-abuse prevention programs for
pharmacists and pharmacy students are needed.
July, 1987
The research team mailed the survey
questionnaire in November 1984 to 510
pharmacists and 470 pharmacy students living in
Massachusetts. The 40-item, multiple-choice
questionnaire contained questions on demo-
graphics, principal work setting or year in school,
access to drugs, and drug and alcohol use. Results
were derived by using standard methods of
statistical analysis.
Pharmacy students used drugs more frequently
than did the practitioners, primarily because of
greater recreational use among the former group.
The purpose of drug use by pharmacists was
rather equally divided among self-treatment,
recreation, and performance enhancement.
Certain demographic risk factors were also found
to be associated with recreational drug use; it was
highest among young pharmacists, those of
American citizenry, and those who rarely or
never attended religious services.
Work settings influenced practitioners' drug
use. For example, among those pharmacists
working in sales or other nontraditional settings,
86 percent reported ever having used a drug;
among those working in health maintenance
organizations and clinics, 38 percent were either
dependent or at risk of abuse. Hospital
pharmacists had the lowest percentage in these
drug-use categories.
Impairment of pharmacists because of drug or
alcohol abuse has recently emerged as an issue for
the profession. At least 30 states have
implemented programs for impaired pharma-
cists. Epidemiological evidence of the extent of
drug abuse by pharmacists, however, is scant.
Based on this initial study, the authors conclude
that there is a clear need for continued
development of impaired-pharmacist commit-
tees and drug-abuse programs for pharmacists.
The report's authors are William W.
McAuliffe, Ph.D., Susan L. Santangelo, Judy
Gingras, Mary Rohman, Ph.D., Arthur Sobol,
M.A., and Elizabeth Magnuson. Information in
the report was derived from a larger study of
drug-use patterns that also included practicing
physicians and medical students. That report, of
which McAuliffe was also primary author, was
published in the New England Journal of
Medicine in September 1 986. A brief review of
this study appears in the News section of the
February issue of AJHP.
For a copy of the report, "Use and Abuse of
Controlled Substances by Pharmacists and
Pharmacy Students," contact the American
Society of Hospital Pharmacists Public
Information Department.
12 THE CAROLINA JOURNAL OF PHARMACY
TWO UNC STUDENTS WIN ROGERS AWARD
Program participants, left to right, A.H. Mebane, II!, Melinda Steele, Ralph Rogers, Jr., Lori
Wilkins, Dr. Jean Gagnon.
Melinda Kay Steele and Lori Lee Wilkins,
both UNC School of Pharmacy fourth year
students, were awarded the Ralph Peele Rogers
Memorial Award for excellence in Pharmacy
Administration at a dinner held in the Carolina
Inn.
The award, made possible by the family of
Ralph Rogers, Sr.; Mr. and Mrs. Ralph P. Rogers,
Jr. and Mr. and Mrs. J. Clinton Rogers, both of
Durham, and Mr. and Mrs. Elizabeth Rogers
Millar of Winston, is presented to a fourth year
student who exhibits an interest in pharmacy
administration and community pharmacy, is
outstanding performance in classwork and
submits a paper on pharmacy which is judged by
the faculty of the UNC Division of Pharmacy
Administration.
For the first time in the nine-year history of the
award, two students were declared to be winners.
Melinda Kay Steele from Shelby and Lori Lee
Wilkins from Gastonia, each having over a 3.3
grade point average, were recognized at a dinner
held in their honor. Representatives of the faculty
and administration of the UNC School of
Pharmacy, the NC Pharmaceutical Association,
their parents and the Rogers and Millar families
in attendance.
Al Mebane, Executive Director of the NCPhA
served as Master of Ceremonies with remarks
about the award and the selection process given
by Dr. Jean Paul Gagnon, Chairman of the
Division of Pharmacy Administration. Ralph
Rogers, Jr. told of his father's interest in
community pharmacy, stories about growing up
in a community pharmacy environment and the
need for expertise in business which led the
family to establish the award.
KAPPA EPSILON
The North Carolina Alumni Chapter of Kappa
Epsilon Fraternity will meet Sunday, October
1 8, 1 987, 2:00 pm at the Institute of Pharmacy in
Chapel Hill.
Topics include the installation of Alpha Rho
Chapter at Campbell University, a review of the
1987 Annual Convention, and Care Packages.
Anyone interested is invited to attend. For more
information, call (919) 846-5799.
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
13
"FINESSE FOR SUCCESS IN
A FUTURE PHARMACIST"
by Melinda K. Steele
(Application Essay for Division of Pharmacy
Administration Awards)
In the vast world of health care, pharmacy has
grown to become a large and very vital part of the
system. Pharmacy has changed dramatically over
the last twenty years and is sure to continue in its
fast-paced improvement in providing quality
health care to the patient. In order for this growth
to occur, the future pharmacist must take on large
responsibilities as a professional and bring fresh
new ideas into the clinics, hospitals, community
pharmacies, and other health care settings. Each
pharmacist must set his own goals, both personal
and professional, although many times the two
are intertwined with each other. I, myself, have
set these goals for my career in order to become a
successful pharmacist.
Being a fourth year pharmacy student, the goal
of education still lies in the forefront of my career.
The vast sea of knowledge has begun to unfold its
depths as I learn through each semester. The
responsibility to society as a pharmacist begins
with striving to comprehend and apply this
wealth of information to be able to provide the
best care possible. Even after graduation, as the
data base expands, so should mine through
continuing education. We are expected to extend
this knowledge, especially drug information, to
the people and fellow professionals. After all, we
are servants to the public. The most important
goal set for myself as a pharmacist is to be the
most useful information source possible,
particularly in the drug related areas, no matter
where I take my career.
The environment in which I plan to practice
pharmacy is in the community pharmacy. I enjoy
interactions with the public at large and feel I will
give the most benefit to the most people in this
setting. Not only will I be dealing directly with
the patients through consultation and dispensing,
but I will also be available to other health
professionals for advice whenever the occasion
should arise. I would like to start out in a chain
pharmacy to learn the ways of the trade. Not only
is there exposure to a great many drugs, but the
opportunity to start to develop the needed
communication skills exists. Working my way up
to the position of manager of the pharmacy
department in one of these chain pharmacies is
another goal set. This position would allow me to
July, 1987
utilize my skills to make the pharmacy most
productive and efficient yet also to meet the needs
of the consumers. Looking further down the
career road, the goal of becoming a manager and
possibly part owner of an independent pharmacy
carrying only health care products and
medication has been set.
When looking at the various career goals I
have set for myself, they may be generalized by
the main goal of being a pharmacist to the utmost
of my ability. Of course these goals may change
and new ones set as opportunities present
themselves. However, the phrase I'll adhere to in
my career is an altered cliche: Ask not what
pharmacy can do for you, but yet what can you
do for pharmacy.
"STARTING A CAREER
IN PHARMACY"
by Lori Wilkins
(Application Essay for Ralph P. Rogers, Sr.
Pharmacy Administration A ward)
I am beginning my pharmacy career right here
while still in school. By taking a variety of classes
in pharmacy school, I am working toward
becoming a success in the business world as well
as a respected pharmacist to my patients. As far as
when I graduate, I hope to find a job in an
independent pharmacy, where I would have time
to spend with my patients. I have worked
extensively in both a chain and independent
setting and I have found that indepdendent
pharmacists have the time and chance to consult
with patients as well as other health professionals,
thereby truly practicing their profession.
I also want to promote pharmacy in the
community, to let the public know what services
we can offer them. As a member of SAPhA I
have already started working towards this goal.
By sponsoring Hypertension and Diabetes
Screening Clinics, the community is conscious of
what the pharmacy school as well as the
pharmacists can provide to them. As a
pharmacist I want to continue these services.
They are vital to health care today and I want to
strive to make the public aware of them.
14
THE CAROLINA JOURNAL OF PHARMACY
GIVING THE CONSUMER
A SAY
by Bruce R. Siecker, Ph.D., R.Ph.
and
Beverly A. Gilbert, R.Ph.
Galaxy Enterprises
P.O. Box 1242
Springfield, VA 22151
With so many choices facing the consumer, it
is very important that pharmacists know how
they and their pharmacy rate with area shoppers.
People have many more choices today in
deciding where to get their prescription needs,
health and beauty aids, and the various sundries
found in the typical community pharmacy.
Grocery and mass merchandisers, together with
mail-order, physician dispensing, and hospital
out-patient services, are all competing for the
same consumers. In such an environment, it is
very important that pharmacists stress service by
continually monitoring their clientele.
Consumers are increasingly segmenting
themselves into narrower life-style bands. The
Saturday shopper in jeans may be the same one
that wears a business suit during the week. What
appears to the casual observer to be a
neighborhood full of married couples may in
reality be singles who are simply sharing housing
expenses. Their needs and shopping behavior are
often quite different than what might be
expected. The challenge for today's pharmacy
manager is to identify the nature of current and
potential customers in some systematic way as a
means of keeping the pharmacy in synch with its
environment.
Trying to determine shopper reactions and
needs in a busy pharmacy is not easy. Often
shoppers are too busy to talk or may feel reticent
to express their real feelings directly. They may
also need more time to think about their answers.
Trying to ask their opinions in the store may
disrupt normal service, which is counter-
productive to the intended purpose.
If customer service is to be more than a
buzzword, it makes sense to learn what customers
really want by asking them in a systematic
fashion. One way to accomplish this is to use a
written, self-addressed, postage-paid question-
naire that shoppers would be asked to complete
and mail back to the pharmacy. An effective way
to position such a program is to give it a special
name, e.g., "Rate Us", "It's Your Turn", or "You
Tell Us". Employees should be told of the
importance of the effort — "It is our way of
learning what the customer really wants; a
satisfied customer is easier to serve, which will
make your job easier" — and be given suggested
ways of presenting the program to shoppers —
"Mrs. X, here is our new 'Rate Us' survey form.
We really want to learn what you think of us and
how we can do a better job for you. Won't you
please take a few minutes to fill out the form,
when you get home. Then just staple it closed and
drop it in a mailbox. We'll even pay the postage.
We read and discuss each card sent in and do our
best to improve our service to you."
There are many questions that can be asked
and different ways to set up such a questionnaire.
Here is a sample that can be used as is or as the
basis for developing your own. (The reverse side
can be used for the return address and a message
to the shopper.)
One employee should be given the
responsibility — a good candidate is one with a
history of problems in understanding why good
service is so important in a community pharmacy
(as a good object lesson) — of recording and
compiling the results on a periodic basis.
Customer feedback, honestly considered and
acted on, is surely preferable to their simply going
somewhere else. Survey results can be used
effectively in staff meetings to improve every
aspect of a pharmacy's operation, particularly
employee attitudes.
In today's highly competitive world, pharmacy
employees and managers need constant
reminders that consumers have real choices. The
best way to assure that they choose your
pharmacy is to seek their views continually. If
listening is followed by sincere action that
maintains a truly market-driven pharmacy, the
future of community pharmacy services will be
much brighter.
It's Your Turn
Dear Shopper:
At ABC Pharmacy we do our very best to
provide high quality products and services that
meet your needs. But, we want to be even better.
One way to accomplish this is by asking for
— and then reviewing — your opinions. Below
are several factors that shoppers tell us are
important to them. Please circle the number that
best describes your opinion about ABC
Pharmacy.
Continued on page 15
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
15
IT'S YOUR TURN
Continued from page 14
Key: l=excellent; 2=verygood; 3=average;
4=below average; 5=poor
Employee product knowledge
12 3 4 5
Employee courtesy
12 3 4 5
Employee friendliness
12 3 4 5
Quality of prescription services
12 3 4 5
Product quality
12 3 4 5
Products on hand
12 3 4 5
Everyday prices
12 3 4 5
Sale prices
12 3 4 5
Overall value for money spent
12 3 4 5
Complaints handled satisfactorily
12 3 4 5
Return policy
12 3 4 5
Store hours
12 3 4 5
Store cleanliness
12 3 4 5
Parking area
12 3 4 5
Emergency prescription service
12 3 4 5
Delivery service
12 3 4 5
Overall rating of ABC Pharmacy
12 3 4 5
Compared to other stores
12 3 4 5
Comments: Please tell us what else — complaint?
compliment? An outstanding employee? — you
think we should know or improve.
Thank you very much. Simply fold this form in
half and staple; then drop it in a mailbox. Postage
paid by ABC Pharmacy.
Rest assured ... WE DO LISTEN.
PJK''^V
■*- ' fl
lp5m
V\ It^l^B
D* 1N^ """^^BPB
r~Hi Zj% -Bni
Bobbie S. Barbrey, center, and his wife Nancy
display the Syntex Practitioner-Instructor of
the Year Award presented by UNC School of
Pharmacy Associate Dean George H. Cocolas.
Barbrey lives in Raleigh and is a native of
Michigan. The award is voted on by the
students on rotation.
WORKSHOP ON
CONSULTANT PHARMACY
SERVICES SET FOR
WILMINGTON, September 19
The NCPhA's Academy of Consulting Pharmacy
will co-sponsor a workshop on consultant pharmacy
services with the UNC Geriatric Education Center. The
2-hour workshop will be held at the Wilmington
AHEC facility from 6:30 to 8:30 p.m. on September 19,
1987. Workshop leaders will be Dr. Timothy J. Ives
from the UNC School of Pharmacy, Ernest Hargett
from NC Division of Facility Services, and Charles
Pulliam who is Pharmacy coordinator for the UNC
Geriatric Education Center. Pre-registration is required
and will be limited to 24 participants because of plans to
make it a "working session", according to Pulliam.
Among things to be covered are the preparation of a
proposal for consultant pharmacy services, practical
and clinically appropriate approaches to chart review,
current regulations for consultant pharmacy services to
LTC facilities, and a look at common pharmacy-related
deficiencies in LTC facilities.
The session has been scheduled to coincide with the
Second Annual Pharmacy Practice Seminar which will
be held in Wilmington the following day, September
20, 1 987. Further information on the Workshop can be
obtained by calling NCPhA offices (1-800-852-7343).
July, 1987
1 6 THE CAROLINA JOURNAL OF PHARMACY
'J^ff#
ASSOCIATION EFFECTIVENESS: YOCIR ROLE
The effectiveness of your State's Pharmacy Association depends
upon many factors such as the elected leaders, a competent staff,
adquate financial resources, continuing education programs, legis-
lative representation, and ties with local and national pharmacy
associations. None of these factors is more important, however,
than is active participation by YOG, the individual member. Individ-
ual members provide an association with the following resources:
LEADERSHIP — by serving in elected or appointed positions.
DIRECTION — by establishing policies to guide the association's
staff and their activities.
FINANCIAL RESOURCES— by paying membership dues.
PROFESSIONAL ENHANCEMENT— by participation in con-
tinuing education programs that update or advance professional
competence.
POLITICAL CLOUT — by providing personal contact with state
legislators.
COLLECTIVE STRENGTH — by personally recruiting new mem-
bers to assure growth in the Association's membership.
NATIONAL REPRESENTATION— by serving as a delegate, com-
mittee member, or officer in one of pharmacy's national asso-
ciations.
i
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
17
HOECHST-ROUSSEL
PRESENTS GIFT TO
CAMPBELL PHARMACY
SCHOOL
Hoechst-Roussel Pharmaceuticals Inc.
recently made a gift to the Campbell University
School of Pharmacy. A liquid chromatograph, a
liquid scintillation system and a virtis lyophilizer
were presented to the Pharmacy School for use in
their laboratories.
Dr. Paul W. Hale, Midwest Manager,
Scientific & Professional Affairs, Hoechst-
Roussel, recently made a visit to the Pharmacy
School to make the presentation to the school.
"We are very pleased that Hoechst-Roussel
has made this substantial contribution to our
School of Pharmacy," said Dr. Ronald Maddox,
dean of the School of Pharmacy.
"All of the equipment is standard in a
functional research laboratory and will be used
frequently. The equipment will complement our
teaching efforts and will be accessible to students
under the supervision of the faculty," said Dr.
Harry Rosenberg, professor of Pharmaceutical
Sciences at Campbell. The equipment has a
combined value of $17,000.
The liquid chromatograph is designed to
separate chemical compounds found in mixtures.
At the School of Pharmacy its primary utilization
will be in the separation and identification of
drugs and their metabolites in body fluids. The
liquid scintillation system is used to measure the
radioactivity emitted by test compounds. The
virtis lyophilizer is designed to freeze-dry
aqueous solutions.
POSITION AVAILABLE
The Kansas Pharmacists Association (KPhA) is
accepting applications for the position of Executive
Director. KPhA is a professional association
representing pharmacists in Kansas with an office
located in the capital city, Topeka. The Association
has its own office building, has a staff of eight (6.5
FTEs), an annual budget exceeding $290,000 and
approximately 1,000 members (57% of the
practicing pharmacists in Kansas).
Experience in general, association and financial
management, as well as lobbying is preferred. The
successful candidate must have excellent oral and
written communication skills, must be well
organized and must be able to work well with
association members and staff. A candidate with a
pharmacy background is preferred, but not required.
Salary is commensurate with education and
experience.
Applicants should send a letter of interest, resume
and a list of references to Lawrence E. Shaw, Jr.,
Chairman, Search Committee, P.O. Box 1068,
Salina, Kansas 67402-1068.
Dr. Ronald Maddox (left), Dr. Paul Hale (center) and Dr. Tom Wiser (right) are pictured with the
liquid chromatograph, a gift of Hoechst-Roussel Pharmaceuticals Inc. to Campbell University
School of Pharmacy
July, 1987
18
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
ADVISING CONSUMERS ON
SOFT CONTACT LENS SOLUTIONS
by J. Richard Wuest, R.Ph., Pharm.D.
Professor of Clinical Pharmacy
University of Cincinnati, Cincinnati, OH
and
Thomas A. Gossel, R.Ph., Ph.D.
Professor of Pharmacology and Toxicology
Ohio Northern University, Ada, OH
Goals
The goals of this lesson are to:
1 . discuss solutions and disinfection methods in
the care of soft contact lenses;
2. explain how to advise patients on the proper
use of the solutions.
Objectives
At the completion of this lesson, the successful
participant will be able to:
1 . identify solutions intended for the care of soft
contact lenses;
2. explain the proper techniques for using these
solutions.
Contact lenses, including the basic difference
between hard and soft lenses, and solutions used
to care for hard contact lenses were discussed in
previous lessons. A quick review of these topics
will be helpful to better understand soft lens care
products.
A basic but important difference between hard
and soft contact lenses is that the soft variety is
hydrophilic and will absorb water. Most
individuals who wear contact lenses report that
the soft lenses feel more comfortable in the eye.
However, soft lenses also have an affinity for
adsorbing smoke, dust, protein, aerosol particles,
bacteria, chemicals, and other foreign material.
The more hydrated the lenses, the greater is their
affinity for colleting deposits. They must,
therefore, be thoroughly cleaned, and inserted
and removed from the eyes properly.
The best technique for inserting and removing
soft contact lenses is to first thoroughly wash the
hands with a noncosmetic soap. The hands
should then be dried with a lint-free towel. This is
especially important for the fingers that will
touch the lenses. The soft lens is then removed
and cleaned.
Deposits that accumulate on lenses are the
most bothersome aspect of caring for soft lenses.
Improper cleaning is reported to be the most
prevalent cause of eye irritation and injury, and is
the leading reason why individuals discontinue
wearing soft lenses.
An ideal method for cleaning soft lenses is to
place two to three drops of cleaning solution on
each lens surface, then gently rub the lens
between the thumb and forefinger, or between a
fingertip and the palm of the other hand, for
twenty to thirty seconds. This emulsifies oily
substances and loosens mucoproteins that have
collected on the surfaces during wearing. The
individual should use care to avoid scratching or
cutting the lens with a fingernail because, unlike
hard lenses, the soft variety can tear rather easily.
After cleaning, the lenses must be rinsed with
sterile saline solution. Tap water should not be
used because minerals in tap water can be
adsorbed onto the lens. After they are thoroughly
rinsed, the lenses must be disinfected by thermal
or chemical means. Following this procedure,
they are rinsed again with sterile saline solution
intho/arvicQ
of pharmacy
This continuing education for
Pharmacy article is provided
through a grant from
MERRELL DOW
PHARMACEUTICALS INC.
© Merrell Dow
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
19
and are ready to be reinserted into the eye, or they
can be left soaking in saline solution for insertion
later.
Cleaning Solutions
The ingredients in most soft contact cleaning
solutions are basically the same as those in hard
contact lens products. However, their
concentrations in soft contact solutions are often
lower.
There is a lack of objective comparative data
for the various brands of solutions because few
studies have been performed. Consumer
preference and fitter recommendations deter-
mine which solutions within a particular category
of soft lens products will be used.
Some manufacturers believe that high
viscosity is important for cleaning solutions.
Therefore, they include cellulose derivatives in
their products to thicken them. Other
manufacturers believe that solutions should be
less viscous to assure optimal cleaning activity.
In either instance, thorough and complete
rinsing of the lenses following use of any cleaning
solution is extremely important to maximize
removal of all of the chemicals and loosened
debris. After cleaning, the individual should hold
the lens up to a light. If the lens appears hazy or
spotted, the cleaning procedure should be
repeated.
There are two basic types of soft lens cleaning
solutions, those intended for daily use and those
for weekly use. Those just mentioned are used as
daily cleaners. They consist of nonionic
detergents and wetting agents, along with
preservatives and buffers. These surface active
solutions are effective for removing lipid
accumulations. They are not as effective for
protein deposits.
Celaning solutions should be used immedi-
ately after removing the lenses from the eye.
Once protein deposits accumulate on the lens
surface, they become extremely difficult to
remove.
Other cleaning aids are designed as weekly
cleaners. They are used to supplement the
surface-active cleaners. Milky white, opaque
deposits can form on soft lenses. These deposits
are composed of protein, a normal component of
conjunctival secretions. They precipitate on the
surface of the lens and become bound to the
plastics. This then leads to decreased visual
acuity, eye irritation, and the inability of the
wearer to keep the lenses in as long.
Products for weekly use are available either as
tablets to be dissolved in water, or as pre-mixed
solutions of highly concentrated cleaning agents.
The tablets contain papain or pancreatin which
are proteolytic enzymes that destroy peptide
bonds formed between the protein and the lens,
without harming the lens. Lenses should be
soaked in the solution for at least four hours,
preferably overnight.
Individuals who use weekly cleaning solutions
must follow the manufacturer's directions
explicitly, including the rinsing off of all traces of
the solution. If they fail to follow the directions
correctly, the chemicals in the cleaners can
adhere to the lens and later cause irritation to the
eye as they are released after the lens is reinserted.
Rinsing Solution
The rinsing solution used for soft lenses is
sterile saline. There are three basic types of
products: preserved solutions, single-use
unpreserved pre-mixed solutions, and solutions
made from salt tablets.
First, the already-prepared, preserved saline
solution is used by most soft contact lens wearers
because of its convenience. Until recently, all
commercially available preserved saline
solutions contained thimerosal as the preserva-
tive. These solutions were basically interchange-
able. However, thimerosal is an organic
mercurial that interferes with bacterial cell
metabolism, resulting in bacteriostatic action. It is
reported to irritate the eyes in approximately 10
to 20 percent of those persons who use it.
Individuals so affected can either use the single-
use, unpreserved premixed saline solution
which is more expensive, or prepare their own
rinse from salt tablets.
Self-prepared saline solutions made from
salt tablets have a cost advantage over
commercially prepared products. But problems
can occur if the individual does not prepare the
solution correctly. Also, they must keep their
storage bottle clean at all times.
Oral salt tablets intended to replace sodium
which is lost in sweat during physical exercise
should not be used to prepare solutions for rinsing
contact lenses. These contain other ingredients, in
addition to sodium chloride. Also, table salt
should never be used to make saline solutions to
rinse lenses because it contains iodine and
numerous other impurities which can be
irritating to the eye. Table salt is not required to
Continued on page 20
July, 1987
20
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
Continued from page 19
meet rigid USP standards as sodium chloride
intended for medicinal purposes.
Another common problem with preparing
saline from salt tablets involves the use of bottled
or tap water instead of distilled water. Again,
these two types of water contain numerous
impurities, some of which can ruin contact lenses.
They can also be contaminated with bacteria and
may contain particular matter that is injurious to
the eye.
Improper preparation of saline solutions may
result in an incorrect pH. Changes in the pH can
either shrink or expand the size of soft lenses. The
same is true if the salt concentration is incorrect,
resulting in a hypotonic or hypertonic solution.
The most important question is, "Has the
solution been correctly prepared so that it is
sterile?" If it isn't sterile, it should not be used to
care for contact lenses that will be placed in the
eye.
Recently, saline solutions preserved with
sorbic acid have been made available in this
country. These solutions, while more expensive
than solutions self-prepared from salt tablets, are
much less expensive than single-use containers of
unpreserved saline solution.
Some manufacturers have recently introduced
multiple-use, unpreserved saline solutions. If used
correctly, these solutions will remain sterile for
the few days during which the contents of a single
bottle are used. In either instance, these solutions
are usually better tolerated by individuals
sensitive to thimerosal.
Disinfection Methods and
Solutions
There are two basic methods for disinfecting
soft lenses: chemical and thermal. Following
cleaning and rinsing, soft lenses must be
disinfected before being reinserted into the eye.
The reason for this is that bacteria, viruses, fungi,
and other microorganisms can be adsorbed onto
soft contact lens surfaces, possibly resulting in
infection.
The term sterility is not used because true
sterility of soft lenses is not possible. As soon as
the lenses are placed in the eye, they become
recontaminated.
Figure 1 demonstrates a protocol for the
various types of disinfection methods. There is
some controversy as to which method is better,
but many experts report that they consider
thermal disinfection to be superior to various
chemical means. Thermal disinfection is easier
and causes less irritation to the eye.
The most common method for chemical
(cold) disinfection is to immerse the lenses in a
chemical disinfection solution for at least four
hours in order to kill any adhering bacteria. There
are solutions for both a two-step method (e.g.,
Normol/Flexsol and Soft Mate), and a one-step
method (e.g., Flex Care and Bausch & Lomb
Sterile Disinfecting Solution). Personal
preference dictates which method a patient will
choose.
Some experts believe that the two-step method
is better for older patients and other persons with
insufficient tear secretion because it adds another
step to rinsing off chemicals that can irritate the
eye.
A newer method of chemical disinfection
utilizing hydrogen peroxide has recently been
introduced to this country. It is widely used in
Europe and has many proponents who claim
better disinfectant activity and less eye iritation.
While the chemical method of disinfection is
more expensive as far as purchasing the solution
is concerned, it does not require electricity to
perform. So, its higher initial cost is tempered
somewhat by the fact that there is no additional
expenditure for energy. Some experts feel that the
chemical method is more likely to prolong the life
DISINFECTION
SALT TABLETS PRESERVED SINGLE-USE ONE SOLUTION
SALINE SALINE
TWO SOLUTIONS
Figure 1. Protocol lor thermal and chemical disinfection of soft contact lenses.
DISINFECTING
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
21
of the lens. But others state that it is too irritating
and that the thermal method is better.
Consumers should not switch from chemical
to heat disinfection method without seeking
professional assistance. However, switching from
thermal to chemical is possible. The reason for
this is that switching from the chemical to
thermal disinfection method without first
leaching out all of the chemicals from the lens can
render them opaque and useless. These chemicals
can form hardened layers which may be baked
into the lens surface by the heating process.
Anyone choosing to make this transition must
run the lenses through several soakings in fresh
batches of saline solution.
Another method is to use the weekly enzyme
tablet cleaner for several days, rinse the lenses in
fresh saline six or more times the next day, then
rinse again and sterilize. It may be best, however,
to have the lens fitter purge the lenses using the
special ultrasonic equipment in his office.
Chemical disinfection solutions must be
completely rinsed off after each use. They contain
thimerosal and either chlorhexidine or
hexadecyltriethanol ammonium chloride, all of
which can cause irritation to the eye. They will
bind to the lens, very little at first, but in
increasing quantities as the lens ages.
Thimerosal does not bind with the lens matrix
to the extent that it does with debris. Therefore,
the cleaner the lens, the less chance for irritation.
Chlorhexidine and hexadecyltriethanol
ammonium chloride, however, can bind tightly
to lenses and accumulate in high concentration to
soft lens polymers. If the lenses are clean, the
chemicals are released very slowly and cause few
problems. The presence of debris on the lenses
enhances their release and, therefore, increases
the chance for irritation.
There are also problems associated with heat
disinfection. First, the storage case must be kept
meticulously clean and should be scrubbed with
surfactant cleaners at lest once a week. It should
then be rinsed with hot tap water and rinsed with
saline. The individual should make sure his
storage case doesn't leak. If it does, the solution
can evaporate during heating and the lens may be
ruined.
The heating unit must also be checked
regularly. The rubber gaskets may deteriorate
because of repeated heating. This could result in
evaporation during heating, with the lenses
sticking to the unit, thus damaging them. The unit
itself may not heat sufficiently so that the lenses
are improperly disinfected. Othertimes, the unit
may fail to shut off.
At one time, heating units sterilized soft lenses
by essentially the same mechanisms as
autoclaving, i.e., heating to 220°F or higher and
holding the temperature for twenty minutes or
longer. One problem with this method was that
daily boiling severely shortened the life of the
lenses. The newer heating units merely raise the
temperature to about 175°F and maintain it for
approximately ten minutes. This procedure has
the same effectiveness as boiling because it is
done under pressure. The complete cycle for heat
disinfection generally requires from twenty to
thirty minutes. After cooling, the lenses can be
removed from the heating unit and inserted.
TABLE 1
Ingredients in Contact Lens Solutions and
Their Functions
CHELATING AGENT:
Ethylenediamine tetraacetic acide (EDTA)*
DETERGENTS:
Octylphenoxyethanol (OCT)
Tyloxapol (TYL)
DISINFECTANTS:
Chlorhexidine (CH)
Hydrogen peroxide (H202)
PRESERVATrVES:
Potassium sorbate (PS)
Sorbic acid (SA)
Thimerosal (TH)
SURFACTANTS:
Bis-2-hydroxyethyl tallow ammonium
chloride (BTA)
Polysorbate (Polyoxyethylene) 21 (P21); 80
(P80)
Poloxamer 407 (P407); 188 (PI 88)
Polyvinyl alcohol (PVA)
Povidone (Polyvinylpyrolidine) (PPP)
Tris-2-hydroxyethyl tallow ammonium
chloride (TTA)
VISCOSITY AGENTS:
Hydroxyethylcellulose (HEC)
Polyvinyl alcohol (PVA)
Propylene glycol (PRG)
*The abbreviations within parentheses are to
simplify Table 2. They are not the chemical
formulae for the compounds listed.
Continued on page 23
July, 1987
WE BRING YOU THE BEST
CHARLESTON, S.C.
GREENVILLE, S.C.
THE CAROLINA JOURNAL OF PHARMACY
23
CORRESPONDENCE COURSE
Continued from page 21
The individual should not reuse preserved
saline in a heating unit. This can lead to grey
discoloration due to thimerosal precipitation on
the lens. He should never use chemical
disinfectant solutions for the thermal procedure
because, again, chemicals in those solutions can
adhere to and ruin soft lenses.
TABLE 2
Commercially Available Soft Contact Lens
Solutions
Lens-Wet
Soft Mate Comfort Drops
Soft Mate ps Comfort
Drops
PVA, TH, EDTA
PVA, HEC, TH, EDTA
PVA, HEC, PS, EDTA
CLEANING (Daily)
INGREDIENTS*
Daily Cleaner (B&L)
PVA, TYL, HEC, TH,
EDTA
LC-65
?, TH, EDTA
Pliagel
P407, SA, EDTA
Preflex
Same as B&L
Soft Mate Daily
OCT, HEC, TH, EDTA
Soft Mate ps Daily
OCT, HEC, PS, EDTA
CLEANING (Weekly)
Alcon
Pancreatin
Softlens
Papain
Soft Mate
?, TH, EDTA
DISINFECTING
Allergan
BTA, TTA, TH, PRG,
P80
B&L Disinfecting
CH, TH, EDTA
Flex Care
Same as B&L
Flexsol/Normol
CH, PPP, P80, TH,
EDTA
Septicon
H202, Na stannate, Na
nitrate
Soft Care
CH, PPP, OCT, TH,
EDTA
Soft Mate Disinfecting
Same as Soft Care
Soft Mate Rinsing
CH, TH, EDTA
All contain NaCl and a borate buffer
PRESERVED SALINE (NaCl +)
B&L
TH, EDTA
Boil 'N Soak
Same as B&L Preserved
Saline
Hydrocare
TH, EDTA
Lensrins
TH, EDTA
MiraSol
P407, TH, EDTA, SA
Sensitive Eye Saline
SA, EDTA
Soft Lens Rinse
TH, EDTA
Soft Mate Therm
Same as Soft Lens
Soft Mate ps
PS, EDTA
Sorbi-Care
SA, EDTA
LUBRICATING
Adapettes
PPP, TH, EDTA
B&L Lubricant
PPP, TH, EDTA
Clerz 2
HEC, P407, SA, EDTA
*See Table 1 for explanation of ingredients.
? = contains unidentified ingredient(s)
Common Consumer Questions
There are several questions that are asked by
contact lens wearers regardless of the type of lens
worn. Some questions and suggested answers
follow.
"My vision is foggy. What should I do?"
The individual should clean the lens again. If
vision is still impaired, the person should make
sure the lenses are in the correct eyes. If the
problem is still not corrected, a physician should
be contacted. It is possible that he is experiencing
hypoxia (insufficient oxygen to the cornea). The
same advice is appropriate if the individual sees
halos around lights, expecially at night.
"I fell asleep with my contacts in. What
should I do?" This is not a problem if the lenses
are the soft variety. With hard lenses, however, it
can be quite an unpleasant and memorable
experience.
The first thing the person should do is blink the
eyes often and hard, to try to increase tear
secretion. Next, he should flush the eyes with a
large quantity of saline, possibly by placing
several drops into the eyes. He should continue
blinking, and, after cleaning the hands
thoroughly, try to remove the lenses. If they can't
be removed or if severe pain is noted, the person
should immediately go to the fitter's office or to
an emergency medical service. These facilities
have specially-made suction cup devices which
can be used to remove the lenses.
"My eyes hurt when I wear my lenses.
What should I do?" First of all, the individual
should remove the lenses. If the pain subsides, the
lenses should be cleaned and rinsed, and replaced
in the eye. If the pain continues, the lenses should
again be removed and examined against a light to
see if there is anything unusual on them. If not,
they should be rinsed again and reinserted. If the
eye still hurts, the individual should see the fitter
or a physician, or repeat the entire process again.
If pain continues after the lenses are removed,
a physician should be consulted. The potential for
corneal abrasion is significant. This is not
amenable to self-treatment.
Continued on page 24
July, 1987
24
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
Continued from page 23
"Can I switch brands of contact lens
solutions?" The answer is probably yes, if it is the
same type of solution for the same type of lens.
The answer is absolutely no, if the label does not
specifically state that the solution is intended for
the type of lens being worn. Since contact lens
solutions are included under the "Device" section
of the Pure Food, Drug and Cosmetic Act, they
must be tested for safe use for each specific type of
lens. Solutions for hard lenses are not indicated
for use with soft lenses. They are generally highly
concentrated and their ingredients (most
specifically benzalkonium chloride) may damage
the lenses or injure the eyes.
"Can I switch from a chemical to thermal
disinfection system?" It is in the individual's best
interest to call the fitter before attempting this
transition, to assure that all of the chemicals are
leached out of the lenses before they are heated.
"Can I use tap water to dissolve my enzyme
tablets?" The answer, absolutely not! These
tablets must be dissolved in either distilled water
or saline depending on the product. Tap water
can inactivate the enzymes.
"How about using tap water for preparing
my saline from salt tablets. Is this okay?"
Again, the answer is absolutely no.
Summary
General consumer advice for contact lenses
and their solutions was summarized in last
month's lesson. Wearing contact lenses and using
contact lens solutions is relatively safe, and not
associated with difficult procedures or dangerous
problems. It should be kept in mind that contact
lenses are foreign substances that are placed in the
eye. The person's present and future vision is at
stake. Common sense and good professional
judgement should be paramount in any
consumer advice on the use of eye preparations.
Because soft contact lenses are hydrophilic,
they can readily react with environmental
chemicals, cosmetics, and drug products used in
and around the eyes. They must be sterilized
(disinfected) before reinsertion to reduce the
chance for contamination. The pharmacist
should assure that these points are understood.
Contact lens wearers should comply with all
steps involved in caring for their lenses.
Pharmacists should assure that all solutions are
stocked at all times. Consumers should be
reminded to keep an adequate supply at home,
including back-up containers.
Contact lens wearers usually start out with the
best intentions for keeping their lenses clean and
properly cared for. However, over time, they may
become less concerned with protocol. While
some persons can afford to be less concerned
because their tear secretions contain few proteins
and accumulated deposits on their lenses are not
excessive, others may experience significant
build-up. Individuals should be reminded to
properly care for their lenses. This will be made
easier if the pharmacist is available to counsel lens
wearers on the proper use of the products he
provides.
A NEW SERVICE TO THE INDEPENDENT AND SMALL CHAIN
PHARMACY OWNER!
Professional Management Consulting by
Gene Minton, RPH
. . . Now you can benefit from 10 years experience in supervisory management of high
volume drug stores on an individual and group basis.
. . . Consultation in all areas ofdecision making such as product mix, pricing, merchandising,
remodeling, site selection, computer applications (and selection), Rx pricing, advertising,
personnel management, etc. with emphasis on results and the bottom line.
... Let us plan your next remodel, design your new store, show you how to save money on
fixtures, evaluate wholesalers, analyze your p&l, and many other services to make you
happier with your store & your profits.
. . . Can you afford not to call?
contact Gene Minton at Gene Minton Consulting Services, 6 Lake Shores, Littleton, NC
919-586-5465. (All client information held in strict confidence.)
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
25
DICKINSONS PHARMACY
by Jim Dickinson
Writing letters. Pharmacists who write letters
get their way, and if only more would do it, more
would be done for the profession.
After reporting the salutary effects of your
letters to HHS Secretary Don Newman on the
question of mandatory Medicaid discounts, I've
had other evidence on the power of pharmacy's
pens.
"I had almost given up writing any more
letters," writes Sutter Creek (Calif.) pharmacist
Paul Wesseler, "but I wrote to Don Newman at
your suggestion. Thanks for reporting the results.
Now I am more ready to fight the MD dispensing
issue . . ."
So, apparently, are many more pharmacists.
Capitol Hill saw the largest outpouring of
grassroots pharmacy energy anyone can
remember, after the National Association of
Retail Druggists activated a 60,000-piece
"legislative alert" mailing on the dispensing
physicians issue in April.
The heat was so intense that one congressman
reportedly assigned a staffer fulltime to fielding
pharmacists' telephone calls.
NARD's strategy was devastatingly simple, if
expensive. It followed up its "alert" mailing
(which went to non-members as well as to
NARD members) with two Western Union
Mailgram alerts, one of which triggered state
association and local grassroots alert systems on
the eve of critical votes by House committees.
Needless to say, both votes went pharmacy's
way, largely overcoming American Medical
Association opposition to federal restrictions on
physician prerogatives. The AMA had earlier
joined with NARD and the National Association
of Chain Drug Stores in a statement opposing
physician dispensing for profit (a position
compatible with its traditional posture down the
years), but it insists that its members are too
honorable to need a law — especially a federal
law.
Now, the united forces of pharmacy face some
exceedingly dishonest tactics by the drug
repackages who exploit physicians' economic
misfortunes in the doctor glut. As these hucksters
face their fate, they're turning nasty, openly
recommending the elimination of the retail
pharmacy marketing level from the drug
distribution system.
And they're aiding AMA efforts to defeat
federal legislation on the ground that it's a state
function to police the practice of medicine. The
repackages would rather fight 50 different fights,
with help from the politically extremist and anti-
pharmacy Federal Trade Commission in each
fight, than lose it all in one Washington fight
where the FTC is out of favor.
But it's the awesome power of the pharmacist's
pen that will win or lose this fight. Pharmacists
have seldom coalesced on an issue as they're
coalescing on this one.
Write your Congressman and your two
Senators now. This much you can do!
Showing the way. Drug companies have been
everyone's favorite villains for so long now, it
comes as a shock to see the industry any other
way.
But there in the middle of the Gary Hart fiasco,
the Irangate hearings, the PTL scandal, insider
trading on Wall Street, and a seemingly endless
list of other national shames, everyone's favorite
villain (the PMA) took the high road in May.
Hard on the heels of a severe beating it
received a few weeks earlier in Congress over
drug price increases, the PMA on May 4 went on
record as being opposed to sales of investigational
drugs.
The very companies that had just been
lambasted for "greed on a masssive scale" by
House health chairman Henry A. Waxman (D-
Cal.), turned their backs on the potentially
enormous profits that might be legally made on
unapproved drugs such as numerous AIDS and
cancer treatments still under development.
The PMA's position puts its members' own
long-term interests ahead of their short-term
interests, setting the industry apart and high
above the likes of Gary Hart, Irangate
manipulators, inside-traders et al
The investigational-drugs-for-sale issue,
advanced to its great discredit by the Food and
Drug Administration as a quick fix for bringing
AIDS drugs to the terminally ill before they're
tested properly, could profit companies in the
short term, but cost them dearly in the long-term,
PMA realized.
Primarily, if you can make a quick profit
without doing expensive, and potentially self-
Continued on page 26
July, 1987
26
THE CAROLINA JOURNAL OF PHARMACY
DICKINSON'S PHARMACY
Continued from page 25
defeating research, the system will eventually be
skewed away from the long, hard grind of finding
truly valuable therapies.
PMA recognized, at least in this instance, that
our society already has too much of a tendency to
live for today and to let tomorrow take care of
itself.
As with physician dispensing also, any time a
vested-interest group (whether retail pharmacy
or drug innovators) puts the long-term view
ahead of the short-term view, chances are the
public interests will be advanced.
In both of our examples above, surely this is
the case.
This feature is presented on a grant from G.D. Searle &
Co. in the interests of promoting the open discussion of
professional issues in pharmacy. G.D. Searle & Co.,
accepts no responsibility for the views expressed herein
as they are those of the author and not necessarily those
of G.D. Searle & Co.
warning sign of which of the following
conditions?
a. Bacterial infection
b. Conjunctivitis
c. Corneal hypoxia
d. Glaucoma
5. The one ingredient that is contained in all
soft lens rinsing solutions is:
a. benzalkonium chloride.
b. methylcellulose.
c. sodium chloride.
d. thimerosal.
6. When compared to hard contact lenses, all
of the following statements about the soft
variety are true EXCEPT:
a. softs are hydrophilic, hards are not.
b. softs are more durable than hards.
c. softs must be sterilized between
wearings, hards to not require this.
d. softs are more difficult to care for than
hards.
CORRESPONDENCE COURSE QUIZ
Soft Contact Lens Products
1 . Which of the following is the preservative
that reportedly causes the LEAST irritation
to the eye?
a. Chlorhexidine
b. Sorbic acid
c. Thimerosal
d. Tyloxapol
2. Unlike daily cleaners, the weekly soft
contact cleaning tablet products contain:
a. cellulose derivatives.
b. nonionic detergents.
c. proteolytic enzymes.
d. wetting agents.
3 . All of the following would be appropriate to
recommend to a customer requesting a daily
cleaner for soft contact lenses EXCEPT:
a. Clerz 2.
b. LC-65.
c. Pliagel.
d. Preflex.
4. Contact lens wearers who see halos around
lights, especially at night, should check with
their ophthalmologist because this is a
7. Papain and pancreatin are contained in soft
lens cleaning preparations to remove
deposits of which of the following?
a. Calcium
b. Carbohydrates
c. Lipids
d. Proteins
8. Which of the following is both a surfactant
and a viscosity agent?
a. Hydroxyethylcellulose
b. Octylphenoxyethanol
c. Polyvinyl alcohol
d. Potassium sorbate
9. If a soft contact lens wearer chooses to
change the method of disinfection, which of
the following is the safest switch without
talking to the fitter?
a. From chemical disinfection to thermal
b. From thermal disinfection to chemical
10. The concentration of potentially irritating
ingredients in soft contact lens solutions is
generally:
a. higher than in hard lens solutions.
b. lower than in hard lens solutions.
ANSWER FORM on page 29
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
27
PHARMACISTS HELP MEDIC ALERT SAVE LIVES
by Robert C. Johnson
Executive Vice President, California Pharmacists Association,
and Chairman, Medic Alert National Pharmacy Task Group
The National Pharmacy Task Group, in
collaboration with Medic Alert Foundation,
unveiled a pharmacist-to-patient education
program featuring Medic Alert's service at the
American Pharmaceutical Association's 1986
Convention in San Francisco.
The program has experienced an excellent
beginning as pharmacists across the United States
daily make the decision to incorporate into their
patient service the Medic Alert Emergency
Information Program.
Through pharmacists' efforts, it is estimated by
the end of the first full year, some 14,400 people
will be protected by the Medic Alert service
representing a 242% increase over 1985.
Based on our users serveys, the following will
be experienced for each 14,400 people who join
Medic Alert:
432 will experience their lives being saved
2880 will receive definite assistance in emer-
gency diagnosis and treatment
1152 will experience having their length of
stay in the hospital reduced
It is believed the pharmacist/Medic Alert
program will continued this rapid growth
because:
1 . It does what it is designed to do:
• Protects our patients health.
• Expedites efficient emergency medical
care.
• Plays an important role in establishing
your pharmacy as a source of
professional medical information to your
patients.
• Shows your patients you value their
health and well-being.
2. It is the only national recognized
emergency data system that provides
medical personnel with vital patient
information — provides it quickly,
accurately, in one place, on time and at no
cost to the medical profession.
3. It is the only nonprofit, tax-exempt
organization devoted solely to providing
quality emergency medical information
service for people with conditions that
could put them at risk in emergency
situations.
4. Because the system is comprehensive:
• It provides for the 37% of all Medic Alert
members who have two or more
conditions since the emblems are
individually engraved and can record
up to 3 conditions.
• The Medic Alert Emblem (bracelet or
necklace) is the TRIGGER that activates
the emergency medical information
system. Anywhere in the world, anytime
of the day or night, medical personnel
need only call Medic Alert's 24-hour
hotline and provide a patient's I.D.
number engraved on the emblem.
Within 30 seconds, information from
computerized emergency medical file
can be provided to assist in treatment. In
addition, each member has a wallet card
and the Foundation initiates an annual
update procedure. Members, however,
can update information at any time.
During the first year, Stuart Pharmaceuticals
Division, ICI Americas, Inc. provided a
generous grant of $75,000 to help launch this
program. Due to the need for the Medic Alert
service and the response of pharmacists across the
United States, Stuart Pharmaceuticals will
provide a second year grant to help expand this
program.
Those who are in the emergency rooms
appreciate this National Pharmacy effort.
A recent study conducted by George
Podgorny, M.D., Past President, American
College of Emergency Physicians, found there is
a potential for over 13,200 emergency room
visits every day in the United States that could
benefit from the information Medic Alert
provides. This led to the following specific
statement by George Podgorny, M.D.: "We need
readily available medical information for every
patient brought into the Emergency Department,
but often we must act in the absence of this data.
Both the American Medical Association and the
American College of Emergency Physicians
emphasize the need for emergency medical
identification. A ready source of personal
emergency information can improve the care we
provide, and Medic Alert is the best system
currently available. It provides up-front
identification on the patient with access to more
Continued on page 29
July, 1987
Human insulin for all. Humuliri
human insulin
[recombinant DNA origin]
Identical to human Insulin. Humulin is the only insulin not
derived from animal pancreases
Recombinant DNA technology makes the production of
Humulin possible and virtually assures every insulin user of a
lifetime supply
From Lilly ... a dependable source of insulin for
generations. Since 1922. when we became the first company
to manufacture insulin, we have led the search for the best
diabetes care products and, at the same time, maintained a
constant supply of insulin for all insulin users
Our 24 formulations of insulin— including Humulin and all
forms of lletin* (insulin)— are available through the widest retail
distribution of insulin in the United States.
Beyond that, we will continue to provide a wide range of
diabetes service and educational materials for use by physi
cians, pharmacists, and diabetes educators
t 1986 ELI LILLY ANDCOMPANY
Our Medical Division is on call. Our Medical Division staff
Is only a phone call away Please contact them if you have any
questions about our diabetes care products
Any change of insulin should be made cautiously and
only under medical supervision. Changes in refinement,
purity, strength, brand (manufacturer), type (regular, NPH,
Lente^, etc), and/or method of manufacture (recombinant DNA
versus animal-source insulin) may result in the need for a change
in dosage
Lilh Leadership
IN DIABETES CARE
For information on insulin delivery systems, contact CPI 1(800) 2273422
Sfay
Eli Lilly and Company
Indianapolis. Indiana 46285
THE CAROLINA JOURNAL OF PHARMACY
29
MEDIC ALERT
Continued from page 27
comprehensive data available 24-hours a day
worldwide."
From the other end of the United States, Paula
Woo who is chairman of the Los Angeles
Emergency Medical Services Commission and a
trauma nurse coordinator, states, "If more
patients had Medic Alert ID we would save
precious time and treat them appropriately and
with confidence. Otherwise, in the first critical
moments of an emergency it's like a shot in the
dark every time we provide emergency care."
Pharmacists can initiate this vital program for
their patients today — Call Medic Alert at 1-
800/ID ALERT or contact your Stuart
representative and request your pharmacy starter
kit which includes:
1. Front window poster (full color) to
announce your pharmacy's involvement in
this program.
2. Counter application holder with applica-
tions to be permanently placed for
convenience of the patient near point of
sale.
3. Medic Alert Reference Guides (2)
— One to be posted in the work area to
highlight conditions covered by Medic
Alert protection
— One to be placed at the point of sale for
your staff and patients.
4. Stuffers to be inserted into all prescription
bags for patients you believe could benefit
from Medic Alert protection or to be used
as a shelf talker.
5. Response card to be returned indicating
participation in the pharmacist's program
and ordering additional materials.
Cut Out or Reproduce and Mail
CONTINUING PHARMACEUTICAL EDUCATION
Soft Contact Lens Solutions
• Attach mailing label from The Carolina Journal of Pharmacy or print your name and
address and mail to CE Test, NCPhA, P.O. Box 151, Chapel Hill NC 27514
• Completed answer sheets may be returned on a monthly or less frequent basis for grading.
• This is a member service. Non-members responses will not be graded nor CPE credit
provided.
• NCPhA will maintain a copy of your completed CPE tests and upon successful completion
of each program, will issue a certificate for one (1) hour of board-approved CPE.
• If more than two questions are answered incorrectly, the test is failed. You will be given one
opportunity to submit a second answer sheet.
Please circle correct answers
1. a b c d
2. a b c d
3. a b c d
4. a b c d
5. a b c d
6. a b c d
7. a b c d
8. a b c d
9. a b c d
10. a b c d
Evaluation: Excellent Good Fair Poor
address
July, 1987
O
We're not
strangers...
uuasnincjeon
national
INSURANCE COMPANY
NCPhA-Endorsed Insurance Plans
Which Merit Member Participation
DISABILITY INCOME PLAN HOSPITAL INCOME PLAN
MAJOR MEDICAL EXPENSE PLAN TERM LIFE PLAN
RETIREMENT AND PROFIT SHARING PLANS
FOR DETAILS WRITE OR TELEPHONE:
HOYT W. SHORE, CLU and Associates
821 Baxter Street-Suite 316
Charlotte, North Carolina 28202
Telephone (704) 333-3764
uuasninqeon
national
INSURANCE COMPANY
Evanston, Illinois 60201 • A Washington National Corporation Financial Service Company
THE CAROLINA JOURNAL OF PHARMACY
31
HOW TO AVOID POISONING
YOURS AND THE
NEIGHBORS' CHILDREN
by J. Starks
With summer just around the corner, many
families become weekend gardeners, sprucing up
their lawns and gardens, and planting unusual
shrubs and plants to liven up their yards, patios,
decks, flower boxes and homes. What many
families don't realize is that they may be
introducing toxic plants that could be ingested by
their own or neighbors' small children.
The ingestion of plants by children is a major
cause of poisoning in the United States. Although
death from these ingestions is rare, it can be
painful and traumatic for the child.
Poisonous plants are generally grouped
according to the toxic substances that they
contain:
Amygdalin — containing plants produce
cyanide poisoning. Examples: seeds of
peach, pear, apple, apricot, bitter almond.
Anticholinergic — containing plants
produce atropine-like anticholinergic
effects. Examples: potato leaves and sprouts,
Deadly Nightshade, Jimson Weed.
Cardiac Glycoside — containing plants
produce digitalis-like effects on the heart.
Examples: Lily of the Valley, Foxglove,
Oleander.
Colchicine — containing plants produce
severe gastrointestinal symptoms with CNS
depression, seizures and bone marrow
suppression. Examples: Autumn Crocus,
Glory Lily.
Nicotine — containing plants produce
acute nicotine poisoning. Examples:
Tobacco, Arnica Root, Poison Hemlock,
Fool's Parsley.
Oxalate — containing plants, the most
commonly ingested group.
Soluble oxalate group produces hypo-
calcemia, gastroenteritis, and oxalate
crystalluria. Examples: American Ivy,
Rhubarb Leaves, Garden Sorrel, Virginia
Creeper.
Insoluble oxalate group produces pain,
swelling and erythema of mucous
membranes. Examples: Dieffenbachia,
Philodendron, Elephant's Ear, Caladium.
Solanine — containing plants produce
severe gastroenteritis, bradycardia, fever,
muscle weakness, and renal failure.
Examples: Black Nightshade, Jessamine,
Jerusalem Cherry.
Stimulant — containing plants produce
CNS excitation with seizures. Example:
Water Hemlock.
Toxalbumin — containing plants produce
severe gastrointestinal burns, shock, hepatic
necrosis and renal failure. Examples: Black
Locust, Castor Bean, Jequirity Bean.
Gardens and yards may also contain other
harmful plants listed below:
Acorns
Arnica Root
Asparagus Berries
and young shoots
Autumn Crocus
Azalia
Baneberries
Begonias
Black Locust
Black Nightshade
Bleeding Heart
Bulbs — many
Buttercup
Caladium
Castor Beans
Carrot Tops
Christmas Cherry
Christmas Rose
Crown of Thorns
Daphine Berries
Devil's Ivy
Diefenbachia
(dumb cane)
Elephant's Ear
Fool's Parsley
Foxglove
Glory Lily
Grape Ivy
Holly
Horse Chestnuts
Iris
Ivy
Jerusalem Cherry
Jessamine
Jesquirity Bean
Jimson Weed
Lily of the Valley
Mistletoe Berries
Mushrooms
Oleander
Philodendron
Poison Hemlock
Potato Leaves
& Stems
Pothos Plant
Privet Berries
& Leaves
Rhubarb Leaves
Rubber Vine (not
rubber plant)
Shamrock
Sorrel
Sweet Pea
Tobacco
Tomato Leaves
& Stem
Virginia Creeper
Water Hemlock
Yew Bush
What can be done to prevent these poisonings?
First, it is a good idea to identify all plants in your
home or yard. Some plants are very familiar to
you, but others may not be. If there is some
question, take a clipping of the plant to a nursery
or florist. They can usually identify plants. Ask
them for the proper name of the plant.
In the home, label all pots or planters with the
proper name of each plant. In the yard, make a
list with the location indicated, or draw a map of
vegetation in the yard. Place the proper name of
all plants on the list or map.
Leave that list in a handy place, in case of
emergency. Instruct any babysitter where the list
Continued on page 32
July, 1987
32
THE CAROLINA JOURNAL OF PHARMACY
POISONING
Continued from page 31
or map can be found, along with the local poison
control center number.
If you have poisonous plants in your home,
consider giving them away or placing them in
high locations where children don't have access
to them. If you have poisonous plants in your
yard, replace them with the non-toxic variety.
Because a few vegetables are listed on the toxic
plant list, it is a good idea to fence in the garden
with chicken wire to prevent children from
having easy access if you choose to grow those
vegetables.
What to do if a plant poisoning occurs?
DON'T PANIC! If you suspect that your child
has eaten any amount of a plant or mushroom
that might be toxic, take the plant and the child,
and give the child milk or water to drink.
CALL THE POISON CONTROL CENTER
IMMEDIATELY! Don't wait until the child
develops symptoms. Delays in treatment could
be very dangerous. Poison control centers will
help you determine if other intervention is
necessary.
Non-Toxic Plants
African Violet
Air Fem
Aluminum Plant
Artichoke
Artillery Plants
Baby Tears
Bayberry
Beauty Bush
Begonia, common
Blood Leaf
Boston Fern
Bread Mold
Chinese Evergreen
Christmas Cactus
Coleus
Coral Bell
Creeping Charlie
False Areola
Ficus Benjamina
Fuchsia
Green Pepper Seeds
Hens and Chickens
Honeysuckle Berries
Impatiens
Jade Plant
Kinnikinnick Berries
Lilac
Lipstick Plant
Maternity Plant
Mountain Ash Berries
Moss
Peperomia
Piggyback Plant
Pine Cone Seeds
Prayer Plant
Purple Passion
Pussywillow
Pyracantha
Schefflera
Rose
Rubber Plant
Sedum
Spider Aralia
Spider Plant
String of Pearls
Wandering Jew
Yucca Plant
Zebra
In North Carolina, call your local poison
control center or the Duke Poison Control
Center at 800-672-1697.
NABP SEEKS EXECUTIVE
DIRECTOR
The National Association of Boards of
Pharmacy announces its search for an Executive
Director. In its quest to fill this leadership
position in American pharmacy, the Executive
Committee has appointed a Search Committee.
The individual selected will serve as the chief
executive officer of the Association and be
responsible to the Executive Committee for the
effective conduct of the affairs of the Association.
The Association is seeking an individual who
is a pharmacist with managerial skills and
relevant experience with association efforts. The
individual should have good speaking and
writing skills, good administration and planning
talents and personal traits that lend to the
favorable image of the Association.
The position also requires an individual with
good working knowledge of the pharmaceutical
industry and the profession of pharmacy.
The selection process is scheduled as:
September 1, 1987 — Application Deadline
November, 1987 — Search Committee
makes recommedations to the Executive
Committee
January 1, 1988 — Selected individual
begins employment
Interested individuals should contact the
Chairman of the Search Committee, Lester
Hosto, Secretary /Treasurer of the Association.
His address is P. O. Box 55356, Little Rock, AR
72225, telephone (501) 661-2833.
A packet of additional information about the
position and application procedures will be
mailed to persons interested in applying.
Remember the °Day
...incPictures
CXLORCRAFT
North Carolina's Most Complete
Film Processing Service
There Is A Plant Located
Near You
For the Finest Quality Plus Fast
Dependable Service on All Your
Photo Needs, Contact the Plant
Nearest You.
CHARLOTTE WILMINGTON
KERNERSVILLE RALEIGH
FAYETTEVILLE DURHAM
If You Don't Know Photofinishing
Know Your Photofinisher
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
33
ANNUAL FALL REUNION
Pharmacy Alumni Association
October 3, 1987
Beard Hall and Kenan Stadium
9:00 a.m. Registration and Refreshments
9:30 a.m. "The Right To Know; The Right
To Lie"
Jack N. Behrman, Associate
Dean, UNC School of Business
10:30 a.m. Business Meeting
11:15 a.m. Lunch (Buffet line in Beard Hall
lobby)
1 2:30 a.m. U.N.C. Tar Heels vs. AUBURN
Tigers
Kenan Stadium
The Fall Reunion C.E. Program will interest
pharmacists and guests alike. The use of
deception and misinformation in business,
government, and professional services has been
given substantial publicity lately. Dr. Behrman
addresses this timely issue, tackling these
questions: What is the role of information in our
society? For what purposes does anyone have the
right to deceive or lie or withhold information?
And, if so, where do these rights come from? This
C.E. session will consider these questions for such
relationships as lawyers — clients, pharmacists
— patients, and employers — employees.
Ken Brown, UNC Director of Ticket
Operations, tells me that we are limited to 700
tickets this year. Auburn fans have already
bought their full allotment. We will not be able to
increase our order beyond the 700 limit, so it will
be "first come — first serve" for our members and
friends. Once again Baxley's will cater our
luncheon buffet. With good food, good friends,
and good football in Chapel Hill . . .how can you
stay away? Please make plans to join us. Register
early.
by Charles Pulliam
Executive Director
LOCKAMY ATTENDS
LEADERSHIP CONFERENCE
Albert F. Lockamy, Jr., a practicing
pharmacist with Revco Drug Stores and
incoming 1988-1989 president of the North
Carolina Pharmaceutical Association, was
among pharmacy association leaders from 49
states, Puerto Rico and Canada who attended a
Leadership Training Conference held recently in
Kansas City.
The two-day conference, sponsored by
Marion Laboratories, Inc., was designed to
provide incoming presidents of state pharmacy
associations with practical information and
instruction in leadership and management
techniques to help make their term of office for
the coming year a personally satisfying and
productive experience. The training was
provided by Lawrence-Leiter and Company, an
internationally acclaimed management consult-
ing firm based in Kansas City.
Although pharmacy associations from 49 of
the 50 states were represented, the presidents-
elect of all 50 state associations throughout the
United States accepted invitations to attend the
Leadership Conference. Also in attendance were
the presidents-elect of two Canadian provincial
pharmacy associations, the newly elected
president of the Candian Hospital Association,
and the top officials of the Puerto Rico College of
Pharmacy.
Gerald J. Mossinghoff, President
Pharmaceutical Manufacturers Association
1100 15th Street, NW
Washington DC 20005
Dear Mr. Mossinghoff:
The North Carolina Pharmaceutical Associa-
tion, in convention assembled in Charlotte, North
Carolina, April 22 through 25, 1987, passed the
following resolution:
Whereas the Pharmaceutical Manufac-
turers Association finished products index has
increased approximately 10% annually over
the last five years, and
Whereas this does not compare favorably
with other economic data such as the 1986
Consumer Price Index increase of 2%;
Now therefore be it resolved that
The North Carolina Pharmaceutical
Association urge pharmaceutical manufac-
turers to use restraint in price increases, and
Be it further Resolved that
A copy of this Resolution be mailed to all
Pharmaceutical Association members.
I hope you will distribute this resolution to all
PMA members and it will have the desired effect.
Community pharmacists are the members of the
drug distribution system who received the most
Continued on page 36
July, 1987
34
THE CAROLINA JOURNAL OF PHARMACY
CLASSIFIED ADVERTISING
Classified advertising (single issue insertion) 25 cents a word with a minimum charge of $5.00 per
insertion. Payment to acompany order.
Names and addresses will be published unless a box number is requested.
In replying to "blind" ads, address Ad. No., Carolina Journal of Pharmacy, P.O. Box 151, Chapel
Hill, NC 27514. Telephone (919) 967-2237.
PROFESSIONAL PHARMACIES: Sev-
eral small prescription-oriented phar-
macies are currently available for
individual ownership in North Carolina.
These opportunities provide the vehicle to
practice pharmacy the way you were
taught, while offering an attractive income
and more time to be with your family. In
some of these cases, financing is also
available to qualified candidates. For
more information write: Jan Patrick,
10121 Paget Dr., St. Louis MO 63132.
STAFF PHARMACIST WANTED: Posi-
tion at Kings Mountain Hospital. Modern
102-bed facility with computerized unit
dosage. Hospital experience preferred
but not necessary. Will consider a May
graduate. Contact Jerry McKee at (704)
739-3601 Ext. 472.
We are seeking an ambitious and
professional career-minded individual for
Pharmacy-manager position in south-
eastern North Carolina near the coast.
Computerized prescriptions, excellent
salary, hospitalization and life insurance,
paid vacations. Small professional
pharmacy located in the center of a
medical complex. Contact Box CDD, c/o
NCPhA, P.O. Box 151, Chapel Hill, NC
27514.
RELIEF PHARMACIST AVAILABLE:
Central & Eastern North Carolina. Contact
Pharmacy Relief, PO Box 2064, Chapel
Hill NC 27515 or call 919-481-1272
evenings.
CLINICAL-STAFF PHARMACIST POSI-
TION: Will be working every 3rd weekend
and will have responsibilities in unit dose,
IV admixtures, cancer chemotherapy,
patient education, nursing inservice,
pharmacy newsletter, pharmokinetic
dosing, drug use evaluation and other
evolving clinical applications. Some
advanced training and experience in
clinical pharmacy preferred. If interested
and qualified please send resume to:
Director of Personnel, Community
General Hospital, PO Box 789, Thomas-
ville NC 27360. EOE.
MEDICINE SHOPPE FOR SALE: Don't
miss this excellent opportunity to be your
own boss in a professional atmosphere.
The Medicine Shoppe, a prescription
oriented pharmacy located in Raeford,
NC has been offered for immediate sale.
This fine opportunity offers clinic hours
and a positive cash flow from Day 1 . If you
have been considering owning your own
pharmacy, this could be an outstanding
opportunity for you! Financing available.
Contact John Aumiller, Medicine Shoppe
Int'l., Inc. at 1-800/325-1397.
Pharmacist with retail experience to
manage Rx Department, monitor patient
profile and compound mixtures. Profes-
sional hours, atmosphere and salary. Call
Gary Newton, Fayetteville 800-682-4664
Office hours or 919-484-6214, 24 hours.
PHARMACY FOR SALE: Western North
Carolina. Well-established pharmacy in a
small town. 27 years same location.
$500,000 in sales. Price $170,000.
Contact Bullock & Whaley, P.O. Box 3764,
Wilmington, NC 28406. (919) 762-2868.
PHARMACIST: Professional Services/
Consultation — Temporary and/or
Continual. Contact: L. W. Matthews at
(919) 967-0333 or 929-1783. 1608 Smith
Level Road, Chapel Hill, NC 27514.
July, 1987
THE CAROLINA JOURNAL OF PHARMACY
35
PHARMACIST WANTED: Independent
pharmacy in Concord seeks a full time
pharmacist. Good salary, excellent
benefits. Call Mickey Watts (704)
782-2194.
PHARMACIST WANTED: We are
seeking an ambitious, and professional
career-minded individual for a pharmacist
position in Greensboro, High Point and
Winston-Salem, NC. We offer excellent
salary, stock ownership, educational
subsidy, extensive benefits, retirement
plan, 41 OK tax plan, annual salary merit
reviews. "Pure pharmacy setting". If
interested call Lew Thompson 1 -800-233-
7018 or send resume to: The Kroger
Company, Attn: Personnel, PO Box
14002, Roanoke VA 24038. EOE.
SUPERVISOR OF PEDIATRIC SATEL-
LITES: North Carolina Baptist Hospital
Pharmacy is seeking a highly motivated
and professional person to fill a pediatric
supervisor's position. This position offers
a close working relationship with a
progressive pediatric staff and the
opportunity to perform and excel in the
role of a pediatric drug specialist.
Responsibilities include: supervision of a
pediatric pharmacy staff; participation in
the clinical and distributive services
provided by the satellite; and administra-
tive details required for monitoring of
clinical and distributive services provided
by the staff. Qualified candidates should
possess strong interpersonal and com-
munication skills and should have a North
Carolina Board license or be eligible for a
North Carolina Board of Pharmacy
license. Completion of a pediatric
residency is a plus. Salary is competitive
with excellent benefits. For more
information, send resume or call collect:
Letha Huffman, North Carolina Baptist
Hospital, 300 S. Hawthorne Road,
Winston-Salem, NC 27103. (919) 748-
4717. EOE.
STAFF PHARMACIST WANTED: Im-
mediate, full-time position available in our
150-bed acute care hospital. Successful
candidate must have North Carolina
license to practice as a Registered
Pharmacist. We offer an excellent
compensation package including com-
petitive salary, paid life and health
insurance, stock purchase plan and many
other great benefits. Qualified profes-
sionals may contact Highsmith-Rainey
Memorial Hospital, Personnel Depart-
ment, 150 Robeson Street, Fayetteville,
NC 28301. (919) 483-7400. An affiliate of
HCA.
PHARMACISTS WANTED: Farmco
Drug Centers have present positions
available in Rocky Mount, Elizabeth City
and Roanoke Rapids, North Carolina. For
more information contact James Thomp-
son at (919) 878-8158.
PHARMACIST WANTED: Leading
independent in Asheville area, computer-
ized with QS-1. 42 hour week, flexible
schedule, competitive salary and bene-
fits. Reply to Box BDE, c/o NCPhA, P.O.
Box 151, Chapel Hill, NC 27514.
PHARMACIST WANTED: Director of
Pharmacy for 64-bed hospital in South-
eastern North Carolina. Excellent hours,
salary negotiable, and good fringe
benefits. Contact Tom Smart at (919)
582-2026.
PHARMACIST WANTED: Pharmacy II
position available at Piedmont Correction
Center in Salisbury. Rowan County. One
year experience. Salary grade; 75. Salary
range; 26,892-43,728. Call Sylvia Matt-
hews at (704) 634-1421 Ext. 501 or 507.
PHARMACY FOR SALE: Coastal NC.
Sales greater than $400,000.00; 60%
prescriptions. 10 miles from the ocean.
Contact Bullock & Whaley (919) 762-
2868; PO Box 3764, Wilmington NC
28406.
PHARMACIST WANTED: Opportunity
for pharmacist interested in progressive
independent practice. Opportunities for
patient counseling, hypertensive screen-
ing, diabetes screening and home health
care. Excellent salary and benefits. No
nights or Sundays. Contact Box ZZZ, c/o
North Carolina Pharmaceutical Associa-
tion, P.O. Box 151, Chapel Hill, NC 27514.
WANT TO BUY: Old or antique
pharmacy fixtures, shelving and possible
soda fountain. Please contact Wheeler
Carver, Jr. at P.O. Box 1121, Roxboro, NC
27573 or call (919) 599-4515.
Continued on page 36
July, 1987
36
THE CAROLINA JOURNAL OF PHARMACY
CLASSIFIEDS
Continued from page 35
PHARMACIST WANTED: Opportunity
for pharmacist for independent pharmacy
store located in Central Piedmont, NC.
Store open 51/2 hours per day. No nights,
Sundays or holidays. Paid vacations.
Reply to Box ABC, c/o NCPhA, P.O. Box
151, Chapel Hill, NC 27514.
WANTED UNIT DOSE PACKING
MACHINE: Call Terminal Drug Store, S.
Harmon, (919) 243-2102, Wilson, NC
27893.
WANTED FULL TIME PHARMACIST.
Western part of the State. Two 10 hour
days in two different locations. Three
consecutive days off, no Sundays, no
nights. Both in resort setting. Contact
Jack Alexander, (704) 526-2366.
RELIEF PHARMACIST: weekend work
in Raleigh area. Excellent working
conditions, computerized pharmacy. Call
(919) 772-4737 or write Tom Jones Drug,
P.O. Box 271, Garner, NC 27529.
PHARMACIST WANTED: Call Norwood
at 259-2676.
PHARMACY FOR SALE: Piedmont area
pharmacy with annual sales of over
$500,000. Annual increase each year.
Owner will assist with financing if
necessary. Contact Box RK, NCPhA, P.O.
Box 151, Chapel Hill 27514.
MOSSINGHOFF
Continued from page 33
criticism from the public for price increases, and
even though the public has experienced the
above-mentioned increases in its prescription
costs, they are not accepting the increases with
good will toward PMA or their pharmacists.
Sincerely,
A.H. Mebane, III
BIRTHS
ELIZABETH RENEE CAULEY of Clayton
married Donald Russel (Rusty) Rains of
Goldsboro at the First Baptist Church of Clayton
on June 6. Renee is a 1982 graduate of the
University of North Carolina at Chapel Hill
School of Pharmacy and is employed as a
pharmacist for Kerr Drugs in Clayton. Rusty is a
graduate of East Carolina University and is a
District Executive for the Boys Scouts of
America in Central Wake County. They make
their home in Raleigh.
WEDDINGS
Connie P. Cousins (1985) and Dr. John F.
Rink, Jr. were married August 8 at Wheat
Swamp Christian Church in Kinston. Connie is a
pharmacist for Kerr Drugs in Shallotte. The
bridegroom is an 1983 University of North
Carolina at Chapel Hill graduate and is a dentist
in Shallotte.
DEATHS
Irvin J. Pruett
Irvin J. Pruett, Angier, died Sunday, May 3,
1987. He was 66 years old. Pruett was a 1955
graduate of Butler University and was owner of
Pruett's Pharmacy in Angier from 1971 to 1983.
He retired in 1983 and worked as a relief
pharmacist in the area, mainly in Lillington.
Hoyt Carlynn Hedrick
Hoyt C. Hedrick, Monroe, died Friday, March
27, 1987, at the age of 77. Hedrick worked in
Lexington and Salisbury before accepting
employment with Secrest Pharmacy in Monroe
where he worked for over 30 years.
George McLarty
George McLarty, High Point, died December
23, 1986, at the age of 87, from kidney failure.
McLarty, a Georgia native, operated McLarty
Drug Company in High Point for many years, the
last few with his son George. McLarty was voted
a Life Membership in the NCPhA in 1986 in
recognition of his years of service to his
profession in High Point.
July, 1987
;*&i— '•■
-■* ... V
: * .
AND DES\UW
; pharWacv
ORDER &Ǥ
ftND |NVENTO«^
COUPDN
REDEEMPTtQ«<
PROGRAM
'
■ntf.r, MLi-aTi.
Put all your eggs in one basket !
Being an independent pharmacist is like walking on egg shells.
The highly computerized systems and massive buying power
of the big chains make the competition tougher than ever.
The best way to meet this competition is to take advantage
of our buying power, computerized systems and our commit-
ment to a high level of service and quality products. So, if
you want a higher measure of return on your investment, put
all your eggs in our basket.
• Electronic Order Entry and Inventory Management • Pharmacy
Computer Systems • Cost Plus Purchasing • Special Deal Purchasing
• Automatic Price Updates • Home Health Care Products • Manage-
ment Reports • Store Planning and Design • Employee Training
• Merchandising and Planogramming • Advertising • Coupon He
deemption Program
OwerLS&Mino^Inc
1010 HERRING AVENUE • WILSON, NORTH CAROLINA 27893 • 1-919-237-1181
"Toll Free 1-800-682-2270"
Dr.T.C.Smith Co./ W.H.King Drug
ASHEVILLE, N.C. 28806 • 704/258-2645 / RALEIGH, N.C. 27622 • 919/782-8400
\-9&i&*-
TOTAL
HOMESPUN
SERVICE
In today's business rush we take the time to help
you with your management decisions . . . whether its
over coffee or part of a regular sales call. We will fill
your order with care and with dispatch today. Just as
we did in 1869.
We use advanced technology to lead in service to our
customers.
Some of our available programs are Electronic Order
Entry • Merchandising and Programming • Valurex
Advertising & Promotion • Retail Pricing
fiche • Pharmacy Computer Systems
Health Care and much more.
Whether you take your coffee
black or with cream,
call us to find
out more details.
Micro-
Home
VALUREX INDEPENDENT
ValuRex
PHARMACY
-,©<
ADVERTISING & PROMOTIONAL
PROGRAMS
P).
TO HELP YOUR BUSINESS IS OUR BUSINESS'
THE GAROLINk
GO
LU
CO
O
>
oo
o
CO
0
<
Health Sciences Library
223-H
UNC
Chapel Hill, NC 27514
M. Keith Fearing, Jr., immediate past presidHtyWGhtyMklQTth Carolina
presents the Mortar-and Pestle Award to 1987 Pharmacist-of-the-
Year John C. Hood, Jr.
OCT 29 V*?
Health Sciences Library
Thank You,
Kendall Customers!
continued excellent service. This
includes evening order taking, accurate
order filling, fast delivery, and a 95+%
service level.
Thanks again, Kendall customers,
for making us your full-line
pharmaceutical wholesaler.
For over 65 years, Kendall has been
serving pharmacists in the Southeast.
Your changing needs and ideas have
helped us grow into the service
oriented wholesaler we are today.
We appreciate your loyalty and
support, and we strive to provide
Kendall Staff:
Front Row:
Marty Bowen (Chargebacks); Sandra Bostic (Warehouse); Cynthia Champion (Sales);
Linda Summey (Contracts)
Back Row:
Ponola Bridges (Warehouse); Lynda Helms (Telephone Sales); Nancy Thackrah
(Warehouse); Robert Weatherford (Purchasing); Tim Hamrick (Delivery)
IE
ILADRUG COlVlFVXrSJV
1305 Frederick St. • P.O. Box 1060 • Shelby, N.C. 28150
NC 1-800-222-3856 • SC 1-800-438-5330
Justice Drug Company
P.O. Box 22025
Greensboro, NC 27420
AN ALCO STANDARD COMPANY
Now in our 87th Year of Service to the North Carolina Pharmacists
l®¥ Partnership
For Profit
Family
Independent
Pharmacy
Total Retail Concept
The Family Independent Pharmacy program provides an
all-inclusive plan covering every aspect of marketing,
merchandising, and management of drug store opera-
tions. It is a wholesaler-sponsored voluntary, and it
embraces the total retail concept in all its forms.
WHC
TOTAL HOME HEALTH CANE
Our Total Home Health Care™ Program offers Durable
Medical Equipmentfor Rentor Resale. Third Party Billing
for Medicare/Medicaid.
Additional
* Services & Programs Offered *
Store Plan-O-Gram: Complete Store Layout & Design
including Fixtures, Merchandise Plan-o-graming,
and Pricing Strategies
Specialty Gift Departments including Arts & Crafts
Affordable Pharmacy Computer Systems
LIBERTY DRUG SYSTEMS, INC.
QS/1 PHARMACY SYSTEMS
Merchandise Racking Service
Group Life
And Health
Insurance
Benefits
For Members Of
North Carolina
Pharmaceutical
Association
Jefferson-Pilot Life Insurance Company is pleased to
have been selected as the Group insurance carrier for
the North Carolina Pharmaceutical Association. It would
be to your advantage to become thoroughly acquainted
with the benefits of this program.
You can expect the best possible service from
Jefferson-Pilot, one of the nation's leading Group
insurance carriers. For full information, contact Mr. Al
Mebane, Executive Director, North Carolina
Pharmaceutical Association.
Write or call:
Sam P. Stuart, CLU
P. O. Box 595
Winston-Salem, NC 27102
Telephone 919/723-8811
Jefferson
PilOI
INSURANCE / FINANCIAL SERVICES
1HE OIROLINk
JOURNKLofPHrVRMkCY
AUGUST 1987
Officers
NORTH CAROLINA
PHARMACEUTICAL
ASSOCIATION
President
Julian E. Upchurch
5201 Pine Way
Durham, NC 27712
(919) 477-7325
Vice Presidents
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh, NC 27612
(919) 876-5600
W. Robert Bizzell
1007 Rhem Street
Kinston, NC 28501
(919) 527-6929
Loni T.Garcia
5210 McLeod Road
Lumberton, NC 28358
(919) 738-6441, Ext. 7317
Executive Director
& Editor
A. H. Mebane, III
P.O. Box 151
Chapel Hill, N.C. 27514
NCPhA Office
(919) 967-2237
or
1-800-852-7343
(USPS 091-280)
VOLUME 67
ISSN 0528-1725
NUMBER 8
CONTENTS
Hood Honored as Pharmacist-of-the-Year 5
State Board of Pharmacy News 7
Newly Licensed Pharmacists 11
CDC Immunobiologic Agents 15
CE Course-OTC Vaginal Contraceptives 19
Dickinson's Pharmacy 29
Local News 31
Lilly Digest Preview-Independent Pharmacy 33
Births and Deaths 30
Classified Advertising 34
ADVERTISERS
Colorcraft 33
Dr. T. C. Smith Co./W.H. King Drug Back Cover
Eli Lilly Company 12
Geer 16
Gene Minton Consulting Services 18
Jefferson-Pilot 2
Justice Drug Division 1
Kendall Drug Company Inside Front Cover
Lawrence Pharmaceuticals 20
Marion Laboratories 28
Owens & Minor, Inc Inside Back Cover
Savage Laboratories 14
Smith Data Processing (QS/1) 26
Store Fixtures & Planning, Inc 10
The Upjohn Company 8
Washington National Insurance Company 24
The Carolina Journal of Pharmacy is published monthly by the
North Carolina Pharmaceutical Association, P. O. Box 151,
Chapel Hill, NC 27514. The Journal is provided to NCPhA
members through allocation of annual dues. Subscription rate to
non-pharmacists (continental US) $20.00. Single copy price
$2.00. Overseas rates on request. Second class postage paid at
Chapel Hill, NC.
THE CAROLINA JOURNAL OF PHARMACY
John and Evalyn Hood, daughter Shields and son John, III.
Program participants, left to right: Keith Fearing, Roland Paylor, Rob Bizzell, John Hood, Dan
Lilley, John Capps, Julian Upchurch and Rev. David Gift.
August, 1987
THE CAROLINA JOURNAL OF PHARMACY
HOOD HONORED AS PHARMACIST-OF-THE-YEAR
John C. Hood, Jr. Kinston, was recognized
Friday night, August 14, as 1987 North Carolina
Pharmacist of the Year at the Mortar-and-Pestle
Dinner held in Kinston. Neighbors, family,
colleagues and friends from across the state
participated in the dinner and program which
followed, held at Vermillion's Buffet.
Julian E. Upchurch, NCPhA President,
presided at the program which featured
presentations by friends of Hood replete with
Gordon Vermillion, President of the Lenoir
County Chamber of Commerce.
The Master of Ceremonies for the evening was
John T. Capps, HI, founder of the Bald Headed
Men of America Club and nephew of the
recipient. He has appeared on many radio and
television talk shows and kept the evening on a
light and merry path.
Mr. Roland L. Paylor, Jr., Executive Director
of the Kinston Housing Authority, told of
A surprise gift for John Hood, a pair of his father's cuff-links, was given by his sister Betsy Proctor.
anecdotes and stories of growing up in Kinston.
The Reverend David S. Clift, Westminster
United Mithodist Church, Hood's minister, told
of the activities of Hood in church and
specifically the gathering of "volunteers" for the
early service choir. He commented that one of the
terms that might be used about Hood in this
respect was "fear". He also noted that Hood was
committed to serving in the church, and was
always there.
Dan T. Lilley, NC House of Representatives
from the Third Destrict, brought official greetings
to the out of town guests, commenting about the
hospitality and warmth of the people of Kinston
and Lenoir County.
Mrs. Peggy Boone, on behalf of the Mayor of
Kinston, Mr. O.A. Rich, read a proclamation
recognizing the achievements of John Hood.
Another special message was delivered by
growing up across the street form the Hoods.
John had five sisters and the two families were on
the same telephone party line and the two
families were quite close. Paylor said he felt part
of the Hood family. Mrs. Hood was quite an artist
and brought art to Kinston in those days, said
Paylor. John Hood, Sr. was also civic minded
and the Housing Authority is named for him.
John and Evalyn Hood are still active in art and
the room was decorated with some original
paintings of the Hoods'. Hood and Paylor went
off to college together and have remained the best
of friends.
Rob Bizzell, a fellow Kinston pharmacist and
2nd Vice President of the North Carolina
Pharmaceutical Association told of the
professional experiences he had with recipient.
Continued on page 6
August, 1987
THE CAROLINA JOURNAL OF PHARMACY
HOOD
Continued from page 5
Hood was now a competitor and a valued
colleague and they worked together to provide
quality pharmacy services. Hood was particularly
good with patients, said Bizzell, and counseled
them well. He noted that the first prescription he
dispensed from his pharmacy was filled with a
drug borrowed from Hood's store, a practice that
continues, according to Hood. Bizzell said he
tried to emulate Hood in his prifessional life and
daily activities.
J. Marshall Tetterton, President of Peoples
Bank, Rocky Mount, told of Hood's high
Hood's sister, Betsy Proctor, of Atlantic Beach,
gave him a special gift, a set of his father's cuff
links he had given up ever having, and she told
him that "Mother and Daddy are smiling down
on you tonight." John was almost speechless, but
he did remind the audience that Betsy was the
first "Miss Kinston."
The North Carolina Pharmaceutical Associa-
tion "Mortar-and-Pestle" Award, emblematic of
Pharmacist-of-the-Year, was presented by
NCPhA Immediate Past President, M. Keith
Fearing, Jr., who gave special recognition to
Evalyn Hood. Fearing commented that the
NCPhA had just gotten its Devisal of Arms and
Past recipients of the Mortar-and-Pestle Award: left to right, back row: Bill Randall, Jack Watts,
Jimmy Creech and B.R. Ward. Front row: Tom Burgiss, Harold Day, Jean Provo, 1987 recipient
John Hood, June West, John Henley, J.C. Jackson and Ralph Rogers.
integrity and his love of tennis. He related how
Hood won his frist tennis trophy at the age of 16
(disputed later by the recipient). Tetterton stated
that John Hood was being honored for the good
he has brought out in others, besides his own
accomplishments and contributions. Hood has
character, courage, intellectual integrity and
reason and is a fierce tennis competitor said
Tetterton.
A special citation from Rotary International
was presented by E. A. Alexander, 773 District
Governor, for Hood's work on Polio Plus. Hood
is a past District Governor of Rotary and
recipient of the coveted Paul Harris Fellow. He is
also a past president of the Kinston Rotary Club.
Kinston was the first US city to get a Devisal of
Arms.
Hood accepted the award and paid tribute to
his wife who made everything possible and been
a part of all he had been involved in. John said "If
wealth can be measured by friends, then I am a
wealthy man. I don't take myself seriously, but I
do take my responsibilities seriously." He
thanked all the program participants, his
employees and friends for coming out on this
evening and introduced his family, with special
notice of what may be North Carolina's first fifth
generation pharmaicst. Most of all, he thanked
his parents for teaching him to work with other
people.
August, 1987
THE CAROLINA JOURNAL OF PHARMACY
STATE BOARD OF
PHARMACY
Members — W. R. Adams, Jr., Wilson; Harold V. Day, Spruce Pine; W. Whitaker Moose,
Mount Pleasant; W. H. Randall, Llllington; Evelyn P. Lloyd, Hillsborough; Joseph R. Roberts,
III, Gastonla; David R. Work, Executive Director, P. O. Box H, Carrboro, NC 27510
Telephone #(919) 942-4454
PHARMACY PERMITS
RECENTLY ISSUED
Medical Arts Phcy., Inc.
200 Robeson St.
Fayetteville, NC
#4769, Issued 4/15/87
Doctor's Family Care Ctr.
1673 Owen Dr.
Fayetteville, NC
#4770, Issued 4/24/87 (LSP)
Giant Genie Discount Drugs
3330 The Plaza
Charlotte, NC
#4771, Issued 4/27/87
Revco Discount Drug Ctr.
1334 N. Main St., Sunset Plaza
Fuquay-Varina, NC
#4772, Issued 4/27/87
Wal-Mart Phcy.
8140 Hwy. 64-70 S.E.
Hickory, NC
#4773, Issued 4/27/87
Kroger Sav-On
#21 The Commons, US Hwy. 1
Southern Pines, NC
#4774, Issued 4/27/87
Cornwell Drug
104 Thornburg Dr.
Concord, NC
#4775, Issued 4/30/87
Lloyd's Phcy.
118 AW. King St.
Hillsborough, NC
#4776, Issued 5/1/87
Rite Aid Discount Phcy.
Rt. 3, Box 50-A
Norwood, NC
#4777, Issued 5/4/87
South
Forsyth Co. Dept. of Public Health
741 N. Highland Ave.
Winston-Salem, NC
#4778, Issued 5/13/87 (LSP)
Drugco Discount Phcy.
107 Smith Church Rd.
Roanoke Rapids, NC
#4779, Issued 5/19/87 (T/O)
Pharm-Save III
1010 N. Main St.
Mooresville, NC
#4780, Issued 5/19/87
WNC Pharmacy Consultants
2 1 1 Montgomery St.
Waynesville, NC
#4781, Issued 5/19/87 (LSP)
Wal-Mart Phcy.
2149RockfordSt.
Mt. Airy, NC (LSP)
#4782, Issued 5/19/87
Presbyterian Specialty Hosp.
1600 E. Third St.
Charlotte, NC
#4783, Issued 6/1/87 (T/O)
Kroger Phcy.
1116 Eastchester Dr.
High Point, NC
#4784, Issued 6/1/87
Revco Discount Drug Ctr.
132 Andrews Rd.
Murphy, NC
#4785, Issued 6/1/87
Continued on page 9
August, 1987
pyngh! lati', !ne Up|Ohn company, Kalamazoo, Micnigan <■
August, 1987
THE CAROLINA JOURNAL OF PHARMACY
PERMITS ISSUED
Continued from page 7
The Medicine Shoppe
707A S. Lafayette St.
Shelby, NC
#4786, Issued 6/1/87
Wal-Mart Phcy.
280 Hwy. 29 South
Concord, NC
#4787, Issued 6/1/87
Wal-Mart Phcy.
1730 East Dixon Blvd.
Shelby, NC
#4788, Issued 6/1/87
Rite Aid Discount Phcy.
Rt. 127 South
Hickory, NC
#4789, Issued 6/8/87
Capps-Daniels Durg Co., Inc.
418 Peacock St.
Ahoskie, NC
#4790, Issued 6/9/87 (T/O)
Kerr Drugs
Westbrook S/C, 3561 S. Church St.
Burlington, NC
#4791, Issued 6/15/87
Kerr Drugs
3802 Bridges St. Ext.
Morehead City, NC
#4792, Issued 6/15/87
Bertie Co. Health Dept.
Wayland
Windsor, NC
#4793, Issued 6/15/87 (LSP)
Cleveland Co. Health Dept.
3 1 5 Grover St.
Shelby, NC
#4794, Issued 6/15/87 (LSP)
Edgecombe Co. Health Dept.
2909 Main St.
Tarboro, NC
#4795, Issued 6/15/87 (LSP)
Halifax Co. Health Dept.
Dobbs St.
Halifax, NC
#4796, Issued 6/15/87 (LSP)
Halifax Co. Health Dept.
215McDanielSt.
Enfield, NC
#4797, Issued 6/15/87 (LSP)
Halifax Co. Health Dept.
House Ave.
Scotland Neck, NC
#4798, Issued 6/15/87 (LSP)
Harnett Co. Health Dept.
715 N. Main St.
Lillington, NC
#4799, Issued 6/15/87 (LSP)
Harnett Co. Health Dept.
904 West Edgerton St.
Dunn, NC
#4800, Issued 6/15/87 (LSP)
Nash Co. Health Dept.
1616 West Thomas St.
Rocky Mt., NC
#4801, Issued 6/15/87 (LSP)
Regional Migrant Ctr.
Stricklands Crossroads
Nashville, NC
#4802, Issued 6/15/87 (LSP)
Nash Co. Health Dept.
214 South Barnes St.
Nashville, NC
#4803, Issued 6/15/87 (LSP)
Moore Co. Health Dept.
Carthage Clinic
Carthage, NC
#4804, Issued 6/15/87 (LSP)
Moore Co. Health Dept.
165 Page Rd.
Pinehurst, NC
#4805, Issued 6/15/87 (LSP)
Orange Co. Health Dept.
300 W. Tryon St.
Hillsborough, NC
#4806, Issued 6/15/87 (LSP)
Orange Co. Health Dept.
Carr Mill Mall, Suite 225, 100 N. Greensboro St.
Carrboro, NC
#4807, Issued 6/15/87 (LSP)
Rockingham Co. Health Dept.
Hwy. 65
Wentworth, NC
#4808, Issued 6/15/87 (LSP)
Surry Co. Health Dept.
Hamby Rd.
Dobson, NC
#4809, Issued 6/15/87 (LSP)
Continued on page 10
August, 1987
10
THE CAROLINA JOURNAL OF PHARMACY
PERMITS ISSUED
Continued from page 9
Phcy. of Columbus Co. Public Health Dept.
304 Jefferson St.
Whiteville, NC
#4810, Issued 6/15/87 (LSP)
Wake Co. Health Dept.
401 East Whitaker Mill Rd.
Raleigh, NC
#4811, Issued 6/15/87 (LSP)
Wake Co. Health Dept.
3010 New Bern Ave.
Raleigh, NC
#4812, Issued 6/15/87 (LSP)
Wilkes Co. Health Dept.
West College St.
Wilkesboro, NC
#4813, Issued 6/15/87 (LSP)
Queens College Health Ctr.
1900 Selwyn Ave.
Charlotte, NC
#4814, Issued 6/16/87 (LSP)
Island Phcy., Inc.
Virginia Dare Hwy.
Manteo, NC
#4815, Issued 6/29/87 (T/O)
Valu-Mart Discount Phcy.
127 S. Main St.
Mt. Holly, NC
#4816, Issued 6/29/87 (T/O)
THE EXPERIENCE WE VE GAINED FROM
OVER 200 PHARMACY INSTALLATIONS IS
AVAILABLE TO YOU . . .
AND, WE ARE THE ONLY STOCKING
DISTRIBUTOR OF DRUG STORE FIXTURES IN
THE CAROLINAS.
IF YOU NEED A SINGLE FIXTURE OR A
COMPLETE STORE, OUR PROFESSIONAL
STAFF IS READY TO SERVE YOU. . . .
"THE AREAS LARGEST DISTRIBUTOR OF
MODULAR DISPLAY FIXTURES"
RICHMOND, VIRGINIA CHARLOTTE, NORTH CAROLINA
7921 -A WEST BROAD ST. 3555 TRYCLAN DRIVE
(804) 740-0793 (704) 525-5300
ROLAND THOMAS RANDY BIVENS
"WE ARE MORE THAN A FIXTURE COMPANY— A TEAM OF PHARMACY
SPECIALISTS WITH OVER 60 YEARS COMBINED EXPERIENCE IN OVER
500 DRUG STORES"
Durailuron o»
5?
STORE FIXTURES
& PLANNING. INC.
MTO*£ riKTUnCW
August, 1987
THE CAROLINA JOURNAL OF PHARMACY
11
LICENSED BY EXAMINATION
— July 22, 1987
Adams, Janet Karen, Marshall
Absher, Pamela Lynn, Charlotte
Barre, William John, Concord
Bird, Ann Abbitt, Oak Ridge
Brooks, Lois Jane, Wilkesboro
Bryant, Joy Laverne, Raleigh
Burnett, John Colbert, Boone
Burrell, James David, Charlotte
Calloway, Andrea Leigh, Pineville
Carr, April Denise, Shelby
Carrington, Shelly Dee, Chapel Hill
Clavin, John Grattan, Charlotte
Clay, Derrik Richard, Charlotte
Clow, Kay Nell, Smithfield
Clyde, Jeanne Cauvel, Winston-Salem
Collins, Robert Vernon, Fayetteville
Collins, Vance Edwin, Jr., Roanoke Rapids
Creech, Cynthia lone, Selma
Crew, Dorothy Jean, Charlotte
Denny, Sheryl Lynn, Jacksonville
Diamond, Robin Anne, Sunrise, FL
Dixon, William Barnett, Charlotte
East, Lisa Marie, Charlotte
Ellsworth, Patricia Anne, Raleigh
Emery, Juliann, Charlotte
Englebert, Frankie Elizabeth, Troutman
Ezzelle, Jeffrey Howard, Wilmington
Ferguson, Michael Todd, Garner
Ferrell, Stanley Eugene, Raleigh
Fields, Suzanne McDonald, Chapel Hill
Frailly, Dawn Marie, Statesville
Gardner, Stephanie Ferrell, Chapel Hill
Gray, Susan Diane, Charlotte
Greene, Christopher Bancroft, Virginia Beach, VA
Haan, Phillip Wayne, Jacksonville
Hall, Don Belois, Washington
Hanson, Scott James, Stony Point
Haverlock, Deanne Fay, Winston-Salem
Helton, Beverly Diane, Charlotte
Hill, Carol Ann, Cary
Hite, Janalea Sue, Red Springs
Hogue, Susan Lynn, Clyde
Holder, Patricia Jeanette, Wilmington
Hopper, Myra Lisa, Rutherfordton
Houser, Merri Melanie, Cherryville
Hudson, Kimberly Dawn, Belmont
Hussey, Marcia Lynnette, Robbins
Jessup, Laura Anne, Chapel Hill
Johnson, Barbara Harper, Cary
Johnson, Samuel Henry, Jr., Goldsboro
Jones, Allison Anne, Buies Creek
Jones, Thomas Lanier, Cary
Journey, Teresa May, Durham
Karres, Nickolaos Gus, Charlotte
Kheirkhah, Peiman, Pineville
Kirkegaard, Gary John, Omaha, NE
Knight, Mary Eloise, Pinehurst
Koonce, Sterling Grady, Chapel Hill
Kothapalli, Suguna, Siler City
Ledoux, Barbara Anne, Winston-Salem
Lewis, Patricia Lula, Garner
Lindsay, Myra Hawkins, Carrboro
Lineberger, Randy Dale, McAdenville
Lyerly, Cynthia Gaye, Salisbury
Lynch, Maurice Oliver, Enfield
Marshall, Daniel Burrell, New Bern
Martin, Thomas Alan, Shelby
Meares, James Hubert, Jr., Fair Bluff
Monds, Robert Howard, Whiteville
Moore, Ellen Bowman, Kernersville
Moorman, Mary Katherine, Charlotte
Moose, William Whitaker, Concord
Morgan, Ginger Lynn, High Point
Morrison, Ann Byrd, Fayetteville
Narron, Bradley Franklin, Southport
Nobles, James Harold, Winterville
O'Daniel, Laurie Ann, New Bern
Olson, James Charles, Red Springs
Overton, Lydia Elizabeth, Troy
Parker, Glynda Diane, Atlantic Beach
Parrish, Rebecca Ann, Selma
Pfeffer, Jill, Charlotte
Pike, Cynthia Deann, Winston-Salem
Plyler, Wesley Scott, Salisbury
Preston, Susan Marie, Wilmington
Pullium, Michelle Lynne, Knightdale
Rains, Daryl Evan, Charlotte
Ratcliff, Leighann Mechel, Monroe
Rayfield, Krista Dawn, Bessemer City
Reece, Jonathan Dairl, Granite Falls
Riley, Beverly Lynn, Goldsboro
Rota, Sharon, Asheville
Sawyer, Cynthia Faye, Moyock
Schoppert, Susan Tracy, Charlotte
Shah, Rajesh Sureshchandra, Rockingham
Shehan, Sheila Elaine, Forest City
Shields, Mary Anna, New Bern
Sigmon, Marsha Anne, Denton
Sillmon, Sandra Diane, Durham
Sims, Karen Patricia, Durham
Skoe, Anne Helene, Park Rapids, MN
Skoe, Steven James, Park Rapids, MN
Smith, Susan Elizabeth, Chapel Hill
Stephenson, Karen Gail, Fuquay-Varina
Suiter, Virginia Pickens, Ahoskie
Sullivan, Leigh Anne, Charlotte
Continued on page 13
August, 1987
Human insulin for all. Humuliri
human insulin
[recombinant DNA origin)
Identical to human insulin. Humulin is the only insulin not
derived from animal pancreases
Recombinant DNA technology makes the production of
Humulin possible and virtually assures every insulin user of a
lifetime supply
From Lilly ... a dependable source of insulin for
generations. Since 1922, when we became the first company
to manufacture insulin, we have led the search for the best
diabetes care products and. at the same time, maintained a
constant supply of insulin for all insulin users
Our 24 formulations of insulin— including Humulin and all
forms of lletm' (insulin)— are available through the widest retail
distribution of insulin in the United States.
Beyond that, we will continue to provide a wide range of
diabetes service and educational materials for use by physi-
cians, pharmacists, and diabetes educators.
£ 1986 ELI LILLY AND COMPANY
Our Medical Division is on call. Our Medical Division staff
is only a phone call away Please contact them if you have any
questions about our diabetes care products
Any change of insulin should be made cautiously and
only under medical supervision. Changes in refinement,
purity, strength, brand (manufacturer), type (regular. NPH,
Lente®, etc), and/or method of manufacture (recombinant DNA
versus animal-source insulin) may result in the need for a change
m dosage
Lufy Leadership
For information on insulin delivery systems, contact CPI 1-(800)-227-3422.
SZfy
Eli Lilly and Company
Indianapolis, Indiana 46285
THE CAROLINA JOURNAL OF PHARMACY
13
NEW PHARMACISTS
Continued from page 11
Sykes, Holly Carol, Pink Hill
Terrell, Deneen Alicia, Raleigh
Tester, Stephen Duane, Vilas
Torda, Stephen Joseph, III, Winter Park, FL
Towne, Cassandra Mary, Chapel Hill
Turlington, Caro Lynn, Benson
Ujhelyi, Michael Robert, Deerfield
Vanhooke, Janeen LaVay, Hillsborough
Ward, David Brooks, Shallotte
Watson, John Williams, Tabor City
Watson, Marti Elizabeth, Little Rock, AR
West, Amy Carol, Fuquay-Varina
West, Kimberly Margaret, Greensboro
White, John Richard, Fayetteville
Wiedenmayer, Karin Anne, Chapel Hill
Williams, Christine Guy, Chapel Hill
Williams, Susan Renee, Franklin
Willyard, Darrell Lee, Garner
Woolard, Lisa Dale, Wilmington
Wynn, Kimberly Anne, Raleigh
Yiottis, Tessie, Charlotte
Younkins, Glenn David, Oxford
^Bahge of tlje
^Nortlt (Harolma
JJrjarmaceuttcai (Association
NATIONAL OBSERVANCES
Listed below is a list of national observances
related to health promotion. These observances
offer a natural opportunity to schedule programs
related to specific health areas.
September
September
September
September 13
September 13-19
September 20-26
September 20-26
October
October
October
October
October
October
October 1
National Sickle Cell Month
National Emergency Care Month
National Sight Saving Month
National Grandparents Day
National Rehabilitation Week
National Farm Safety Week
National Adult Day Care Center
Week
Family Health Month
National Spinal Health Month
National Lupus Awareness Month
National Diabetes Research
Month
National Family Sexuality
Education Month
Talk About Prescriptions Month
World Vegetarian Day
October 4-10
October 4-10
October 4-10
October 5
October 15
October 16
October 18-24
October 25-31
November
November
November
November 6
November 15-21
November 19
November 23-28
December 10
December 13 19
National Running and Fitness
Week
National Employ the
Handicapped Week
National Fire Prevention Week
Child Health Day
White Cane Safety Day
World Food Day
National Infection Control Week
National Safety on the Streets
Week
National Alzheimer's Disease
Awareness Month
National Diabetes Month
National Epilepsy Month
World Community Day
American Education Week
Great American Smokeout
National Family Caregivers Week
Human Rights Day
National Drunk and Drugged
Driver Awareness Week
August, 1987
Kelly Jenkins
His responsibility is to
do the best job possible... for you
wherever you are in North Carolina.
How specially-trained
Savage professional representatives
can serve you and your business:
• Help maximize inventory turnover for greater
profitability
• Rapid-response order taking and delivery
...and a fair product-return policy
• Close liaison for you with wholesalers,
physicians, and headquarters customer
service at Savage
• Help to keep you informed about current
trends and competitive strategies
• Promotion specialist: Not only helps make the
deals, but helps build traffic
Savage products...
They help build customer traffic
for your pharmacy
The right strengths, the right formulations,
the right quality, at the right price...
to help you serve your customers and
maintain your profits
^
22 high-quality products
from a single source
Allergy: BREXIN ■ LA CAPSULES chlorpheniramine maleale 8mg,
pseudoephednne hydrochloride 120mg •
Antiprotozoal: SATRIC" TABLETS - 250mg (metronidazole USP) •
SATRIC'" - 500 TABLETS (metronidazole USP) •
Bronchodilators: DILOR" ELIXIR (dyphylline) •
DIL0R" INJECTABLE (dyphylline) • DILOR'" TABLETS - 200mg (dyphylline) •
DILOR" -400 TABLETS (dyphylline) • DILOR-G" LIQUID
dyphylline 100mg. guaifenesin USP lOOmg • DILOR-G" TABLETS
dyphylline 200mg. guaifenesin USP 200mg •
Contrast Medium: ETHIODOL" (ethiodized oil (or injection) ■
Cough/Cold: BREXIN" E-X (pseudoephedrine HCI and guaifenesin) ■
Hormone: DITATE 6 -DS (testosterone enanthate and
estradiol valerate injection) •'
Topicals: ALPHATREX" CREAM. OINTMENT AND LOTION 0 05%
(betamethasone dipropionate USP) •
BETATREX" CREAM. OINTMENT AND LOTION 0 1%
(betamethasone valerate USP) •
MYTREX'* F CREAM AND OINTMENT (nystatin - triamcinolone acetonide) •
NYSTEX" CREAM AND OINTMENT (nystatin USP) •
NYSTEX'" ORAL SUSPENSION (nystatin oral suspension USP) •
TRYMEX CREAM AND OINTMENT 0 025% (triamcinolone acetonide USP) •
TRYMEX CREAM AND OINTMENT 0 1% (triamcinolone acetonide USP) ■
Vaginal Preparations: TRYSUL™ (triple sulfa vaginal cream)
(sultalhiazole 3 42%. sulfacetamide 2 86%, sulfabenzamine 3 70%) •
Vitamins: CHROMAGEN'" CAPSULES ferrous lumarale USP 200mg,
ascorbic acid USP 250mg, cyanocobalamm USP 10mcg. desiccated
stomach substance 100mg •
CHROMAGEN" OB CAPSULES a phosphorus- Iree vitamin and mineral
dietary supplement lor use during pregnancy and lactation
SAVAGE
LABORATORIES
a division of Altana Inc. • Melville. New York 1 1 747
People and products to serve your needs.
THE CAROLINA JOURNAL OF PHARMACY
15
FOR YOUR INFORMATION: CDC IMMUNOBIOLOGIC AGENTS
by James R. Talley, M.S.
School of Pharmacy
Northeast Louisiana University
Monroe, Louisiana
Various immunobiologic agents are available
to physicians from the US Centers for Disease
Control (CDC) and Immunobiologics Service.
The agents supplied to physicians are furnished
free of cost to patients. The physician must
provide information about the infection, specific
laboratory data, and limited patient data (name,
age, sex, and weight) and agree to register as a
Clinical Investigator by completing FDA Form
FD-1573.
Several of these agents are considered
"Emergency Life Saving" products and are
stored and dispensed from CDC Atlanta or from
one of nine Quarantine Stations located at
airports in Boston, Chicago, Honolulu, Los
Angeles, Miami, New York, San Francisco,
Seattle, and Washington DC.
For product information or the product may
be obtained by contacting:
Centers for Disease Control
Drug & Immunobiologics Service
1600 Clifton Rd, Bldg 1, Rm 1259
Atlanta, GA 30333
Business Hours Monday-Friday
8:00 a.m. to 4:30 p.m. (EST)
(404) 329-3670
Nights, Weekends, or Holidays
(Emergency Requests Only)
(404) 329-2888
Antitoxins
Botulism Antitoxin (contains antitoxic anti-
bodies against toxins produced by types A, B,
and C strains of Clostridium botulinum)
Diphtheria Antitoxin
Vaccines
Botulinum Toxoid Pentavalent Vaccine (against
types A, B, C, D, and E, strains of Clostridium
botulinum)
Eastern Equine Encephalitis (EEE) Vaccine
Japanese Encephalitis (JE) Vaccine
Venezuelan Equine Encephalitis (VEE) Vaccine
Western Equine Encephalitis (WEE) Vaccine
Smallpox Vaccine
Tularemia Vaccine
Immune Globulins
Vaccinia Immune Globulin (VIG)
Western Equine Encephalitis (WEE) Immune
Globulin
Immune Plasmas
African Hemorrhagic Fever (Ebola Disease)
Immune Plasma
Eastern Equine Encephalitis (EEE) Immune
Plasma
Herpes Simian B (Monkey B) Immune Plasma
Lassa Fever Immune Plasma
Marburg (Green Monkey Disease) Immune
Plasma
St. Louis Encephalitis (SLE) Immune Plasma
Venezuelan Equine Encephalitis (VEE) Immune
Plasma
IMMUNIZATION SCHEDULES
As pharmacists, we are frequently asked
questions about immunizations and childhood
diseases. The following information is provided
as a starting reference source. More specific and
detailed information may be obtained from your
local Public Health Office.
Immunization Schedule for
Normal Infants and Children
AGE IMMUNIZATION
2 months DTP, TOPV
4 months DTP, TOPV
6 months DTP, TOPV (1)
15 months DTP (2), TOPV (1),
MMR (3)
4-6 years DTP (4), TOPV (4)
14-16 years of age and
every ten years
thereafter TD (5)
1 Third dose of TOPV is recommended
where polio is epidemic, otherwise this
dose is optional
2 Give DTP and/or TOPV only after a
minimum of 6 months have elapsed since
Continued on page 17
August, 1987
WE BRING YOU THE BEST
CHARLESTON, S.C.
GREENVILLE, S.C.
THE CAROLINA JOURNAL OF PHARMACY
17
IMMUNIZATION
Continued from page 15
3rd dose. The MMR, however, should
not be delayed.
3 Give MMR anytime child comes to clinic
after 13 months of age. Give 2nd
injection to any child vaccinated before
12 months of age.
4 Give after 4th birthday but before or at the
time of entering school. If child has
reached sixth birthday, give Td instead of
DTP.
5 Booster dose may be given earlier (i.e.,
10-13 years of age) in situations such as
organized school programs.
Immunization Schedule for
Children Not Immunized in
Infancy
15 months (6) through 5 years and over
Under 6 years
6 years & over
First Visit
DTP, TOPV,
MMR (6)
Td, TOPV, MMR
2 months later
DTP, TOPV
Td, TOPV
DTP TOPV (1)
6- 1 2 months later
DTP (6),
TOPV (7)
Td, TOPV
14-16 yrs. of age
Td
Td
Thereafter, repeat
Td every 10
years for both
schedules
6 MMR is not routinely given before 13
months of age.
7 If child completes these immunizations prior
to 4 years of age a supplemental dose of
each is recommended after 4 years of age
prior to school entry.
DTP = Diptheria and Tetanus toxoids
combined with Pertussis Vaccine
TOPV = Trivalent Oral Polio Vaccine
Td = Tetanus and Diphtheria Toxoids,
Adult type
MMR = Measles, Mumps, Rubella combined
THE UNITED STATES
PHARMACOPEIAL
CONVENTION, INC.
The United State Pharmacopeial Convention,
Inc. (USPC), is the organization which sets the
official standards of strength, quality, purity,
packaging, and labeling for drugs and other
articles used in medical practice in the United
States. It is the publisher of the United States
Pharmacopeia (USP) and the National
Formulary (NF) which are recognized as official
compendia by Federal and State Food, Drug and
Cosmetic Acts, and the standards contained
therein are legally enforceable by the U.S. Food
and Drug Administration. Standards are
developed by elected volunteer experts in
academia, industry and government.
The USPC is an independent, nonprofit
organization composed of representatives from
accredited colleges of medicine and pharmacy in
the U.S., state medical and pharmaceutical
associates; many national associations concerned
with medicines, such as the American Medical
Association, the American Nurses Association,
the American Dental Association, and the
American Pharmaceutical Association; and
various departments of the federal government,
including the Food and Drug Administration. It
was established over 160 years ago, and is the
only national body that represents the professions
of both pharmacy and medicine.
In addition to setting the official drug
standards for the United States, USPC maintains
a comprehensive data base of drug-use
information for patients and physicians,
pharmacists and other health care professionals:
USP DI. USP DI is a mandatory reference for
pharmacies in many states. It is the data base used
for the patient education leaflet programs of the
American Medical Association, the National
Association of Retail Druggists, the American
Academy of Family Physicians, several state
pharmacy associations and clinics. It is the most
widely used patient education data base in
America today.
The USPC also operates the Drug Product and
Medical Device. Problem Reporting Systems for
health professionals to use in identifying and
correcting problems associated with health-care
products. Reports received at USP are forwarded
to the Food and Drug Administration and
industry officials for corrective action.
For further information, contact Alice E.
Kimball, Director of Professional Affairs, The
United States Pharmacopeial Convention, Inc.,
12601 Twinbrook Parkway, Rockville, MD
20852,(301/881-0666).
<-J
August, 1987
THE CAROLINA JOURNAL OF PHARMACY
Cut Out or Reproduce and Mail
CONTINUING PHARMACEUTICAL EDUCATION
Vaginal Contraceptives
Attach mailing label from The Carolina Journal of Pharmacy or print your name
and address and mail to CE Test, NCPhA, P.O. Box 151 , Chapel Hill NC 27514
Completed answer sheets may be returned on a monthly or less frequent basis
for grading.
This is a member service. Non-members responses will not be graded nor
CPE credit provided.
NCPhA will maintain a copy of your completed CPE tests and upon successful
completion of each program, will issue a certificate for one (1 ) hour of board-
approved CPE.
If more than two questions are answered incorrectly, the test is failed. You
will be given one opportunity to submit a second answer sheet.
Please circle correct answers
1. abed
2. abed
3. abed
Evaluation:
4. abed
5. abed
6 abed
Excellent Good
7.
8.
9.
10.
Fair
abed
abed
abed
abed
Poor
name
address
A NEW SERVICE TO THE INDEPENDENT AND SMALL
CHAIN PHARMACY OWNER
Professional Management Consulting by
Gene Minton, RPH
. . . Now you can benefit from 10 years experience in supervisory management of
high volume drug stores on an individual and group basis.
. . . Consultation in all areas of decision making such as product mix, pricing,
merchandising, remodeling, site selection, computer applications (and selection),
Rx pricing, advertising, personnel management, etc. with emphasis on results and
the bottom line.
. . . Let us plan your next remodel, design your new store, show you how to save
money on fixtures, evaluate wholesalers, analyze your p&l, and many other
services to make you happier with your store & your profits.
. . . Can you afford not to call?
contact Gene Minton at Gene Minton Consulting Services, 6 Lake Shores, Littleton,
NC 919-586-5465. (All client information held in strict confidence).
August, 1987
THE CAROLINA JOURNAL OF PHARMACY
19
CORRESPONDENCE COURSE
ADVISING CONSUMERS ON
OTC VAGINAL CONTRACEPTIVES
by Thomas A. Gossel, R.Ph., Ph.D.
Professor of Pharmacology and Toxicology
Ohio Northern University, Ada, OH
and
J. Richard Wuest, Pharm.D., R.Ph.
Professor of Clinical Pharmacy
University of Cincinnati, Cincinnati, OH
Goals
The goals of this lesson are to:
1 . explain the mechanism of action and utility
of commonly used spermicidal agents;
2. present the conclusions of an FDA advisory
panel on OTC spermicidal products.
3. describe the reported relationship between
the Today contraceptive sponge and
carcinogenesis, and toxic shock syndrome;
4. discuss consumer advice about spermicidal
products.
Objectives
At the completion of this lesson, the successful
participant will be able to:
1. categorize each of the ingredients in OTC
spermicidal products as to their safety and
efficacy;
2. list the various types of vaginal contraceptive
products and list their advantages and
disadvantages;
3. compare OTC spermicidal contraceptives
for efficacy with other methods of birth
control;
4. summarize directions for correctly using the
contraceptive sponge.
The human race is reported to be increasing by
the rate of nearly 150 persons per minute, or 77
million persons per year. If this rate continues, by
the year 2040 the world population will be 8
billion people, almost double the current 4.6
billion figure.
Regardless of whether an American woman is
concerned about the total world population or
her own family size, she desires control over her
body and when she chooses to be pregnant.
Therefore, OTC vaginal contraceptives are an
integral component of family health care. Their
August, 1987
availability to any person at any time is extremely
important.
Consumers may choose from a variety of OTC
or physician-prescribed contraceptives (Table 1).
Each has advantages and disadvantages.
Spermicidal agents applied within the vagina are
the topic of this month's lesson.
History
The introduction of substances into the vagina
is the oldest recorded means of contraception,
first reported in the 19th century B.C. Early
Egyptians mixed honey natron (sodium
carbonate) and crocodile dung to form a vaginal
contraceptive paste. Oil of cedar and
frankincense mixed in olive oil were in vogue in
the 4th century B.C. Peppermint oil in honey,
cedar gum, alum, and pieces of sea sponge were
reportedly inserted into the vagina in the first and
second centuries A.D. for contraceptive
purposes.
Continued on page 21
in the /or vice
of phcir mocy
This continuing education for
Pharmacy article is provided
through a grant from
MERRELL DOW
PHARMACEUTICALS INC.
© Merrell Dow
THE CAROLINA JOURNAL OF PHARMACY
If things go wrong . ♦ .
call Bubba*
904-7314610
Lawrence Pharmaceuticals
takes great pride in doing
things right. But the people
at Lawrence are also
human and. . . once in a
while . . . things go wrong
and an error may occur
in one of your orders.
That's the time to
call Bubba Smith.
Bubba (his real name
is Robert Smith) is our
customer service
manager. He's been with
Lawrence for 15 years
and he takes great
pride in "telling it
like it is. "Which
means you
won't get
any alibis or
doubletalk
out of
Bubba.
What you
get is action.
Fast.
The
number is
(904)731-4610. Keep it handy.
It could help you soothe your
customers' headaches —
instead of having one of your
own. w
.^Lawrence. ,
Pharmaceuticals
6100 Phillips Highway
Post Office Box 5386
Jacksonville, Florida
32207-0386
(904)731-4610
August, 1987
THE CAROLINA JOURNAL OF PHARMACY
21
CORRESPONDENCE COURSE
Continued from page 19
In the 1 8th century, Casanova recommended
squeezing a lemon and inserting it over the
cervical opening. This cup-shaped lemon rind
provided a physical barrier to sperm movement
into the cervix. The citric acid also conferred
spermicidal action.
The first commercial vaginal product was a
suppository containing quinine sulfate in cocoa
butter. This was manufactured in London in
1855. By the turn of the century, it was available
in many countries. This was followed in the
1920's and 1930's with suppositories and
foaming tablets containing ingredients such as
mercury, quinine, lactic acid, boric acid, or burnt
alum. With the discovery that several surfactants
were effective spermicides, their use was
popularized in the 1950's.
The use of vaginal contraceptives declined
during the 1960's and early 1970's when oral
contraceptive steroids made their debut. Later,
intrauterine devices (IUD's) became popular.
For awhile it seemed that this national trend
away from OTC creams and jellies, and toward
effective but potentially dangerous devices
requiring physician supervision would continue.
Now, however, there is growing concern over
the safety or oral contraceptives and IUD's,
which are contraindicated for many women.
Women are looking for alternate, safe means for
birth control. Therefore, a resurgence of interest
in OTC vaginal contraceptives has occurred.
Except for sterilization, many people believe that
OTC spermicides are the safest and most effective
contraceptives.
Vaginal Contraceptives
OTC contraceptives (spermicides) are agents
intended to be placed within the vagina. They
consist of jellies, creams, foams, suppositories,
foaming tablets, and sponges impregnated with
spermicides.
These items provide contraceptive action in
two ways. First, they physically prevent sperm
movement through the cervical opening into the
uterus and fallopian tubes. Secondly, they
provide direct spermicidal or sperm-immobili-
zing activity before sperm can move into the
upper genital tract.
An ideal spermicide meets the criteria outlined
in Table 2. Currently available OTC products
come close to meeting these requirements.
The FDA Advisory Panel on OTC
Contraceptives and Other Vaginal Drug
Products has reviewed all available data on
spermicidal products. The results of this review
and a categorization of spermicidal ingredients
are summarized in Table 3.
Surfactants
Surfactants (a contraction of the term "surface
active agent") have been used as contraceptives
since the 1950's. Unlike many of the earlier
compounds, surfactants were effective and they
did not irritate the vaginal lining or penile
membrane. Many surfactant substances,
including cationic, anionic, and nonionic
chemicals, have been tested over the years. The
nonionic substances have surfaced as the most
effective contraceptives.
Nonionic surfactants (i.e., those which do not
dissociate into positively or negatively charged
ions) act directly on the lipid membrane of sperm.
Their surface tension lowering capacity enhances
their activity. This alters the sperm's membrane
permeability characteristics and causes osmotic
imbalance. In turn, the sperm's ability to absorb
fructose, required for their metabolism, is
reduced. This leads to a loss of motility and death
of the sperm.
The two ingredients in current use in this
country, nonoxynol 9 and octoxynol 9 are
alkylphenyl polyoxyethylene nonionic surfac-
tants. Octoxynol has a slightly different chemical
structure than nonoxynol. However, both
ingredients are equally safe and effective.
Menfegol, an agent used in foaming tablets
elsewhere in the world, has been categorized as
safe and effective by the OTC advisory panel.
However, it has not been marketed in the U.S. at
the time of publication of this lesson.
Effectiveness
Various studies have shown that between 1
and 30 percent of spermicidal users will become
pregnant during a year of use. However, this
should not be construed as an index of
ineffectiveness of the products. The major reason
for failure is improper use of the contraceptive
rather than the particular spermicide product.
Many factors influence a product's effective-
ness. These include proper placement, time
required for melting to release the drug, and the
duration of effectiveness. But the most important
factor is compliance, i.e., the user following the
directions correctly.
Continued on page 22
August, 1987
22
THE CAROLINA JOURNAL OF PHARMACY
CORRESPONDENCE COURSE
Continued from page 21
It is reported that foams are best. They are
followed by foaming suppositories, creams, and
jellies, in that order. Suppositories are convenient
and easy to use, but may take 1 0 to 1 5 minutes to
melt. One study showed that Encare
suppositories were still intact 15 minutes after
insertion in 9 of 20 women.
Safety
Surfactants have a long history of safe use.
They have no known effects on the human
embryo and no long-term adverse effects on the
woman.
Recently, the potential for causing adverse
effects to the user and the fetus have been
questioned. It is known that these agents can be
absorbed into the blood.
Several mechanisms for possible spermicide-
induced congenital damage have been proposed.
Some investigators believe that spermicides
could injure sperm resulting in defective
fertilization. This doesn't seem likely since the
drugs work by destroying sperm cell membranes
• No effect on development of embryo or
fetus, or development of nursing infant
• Inexpensive and readily available
• Aesthetic and easy to use
• Suitable for multiple uses per application
TABLE 1
Comparative Effectiveness of Various
Contraceptive Methods*
Pregnancies Per 100
Method
Woman - Years
Oral contraceptives
<1 -3
Intrauterine devices
< 1 -6
Diaphragm with cream or gel
2-20
Vaginal sponge
2-20
Aerosol foams
2-29
Condoms
3-36
Spermicidal cream or gel
4-36
Rhythm - calendar method
< 1 -47
Rhythm - temperature method
1 -20
*Modified from Kastrup, EK et. al. (Eds.): Facts and
Comparisons, St. Louis, MO, F&C Division of JB
Lippincott Co., 1984.
TABLE 2
Properties of an Ideal Spermicide
• Act rapidly and effectively; either kill all
sperm on contact, or render them incapable of
fertilization
• Systemically nontoxic, and nonirritating to
the vaginal wall and penile membrane; be free of
adverse long-term toxicity
TABLE 3
OTC Spermicidal Ingredients
Ingredient Category
Dodecaethyleneglycol monolaurate
III*
Laureth 10s
III*
Menfegol
I
Methoxypolyoxyethyleneglycol
550 laurate and nonoxynol 9
III*
Nonoxynol 9
I
Octoxynol 9
I
Phenvlmercuric acetate and
phenylmercuric nitrate
II**
Other ingredients containing mercury
II**
*Safe; effectiveness remains unestablished
**Unsafe for OTC use
and rendering a sperm incapable of reacting with
an ovum. Other researchers feel spermicides
could damage the ovum before conception. If the
spermicide were used after conception and it was
absorbed, the embryo could be damaged on
transfer from the mother through the placenta.
In one report based on 763 live-born infants of
mothers who had used a vaginal spermicide
within 10 months of conception, the rate of
congenital birth defects was 2.2 percent
compared to 1.0 percent in a group of 3,900
women who did not use a spermicide product.
Furthermore, it was reported that spontaneous
abortion occurred nearly twice as often in
pregnant women who had used vaginal
spermicides compared to women who did not.
While there was a positive correlation
reported, many still believe that the data were
inconclusive. They state that the women reported
to have used the spermicide were presumed to
have used it during a period prior to conception.
They further argue that the study was
retrospective in design and time of exposure to
the substance, and that proper use of the
spermicide could not be accurately assessed.
Other more recent studies have shown that
spermicide use is not associated with a higher
birth defect rate or spontaneous abortion risk.
The current rate of all serious birth defects
August, 1987
THE CAROLINA JOURNAL OF PHARMACY
23
diagnosed at the time of birth in the U.S. is 2 to 3
percent. To date, there have been few well-
controlled clinical studies to prove or disprove a
direct relationship. At this point in time, there
does not appear to be a definite correlation
between spermicidal use and biochemical/
physiological changes in humans.
Category II (Unsafe)
Ingredients
Phenylmercuric acetate was the only mercury-
containing ingredient submitted to the OTC
advisory panel for review. Phenylmercuric
acetate per se is associated with a low incidence
of systemic toxicity following absorption from
the vaginal mucosa. Nevertheless, the panel cited
information on mercury salts in general.
It is well known that mercury salts are
absorbed vaginally and distributed systemically.
This could be injurious to both the mother and
developing fetus. It also enters the milk.
Both the human fetus and neonate are
especially vulnerable to mercury toxicity. The
damage is primarily associated with neurological
and renal toxicity. In cases of contraceptive
failure involving the use of mercury-containing
vaginal contraceptives, overt symptoms of
toxicity have not been noted to date in infants.
There have been no specific systemic studies to
assess potential long-term neurotoxicity or
intellectual deficiency.
However, the panel determined that all
mercury-containing ingredients could be
expected to induce similar toxic reactions. Thus,
it placed all mercury-based vaginal contracep-
tives in Category II (i.e., banned from future sale).
Contraceptive Sponge
Even though sponges have been used as
contraceptives for centuries, the Today
contraceptives sponge is the first one approved by
FDA. It is a disposable, hydrophilic polyurethane
mushroom-shaped device that contains one gram
of nonoxynol 9. The device reportedly works in
the following three ways.
1 . It releases spermicide.
2. It blocks the cervical opening to penetration
by sperm.
3. It absorbs seminal fluid.
The sponge possesses several distinct
advantages over other OTC vaginal contracep-
tives. But it must be inserted properly to be
effective. Most users experience no difficulty.
However, because of its softness and shape, a few
users report that it is more difficult to insert,
August, 1987
remove, or check for proper fit than a diaphragm.
If the removal strap is turned the wrong way, for
example, it is quite difficult to remove.
Effectiveness
The product is still too new to establish long-
term effectiveness data. Studies to date report a
10 to 27 percent pregnancy rate for users of the
sponge compared with 8 to 12 percent failure
with the diaphragm.
The sponge can be inserted up to 24 hours
prior to intercourse. It provides continuous
protection for a number of acts of intercourse. It is
not necessary to leave the sponge in place for a
24-hour period, but it must not be removed
before 6 hours after the last intercourse.
Adverse Effects
A few users have reported localized irritation,
itching and rash with the use of the contraceptive
sponge. However, less than 2 percent discontinue
use because of these reactions. Occasionally the
sponge will absorb vaginal lubricating fluids
making intercourse painful. Rarely, it may be
dislodged from the vagina.
Leaving the sponge in place longer than
necessary can cause offensive odors from vaginal
discharge or seminal fluid. Also, extended
contact of the sponge with vaginal membranes
may be a major factor in the development of toxic
shock syndrome which has recently been
associated with the product.
Toxic shock syndrome (TSS) is the result of a
bacterial infection from Staphylococcus aureus.
This microbe is one of many normally present in
the vagina which constitutes part of its normal
microflora. When the vaginal epithelium is
irritated (as a result from numerous stimuli), the
microbial balance may shift allowing increased
colonization of pathogens.
When foreign objects (e.g., contraceptive
sponges, tampons) are inserted into the vagina,
there is an inci easing chance for irritation to the
vaginal epithelium. If S. aureus colonizes there,
TSS may develop. Symptoms result from a toxin
that is secreted by the colonizing bacteria and
absorbed across the vaginal wall into the blood.
The development of TSS is minimized if the
sponge is used correctly. In most of the women
who have reportedly developed TSS after using
the sponge, it has been shown that they did not
follow directions properly. For example, one
used the sponge too soon after childbirth. Others
Continued on page 25
O
We're not
strangers...
uuasninqeon
national
INSURANCE COMPANY
NCPhA-Endorsed Insurance Plans
Which Merit Member Participation
DISABILITY INCOME PLAN HOSPITAL INCOME PLAN
MAJOR MEDICAL EXPENSE PLAN TERM LIFE PLAN
RETIREMENT AND PROFIT SHARING PLANS
FOR DETAILS WRITE OR TELEPHONE:
HOYT W. SHORE, CLU and Associates
821 Baxter Street-Suite 316
Charlotte, North Carolina 28202
Telephone (704) 333-3764
LUasninpcon
national
INSURANCE COMPANY
Evanston. Illinois 60201 ■ A Washington National Corporation Financial Service Company
THE CAROLINA JOURNAL OF PHARMACY
25
CORRESPONDENCE COURSE
Continued from page 23
left the device in place longer than the
recommended time (up to 5 days). One person
inserted the sponge improperly, and while
attempting to withdraw it, tore it into pieces.
These pieces probably remained past the
recommended period and irritated the vaginal
mucosa.
The sponge itself does not cause TSS, nor does
it predispose women to greater risk than would
be expected from a tampon placed in the vagina.
However, any woman who develops symptoms
of TSS while using the sponge should contact a
physician immediately. The symptoms include:
1. rapidly developing high fever (usually
102°F or more);
2. vomiting or diarrhea;
3. sudden drop in blood pressure (noted by
dizziness);
4. generalized rash.
Odors may occur any time a foreign material is
placed in the vagina and interacts with or collects
vaginal fluids or semen. However, an odor that is
stronger than normal or has a distinctly different
smell may indicate the presence of infection.
Two or possibly three carcinogens are reported
to be present in the sponge in trace
concentrations. These are normal by-products
associated with manufacturing techniques of both
nonoxynol 9 and the sponge material. However,
the concentrations of each of these are well below
toxic levels. Furthermore, nonoxynol 9 has been
used for decades without reports of cancer
occurring.
One gram of nonoxynol 9 appears to be safe.
Tests have shown that only about 200 mg of
spermicide is released during a 24-hour period of
use. Most spermicidal cream or gel products
contain between 75 and 140 mg. per application.
Patient Advice
Since vaginal contraceptives are available
without prescription, they are often used without
medical guidance. The effectiveness of the
product is directly related to the accuracy with
which it is used. Compliance is the most
important factor in successful product use.
Spermicides reportedly have certain advan-
tages over other contraceptive products. They are
safe and cause no serious local reactions or
proven systemic effects. They are simple to use
and ideal for persons who have intercourse
infrequently.
On the other hand, they must be inserted at
least 5 to 15 minutes, but no longer than one
hour, before intercourse. Some individuals feel
this removes the spontaneity from intercourse.
The optimum time for insertion depends on the
particular product and dosage form. Except for
the sponge, a new application is necessary for
each intercourse.
Applicators for foam products must be
inserted deep into the vagina before releasing the
product. Deposited too shallow, the product may
drain out. Or, it may be too far away from where
sperm will be deposited to be effective. Some
foam products use a 5 ml applicator while others
use a 10 ml applicator. This should not confuse
the user. The smaller device requires two
applications of product per use.
Because products are formulated into different
bases, each may cause various degrees of
irritation or burning. If one product irritates,
another one having either different or the same
spermicidal ingredient may be selected. Table 4
lists representative OTC products.
TABLE 4
Representative OTC Contraceptives That
Meet The FDA Advisory Panel's Criteria of
Safety and Effectiveness
Product
Form
Nonoxynol
Octoxynol
Because
Foam
X
Conceptol
Birth
Control
Cream
X
Conceptol
Disposable
Jelly
X
Delfen
Foam
X
Emko
Foam
X
Encare
Suppository
X
Gynol II
Jelly
X
Intercept
Inserts
Suppository
X
Koromex
Cream
X
Koromex
Foam
X
Koromex
Jelly
X
Koromex
II-A
Jelly
X
Ortho-Gynol
Jelly
X
Ramses
Jelly
X
Ramses Extra
Condom
X
Semicid
Suppository
X
Shur-Seal Gel
Jelly
X
Today
Sponge
X
Some recent reports have suggested that
nonoxynol 9 and octoxynol 9 are effective
antibacterials and antivirals. Preliminary studies
have confirmed that the agents can kill the
Continued on page 27
August, 1987
'^HBRh^^^HHHh
-■>IW
1
wBiMf
€
|' I
Hjfc
,
* 3
9H|K ■
HRE(:
J
"*«^p» ■ .<
She'scountingonyou.
Your patients count on you for consistent quality
care. At QS/1, we know that you need the full service
of your computer system every minute of every day.
Your patients' depend on it. When you get
a QS/1 computer system, we walk you
through every step until you are thoroughly
comfortable with the system. But more
important, if you ever have a problem or
a question we're only a phone call awayr
To find out more about the pharmacy system you can count on
call today: 1-800-845-7558.
THE CAROLINA JOURNAL OF PHARMACY
27
organisms that cause gonorrhea, genital herpes,
and trichomoniasis. Consumers who ask about
this potential activity should be told that the
reports are as yet unproven. And, they should be
reminded that if the chance for exposure to one of
these causative organisms is great, then the
spermicidal agents alone should not be relied
upon for protection.
There is no evidence to prove that douching is
an effective contraceptive. If a spermicide is being
used, douching should be delayed for at least 6
hours after coitus because this could flush out the
active spermicidal ingredient.
What's Ahead?
Researchers are actively searching for longer-
acting forms of spermicidal products. One
substance in clinical trial is gossypol. This has
long been used in China as an oral contraceptive
for men. It appears to have intra vaginal
spermicidal action as well.
CORRESPONDENCE COURSE QUIZ!
Vaginal Contraceptives
1 . The most effective OTC vaginal contracep-
tives are the:
a. amphoteric surfactants.
b. anionic surfactants.
c. cationic surfactants.
d. nonionic surfactants.
2. The OTC vaginal contraceptive dosage
form that is reported to be most effective is
the:
a. cream.
b. foam.
c. jelly.
d. suppository.
3. Surfactant spermicides act in all the
following ways EXCEPT:
a. altering membrane permeability.
b. causing osmotic imbalance.
c. increasing surface tension.
d. reducing sperm motility.
4. Which of the following ingredients is
contained in the greatest number of OTC
vaginal contraceptives?
a. Nonoxynol 9
b. Octoxynol 9
5. Which of the following products can be
relied on to be effective even if it is used 12
hours prior to intercourse?
a. Conceptol
b. Delfen
c. Emko
d. Today
Another substance currently under investiga-
tion in animal trials works by immobilizing
sperm. It is reported to be 25 to 50 times more
potent than nonoxynol 9.
One quite interesting study recently
highlighted a possible spermicidal action of
propranolol, a beta-adrenergic blocker. In this
South American trial, nearly 200 women
inserted propranol vaginal tablets each evening,
regardless of when coitus occurred. The failure
rate for the medication was recorded as 3.9 per
100 woman-years. The study also reported that
intravaginally applied propranolol was effective
for up to 10 hours. The mechanism of possible
contraceptive action remains unknown.
Research will no doubt continue to develop
newer contraceptives that are perhaps more
effective than those currently available.
Meanwhile, OTC spermicidal products can be
recommended with confidence. If they are used
correctly, they are both safe and effective.
6. The use of surfactants as effective
spermicidal agents was popularized in
which of the following decades?
a. 1910's
b. 1930's
c. 1950's
d. 1970's
7. The agent that was classified as safe and
effective for use as a vaginal contraceptive in
a foaming tablet dosage form is:
a. menfegol.
b. laureth 10S.
c. phenylmercuric nitrate.
d. sodium bicarbonate.
8. Toxic shock syndrome is the result of an
infection caused by:
a. Herpes simplex.
b. Neisseria gonorrhea.
c. Pseudomonas aeruginosa.
d. Staphylococcus aureus.
9. Surfactant OTC vaginal contraceptives act
by reducing the ability of sperm to absorb:
a. glucose.
b. fructose.
c. mannitol.
d. sorbitol.
1 0. All of the following are vaginal suppository
dosage forms EXCEPT:
a. Because.
b. Encare.
c. Intercept.
d. Semicid. Answer sheet on p 18
August, 1987
YOU WANT
PRACTICAL,
BUSINESS-ORIENTED
CE PROGRAMS.
SO DO WE.
While CE may be required, nobody said it
had to be boring or impractical. If you prefer
Continuing Education with a practical,
bottom-line orientation, Marion Laboratories
may have just what you're looking for.
Our ACPE-accredited programs are designed
to develop and refine your pharmacy
management skills.
Effective OTC Merchandising is a four-
part program that reviews the principles
behind successful merchandising. Our text-
book. Effective Pharmacy Management,
covers all of the essential aspects of day-to-day
retail pharmacy management, from inventory
control to third-party payment programs.
And it's authored by some of the best-known
experts in the field of pharmacy management.
The latest addition to our growing CE
library is a program entitled From Potential
to Performance: Choosing, Training, and
Motivating Employees. For more details about
this program or any of the others described
above, call our Pharmacy/Trade Relations
Department toll free (1-800-821-2644,
ext. 4259).
It might be the most profitable decision
you make all day.
Service to Pharmacy
PHARMACEUTICAL DIVISION
MARION
LABORATORJES INC
August, 1987
THE CAROLINA JOURNAL OF PHARMACY
29
DICKINSON'S PHARMACY
by Jim Dickinson
Verbal or oral? The very practice of pharmacy
as we have come to know it could depend on the
legal answer to that question. Another way of
putting it might be: Is there any legally
recognizable value in pharmacist-patient dialog
at the time of dispensing?
If you think "verbal" and "oral" communica-
tion are synonymous terms, you agree with most
people and with the Ohio State Board of
Pharmacy before the country's largest mail-order
company had the state make it change its mind.
You will be surprised to learn that some
lawyers, and most dictionaries, think "verbal"
can mean "written" — which, in the case of
pharmacist-advice laws, is a loophole big enough
to sail a supertanker full of under-regulated mail-
order prescriptions through.
And, since huge mail-order prescription
factories have fewer regulatory restrictions than
yours does, that's an advantage to be reckoned
with.
In a case being watched by every state
pharmacy board in the country, Ohio
pharmacists have put the issue squarely on the
line. Their state association is suing their state
board, four state retirement programs and
Medco/National Rxs over the state's reluctance
to enforce Ohio laws — including one mandating
"verbal" communication with patients — against
Medco, which has two large facilities in the
economically-depressed state.
The case, to be tried this fall, has been whittled
down in pre-trial legal maneuvering to a single
federal-state constitutional issue, referencing the
filling of out-of-state prescriptions. How the
"verbal-means-oral" issue got started from it is a
strange tale.
It seems that after the case was well under way,
the board agreed to adopt the requested "verbal-
means-oral" definition and to start enforcing it
last year. But that never happened. After the issue
had been formally dropped from the lawsuit,
Medco gained the ear of the state attorney-
general's office, causing the board to flip-flop.
The relevant Ohio law that's not being
enforced says "the pharmacist shall verbally
notify the recipient that a generic substitution has
been made." Another section requires the
pharmacist to inform the recipient about the price
difference and to offer an opportunity to decline
the generic.
Medco has big plans to expand its base in
friendly Ohio (state motto: "The Heart of It All").
To do so, it needs state laws unfriendly to its
interests to yield on the theory that they might
violate the U.S. Constitution's interstate
commerce clause (even though that actually
defers to state health-and-safety statutes).
By its cooperative and polite manner with state
boards everywhere it operates, Medco seems to
have impressed everyone with its superior
operation ("Medco is fantastic!" Florida board
exec Rod Presnell told me July 7). But, as
detailed in a previous column, Medco is said by
its employees to have an unacceptably high rate
of prescription mixups because of high-speed
dispensing, and to pay pharmacists salaries that
are far higher than they can obtain elsewhere —
thus going a long way toward assuring their
silence on said mixups.
In the spirit of its generous help to state boards
(which always seem strapped for resources),
Medco/National early this year researched 13
different dictionaries and found that the most-
preferred definition of "verbal" in each allowed
for "spoken or written."
My American Heritage Dictionary 1979
edition, though, gives its first meaning of "verbal"
as, "Of, pertaining to, or associated with words,"
its second as, "Concerned with words rather than
the facts or ideas they represent," and its third as,
"Expressed or transmitted in speech; unwritten."
It adds as a footnote on usage, however: " Verbal
(adjective) is less precise than oral in expressing
the sense of 'by word of mouth.' Verbal can also
refer to what is written; oral cannot."
With the concurring help of Ohio assistant
attorney-general Yvette McGee (who told me she
thinks mail-order prescriptions are proconsumer
because they save elderly folk from having to
"trudge" to their local pharmacy), Medco and its
research persuaded the board to change its mind.
Consisting only of non-lawyers, the board
learned from a personal briefing by McGee and
from a legalistic 11 -page Medco letter that
"verbal" can indeed mean "written," and that the
spirit of state law — if not the actual letter of it —
means that before you take away somebody's
property rights (e.g., Medco's income and all
those Medco jobs and taxes in Ohio), you board
members must publish notice-and-comment and
go through open public rulemaking procedures.
Continued on page 30
August, 1987
30
THE CAROLINA JOURNAL OF PHARMACY
DICKINSONS PHARMACY
Continued from page 29
Which is a lot of trouble, and not in the best
interests of the State of Ohio — as distinct from
the interests of patients who live outside Ohio.
Whether the healthy, young, career-path lawyers
and judges, having shrunk those interests down to
a point of constitutional law will realize it or not
at the trial in September, the case inevitably
challenges the worth of pharmacy's counseling
role.
Is there any important value in oral advice at
the time of dispensing? If not, why even call it
"verbal"? Advice is advice, in any form, as is a
notification.
As for the underlying case itself, does the
vastness of a Medco justify fewer rules than
smaller pharmacies have to follow? And what is
pharmacy, anyway? Simple commodity-
shipping to avoid "trudging"?
If this is important to you, the Ohio State
Pharmaceutical Association is running out of
legal funds; mail checks to its P.L.A.N. Trust, 250
East Broad Street, Suite 1250, Columbus, OH
43215.
This feature is presented on a grant from G.D. Searle &
Co. in the interests of promoting the open discussion of
professional issues in pharmacy. G.D. Searle & Co.,
accepts no responsibility for the views expressed herein
as they are those of the author and not necessarily those
of G.D. Searle & Co.
BIRTHS
Congratulations to Mike and LONI
GARCIA, Lumberton, on the birth of Emily
Camille, July 7, 1987, at Southeastern General
Hospital. Emily weighed 7 pounds, 15 ounces
and Loni, NCPhA Third Vice President, and
Mike are doing well.
DEATHS
Fenton H. Harris
Fenton H. Harris, Jacksonville, died June 26,
1986, at the age of 58. Harris worked at Harfen
Corporation in Jacksonville until his retirement.
A native of Pennsylvania, Harris was a 1956
graduate of Howard University School of
Pharmacy.
William Lacy Harper, Sr.
William L. Harper, Hendersonville, died
Monday, August 17, 1987, at his home. He was
86 years old. Harper was born in Montgomery
County and was a graduate of the UNC School of
Pharmacy. He operated Rose Pharmacy in
Hendersonville for 34 years. His daughter, Becky
Elliot is a pharmacist in Ft. Meyers, Florida, and
one son, John is also a graduate of the UNC
School of Pharmacy and School of Medicine.
1987 Officers of the Woman's Auxiliary, NCPhA.
Left to right: Dollie Corwin, Corresponding Secretary; Jean Morse, Advisor; Frances Jones,
Recording Secretary; Peggy Jackson, Parliamentarian; Betsy Mebane, Coordinator; Eloise Watts,
Treasurer; Rose Boyd, First Vice President; Mary Lou Davis, President; Gladys Jones, Second
Vice President; Jewell Oxendine, Advisor. Not pictured: Rebecca Work, Historian.
August, 1987
THE CAROLINA JOURNAL OF PHARMACY
31
LOCAL NEWS
WINSTON-SALEM
PHARMACIST RECEIVES
NORTH CAROLINA
PHARMACY AWARD
Lori C. Tutterow
Lori C. Tutterow has been named the
Distinguished Young Pharmacist of the Year in
North Carolina. The award was conferred on the
27-year-old Winston-Salem pharmacist at the
recent annual meeting of the North Carolina
Pharmaceutical Association.
Tutterow is a pharmacist at Revco-Oldtown in
Winston-Salem. She earned her bachelor's
degree in pharmacy at the University of North
Carolina-Chapel Hill.
The award, sponsored by Marion Labora-
tories, Inc., a Kansas City, Mo., pharmaceutical
company, is presented annually to a young
pharmacist in each state for individual excellence
and outstanding contributions in state pharmacy
association activities, community affairs and in
professional practice.
MOORE RECEIVES AWARD
In recent ceremonies, CDR Steven R. Moore,
U.S.P.H.S., was awarded the Public Health
Service Outstanding Service Medal. The third
highest medal awarded by the Commissioned
Corps of the Public Health Service, the citation
read, "For outstanding leadership in carrying out
the mission of the PHS and accomplishments in
furthering the Surgeon General's Initiative —
PHS/Administration on Aging Initiative —
Health Promotion and Disease Prevention
Among the Elderly"
Moore is affiliated with the Food and Drug
Administration, but currently detailed in the
National Institute on Aging at NIH.
OWENS & MINOR, INC.
ANNOUNCES ACQUISITION
Owens & Minor, Inc. announces it has signed
a letter of intent to acquire the stock of Bellamy
Drug Company of Wilmington, North Carolina
and King Drug Company of Florence, South
Carolina. The transaction is expected to be
completed by July 31,1 987. The combined sales
of Bellamy Drug and King Drug were
approximately $22.5 million for their fiscal year
ended April 30, 1987.
Owens & Minor, Inc. currently operates
wholesale drug distribution centers in Richmond
and Norfolk, Virginia; Wilson, North Carolina;
and Miami and Orlando, Florida. The Company
also operates 17 medical/surgical distribution
centers in the mid-Atlantic, southeast, south
central, and southwestern part of the United
States.
According to G. Gilmer Minor, III, President
and CEO, "this is a positive strategic move
because it strengthens our market share in eastern
North Carolina and gives us a pharmaceutical
presence in South Carolina. This transaction is
also in line with our strategy of expanding our
drug distribution capabilities in the Sun Belt.
Present management is excellent and will stay in
place."
The bi-monthly meeting of the Randolph
County Pharmaceutical Society was held Sunday
evening, August 23, 1987 at Randolph Hospital
in Asheboro. Vice-President Charles F. Owen
was instated as new President since the current
President, Neill Wilson would be leaving
Randolph County. Jack Duggins of Asheboro
was then elected Vice-President. Guests included
Dr. Larry Simpson and DR. Wiliam Hendricks.
A short business session was held, then an open
forum discussion was conducted with both
physicians and pharmacists expressing views
over topics important to Health Care.
Kim Farrington
Sec./Treas.
August, 1987
32
THE CAROLINA JOURNAL OF PHARMACY
Lilly Digest Preliminary Report — 1987
Averages
per
Pharmacy
1986
(Preliminary Sample)
(997 Pharmacies)
1986
(Full Sample)
(1378 Pharmacies)
Amount and
Percent of
Change
Sales
Prescription
Other
Percent
of
Sales
$418,601— 63.3%
243,009— 36.7%
Percent
of
Sales
$369,595— 62.2%
224,323— 37.8%
+$49,006-
+$18,686-
-13.3%
- 8.3%
Total
$661,610—100.0%
$593,918—100.0%
+$67,692-
-11.4%
Cost of goods sold
449,278— 67.9%
400,255— 67.4%
+$49,023-
-12.2%
Gross margin
$212,332— 32.1%
$193,663— 32.6%
+$18,669-
- 9.6%
Expenses
Proprietor's salary
Employees' wages
Rent
Miscellaneous
operating costs
$ 38,505— 5.8%
67,356— 10.2%
15,439— 2.3%
72,832— 11.0%
$ 35,196— 5.9%
60,316— 10.2%
14,166— 2.4%
67,422— 11.3%
+$ 3,309-
+$ 7,040-
+$ 1,273-
+$ 5,401-
- 9.4%
-11.7%
- 9.0%
- 8.0%
Total expenses
Net profit
$194,123— 29.3%
$177,100— 29.8%
+$17,023-
+$ 1,646-
- 9.6%
(before taxes)
$ 18,209— 2.8%
$ 16,563— 2.8%
- 9.9%
Total income
(includes
proprietor's
salary)
$ 56,714— 8.6%
$ 51,759— 8.7%
+$ 4,955-
- 9.6%
Inventory at cost
Prescription
Other
$ 43,415— 10.4%
50,648— 20.8%
$ 38,939— 10.5%
49,375— 22.0%
+$ 4,476-
+$ 1,273-
-11.5%
- 2.6%
Total
$ 94,063— 14.2%
$ 88,314— 14.9%
+$ 5,749-
- 6.5%
Annual rate of
turnover of inventory
4.8 times
4.6 times
Prescriptions
dispensed
New
Renewed
14,730— 50.1%
14,697— 49.9%
14,086— 49.7%
14,261— 50.3%
+ 644-
+ 436-
- 4.6%
- 3.1%
Total
29,427—100.0%
28,347—100.0%
+ 1,080-
- 3.8%
Average prescription
charge
$14.23
$13.04
+$ 1.19-
- 9.1%
Floor area and
2,886 sq.ft.
2,673 sq.ft.
+ 214—
- 8.0%
sales per square
foot*
$229.25
$219.98
+$ 9.27-
- 4.2%
Pharmacy hours open
61
62
* Based on averages of
pharmacies that reported all data.
August, 1987
THE CAROLINA JOURNAL OF PHARMACY
33
A PREVIEW OF
INDEPENDENT COMMUNITY
PHARMACY — 1987
This preliminary Lilly Digest report is based on
the 1986 operating statistics of 997 independent
community pharmacies. Although the cost of
goods sold increased, it was offset by a reduced
total expense figure, which resulted in net profit
remaining unchanged from the previous year at
2.8% of sales. Comparison of Lilly Digest figures
for 1985 with 1986 income and expense figures
shows that . . .
Sales totaled over $661,000, an 1 1% gain
of almost $68,000 over 1985's figure. This
rate of increase is somewhat higher than the
average annual growth of 10.5% observed
during the past decade. Prescription sales
increased over 13% from 1985 figure and
significantly outpaced the 8% increase noted
in other sales. Prescription sales accounted
for 63.3% of the average pharmacy's
volume.
Gross margin declined to 32.1% of sales
(down from 32.6% in 1985), the lowest
gross margin level since 1942. Total
expenses decreased to 29.3% of sales —
down from 29.8% the previous year. Net
profit before taxes was 2.8% of sales,
unchanged from the prior year.
Although total expenses fell percentagewise,
there was an increase in dollars of over $17,000,
or 9.6% higher than the 1985 figure. Proprietor's
salary was higher in dollars (up about $3,300)
but decreased slightly to 5.8% of sales. Similarly,
employees' wages rose dollarwise but remained
unchanged at 10.2% of total volume. The
percentage figures for employees' wages for 1 986
as well as 1985 were the lowest since 1954.
Rent declined slightly to 2.3% of sales, but was
almost $1,300, or 9% higher for the year.
Miscellaneous operating costs rose just over
$5,400, an 8% increase. However, during 1986
these miscellaneous costs comprised a smaller
share (11%) of the sales dollar. This was the result
of a percentagewise decline, in advertising,
delivery, and interest expenses, which more than
offset the increase in insurance and miscellaneous
expenses.
Net profit before taxes showed an increase of
over $1,600 — up almost 10% from 1985. In
dollars, total income (proprietor's salary plus net
profit before taxes) increased 9.6% but declined
slightly as a percent of sales from 8.7 to 8.6%.
Prescription and nonprescription inventories
required more dollars during 1986; however,
both declined as a percent of sales — from 10.5 to
10.4% and from 22.0 to 20.8% respectively. The
sales productivity of the prescription inventory
moved up to $9.64 per stock dollar (15 cents
higher than in 1985), whereas the productivity of
other merchandise rose to $4.80, up 26 cents
from the previous year.
The average number of new prescriptions
increased by 644 to 50.1% of total prescriptions
dispensed (up 4.6% from 1985). Renewed
prescriptions were higher by 436 (up 3.1%) over
the previous year's figure and accounted for
49.9% of total prescriptions dispensed. A record
high of 29,427 prescriptions were dispensed
during 1986 (up almost 4%). The average
prescription charge was $14.23 during 1986, an
increase of $1.19, over the 1985 figure of $13.04.
Merchandise selling space in the average
independent community pharmacy was over
2,800 square feet during 1986. Sales per square
foot of floor area advanced $9.27 from the year
earlier to $229.25. The hours of operation in the
typical Lilly Digest pharmacy declined slightly
during 1986 to 61 hours per week.
The annual Lilly Digest will be completed and
distributed during September of this year.
Remember the ^ay
...in^Pictures
COLORCRAFT
North Carolina's Most Complete
Film Processing Service
There Is A Plant Located
Near You
For the Finest Quality Plus Fast
Dependable Service on All Your
Photo Needs, Contact the Plant
Nearest You.
CHARLOTTE WILMINGTON
KERNERSVILLE RALEIGH
FAYETTEVILLE DURHAM
If You Don't Know Photofinishing
Know Your Photofinisher
August, 1987
34
THE CAROLINA JOURNAL OF PHARMACY
CLASSIFIED ADVERTISING
Classified advertising (single issue insertion) 25 cents a word with a minimum charge of $5.00 per
insertion. Payment to acompany order.
Names and addresses will be published unless a box number is requested.
In replying to "blind" ads, address Ad. No., Carolina Journal of Pharmacy, P.O. Box 151, Chapel
Hill, NC 27514. Telephone (919) 967-2237.
PROFESSIONAL PHARMACIES: Sev-
eral small prescription-oriented phar-
macies are currently available for
individual ownership in North Carolina.
These opportunities provide the vehicle to
practice pharmacy the way you were
taught, while offering an attractive income
and more time to be with your family. In
some of these cases, financing is also
available to qualified candidates. For
more information write: Jan Patrick,
10121 Paget Dr., St. Louis MO 63132.
PHARMACY FOR SALE: Coastal NC.
Sales greater than $400,000.00; 60%
prescriptions. 10 miles from the ocean.
Contact Bullock & Whaley (919) 762-
2868; PO Box 3764, Wilmington NC
28406.
CLINICAL-STAFF PHARMACIST POSI-
TION: Will be working every 3rd weekend
and will have responsibilities in unit dose,
IV admixtures, cancer chemotherapy,
patient education, nursing inservice,
pharmacy newsletter, pharmokinetic
dosing, drug use evaluation and other
evolving clinical applications. Some
advanced training and experience in
clinical pharmacy preferred. If interested
and qualified please send resume to:
Director of Personnel, Community
General Hospital, PO Box 789, Thomas-
ville NC 27360. EOE.
Pharmacist looking for both retail and
hospital relief work in Fayetteville,
Lumberton and Piedmont area. Has 18
years of experience. If you are in need of
such a person please contact Box DAK,
c/o NCPhA, PO Box 151, Chapel Hill NC
27514.
PHARMACISTS WANTED: Farmco
Drug Centers have present positions
available in Rocky Mount, Elizabeth City
and Roanoke Rapids, North Carolina. For
more information contact James Thomp-
son at (919) 878-8158.
PHARMACIST WANTED: Opportunity
for pharmacist interested in progressive
independent practice. Opportunities for
patient counseling, hypertensive screen-
ing, diabetes screening and home health
care. Excellent salary and benefits. No
nights or Sundays. Contact Box ZZZ, c/o
North Carolina Pharmaceutical Associa-
tion, PO Box 151, Chapel Hill NC 27514.
Pharmacist with retail experience to
manage Rx Department, monitor patient
profile and compound mixtures. Profes-
sional hours, atmosphere and salary. Call
Gary Newton, Fayetteville 800-682-4664
Office hours or 919-484-6214, 24 hours.
PHARMACIST WANTED: Leading
independent in Asheville area, computer-
ized with QS-1. 42 hour week, flexible
schedule, competitive salary and bene-
fits. Reply to Box BDE, c/o NCPhA, PO
Box 151, Chapel Hill NC 27514.
PHARMACIST WANTED: Director of
Pharmacy for 64-bed hospital in South-
eastern North Carolina. Excellent hours,
salary negotiable, and good fringe
benefits. Contact Tom Smart at (91 9) 582-
2026.
Owners want to retire. Old established
store 30 miles from Raleigh in a small town
with one doctor. $250,000 in sales, with an
inventory of $50,000. Sales price of
$65,000, includes fixtures and equipment.
85% Rx business. Reply to Box POK, c/o
NCPhA, PO Box 151, Chapel Hill NC
27514.
August, 1987
THE CAROLINA JOURNAL OF PHARMACY
35
PHARMACIST WANTED: Independent
pharmacy in Concord seeks a full time
pharmacist. Good salary, excellent
benefits. Call Mickey Watts (704)
782-2194.
PHARMACY FOR SALE: Western North
Carolina. Well-established pharmacy in a
small town. 27 years same location.
$500,000 in sales. Price $170,000.
Contact Bullock & Whaley, PO Box 3764,
Wilmington NC 28406. (919) 762-2868.
PHARMACISTS WANTED: Greensboro
and Greensboro market area. Contact
David Cox, Revco Drug Stores, at (919)
766-6252.
STAFF PHARMACIST WANTED: Staff
position with long term care nursing home
at Pharm-Save located in Hookerton
(near Greenville). Contact Dan Hardy at
1-800-682-0062.
WANTED UNIT DOSE PACKING
MACHINE: Call Terminal Drug Store, S.
Harmon, (919) 243-2102, Wilson NC
27893.
WANT TO BUY: Old or antique
pharmacy fixtures, shelving and possible
soda fountain. Please contact Wheeler
Carver, Jr. at PO Box 1121, Roxboro NC
27573 or call (919) 599-4515.
PHARMACIST WANTED: Call Norwood
at 259-2676.
SUPERVISOR OF PEDIATRIC SATEL-
LITES: North Carolina Baptist Hospital
Pharmacy is seeking a highly motivated
and professional person to fill a pediatric
supervisor's position. This position offers
a close working relationship with a
progressive pediatric staff and the
opportunity to perform and excel in the
role of a pediatric drug specialist.
Responsibilities include: supervision of a
pediatric pharmacy staff; participation in
the clinical and distributive services
provided by the satellite; and administra-
tive details required for monitoring of
clinical and distributive services provided
by the staff. Qualified candidates should
possess strong interpersonal and com-
munication skills and should have a North
Carolina Board license or be eligible for a
North Carolina Board of Pharmacy
license. Completion of a pediatric
residency is a plus. Salary is competitive
with excellent benefits. For more
information, send resume or call collect:
Letha Huffman, North Carolina Baptist
Hospital, 300 S. Hawthorne Road,
Winston-Salem NC 27103. (919) 748-
4717. EOE.
We are seeking an ambitious and
professional career-minded individual for
Pharmacy-manager position in south-
eastern North Carolina near the coast.
Computerized prescriptions, excellent
salary, hospitalization and life insurance,
paid vacations. Small professional
pharmacy located in the center of a
medical complex. Contact Box CDD, c/o
NCPhA, PO Box 151, Chapel Hill NC
27514.
CLINICAL-STAFF PHARMACIST POSI-
TION: located on the beautiful N.C. coast
in Morehead City. Some advanced
training and experience in clinical
pharmacy preferred. Will have respon-
sibilities in unit dose, IV-Ad mixtures,
chemotherapy, patient education, nurs-
ing inservice, pharmacy newsletter,
pharmakinetic dosing, drug evaluation
and other evolving clinical applications. If
interested and qualified please send
resume to Director of Personnel, Carteret
General Hospital, PO Drawer 1619,
Morehead City NC 28557 or call Beth
Beswick (919) 247-1547. EOE.
STAFF PHARMACIST WANTED: Im-
mediate, full-time position available in our
150-bed acute care hospital. Successful
candidate must have North Carolina
license to practice as a Registered
Pharmacist. We offer an excellent
compensation package including com-
petitive salary, paid life and health
insurance, stock purchase plan and many
other great benefits. Qualified profes-
sionals may contact Highsmith-Rainey
Memorial Hospital, Personnel Depart-
ment, 150 Robeson Street, Fayetteville
NC 28301. (919) 483-7400. An affiliate of
HCA.
Continued on page 36
August, 1987
36
THE CAROLINA JOURNAL OF PHARMACY
CLASSIFIEDS
Continued from page 35
PHARMACIST WANTED: We are
seeking an ambitious, and professional
career-minded individual for a pharmacist
position in Greensboro, High Point and
Winston-Salem NC. We offer excellent
salary, stock ownership, educational
subsidy, extensive benefits, retirement
plan, 401 K tax plan, annual salary merit
reviews. "Pure pharmacy setting". If
interested call Lew Thompson 1 -800-233-
7018 or send resume to: The Kroger
Company, Attn: Personnel, PO Box
14002, Roanoke VA 24038. EOE.
PHARMACIST: Professional Services/
Consultation — Temporary and/or
Continual. Contact: L. W. Matthews at
(919) 967-0333 or 929-1783. 1608 Smith
Level Road, Chapel Hill NC 27514.
STAFF PHARMACIST WANTED: Posi-
tion at Kings Mountain Hospital. Modern
102-bed facility with computerized unit
dosage. Hospital experience preferred
but not necessary. Will consider a May
graduate. Contact Jerry McKee at (704)
739-3601 Ext. 472.
PHARMACIST WANTED: Opportunity
for pharmacist for independent pharmacy
store located in Central Piedmont, NC.
Store open 51/2 day week. No nights,
Sundays or holidays. Paid vacations.
Reply to Box ABC, c/o NCPhA, PO Box
151, Chapel Hill NC 27514.
COLUMBUS STORE FIXTURES FOR
SALE. Complete Prescription Depart-
ment, 40 foot wall shelving, and 30 foot
greeting card fixtures. Contact Bud
O'Neal, Work: 919-943-2462, Home:
919-943-3751.
RELIEF PHARMACIST AVAILABLE:
Central & Eastern North Carolina. Contact
Pharmacy Relief, PO Box 2064, Chapel
Hill NC 27515 or call 919-481-1272
evenings.
PHARMACIST WANTED: Pharmacy II
position available at Piedmont Correction
Center in Salisbury. Rowan County. One
year experience. Salary grade: 75. Salary
range: 26,892-43,728. Call Sylvia Matth-
ews at (704) 637-1421 Ext. 501 or 507.
RELIEF PHARMACIST, weekend work
in Raleigh area. Excellent working
conditions, computerized pharmacy. Call
(919) 772-4737 or write Tom Jones Drug,
PO Box 271 , Garner NC 27529.
WANTED FULL TIME PHARMACIST.
Western part of the State. Two 10 hour
days in two different locations. Three
consecutive days off, no Sundays, no
nights. Both in resort setting. Contact
Jack Alexander, (704) 526-2366.
WANT TO BUY: Profitable Drugstore on
Contract. Prefer Eastern/Central North
Carolina. Would consider other areas of
the state and other types of financing with
low money down. Reply to Box PDQ, c/o
NCPhA, PO Box 151, Chapel Hill NC
27514.
PHARMACY FOR SALE: Piedmont area
pharmacy with annual sales of over
$500,000. Annual increase each year.
Owner will assist with financing if
necessary. Contact Box RK, NCPhA, PO
Box 151, Chapel Hill NC 27514.
August 10, 1987
Mr. A. H. Mebane, III
Executive Director
North Carolina Pharmaceutical Association
P.O. Box 151
Chapel Hill, North Carolina 27514
Dear Mr. Mebane:
As requested in your letter of July 1 5, I
have forwarded copies of your letter to all of
the members of the Pharmacy Liaison
Committee of the PM A Board of Directors.
For your information and that of the
leadership of your Association, I am
enclosing several copies of the pamphlet,
"Pharmaceutical Research and Develop-
ment/Prescription Drug Prices." This
pamphlet places in context the prices of
prescription drugs compared with all other
items, and how those prices relate to the
enormous investment PMA companies
make every year in research and
development.
I hope the enclosed pamphlet will be of
interest to you and your membership.
Sincerely,
Gerald J. Mossinghoff, President
Pharmaceutical Manufacturers Association
cc: To the Members of the
Pharmacy Liaison Committee,
PMA Board of Directors
August, 1987
w
HE PORTS
?-:k
ST AND DESIGN
.-•ft*. ■
.-:>
:
COMPtf^
ANO INVEWTOftl,
COUPON '
REDEEMPTtQ«-
PROGftAM
■ irir ■ ii ' i
Put all your eggs in one basket!
Being an independent pharmacist is like walking on egg shells.
The highly computerized systems and massive buying power
of the big chains make the competition tougher than ever.
The best way to meet this competition is to take advantage
of our buying power, computerized systems and our commit-
ment to a high level of service and quality products. So, if
you want a higher measure of return on your investment, put
all your eggs in our basket.
• Electronic Order Entry and Inventory Management • Pharmacy
Computer Systems • Cost Plus Purchasing • Special Deal Purchasing
• Automatic Price Updates • Home Health Care Products • Manage-
ment Reports • Store Planning and Design • Employee Training
• Merchandising and Planogramming • Advertising • Coupon Re
deemption Program
Owens &Minor;InG
1010 HERRING AVENUE
WILSON, NORTH CAROLINA 27893
"Toll Free 1-800-682-2270"
1-919-237-1181
Dr.T.C.Smith Co. / W.H.King Drug
ASHEVILLE, N.C. 28806 • 704/258-2645
RALEIGH, N.C. 27622 • 919/782-8400
TOTAL
HOMESPUN
SERVICE
In today's business rush we take the time to help
you with your management decisions . . . whether its
over coffee or part of a regular sales call. We will fill
your order with care and with dispatch today. Just as
we did in 1869.
We use advanced technology to lead in service to our
customers.
Some of our available programs are Electronic Order
Entry • Merchandising and Programming • Valurex
Advertising & Promotion • Retail Pricing • Micro-
fiche • Pharmacy Computer Systems • Home
Health Care and much more.
Whether you take your coffee
black or with cream,
call us to find
out more details.
VALUREX INDEPENDENT
VALUREX
PHARMACY
ADVERTISING & PROMOTIONAL
PROGRAMS
TO HELP YOUR BUSINESS IS OUR BUSINESS'
TIE GIROLINk
JOURNN_ofPHN2MkCY
LLJ
GQ
o
>
go
o
LU
GO
:i*i
SCIENCES
LIBRARX
NOV 25 1987
The Cupola House at Edenton, North Carolina, c. 1 725 has been described as "the best
example of an existing wooden house in the Jacobean tradition in all America."
a.
LU
CO
H e a I. t h S c i e n c e s
2 23-H
UMC
Chape 1 Kill, I 27
Plagued by Back-Orders?
Kendall Has the Cure.
Kendall customers choose us because
we know the pharmacy business, and
give excellent service. Kendall offers
evening order taking, fast delivery, and
a 95+% service level. For over 65 years,
pharmacists have counted on Kendall to
be their full line pharmaceutical
wholesaler.
IE
Look to Kendall for:
• Wholesale Pharmaceuticals
• OTC Products
• Electronic Order Entry
• Drug Store Design and Fixtures
• Associated Druggist Advertising
Program
• Pricing Strategy
• Microfiche Service
• Per-Product Sales Analysis
• UPS Service Outside Kendall
Delivery Area
IIADRUG COIVlFy\IMV
1305 Frederick St. • P.O. Box 1060 • Shelby, N.C. 28150
NC 1-800-222-3856 SC 1-800-438-5330
Justice Drug Company
P.O. Box 22025
Greensboro, NC 27420
AN ALCO STANDARD COMPANY
Now in our 87th Year of Service to the North Carolina Pharmacists
1-800-632-1295
M»jJW Partnership
For Profit
Family
Independent
Pharmacy
Total Retail Concept
The Family Independent Pharmacy program provides an
all-inclusive plan covering every aspect of marketing,
merchandising, and management of drug store opera-
tions. It is a wholesaler-sponsored voluntary, and it
embraces the total retail concept in all its forms.
1HHC
TOTAL HOME HEALTH CARE
Our Total Home Health Care" Program offers Durable
Medical Equipmentfor Rent or Resale. Third Party Billing
for Medicare/Medicaid.
Additional
* Services & Programs Offered *
Store Plan-O-Gram: Complete Store Layout & Design
including Fixtures, Merchandise Plan-o-graming,
and Pricing Strategies
Specialty Gift Departments including Arts & Crafts
Affordable Pharmacy Computer Systems
LIBERTY DRUG SYSTEMS, INC.
QS/1 PHARMACY SYSTEMS
Merchandise Racking Service
Group Life
And Health
Insurance
Benefits
For Members Of
North Carolina
Pharmaceutical
Association
Jefferson-Pilot Life Insurance Company is pleased to
have been selected as the Group insurance carrier for
the North Carolina Pharmaceutical Association. It would
be to your advantage to become thoroughly acquainted
with the benefits of this program.
You can expect the best possible service from
Jefferson -Pi lot, one of the nation's leading Group
insurance carriers. For full information, contact Mr. Al
Mebane, Executive Director, North Carolina
Pharmaceutical Association.
Write or call:
Sam P. Stuart, CLU
P. O. Box 595
Winston-Salem, NC 27102
Telephone 919/723-8811
Jefferson
Pilot
INSURANCE / FINANCIAL SERVICES
1HE OIROUNk
JOURNMofPHN^MkCY
SEPTEMBER 1987
(USPS 091-280)
VOLUME 67
ISSN 0528-1725
NUMBER 9
Officers
NORTH CAROLINA
PHARMACEUTICAL
ASSOCIATION
President
M. Keith Fearing, Jr.
P.O. Box 1048
Manteo, NC 27954
(919)473-3463
Vice Presidents
Julian E. Upchurch
5201 Pine Way
Durham, NC 27712
(919)477-7325
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh, NC 27612
(919) 876-5600
W. Robert Bizzell
1007 Rhem Street
Kinston, NC 28501
(919) 527-6929
Executive Director
& Editor
A. H. Mebane, III
P.O. Box 151
Chapel Hill, N.C. 27514
NCPhA Office
(919) 967-2237
or
1-800-852-7343
CONTENTS
NCPhA Service and Performance Survey 4
War Against Drugs 11
Campbell Student Body Report 13
Campbell School of Pharmacy Report 15
State Board of Pharmacy 17
TMA Convention and Annual Meeting Report 19
Current Pressures on Hospital Pharmacy 23
Lilly Hospital Pharmacy Operations Survey 25
Dickinson's Pharmacy 27
Personal Notes 32
Classified Advertising 30
34
ADVERTISERS
Burroughs Assets Management Company 29
Colorcraft 27
Dr. T.C. Smith Co./W.H. King Drug Back Cover
Eli Lilly and Company 6
Geer Drug 10
Jefferson Pilot 2
Justice Drug Company 1
Kendall Drug Company Inside Front Cover
Marion Laboratories 22
Owens & Minor, Inc Inside Back Cover
Return Goods Policy Manual 8
Spear Associates 1 6 & 28
The Upjohn Company 26
Washington National Insurance Company 14
The Carolina Journal of Pharmacy is published monthly by the
North Carolina Pharmaceutical Association, P. O. Box 151,
Chapel Hill, NC 27514. The Journal is provided to NCPhA
members through allocation of annual dues. Subscription rate to
non-pharmacists (continental US) $20.00. Single copy price
$2.00. Overseas rates on request. Second class postage paid at
Chapel Hill, NC.
THE NORTH CAROLINA JOURNAL OF PHARMACY
MEMBERS AND NON-MEMBERS SPEAK OUT ON SERVICE
IMPORTANCE AND NCPhA PERFORMANCE
The majority of North Carolina pharmacists
believe that overall, the Association is doing an
average (non-members) to good (members) job
at providing standard state association services.
Members and non-members also agree that there
are certain services that are not being performed
at a level which equals the importance they attach
to those services.
These results and others were revealed in a
study conducted for the Association by Jan
Hirsch Phillips, Ph.D. at the University of North
Carolina School of Pharmacy. The purpose of the
study was to determine if the Association was
expending adequate resources and energy on the
types of services that members and non-members
believed to be most important for a state
association to provide.
Methods
The opinions of 200 members and 200 non-
members were solicited during the fall of 1986.
Questionnaires were randomly enclosed in the
Association's regular membership renewal
package to members and the regular membership
solicitation mailing to non-member N.C.
pharmacists. Response to the questionnaire was
commendable as 74% of the member sample and
55% of the non-member sample took the time to
complete and return the questionnaire.
The goal of the questionnaire was twofold.
First, pharmacists were asked to indicate the level
of importance they placed upon each of a selected
list of services. (Table 1) Importance ratings
ranged from 1 which indicated the service was
"Strongly Unimportant" to 5 which indicated
that the service was "Strongly Important".
Secondly, pharmacists were asked to indicate
how well they believed NCPhA had performed
each of the listed services. (Table 2) Performance
ratings ranged from 1 which indicated that
NCPhA has performed the service poorly to 5
which indicated that NCPhA performance of the
service has been excellent.
Comparisons were then made between how
important pharmacists (members and non-
members) believed a service was and how well
they thought the Association performed the
service. Disparity between importance and
performance ratings for services is indicative of a
"mis-match" between the emphasis of
Association leadership and the priorities of
Association constituents (current and prospective
members).
Table 1
Importance Ratings1
Members and Non-members
Service
Members
Mean
Rating S.D.2
Non-members
Mean
Rating S.D.2
Monthly Journal and
News Bulletin
4.7
0.64
4.3
0.99
Federal and State
Lobbying
4.7
0.72
4.5
0.87
Liaison with Government,
Regulatory, Third Party
and other Professional
Organizations
4.7
0.64
4.0
1.09
Continuing Education
Programs
4.6
0.87
4.6
0.93
Assist Local Assns. with
C.E.
4.5
0.79
4.4
1.07
Professional Liability
Insurance
4.4
0.88
4.3
1.02
Third Party Plan
Information
4.4
1.07
4.0
1.16
Job Placement Service
4.2
0.97
4.2
1.00
Insurance Plans (Health,
Life Store Owners &
Income Replacement)
4.1
1.03
4.0
1.27
Annual Convention
4.1
0.92
3.4
1.37
Outlines for Community
Presentations
4.0
0.87
3.8
1.17
Consultant Pharmacist
Section
3.8
0.97
3.6
1.06
Women's Auxiliary
3.1
0.16
2.2
0.17
Collection Service
3.1
1.35
2.8
1.56
Traveling Members
Auxiliary
3.1
1.43
2.2
1.38
■Importance Ratings were collected on a five-point Liken
scale ranging from 1 = Strongly Unimportant to
5 = Strongly Important
2S.D. = Standard Deviation — a measure of diversity of
response.
Significant difference between mean importance rating for
members and mean importance rating for non-members.
(64 = .05, p 6 .05)
Member Opinions
Members indicated that the performance of
many services by NCPhA was not at a level
which equaled the importance they attached to
the respective services. The services for which
members rated importance much higher than
NCPhA performance were:
September, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
(greatest difference between importance and
performance rating listed first)
* Federal and state lobbying efforts
* Liaison with government, regulatory, third
party, and other professional organizations
* Provision of third party plan information
* Monthly journal and news bulletin
* Continuing education programs
* Professional liability insurance
* Assist local associations with continuing
education
The disparity in importance and performance
ratings indicates that the Association may want to
realign its efforts related to the above services
more closely with member needs and wants.
Simultaneous improvements or alterations in all
of these services is obviously not feasible.
Therefore, the services which members rated as
most important to them should initially be
addressed by the Association.
The provision of a monthly journal and news
bulletin was one of the three services which
received the highest importance rating from
members. Improvements in the journal or
bulletins could be easily implemented and
experimented with. Member feedback regarding
changes could also be readily obtained. The two
other services that shared the top member
importance rating were lobbying (federal and
state) and the Association's function as a liaison
with government and other organizations. These
were also the services for which the greatest
disparity between importance and NCPhA
performance ratings were reported. Low
performance ratings for these services could be
indicative of a low level of member awareness of
the specific lobbying and liaison activities.
However, another possible explanation with
greater ramifications for the NCPhA leadership
could be that members do not believe the
Association's lobbying and liaison efforts are
aligned with their interests.
The second and third most important services
to members were providing C.E. programs and
assisting local associations in providing their own
C.E. programs. The disparity between
importance and performance ratings indicates
that improvement of these services could
represent additional opporunities to better serve
current members. The specific reasons for low
NCPhA performance ratings releated to C.E.
were not addressed in this study. Solutions to
lessen the disparity between importance and
September, 1987
ratings could range from improving promotion
and/or organization of C.E. assistance to local
associations to updating or changing the content
of NCPhA C.E. programs.
The pendulum also swung in the opposite
direction. There were three services for which
members rated importance much lower than
NCPhA's performance level of the services.
These services were:
* Collection service
* Traveling members' auxiliary
* Woman's auxiliary
These services most likely appeal to some small
segments of the member population. However,
the Association should not rely on these services
to contribute to overall member satisfaction.
Resources directed toward providing these
services may be better utilized if the services were
expanded to appeal to broad segments of the
member population. For example, the woman's
auxiliary could be restructured to provide
support for male and female spouses.
N on -Member Opinions
As with members, non-members indicated
that some of the listed services were not being
performed at a level which equaled the
importance they attached to them. The services
for which non-members rated importance much
higher than NCPhA performance were:
(greatest difference between importance and
performance rating listed first)
* Federal and state lobbying
* Job placement service
* Continuing education programs
* Third party plan information
* Professional liability insurance
* Assist local associations with continuing
education
* Outlines for community presentations
* Liaison with government, regulatory, third
party and other professional organizations
Except for the ordering, this list is similar to
that reported for members. However, as would
be expected, the number of services for which a
disparity between performance and importance
ratings was reported was greater for non-
members than for members. Those services
which non-members rated as most importance to
them represent the most promising opportunities
for the Association to increase its membership.
Continued on page 7
Human insulin for all. Humuliri
human insulin
[recombinant DNA origin]
Identical to human insulin. Humulin is the only insulin not
derived from animal pancreases.
Recombinant DNA technology makes the production of
Humulm possible and virtually assures every insulin user of a
lifetime supply
From Lilly ... a dependable source of insulin for
generations. Since 1922, when we became the first company
to manufacture insulin, we have led the search for the best
diabetes care products and, at the same time, maintained a
constant supply of insulin for all insulin users
Our 24 formulations of insulin— including Humulin and all
forms of lletm" (insulin)— are available through the widest retail
distribution of insulin in the United States
Beyond that, we will continue to provide a wide range of
diabetes service and educational materials for use by physi-
cians, pharmacists, and diabetes educators
£ 1986 ELI LILLY AND COMPANY
Our Medical Division is on call. Our Medical Division staff
is only a phone call away Please contact them if you have any
guestions about our diabetes care products
Any change of insulin should be made cautiously and
only under medical supervision. Changes in refinement,
purity, strength, brand (manufacturer), type (regular. NPH.
Lente* , etc), and/or method of manufacture (recombinant DNA
versus animal-source insulin) may result in the need for a change
in dosage
For information on insulin delivery systems, contact CPI 1-(800)-227-3422
Sbey
Eli Lilly and Company
Indianapolis. Indiana 46285
THE NORTH CAROLINA JOURNAL OF PHARMACY
NCPhA PERFORMANCE
Continued from page 5
Table 2
NCPhA Performance Ratings1
Members and Non-members
Service
Monthly Journal and
News Bulletin
Members
Mean
Rating S.D.2
4.3 0.85
Non-members
Mean
Rating S.D.2
3.9 0.81
Assist Local Assns. with
C.E.
4.2
0.84
3.8
0.94
Continuing Education
Programs
4.2
0.83
3.8
0.82
Annual Convention
4.0
0.79
3.7
0.76
Woman's Auxiliary
4.0
0.89
3.0
1.21
Professional Liaibility
Insurance
4.0
0.09
3.6
0.14
Insurance Plans (Health,
Life Store Owners &
Income Replacement)
3.9
0.76
3.7
0.64
Job Placement Service
3.9
0.77
3.1
0.98
Liaison with Government,
Regulatory, Third Party
and other Professional
Organizations
3.8
0.86
3.4
0.78
Third Party Plan
Information
3.7
0.99
3.2
0.93
Traveling Members
Auxiliary
3.7
0.84
3.1
0.84
Consultant Pharmacist
Section
3.7
0.74
3.4
0.50
Outlines for Community
Presentations
3.7
0.87
3.4
0.72
Federal and State
Lobbying
3.6
0.96
3.4
0.88
Collection Service
3.3
1.09
3.4
0.64
■Performance Ratings were collected on a five-point Likert
scale ranging from 1 = Poor to 5 = Excellent
2S.D. = Standard Deviation — a measure of diversity of
response.
Significant difference between mean importance rating for
members and mean importance rating for non-members.
(H = .05, p * .05)
Non-members indicated that the provision of
C.E. programs was the most important service an
association could offer. Improving either non-
member awareness of NCPhA C.E. programs or
if necessary improving specific C.E. programs
could attract new members. Since members, who
presumably have more actual experience with
NCPhA C.E. programs, also indicated a
substantial disparity between importance and
performance ratings for C.E. programs, the
problem may not be limited to a lack of non-
member awareness but perhaps Association C.E.
programs need to be altered or updated. Similar
reasoning suggests that a change in, rather than
September, 1987
increased awareness of, the Association's
methods of assisting local associations in the
provisions of their own C.E. programs may be
appropriate.
As with members, non-members rated
lobbying (state and federal) high on their list of
important services but gave the Association a
relatively low performance rating (largest
disparity between importance and performance
ratings for non-members.) Improvement in
perceived lobbying efforts offers an opportunity
for the Association to attract new members.
However, as with members, lack of awareness of
specific lobbying activities and results could
explain the observed disparity or non-members
may believe the Association's lobbying efforts are
not aligned with their interests. Thus, further
exploration of the problem is needed before
corrective measures are implemented.
Non-members also indicated that the
Association's provision of a professional liability
insurance program was at a level less than the
level of importance they attached to that service.
Either the Association has not adequately
publicized the availability and/or benefits of the
program to non-members or the provisions of the
program are not aligned with the needs of many
non-members. Promotion and/or augmentation
of the Association's job placement service also
appears to represent an opportunity for attracting
new members.
Reasons for Not Joining
NCPhA
Pharmacists were asked to indicate which of a
list often reasons for not joining NCPhA applied
to them. Members were asked to respond as well
as non-members because some reasons could
have been relevant to members due to either a
sporadic membership history or recently
acquired membership status. The top three
reasons for not joining NCPhA given by non-
members and members were:
* "It costs too much to join"
* "I don't have time to get involved"
* "I can't get off work to go to the meetings"
Summary results of this question are presented in
Table 3. Member responses presumably apply to
a previous or anticipated period of non-
membership.
Continued on page 9
THE NORTH CAROLINA JOURNAL OF PHARMACY
Outdated Merchandise
Costs You Money
Finding out how to return it can also be costly
and time consuming!
The Return Goods Policy Manual. 4th Edition
can expedite the process of returning your
unsalable inventory.
• Returns policies for over 185 pharmaceutical manufacturers
• Who to contact, toll-free numbers, returns procedures,
what is returnable
• Transportation charges, type of compensation, terms of credit
or exchange and much more
Return Goods Policy ManualAth Edition
□ Please send me
_copies of the Return Goods Policy Manual. 4th Edition.
YES! J □ Enclosed is a check for $30 for each book, payable to Return Goods Policy
Manual.
□ Please charge my Mastercard # , expiration date .
VISA # , expiration date
NAME
ADDRESS
CITY
STATE
ZIP
Mail this form with payment to: N Carolina Pharmaceutical Assoc.
POBox 151
Chapel Hill, NC 27514
September, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
NCPhA PERFORMANCE
Continued from page 7
Table 3
Reasons for Not Joining NCPhA
Reason
Non-Members
Members
%
"It costs too much to join."
51
20
"I don't ahve time to get
involved."
42
15
"I can't get off work to go to
the meetings."
33
25
"I'm not interested in joining
another association."
29
7
"I tried it but didn't feel like it
was worth it."
28
12
"NCPhA offers no services for
my type of practice."
22
8
"I didn't graduate from
UNC."
14
11
"NCPhA is for owners, not
employees."
12
12
"Nobody has asked me to
join."
12
5
"NCPhA doesn't care about
my part of the state."
8
6
'% percentage of respondents who agreed the reason applied to
them.
Reasons cited by non-members are of
particular interest. Some of the reasons for not
joining the NCPhA cited by non-members are
not easy for the Association to address, e.g. "I
can't get off work", "I don't have time to get
involved." However, the reason most frequently
given by non-member respondents was that it
costs too much to join. (This was also the second
most frequently cited reason for members.) A
substantial number of non-member respondents
also indicated they had tried NCPhA
membership but didn't feel it was worth it. The
Association leadership may be able to increase
the perceived value of NCPhA membership for
non-members by investing time, effort and
resources into improving the services non-
members deem most important. By increasing the
perceived value per dollar ratio, the actual dollar
investment may not appear as unreasonable to
non-members.
Summary
The purpose of this study was to determine if
the Association was expending adequate
resources and energy on the types of services
members and non-members believed to be most
important for a state pharmacy association to
September, 1987
provide. Overall, the Association's provision of
standard state association services was rated as
average (by non-members) to good (by
members). However, many services were not
being provided at a level that equaled the
importance attached to the services by members
and non-members. The "mismatch" of
Association performance level and member/
non-member perceived importance for many
services indicates realignment of Association
goals and objectives may be appropriate.
The major limitation of this study is that only
the currently perceived realm of possibility was
examined. Given the changing health care
environment and trend in pharmacist characteris-
tics (younger and employee pharmacists), the
Association may need to consider redefining its
role. Is the Association's primary responsibility to
provide services so that its members can better
cope and adapt to changes within the pharmacy
environment? Or, is the Association's primary
responsibility to be a driving force in the creation
of an environment that will serve the needs of the
pharmacy profession?
North Carolina pharmacists may have needs
and wants which were not addressed in this
survey or perhaps they have needs or wants
which they do not readily recognize or are not
able to affect as individuals. A portion of the
Association's role may be to anticipate the
services which will be needed by N.C.
pharamcists, collectively, in the future. Should
the Association advocate adequate compensation
or working conditions for all N.C. pharmacists?
Should the Association spearhead the
development of programs to accommodate two
worker households, e.g. day care facilities,
flexible scheduling? Policy questions such as
these coupled with the results of this study should
provide common ground for further exploration
and discussion between Association leadership
and the pharmacists of North Carolina regarding
future directions for the North Carolina
Pharmaceutical Association.
Controlled
Substances Samples
The Drug Enforcement Administration has
restated its rules require all dispensers of
controlled substances, including samples, to keep
detailed records. DEA says "Complete and
accurate records of all controlled substances
given to the patient must be maintained
regardless of their origin. Samples of controlled
substances are not excluded from this
requirement." (Paraphrased from Rx Ipsa
Loquitur, Volume 14 Number 7.)
WE BRING YOU THE BEST
CHARLESTON, S.C.
GREENVILLE, S.C.
THE NORTH CAROLINA JOURNAL OF PHARMACY
11
IN THE WAR AGAINST DRUGS,
WHAT CAN WE DO?
Everywhere you turn, you hear about the
problem of drug abuse in our country. Nancy
Reagan, in a speech delivered to the World
Affairs council in June of 1986, said that "there's
a drug and alcohol epidemic in this country and
no one is safe from its consequences." And an
epidemic it is.
A Billion Dollar Industry
Americans spend $50 billion a year on
marijuana, smoking 3 1 tons of the substance each
day. The use of cocaine among high school
students has risen to 5.8%, an all-time high. An
amazing 35% of high school seniors use
stimulants. Of these, 1% use them daily. Ninety-
three percent report trying alcohol, and 5.8%
report being daily users. The ratio of seniors who
report drinking five or more drinks in the prior
two-week interval is at a shocking 41%. The use
of heroin has remained steady with 1.2%
reporting experience with the drug. Nine percent
report experience with opiates other than heroin.
However, these statistics can be misleading,
considering that 1 5% of today's students leave
school before their senior year.
It usually starts with cigarettes, which serve as
the first break from parental guidance. After
cigarettes, alcohol is usually the next step on the
experimentation field. From there, an astonishing
95% experiment with marijuana. Then, it seems,
the sky's the limit as they begin to abuse the
"street drugs" — cocaine, LSD, and various
prescription drugs. According to the National
Institute on Drug Abuse (NIDA), "of kids who
smoke cigarettes, 81% will try marijuana, and of
those who try marijuana, 60%< will then try other
drugs."
The most staggering problem is cocaine.
Americans spend $39 billion annually on the
substance. It is estimated that 22 million
Americans have tried the drug. Of these, at least
10 million use the drug monthly. An incredible
one million suffer from chronic addiction. The
members of the "baby boom generation," the
now so-called "yuppies," comprise the largest
group of users.
Americans feed $80 billion into the illicit drug
market each year, not including alcohol.
Amazingly, this amount is four times the
combined OTC and prescription drug markets.
September, 1987
Pharmacists Against
Drug Abuse
Many pharmacists are getting involved in the
war on drug abuse. They are meeting with
parents, youth, and members of their community
to combat the problem. The pharmacist is the
most accessible health professional. This
accessibility, combined with extensive education,
puts the pharmacist in a perfect position to serve
as a drug abuse counselor.
One way in which you can get involved is with
the Pharmacists Against Drug Abuse Foundation
(PADA). Founded in 1982, PADA is an
organization of pharmacists working hard to fight
drug abuse.
The organization was an inspiration of Jack B.
O'Brien, then president of McNeil Pharmaceu-
tical, following a meeting at the White House
with approximately 200 business executives
whom Mrs. Reagan wanted to inform about the
seriousness of the drug abuse problem in this
nation. Shocked by what he learned at that
meeting, Mr. O'Brien promised Mrs. Reagan that
his company would establish a drug abuse
program. He assigned Herbert W. Browne the
responsibility of developing such a program with
the suggestion that community pharmacists
should be a key ingredient.
While meeting with the National Federation
of Parents for Drug-Free Youth (NFP) and the
Parent Resources Institute for Drug Education
(PRIDE), an idea was proposed. If an
educational program could be devised that would
make drug abuse information widely available to
parents, and if these parents would unite in the
community to develop programs to curtail drug
abuse, the program should be successful. The
result: Pharmacists Against Drug Abuse.
Pharmacists — The Active
Ingredient
Pharmacists are getting involved for many
reasons. First, they have a vast knowledge about
drugs and their pharmacological effects on the
body. Second, they are accessible, since fifty to
seventy thousand people walk through the doors
of a pharmacy each day. Third, pharmacists care
about the communities they serve and about
maintaining a safe pharmacy environment.
When drug supply on the street runs low, drug
Continued on page 12
12
THE NORTH CAROLINA JOURNAL OF PHARMACY
WAR AGAINST DRUGS
Continued from page 11
addicts must turn to the pharmacies. This
phenomenon translates into an increase in theft
and endangers the lives of pharmacists.
What does PADA do? PADA provides
education for pharmacists through a 50-page
booklet entitled "A Pharmacist's Guide to Drug
Abuse." The booklet contains information about
many street drugs, including marijuana, cocaine,
LSD, and PCP, and about tobacco, alcohol, and
abuse of prescription drugs.
Pharmacists may obtain a brochure entitled
"The Kinds of Drugs Kids Are Getting Into" free
of charge from their local wholesalers. This
educational brochure is for parents and comes
with an easel for display on the pharmacist's
counter. Window signs and pocket-savers that
say "This is a place where parents can learn about
drug abuse" may also be obtained.
PADA also hosts training sessions to aid
pharmacists in anti-drug abuse speeches in their
communities. Participants receive speaker kits,
containing slides and two sample speeches, one
for parents and one for young people.
Since its launch on November 15, 1982,
approximately 15 million brochures have been
distributed. PADA has hosted over thirty training
sessions in as many cities. Herb Browne,
president of the Pharmacists Against Drug Abuse
Foundation, says that attendance at the sessions
averages over 100 pharmacists. This computes to
over 4000 pharmacists who have benefited from
the sessions. Literally hundreds of speeches are
now given each month by pharmacists to parents
groups, civic and religious organizations,
students, etc. But there is still much to be done.
The PADA program has also been launched in
foreign countries. In 1985 the program was
launched in Italy and is still growing today. Other
PADA programs have been launched in South
Africa, Ireland, England, and Canada, with more
planned in other countries.
To Find Out More
On October 24 at the American Pharmaceu-
tical Association Midyear Regional meeting in
Birmingham, AL, PADA will present a one and
one-half hour program to pharmacists and
students to help them get involved. Here you can
learn what pharmacists all across the country are
doing to curb the abuse of drugs. The program
will feature speakers who will present an
overview of drug abuse and discuss specific
agents. Pharmacists can also receive continuing
education credit for the session.
Now is the time to do your part in the battle
against drug abuse.
SUPPORT GROUP
ORGANIZED
A new mutual support group for pharmacists
recovering from chemical dependence or other
impairments, International Pharmacists Anony-
mous (IPA), has been formed. The new group
held its organizational meeting during the
American Medical Association's 8th National
Conference on Impaired Health Professionals in
Chicago and its first membership meeting during
the American Association of Colleges of Phar-
macy-National Association of Boards of Phar-
macy District II meeting in Niagara Falls, NY.
IPA membership is open to any pharmacist or
pharmacy student who belongs to or is seriously
considering joining any of the traditional "12-
step" programs (such as Alcoholics Anonymous,
Narcotics Anonymous, and others), regardless of
current license status. There are no dues or fees
and inquiries are strictly confidential. IPA is not
affiliated with any professional disciplinary or
regulatory body or other organization.
IPA goals are "to share experience, strength
and hope with phramacists and their families in
recovery, to offer fellowship and peer support,
and to provide a resource for colleagues in need
of help." Experience will be shared concerning
available treatment, possible consequences if a
problem is acknowledged, and the different
options available. A caller need not be identified
in order to obtain information.
The current anonymous "listkeeper" of IPA
states that there are already more than one
hundred members, at least ten of them women.
Over 30 states are represented and members are
from varied backgrounds. Some are students,
others faculty members at colleges of pharmacy.
Many work for chain pharmacy organizations,
some are pharmacy owners, and others have left
pharmacy altogether. While the majority have
had alcohol problems, many others have had
difficulty with other drugs and at least one
primarily with gambling.
An IPA national meeting is being planned for
1988, and other future meetings are being
planned to be held in conjunction with other
pharmacy or addiction conferences.
For information on membership in IPA, con-
tact: Nan Davis, Pharmacist, St. Elizabeth
Hospital, 225 Williamson St., Elizabeth, NJ
07207; (201) 527-5021. Ms. Davis may also be
contacted at home: 36 Cedar Grove Rd.,
Annandale, NJ 08801; (201) 730-9072 or (201)
735-2789 (recording).
September, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
13
REPORT OF THE STUDENT BRANCH
Campbell University
School of Pharmacy
by Joseph S. Moose
President SAPhA 1986-1987
Campbell University
The Campbell University School of Pharmacy
Chapter of NCPhA was just an idea this time last
year. We wanted to start our chapter out with a
strong foundation — and we did. Out of fifty four
students, we recruited fifty four members. 100%
membership is something very few, if any,
pharmacy school in the nation can boast and I'm
proud to be one of the fifty four.
After the majority of the students signed up,
elections were held for the offices of President
and Vice President. Michael Williams was
elected Vice President. Mike as well as Dean
Maddox played an instrumental role in getting
the membership to the 100% mark and I thank
them both for doing such a grand job.
Now that the foundation was layed with two
officers and a strong membership, all we needed
was an advisor. That position was filled by a new
and welcomed member to the Campbell family,
Dr. Tom Wiser. Dr. Wiser was very active in the
Maryland Pharmaceutical Association at the
University of Maryland School of Pharmacy
where he taught prior to Campbell. Although he
hasn't been with us that long, he has showered us
with ideas and projects.
One project in the making is an education/
question and answer drug abuse program with
the Buies Creek School System.
Some of the functions that the organization has
accomplished in the short period of time that we
have been together are: two awards have been set
up for "Outstanding Service to the Profession of
Pharmacy" and "Outstanding Professor." These
awards are to be given yearly and their recipients
are voted on by the members.
We helped solicit funds for Kappa Epsilon, the
first professional pharmacy fraternity at
Campbell. As well as the awards and KE, we also
had a social with the law school, the only other
professional school at Campbell. It gave both
schools a chance to get out of the books and relax
for an evening.
The School of Pharmacy held Parents Day
where all the pharmacy students parents were
invited to Buies Creek to see just what their
children have gotten themselves into. They got a
chance to meet the faculty and SAPhA members
gave tours of the pharmacy school, facilities and
campus.
Dr. Wiser and six students represented
Campbell in Chicago at the National APhA
Convention. National officers were elected and
proposals were voted on but the biggest
educational experience came from meeting with
other chapters in our region as well as nationally
and discussing projects and ideas. Overall, I
believe we left a very good impression in the eyes
of other SAPhA/APhA members as well as the
good citizens of Chicago.
To sum it up, I know the Campbell Chapter
isn't that large in number, but what we lack in size
we more than make up for with our zeal and
attitude toward the profession. Our great rapport
with faculty and other students makes for an
entertaining and educational experience that will
benefit the profession in just a few years.
I would like to personally thank Mr. & Mrs.
Mebane, Dean Maddox, Dr. Wiser and Mrs.
Wallace for everything they have done. I feel like
I should thank Dr. Teat but I'm not really sure
what, if anything, he's done. Finally, I would like
to thank Vice President Mike Williams for being
there with the rope to pull me out of the hole
when it gets too deep. Thanks.
Joe Moose, President
September, 1987
We're not
^^ strangers...
UJasninqcon
national
INSURANCE COMPANY
NCPhA-Endorsed Insurance Plans
Which Merit Member Participation
DISABILITY INCOME PLAN HOSPITAL INCOME PLAN
MAJOR MEDICAL EXPENSE PLAN TERM LIFE PLAN
RETIREMENT AND PROFIT SHARING PLANS
FOR DETAILS WRITE OR TELEPHONE:
HOYT W. SHORE, CLU and Associates
821 Baxter Street-Suite 316
Charlotte, North Carolina 28202
O
Telephone (704) 333-3764
uuasninqeon
national
INSURANCE COMPANY
Evanston. Illinois 60201 • A Washington National Corporation Financial Service Company
THE NORTH CAROLINA JOURNAL OF PHARMACY
15
CAMPBELL UNIVERSITY
SCHOOL OF PHARMACY
REPORT TO
NORTH CAROLINA PHARMACEUTICAL ASSOCIATION
April 23, 1987
by Ronald W. Maddox, Dean
Faculty
The faculty of the school of pharmacy
currently consists of nine faculty members from a
variety of academic institutions and back-
grounds. Additions to our faculty since last year
include Drs. Thomas Wiser, Robert Greenwood,
Alan Richards, and Edward Soltis.
Dr. Thomas Wiser, who is Chairman of the
Department of Pharmacy Practice, graduated
from the University of Minnesota where he
received a B.S. in Pharmacy and Pharm.D. Prior
to joining Campbell, Dr. Wiser was on the
faculty at the University of Maryland School of
Pharmacy where he was involved in teaching and
clinical practice. Dr. Wiser has the responsibility
for the development of our practice faculty and
clerkship program.
Dr. Robert Greenwood is a graduate of the
University of North Carolina, Chapel Hill, with a
B.S. in Pharmacy and Ph.D. in Pharmaceutics.
Prior to joining our faculty, Dr. Greenwood was
Assistant Professor of Pharmacokinetics and
Biopharmaceutics, College of Pharmacy, Univer-
sity of Oklahoma. Dr. Greenwood will teach
biopharmaceutics and pharmacokinetics.
Dr. Edward Soltis graduated from Butler
University with a B.S. in Pharmacy and from the
University of Florida with a Ph.D. in Pharmaceu-
tical Sciences. Dr. Soltis will teach patho-
physiology.
Dr. Alan Richards graduated from Brigham
Young University with a B.S. in Physiology and
M.S. in Anatomy. He received his Ph.D. in
Microbiology from Texas A&M. Dr. Richards
will teach in the areas of microbiology and
immunology.
The school of pharmacy has eight additional
faculty positions funded in its 1987 88 budget.
Faculty will be employed in the following
disciplines: pharmacology, drug information,
pharmacy administration, geriatrics, internal
medicine, pharmaceutics, medicinal chemistry,
and toxicology.
September, 1987
Ronald W. Maddox, Dean
Enrollment
Our charter class entered in the fall semester of
1986. This class consisted of 54 students selected
from 120 applications. We feel these students
were well qualified academically to enter
pharmacy school as their over-all grade point
average was a 3.2 and 28% had a B.S. degree. It is
also noteworthy that 90% of our students are
North Carolina residents.
Our pre-pharmacy program continues to
grow. We currently have 55 students on campus
enrolled in pre-pharmacy as compared with 20
last year.
Drug Information
Renovation has been completed for the
Campbell University Drug Information Center
that will be located in the university library. We
are currently advertising for a faculty member
that will serve as Director of the Drug
Information Center. The Center is projected to be
operational this fall.
Continued on page 16
16
THE NORTH CAROLINA JOURNAL OF PHARMACY
CAMPBELL UNIVERSITY
Continued from page 15
Research
A faculty research laboratory has been
completely renovated with the installation of new
laboratory benches and fume hood. The
acquisition of laboratory equipment is
proceeding as planned. The animal care facility is
awaiting arrival of the cage washer for comple-
tion of renovation. The faculty has submitted five
research grant applications to national funding
agencies. Research activity will commence at the
conclusion of spring semester classes.
Continuing Education
We were approved as a provider of
Continuing Education by the American Council
on Pharmaceutical Education at their January
1987 meeting. Dr. Daniel Teat, our director of
continuing education, is developing programs to
help meet continuing education needs in North
Carolina.
Advancement
The school of pharmacy has received support
from various individuals and pharmaceutical
companies. During our first year of operation, we
have received donations of equipment and funds
totaling over $250,000. The following
companies have made major contributions:
DuPont Pharmaceutical Company, Glaxo
Pharmaceutical Company, Burroughs Wellcome
Pharmaceutical Company, and Hoechst-Roussel.
In summary, the first year of operation of the
Campbell University School of Pharmacy has
gone smoothly. We have had tremendous
university support, an excellent student response,
and exceptional professional acceptance. On
behalf of the faculty and students of Campbell
University School of Pharmacy, we are proud to
be part of the pharmacy community in North
Carolina.
CONGRATULATIONS TO
DANNY McNEILL and JIM MEARES
On their new store, Fair Bluff Discount
Pharmacy, Fair Bluff. We are pleased to have
been a part in the design and outfitting this new
store, which may keep Danny off the golf course
a bit.
H. Warren Spear, R. Ph.
Pharmacy Design Specialist
415 Augusta Drive
Statesville, North Carolina 28677
(704) 873-9993
Spear Associates — planners,
designers and installers of
pharmacy fixtures & equipment.
September, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
17
STATE BOARD OF
PHARMACY
Members — W. R. Adams, Jr., Wilson; Harold V. Day, Spruce Pine; W. Whitaker Moose,
Mount Pleasant; W. H. Randall, Lillington; Evelyn P. Lloyd, Hillsborough; Joseph R. Roberts,
III, Gastonia; David R. Work, Executive Director, P. O. Box H, Carrboro, NC 27510.
Telephone # (919) 942-4454
PHARMACY PERMITS ISSUED
July 6, 1987
Eckerd Drugs
3925 New Bern Ave.
Raleigh, NC
Robert Ennis Parrish, ph-mgr.
Kerr Drugs
Village S/C
3020 Hope Mills Rd., Suite 274
Hope Mills, NC
Robert M. Wood, ph-mgr.
Kroger Pharmacy
401 Jonestown Rd.
Winston-Salem, NC
Andrew Brown, ph-mgr.
Rite Aid Discount Pharmacy (T/O)
389 Raleigh Rd.
Henderson, NC
Janice M. Moon, ph-mgr.
July 20, 1987
Tiger Drugs #4
4508 South Main, Hwy. 311
Archdale, NC
Clyde Dean Bryson, ph-mgr.
July 21, 1987
Wal-Mart Pharmacy
40 Pinecrest Plaza
Southern Pines, NC
Jerry Rhoades, ph-mgr.
Wal-Mart Pharmacy
845-R Blowing Rock Blvd.
Lenoir, NC
Judith Goodman, ph-mgr.
Cleveland Co. Health Dept. (LSP)
Kings Mountain Satelite, 706 W. King St.
Kings Mountain, NC
Jerry R. McKee, ph-mgr.
Drug World Phcy. #3 (T/O)
331 W. Main
Taylorsville, NC
Alvin D. Woody, ph-mgr.
July 22, 1987
Drug Emporium
3501 North Blvd.
Raleigh, NC
Joseph Paul Graham, ph-mgr.
August 3, 1987
Rite Aid Discount Pharmacy
Hills- Jones S/C, East 5th. St.
Tabor City, NC
Daniel Burden, ph-mgr.
Revco Discount Drug Center
7665 Cliffdale Rd.
Fayetteville, NC
James F. Reale, ph-mgr.
Revco Discount Drug Center
NEC NC Hwy. 226 & Henry St.
Spruce Pine, NC
Cherrie Owens, ph-mgr.
September, 1987
Continued on page 18
1!
THE NORTH CAROLINA JOURNAL OF PHARMACY
PHARMACY PERMITS
Continued from page 17
August 12, 1987
The Medicine Shoppe (T/O)
2919 Central Ave.
Charlotte, NC
David Jamison, ph-mgr.
August 17, 1987
Kerr Drugs
Sunset Crossing
5220 Sunset Rd.
Charlotte, NC
Jerry Bridgers, ph-mgr.
Kerr Drugs
Steele Creek Commons
91 18 York Rd.
Charlotte, NC
Michael Best, ph-mgr.
Revco Discount Drug Center
3140 East 10th St.
Greenville, NC
Jeffrey D. Strickland, ph-mgr.
Dare Co. Health Dept. (LSP)
Manteo, NC
Roy Odell Phillips, ph-mgr.
Wake Co. Health Dept. (LSP)
1 2 1 Fuquay Ave.
Fuquay-Varina, NC
Danny J. Cress, ph-mgr.
Wake Co. Health Dept. (LSP)
110 Pearl St.
Garner, NC
Danny J. Cress, ph-mgr.
August 17, 1987
Wake Co. Health Dept. (LSP)
Brooks & Ownes St.
Wake Forest, NC
Danny J. Cress, ph-mgr.
Wake Co. Health Dept. (LSP)
201 East Vance St.
Zebulon, NC
Danny J. Cress, ph-mgr.
August 18, 1987
Women's Healthcare, Inc. (LSP)
1012 South Kings Dr., Suite 306
Charlotte, NC
Vic Pendergrass, ph-mgr.
Urgent Care Plus (LSP)
518 Owen Dr.
Fayetteville, NC
Thomas B. Reaves, ph-mgr.
August 21, 1987
Kerr Drug
Hoods Crossroads
3611 Matthews-Mint Hill Rd.
Matthews, NC
Patricia Griffeth, ph-mgr.
August 25, 1987
Morven Pharmacy (T/O)
Main St.
Morven, NC
Thomas W. Hough, Jr., ph-mgr.
Eckerd Drugs (T/O)
6829 Newell-Hickory Grove Rd.
Charlotte, NC
Ann Walker, ph-mgr.
Eckerd Drugs (T/O)
2001 East 7th St.
Charlotte, NC
Allen M. Charney, ph-mgr.
Medical Urgent Care Center
of Raleigh (LSP) (T/O)
8312CreedmoorRd.
Raleigh, NC
Robert Darrell Jenkins, Jr., ph-mgr.
September 8, 1987
Fair Bluff Discount Drug
142 E. Main St.
Fair Bluff, NC
James Hubert Meares, Jr., ph-mgr.
Kmart Pharmacy
Canova Ctr.
508-K 10th. St. N.W.
Conover, NC
Michael C. Rhodus, ph-mgr.
Beddingfield Drug Co. (T/O)
325 E. Main St.
Clayton, NC
Richard T. Crowder, ph-mgr.
Link Bros. Pharmacy (T/O)
1 18 S. Scales St.
Reidsville, NC
Oscar N. McCollum, ph-mgr.
September, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
19
TRAVELING MEMBER'S AUXILIARY
OF
NORTH CAROLINA PHARMACEUTICAL ASSOCIATION
1987-1988
ADAMS MARK HOTEL
April 23, 1987
Charlotte, N.C.
BREAKFAST MEETING OF THE BOARD OF
GOVERNORS AND OFFICERS OF T.M.A.
The meeting was called to order by Doug
Sanders in the absence of President John T. Black
who was ill.
The minutes of the last meeting was read by
L.M. McCombs. A motion was made by Tom
Sanders and seconded by Len Phillipps that they
be passed as read.
Treasurers Report by L.M. McCombs —
Savings $2848.06
Note 2500.00
Checking 2098.00
Total $7446.36
All were pleased with the financial report.
Printing of Roster for 1987-88: Cost in the
Carolina Journal of Pharmacy for 1985 was
$1 100.00, for 1986 it was $973.00. A discussion
was held as to the cost of the old card method
which was mailed to each drug store and hospital.
A motion was made by Rusty Hamrick and
seconded by Len Phillipps that Tom Sanders and
Mac McCombs investigate the cost and printing
of the old card method (not to exceed $1500.00
in cost) and report back to the office. The motion
passed.
Treasurer Audit: Steve Collins was appointed
by Doug Sanders to audit the T.M.A. books.
Search for a 2nd Vice President: Rusty
Hamrick, Roy Moss, and Steve Collins was asked
to look for a 2nd Vice President and report at the
annual meeting the next day. Tom Terry III
(Owens Minor) and William V. O'Quinn (N.C.
Mutual) were mentioned.
Golf Report: Owens-Illinois will pay the green
fee, Burroughs Wellcome will pay for cards, and
Justice Drug will pay for drinks and sandwiches.
Life Members: The following requested by
letter for Life Membership in the T.M.A. —
C. Rush Hamrick (Kendall Drug Co.)
Hartwell M. Smith (Kendall Drug)
September, 1987
A motion was made by Tom Sanders and
seconded by Steve Collins to grant life
membership to these two. The motion passed.
There being no further business, the meeting
adjourned.
— L.M. McCombs, Secretary /Treasurer
THURSDAY MORNING BREAKFAST
MEETING OF T.M.A. FOUNDATION
CHAIRMAN: Tom Sanders, Presiding
The minutes of the last years meeting were
read by L.M. McCombs. On a motion by Steve
Collins and seconded by Roy Moss, they were
accepted as read.
Financial Report by Zack Lyon: Cash on hand
is $ 1 7,4 1 0.80. After the report Mr. Lyon asked to
be relieved of handling the finances of the
Foundation Fund. Mr. Lyon nominated Steve
Collins to take his place. After a brief discussion,
Mr. Collins agreed to accept the office. This was
seconded by Roy Moss, and the motion passed.
Audit: Mr. Sanders asked Rusty Hamrick and
Len Phillipps to audit Mr. Lyons books. They
accepted.
Loan Money to Chapel Hill: After a brief
discussion concerning the amount of money sent
to Chapel Hill ($9,500) for loans to students, a
motion was made by Rusty Hamrick that we
send $2,000 more to Chapel Hill. ($1,500 to
Chapel Hill and $500 to Campbell College. All
money to be handled by Mr. Al Mebane.) The
motion was seconded by Ralph Rogers, Jr. and
passed.
Mr. Sanders made a motion that the new
Secretary (Steve Collins) contact all wholesalers
and ask for money to support the T.M.A.
Foundation. It was seconded by McCombs, and
passed.
Continued on page 20
20
THE NORTH CAROLINA JOURNAL OF PHARMACY
AUXILIARY
Continued from page 19
Nominating Committee: Steve Collins and
Roy Moss. Mr. Collins nominated the following
Board of Directors for 1987-88. The motion was
made by Rusty Hamrick, and seconded by Bobby
McDaniels, and passed.
Replacement on Board of Directors: Doug
Sanders to replace W.H. Andrews. The Directors
for 1987-88 are as follows:
1-Year
John Black (Emeritus)
Frank Fife
Len Phillips, Jr.
Ralph Rogers, Jr.
3-Years
Rush Hamrick, Jr.
Tom Sanders
Stephen L. Collins
Doug Sanders
2-Years
E. Delacy Luke
Tom Terry, III
Bobby McDaniel
Roy Moss
Officers for 1987-88 presented by Nominat-
ing Committee as follows:
CHAIRMAN:
SEC.-TREAS:
ASST.SEC. Treas.
Tom Sanders
Steve Collins
L.M. McCombs
A motion was made by Len Phillipps to accept
the officers as nominated, and seconded by Ralph
Rogers, Jr. The motion passed.
There being no further business, the meeting
was adjourned.
— L. M. McCombs
TRAVELING MEMBER'S
AUXILIARY
11:00 A.M. — FRIDAY MORNING
73rd ANNUAL MEETING OF T.M.A.
The meeting was called to order by First Vice
President Doug Sanders, due to the absence of
John T. Black, who was ill. The invocation was
given by C. Rush Hamrick, Jr.
Greetings from Womans Auxiliary: by Mrs.
Jesse E. Oxendine. Her words of praise and
encouragement was welcomed by all members of
the T.M.A. present.
Minutes of Last Meeting: On a motion by
Steve Collins, and seconded by Horace Lewis,
the minutes were omitted as they were read and
passed at the Thursday morning meeting of the
officers and Board of Directors. The motion
passed.
Rite of Roses: The Rite of Roses was
conducted by C. Rush Hamrick, Jr. and Rusty
Hamrick, III. It was very impressive and in
memory of the following:
Thomas B. Waugh, 7/9/86
Justice Drug Co.
James M. Darlington, 10/10/86
O'Hanlon Watson Drug Co.
David F. McGowan, 3/07/87
Eli Lilly & Co.
Wilbur Leon Hickman, 2/25/87
Eli Lilly & Co.
A moment of silence was observed in their
memory.
Treasurer's Report:
Savings
Note
Checking
Total
$2848.06
2500.00
2098.00
$7446.36
Audit: The books were audited by Steve Collins
who reported that same were in order as
reported.
Golf Report: Given by Junior Little (Owens
Illinois). Fifty-One Men and two Women played
golf. Little stated that he hoped more women
would play next year.
Tennis Report: Given by Sam Stuart
(Jefferson Pilot) reported that 1 2 played tennis (9
men and 3 women).
Dance Report: by Mac McCombs. All seemed
to enjoy the dance. The music was great, and
hope we can afford them in Asheville next year.
Foundation Report: by Tom Sanders. The
total Foundation Fund is $29,000.00, including
money in bank and loan fund. Mr. Sanders ask
for more contributions to the fund from all
members and wholesalers and drug stores. Mr.
Sanders made a motion that we send $2,000 to
Chapel Hill. $1500.00 for Chapel Hill and
$500.00 for Campbell College. It was seconded
by Zack Lyon, and the motion passed.
Foundation Treasury Report: by Zack Lyon.
Total money on hand (Savings, Notes, etc.) is
$17,410.80. In the officers and Board meeting
Thursday, Mr. Lyon stated that some younger
blood should start handling the Foundation
Funds. Mr. Steve Collins was elected as
Secretary-Treasurer of the Foundation Fund.
(4-23-87)
September, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
21
Foundation Fund Audit: by Len Phillipps. Mr.
Phillipps stated that after hours and hours of
checking he found the books in order.
Foundation Fund Officers for Year 1987-88:
Chairman: Tom Sanders
Sec.-Treas: Steve Collins
Asst. Sec.Treas: L.M. McCombs
Life Membership: by L.M. McCombs.
Recommended (after letter of request) for Life
Membership:
C. Rush Hamrick, Jr. (Kendall Drug Co.)
Hartwell M. Smith (Kendall Drug Co.)
The motion was seconded by William E. Harris,
and passed.
New Members: by Roy Moss. Mr. Moss asked
that all members of T.M.A. should try to get some
new members as our membership seems to be
decreasing. All members present agreed with Mr.
Moss.
Change time of T.M.A. Annual Meeting from
1 1:00 A.M. to 9:00 A.M., by Mr. Steve Collins:
Mr. Collins made several good reasons for
changing the time of our annual meeting. Many
reasons came from the floor not to change the
time. No action was taken at this time.
Steve Collins Report on Al Mebane
granddaughter, Sarah Clampet. Born and lived
about 30 hours. Mr. Collins made a motion that
the T.M.A. send $100.00 to the loan fund in
memory of Sarah Clampet. Seconded by Rusty
Hamrick, III. The motion also asked members
(individuals) to contribute to this fund. This
money to be sent to Chapel Hill at a later date.
The officers to meet and decide exactly how the
memorial be written, and also to wait on
donations from members. The motion passed.
New Business: L.M. McCombs stated that
$2,000.00 of the $2,500.00 Note could be turned
over to the Foundation Fund. The note matures
7/3/87. It all depends upon how many members
we have at that time.
Presidents Plaque: Doug Sanders asked Roy
Moss if he would take the President's Plaque to
President John T. Black (who is ill). Mr. Moss
said he would be happy to do so.
Nominating Committee Report: by Rusty
Hamrick, III. Mr. Hamrick nominated the
following for office in the T.M.A. for 1987-88:
PRESIDENT:
Doug Sanders (W.H. King Drug)
1st VICE PRES:
E. Delacy Luke (The Upjohn Co.)
2nd VICE PRES:
Tom Terry (Owens Minor Drug Co.)
SEC.-TREAS:
L.M. McCombs (Eli Lilly — Retired)
The motion was seconded by Zack Lyon and Len
Phillipps, and passed.
Installation of Officers: by C. Rush Hamrick,
Jr. T.M.A. Officers for the year 1987-88 were
installed by C. Rush Hamrick, Jr.
There being no further business, the meeting
was adjourned.
L.M. McCombs, Secretary & Treasurer
Doug Sanders (left) receives the T.M.A. President's gavel from Roy Moss.
September, 1987
YOU WANT
GREATER RECOGNITION
FOR PHARMACY.
SO DO WE.
The future of pharmacy will be shaped by the many
bright, well-trained young pharmacists entering
the work force today. Their high standards of
practice will carry the profession well into the
next century.
At Marion, we believe in recognizing the
best of these young pharmacists and their
accomplishments as an example for others to follow.
That's why we sponsor our "Distinguished Young
Pharmacist Award',' presented annually to a young
pharmacist in each state for individual excellence
and outstanding contributions in state pharmacy
association activities, community affairs, and in
professional practice.
t£ In Colorado, this year's Distinguished «i
jff Young Pharmacist Award goes to Bradley D. S*
5> Haas of Denver. Congratulations! CJ
We're confident that this year's distinguished young
pharmacists will become the leaders who shape
pharmacy's future well into the next century. And
that's a future Marion believes is worth looking
forward to!
Service to Pharmacy
M
PHARMACEUTICAL DIVISION
MARION
LABORATORIES INC
THE NORTH CAROLINA JOURNAL OF PHARMACY
23
CURRENT PRESSURES ON HOSPITALS
AND HOSPITAL PHARMACY
by James R. Talley, M.S.
School of Pharmacy
Northeast Louisiana University
Monroe, Louisiana
Current cost-containment for health care was
initiated by the implementation of Medicare
prospective pricing in 1984. The pressure
continues for hospitals to further reduce costs and
be more efficient in treating patients. The results
are that length of patient stays have declined
whereas the intensity of care has increased. Thus,
the average hospital occupancy rate, the number
of patient days, and hospital admissions have
decreased.
In 1985, peer review organizations (PROs)
were implemented which focused on unneces-
sary Medicare hospital use. These aspects of cost
containment for Medicare patients has created
similar pressure for cost containment in the
private sector of health care. It is possible that
private use-review programs may have an even
more profound effect than Medicare prospective
pricing and PROs on hospital admissions, patient
days, and average occupancy.
A number of insurance companies and
employers are promoting the concept of private
use-review programs. These programs include
preadmission review, second-surgical-opinions,
continued-stay review, and case-management
services. Companies engaged in preadmission
and concurrent review are predicting reductions
of 15-20% for the number of hospital patient
days.
These factors are resulting in a decreased use of
hospital inpatient services. One report stated that
in 1985, hospital outpatient visits increased by
4.7%, inpatient admissions decreased by 4.4% and
average hospital occupancy attained a new low
of 64%. This decrease in the use of hospital
inpatient services has resulted in a decline of
revenue for hospitals. In an attempt to off-set this
decline in revenue, hospitals are engaging in
alternative-care (home-care) services and for-
profit subsidiary corporations. These include
home infusion therapy programs, durable
medical equipment, and joint ventures with
physicians.
This decrease in the length of patient stays has
resulted in an increase in the intensity of care
provided patients. These aspects are directly
affecting pharmacy services in hospitals because
September, 1987
aggressive drug therapy is resulting in an
increased use of injectable dosage forms. Thus,
the increased costs of using parenteral products
results in a disproportionate decrease in costs for
pharmacy services. Unfortunately, hospital
administrators may exert even greater pressure
on pharmacy managers to obtain a proportionate
decrease in pharmacy managers to obtain a
proportionate decrease in pharmacy expenses as
compared to other departments. A task which is
almost impossible. Thus, pharmacy managers are
being forced to reevaluate pharmacy services.
This reevaluation may equate to a decrease in
pharmacy services to patients.
The pressure on pharmacy to reduce costs is
tremendous. Hopefully, the pharmacy profession
will create innovative cost-reduction programs
which will not sacrifice patient care. Our goal
must remain, "to deliver the highest level of
patient care at the least possible cost."
vjc::;:'." .,, «,
^iffiS
| M i, mi
S.m« ., .bo..
■ wlh Crohn. Pl».m.cr„llt.l MlOcl.llon POOo.UICl.. 1 IIIII NC 111 1 <
ft.ll.MtMM.M.r.O Do. III. Ctep.1 IIIII HC
:.T^v.^.:^/.:■^^l^■.-:r.^r,^li»'~li'i:::-.r.:■r■.;r.^=r^r^r';r;s".
_..,_.. » — ,
""".:""^:'j:.'.::^;""
"l^SXUZXXS
s6iv^r,.^j'Ap'.ra
•..«..,. «..«.. „_._
1110
• :*£.*sii2.'i;°s?!^.'s__ —
Hon.
' SK5SS-.
c :z-i::?.~~"~""°"" — —
°L"u°.""oS:s;.v.,r."iK"'"."?:"i,r,—
III
i»i
c nfuMramMa-tfr—a
1101
mi
' r?.'-"""^"""?'" i. .. in i ..
101
, , — . — _
Hon.
O ,...l».«„_, ,_,„ ..,
III!
1010
i »mi, a*, *. ...I— ».»»«).b, r\|'">"vj""M""""'"°
24
THE NORTH CAROLINA JOURNAL OF PHARMACY
Table 1
Average Hospital Pharmacy
Percent
1986
1985
of
(2,167 Hospitals)
(1,651 Hospitals)
Change
Bed capacity
235
244
-3.8%
Class
private nonprofit
private nonprofit
Profile
General
General
Census (beds occupied)
59%
60%
Admissions
8,416
8,566
-1.8%
Patient days
50,607
53,436
Length of patient stay
6.0 days
6.2 days
Hours central pharmacy
open/week
97
100
-3.1%
Pharmacist hours/week
294 (7.3 FTE)
309 (7.7 FTE)
-5.1%
Technician hours/week
268 (6.7 FTE)
276 (6.9 FTE)
-3.0%
Support personnel hours/week
115 (2.9 FTE)
114 (2.9 FTE)
+0.9%
Inventory
$120,397
$121,198
-0.7%
$ 2.38/patient day
$ 2.27/patient day
+4.8%
$ 512/bed
$ 497/bed
+3.0%
$ 868/occupied bed
$ 828/occupied bed
+4.8%
$14.31 /admission
$1415/admission
+1.1%
$1,053,737
$1,032,831
+2.0%
$ 20.82/patient day
$ 19.33/patientday
+7.7%
$ 4,484/bed
$ 4,233/bed
+5.9%
$ 7,600/occupied bed
$ 7,055/occupied bed
+7.7%
$125.21 /admission
$ 1 20.57/admission
+3.8%
Purchases
Inventory turnover rate
8.7 times
8.5 times
Floor area (central pharmacy)
1712 sq ft
1799 sq ft
Services offered by over 60% of pharmacies:
Monitoring patient profiles 94.4%
Monitoring drug interactions 91.2%
Providing drug information services 74.6%
Drug therapy consultation 67.9%
Monitoring patient profiles 96.5%
Monitoring drug interactions 92.6%
Providing drug information services 82.5%
Drug therapy consultation 7 1 .2%
September, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
25
A PREVIEW OF 1986
HOSPITAL PHARMACY OPERATIONS
This preview of 1986 hospital pharmacy
operations was abstracted from the 1987 edition
of the Lilly Hospital Pharmacy Survey. The new
Survey is based on information received from
2,167 hospital pharmacies and is the tenth
consecutive edition prepared by Eli Lilly and
Company.
Table 1 shows that in 1986 the average
hospital had 235 beds — down almost 4% from
the previous year. Census again declined during
1986. Census has fallen consistently since 1982,
and is almost 15 percentage points below the
average annual census rate of close to 73%
observed during the 1975 through 1981 period.
Admissions during 1986 were about 2% lower
than the previous year.
The average length of hospital stay declined
from 6.2 days last year to 6.0 days in 1986, the
shortest period of patient stay ever recorded in the
Lilly Survey. The largest segment of hospitals
reporting to the Survey continues to be private,
nonprofit, general hospitals.
The number of hours the central pharmacy
was open as well as the hours worked by phar-
macists and technicians declined slightly during
1986, although support personnel hours
remained virtually unchanged. The total hours
worked by the overall pharmacy department staff
fell over 3%, while the central pharmacy was
open 3% fewer hours. Three hours of pharmacist
time were required for each hour the central
pharmacy was open during 1986 — slightly less
than that recorded last year. The ratio of hours
worked by technicians to hours open was
unchanged at 2.8. Hours worked by support
personnel for each hour open increased slightly
from 1.1 to 1.2 during 1986.
For the third time in as many years, the dollar
value of inventory declined when compared with
the previous year's figure. In addition, purchases
were 2% higher, with the result that the estimated
inventory turnover rate increased from 8.5 to 8.7
times. However, on a pre-occupied-bed basis,
inventory and purchases figures were about 5% to
8% higher respectively than in 1985.
Comparison of inventory and purchases based
on patient days shows that inventory during 1 986
equaled $2.38 per patient day — up 1 1 cents
— or almost 5% higher than the year earlier.
September, 1987
Purchases were $20.82 per patient day, an
increase of close to 8%. Because inflation is not
taken into account, its influence on inventory and
purchases cannot be isolated. Therefore, these
figures do not necessarily reflect increased use of
pharmaceuticals and related items by hospital
patients.
The floor area of the central pharmacy
declined about 5% during 1986. This may be
explained, in part, by the slight shift in
distribution of the overall sample over the two
years. It appears that smaller-sized hospitals
accounted for a larger share of the total sample
during 1986.
The ranking for the top four pharmacy
department services was the same for 1 986 as for
1 985. These services were offered by over 60% of
responding hospital pharmacies. However, there
was a decline in the percentage of hospitals
reporting these staff activities during 1986 when
compared with 1985 figures.
Review of a decade of selected operating
statistics from past editions of the Lilly Hospital
Pharmacy Survey reveals the following trends:
• Since 1982, central pharmacy hours open
per week increased at a slower rate than
during the 1978-1982 period. Had the
earlier trend continued, the 1986 average
hospital pharmacy would have been open
over 100 hours per week.
• The average number of occupied beds
declined dramatically since 1 98 1 , reversing a
significant uptrend. Had the earlier trend
continued, one third more beds would have
been occupied during 1986.
• Inventory and purchases per occupied bed
showed steady, moderate growth of about
8% per year during the past decade.
• Pharmacist and technician hours worked per
week per occupied bed increased steadily but
moderately since 1978. However, pharma-
cist hours showed a slightly faster rate of
growth than technician hours.
The 1987 issue of the Survey will be
distributed to hospital pharmacy directors and
others interested in hospital pharmacy during
August, 1987.
*% I L^
M WhH£I
Meet the newest
chapter in our history
of excellence.
For ten weeks, they skimm
of a century's experience in the pharma-
ceutical industry. And they learned, '
manufacturing, about research, c,—
control and marketing. But they didn't stop
there. As members of Upjohn's 14th annual
National Pharmaceutical Council-Student
American Pharmaceutical Association
(NPC-Student APhA) Internship Program,
they went on to begin a chapter of their
own. And quite frankly, we were impressed.
Through their eyes, we got an exciting
glimpse into the future. And renewed as-
surance that pharmacy's next chapter will
be promising indeed.
The miems lour the corporate museum ai the Uptohn
Viator's Center. From led to right:
Allison L Vordenbaumen. University of Texas at Austin
Mark B. Boeckmann, University ol llinois at Chicago
Hedi M. Bloom. Wayne State University
Judith A Shinogle, University ol Kansas
THE NORTH CAROLINA JOURNAL OF PHARMACY
DICKINSON'S PHARMACY
by Jim Dickinson
27
Pharmacy according to Medco. At the outset of
this latest of many Dickinson writings on mail-
order pharmacy, let me make it clear that I am
not opposed to mail-order — I am just skeptical.
Mail-order worries me because there is no
pharmacist-patient relationship, and I believe in
those, even though some pharmacists are rotten
at them.
My worries — and the worries of a growing
number of legislators at both the state and federal
levels — are heightened by the testimony in
August at a Senate Governmental Affairs
subcommittee hearing chaired by Senator Jim
Sasser (D-TN), and by what came in my mail
shortly afterward.
Medco Containment Services, Inc., owner of
National Rx Services, was the focus of the
hearing, which dealt with complaints by a panel
of three former employees (all registered
pharmacists), and with a complaint by a former
patient who was dispensed Coumadin instead of
Corgard.
Basically, the former Medco pharmacists, all of
whom resigned voluntarily out of conscience,
complained about Medco's high-volume quota
system (54 Rxs per hour, six-plus hours per day),
the 1 5-cents-per-Rx monthly bonus paid for Rxs
averages exceeding 50-per-hour, the high levels
of misfills by technicians (5% of all Rxs), and their
inability to reassure themselves that the speed of
the filling line could not cause them in their
last-check responsibility to mail out death instead
of therapy.
The pace of Medco's production line was
"suicidal," they complained.
Mrs. Winifred Own, of Virginia Beach,
Virginia, testified that after her close call (she
referred the different-looking tablets to her
neighborhood pharmacist), she had quit her
federal employee benefit Blue Cross/Blue Shield
mail-order option, to pay full price at the local
pharmacy. "I'm not ready to die yet," she told the
Washington Post.
Medco was highly indignant about all these
dreadful slurs. Its chairman, Martin Wygod,
challenged the anonymity that the subcommittee
had given to his former employees (they testified
from behind a screen), and questioned their
motives ("Are they disgruntled former
employees? Are they now affiliated with Medco's
September, 1987
competitors in the retail market? Do they have a
financial interest in undermining Medco's
reputation?")
As the agent who brought these pharmacists to
the subcommittee, I am the one who initially
guaranteed them anonymity — and the
subcommittee staff agreed with me, after being
introduced them. These pharmacists had seen
enough of the unwholesomely cozy relationship
between their state pharmacy board and their
Medco bosses to be terrified for their licenses.
And, indeed, one state pharmacy board exec
who has a major Medco facility in his state told
me that, at least so far as he was concerned,
"Medco is wonderful." The company is so
cooperative, unlike independent pharmacists
who often resent being inspected, and give
inspectors a hard time.
And another board exec was alleged by a
Medco pharmacist to have refused to conduct a
snap inspection based on her long, anonymous
complaints because (a) the board doesn't act on
anonymous complaints, and (b) anyway, he
would have to alert Medco to the inspection first,
for "security reasons."
Continued on page 28
Remember the ^Day
...incPicturts
CXDLORCRAFT
North Carolina's Most Complete
Film Processing Service
There Is A Plant Located
Near You
For the Finest Quality Plus Fast
Dependable Service on All Your
Photo Needs, Contact the Plant
Nearest You.
CHARLOTTE WILMINGTON
KERNERSVILLE RALEIGH
FAYETTEVILLE DURHAM
If You Don't Know Photofinishing
Know Your Photofinisher
28
THE NORTH CAROLINA JOURNAL OF PHARMACY
DICKINSON'S PHARMACY
Continued from page 27
Is it any wonder my anonymous witnesses
were slightly paranoid? As for who was paying
them to tell lies about innocent Medco, one of my
informants, offered $100 by me to critique Mr.
Wygod's subcommittee testimony (which I sent
her), completed the chore and wrote: "I wish to
donate my $100 back to the cause at hand."
(Let me make an open invitation to all
pharmacists at this point. If you know of a similar
public safety hazard in pharmacy to the one
described here, write me at P.O. Box 848,
Morgantown, WV 26507-0848, or call on your
nickel 304-291-6690, and I will provide the same
anonymity guarantees as I did for the Medco
pharmacists.)
To wrap up, the critiques my Medco
pharmacists made of Mr. Wygod's written
testimony have been (anonymously) turned over
to Senator Sasser's committee. They describe that
testimony as filled with falsehoods, and I believe
there will be another hearing, to force testimony
from the company under oath.
Other mail-order companies testified at the
hearing, too. They told a more believable story.
For example, instead of 54 Rxs/hour quotas and
bonuses, and technician RX mixups, Thrift
Drug's Express Pharmacy Service testified that it
is striving for a modest 30 Rxs/hour "goal" and
every one of its RXs is checked by at least two
registered pharmacists.
If mail-order pharmacy can be practiced
soundly (as the Veterans Administration and
AARP seem to), I think this may be a way to do
it. I have asked Thrift to let me bring my ex-
Medco pharmacists in for a look.
I'll keep you posted. It's public health, safety
and service that we're all interested in.
This feature is presented on a grant from G.D. Searle &
Co., in the interests of promoting the open discussion of
professional issues in pharmacy. G.D. Searle & Co.
accepts no responsibility for the views expressed herein
as they are those of the author and not necessarily those
of G.D. Searle & Co.
CONGRATULATIONS TO
FRANKLIN WELLS
On remodeling his store, Warren Drug in
Benson. We are pleased to have helped in this
modernization and expansion into office
products.
H. Warren Spear, R. Ph.
Pharmacy Design Specialist
415 Augusta Drive
Statesville, North Carolina 28677
(704) 873-9993
Spear Associates — planners,
designers and installers of
pharmacy fixtures & equipment.
September, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
29
COMMEMORATIVE POSTMARK READY
FOR JUC PHARM SCI
A pictorial United States Postal Service
commemorative postmark will be affixed to all
mail posted at the joint Japan-United States
Congress of Pharmaceutical Sciences to be held
in Honolulu, Hawaii, December 2-7, 1987. The
Congress is being hosted by the American
Pharmaceutical Association and the Pharma-
ceutical Society of Japan; over 1,500 U.S. and
1,500 Japanese pharmaceutical scientists are
expected to attend.
The postal cancellation pictures a distillation
retort serving as the circular postmark with the
words JUC PHARM SCI STATION / (DATE)
/ HONOLULU, HI 96815. The acronym for
Congress — JUC PHARM SCI — appears in
both English and Japanese and the flask pictures
the JUC PHARM SCI logo.
The U.S. Postal Service JUC PHARM SCI
Station will be located at the Sheraton Waikiki
Hotel in Honolulu on the following days and
times:
Thursday, December 3
8:30 a.m. to 4:00 p.m.
Friday, December 4
8:30 a.m. to 4:00 p.m.
Saturday, December 5
8:30 a.m. to 12:00 noon
Sunday, December 6
No service
Monday, December 7
8:30 a.m. to 4:00 p.m.
For those unable to have their own mail
serviced at the JUC PHARM SCI Station, the
Secretariat offers serviced covers with the special
postmark, appropriate U.S. postage stamp, and a
cachet picturing the JUC PHARM SCI logo at
$ 1 .00 per cover (our choice of postmark date) or
$3.00 for all four postmark dates plus a #10
self-addressed, stamped envelope. Only orders
with checks made payable to JUC PHARM SCI
and a #10 stamped, self-addressed envelope
received before December 1, 1987 can be
honored. Send orders to JUC PHARM SCI,
2215 Constitution, N.W., Washington, DC
20037.
Burroughs Assets Management Company
Specializing in health care and small business consulting.
Serving pharmacists with new or existing stores by performing:
Business plans for startup
operations or expanding
operations
* Feasibility studies
* Market planning
* Efficiency studies that
detail financial analysis
Terrence B. Burroughs, M.B.A., R.Ph.
President
(919)481-4439
226 Adams Street
Cary NC 27511
September, 1987
30
THE NORTH CAROLINA JOURNAL OF PHARMACY
CLASSIFIED ADVERTISING
Classified advertising (single issue insertion) 25 centers a word with a minimum charge of $5.00 per
insertion. Payment to accompany order.
Names and addresses will be published unless a box number is requested.
In replying to "blind" ads, address Ad. No., Carolina Journal of Pharmacy, P.O. Box 151, Chapel
Hill, NC 275 1 4. Telephone (919) 967-2237.
PHARMACIST WANTED: Director of
Pharmacy for 64-bed hospital in South-
eastern North Carolina. Excellent hours,
salary negotiable, and good fringe
benefits. Contact Tom Smart at (91 9) 582-
2026.
PHARMACIST: Professional Ser-
vices/Consultation — Temporary and/or
Continual. Contact: L. W. Matthews at
(919) 967-0333 or 929-1783. 1608 Smith
Level Road, Chapel Hill, NC 27514.
CLINICAL-STAFF PHARMACIST POSI-
TION: Will be working every 3rd weekend
and will have responsibilities in unit dose,
IV admixtures, cancer chemotherapy,
patient education, nursing inservice,
pharmacy newsletter, pharmokinetic
dosing, drug use evaluation and other
evolving clinical applications. Some
advanced training and experience in
clinical pharmacy preferred. If interested
and qualified please send resume to:
Director of Personnel, Community
General Hospital, P.O. Box 789, Thomas-
ville, NC 27360. EOE.
STAFF PHARMACIST WANTED: Posi-
tion at Kings Mountain Hospital. Modern
102-bed facility with computerized unit
dosage. Hospital experience preferred
but not necessary. Will consider a May
graduate. Contact Jerry McKee at (704)
739-3601 Ext. 472.
We are seeking an ambitious and
professional career-minded individual for
Pharmacy-manager position in south-
eastern North Carolina near the coast.
Computerized prescriptions, exellent
salary, hospitalization and life insurance,
paid vacations. Small professional
pharmacy located in the center of a
medical complex. Contact: Box CDD, c/o
NCPhA, P.O. Box 151, Chapel Hill, NC
27514.
Pharmacist looking for both retail and
hospital relief work in Fayetteville,
Lumberton and Piedmont area. Has 18
years of experience. If you are in need of
such a person please contact Box DAK,
c/o P.O. Box 151, Chapel Hill, NC 27514.
PHARMACIST WANTED: Drug Em-
porium, Greensboro, NC now hiring
pharmacist. Excellent starting salary.
Complete benefit package, plus bonuses
included. Call Kent Huffman for details at
(919)282-3993.
PHARMACIST WANTED: We are
seeking an ambitious, and professional
career-minded individual for a pharmacist
position in Greensboro, High Point and
Winston-Salem, NC. We offer excellent
salary, stock ownership, educational
subsidy, extensive benefits, retirement
plan, 401 K tax plan, annual salary merit
reviews. "Pure pharmacy setting". If
interested call Lew Thompson 1-800-233-
7018 or send resume to: The Kroger
Company, Attn: Personnel, PO Box
14002, Roanoke, VA 24038. EOE.
Pharmacists Wanted: Farmco Drug
Centers have present positions available
in Rocky Mount, Elizabeth City and
Roanoke Rapids, North Carolina. For
more information contact James Thom-
pson at (919) 878-8158.
PHARMACIST WANTED: Pharmacy II
position available at Piedmont Correction
Center in Salisbury. Rowan County. One
year experience. Salary grade; 75. Salary
range; 26,892-43,728. Call Sylvia Mat-
thews at (704) 637-1421 Ext. 501 or 507.
September, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
31
PHARMACIST WANTED: Opportunity
for pharmacist for independent pharmacy
store located in Central Piedmont, NC.
Store open 51/2 day week. No nights,
Sundays or holidays. Paid vacations.
Reply to Box ABC, c/o NCPhA, P.O. Box
151, Chapel Hill, NC 27514.
Pharmacists Wanted: Greensboro and
Greensboro market area. Contact David
Cox, Revco Drug Stores, at (919) 766-
6252.
RELIEF PHARMACIST AVAILABLE:
Central & Eastern North Carolina. Contact
Pharmacy Relief, PO Box 2064, Chapel
Hill, NC 27515 or call 919-481-1272
evenings.
Pharmacist with retail experience to
manage Rx Department, monitor patient
profile and compound mixtures. Profes-
sional hours, atmosphere and salary. Call
Gary Newton, Fayetteville 800-682-4664
Office hours or 919-484-6214, 24 hours.
Pharmacy for Sale: Piedmont area
pharmacy with annual sales of over
$500,000. Annual increase each year.
Owner will assist with financing if
necessary. Contact Box RK, NCPhA, P.O.
Box 151, Chapel Hill 27514.
Want to Buy: Profitable Drugstore on
Contract. Prefer Eastern/Central North
Carolina. Would consider other areas of
the state and other types of financing with
low money down. Reply to Box PDQ, c/o
NCPhA, P.O. Box 151, Chapel Hill, NC
27514.
WANT TO BUY: Old or antique
pharmacy fixtures, shelving and possibly
soda fountain. Please contact Wheeler
Carver, Jr. at P.O. Box 1121, Roxboro, NC
27573 or call (919) 599-4515.
Pharmacist Wanted: Excellent oppor-
tunity to work in independent profes-
sional pharmacy (80% Rxs) in large
medical complex in Sandhills. No nights
or Sundays. Excellent salary & benefits.
Box 1119, Pinehurst, N.C. 28374. 919-
295-2222 (day or night).
September, 1987
The Department of Pharmacy Services
at Sampson County Memorial Hospital
has opportunities available for hospital
pharmacy practice. This 145 bed JCAH
approved hospital is located within 1 hour
drive of the coast. Good working
conditions with Nursing and Medical
Staff. Excellent starting salary, plus
comprehensive benefit package. Activi-
ties include complete computerization,
unit dose, IV admixture, patient profile
and inventory control. Patient care
services include: antibiotic monitoring,
TPN, Aminoglycoside dosing and support
for continuing education. Contact:
Patricia Britt, director, Personnel or Jenny
Strickland, Director Pharmacy at (919)
592-8511.
Owners want to retire. Old established
store 30 miles from Raleigh in a small town
with one doctor. $250,000 in sales, with an
inventory of $50,000. Sales price of
$65,000, includes fixtures and equipment.
85% Rx business. Reply to Box POK, c/o
NCPhA, P.O. Box 151, Chapel Hill, NC
27514.
Columbus Store Fixtures for Sale.
Complete Prescription Department and
30 foot greeting card fixtures. Contact
Bud O'Neal. Work: 919-943-2462, Home:
919-943-3751.
PHARMACIST NEEDED: Pharmacist
for Community Pharmacy located in
Carrboro. Approximately 45 hours a week
with alternate weekends off. Must be
willing to live in Chapel Hill or Carrboro
telephone area. Send resume to Vaughn
Independent Pharmacy, 503 W. Main
Street, Carrboro, NC 27510 or call 919-
967-3766.
Experienced relief pharmacist wanted
1-2 days a week in independent retail
store in Kinston. Computer experience
helpful. Call Dan Eudy at 523-3172.
Wanted full time pharmacist. Western
part of the State. Two 10 hour days in two
different locations. Three consecutive
days off, no Sundays, no nights. Both in
resort setting. Contact Jack Alexander,
(704) 526-2366.
(Continued on page 32)
32
THE NORTH CAROLINA JOURNAL OF PHARMACY
PERSONAL NOTES
WHITE WINS
SCHERING'S SECOND
MAJOR SWEEPSTAKES
John White, the owner of John White
Pharmacy in Fayetteville, NC, will join 39 other
pharmacists and their guests on a week-long trip
to Bavaria in November for winning the "Very
Important Pharmacist II" sweepstakes pro-
motion sponsored by Schering Corporation.
To become a winner, White, a pharmacist for
25 years, correctly answered the question, "What
do most pharmacists recommend for athlete's
foot?" which was posed to him by an unidentified
bonded security agent acting as a customer. The
correct answer, Tinactin, based on a recent
survey of American pharmacists, is one of
Schering Corporation's leading over-the-counter
medications.
John White Pharmacy was one of nearly
53,000 pharmacies in this country to receive a
sweepstakes entry form from Schering
Corporation in April.
Every pharmacist who correctly answers
questions about leading OTC brands on their
sweepstakes entry form was eligible to receive a
visit from an unidentified agent posing as a
customer. The shopper surprised eligible
pharmacists, who were all randomly selected,
with one of the five questions they had correctly
answered on their entry form.
Thirty-two winners of Schering's "Very
Important Pharmacist II" Sweepstakes promo-
tion have already been chosen, and another eight
will beselected before the trip in November. The
promotion is designed to thank pharmacists for
recognizing the quality and effectiveness of
Schering's leading OTC products. This is the
second year that Schering is rewarding
pharmacists' knowledge of these number-one
OTC remedies with a week-long vacation. Last
year, winning pharmacists enjoyed a luxurious
week in London.
John White, a member of the North Carolina
Pharmaceutical Association and the American
Pharmaceutical Association, has owned his own
pharmacy for nine years. His wife Peggy will
accompany him on the trip to Bavaria where they
plan to see the sights and tour the famed Bavarian
castles. The Whites are the parents of two
children who are also practicing pharmacists.
WEDDINGS
LISA JOYCE KROENUNG and Richard
Clyde Wagoner were married Saturday, August
1 5 at Mount Pleasant Baptist Church by the Rev.
John D. Attaway.
The bride is a graduate of the School of
Pharmacy, University of North Carolina at
Chapel Hill. She is employed as pharmacist-
manager at Revco in Glen Raven. The groom
serves in the U.S. Navy as a boiler technician, 2nd
Class Petty Officer. The couple will reside in
Burlington.
DEATHS
LEONARD ERASTUS REEVES, JR.
L.E. Reeves, Jr., Fayetteville, died Friday,
August 7, 1987 at the age of 79. He was retired
and was the former owner of Reaves Drug Stores
of Fayetteville. He was a 1930 graduate of the
UNC School of Pharmacy and was licensed by
examination in 1930. Born in Waxhaw, Reeves
was associated with stores in Asheville, Mt. Airy,
Fayetteville and Raeford, before moving to
California in 1945 for employment with Owl
Drug Chain. He returned to Fayetteville in 1947
and opened Reaves Drug Store on Hay Street. He
operated several stores in Fayetteville before
retiring. Three of his six children are pharmacists.
CLASSIFIED ADVERTISING
(Continued from page 31)
PROFESIONAL PHARMACIES: Several
small prescription-oriented pharmacies
are currently available for individual
ownership in North Carolina. These
opportunities provide the vehicle to
practice pharmacy the way you were
taught, while offering an attractive income
and more time to be with your family. In
some of these cases, financing is also
available to qualified candidates. For
more information write: Jan Patrick,
10121 Paget Dr., St. Louis MO 63132.
Relief Pharmacist Wanted: Relief
Pharmacist Available. Has RV, will travel.
Call Robert Lucas at (919) 383-1421.
September, 1987
In Delaware,
Maryland,
Virginia, the
District of Columbia,
North Carolina,
South Carolina,
Georgia,
and Florida,
two words
insure responsive,
efficient healthcare
distribution. . .
Owens & Minor.
=JOwens&
Minor, Inc.
2727 Enterprise Parkway Richmond, Virginia 23229
For additional information, please contact:
Hugh F. Gouldthorpe, Jr. or Hue Thomas, III
804/747-9794
Dr.T.C.Smith Co. / W.H.King Drug
ASHEVILLE, N.C. 28806 • 704/258-2645
RALEIGH, N.C. 27622 • 919/782-8400
-:4r «v
■ *--*?i*i v** ■^i*^
TOTAL
HOMESPUN
SERVICE
In today's business rush we take the time to help
you with your management decisions . . . whether its
over coffee or part of a regular sales call. We will fill
your order with care and with dispatch today. Just as
we did in 1869.
We use advanced technology to lead in service to our
customers.
Some of our available programs are Electronic Order
Entry • Merchandising and Programming • Valurex
Advertising & Promotion • Retail Pricing • Micro-
fiche • Pharmacy Computer Systems • Home
Health Care and much more.
Whether you take your coffee
black or with cream,
call us to find
out more details. iff
VALUREX INDEPENDENT
VALURex
PHARMACY
ADVERTISING & PROMOTIONAL
PROGRAMS
TO HELP YOUR BUSINESS IS OUR BUSINESS'
TIE OIROLINK
JOURNN.ofPHN?MKCY
UNIVERSITY OF NORTH CAROLINA
OH
LU
CO
O
>
oo
o
or
LU
CO
o
U
O
HEALTH SCIENCES LIBRARY
Tom Sanders, left (and bearded), Chairman of the T.M.A. Foundation,
presents a $2,670.00 check to NCPhA President Julian E. Upchurch for
the Student Loan Fund.
Health Sciences Library
223-H
UNC
Chape i Hi i i , NC 2 7 5 14
Thank You,
Kendall Customers!
continued excellent service. This
includes evening order taking, accurate
order filling, fast delivery, and a 95+%
service level.
Thanks again, Kendall customers,
for making us your full-line
pharmaceutical wholesaler.
For over 65 years, Kendall has been
serving pharmacists in the Southeast.
Your changing needs and ideas have
helped us grow into the service
oriented wholesaler we are today.
We appreciate your loyalty and
support, and we strive to provide
Kendall Staff:
Front Row:
Marty Bowen (Chargebacks); Sandra Bostic (Warehouse); Cynthia Champion (Sales);
Linda Summey (Contracts)
Back Row:
Ponola Bridges (Warehouse); Lynda Helms (Telephone Sales); Nancy Thackrah
(Warehouse); Robert Weatherford (Purchasing); Tim Hamrick (Delivery)
IK
ILXDRCJG COIVIF>AI\JY
1305 Frederick St. • P.O. Box 1060 • Shelby, N.C. 28150
NC 1-800-222-3856 • SC 1-800-438-5330
Justice Drug Company
P.O. Box 22025
Greensboro, NC 27420
AN ALCO STANDARD COMPANY
Now in our 87th Year of Service to the North Carolina Pharmacists
m
HX» Partnership
For Profit
Family
Independent
Pharmacy
Total Retail Concept
The Family Independent Pharmacy program provides an
all-inclusive plan covering every aspect of marketing,
merchandising, and management of drug store opera-
tions. It is a wholesaler-sponsored voluntary, and it
embraces the total retail concept in all its forms.
1HHC
TOTAL HOME HEALTH CARE
Our Total Home Health Care™ Program offers Durable
Medical Equipmentfor RentorResale. Third Party Billing
for Medicare/Medicaid.
Additional
* Services & Programs Offered *
Store Plan-O-Gram: Complete Store Layouts Design
including Fixtures, Merchandise Plan-o-graming,
and Pricing Strategies
Specialty Qift Departments including Arts & Crafts
Affordable Pharmacy Computer Systems
LIBERTY DRUG SYSTEMS, INC.
QS/1 PHARMACY SYSTEMS
Merchandise Racking Service
Group Life
And Health
Insurance
Benefits
For Members Of
North Carolina
Pharmaceutical
Association
Jefferson-Pilot Life Insurance Company is pleased to
have been selected as the Group insurance carrier for
the North Carolina Pharmaceutical Association. It would
be to your advantage to become thoroughly acquainted
with the benefits of this program.
You can expect the best possible service from
Jefferson-Pilot, one of the nation's leading Group
insurance carriers. For full information, contact Mr. Al
Mebane, Executive Director, North Carolina
Pharmaceutical Association.
Write or call:
Sam P. Stuart, CLU
P. O. Box 595
Winston-Salem, NC 27102
Telephone 919/723-8811
Jefferson
Pilot
INSURANCE / FINANCIAL SERVICES
THE GtROLINK
JOURNAL of PHNWkCY
OCTOBER 1987
Officers
NORTH CAROLINA
PHARMACEUTICAL
ASSOCIATION
President
M. Keith Fearing, Jr.
P.O. Box 1048
Manteo, NC 27954
(919) 473-3463
Vice Presidents
Julian E. Upchurch
5201 Pine Way
Durham, NC 27712
(919)477-7325
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh, NC 27612
(919)876-5600
W. Robert Bizzell
1007 Rhem Street
Kinston, NC 28501
(919)527-6929
Executive Director
& Editor
A. H. Mebane, III
P.O.Box 151
Chapel Hill, N.C. 27514
NCPhA Office
(919) 967-2237
or
1-800-852-7343
(USPS 091-280)
VOLUME 67
ISSN 0528-1725
NUMBER 10
CONTENTS
1987-1988 NCPhA Committees 5
Designing Steroids for the Future 17
How Personal Computers Work 21
NARD Physician Dispensing Brochure 24
Dickinson's Pharmacy 25
People News 28
Social Phobia 31
Births, Marriages and Obituaries 35
Classified Advertising 37
ADVERTISERS
Burroughs Wellcome Co 22
Colorcraft 21
Dr. T.C. Smith Co./W.H. King Drug Back Cover
Geer Drug 12
Gene Minton Consulting Services 20
Jefferson Pilot 2
Justice Drug Company 1
Kendall Drug Company Inside Front Cover
Lawrence Pharmaceuticals 26
Lilly 30
Medi-Span 19
Owens & Minor, Inc Inside Back Cover
QS/1 ,.38
Revco DS 40
Savage Laboratories 36
Spear Associates 16
Store Fixtures and Planning, Inc 8
Upjohn 34
USPDI 10
Washington National Insurance Company 18
The Carolina Journal of Pharmacy is published monthly by the
North Carolina Pharmaceutical Association, P. O. Box 151,
Chapel Hill, NC 27514. The Journal is provided to NCPhA
members through allocation of annual dues. Subscription rate to
non-pharmacists (continental US) $20.00. Single copy price
$2.00. Overseas rates on request. Second class postage paid at
Chapel Hill, NC.
THE CAROLINA JOURNAL OF PHARMACY
'iHMf'
"PHARMACY NEEDS LEADERS."
"How an Individual Can Get Involved
in a State Pharmacy Association"
DIRECTED BY AND FOR MEMBERS the essence of association
involvement
Your state pharmacy association is exceptionally responsive to the ideas,
needs and wishes of all its members. The Association is structured to offer
members the opportunity to influence polity and activities at every level.
As a member you have the opportunity to be involved in many activities
ranging from elected office to simply bringing forth your ideas. The fact is
that you are encouraged to be as active as your career, interest, and time
allow. All you need to do is understand the association process and have the
willingness to get involved, then you can chart your career and begin to
influence your profession's future.
A GOOD BEGINNING Call the association staff office to find out
who you can contact in your area to get involved.
(800-852-7343)
Your first step toward greater involvement is to become active at your local
or regional level. This will provide the opportunity to become aware of
issues, priorities and activities that are important to the state association
and its members. With that understanding, you will find many opportunities
to participate in projects, program development and committee activities
within your community and surrounding area.
The progression is natural from committee member to chariman, then to
local office. As an officer at the local level, you will be responsible for
decision-making and implementation and for bringing matters of local and
state concern to the attention of the Association's Executive Committee. ■
I
October, 1987
THE CAROLINA JOURNAL OF PHARMACY
1987-1988 Committees
of the
North Carolina Pharmaceutical Association
Executive Committee
Julian E. Upchurch, President
5201 Pine Way
Durham NC 27712
H (919) 383-5117
B (919) 477-7325
Shelton Brown, Jr., Past President
2516 Fillmore Road
Richmond VA 23235
H (804) 272-3883
B (804) 359-0088
Albert F. Lockamy, Jr., 1st Vice President
6708 Candlewood Drive
Raleigh NC 27612
H (919) 848-0368
B (919) 876-5600
M. Keith Fearing, Jr., Past President
P.O. Box 1048
Manteo NC 27954
H (919) 473-2822
B (919) 473-3463
W. Robert Bizzell, Jr.,
1007 Rhem Street
Kinston NC 28501
H (919) 527-9463
B (919) 527-6929
2nd Vice President
W. Artemus West, P.D., Past President
P.O. Box 248
Roseboro NC 28382
H (919) 525-5468
B (919) 525-5333
Loni T. Garcia, 3rd Vice President
5201 McLeod Road
Lumberton NC 28358
H (919) 738-3553
B (919) 738-6441, Ext 7317
Betty H. Dennis, Member at Large
104 Calumet Court
Carrboro NC 27510
H (919) 929-5786
B (919) 966-1 128
Claude U. Paoloni, Member at Large
300 Spruce Street
Chapel Hill NC 27514
H (919) 942-2239
B (919) 966-3023
Donald V. Peterson, Member at Large
917 Kimball Drive
Durham NC 27705
H (919) 383-7908
B (919) 596-2151
October, 1987
W. J. Smith, Consultant
908 Arrowhead Road
Chapel Hill NC 27514
H (919) 929-2656
A.H. Mebane, III, Executive Director
P.O. Box 151
Chapel Hill NC 27514
H (919) 967-2925
B (919) 967-2237
B (800) 852-7343
Fred M. Eckel, Ex Officio
713 Churchill Drive
Chapel Hill NC 27514
H (919) 929-1746
B (919) 962-0034
Thomas M. Hughes, Ex Officio
Route 5, Box 325E
Chapel Hill NC 27514
H (919) 967-1833
B (919) 966-2371
(continued on page 6)
THE CAROLINA JOURNAL OF PHARMACY
Committee on Pharmacy Museum
WJ. Smith, Chairman
908 Arrowhead Road
Chapel Hill NC 27514
M. Keith Fearing, Jr., Co-Chairman
P.O. Box 1048
Manteo NC 27954
E.A. Brecht
P.O. Box 777
Chapel Hill NC 27514
Tom Burgiss
Rt. 1 Box 75
Laurel Springs NC 28644
George T. Cornwell
P.O. Box 775
Lincolnton NC 28092
James L. Creech
109 S. 3rd St.
Smithfield NC 27577
Ruby S. Creech
105 Longview Drive
Smithfield NC 27577 77
Vivia R. Creech
107 Meadowbrook Drive
Smithfield NC 27577 7
Howard Q. Ferguson
P.O. Box 65
RandlemanNC 27317
Robert B. Hall
P.O. Box 816
Mocksville NC 27028
Haywood Jones
119 W.Glenn St.
Zebulon NC 27597
Herman W. Lynch
118 Fairfield Cr.
Dunn NC 28334
Joe Miller
P.O.Box 151
Boone NC 28607
Tom S. Miya
School of Pharmacy
Beard Hall 200-H
Chapel Hill NC 27514
W.W. Moose
P.O. Box 67
Mount Pleasant NC 281
24
Ernest J. Rabil
P.O. Box 5891
Winston-Salem NC 27103
Milton W. Skolaut
Rt. 8 Box 33
Chapel Hill NC 27514
Rheta Skolaut
Rt. 8 Box 33
Chapel Hill NC 27514
Roland G. Thomas
Store Fixtures & Planning, Inc.
3555 Trycian Drive
Charlotte NC 28217
B.R. Ward
1901 E. Walnut St.
Goldsboro NC 27530
Jack G. Watts
444 Tarleton Ave.
Burlington NC 27215
W. Artemus West
Tart and West Druggists
P.O. Box 248
Roseboro NC 28382
L.M. Whaley
3705 St. Marks Rd.
Durham NC 27707
Neta Whaley
3705 St. Marks Rd.
Durham NC 27707
William H. Wilson
2000 Fairview Rd.
Raleigh NC 27608
Barney Paul Woodard
Woodard's Pharmacy
Princeton NC 27569
David R. Work
130 Gristmill Lane
Chapel Hill NC 27514
October, 1987
THE CAROLINA JOURNAL OF PHARMACY
Committee on National Legislation
G.N. (Jerry) Brunson, Chairman
4940 Windhaven Court
Dunwoody, GA 30338
Fred M. Eckel
Beard Hall 200H
Chapel Hill NC 27514
William H. Edmondson, Ph.D.
Glaxo, Inc.
Five Moore Drive
Research Triangle Park NC 27709
Jean Paul Gagnon
UNC School of Pharmacy
Beard Hall 200H
Chapel Hill 27514
Jerry T. Gaylord
1036 General Lafayette Boulevard
West Chester PA 19382
W. Seymour Holt
6325 N. Ewing
Indianapolis IN 46220
W.H. Randall
Box 999
Lington NC 27546
Milton W. Skolaut
Route 8, Box 33
Chapel Hill NC 27514
Daniel W. Teat
P.O. Box 564
Campbell University School of Pharmacy
Buies Creek NC 27506
Committee on Social and Economic Relations
Bill Taylor, Chairman
61 1 Alamance Road
Burlington NC 27215
Winston Burroughs
360 East Conn. Ave.
Southern Pines NC 28387
Fred M. Eckel
Beard Hall 200H
Chapel Hill NC 27514
Mack Erwin
2410 W. Sugar Creek Road
Charlotte NC 28213
Mike James
314 Yadkin Drive
Raleigh NC 27609
Laura J. McLeod
141 Charlestowne Circle
Winston-Salem NC 27103
W.H. Randall
Box 999
Lington NC 27546
Committee on Women in Pharmacy
Kim Deloatch, Chairman
201 Meadow Lane
Route 4
Chapel Hill NC 27514
Leesa D. Furniss, Vice Chairman
11973 Eagle Cliff Court
Raleigh NC 27612
Sonja Estes
1915 Colewood Drive
Raleigh NC 27604
Nancie Hardie
915 Panola Road
Winston-Salem NC 27106
Debbie Ladd
4012 Ketch Point Drive
Rocky Mount NC 27803
Rebecca Rowell
1 12 Marcus Rd.
Chapel Hill NC 27514
Joy W. Southerland
504 Lausanne Drive
Greensboro NC 27410
October, 1987
THE CAROLINA JOURNAL OF PHARMACY
Committee on Employer/Employee Relations
John F. Watts, Chairman
636 Highway 90 West
Taylorsville NC 28681
Lawrence M. Benson Jr.
Rt. 4, Daugiac Drive
Charlotte NC 28208
Charlie Blanton
Rt. 6 Box 93
Kings Mountain NC 28086
Melvin A. Chambers
916 Emory Drive
Chapel Hill NC 27514
Brent Clevenger
409 Sedgefield Drive
Greenville NC 27834
Alvin E. Gurganus II
P.O. Box 213
Swansboro NC 28584
Tim Lassiter
15 McBenson Place
Durham NC 27705
Margaret LeDoux
2602 Talelon Place
Winston-Salem NC 27107
J. C. McCowen III
5106 Bennington Drive
Greensboro NC 27410
Ruth Mitcham
104 Alpine Drive
Lexington NC 27292
Roger H. Sloop
7870 Creedmoor Drive
Rural Hall NC 27045
P. David Smith
P.O. Box 134
Elon College NC 27244
Over the past 17 years, we have provided practical solutions to
N.C. Pharmacy Owners. We carefully guide you through the
many steps to reach maximum productivity to make certain that
your store is working for you rather than against you.
■ Experience in over 600 RETAIL PHARMACIES.
■ Largest store fixture distributor in the Southeast.
■ Endless research and study in layout and design to
produce the maximum results for Pharmacy Owners.
So why not check us out! Our reputation is our most important asset!
Call Us Today. . .
704-525-5300
EX STORE FIXTURES
SP & PLANNING, INC.
Roland Thomas or Randy Bivens, Pharmacy Planning Specialists
3555 Tryclan Drive ■ Charlotte, NC 28217
October, 1987
THE CAROLINA JOURNAL OF PHARMACY
Committee on Mental Health, Mental Retardation
and Substance Abuse
Julian Baker, Chairman
Box 81
Cherry Hospital
Goldsboro NC 27530
Robert J. Allen, Pharmacy Coordinator, Advisor
Division of Mental Health Services
325 S. Salisbury Street
Raleigh NC 27611
Hugh M. Clark PD
1105 Elanor Ave.
Goldsboro NC 27530
Edward M. Durand
2400 Jullibee Drive
Norfolk VA 23518
Martha P. Johnson
605 Yates Place
Zebulon NC 27597
Jerry McKee
3883 Redman Road
Shelby NC 28150
John H. Myhre
1005 Park Avenue
Garner NC 27529
Rodney G. Richmond
B2 Riverwatch
Route 6, Box 2188
Bluff City TN 37618
James Richard Sessions, Jr.
504-A N. Hillcrest Drive
Goldsboro NC 27530
Horace D. Steadman, Jr.
1410 Fern wood Drive
High Point NC 27260
Paul Stevenson
5 1 2 East Main Street
Elizabeth City NC 27909-0465
Committee on State Legislation
Jimmy Jackson, Chairman
1211 Dubose
Garner NC 27529
Gary Faulkner
P.O. Box 249
Monroe NC 28810
John T. Henley, Special Advisor
200 S. Main St.
Hope Mills NC 28348
William A. Jackson
1 03 Saddletree Road
Oxford NC 27565
Bradford Ligon, Consultant
Route 12, Box 460
Salisbury NC 28144
Jerry D. Rhoades
Box 2
Southern Pines NC
Benny Ridout, Special Consultant
P.O. Box 88
Morrisville NC 27560
Billy Smith
P.O. Box 1792
Morehead City NC 28557
Henry L. Smith
P.O. Box 31
Farmville NC 27828
Jack Watts, Ex Officio
444 Tarlton Ave
Burlington NC 27215
Josiah R. Whitehead
Burroughs Wellcome Co.
3030 Cornwallis Drive
Research Triangle Park NC 27709
Franklin Williams, Special Advisor
25 Market Street
Wilmington NC 28401
Barney Paul Woodard, Consultant
Woodard's Pharmacy
Princeton NC 27569
October, 1987
10
THE CAROLINA JOURNAL OF PHARMACY
WHY BUY
JUSTA
BOOK
. . , when you can
subscribe to USPDI?
USPDP- a clinically
relevant drug-use. patient
education information
service providing health care
professionals with
continuously updated,
unbiased drug data
throughout the year
Bimonthly Updates provide
new and revised information
in a bound, cumulatively
indexed, 'newsletter"
format, avoiding the
inconvenience of replacing,
or worse, losing pages.
FEATURES OF 1988
EDITION:
■ 16-page drug product l.D.
directory. Includes
approximately 800 color
photographs of the most
widely used medications,
both brand and generic.
■ Indications separated
into "accepted" and
"unaccepted" sections in
each drug monograph.
■ USP legal requirements
for quality. labeling, storage,
and packaging important to
the dispensing situation.
■ Patient drug-use
counseling guidelines.
Start a calendar year
subscnption to the USPDI
two-volume set (three
books) and six Updates
before lanuary 29. 1988 at the
special price of $95.00
(regularly $115.00).
Continue your subscription
annually at the lower
renewal rate (billed each
December) so you are
assured of receiving revised
main volumes and a
continuous flow of Updates
ORDER FROM YOUR STATE ASSOCIATION BEFORE JANUARY 29 AND SAVE $20.
Get more than just a "book"
□ Yesl I want to join the USPDI service at the special
price of $95 00 for the 1 988 calendar year ($20.00 off
the regular price).
D Add $500 to each subscription for UPS (or equiva-
lent) delivery of the main volumes.
D YESI Send me one USP.leaflet Diskette with a one
year licensing agreement for $229.00. (Inquire about
quantity discounts.)
The 1988 USPDI is scheduled for release in ]anuary 1988.
Please allow 4-6 weeks for book rate postal delivery.
SEND
ORDER
TO: North Carolina Pharmaceutical Aaaoctatton
109 Church Street. P.O. Box 151
Chapel Hill. North Carolina 27514
RILL MONET BACK GUARANTEEI If for any reason, you
aie not satisfied after receipt, return your purchase (in
resaleable condition, or with Diskette envelope
unopened) within )0 days for a full refund.
D Enclosed is my check or money order payable to
USPC for $
(PA residents add 6% sales tax MD residents add
5% sales tax.)
n Charge my: D MasterCard D VISA
L
"J
October, 1987
THE CAROLINA JOURNAL OF PHARMACY
11
Committee on Public and Professional Relations
William H. Wilson, Chairman
2000 Fairview Rd.
Raleigh NC 27608
Sarah J. Beale, R.Ph.
4920 F Wallingford Drive
Raleigh NC 27604
Ken W. Burleson
Catawba Memorial Hospital
Hickory NC 28601
Ned Clark
652 Short Spoon Circle
Rocky Mount NC 27804
Kathleen M. D'Achille, Vice Chairman
707 Whitby Avenue
Clemmons NC 27012
Linda K. Griffin
5 Moore Drive
R.T.P. NC 27705
Laura J. McLeod
141 Charlestowne Circle
Winston-Salem NC 27103
Frank Measamer
P.O. Box 1087
Robersonville NC 27871
Wallace E. Nelson, R.Ph.
P.O. Box 629
Edenton NC 27932
Julia E. Rawlings
Camelot Village C-8
Chapel Hill NC 27514
Donna B. Rivenbark
1605 Gilmont Court
High Point NC 27260
Reid Stewart Saleeby
2010 Northcliffe Drive #612
Winston-Salem NC
Martha H. Southern
5941 Woodfield Drive
Kernersville NC 27284
Carl D. Taylor
420 Pembroke
Ahoskie NC 27910
L.D. Werley, Jr.
1403 Halifax Drive
Chapel Hill NC 27514
W. Artemus West, P.D., Liaison
Tart & West Druggists
P.O. Box 248
Roseboro NC 28382
Dennis Williams
1 05 Outrider Trace
Chapel Hill NC 27514
Committee on Consolidated Student Loan Fund
Donald V. Peterson, Chairman
917 Kimball Drive
Durham NC 27705
Suzanne Blaug
208 Bakers Basin Road
Lawrenceville NJ 08648
Howard Q. Ferguson
P.O. Box 65
RandlemanNC 27317
J. Howard Garrett
1603CresentDr.
Elizabeth City NC 27909
Robert B. Hall
P.O. Box 816
Mocksville NC 27028
Joseph L. Johnson, Jr.
10 Staunton Court
Greensboro NC 27410
Banks Kerr
P.O. Box 61000
Raleigh NC 27661
Ronald W. Maddox
415 Keith Hills Road
Lillington NC 27546
A. Wayne Pittman
74 Polks Landing
Chapel Hill NC 27514
Ralph P. Rogers, Jr.
1513 Sycamore Street
Durham NC 27707
October, 1987
WE BRING YOU THE BEST
CHARLESTON, S.C.
GREENVILLE, S.C.
THE CAROLINA JOURNAL OF PHARMACY
13
Committee on Ethics, Grievance and Practice
Thomas R. Thutt, Chairman
2805 Graham Drive
Kinston NC 28501
Loni T. Garcia, Liaison to Executive Committee
5210 McLeod Road
Lumberton NC 28358-9007
C.E. Hemingway
5615 Closeburn Road
Charlotte NC
Andy Hunter
613 East Roosevelt
Monroe NC 281 10
A. Wayne Pittman
74 Polks Landing
Chapel Hill NC 27514
Max G. Reece, Jr.
Rt. 1, Box 193
Siver City NC 27344
David R. Work, Chairman
NC Board of Pharmacy
P.O. Box H
CarrboroNC 27510
Committee on Resolutions
Ginger Lockamy
6708 Candlewood Drive
Raleigh NC 27612
Robert S. Beddingfield
Moore Regional Hospital Pharmacy
Box 3000 Page Road
Pinehurst NC 28374
Kathleen M. D'Achille
707 Whitby Avenue
ClemmonsNC 27012
John R. Setzer
421 Bethabara Hills Drive
Winston-Salem NC 27106
Committee on Continuing Education
Betty H. Dennis, Chairman
104 Calumet Ct.
CarrboroNC 27510
Larry D. Cole, R.Ph.
P.O. Box 838
Etowah NC 28729
William A. Dawkins, P.D.
Rt 6 Box 161A
Clinton NC 28328
Salmen T. Fayed
P.O. Box 1106
Roanoke Rapids NC 27870
Howard M. Glazer
P.O. Box 32861
Charlotte NC 28232
Patsy Myers
4670 Forest Manor Drive
Winston-Salem NC 27103
Al Rachide
P.O. Box 517
Pink Hill NC 28572
Lloyd E. Ruona
4710 Duffer Lane
Pfafftown NC 27040
Ronald H. Small
300 S. Hawthorne Road
Winston-Salem NC 27103
Regina Snyder
1 Lark Circle
Chapel Hill NC 27514
Daniel W. Teat
P.O. Box 564
Campbell University School of Pharmacy
Buies Creek NC 27506
Connie Webster
1333 Clermont Drive
Durham NC 27713
October, 1987
14
THE CAROLINA JOURNAL OF PHARMACY
Committee on Finance
L. Milton Whaley, Chairman
3705 St. Marks Rd.
Durham NC 27707
M. Keith Fearing, Jr.
P.O. Box 1048
Manteo NC 27954
Howard Q. Ferguson
P.O. Box 65
RandlemanNC 27317
Robert B. Hall
P.O. Box 816
Mocksville NC 27028
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh NC 27612
Albert P. Rachide
302 Country Club Drive
Jacksonville NC 28540
Julian E. Upchurch
5201 Pine Way
Durham NC 27712
Committee on Third Party Programs
Bill Mast, Chairman
950 Meadow Lane
Henderson NC 27536
W. Robert Bizzell
1007 Rhem Street
Kington NC 28501
Terri Bostick
1100 Theresa Ct.
Raleigh NC 27615
J. Frank Burton
1 20 E. Lindsay Street
Greensboro NC 27401
Sam T. Fayed
P.O.Box 1106
Roanoke Rapids NC 27870
James R. Hall
P.O. Box 3457
Chapel Hill NC 27541
David T. Hix
1 19 E. Main Street
Gibsonville NC 27249
Zeb T. Keever, Jr.
1 1 2 Saddletree Road
Lincolnton NC 28092
Lazelle Marks
805 Long Drive
Rockingham NC 28379
William L. Marsh
1 154 Wyk. Road
Shelby NC 28150
Gene Minton
107 Smith Church Road
Roanoke Rapids NC 27870
Samuel Petteway
1 504 Pree Top Lane
Rocky Mount NC 27804
Sharon Reynolds, Vice Chairman
6920 Abbotswood Drive
Charlotte NC 28226
C.B. (Benny) Ridout, Consultant
Box 88
Morrisville NC 27560
Ronald J. Shokes
Medical Village Phcy.
Rt 2 Box 188
Conover NC 28613
Debra Smith
3200 E. Ford Road
Charlotte NC 28205
Larry W. Thomas
P.O. Box 245
Dunn NC 28334
Mitchell (Mickey) Watts
39 Lake Concord Road
Concord NC 28025
October, 1987
THE CAROLINA JOURNAL OF PHARMACY
15
Committee on Nominations
Albert F. Lockamy, Jr., Chairman
6708 Candlewood Drive
Raleigh NC 27612
Laura G. Burnham
2957 Buena Vista Road
Winston-Salem NC 27106
LaRue Dedrick
5404 Hallmark Road
Durham NC 27712
J. Howard Garrett
1603 Cresent Dr.
Elizabeth City NC 27909
Lazelle Marks
805 Long Drive
Rockingham NC 28379
Wallace E. Nelson, R.Ph.
P.O. Box 629
Edenton NC 27932
Henry Smith
P.O. Box 31
Farmville NC 27828
Committee on Community Pharmacy
Mitchell (Mickey) Watts, Chairman
39 Lake Concord Road
Concord NC 28025
Jim Aemone
220 North Main Street
RandlemanNC 27317
Ralph H. Ashworth
P.O. Box 98
CaryNC 27511
Wayne Avery
1725 Westweed Ave.
Wilson NC 27893
Alan G. Banner
139 N. Center Street
Statesville NC 28677
Terri Bostick
1100 Theresa Ct.
Raleigh NC 27615
David Cox
7729 Labater Road
ClemmonsNC 27012
Connie Daughty, R.Ph.
605 Oak Run Drive
Raleigh NC 27606
Charles F. Delaney
Rt #3 Box 235-G
Advance NC 27006
Betty H. Dennis, Liaison to Executive Committee
104 Calumet Ct.
CarrboroNC 27510
Keith E. Kirby
304 Cedar Valley Road C-14A-5
Hudson NC 28638
Randy N. Lawson
Rt 2 Box 303-A
Pinnacle NC 27043
Ed Lowdermilk
Rt 2 Falls of New Hope
Chapel Hill NC 27514
John E. Malone
P.O. Box 976
Zebulon NC 27597
Rad Rich
530 Grove Street
Fayetteville NC 28301
Stuart W. Rollins
5621 Folkstone Road
Pfafftown NC 27040
Carl Taylor
420 Pembroke Avenue
AhoskieNC 27910
Lori Tutterow
221 Bethabara Hills Drive
Winston-Salem NC 27106
Mitchell Harris Walker
Box 207
Rowland NC 28383
Ronald J. Winstead
5215 Guess Road
Durham NC 27712
October, 1987
16
THE CAROLINA JOURNAL OF PHARMACY
Seth G. Miller, Chairman
412 Arbor Drive
Lexington NC
Ruth Baldwin
2622 Pickett Road
Durham NC 27705
Linda Burke
7309 N. Thorncliff Place
Raleigh NC 27604
Laura G. Burnham
2957 Buena Vista Road
Winston-Salem NC 27106
Steve Caiola
505 Colony Woods Drive
Chapel Hill NC 27514
Suzy Conner
712 Brookgreen Drive
Lexington NC 27292
Committee on Public Health
James L. Creech
109 S. 3rd St.
Smithfield NC 27577
Neil McPhail
P.O. Box 614
Lillington NC 27546
James Ray Oakley
107 Hillcrest Drive
Washington NC 27889
Charles Reed, Consultant
1072 Ridge Drive
Clayton NC 27520
Rebecca Rowell
1 1 2 Marcus Rd.
Chapel Hill NC 27514
CONGRATULATIONS TO
BILL MANNING
On the renovation of his store, Columbia
Pharmacy, Columbia. We are particularly pleased
to have helped put in the first awning in town.
H. Warren Spear, R. Ph.
Pharmacy Design Specialist
415 Augusta Drive
Statesville, North Carolina 28677
(704) 873-9993
Spear Associates — planners,
designers and installers of
pharmacy fixtures & equipment.
October, 1987
THE CAROLINA JOURNAL OF PHARMACY
17
DESIGNING STEROIDS FOR THE FUTURE:
NOVEL DELIVERY SYSTEMS AND USES ON THE HORIZON
The year is 2010, and you've gone to the
doctor complaining of joint pain and stiffness.
He might send you home with a prescription
for steroid therapy and the recommendation that
you book passage aboard a space shuttle
"recuperation hospital" otherwise known as the
zero gravity retreat.
Farfetched? The National Aeronautics and
Space Administration (NASA) is now studying
the effects of exposure to zero gravity on Cortisol
secretion and the relationship to the brittle bones
of osteoporosis (loss of minerals from bone).
"The astronauts are having their blood, urine
Cortisol and electrolyte levels monitored during
some shuttle missions so we can study the effects
of zero gravity on steroid synthesis," says Mavis
Fujii, M.D., physician, medical operations, life
sciences division at NASA in Washington, D.C.
"We will continue to assess and evaluate these
changes in light of current knowledge about
osteoporosis and muscle atrophy."
In fact, the entire field of pharmacology and
medical therapeutics is going through a
revolution, reaching into all aspects of modern
medicine.
The Challenge: Delivering
Active Drug Where the Body
Needs It
Historically, the problem with most drug
therapy has been that not enough of the drug
reached the area where it was most needed. It was
not unusual to discover that a drug produced
excellent results in controlled animal studies or in
test tubes, only to be disappointing in human
clinical trials. Many researchers believe this
failure is due primarily to the body's natural
defenses and normal metabolic actions such as
the following:
• Barriers exist to prevent noxious agents
(toxins and germs) from reaching sensitive
regions of the body. However, these same
barriers often prevent therapeutic drugs
from entering regions of tissue insult or
injury.
• Oral or injected drugs are rapidly reduced to
inactive metabolites by stomach acids or
digestive and blood enzymes. Only small
amounts of the active drug may ever reach
the target site intact.
• Conventional drug delivery may result in
undesirably high blood levels of drugs but
low levels where most needed.
• Active drugs may remain in the therapeutic
dose range for only a short period, quickly
dissipating to levels considered useless.
New methods of drug delivery seek to improve
drug effectiveness by maintaining therapeutic
drug levels in the bloodstream and at the targeted
site, reducing toxicity and enhancing patient
compliance.
Controlled-Release System
Introduced in the early 1950s by Smith, Kline
and French, controlled release (also known as
sustained, timed, programmed or extended
release) of medication was the first major
innovation in drug delivery in decades.
Controlled-release spansules are prepared with
drug in the core, surrounded by layers of natural
wax. Due to the different thicknesses of wax, the
beads dissolve at different times, releasing their
contents over a prolonged period.
The next development, in the 1970s, involved
implantation under the skin of a drug reservoir in
a semipermeable compartment that would
slowly allow its contents to diffuse into the
bloodstream. Early studies using this approach
showed that a rubberized reservoir of sex
hormones implanted in cattle could provide
effective contraception for more than a year.
Implantation of other sex hormones could induce
synchronized ovulation in cattle, simplifying the
process of artifical insemination.
Today, women in Sweden and Finland are
receiving silicone implants in the upper arm that
contain the steroid contraceptive levonorgestrel
(Norplant, Leiras) which produces effective
contraception for five years. The implant can be
removed easily at any time and fertility restored.
In the 1980s, drug companies began studying
the release of drugs from miniature pressurized
systems.
• Osmotic pressure (pressure exerted across a
membrane by dissolved particles on one
side) is being harnessed to force release of a
constant amount of drug.
• Miniature osmotic pumps attached to
thumb-sized, drug-filled reservoirs are now
being implanted in cancer patients for
Continued on page 19
October, 1987
o
We're not
strangers...
LUasninpcon
national
INSURANCE COMPANY
NCPhA-Endorsed Insurance Plans
Which Merit Member Participation
DISABILITY INCOME PLAN HOSPITAL INCOME PLAN
MAJOR MEDICAL EXPENSE PLAN TERM LIFE PLAN
RETIREMENT AND PROFIT SHARING PLANS
FOR DETAILS WRITE OR TELEPHONE:
HOYT W. SHORE, CLU and Associates
821 Baxter Street-Suite 316
Charlotte, North Carolina 28202
Telephone (704) 333-3764
uuasninqeon
national
INSURANCE COMPANY
Evanston. Illinois 60201 ■ A Washington National Corporation Financial Service Company
THE CAROLINA JOURNAL OF PHARMACY
19
STEROIDS
Continued from page 17
continuous delivery of chemotherapy or
painkillers.
• A small group of patients have been
implanted with a more sophisticated,
programmable pump that can be regulated
by an external computer. It enables
physicians to tailor treatment to the
individual's fluctuating needs.
• Other "pills of the future" now being studied
utilize synthetic polymers or resins, which
absorb drugs and release them slowly into
the bloodstream.
Transdermal drug delivery systems —
involving adhesive, drug-containing patches
worn on the skin — will likely reduce the
incidence of patient noncompliance. In theory,
the patient need only apply the patch in the
morning and forget about it for the rest of the day.
This is in contrast to the complex instructions
often given for patients to follow — for example,
take two pills three times a day for 10 days, before
meals but not before bedtime. However, there is
some question about the patches' ability to
deliver an even flow of drugs over a 24 hour
period.
Ideally, drug contained in the patch reservoir
penetrates the skin and produces a constant blood
level. Oral or injected drugs often produce
uneven blood levels. Transdermal patch systems
have been tested and approved for use in the
administration of the cardiac medication
nitroglycerin and the motion sickness drug
scopolamine. Clinical trials are under way with
transdermal patch preparations for anti-
hypertensives, anti-asthmatics, anti-inflam-
matory medications and insulin.
Carriers and Precursors
Not all drugs can penetrate the skin or be
effectively released from implanted reservoirs.
Some drugs must be carried directly to the target
site to maximize effect and reduce toxicity.
Perhaps the best example is the delivery of a
chemotherapeutic drug directly to a tumor,
sparing the healthy cells nearby.
Liposomes, spherical fatty molecules
composed of three layers, are being tested as
possible carriers. Liposomes' inner and outer
layers are water soluble, and the middle core is fat
soluble. Drug is contained in the center,
surrounded by these three layers.
Ideally, when the drug/liposome complex is
injected into the bloodstream, it should travel
through the body without spilling its content until
the crucial area is reached. Depending on the
choice of lipids (fatty substances), the liposome
can be designed to dissolve at a warm spot (such
as a tumor), delivering its drug on target as does a
heat-seeking missile.
Liposome developers are now concentrating
on inflammatory or immunologic disorders,
where it is possible to take advantage of
abnormal tissue conditions.
Prodrugs are inactive agents that are converted
into active drugs by enzymes or other chemicals
in the body. The development of the prodrug,
such as methylprednisolone (Solu-Medrol,
Upjohn) represents another attempt to utilize the
body's chemistry to advantage. Since drugs are
often rapidly inactivated or "captured" by
circualting proteins and enzymes long before they
reach the problem site, a better method of
delivering more of the drug intact to the problem
site was needed.
Converting an inactive drug to an active one
when the compound is closer to the target site
prevents some of the degradation by proteins and
enzymes and allows a greater amount of the
active form of the drug to reach the site. This
technique is being applied to the delivery of
Continued on page 20
MEDI-SPAN
Preferred ^r Vendor
Rx Software $1,248
Try Before You Buy:
Use our software for 90 days If you are not
completely satisfied, return it with no obligation to
purchase.
Performs These Functions:
Rx Labels — Patient Profiles — Counseling Messages
Interactions — Generic Substitutions — Discounts
IRS and Insurance Summaries — Accounts Receivable
Daily Logs — 1 hird Party Billing — Inventory Control
Nursing Home.
Medi-Span Services:
Price Updates — Drug Base — Interaction Base
Competitive Pricing Guide
For Information Call:
1-800-423-0276 ext. 4706
October, 1987
20
THE CAROLINA JOURNAL OF PHARMACY
STEROIDS
Continued from page 19
steroid hormones for the controlled release of
contraceptives and anti-inflammatory agents in
the treatment of head injury.
Swelling and tissue damage occurring soon
after severe head injury appear to be responsible
for a good deal of the long-term damage such
injury produces. Leading neurosurgeons have
recommended that steroids be administered as
soon as possible to reduce swelling. One problem
with this approach is the exclusionary net of
blood capillaries known as the blood-brain
barrier. These screen out many chemicals,
barring them from the brain. By using prodrugs
such as methylprednisolone, physicians find that
more of the drug reaches the brain since less is
broken down in the periphery.
Researchers are also attempting to couple
prodrugs with carrier molecules that have greater
solubility in fatty tissues such as the brain. This
technique could facilitate drug passage from the
bloodstream into the brain and improve
effectiveness in treating brain edema (swelling)
and tumors.
"We're learning a lot about prodrugs from
research with Solu-Medrol," says Sherman
Kramer, Ph.D., associate director of pharmacy
research at The Upjohn Company.
By combining prodrugs with the technique of
high-dose pulsing in the treatment of acute head
Table 1
The Many Uses of Steroid Hormones
I Cancerous Diseases
II Central Nervous
System Disorders
III Hormonal Disorders
IV Respiratory Disorders
V Arthritic Disorders
VI Allergic States
VII Eye Disease
VIII Skin Diseases
Leukemia
Lymphoma
Breast Cancer (estrogen-
dependent)
Mild/Moderate
Spinal or Head injury
Localized Brain Tumor
Adrenal Gland Insufficiency
(Addison's Disease)
Hormone Replacement
(menopause, physical
development, impotence)
Asthma
Aspiration Pneumonitis
Rheumatoid Arthritis
Osteoarthritis
Bursitis
Severe Bronchial Asthma
Serum Sickness
Drug Hypersensitivity
Reaction
Transfusion Reaction
Nonresponsive Allergic
Rhinitis and Hay Fever
Inflammation of the Eye
Allergic Conjunctivitis
Psoriasis
Eczema
Contact Dermatitis
Exfoliative Dermatitis
courtesy — The Upjohn Company
A NEW SERVICE TO THE INDEPENDENT AND SMALL
CHAIN PHARMACY OWNER
Professional Management Consulting by
Gene Minton, RPH
. . . Now you can benefit from 1 0 years experience in supervisory management of
high volume drug stores on an individual and group basis.
. . . Consultation in all areas of decision making such as product mix, pricing,
merchandising, remodeling, site selection, computer applications (and selection),
Rx pricing, advertising, personnel management, etc. with emphasis on results and
the bottom line.
. . . Let us plan your next remodel, design your new store, show you how to save
money on fixtures, evaluate wholesalers, analyze your p&l, and many other
services to make you happier with your store & your profits.
. . . Can you afford not to call?
contact Gene Minton at Gene Minton Consulting Services, 6 Lake Shores, Littleton,
NC 919-586-5465. (All client information held in strict confidence).
October, 1987
THE CAROLINA JOURNAL OF PHARMACY
HOW PERSONAL COMPUTERS WORK
by James R. Talley, M.S.
School of Pharmacy
Northeast Louisiana University
21
The computer age is upon us and in some
circles is referred to as a revolution. Whether you
believe it or not that we are in a computer
revolution, the reality is that the technology of
electronic logic devices and computers influence
our lives daily. The term "computer" has become
a household word and you may be one of the
millions of educated people attempting to
become "computer literate." Computer literacy
can be viewed as three categories: "experts,"
"consumers." and "uninitiates." The "experts"
represent a rather small group of individuals who
have the ability to combine technical aspects with
principles of computer operation. The "con-
sumers" represent a rather large group and are
primarily "users." The "uninitiates" are the
largest group and they do not actively use or
understand computers, but are somewhat aware
of their existence primarily from a cause and
effect standpoint on their daily lives.
Computers are extremely fast and reliable.
They can perform complex logical operations in
seconds. A computer can perform all the daily
accounting of your business in minutes. The
ability of a computer to perform pattern
matching and function application enable it to
generate lists, search in these lists, and then
perform specific operations to fit each case it
finds. This capability is especially useful when
applied to operating a pharmacy and the
numerous aspects of keeping records on patients
and prescriptions. However, computers can only
do what we tell them to do. We must
"communicate" with computers by the use of
computer "programs" written in computer
"language." As a "user", this aspect of making the
computer do what you want it to do can, at times,
become extremely frustrating. There are days
when I personally feel that this blasted hunk of
plastic and silicon has embarked on a vendetta. It
is during these frustrating periods which may
encompass hours that I fantasize physical
retaliation. Suffice to say, some of you probably
also have had similar thoughts. However, these
feelings slowly recede as I discover the error I
mistakenly committed.
This brings us to the point of trying to
determine how personal computers work. First,
let's review several definitions of computers. A
computer is: a data processor; takes input
information, processes it, and produces output
information; a calculator with a program; a
device to extend human intelligence; a device that
can be programmed to perform routine tasks.
You will note that these definitions describe
several aspects of computers. Thus, a computer
requires input data which is usually entered
manually from a keyboard which is similar to
keys on a typewriter. The computer also requires
programs to process data that is entered and
without a program the computer cannot accept
input data. The computer also requires some type
of output device so you can observe the results.
Regardless of the complexity of your computer
task, it should involve three operations: input,
processing, and output. The "input" is the entry
of data and is the starting point for all computer
operations. When data is entered on a keyboard
Continued on page 23
Remember the °Day
...in^'ctures
CXLORCRAFT
North Carolina's Most Complete
Film Processing Service
There Is A Plant Located
Near You
For the Finest Quality Plus Fast
Dependable Service on All Your
Photo Needs, Contact the Plant
Nearest You.
CHARLOTTE WILMINGTON
KERNERSVILLE RALEIGH
FAYETTEVILLE DURHAM
If You Don't Know Photofinishing
Know Your Photofinisher
October, 1987
156 pharmacists
across the country
are winners —
But the future pharmacists
of America are the real winners
During this past summer, pharmacists from across the United States and Puerto
Rico were invited to enter a drawing to support pharmacy education. □ For every win-
ning entry — 156 in all — Burroughs Wellcome Co. pledged to donate a S500.00 scholarship to a pharmacy school and a
matching $500 grant to one of six national pharmacy associations of the winner's choice. □ To everyone who entered
the drawing, thank you very much. And to the following winners, our most sincere congratulations:
ALABAMA
Charlie Loftin
Larry P Myers
|ohn VI Richej
ALASKA
Tom R Nash
Charles A Decker
Kav Etiason Houghto
Kirk Huffaker
Linda G. Lynns
I Fred Smith
lames H Rumbaih
CALIFORNIA
Kanaan Jajeh
Lloyd Mishlove
George W Tainter
COLORADO
Keiih M Higher
Lawrence I. Luhin
C Joseph Vigil
CONNECTICLT
.1 Kemler Appell
David Chuckta
Frank V Potrepka
DELAWARE
Thomas Knlakimski
Alfred J Scarpelln
Richard R Steele, If
HIS IRK 1 OF (.01.1 MRI\
Albert L. Fauss
lames W Noonan
Henry Wineglass
FLORIDA
George B Browning
Samuel M. Steger
Fred W. Werner
GEORGIA
William Z Kiltrell.Jr
Harrv Tassopoulos
lames II Yandiver
IDAHO
Richard N F.versoi
Gordon M, lower
Ed Wimer
INDIANA
Cynthia Conlev
Foster Dale Propsi
John Topham
tOW A
Rohert I Metelak
Thomas W. Rirder
Lam I) Uolterman
KENTUCKY
Marj E Enzweiler
Christine M. Miles
William A Shinkle. Jr
LOUISIANA
Lamar W. Lane, Sr.
Erline S. Martin
Robert R Price
MAINE
Francis J. Bush
Thomas M Chan
Joan G Mills
MARYLAND
Karen K Dunavant
Arthur John Guido, JT
llene Maier
MASSACHUSETTS
Eric J French
Gino V. Gangai
Stuan C Leroy, Jr
MICHIGAN
Ron L. Cobb
Harrv Ganas
Colin Harvey, Jr
MINNESOTA
Joseph \ BrochJn
Joseph U l.u/ius Jr
MISSISSIPPI
John Thomas Davis
James B Fox
Brcnda Park
MISSOURI
ludith II Evans
Jerry Popek
Tim Roettger
MONTANA
Warren Amole
lohn T Rruion
Russell LT. Svmbal
NEBRASKA
Paul « Man/
Janei L. Ohrt
Carol L. Zikmund
NEVADA
Barbara A Beeman
Glenn M Ellsworth
Cynthia Nelson
NFU HAMPSHIRE
Robert R Cone
Lawrence Ford
Jack Robitaille
NEW JERSEY
Roy C. Putrino
Rich Rassxs
Lihbv E Shapiro
NF.tt MEXICO
S Wayne Mosteller
Robert E Phelps
Gilbeno R Rivera
NEW YORK
MyraBeliavia
Paul R Lipinoga
Elliott B Prillig
NORTH CAROLINA
James Thomas Brown
Winston Burroughs
Rita L.C McCarthy
NORTH DAKOTA
Howard C Anderson, Jr
Doreen M. Reisu anger
Shelley Doherty
OHIO
Kalh\ A Fudge
Pamela I Sharkey
Stanle\ A. Weiss
OKLAHOMA
Mark Deevers
Gerald Heller
Jim Lovell
OREGON
Philip Baehmann
Bobbi Merrill
Jerry G Sachtjen
PENNSYLVANIA
PI ERTO RICO
Zoraida Dejesu
Gradela Martin
RHODE ISLAND
Cathenne B Alv
John J Frajiko
Bernard Keegan Jai
SOITH CAROLINA 1 1
Richard Dewavne Caldwell Lv
Alton Dale Hardv Jai
TEXAS
J.J. BaUi
Beverlv Brewe
W.G. Walter
SOUTH DAKOTA
Lyle A Boes
Marlin Brozik
CorinneJ Chi
TENNESSEE
Wilson C. Daniel
Joe G. Price
TedL RozeU.Jr.
Stanley Pestotnik
Terry A Dennis
Michael J. Gaidys
Barbara T Nye
VIRGINIA
Daniel W Hancock
Donald E Hanky
Man Peterson
WASHINGTON
Wayne Engstrom
Arthur L. Gurtel
Jack Holt
WEST VIRGINIA
Donald II Green well
Nicholas D. Linger 111
John F Rist. Jr.
WISCONSIN
Leroy N. Genke
Norman Malmon
David J. Wunrow
WYOMING
George E Darlington
Terry Long
Ken W il/ebng
Burroughs Wellcome Co.
Working today
for tomorrow
II nijhl- riMTU-d BW-I
THE CAROLINA JOURNAL OF PHARMACY
23
COMPUTERS
Continued from page 21
the computer immediately displays the entry on
the display screen. It is also possible to have these
entries printed on paper by the printer as well as
displayed on the screen. It should be pointed out
that the printer is seldom utilized in this manner.
Other input devices besides the keyboard are
cassette tape, diskettes, light pen, communication
line, and game paddles. The input of data into the
computer can be divided into data, programs,
and commands. "Data" refers to what you want
the computer to process. "Programs" tell the
computer exactly what to do with the data that
you have entered. "Commands" tell the
computer what mode of operation to perform. It
is important to realize that all three types of input
are required, both before and during processing.
In the "processing" phase, after you have
entered a program, data, and appropriate
commands, the computer processes the data and
generates output. The "output" phase is your
ultimate goal and can involve a variety of devices
such as: screen display, a printer, speaker, cassette
tape, diskette, and communication line. You
probably noticed that cassettes, diskettes, and
communication lines serve as both input and
output devices.
From a practical standpoint, there is no basic
difference between a personal computer and the
minis and mainframes. The primary differences
are in the speed of operation, the amount of
storage, and the flexibility. If you removed the
cover of your computer (which I have done
numerous times) you would see circuit boards
populated by the microprocessor and memory
chips, disk drives (a hard drive if your unit is so
equipped), power supply, and a small speaker. A
computer utilizes information stored in a manner
which allows it to read and write fast (less than a
millionth of a second). Memory is referred to as
RAM (random-access memory) and ROM
(read-only memory). Thus, devices referred to as
memory chips are utilized. The memory chips are
encased in small oblong plastic packages which
contain rows of prongs on each side that enable
them to be inserted or removed from sockets in
the computer.
Memory is measured in bytes and one byte can
store one character (either a letter or a number).
Most memory systems store thousands of
characters and thus the term kilobyte is used.
Kilobyte is abbreviated with the letter K and
actually stands for 1024 bytes (often rounded to
1000). Bit is another unit of measurement for
memory and is the smallest possible unit of
storage and refers to the opening or closing of one
switch. One byte contains eight bits which
represents eight switches of which any
combination may be open or closed. Thus, there
are enough combinations to store all the letters
and numbers.
Codes are utilized to store information in
computers. These codes represent the assignment
of numbers and letters to combinations of bits.
Although there are several computer codes, the
standard code is the American National Standard
Code for Information Exchange, which is
abbreviated as ASCII. These codes are important
for communication and the use of ASCII code
facilitates the interchange of data between
computers. It should be noted that the keyboard
in the IBM Personal Computer deviates from the
ASCII code by using a special IBM expanded
code.
The processor is literally the brains of the
computer and the other components support its
operation because all data must pass through the
processor. The processor also controls the overall
operation of the computer by way of sequencing,
control, and clock signals. In personal computers,
the processor is actually a microprocessor and is
often referred to as "micro." There are a variety
of microprocessors used in personal computers
and each type is different in its functions. The
microprocessor used in the IBM Personal
Computer (also in many compatibles) is the Intell
One measure of a micro's power is its word
length (word, in computer terminology) which is
the number of bits that a processor can handle at
one time. Personal computers utilize word
lengths of 8 bits, 16 bits, and 32 bits which means
that they can process 1, 2, or 4 characters at a
time. Longer words provide more memory and
increased speed. It should be pointed out that
word lengths used to address memory are usually
different from word lengths used for data. For
example, the Intell 8088 micro used in the IBM
PC is an 8 bit and 16 bit hybrid. It has an 8 bit
word for transferring data to and from memory,
is a 16 bit data word internally, and is a 20 bit
word for addressing 1 million memory locations.
If you could view the internals of a
microprocessor you would find that it contains an
arithmetic unit and a set of registers (very high
speed memory). The address registers store
memory addresses that are utilized to select the
Continued on page 24
October, 1987
24
THE CAROLINA JOURNAL OF PHARMACY
COMPUTERS
Continued from page 23
area of memory to read from or written into. The
computer obtains these addresses from the
program being used and trasnfers this
information to the address register which selects a
location in the memory.
Although the memory chip is fast, it loses data
every time power to the computer is turned off.
Thus, disk memory (which is much slower) is
utilized to provide permanent storage of data.
Large amounts of data are transferred from disk
memory to main memory, main memory feeds
data to register memory (one word at a time),
output of the microprocessor is accumulated in
main memory, and then data is transferred from
main memory to disk.
Special control programs (operating systems),
are utilized to control this enormous flow of data.
IBM refers to its control program as a disk-
operating system (DOS). MS-DOS is a product
of Microsoft. It should be pointed out that there
are other operating systems besides DOS, but
generally they are for experienced users. A
summary of the functions of operating systems
such as DOS are: transfer data between memory
and disk (or tape), start-up the computer and
perform diagnostic tests (circuits and memory),
accept commands entered at the keyboard
(allows you to control the computer), copy files
from one disk to another, transfer data and
commands to the printer, and transfer data and
cursor movements to the screen.
STEROIDS
Continued from page 21
and spinal trauma, the physician may have a
more effective weapon and a better way to
deliver it. With high-dose pulsing, a much greater
concentration of drug is administered early in the
course of an illness, over a limited period. It is
hoped that maximum benefit will be derived
before the disease has had a chance to progress.
NARD ANNOUNCES
NEW CONSUMER BROCHURE
ON
PHYSICIAN DRUG SALES
FOR PROFIT
As part of a continuing effort to bring
consumers accurate information on the unethical
and anticompetitive practice of physician drug
sales for profit, NARD has published a consumer
brochure on the subject.
The brochure, entitled "Doctors Selling Drugs
for Profit: Just Say No," will be distributed to
consumers through independent retail pharma-
cists nationwide. It explains both the potential
public health threat associated with physician
drug sales for profit and the conflict of interest
created when doctors make a profit on the drugs
they prescribe.
"In the past two years, drug repackaging
companies have sprung up that urge doctors to
sell drugs directly to patients," the brochure tells
consumers. "The companies tell doctors they can
add 'up to $50,000 to their incomes' by selling
drugs."
The brochure answers for consumers the most
frequently asked questions about physician drug
sales for profit and debunks many of the myths
about the practice that have been circulated by
the drug repackagers and others.
The brochure explains to consumers, for
example, that physicians have free drug samples
at their disposal to treat acute problems or
emergencies, and points out that the inherent
coercion that exists in the doctor-patient
relationship effectively denies them freedom of
choice in purchasing their prescription drugs. It
also details the vital importance of the checks and
balances that are guaranteed when physicians
prescribe and pharmacists dispense — guarantees
that are lost when physicians prescribe with one
hand and dispense with the other.
The two-color "Just Say No" brochure is
available to NARD members at $10 for 100
copies (nonmembers $20 per 100 copies).
October, 1987
THE CAROLINA JOURNAL OF PHARMACY
25
DICKINSONS PHARMACY
by Jim Dickinson
HELP WANTED — PHARMACISTS
Enormous salary plus big bonus
No nights or weekends
Accepting attitude a must; moderate-to-low IQ
preferred. Apply Megabuck Mail Service
Pharmacies, Englewood Park, NJ.
Could you fake a small IQ to land a job like
that — $39,000 a year to start plus $10,000 in
productivity bonuses? Hundreds of pharmacists
— especially new college graduates anxious to
pay off a heavy loan burden — are answering the
seductive call of the hottest new practice setting in
the profession.
But all that glitters is not gold, as seven
Medco/National pharmacists told me in a taped,
three-hour confidential disclosure session
recently. They got sick of shipping intermingled
drugs when dispensing speed overtook
dispensing quality.
But until then, their working conditions were
simply idyllic. "We worked 9-5, had every
weekend off and we didn't have to sell baby
diapers. We had plenty of patient and physician
dialog (admittedly only by telephone), and we
had access to patient profiles. National even
bought us subs at lunch time. It was a dream
come true. No pharmacist could want more."
Then everything changed. Coinciding with an
avalanche of new employee benefit prescription
contracts, National had to contend with a
damaging, widely-publicized PCS survey on
mail-order prescription costs that found them not
to be cost-effective due to wastage rates.
Not only did National have much more
business to service, but now it had to defend it in
ever-deeper discounting. The company's
response was to crank up the prescription line,
from a leisurely (!) 50 Rxs/hour to 70-plus, and
to extend the checking pharmacists' hours on-line
from four to eight. The line's error rate soared.
The pharmacist-checking process is supposed
to assure that the dosage units in the outgoing
vials are true to label and true to prescription, but
the line's speed, boosted by greed in the volume-
based bonus system ( 1 5 cents bonus for every Rx
by which the pharmacists' checking average
exceeds 50/hour) makes for blurry checking.
Only the top layer of tablets, capsules, pills in a
vial can be eyeballed.
One informant-pharmacist, who was making
five figures in productivity bonuses on top of
salary before rebelling, put it this way: "I was
checking 75 Rxs an hour; it got so I couldn't
remember what I had just checked."
And the pharmacists were never far from their
non-pharmacist supervisors' taunts: "If a tech can
do 60 an hour, why can't a pharmacist do it
quicker?"
Another of my informants provided me with a
77-item list of errors personally observed during a
thirty-day period. The pharmacists estimated that
they rejected 5% of all prescriptions processed.
Worse, the rejects were all dumped, together,
in large "Return to Stock" cartons at the end of
each day, for redistribution by technicians to their
originating Baker dispensing units and rotating
travs in the filline area.
That's probably where the intermingling
begins. One white tablet of Proventil 2 mg looks
exactly like one white tablet of Lanoxin 0.25 mg,
to a technician. Only a pharmacist can tell them
apart, and even then it takes more than a trained
eye — it takes a little time, which is something
that National does not have to spare.
My informants testified — on tape — that
many interminglings routinely occur, and any
resulting complaints are dealt with in a top-
security Customer Relations Department that
pharmacists are discouraged from entering, and
where patient records are kept away from
effective access to line pharmacists.
One complaint in April that did escape the seal
and become known on the floor was a phoned-in
emergency involving a female Lanoxin patient
with arrythmias from taking intermingled
Proventil.
National's response to errors, my informants
said, was to send a headquarters executive to give
assembled pharmacists a "pep" talk and to warn
them that the consequences of making mistakes
would be "elimination." Plant procedures
remained unchanged, however.
The pressure continued to build, and the
pharmacists began to forget that they were
making the best money in the profession. They
began grumbling, and morale fell to a serious
low.
That's when a new management bulletin was
issued. A two-column specifications sheet, one
side bore the heading "What we are looking for
Continued on page 27
October, 1987
Behind every good computer,
stands an even better employee.
The home office and warehouse of
Lawrence Pharmaceuticals are
models of automated efficiency.
Orders are received
electronically. Shelf labels, shipping
documents and invoices are quickly
prepared even as shipments are
being filled. Mechanized conveyor
systems smoothly carry products
from receiving to bulk storage to
order filling to shipping.
Everything runs with quiet
precision. Why then does Lawrence
need over 200 employees?
Because Lawrence still is a
people business. Computers can't
call on customers or help
pharmacists arrange their shelves
for better sales. Computers can't
prepare advertising programs for
participating members of True
Pharmacy. Computers can't
introduce new products or answer
questions when you call on
the phone.
Computers are invaluable in
much that we do. But when all of the
microchips are on the table, people
are still what we're all about. At
Lawrence we never forget that.
A FoxMeyer Company %m^w
^Xawrenety^i
rliarnia<*ciili<*als
6100 Phillips Highway • Post Office Box 5386
Jacksonville, Florida 32207-0386 • (904)731-4610
THE CAROLINA JOURNAL OF PHARMACY
27
DICKINSON'S PHARMACY
Continued from page 25
or at," and the other, "What we are not looking
for or at."
According to this, the first desirable trait was
"big picture oriented" (despite the fact that
National ensures that its pharmacists know only
what is involved in their immediate task, and
vigorously discourages pharmacists going into
other areas); the first undesirable trait in a
pharmacist, according to the list, was high IQ.
Other sought-after attributes in the first
column were: "High ethical/professional
standards, aggressive, high energy level, not petty,
can make tough decisions, objective, ability to
communicate with management ..." And on
the other side, detriments included "on-line
checking average, charisma, ability to socialize,
ability to amuse, people who own a wristwatch
(clockwatchers), people who are concerned with
what they're going to make this week, people
who are focused upon the almighty dollar,
clowns and circus acts ..."
Clearly, National was determined to quell
dissent and to impose its standards on the
pharmacists. So, my informants said, they took
their complaints to the Pharmacy Board, and
were astonished at the reaction they got.
"He (the board exec) told me they couldn't do
an inspection without solid documentation and
evidence, and even then they were required to
give the plant notice before the inspection,
because of 'security'," the pharmacist who made
the anonymous call to the board said.
The National plant was not inspected as a
result of this complaint.
Perhaps because mail-order pharmacy
operations compete mainly with out-of-state
pharmacies, they are viewed as a trouble-free, net
asset to the state, bringing needed dollars in and
boosting employment. This especially benefits
minimum-wage ethnic groups who have little
command of the English language and who are
most likely to be intimidated by their supervisors.
What's National's side of the story? Five
phone calls and a certified letter to president
Martin Wygod yielded no response.
UNC CAREER DAY
The School of Pharmacy of the University of
North Carolina will hold its annual Career Day
on Friday, February 5, 1988 in the Great Hall of
the Student Union Building. All pharmacy
students have been urged to participate and
potential employers will have the opportunity to
interview graduating seniors and those seeking
summer employment as interns.
This year, individual partitioned booths will be
available for each employer and scheduling of
student interviews will be at 30 minute intervals.
A continental breakfast and lunch for both
students and employers will be provided as well
as afternoon refreshments for employers.
The change informat and location is in
response to comments and suggestions received
over the past few years. Employers wishing to
participate in Career Day should contact John
Mackowiak, Ph.D., UNC School of Pharmacy at
(919) 962-0081 for more information.
W. J. SMITH
RESIDENCE PROGRAM
The UNC School of pharmacy and Glaxo Inc.
announce the establishment of the W.J. Smith
Practitioner-in-Residence Program.
Scheduled to begin this year, the program is
designed to identify and bring innovative
pharmacy practitioners to UNC to interact with
students and faculty, and to influence students in
their career decisions.
One pharmacist will be selected annually to
participate in the four-day program. The first will
be named in November and will begin serving in
January.
Practitioners will be chosen from nominations
by national pharmaceutical associations, Glaxo
Inc. and the UNC Pharmacy School faculty.
The program honors W.J. Smith of Chapel
Hill, for his contributions to North Carolina
pharmacy during his 37 years as secretary
treasurer of the North Carolina Pharmaceutical
Association. Smith retired in 1978. The program
is supported by an educational grant from Glaxo
Inc.
This feature is presented on a grant from G.D. Searle &
Co. in the interests of promoting the open discussion of
professional issues in pharmacy. G.D. Searle & Co.,
accepts no responsibility for the views expressed herein
as they are those of the author and not necessarily those
of G.D. Searle & Co.
October, 1987
28
THE CAROLINA JOURNAL OF PHARMACY
PEOPLE NEWS
CHARLOTTE WOMAN'S
PHARMACEUTICAL AUXILIARY
The Charlotte Woman's Pharmaceutical
Auxiliary held its regular meeting Tuesday,
October 1 3, 1 987. Auxiliary members met at the
home of Mrs. Jesse Oxendine to form car pools
for a trip to Mission Air in Monroe, N.C.
At Mission Air we were welcomed by Mr. J.
L. Brookes. Mrs. Sandy Simpson gave an
interesting account of its beginning, which was
started by her husband. It is a nonprofit
organization, founded and operated by pilots,
citizens, businessmen, and medical personnel
who volunteer their time and talents. It is
supported entirely by contributions and grants.
Last year they had 700 requests for service, some
having to be turned down for lack of funds.
After touring their premises and inspecting one
of their aircraft, the members returned to
Charlotte. They enjoyed lunch at Ryans Steak
House.
Margaret Robinson, president, held a short
business meeting. The annual bazaar was
discussed. A motion was made by Dollie Corwin
to hold an attic and bake sale at her home on
Saturday, November 7th. The motion was
seconded by Lurlene Barnhardt and passed.
New officers serving this year are: President —
Mrs. Don B. Robinson, (Margaret); 1st Vice-
President — Mrs. Jesse Oxendine (Jewell); 2nd
Vice-President — Mrs. W. B. Hawfield, (Nancy);
Secretary - - Mrs. Tobie Steele, (Virginia);
Treasurer - - Mrs. Gibbs Henley, (Evelyn);
Historian - - Mrs. C. L. Cannon, (Laura);
Parliamentarian — Mrs. Don Smith, (Betty);
Advisor — Mrs. Leslie Davis, (Mary Lou).
Fred M. Cole, center, was presented a plaque of appreciation at a dinner in his honor at the
Institute of Pharmacy. Cole has been building custodian of the Institute for 36 years and is
retiring at the end of 1987. He retired from his job as laboratory technician at the Research
Triangle Institute earlier in October. On the left is W.J. Smith, former Executive Director of the
North Carolina Pharmaceutical Association and on the right is Al Mebane, current Executive
Director.
October, 1987
THE CAROLINA JOURNAL OF PHARMACY
29
WILL YOU LIVE 100 YEARS?
The projected size of the centenarian
population over the next 100 years and the
characteristics of that population from the 1980
census are detailed in a report prepared for the
National Institute on Aging by the Commerce
Department's Census Bureau. The report was
prepared as part of the National Institute on
Aging's major initiative on the rapidly growing
oldest-old population (those over 85+).
The report, prepared by Cynthia Taeuber,
Arnold Goldstein and Greg Spencer noted that,
although centenarians are a rare population
group, the United States is experiencing a steady
increase in the number of people aged 100 or
more years. In 1985, there were an estimated
25,000 centenarians, about 1 in 10,000 persons.
By the year 2000, the centenarian population is
projected to number over 100,000.
For those born in 1 879, the odds against living
100 years were 400 to 1; by 1980, the odds had
improved to 87 to 1 . In the year 2080, the United
States will have over one million centenarians if
the assumptions underlying the Census Bureau's
middle series projections hold true. The actual
number, however, will depend on future changes
in immigration and mortality. Lower mortality
and changes in immigration could lead to as
many as 5 million centenarians by 2080.
The report also found that centenarians as a
group are socially and economically diverse, and
that (as a group) their characteristics are quite
similar to the population aged 85 and over.
However, compared with people 85 and over,
centenarians are more likely to be women, to be
living with someone other than a spouse, and to
have lower incomes. Between 76 and 84 percent
of centenarians are widowed but over one-fifth
(20 to 37 percent) of centenarian men are still
married compared with less than one-tenth of
women. Centenarians are found at all levels of
educational attainment but women are more
likely than men to have a high school diploma.
Forty-five to fifty-five percent of all centenarians
live in households with others or by themselves.
Most of the remainder live in nursing homes.
Black centenarians are different from White
centenarians in many respects. When comparing
their respective proportion of the populations,
there is some evidence that there are somewhat
more Blacks than Whites among the oldest of
centenarians, 1 05 years or more. There is a higher
proportion of men among Black centenarians
that among White centenarians. Blacks are also
less likely to be found in institutional settings and
they are more likely to be poor.
The report also provides data for each state on
the number of centenarians living in institutional
settings, their marital status, educational
attainment, and income distribution.
For more information please contact Cynthia
Taeuber or Arnold Goldstein 301/763-7883 at
the Census Bureau, or the NIA Public
Information Office 301/496-1752.
APhA ANNOUNCES ACTION AGENDA
The American Pharmaceutical Association
(APhA) has announced the adoption of its
strategic planning agenda to be implemented
over the next three years. The details of this
announcement were released in the October
1987 issue of American Pharmacy, the journal of
APhA.
According to the article, association leadership
targeted two efforts as being essential for building
the organization so that it could best serve and
represent its members. These efforts are growth of
APhA membership, and renewal of pharmacists'
image and influence.
APhA's "action agenda" will provide more
than $1 million worth of new programs,
products, and services over the next three years.
The association's Board of Trustees developed
the principles which served as overriding
considerations for determining the structure and
direction of the agenda.
These principles include encouraging state
pharmaceutical associations to participate in the
programs; ensuring that the basic mission of
enhancing the profession and improving the
status of individual pharmacists is maintained;
focusing on retaining current members and
recruiting new members; and stepping up
communications efforts, including marketing and
production.
One of the significant outcomes of APhA's
strategic planning process is that it will ensure
that the Association will continually remain
abreast of the needs of its membership. It also
establishes unity of purpose among membership,
association leadership, and staff.
NOTE: A copy of the American Pharmacy
article is attached for your information.
October, 1987
Human insulin for all. Humulm
human insulin
[recombinant DNA origin]
Identical to human insulin. Humulm is the only insulin not
derived from animal pancreases.
Recombinant DNA technology makes the production of
Humulm possible and virtually assures every insulin user of a
lifetime supply
From Lilly . . . a dependable source of insulin for
generations. Since 1922, when we became the first company
to manufacture insulin, we have led the search for the best
diabetes care products and, at the same time, maintained a
constant supply of insulin for all insulin users
Our 24 formulations of insulin— including Humulm and all
forms of lletm* (insulin)— are available through the widest retail
distribution of insulin in the United States.
Beyond that, we will continue to provide a wide range of
diabetes service and educational materials for use by physi-
cians, pharmacists, and diabetes educators
f 1986 ELI LILLY ANDCOMPANY
Our Medical Division is on call. Our Medical Division staff
is only a phone call away Please contact them if you have any
questions about our diabetes care products
Any change of insulin should be made cautiously and
only under medical supervision. Changes in refinement,
purity, strength, brand (manufacturer), type (regular. NPH,
Lente®, etc), and/or method of manufacture (recombinant DNA
versus animal-source insulin) may result in the need for a change
in dosage
T.I--HW,
For information on insulin delivery systems, contact CPI 1 (800) 227 3422
Sfay
Eli Lilly and Company
Indianapolis, Indiana 46285
THE CAROLINA JOURNAL OF PHARMACY
31
SOCIAL PHOBIA:
WHERE SHYNESS ENDS AND ILLNESS BEGINS
by Michael R. Liebowitz, M.D.
Associate Professor of Clinical Pharmacy
Columbia University College of Physicians & Surgeons;
Anxiety Disorders Clinic
New York State Psychiatric Institute
Imagine Kathy, a pretty 16-year-old, standing
fixed before the closed door to the immense hall.
She can hear the buzzing voices of people,
already seated. It's time for her to enter. But she is
too afraid — her hands are trembling
uncontrollably, her heart pounds. She's
perspiring profusely and feels unable to catch her
breath. She can think only of the thousand eyes
that will be on her.
Her debut at the Metropolitan Opera?
No. Kathy is a high-school student trying to
enter the school cafeteria. She has lunch there
most school days, but it literally terrifies her every
time. Kathy imagines that all the students stare at
her and think she looks "stupid." In fact, she
draws no more notice than any other student, and
no one ever speaks disparagingly to or about her.
Kathy is not paranoid or psychotic. In most
respects she's absolutely normal. But she is one of
perhaps a million or more individuals who suffer
from a seldom-discussed anxiety disorder called
"social phobia." These people experience
incapacitating anxiety at the prospect of entering
situations where they believe they will be
scrutinized by others. The condition is a distinct
illness recognized by the Diagnostic and
Statistical Manual of Mental Disorders (DSM-
III), the psychiatric "bible" for mental health
professionals and medical insurance companies.
Social phobia is different from the social
anxiety we all feel about new situations, such as
giving a sales presentation, delivering a speech or
performing music before an audience. For most
people, these tasks become easier with
experience. Indeed, the nervousness may even be
beneficial, prompting us to prepare and rehearse
so we do our best. But for the social phobic, social
exposure often becomes more difficult with
repeated efforts. The person may become
increasingly aware of a physical symptom, such
as a hand tremor, and grow convinced that
everyone will see it and know he or she is scared.
This conviction magnifies anxiety and generates
more shaking, sweating and other physical signs.
Impact on Behavior
Unlike moderate shyness or the fairly common
social anxiety, social phobia does not go away by
itself. People remain gripped by the irrational fear
that they will act in a way that is humiliating,
even though they know the fear is excessive. This
anxiety disorder takes many forms — fear of
speaking or eating in public, fear of using public
lavatories, inability to write in the presence of
others, terror of attending parties or social
functions, and fear of going on dates. The
individuals modify their life styles to adjust to
their anxiety, which leads to severe restriction in
social activity and, often, in occupational activity
as well.
In one group of patients that I evaluated, social
phobia had prevented the majority from
advancing in their careers. About half avoided all
social contacts outside the immediate family.
More than a third abused alcohol, and some
dropped out of school or were unable to work.
The role of social phobia in causing alcoholism
may be very significant — and largely
unrecognized. In one group of 102 alcoholics, 25
percent of the men and 17 percent of the women
could not face social situations without alcohol or
medication. An additional 35 percent of the men
and 28 percent of the women were borderline
social phobics; social settings were extremely
stressful to them. Another study found that 39
percent of a group of abstinent alcoholics had
suffered from social phobia, and 60 to 70 percent
of these socially phobic alcoholics had used
alcohol to cope with social anxiety.
Different From Other Anxiety
Disorders
It's important to distinguish social phobia from
the other anxiety disorders that are also called
phobias. Simple phobia is an irrational fear of a
particular type of object or situation, such as
dogs, spiders, thunder or heights. In contrast, the
outstanding fear for social phobics is any
situation where they feel they may be singled out
for ridicule.
A person with agoraphobia has a dread of
Continued on page 32
October, 1987
32
THE CAROLINA JOURNAL OF PHARMACY
Social Phobia: The Shyness That Is an Illness
Social phobia— incapacitating anxiety about social situations-
is a common, largely unrecognized cause of alcoholism.
SOCIAL PHOBIA
Continued from page 31
being alone in a public place. Most agoraphobics
also suffer from panic disorder, experiencing
panic attacks marked by severe, irrational
apprehension, dizziness, sweating, pounding
heart and a feeling of being suffocated. The
underlying fear of such individuals is that they
might have a panic attack in a place where escape
may be difficult. They are comforted by the
presence of a close friend or family member.
Social phobics are generally afraid only of
situations where they imagine they'll be stared at,
and feel most comfortable when alone.
Social phobia is different in another respect: It
affects men and women fairly equally, and may
even be more common among men. Agora-
phobics appear to be overwhelmingly women
(75 to 86 percent) — accounting for the
"household woman" syndrome in which women
are afraid to leave the house. The onset of social
October, 1987
THE CAROLINA JOURNAL OF PHARMACY
33
phobia is also likely to be earlier, the first
symptoms appearing in adolescence, though its
victims do not usually seek treatment until 10
years later. Agoraphobics generally develop
symptoms in their mid-twenties and may not seek
help until well into their thirties.
How Social Phobia Begins
It is a mystery why these people who very
much desire normal social contact suffer
incapacitating anxiety that results in a genuine
disability. Equally puzzling is why they do not
adjust to social situations and become more
confident, as most other people do.
One possible cause is an inborn, inherited
tendency that is not easily overcome. A
Norwegian study found that identical twins were
far more likely to have social phobic traits in
common than nonidentical twins, who
genetically are like ordinary brothers and sisters.
Another feature found commonly in people with
social phobia is great sensitivity to rejection. This
trait often exists in people prone to types of
depression. In fact, many social phobics have
suffered from depression.
Social phobics may also have a pronounced
tendency to produce bodily reactions to
uncomfortable situations. In one study, 34 social
phobics experienced greater increases in heart
rate while talking to a stranger of the opposite sex
than 36 claustrophics (who fear closed, narrow
places) experienced when confined in a small
room. What's more, the social phobics were
extremely aware of their accelerated heart rate. In
life situations, this awareness tends to add to their
anxiety.
Promising Treatments
The major obstacle to helping social phobics is
getting them to seek assistance instead of
retreating into protective seclusion — which, of
course, is not protective since they are generally
anguished. Specialized anxiety clinics have begun
to make significant therapeutic inroads.
Behavior-oriented psychotherapy and medica-
tion offer considerable hope for the future.
The various psychotherapeutic approaches
employ behavioral programs, often used most
successfully in combination.
Relaxation training. People are taught to relax
different sets of muscles to eliminate tension.
They do this while imagining (or while actually
in) threatening social situations.
Cognitive restructuring. Social phobics are
October, 1987
made aware of how they sabotage self-
confidence with belittling self-messages: "I look
like a fool" or "Everyone sees me sweating."
They are helped to substitute positive self-
messages: "I look very good today" and "My
presentation is truly interesting."
Social skills training/ desensitization/ expo-
sure. These behavioral techniques help people
become — as well as feel — capable regarding
skills in which they feel so deficient. They
practice conversational skills with a therapist or a
therapy group and deliver talks as if at a staff
meeting. Eventually, they engage in "real-life"
exercises, such as walking up to a gathering and
joining their conversation.
The other promising area of research is with
medications. Beta blockers — drugs normally
used for high blood pressure, angina and
migraines — have been helpful to people who
experience social anxiety, such as musicians who
suffer stage fright. These drugs may help social
phobics also, by suppressing the rapid heart beat,
flushing and other signs of anxiety that alarm
them and make their distress unmanageable.
While some individuals with social phobia
appear to have been helped by beta blockers,
research findings are too mixed to point to beta
blockers as the future remedy.
Other studies with phenelzine, an antidepres-
sant medication of the group called monoamine
oxidase inhibitors, find that a considerable
percentage of social phobics respond favorably.
Phenelzine not only blocks the physical
manifestations of anxiety but also may act on the
central nervous system to increase confidence.
Serious potential side effects, however, are a
major obstacle to its use. Promising studies are in
progress with other medications, such as
benzodiazepine anti-anxiety agents.
The most valuable first step is to appreciate
that a young person who is so anxious that he or
she avoids participating in social and classroom
activities may be suffering from more than
shyness. Enlisting help early can save years of
pain. Gratifying progress in treatment studies
makes involved professionals believe that
disabled social phobics may be highly responsive
to treatment.
World class
advice for
your every day
problems.
More than 50,000 pharmacists know these men
and use their wisdom to solve everyday problems.
Dave Schmidt and Harles Cone, Ph.D., gave
them a better understanding of human nature
and improved their ability to communicate.
And many have profited from the good dollar
sense of Allan Hurst and his lectures on financial
planning, cash flow and store management.
We're proud to have brought their Professional
Development programs to your association meet-
ings and conventions during the past 12 years.
We hope they made your- world better.
'mm
mm
fJk
(jM^g.-^/^^
%oS^\%2uM f/t
'.Xr::V-':
'""'■"'•'■"■
WSm
m
1985 The Upjohn Company, Kalamazoo. Ml
THE CAROLINA JOURNAL OF PHARMACY
35
WEDDING
Patricia Lester Philips and JAMES KEITH
CAVINESS were married on Saturday,
September 26th in Calvary Episcopal Church,
Tarboro. The Rev. Douglas Errick Remer and
the Rev. David DeWitt Stanford officiated at the
double-ring ceremony. Jerry Cobb ('82) was a
groomsman.
The bride is a graduate of Salem College. She
is a paralegal with Northern, Blue law firm of
Chapel Hill. The bridegroom is a graduate of the
University of North Carolina School of
Pharmacy (Class of 1982). He is a pharmacist
with Rite Aid Pharmacy of Oxford. The couple
reside in Chapel Hill.
Dear PCS Member Pharmacy:
By now you have probably heard or read
about Recap, PCS' exciting new method of
electronic claims submission. Recap is up and
running with great success. Now you too can take
advantage of the Recap system.
With Recap, claim forms are eliminated. PCS
claims are electronically transmitted directly to
our computer at the time the prescriptions are
dispensed.
Recap is available to both computerized and
non-computerized pharmacies.
If your pharmacy is not computerized —
You can order a Recap terminal. It is user-
friendly and easy to operate.
If your pharmacy is computerized — You
can also use the Recap terminal — or — contact
your software vendor for details about how to
participate with your own computer system.
As PCS cardholder groups are issued the new
PCS Recap cards, on-line Recap capability will
be necessary for pharmacies to participate in
these plans. However, claims for the familiar blue
PCS cards can also be processed via the Recap
system.
What recap will do for you:
1. Reduce paperwork — Claim forms will be
eliminated.
2. Improve your cash flow — Claims are
automatically entered into the PCS computer
as each prescription is filled. This will greatly
improve reimbursement turnaround time.
3. Eliminate rejections — (both errors and non-
eligibles) — This will further improve your
cash flow and reduce your bad-debt factor.
Recap will save you time and money!
Further details are outlined in the enclosed
material. Don't wait. You can enroll now and
begin taking advantage of the PCS Recap system.
Charles D. Pulido, R.Ph.
Vice President
Professional Relations
Owens and Minor/ Bellamy
Drug and King Drug Company
In the August issue of the Carolina Journal of
Pharmacy, a press release was published stating a
letter of intent had been signed by Owens &
Minor, Inc., Bellamy Drug of Wilmington and
King Drug Company of Florence, SC, under
which Owens & Minor would acquire the stock
of the other two drug wholesalers. After much
discussion, negotiations were terminated by
mutual consent and the companies ended
attempts to complete the transaction.
OBITUARIES
ADDIE BRADSHAW PEGRAM
Addie B. Pegram, Cary, died Saturday,
October 17, 1987, at the age of 87. A 1922
graduate of the UNC School of Pharmacy, Mrs.
Pegram retired in 1965 after 20 years of owning
and managing Pegram's Pharmacy in Apex. She
received her Fifty Plus Pin from the NCPhA in
1972 and was the first woman so recognized.
One of her four daughters, Sarah Pearson, is a
pharmacist.
JASPER EDWARD PHILLIPS
Jasper E. (Jack) Phillips, Raleigh, died
Tuesday, March 31, 1987, at the age of 74.
Phillips was retired and was a former owner of
C.O.D. Drug Company in Rocky Mount. He
was a graduate of the UNC School of Pharmacy,
class of 1933, and worked with Bobbin's
Pharmacy in Winston Salem, Ring Drug
Company in High Point and Terminal Drug in
Wilson, as well as the I.W. Rose Drug Company
in Rocky Mount.
JAMES RICHARD CURTIS
J.R. Curtis, Bessemer City, died Saturday,
September 12 after an extended illness. He was
82 years old. He was retired after operating Curtis
Pharmacy for 35 years. He had been doing relief
work since 1968. Curtis was a native of Guilford
County, a graduate of the UNC School of
Pharmacy and moved to Bessemer City in 1932.
He received his 50 year pin in 1978 from the
NCPhA.
October, 1987
His responsibility is to
do the best job possible... for you
wherever you are in North Carolina.
How specially-trained
Savage professional representatives
:an serve you and your business:
• Help maximize inventory turnover for greater
profitability
• Rapid-response order taking and delivery
...and a fair product-return policy
• Close liaison for you with wholesalers,
physicians, and headquarters customer
service at Savage
• Help to keep you informed about current
trends and competitive strategies
• Promotion specialist: Not only helps make the
deals, but helps build traffic
Savage products...
They help build customer traffic
for your pharmacy
The right strengths, the right formulations,
the right quality, at the right price...
to help you serve your customers and
maintain your profits
22 high-quality products
from a single source
9
Allergy: BREXIN" LA CAPSULES chlorpheniramine maleale 8mg.
pseudoephednne hydrochloride 120mg •
Antiprotozoal: SATRIC" TABLETS- 250mg (metronidazole USP) ■
SATRIC" -500 TABLETS (metronidazole USP) •
Bronchodilators: DILOR* ELIXIR (dyphylline) •
DILOR'* INJECTABLE (dyphylline) • DILOR* TABLETS - 200mg (dyphylline) •
DILOR" -400 TABLETS (dyphylline) • DILOR-G" LIQUID
dyphylline 100mg, guaifenesin USP lOOrng ■ DILOR-G" TABLETS
dyphylline 200mg, guaifenesin USP200mg •
Contrast Medium: ETHI0D0L" (ethmdized oil for injection) •
Cough/Cold: BREXIN" E-X (pseudoephedrine HCI and guaifenesin) •
Hormone: DITATE* -DS (testosterone enanthate and
estradiol valerate injection) •
Topicals: ALPHATREX* CREAM, OINTMENT AND LOTION 0 05%
(betamethasone dipropionale USP) •
BETATREX" CREAM. OINTMENT AND LOTION 0 1%
(betamethasone valerate USP) ■ '
MYTREX* F CREAM AND OINTMENT (nystatin- triamcinolone acetonide) •
NYSTEX'" CREAM AND OINTMENT (nystatin USP) •
NYSTEX'" ORAL SUSPENSION (nystatin oral suspension USP) •
TRYMEX CREAM AND OINTMENT 0 025% (triamcinolone acetonide USP) ■
TRYMEX CREAM AND OINTMENT 0 1% (triamcinolone acelonide USP) •
Vaginal Preparations: TRYSUL'" (triple sulfa vaginal cream)
(sullalhiazole 3 42%. sulfacetamide 2 86%. sulfabenzamme 3 70%) ■
Vitamins: CHROMAGEN* CAPSULES ferrous tumarate USP 200mg.
ascorbic acid USP 250mg, cyanocobalamm USP 10mcg. desiccated
stomach substance 100mg ■
CHROMAGEN* OB CAPSULES a phosphorus- tree vitamin and mineral
dietary supplement for use during pregnancy and lactation
SAVAGE
LABORATORIES
a division of Altana Inc • Melville, New York 1 1 747
People and products to serve your needs.
THE CAROLINA JOURNAL OF PHARMACY
37
CLASSIFIED ADVERTISING
Classified advertising (single issue insertion) 25 cents a word with a minimum charge of $5.00 per
insertion. Payment to acompany order.
Names and addresses will be published unless a box number is requested.
In replying to "blind" ads, address Ad. No., Carolina Journal of Pharmacy, P.O. Box 151, Chapel
Hill, NC 275 1 4. Telephone (919) 967-2237.
Pharmacist Needed: Pharmacist for
Community Pharmacy located in Carr-
boro. Approximately 45 hours a week with
alternate weekends off. Must be willing to
live in Chapel Hill or Carrboro telephone
area. Send resume to Vaughn Indepen-
dent Pharmacy, 503 W. Main Street,
Carrboro, NC 27510 or call (919) 967-
3766.
Pharmacist Wanted: Excellent opportun-
ity to work in independent professional
pharmacy (80% Rxs) in large medical
complex in Sandhills. No nights or
Sundays. Excellent salary and benefits.
Box 1119, Pinehurst, NC 28374. (919)
295-2222 (day or night).
Store Fixtures For Sale: Fixtures available
after January 31. Complete store fixtures
for a 5,000 square foot store in excellent
condition including wall, gondolas, end
pieces, one or more glass showcases and
Rx department. Contact Hamp Langdon,
Kernersville at (91 9) 993-21 95.
Pharmacist Wanted: Strong independent
in Northeastern North Carolina seeking
energetic professional pharmacist.
Excellent salary, benefits and working
conditions. Contact NCPhA, P.O. Box
MAA.
ADVERTISING expertise and PR savy.
Familiar company offers 17 years
experience. Program engineered for
professional-minded independents. Ef-
fectively utilizes hometown newspaper
and in-pharmacy goodwill. Cost per
family impacted lowest of any media.
Personalized formats and frequency fit
any budget. $95 initiates your exclusive
use. Contact W. Joe Davis, (919) 946-
1553, any hour, any day.
Pharmacy For Sale: Owner wishes to
retire; 25 years same location. 30 miles
from Charlotte. Annual Sales: $270,000.
Inventory: $85,000. Sales Price: $80,000.
Includes inventory, fixtures, etc. $11,000
Accounts Receivable and delivery car.
75% Rx, 40% charge accounts. Reply
JNR, c/o NCPhA, P.O. Box 151, Chapel
Hill, NC 27514, or call 1-704-933-6551
after 6 pm.
Pharmacy Wanted: Pharmacist wants to
buy an Eastern or Piedmont NC
pharmacy. Strictly confidential. If you are
interested in selling your pharmacy,
contact Box JGM, c/o NCPhA, P.O. Box
151, Chapel Hill, NC 27514.
Staff Pharmacist Wanted: Moore Regional
Hospital, a 316-bed, acute care facility
has an opening for a staff pharmacist. This
pharmacy offers unit dose, IV Admixture,
chemotherapy, support for C.E. educa-
tion, patient profile, and a mobile
medication service. Moore Regional
Hospital is located in Pinehurst, a
beautiful part of the Sandhills. Excellent
starting salary, on-site Day Care, plus
comprehensive benefit package. Contact
Cornelia Perry, Vice President of Human
Resources, (919) 295-7808, or Robert
Beddingfield, Director of Pharmacy, (91 9)
295-7112 or send resume to: Moore
Regional Hospital, Human Resources,
P.O. Box 3000, Pinehurst, NC 28374. EOE.
WANTED: Tenant for a new drug store
building adjacent to a new Food Lion
building located in Burlington, N.C. Any
size up to 9,200 square feet. Call 91 9-449-
7521 or 919-584-7745
Continued on page 39
October, 1987
■;>■.
Howtomeet his needs
today and tomorrow
This child is going to be a patient of yours for a long time.
As he grows older and his needs change, he'll be counting on
you to keep up. With a computer system from QS/1, you'll
have no trouble meeting his needs now or in the
future. Because no one in the industry is more
fiercely devoted to updating and enhancing
their system than QS/1. You will always
have the latest information, the latest
pharmacy programs, and the best tools
to serve your patients. That helps you
to be the best pharmacist you can, <4af
today and in 15 years.
To find out more about the pharmacy system that grows as
you grow call today: 1-800-845-7558.
IBM Personal System/2
THE CAROLINA JOURNAL OF PHARMACY
39
CLASSIFIEDS
Continued from page 37
Relief Pharmacist Available: Central and
Eastern North Carolina. Contact Phar-
macy Relief, P.O. Box 2064. Chapel Hill,
NC 27515, or call (919) 481-1272
evenings.
Clinical-Staff Pharmacist Position: Will be
working every 3rd weekend and will have
responsibilities in unit dose, IV admix-
tures, cancer chemotherapy, patient
education, nursing inservice, pharmacy
newsletter, pharmakinetic dosing, drug
use evaluation and other evolving clinical
applications. Some advanced training
and experience in clinical pharmacy
preferred. If interested and qualified,
please send resume to: Director of
Personnel, Community General Hospital,
P.O. Box 789, Thomasville, NC 27360
EOE.
Pharmacist Professional Services/Con-
sultation: Temporary and or Continual.
Contact: L. W. Matthews, III, (919) 967-
0333 or 929-1 783. 1 608 Smith Level Road,
Chapel Hill, NC 27514.
Professional Pharmacies: Several small
prescription -oriented pharmacies are
currently available for individual owner-
ship in North Carolina. These opportun-
ities provide the vehicle to practice
pharmacy the way you were taught, while
offering an attractive income and more
time to be with your family. In some of
these cases, financing is also available to
qualified candidates. For more informa-
tion write: Jan Patrick, 10121 Paget Drive,
St. Louis, MO 63132.
Pharmacists Wanted: We are seeking
ambitious, and professional career-
minded individuals for pharmacist
positions in High Point, Greensboro and
Winston Salem, N.C. We offer excellent
salary, stock ownership, education
subsidy, extensive benefits, retirement
plan, 401 K tax plan, annual salary merit
reviews. "Pure pharmacy setting." If
interested, call Lew Thompson 1-800-
233-7018 or send resume to: The Kroger
Company, Attn: Personnel, P.O. Box
14002, Roanoke, VA 24038. EOE.
Pharmacy-manager needed: We are
seeking an ambitious and professional
career-minded individual for Pharmacy-
manager position in Southeastern North
Carolina near the coast. Computerized
prescriptions, excellent salary, hospital-
ization and life insurance, paid vacations.
Small professional pharmacy located in
the center of a medical complex. Contact
Box CDD, c/o NCPhA, P.O. Box 151,
Chapel Hill, NC 27514.
Staff Pharmacist Wanted: Position at
Kings Mountain Hospital. Modern 102-
bed facility with computerized unit
dosage. Hospital experience preferred,
but not necessary. Will consider a May
graduate. Contact Jerry McKee at (704)
739-3601 Ext. 472.
Pharmacist Wanted: Pharmacy II position
available at Piedmont Correction Center
in Salisbury. Rowan County. One year
experience. Salary grade; 75. Salary
range; 26,892-43,728. Call Sylvia Mat-
thews at (704) 637-1421 Ext. 501 or 507.
Pharmacist Wanted: Director of Pharmacy
for 64-bed hospital in Southeastern North
Carolina. Excellent hours, salary negoti-
able, and good fringe benefits. Contact
Tom Smart at (919) 582-2026.
Clinical-Staff Pharmacist Position:
Located on the beautiful N.C. coast in
Morehead City. Some advanced training
and experience in clinical pharmacy
preferred. Will have responsibilities in unit
dose, IV-Ad mixtures, chemotherapy,
patient education, nursing inservice,
pharmacy newsletter, pharmakinetic
dosing, drug evaluation and other
evolving clinical applications. If interested
and qualified, please send resume to
Director of Personnel, Carteret General
Hospital, P.O. Drawer 1619, Morehead
City, NC 28557 or call Beth Beswick (919)
247-1547. EOE.
Pharmacists Wanted: Farmco Drug
Centers have present positions available
in Rocky Mount, Elizabeth City and
Roanoke Rapids, North Carolina. For
more information contact James Thomp-
son at (919) 878-8158.
Continued on page 40
October, 1987
40
THE CAROLINA JOURNAL OF PHARMACY
CLASSIFIED
Continued from page 39
Relief Pharmacist: Relief Pharmacist
available. Has RV, will travel. Call Robert
Lucas at (919) 383-1421.
Pharmacist Owner relocating; Seeking
position in community pharmacy (inde-
pendent or chain). Open to partnership
from Statesville and Charlotte area west.
Call or write: David de Chester, 546
Uniondale Avenue, NY 11553. (516) 481-
0816.
Pharmacist Wanted: Greensboro and
trading area. Contact David Cox, Revco
Drug Stores at (919) 766-6252.
Columbus Store Fixtures for Sale:
Complete Prescription Department and
30 foot greeting card fixtures. Contact
Bud O'Neal, Work: (919) 943-2462, Home:
(919)943-3751.
Pharmacy for Sale: Owners want to retire.
Old established store 30 miles from
Raleigh in a small town with one doctor.
$250,000 in sales, with an inventory of
$50,000. Sales price of $65,000, includes
fixtures and equipment. 85% Rx business.
Reply to Box POK, c/o NCPhA, P.O. Box
151, Chapel Hill, NC 27514.
Pharmacist Wanted: Wanted full-time
pharmacist. Western part of the state.
Two 10 hour days in two different
locations. Three consecutive days off, no
Sundays, no nights. Both in resort setting.
Contact Jack Alexander, (704) 526-2366.
Pharmacy for Sale: Piedmont area
pharmacy with annual sales of over
$500,000. Annual increase each year.
Owner will assist in financing if necessary.
Contact Box RK, c/o NCPhA, P.O. Box
151, Chapel Hill, NC 27514.
Want to Buy: Profitable Drugstore on
Contract. Prefer Eastern/Central North
Carolina. Would consider other areas of
the state and other types of financing with
low money down. Reply to PDQ, c/o
NCPhA, P.O. Box 151, Chapel Hill, NC
27514.
Pharmacists
Newland, North Carolina
We are an industry leader in the operation of
community drug stores and are actively seeking
professional Pharmacists who are interested in a
prosperous association with a Pharmacy-
oriented company These individuals must be
health care professionals who enjoy patient
contact and are concerned about the wellness
of the community.
Due to our numerous innovative methods, we
are able to allow our Pharmacists to develop
both their professional and business careers. Our
store design encourages patient contact and, in
order for us to maintain our leadership role, our
Pharmacists are responsible, as well as
encouraged, to advise customers regarding over-
the-counter products.
We offer a salary and benefits plan that are
unequalled by any other drug chain (a claim
which we are extremely proud of) and the
opportunity to join a solid company with
definite goals of success
Qualified, interested candidates should contact:
A.D. North at 615-282-5722. An equal
opportunity employer, m/f/h.
t7ReVC0D.S..ING.
Pharmacist Wanted: The Department of
Pharmacy Services at Sampson County
Memorial Hospital has opportunities
available for hospital pharmacy practice.
This 145-bed JCAH approved hospital is
located within 1 hour drive of the coast.
Good working conditions with Nursing
and Medical Staff. Excellent starting
salary, plus comprehensive benefit
package. Activities include: complete
computerization, unit dose, IV admixture,
patient profile and inventory control.
Patient care services include: antibiotic
monitoring, TPN, Aminoglycoside dosing
and support for continuing education.
Contact: Patricia Britt, Director of
Personnel, or Jenny Strickland, Director
of Pharmacy at (919) 592-8511.
Pharmacist Wanted: Call Norwood at 259-
2676.
OmAj Varieties
October, 1987
In Delaware,
Maryland,
Virginia, the
District of Columbia,
North Carolina,
South Carolina,
Georgia,
and Florida,
two words
insure responsive,
efficient healthcare
distribution. . .
Owens & Minor.
=JOwens&
Minor, Inc.
2727 Enterprise Parkway Richmond, Virginia 23229
For additional information, please contact:
Hugh F. Gouldthorpe, Jr. or Hue Thomas, III
804/747-9794
Dr.T.C. Smith Co. / W.H.King Drug
ASHEVILLE, N.C. 28806 • 704/258-2645
RALEIGH, N.C. 27622 • 919/782-8400
TOTAL
HOMESPUN
SERVICE
In today's business rush we take the time to help
you with your management decisions . . . whether its
over coffee or part of a regular sales call. We will fill
your order with care and with dispatch today. Just as
we did in 1869.
We use advanced technology to lead in service to our
customers.
Some of our available programs are Electronic Order
Entry • Merchandising and Programming • Valurex
Advertising & Promotion • Retail Pricing • Micro-
fiche • Pharmacy Computer Systems • Home
Health Care and much more.
Whether you take your coffee
black or with cream,
call us to find
out more details.
VALUREX INDEPENDENT
Valurex
•PHARMACY
ADVERTISING & PROMOTIONAL
PROGRAMS
TO HELP YOUR BUSINESS IS OUR BUSINESS'
4
THE GIROUNk
JOURNN-OfPHN^MkCY
or
LU
GO
1^
O
>
go
o
on
LU
CQ
s
Health Sciences Librar
223-H
UNC
Chapel Hill, HC 27514
Gregory G. Kergosien, Jr., right, State Government Relations Manager for the Upjohn
Company, is shown presenting a commemorative mortar and pestle to Julian E.
Upchurch, NCPhA President. The Mortar and Pestle celebrates Upjohn's Centry of
pharmaceutical manufacturing.
University of North Carolin?
fin in iniiinui
Looking for a
Dependable Wholesaler?
Look to Kendall.
Kendall customers choose us because
we know the pharmacy business and give
excellent service. Kendall offers evening
order-taking and fast delivery. Also look
to Kendall for Drug Store Designs and
Fixtures, Pricing Strategies, Microfiche,
Advertising Programs and Electronic
Order Entry.
Kendall also offers the Triad Pharmacy
Computer System, featuring Prescription
Processing, Drug Interactions, Accounts
Receivables, Third Party Billing and
Medi-Span Price Updates. Triad
increases efficiency and organization, is
easy to use, and is fully supported by
Kendall. Call Triad direct at
1-800-532-3087.
Count On
1[7KEI\IDAI_I_
M\ \ DRUG COIVIR/VIMV
1305 Frederick St. • P.O. Box 1060 • Shelby, N.C. 28150
N.C. 1-800-222-3856
S.C. 1-800-438-5330
Justice Drug Company
P.O. Box 22025
Greensboro, NC 27420
AN ALCO STANDARD COMPANY
Now in our 87th Year of Service to the North Carolina Pharmacists
1-800-632-1295
P
WTW Partnership
For Profit
Family
Independent
Pharmacy
Total Retail Concept
The Family Independent Pharmacy program provides an
all-inclusive plan covering every aspect of marketing,
merchandising, and management of drug store opera-
tions. It is a wholesaler-sponsored voluntary, and it
embraces the total retail concept in all its forms.
IHHC
TOTAL HOME HEALTH CAME
Our Total Home Health Care™ Program offers Durable
Medical Equipment for Rent or Resale. Third Party Billing
for Medicare/Medicaid.
Additional
* Services & Programs Offered *
Store Plan-O-Gram: Complete Store Layouts Design
including Fixtures, Merchandise Plan-o-graming,
and Pricing Strategies
Specialty (Jift Departments including Arts & Crafts
Affordable Pharmacy Computer Systems
LIBERTY DRUG SYSTEMS, INC.
QS/1 PHARMACY SYSTEMS
Merchandise Racking Service
Group Life
And Health
Insurance
Benefits
For Members Of
North Carolina
Pharmaceutical
Association
Jefferson-Pilot Life Insurance Company is pleased to
have been selected as the Group insurance carrier for
the North Carolina Pharmaceutical Association. It would
be to your advantage to become thoroughly acquainted
with the benefits of this program.
You can expect the best possible service from
Jefferson-Pilot, one of the nation's leading Group
insurance carriers. For full information, contact Mr. Al
Mebane, Executive Director, North Carolina
Pharmaceutical Association.
Write or call:
Sam P. Stuart, CLU
P. O. Box 595
Winston-Salem, NC 27102
Telephone 919/723-8811
Jfilfopsnn
Pilot
INSURANCE / FINANCIAL SERVICES
THE OIROLINK
JOURNMofPHN^MKCY
(USPS 091-280)
NOVEMBER 1 987 VOLUME 67
NUMBER 11
Officers
NORTH CAROLINA
PHARMACEUTICAL
ASSOCIATION
President
Julian E. Upchurch
5201 Pine Way
Durham, NC 27712
(919) 477-7325
Vice Presidents
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh, NC 27612
(919) 876-5600
W. Robert Bizzell
1007 Rhem Street
Kinston, NC 28501
(919) 527-6929
Loni T.Garcia
5210 McLeod Road
Lumberton, NC 28358
(919) 738-6441, Ext. 7317
Executive Director
& Editor
A. H. Mebane, III
P.O. Box 151
Chapel Hill, N.C. 27514
NCPhA Office
(919)967-2237
or
1-800-852-7343
CONTENTS
Endowment Fund Dinner 4
NC Pharmacy Tripartite Committee 7
State Board of Pharmacy 13
Census of Pharmacists & Pharmacies 16
Reciprocity Questions Most Often Asked 17
Heart Disease and Diabetes 19
CE Course: Artificial Sweeteners 23
CE Test 29
News About People 33
Classified Advertising 34
ADVERTISERS
APHA 18
Colorcraft 15
Dr. T.C. Smith Co./W.H. King Drug Back Cover
Geer 22
Gene Minton Consulting Services 8
I.C. Systems 10
Jefferson Pilot 2
Justice Drug Company 1
Kendall Drug Company Inside Front Cover
Lilly 30
Marion Laboratories 6
Medi-span 33
Owens & Minor, Inc Inside Back Cover
Return Goods Manual 36
Upjohn 12
Washington National Insurance Company 14
The Carolina Journal of Pharmacy is published monthly by the
North Carolina Pharmaceutical Association, P. O. Box 151,
Chapel Hill, NC 27514. The Journal is provided to NCPhA
members through allocation of annual dues. Subscription rate to
non-pharmacists (continental US) $20.00. Single copy price
$2.00. Overseas rates on request. Second class postage paid at
Chapel Hill, NC.
THE CAROLINA JOURNAL OF PHARMACY
ENDOWMENT FUND DINNER RAISES $17,000.00
The First Annual Endowment Fund Dinner
held Saturday night, October 17, 1987, at the
Kenan Center in Chapel Hill, raised over
$17,000.00 for the NCPhA Endowment Fund.
Planned and promoted by the Board of
Trustees of the Endowment Fund, the dinner was
attended by over fifty pharmacy leaders and
spouses from across the state. The one-hundred a
plate fund-raiser featured Jonathan C. Peck,
Associate Director of the Institute for Alternative
Futures, Alexandria, Virginia who spoke on
"Pharmacy — Yesterday, Today and Tomor-
row." Mr. Peck was introduced by Roy
Bussewitz, Federal Governmental Relations
\ <s- *i * z m
X ? f >
1 &
Endowment Fund Dinner. Left to right: Roy Bussewitz, Glaxo, Inc., Milton and Neta Whaley,
Jonathan Peck, and Al Mebane. Photo by Colorcraft.
Manager, Glaxo, Inc., who sponsored the
speaker.
L. Milton Whaley, Chairman of the Board of
Trustees of the NCPhA Endowment Fund, was
the Master of Ceremonies for the program
following the dinner and introduced the special
"Endowment Fund Members", persons who had
contributed one thousand dollars or more to the
Endowment Fund. Those "Endowment Fund
Members" are M. Keith Fearing, Jr, Manteo;
Howard Q. Ferguson, Randleman; Robert B.
Hall, Mocksville; Frances Rader Lena, Dallas,
Texas; J. Marshall Sasser, Smithfield; William J.
Taylor, Burlington; B.R. Ward, Goldsboro; and
L. Milton Whaley, Durham. Special mention
was made to Glaxo, Inc. for their sponsorship of
the speaker and a five thousand dollar
contribution to the Fund. "Endowment Fund
Members" are to receive a plaque designed for
them, bearing the NCPhA Coat of Arms. In
addition, a permanent plaque will be installed in
the Institute of Pharmacy in Chapel Hill and each
"Endowment Fund Member's" name will be
engraved on it.
The evening was an elegant affair in the
beautifully appointed Kenan Center, with light
music during the reception and dinner provided
by Musica, a professional quartet who played the
violin, viola, cello and flute. Dinner was catered
by Savory Fare, Durham, one of three caterers
November, 1987
THE CAROLINA JOURNAL OF PHARMACY
permitted to serve at the Kenan Center.
Funds raised by the dinner go into the
Endowment Fund of the NCPhA and interest
generated by the investment of these monies
support special programs and projects of the
Association. The principle of the Endowment
Fund is not touched, only the interest, and only
on authority of the Executive Committee of the
NCPhA. Often the upkeep of the Institute of
Pharmacy, headquarters of the NCPhA, is
financed by proceeds from the Endowment
Fund, avoiding increase in membership dues.
Members who attended the Dinner but did not
contribute one thousand dollars have their
contributions recorded and if, over the years, they
accumulate a total of one thousand dollars, they
will be recognized as "Endowment Fund
Members".
NORTH CAROLINA PHARMACEUTICAL ASSOCIATION
ENDOWMENT FUND
Board of Trustees
L. Milton Whaley, Chairman
P.O. Box 51099
Durham NC 27717
Howard Q. Ferguson
P.O. Box 65
RandlemanNC 27317
Robert B. Hall
P.O. Box 816
Mocksville NC 27028
Albert P. Rachide
302 Country Club Drive
Jacksonville NC 28540
M. Keith Fearing, Jr.
P.O. Box 1049
Manteo NC 27954
Julian E. Upchurch
5201 Pine Way
Durham NC 27712
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh NC 27612
Light entertainment provided by Musica during the Endowment Fund Dinner and Reception.
November, 1987
YOUR ROLE
IN HEALTH CARE
IS CHANGING.
SO IS OURS.
Pressures for change in the practice
of pharmacy are coming from within the
profession and from without. As a key member
of the health care delivery team, you need
to be aware of the economic and professional
forces that are driving these changes.
Marion Laboratories believes that the
better you're prepared for these changes,
the more you'll benefit, both personally and
professionally, from this new environment.
That's why Marion sponsors annual
leadership conferences for new presidents
of state pharmacy associations. That's also
why Marion recently joined with Drug
Topics magazine to fund a study on the effects
that HMOs and PPOs are having on the
practice of pharmacy.
By supporting pharmacy programs like
these, Marion hopes to make these changes
more understandable and worthwhile for
you. It's Marion's way of making our
commitment to your profession felt, not just
in words, but by positive, useful actions.
Service to Pharmacy M MARION
J -LVA LABORATORIES INC
PHARMACEUTICAL DIVISION
THE CAROLINA JOURNAL OF PHARMACY
THE NORTH CAROLINA PHARMACY
TRIPARTITE COMMITTEE MEETING
Monday, September 14, 1987
Institute of Pharmacy
Chapel Hill, NC
MINUTES
Members Present: Evelyn Lloyd (Chairman), Joe
Johnson (Vice Chairman), Steve Caiola
(Secretary), Whit Moose, Linda Butler, Pam
Joyner, Tom Hughes, Bob Greenwood, George
Cocolas
Ex Officio Members Present: David Work, Al
Mebane, Fred Eckel, Ron Maddox
Student Guests Present: Monte Yoder, Joe
Moose, Ken Krause, Conley McCoy
The meeting was called to order by Chairman
Lloyd at 7:10 PM. Ms. Lloyd welcomed new
committe members representing the Campbell
University School of Pharmacy and the North
Carolina Society of Hospital Pharmacists. She
also gave a special welcome to the student guests.
All members then introduced themselves and
stated the organization whom they represented.
Chairman Lloyd mentioned the positive effect
upon North Carolina pharmacy created by
UNC-CH Schoolof Pharmacy Dean Tom Miya's
newspaper article on physician dispensing and
Board of Pharmacy Executive Director David
Work's article (in American Pharmacy) on
illiteracy and pharmacists' awareness of the
problem. Ms. Lloyd then turned to the student
guests and invited them to participate fully in the
Committee's deliberations.
1 . Approval of the Minutes of the Last Meeting
On the motion of Whit Moose and the second
of George Cocolas, the Committee unani-
mously approved the minutes of the October
20, 1 986 Committee meeting.
2. Reports From the Member Organizations:
a. Board of Pharmacy.
Executive Director, David Work,
explained that the Federal Trade
Commission is attempting to get the Board
to change its Regulations regarding
prescriptions by mail and prescription
drop-offs. At present, the Board
Regulations prohibit prescription drop-
offs. The Board is proposing an
amendment to its Regulations to allow
prescription deliveries but not permit
prescription drop-offs. Hearings will be
held in the near future regarding these
amendments.
The Board Regulations prohibit mailing
prescriptions where no physician-
pharmacist-patient relationship exists.
The Board has appointed a committee to
study this issue and may introduce
legislation regarding the matter at the next
session of the General Assembly.
Whit Moose mentioned Al Mebane's
letter to the Board regarding the propriety
of a patient picking up prescriptions that
have already been filled, but the pharmacy
is closed at the time the patient comes to
obtain the medication. No regulations or
statutes prevent this practice. It is the
feeling of the Board that if the State
Association would support mandatory
pharmacist counseling at the time patients
receive their prescriptions, the Board of
Pharmacy would consider developing a
regulation to support this practice.
David Work mentioned that the Board is
planning a new publication. Starting in
October, the regular Board newsletter will
be supplemented with a second publica-
tion entitled Report on Invalid Prescrip-
tions (RIP Sheet). The RIP Sheet will
cover such items as stolen prescription
blanks and give brief reports of current
schemes people are using to obtain
controlled substances. The RIP Sheet will
be published on a "prn" basis and will be
distributed through wholesalers, at least
for the first distribution, to decrease
mailing cost,
b. The North Carolina Pharmaceutical
Association
Al Mebane stated that for the past six
months, the NCPhA had concentrated its
efforts on legislation at the state level. The
outcomes had been quite satisfying. Bills
regulating physician dispensing, and drug
repackaging, the prescription fee for
Continued on page 8
November, 1987
THE CAROLINA JOURNAL OF PHARMACY
Tripartite Committee
Continued from page 7
Medicaid patients, and the State
Employee Health Benefit Program all
reflected benefits for pharmacy. At the
federal level, the next session of Congress
should pass a bill bringing tighter control
to drug samples and decreasing the
opportunity for drug diversion. Another
bill related to physician dispensing for
profit will probably not come before the
Senate during this session. It may be
considered during the next session by
Senator Kennedy's Committee. Also on
the national scene, a bill regarding
Medicare catastrophic illness will most
likely include a drug benefit. The exact
nature of this benefit is still being debated.
A major problem concerns how often
drug charges will be updated.
Al then mentioned that the 1988 NCPhA
convention will be held in Asheville at the
Grove Park Inn and that the 1989
convention will be held at Myrtle Beach in
the Myrtle Beach Hilton.
The North Carolina Society of Hospital
Pharmacists
Tom Hughes highlighted the recent
Regional Consensus Development
Conference held in Charlotte, August 23
to 25. This was a follow-up to the Hilton
Head Conference sponsored by the
American Society of Hospital Pharmacists
during February 1985. The Charlotte
Conference consisted of representatives
from the North Carolina, South Carolina,
and Virginia Societies of Hospital
Pharmacists. The conference format
called for each state to work individually
to develop a consensus regarding goals
and objectives for clinical pharmacy
practice, to identify barriers to reaching
these goals and objectives, and then to
identify strategies to overcome these
barriers. The outcomes of this Conference
will be published in the next NCSHP
newsletter. In the near future, a consensus
development conference will be con-
ducted for our state's hospital pharmacy a
directors. This is a direct attempt to take
the outcomes of the regional meeting held
in Charlotte down to the next level in the
continuum to the grass roots practitioner.
The outcomes of the Charlotte meeting
also will be distributed to other pharmacy
organizations in our state and to the Board
of Pharmacy through Bill Adams, who
represented the Board at the Charlotte
meeting.
A NEW SERVICE TO THE INDEPENDENT AND SMALL
CHAIN PHARMACY OWNER
Professional Management Consulting by
Gene Minton, RPH
. . . Now you can benefit from 10 years experience in supervisory management of
high volume drug stores on an individual and group basis.
. . . Consultation in all areas of decision making such as product mix, pricing,
merchandising, remodeling, site selection, computer applications (and selection),
Rx pricing, advertising, personnel management, etc. with emphasis on results and
the bottom line.
. . . Let us plan your next remodel, design your new store, show you how to save
money on fixtures, evaluate wholesalers, analyze your p&l, and many other
services to make you happier with your store & your profits.
. . . Can you afford not to call?
contact Gene Minton at Gene Minton Consulting Services, 6 Lake Shores, Littleton,
NC 919-586-5465. (All client information held in strict confidence).
November, 1987
THE CAROLINA JOURNAL OF PHARMACY
Tom also reported that the Board of
Pharmaceutical Specialties had denied a
request to name "Clinical Pharmacy" as a
specialty. The NCSHP had submitted
their recommendation to the American
Society of Hospital Pharmacists that
Clinical Pharmacy not be declared a
specialty because, as defined in the
submission, Clinical Pharmacy was the
base of all pharmacy practice and not a
specialty. The NCSHP officers are now
reviewing a draft of a proposal to
recognize Nutrition Support Pharmacy
Practice as a specialty. The NCSHP Board
supports this specialty designation and
expects the Board of Pharmaceutical
Specialties to approve this application.
When asked what it generally took to
become Board certified, Tom responded
that requirements usually involved the
doctor of pharmacy degree, residency
and/or fellowship, significant experience
in practice, and passing the certification
examination.
Tom reminded Committe members of the
upcoming NCSHP Continuing Education
Programs. On September 17, in
Greensboro, the Society's SIG on Adult
Clinical Pharmacy Practice is sponsoring
a program entitled New Advances in Drug
Therapy. On October 6, 7, and 8, the
Society's Annual Carolina Hospital/
Clinical Pharmacy Seminar is being held
in Raleigh,
d. School of Pharmacy,
Campbell University —
Dean Ron Maddox stated that the second
class at Campbell University's School of
Pharmacy consists of 70 students who
were admitted from among 202
applicants. Eighty-five percent of the
admissions are North Carolina Residents,
56% being female and 29% having a bacca-
laureate degree. The overall grade point
for the class is 3.2. Enrollment in the
School of Pharmacy is now 120, with 1 1 1
pre-pharmacy majors also being on
campus at Campbell.
In January, Dr. Robert Greenwood and
Dr. Alan Richards joined the School's
faculty. Dr. Greenwood had been on
faculty at the University of Oklahoma
College of Pharmacy, and Dr. Richards
was in a research position at the
Department of Agriculture Research
Sevice. Dr. Thomas Wiser joined the
faculty in February as Chairman and
Professor of Pharmacy Practice. Dr.
Wiser had been in practice and teaching
for 14 years at the University of Maryland
School of Pharmacy. In March, Dr.
Edward Soltis completed post-doctoral
training at the University of Iowa and
joined the Pharmaceutical Science
Faculty. In August, two more faculty
came to Campbell. Dr. Thomas Holmes
left the University of Minnesota College of
Pharmacy, where he won three teaching
awards, to join the Campbell faculty. Dr.
Constance McKenzie came to Campbell
from Mercer University where she
received post-doctoral training in drug
information. Seven other faculty positions
are to be filled this year. These include two
positions in pharmacology, two in internal
medicine, one in geriatrics, one in
ambulatory medicine, and one in
pharmaceutics.
Immediate plans for the School of
Pharmacy include: establishment of a drug
information center, completion of
research facilities, interfacing of training
activities with the University of North
Carolina School of Pharmacy, and the
continued development of the clerkship
program,
e. School of Pharmacy, University of
North Carolina — Chapel Hill
George Cocolas reported that the School
of Pharmacy continues to be one of the
larger schools in the country. Its B.S.
enrollment in the last three years is 529.
The student body composition is 67%
female. This year's beginning class has 1 72
students selected out of an applicant pool
of about 350. The class is 74.1% female.
Only 30% of the applicants for this class
were males.
Three faculty members have retired this
year. Mel Chambers retired after 26 years
of service to the School. Jack Weir has left
after 25 years of service. Dr. Larry Leflor
has retired after 17 years because of
declining health.
The School is a "big business". Of its
budget of over $5 million, $1.3 million
was generated by the faculty from
Continued on page 11
November, 1987
1 0 THE CAROLINA JOURNAL OF PHARMACY
A MEMBERSHIP SERVICE
Do \bu . . .
. . . think you're too small
to get good collection service?
We suggest you try I.C. System. I.C. System has been researched,
investigated and has made it through the tough approval process
required to become an endorsed membership service.
It doesn't matter where you are located or where your debtors live,
I.C. System is there. It's immaterial what the age or condition of your
accounts are, I.C. System goes after them. Even ones as small as
$15.00. I.C. System is made available to members. You won't find
them advertised elsewhere. You won't even find them in your phone
book. They are a service company specializing in collecting for
members of associations and societies nationwide.
If you have any doubts about what you are now doing to control
accounts receivable, try I.C. System. You owe it to yourself. And,
The System Works.
Write for literature to: I.C. System, P.O. Box 64444, St. Paul, MN 55164 0444
Send me facts about I.C. System:
Name (Firm)
Address
City State Zip
Signed
Tide
3362
November, 1987
THE CAROLINA JOURNAL OF PHARMACY
11
Tripartite Committee
Continued from page 9
extramural contracts and grants. Programs
such as the Natural Products Laboratory
under the supervision of Dr. K . H . Lee, the
Radiosynthesis Laboratory under the
direction of Dr. Steven Wyrick, and the
Health Policy Research Laboratory under
the direction of Dr. Jane Osterhaus are
some of the in-house programs that
provide a spectrum of research activity
and a source of financial support to the
School.
The School recently published its
Strategic Plan after over a year of study.
The Plan lists ongoing programs, their
immediate and long-term goals, and areas
where new projects and programs should
be developed. The Strategic Plan identifies
a set of charges for the administration and
faculty to address to aid in the
development of the School and allow for
orderly growth into an even stronger
educational institution.
The School's B.S. curriculum remains
essentially the same. However, the
Pharm.D. curriculum has been modified
to allow the inclusion of elective courses
and provide flexibility for the student who
has special interests. There are 29 students
in the Pharm.D. program; the beginning
class consists of 15 students.
Finally, the School is undergoing some
minor renovations to increase the number
of small classrooms and provide needed
office space for staff. The renovations
should be completed by the beginning of
Spring Semester, 1988.
3. Election of Officers
The following committee members were
nominated for office and approved by
acclamation by the committe:
Chairman: Joe Johnson (representing the
NCPhA) on the motion of Linda Butler
and the second of George Cocolas
Vice Chairman: Pam Joyner (representing
the NCSHP) on the motion of Tom
Hughes and the second of Al M ebane
Secretary: Tom Wiser (representing the
School of Pharmacy at Campbell
University) on the motion of Whit Moose
and the second of Bob Greenwood
4. Adjournment
Joe Johnson assumed the office of Chairman
of the Committee and accepted a motion for
adjournment at 8:43 p.m. (on the motion of
Fred Eckel and the second of Steve Caiola).
Respectfully submitted,
Stephen M. Caiola
MADDOX PARTICIPATES IN INDUSTRY PROGRAM
Ronald W. Maddox,
Pharm.D., professor and
dean of Campbell Uni-
versity School of Phar-
macy in North Carolina,
recently spent two weeks
at Merrell Dow Phar-
maceuticals Inc.'s world-
wide headquarters in
Cincinnati. He was one of two pharmacy school
faculty members visiting Merrell Dow through
the Pharmaceutical Manufacturers Association's
(PMA) Coordinated Industry Program for
Pharmacy Faculty.
Created in 1 976, the program was established
to enable pharmacy faculty members to better
understand the current industry by providing an
overview of different aspects of a pharmaceutical
company's operations. Selected faculty
participate in two-week conferences sponsored
by individual PMA-member companies. Topics
covered can include such areas as sales,
manufacturing, research, marketing, product
development, legal and regulatory affairs, and
quality control.
Dr. Maddox was born and raised in Centre,
Alabama. He received his bachelor's degree in
Pharmacy in 1969 from Auburn University in
Alabama. He subsequently worked as a
pharmacist and assistant manager at a pharmacy
in Anniston, Alabama. Following two years of
active duty as a pharmacy officer at Fort Rucker,
Alabama, he entered the Doctor of Pharmacy
program at the University of Tennessee. After
graduation, he joined the faculty at Mercer
University's Southern School of Pharmacy in
Atlanta, Georgia, where he taught the first
Pharm.D. students and assisted in the
development of the Clinical Pharmacy program.
After twelve years at Mercer, he decided to accept
the challenge of starting a new school of pharmacy
Continued on page 15
November, 1987
ip-^
,■,,„,,,
£>
Through their expertoice
ycxir concerns
Throtjgh their insjgHts
is panelists, we discovered
/ideas.
The members of our 1987 Pharmacy Consultant Panel
spoke from personal experience. But their ideas and concerns
spanned the breadth of our profession. We thank them
for sharing their wisdom, experience and advice. Most
of all, we look forward to putting their ideas to work
to serve pharmacy professionals better.
Oarwyn j Warn Hwn—
W»wn G Than. Rwnnl Dannyfl J W»«ms.
vtc* PraMcni Pn
Hm»i Sovkm & Pharmacy C*m»ara Mm 0mo» mc
VWgrawi t>ug Skm ttfcnaw Cty, »
Merrfy Hhudy Phaimac*
' Thomas R Tomp4t. Pharmacol
Ekocukva Dvactor
Dwctt o( Pharmacy
UCSOMaAcalCanlw
SanRego.CA
Not pcfurad Barnard MoN. Pharmac*. Oracror ol Pharmacy Mount Sum Hoaprttl. Now VoA. NT
m J Pwcwo Jr Pharmacol. Auor mm Mack* Caracal Sewtw Crwndtr* Medical Conic lanngton.
= Upionn Company.
THE CAROLINA JOURNAL OF PHARMACY
13
STATE BOARD OF
PHARMACY
Members — W. R. Adams, Jr., Wilson; Harold V. Day, Spruce Pine; W. Whitaker Moose,
Mount Pleasant; W. H. Randall, Liilington; Evelyn P. Lloyd, Hillsborough; Joseph R. Roberts,
III, Gastonia; David R. Work, Executive Director, P. O. Box H, Carrboro, NC 27510.
Telephone # (919) 942-4454
Permits Issued 9/14/87
Big Star Pharmacy
Benchmark Sq. S/C
2920 Randleman Rd.
Greensboro
Kerr Drugs
Glenwood Village
1218 Raleigh Rd.
Chapel Hill
Kerr Drugs
Pinecrest Plaza
38 Pinecrest Plaza
Southern Pines
Kroger Sav-On
3650 Raleigh Rd.
Fayetteville
PHARMACY PERMITS ISSUED
Permits Issued 9/29/87
Reidsville Pharmacy
924 South Scales St.
Reidsville
Revco Discount Drug Center
1318 Lees Chapel Rd.
Church Crossing S/C
Greensboro
Permits Issued 10/5/87
Kerr Drug Store
245 Timber Dr. West
Garner
Kerr Drug Store
Westchester Commons
1677 Westchester Dr.
High Point
OPT.I.O.N. Care, Inc. (LSP)
Baldwin Woods
Whiteville
Revco Discount Drug Center
231 West Mill St.
Columbus Plaza S/C
Columbus
Rite Aid Discount Pharmacy
Old Hickory S/C, Rt. 16
Waxhaw
Permits Issued 9/15/87
Gates Co. Health Dept. Phcy. (LSP)
Easons Crossroads
Gatesville
Permits Issued 9/22/87
Kaiser Permanente
South Sq. Medical Office
3500 Westgate Dr., Suite 705
Durham
Phar-Mor
1001 1 E. Independence
Matthews
Revco Discount Drug Center
Creekside Ctr. S/C
799 West Charlotte Ave.
Mt. Holly
Wal-Mart Pharmacy
1063 Yadkinville Rd.
Mocksville
Wal-Mart Pharmacy
1227 Burkemont Ave.
Morganton
Permits Issued 10/9/87
Drug Emporium
8330 Pineville-Matthews Rd.
Pineville
Rite Aid Discount Pharmacy
R #1453 @ 31st St.
Hickory
Continued on page 15
November, 1987
We're not
~Y! strangers...
LUasninpcon
national
INSURANCE COMPANY
NCPhA-Endorsed Insurance Plans
Which Merit Member Participation
DISABILITY INCOME PLAN HOSPITAL INCOME PLAN
MAJOR MEDICAL EXPENSE PLAN TERM LIFE PLAN
RETIREMENT AND PROFIT SHARING PLANS
FOR DETAILS WRITE OR TELEPHONE:
HOYT W. SHORE, CLU and Associates
821 Baxter Street-Suite 316
Charlotte, North Carolina 28202
O
Telephone (704) 333-3764
uuasninqeon
national
INSURANCE COMPANY
Evanston. Illinois 60201 • A Washington National Corporation Financial Service Company
THE CAROLINA JOURNAL OF PHARMACY
15
Permits Issued
Continued from page 13
Permits Issued 10/19/87
Carteret Co. Health Dept. (LSP)
Court House Sq.
Beaufort
Crown Drugs, Inc.
West Market Sq. S/C
708 Salisbury Blvd., West
Salisbury
Drug Emporium
3400 Westgate Dr.
Durham
Kerr Drugs
Norman Crossing
2042 Hwy. 73
Cornelius
Lenox Baker Children's Hospital Phcy. (LSP)
3000 Erwin Rd.
Durham
Pender Co. Health Dept. (LSP)
Burgaw
Pharm-Mor
6270 Glenwood Ave.
Raleigh
Revco Discount Drug Center
1407 West Church St.
Cherryville
Revco Discount Drug Center
Magnolia Plaza
1247 Brukemont Ave.
Morganton
Permits Issued 10/20/87
Chatham Health Dept. (LSP)
Rt. 5, Box 5 (Old Graham Rd.)
Pittsboro
Chatham Co. Health Dept. (LSP)
1 105 E. Cardinal St.
Siler City
Lee Co. Health Dept. (LSP)
402 W. Makepeach St.
Sanford
Permits Issued 11/2/87
Farmco Drug Center
8111 CreedmoreRd.
Raleigh
Revco Discount Drug Center
Rt. 7, US Hwy. 74, Ingles S/C
Fairview
Revco Discount Drug Center
College Park Plaza
929 McArthur Rd., Suite 206
Fayetteville
Revco Discount Drug Center
Wal-Mart Plaza
1035 Yadkinville Rd.
Mocksville
Rite Aid Discount Pharmacy
1987 Cotton Grove Rd.
Lexington
Permit Issued 11/10/87
Corner Drug Store, Inc. (T/O)
2 South Main St.
Franklinton
Maddox
Continued from page 11
in his current position at Campbell University.
"I thoroughly enjoyed this unique opportunity
to experience operations of a major pharma-
ceutical company," said Dr. Maddox in
commenting on his visit to Merrell Dow. "It was
reassuring to see the commitment to quality and
excellence in pharmaceutical manufacturing at
Merrell Dow."
Remember the °Day
...incPictures
COLORCRAFT
North Carolina's Most Complete
Film Processing Service
There Is A Plant Located
Near You
For the Finest Quality Plus Fast
Dependable Service on All Your
Photo Needs, Contact the Plant
Nearest You.
CHARLOTTE WILMINGTON
KERNERSVILLE RALEIGH
FAYETTEVILLE DURHAM
If You Don't Know Photofinishing
Know Your Photofinisher
November, 1987
16 THE CAROLINA JOURNAL OF PHARMACY
NORTH CAROLINA BOARD OF PHARMACY
CENSUS OF PHARMACISTS AND PHARMACIES
PHARMACISTS
Total number of pharmacists licensed and on roster September 30, 1986 5,404
Total number of pharmacists residing in North Carolina 4,418
inactive 417
Known status for in-state pharmacists 3,894
Breakdown of employment in state:
In retail community pharmacy (independent) 1,320
In retail community pharmacy (chain stores) 1,507
In hospital pharmacies 800
In nursing homes 8
In teaching and government positions . . , 33
In manufacturing and wholesale 38
In sales and research 67
Other 121
Place of practice unknown 1 07
Breakdown of age groups of pharmacists residing in NC:
Under the age of 30 929
In the age group of 30-39 1,548
In the age group of 40-49 850
In the age group of 50-59 600
In the age group of 60-65 244
Over the age of 65 247
* Breakdown of inactive status:
Retired 112
Unemployed or unknown 305
In-state female pharmacists 1,399
In-state male pharmacists 3,019
Total number of pharmacists who reside out-of-state 986
Out-of-state female pharmacists 375
Out-of-state male pharmacists 611
PHARMACIES
Total number of pharmacy permits on roster September 30, 1986 1,900
Number classified as retail pharmacies (independent) 836
Number classified as retail pharmacies (chain — 4 or more) 754
Number classified as hospital pharmacies 1 57
Number classified as nursing homes 18
Number classified as others 135
November, 1987
THE CAROLINA JOURNAL OF PHARMACY
17
RECIPROCITY QUESTIONS MOST OFTEN ASKED
Reprinted with permission from the National
Association of Boards of Pharmacy October
1987 Newsletter.
1 . If an applicant reciprocates more than once
within a short period of time, how much of the
reciprocal application process is repeated by the
NABP office?
A 11 of it. There is a need to update information
on preliminary applications each time a
pharmacist reciprocates.
2. Do you have to give up your license in your
original state of licensure when you reciprocate?
No.
3. Do you need to keep your license in your
original state of licensure in good standing to
keep your reciprocal licenses in good standing?
No.
4. Can a license acquired by score transfer be
used as a base for reciprocity?
Yes. Licenses acquired through score transfers
are considered licenses by full board
examination.
5. Can a license acquired by reciprocity be
used as a basis for reciprocity?
No.
6. Can an applicant reciprocate to more than
one state at the same time?
Yes — $125/state.
7. Can an applicant reciprocate if he/she has
not be actively engaged in the practice of
pharmacy?
This depends on individual state requirements.
See the NABP Survey of Pharmacy Law.
8. What does an applicant need to do if they
have let the license in the original state of
licensure lapse? Does NABP maintain the
requirements for reinstatement of a license?
// an applicant lets the license in his/her
original state of licensure lapse he/she needs to
become reinstated in that state. NABP does not
maintain the requirements for reinstatement
because they vary from state to state and can
change at any time.
9. Is internship an important factor in
reciprocity?
Only during the first year of practice. If an
applicant has not been licensed one full year and
doesn't meet internship requirements in a state
he/she may not be eligible to transfer licensure.
10. What is the applicant required to provide
to NABP to initiate the reciprocal process?
A completed NABP Preliminarv Application
and $125.00 fee.
1 1 . What is the applicant required to provide
to the board to complete the process?
The NABP Official Application with all
necessary attachments and information, and
appropriate fees.
12. What type of credentials check and
character search does the NABP office conduct?
Status of all pharmacy licenses; educational
credentials; disciplinary actions taken against any
pharmacy licenses; past and present employers to
verify employment in pharmacy.
13. Does the NABP office provide informa-
tion on when the reciprocity hearings are
scheduled?
No. We advise applicants to contact the state
boards of pharmacy.
14. Does NABP office provide a copy of the
individual state laws to the applicant to prepare
for the state jurisprudence examination?
No. Contact the state boards of pharmacy.
15. How long does it take to process a
reciprocity application? in the NABP office? to
complete the paper work?
It takes NABP from four to six weeks to
process an application; it will take the applicant
approximately two more weeks to complete the
requirements for filing an Official Application.
16. Once the NABP Official Application has
been issued for one state, can it be changed to use
in a different state?
Yes; the application is reviewed again to ensure
that the state requirements have been met.
17. What are the time requirements on an
Official Application, once it has been issued?
90 days to complete and file the application; up
to three time extensions may be granted at $25 per
extension; application is null and void after one
year.
18. If the applicant does not return the
application within the 90 day time requirement,
for a time extension, does it become null and
void?
Application is null and void after one year.
Applicant may file for time extension at any time
during the one year period
19. What type of refund does the applicant
receive should they choose not to complete the
reciprocity transaction?
25 percent of the $125 NABP fee.
20. What type of refund does the applicant
receive if they are rejected by the recipient board
of pharmacy?
Continued on page 18
November, 1987
18
THE CAROLINA JOURNAL OF PHARMACY
Questions
Continued from page 17
25 percent of the NABPfee.
2 1 . What type of refund does the applicant
receive if they are not eligible to reciprocate to the
indicated state?
75 percent of the NABPfee.
22. On what basis would an applicant not be
eligible to reciprocate to the indicated state?
Does not meet individual state requirements;
any disciplinary actions taken against any
pharmacy licenses; lapsed license in state of
original licensure; not in pharmacy practice for
over one year; not licensed in original state of
licensure for at least one year; does not meet
citizenship requirements; attended a non-
accredited educational institution; failure of state
jurisprudence examination; inadequate score on
licensure examination.
23. Does the NABP office determine whether
or not an applicant is eligible for reciprocity?
No.
24. Is an applicant ever rejected by the board,
after the NABP recommends that they are
eligible for reciprocity? for what reasons?
It is possible, for example, due to unacceptable
licensure examination scores, or failure to pass
the jurisprudence examination.
25. How does the NABP office know if an
applicant has been rejected by the recipient
board?
Via a coupon which is attached to the Official
Application; the board completes the coupon and
forwards it to NABP.
26. What action does the NABP office take in
behalf of applicants who have been rejected?
If NABP feels that the applicant has been
unjustly rejected they will contact the board office
and ask them to reconsider the application.
27. What records are maintained in the NABP
office for reciprocal applicants? For how long?
NABP maintains, in hard copy or microfiche,
copies of all preliminary applications filed since
1965.
28. What type of information is maintained in
the disciplinary clearinghouse?
If any action has been taken against a license;
date action was taken; state action was taken in.
Type of action and additional details must be
obtained through the state board of pharmacy that
took action.
29. How many applications are processed
through the NABP office each year?
Approximately 4,000.
30. How many applicants who apply for
reciprocity are not eligible?
Approximately one percent.
3 1 . How many applicants are rejected at the
state level?
Less than two percent.
32. Does NABP maintain information on job
availability and a need for pharmacists?
No.
33. Is it true that if you hold a license in the
District of Columbia, you can practice anywhere
in the United States?
No.
34. Is there reciprocity between the United
States and the Canadian Provinces?
No.
35. Are federal employee pharmacists
required to reciprocate to a state in order to
practice in a federal facility in the State?
No.
Expand your knowledge.
Expand your know-how.
j&cparid'wg^
tnorizoi i<lS-^^
American Pharmaceutical Association
135th Annual Meeting and Exhibit
March 12-16, 1988
November, 1987
THE CAROLINA JOURNAL OF PHARMACY
19
HEART DISEASE AND DIABETES:
DEADLY LINK UNCOVERED
by William C. Duckworth, M.D.
Professor of Medicine
Indiana University School of Medicine
Indianapolis, Ind.
Heart disease, as most people know, is the
leading cause of death by disease in the United
States. It is expected to kill some 540,000 people
this year.
But here's another fact — one which all too
few people know: Diabetes, together with its
complications, is the third leading cause of death
by disease in this country. With its implications, it
will cause the deaths of 300,000 Americans in
1987.
New evidence shows a strong and deadly link
between diabetes and heart disease. In fact,
atherosclerosis (clogging of the arteries, which
can lead to coronary heart disease) is the single
most common cause of death in adults with
diabetes in the U.S.
•Compared with nondiabetic people,
approximately twice as many people with
diabetes have heart conditions. This ratio
comes out even higher when women alone
are considered.
•Coronary heart disease is present in about 13
percent of diabetic adults and congestive heart
failure in about 7 percent.
•Heart disease is involved in about 50 to 60
percent of all recorded deaths of diabetic
adults and in about 15 percent of fatalities
among diabetic children.
•The risk of death from heart disease in people
with diabetes is about twice that among
nondiabetic individuals.
•Heart disease due to blocked coronary
arteries is the direct cause oi &t least one-third
of all deaths occurring in diabetic patients
over 40 years of age.
•Diabetic patients who smoke have an even
greater risk of heart disease than do
nondiabetics who smoke.
Blood Fats Play Role
According to the American Diabetes
Association (ADA), most of the risk factors for
atherosclerosis and coronary heart disease are
much more prevalent in patients with diabetes
than in the general population.
Among the most widely studied of these risk
factors are alterations in cholesterol brought
about by the faulty metabolism that characterizes
diabetes. (Insulin deficiencies or flaws in its
action inhibit the diabetic body's ability to turn
sugar into energy.)
In untreated non-insulin-dependent diabetes,
which accounts for about 80 to 90 percent of all
diabetes in the U.S., two prominent components
of cholesterol may be altered. The proportion of
what is called very low density lipoprotein
( VLDL) may increase, and the proportion of high
density lipoprotein (HDL) may decrease.
High levels of VLDL are suspected of
contributing to atherosclerotic heart disease in
some individuals. High levels of HDL, on the
other hand, appear to lessen the risk of heart
disease. Small wonder, then, that the diabetic
patient who has developed high levels of VLDL
and low levels of HDL is at increased risk for
heart disease and, of course, for death from heart
disease.
Steps That Can Be Taken
The picture is undeniably grim, but not
hopeless. Whereas there is no way known to
prevent or cure diabetes, ways are known to
control the risk factors for heart disease — and
that is just what the American Diabetes
Association is recommending.
Diet and exercise have long been the
cornerstone of non-insulin-dependent diabetes
therapy. The objective has been to lower the
abnormal blood glucose (sugar) levels that result
when the body is unable to convert sugar into
energy.
The basic diet for people with diabetes calls for
a reduction in total fat and an increased
proportion of polyunsaturates. It is virtually the
same as the diet recommended by the American
Heart Association (AHA) for lowering the high
cholesterol levels that so often foreshadow
impending cardiovascular disease. Of particular
importance to the person with diabetes is that the
fat-modified diet reduces VLDL concentrations
Continued on page 20
November, 1987
20
THE CAROLINA JOURNAL OF PHARMACY
Heart Disease
Continued from page 19
and often can result in increased HDL levels.
Thus, strict compliance with the diet
recommended by the ADA can, in many cases,
not only bring down the high blood glucose levels
that plague diabetic patients, but also forestall the
atherosclerotic buildup that can lead to heart
disease.
Although both the ADA and AHA emphasize
that diets should be developed to serve each
individual's specific needs, both recommend diets
that restrict total fat intake to less than 30 percent
of total calories consumed. Of that 30 percent,
less than 1 0 percent should be saturated fats (such
as in dairy products or meat); unsaturated fats
(such as vegetable oil) should make up the other
20 percent. (The average American diet is about
40 percent fat.)
The ADA also notes that current evidence
suggests high-fiber diets and soluble-fiber supple-
ments are helpful in improving metabolism,
lowering total cholesterol levels and decreasing
VLDL concentrations. It says an intake of 40
grams of fiber a day (the average daily intake for
most adult Americans is around 10 to 30 grams)
can be particularly helpful. And more is
acceptable for individuals on weight-reducing
diets — a matter of special concern in non-
insulin-dependent diabetes, which so often is
characterized by obesity.
Exercise is an integral part of any weight-
reducing program, of course, but the ADA
emphasizes that exercise alone, without
concurrent caloric restriction, rarely results in
significant weight loss. Still, the ADA says, even
light exercise can be quite important in
controlling both blood glucose and cholesterol
levels.
If diet and exercise fail to cut the cholesterol
levels to at least 200 milligrams per deciliter of
blood, the physician can prescribe cholesterol-
lowering agents.
Robert Levy, M.D., the senior associate vice
president for health sciences at Columbia
University in New York, quotes one projection
that says we could lower the heart disease death
toll by 100,000 deaths a year if we could lower
the average cholesterol level by just 10 percent.
Effective means of cutting the heart disease toll
in the diabetic population, as well as in the
population as a whole, exist.
It's a goal worth setting our sights on.
WHEN WOULD YOU SUSPECT
YOU MIGHT HAVE DIABETES?
by Charles M. Clark, Jr., M.D.
Vice President
American Diabetes Association
Alexandria, Va.
Could you have diabetes and not know it?
The answer is an unequivocal yes. Of the
estimated 1 1 million people in the United States
who have diabetes only six million know it. An
additional four to five million have diabetes but
haven't yet been diagnosed. All told, that's about
5 percent of the population.
This year, there will be about 1 3,000 new cases
of insulin-dependent diabetes diagnosed in
people under the age of 20. Another half million
Americans will develop non-insulin-dependent
diabetes — and if past trends continue, about 85
percent of them will be over the age of 45.
But since the earliest extant descriptions of
diabetes go back some 3,500 years, why is it
estimated that there are almost as many
undiagnosed cases as diagnosed cases? The
answer is that although there are plenty of
warning signs of diabetes, they are — for the most
part — nonspecific and easily missed,
particularly for non-insulin-dependent diabetes,
which accounts for 85 to 90 percent of people
with diabetes.
Insulin-dependent diabetes is not that difficult
to spot, although only a physician can actually
diagnose the disease. The major warning signs,
usually found in youngsters under the age of 20,
are:
• Frequent urination, accompanied by an
unusual thirst and the drinking of an
excessive amount of fluids.
• Rapid weight loss, with frequent attacks of
fatigue, irritability and nausea.
• Extreme hunger.
When those symptoms occur suddenly, a
physician must be seen at once.
Non-Insulin-Dependent
Diabetes
Most Americans with diabetes, however, have
the non-insulin-dependent type of disease, and
that's harder to find. Usually it develops quite
gradually — so gradually, in fact, that many
patients are diagnosed only after they have gone
to the doctor for treatment of one of the many
life-threatening complications of diabetes such as
November, 1987
THE CAROLINA JOURNAL OF PHARMACY
21
heart attack, kidney disease or eye problems.
The major warning signs of non-insulin-
dependent diabetes may include any of the
previously mentioned signs, or:
• Easy fatigue.
• Blurred vision or any change in sight.
• A tingling feeling, numbness or pain in legs,
feet, fingers or toes.
• Excessive weight.
• Frequent skin infections or itchiness.
• Drowsiness.
• Slow healing of wounds.
If any of those warning signs are evident, a
diagnostic test is called for because, while
diabetes cannot yet be cured by medical science,
it can be controlled by daily insulin injections in
insulin-dependent diabetes, and usually by diet
and exercise in non-insulin-dependent diabetes.
If you have any of the diabetic symptoms, the
American Diabetes Association (ADA) says you
should be tested for the disease. And if you have
more than one of those signs, a checkup is even
more imperative.
One more factor, and a most important one:
The ADA says a diabetes screening test is
absolutely vital during pregnancy for a woman
who has given birth to a baby weighing more
than nine pounds.
Actually, the once standard urine test can only
hint at diabetes. Now, however, physicians can
come up with a highly accurate diagnosis with
blood testing, which is usually done after the
patient has gone without food for at least eight
hours, or directly after a meal or after ingesting a
measured amount of glucose (basic sugar). Each
test, of course, examines different values.
Diabetes Is Life-Threatening
But most of those warning signs are more
discomforting than life-threatening and thus are
not a cause for immediate concern. Then why
bother to check for diabetes? There are six
striking reasons:
1. Diabetes with its complications is the
number three cause of death by disease in
the U.S.
2. Diabetes is the number one cause of new
cases of blindness in Americans between the
ages of 20 and 74.
3. More than two million Americans are
hospitalized each year because of diabetes.
4. Diabetes decreases life-expectancy approx-
imately one-third, although this decrease
can be prevented by treatment. Diabetic
patients are leading longer lives these days
than they used to.
5. people with diabetes are at a higher risk of
heart disease, stroke, kidney failure and
severe nerve damage.
6. Diabetes causes 20,000 leg and foot
amputations annually as the result of
gangrene infections.
Who Should Be Checked for
Diabetes?
One in every 20 Americans has diabetes, and
picking out those who are at highest risk is not,
with the wealth of information we have compiled
over the years, as difficult as it might seem.
Four groups of Americans are generally
conceded to be at highest risk: those who are
overweight, are over the age of 45, have relatives
who have had diabetes, and/or women who are
pregnant. Some authorities say the probability of
getting diabetes doubles with each decade of life
and with each 20 percent of excess weight.
In general, all pregnant women and anyone
with two or more risk factors should be screened
— even without any symptoms.
If there's a history of diabetes in your family,
your chances of developing non-insulin-
dependent diabetes are quite high. Some studies
indicate that if one of your parents plus a
grandparent and aunt or uncle have had the
disease, your chances of developing it are near 85
percent.
There are, of course, other risk factors to be
considered:
• Diabetes strikes women nearly twice as
often as men.
• Black Americans develop diabetes at double
the rate of whites, and black females have
the highest diabetes-related death rates.
• Hispanic Americans are five times more
prone to develop diabetes than other ethnic
groups in the U.S.
There's not much you can do about your
genetic makeup, of course, or about your age.
There is, however, a lot you can do about your
weight — and obesity has long been known to be
a major risk factor in non-insulin-dependent
diabetes. Proper diet and exercise are the primary
treatment approaches although oral medication
or even insulin may be required in some cases.
This year the American Diabetes Association,
Continued on page 33
November, 1987
WE BRING YOU THE BEST
CHARLESTON, S.C.
GREENVILLE, S.C.
THE CAROLINA JOURNAL OF PHARMACY
23
CORRESPONDENCE COURSE
Advising Consumers on Artificial Sweeteners
by
Thomas A. Gossel, R.Ph., Ph.D.
Professor of Pharmacology and Toxicology
Ohio Northern University
Ada, Ohio
and
J. Richard Wuest, R.Ph., Pharm.D.
Professor of Clinical Pharmacy
University of Cincinnati
Cincinnati, Ohio
Goals
The goals of this lesson are to:
1. present the background and important
considerations of the discovery of each artificial
sweetener;
2. relate artificial sweeteners to sucrose in
response to nutritive value;
3. give ideas concerning an eventual
remarketing of cyclamate in the U.S.
Objectives
At the conclusion of this lesson, the successful
participant should be able to:
1 . discuss the nutritive value of each artifical
sweetener;
2. relate current information concerning
toxicological issues of each artificial sweetener;
3. explain the limitation of procedures used for
testing artificial sweeteners for safety;
4. list sugars other than sucrose which are used
to sweeten food and drug items;
5. discuss important consumer information
needed for correct use of each of the artificial
sweeteners.
Artificial sweeteners have been the topic of
scientific debate and consumer concern for the
past several decades. Scientists and the public are
concerned about the safety of the sweeteners; and
the scientific community also questions the
reliability and appropriateness of the laboratory
methodology used to assess the safety of these
products.
This month's lesson discusses the history and
characteristics of artificial sweeteners, and
suggests what the future may hold for each of
them. It explains the scientific rationale for the
current concerns. And it also offers consumer
information on artificial sweeteners in general
and discusses aspartame, a recently introduced
sweetener, in more detail.
Satisfying America's
Sweet Tooth
Humans have sought ways to sweeten their
food since earliest times. A cave painting in
southern Spain shows an inhabitant stealing
honey from a nest of wild bees. References to
sugar and honey are commonplace from Biblical
times.
Today, Americans continue to love their
sweets! Sugar consumption represents an average
1 6 to 1 7 percent of Americans' total calories. This
amounts to 1.5 gm/kg or 100 to 150 gm/day.
Sixty-five percent of this sugar is ingested in
processed foods and beverages; the remainder is
added at home.
Continued on page 24
in Ihe service
of pharmacy
This continuing education for
Pharmacy article is provided
through a grant from
MERRELL DOW & LAKESIDE PHARMACEUTICALS
Division of
MERRELL DOW PHARMACEUTICALS INC.
November, 1987
24
THE CAROLINA JOURNAL OF PHARMACY
Correspondence Course
Continued from page 23
Excess sugar (sucrose) has been medically
linked to development of dental caries (cavities),
obesity, and hypertriglyceridemia. While sugar
does not cause diabetes, it can exacerbate
symptoms and intefere with control of the
disease. Artificial sweeteners permit Americans
to continue to satisfay their craving for sweets
while curtailing development of the afore-
mentioned conditions.
The artificial sweeteners differ from one
antoher in chemical composition. Each of them
also has advantages and disadvantages. The
properties of an ideal artificial sweetener are
listed in Table 1.
TABLE 1
Properties of an Ideal Artificial
Sweetener
The ideal artificial sweetener should be:
Sweeter than sucrose
Colorless
Odorless
Noncarcinogenic
Good tasting
Stable to heat
Soluble in water
Inexpensive
Nontoxic
Metabolized to nontoxic compounds, or
excreted unchanged
Ref: O'Brien L, Gelardi RC: Chemtech
11:274, 1981
Saccharin
Saccharin, which was discoverd in 1 878, was
originally employed as an antiseptic and food
preservative. It did not gain public acceptance as
an artificial sweetener until 1 907. It has been the
most widely used of all the artificial sweeteners
except during the 1950's and 1960's when
cyclamates dominated the market. In 1978
Americans consumed six million pounds of
saccharin, mostly in soft drinks.
Saccharin sodium is approximately 300 times
sweeter than sucrose and contains no calories. It
is freely soluble in water ( 1 gm dissolves in 1 .2 ml
water), stable at temperatures up to 150°C
(302°F), and has an acidic pH of 3.3. Saccharin is
not metabolized and is excreted unchanged.
Some individuals who use saccharin report a
bitter aftertaste.
Canada's Health Protection Branch (similar to
the American Food and Drug Administration)
first questioned saccharin's safety in 1974. Rats
were given massive daily doses of 2,500 mg/kg.
As a result, 2 1 of 200 animals developed bladder
tumors, versus only one positive response in 100
control animals.
The study was completed in 1977. FDA
responded to it stating, "The findings indicate
unequivocally that saccharin causes bladder
cancer in animals."
In 1 980 a study cosponsored by FDA and the
National Cancer Institute investigated the
potential problem in human epidemiologic
studies. Nearly 9000 saccharin users were found
to not be at any greater risk for developing tumors
than the general population.
But not all study results were as favorable. The
investigation showed that persons who smoked
heavily and those who used excessive saccharin
(two or more diet colas or six or more packets of
artificial sweetener per day) were at greater risk
of disease. Women who ingested diet beverages
or sugar substitutes at least twice daily were at 60
percent greater risk of developing bladder cancer
than women who did not use saccharin.
Impelled by the Delaney Amendment of the
Pure Food, Drug and Cosmetic Act (which
requires removal from the American market of
food additives that cause cancer in animals),
Congress quickly enacted a moratorium on the
ban. This was largely due to public outcry that
persons (e.g., diabetics) needing an artificial
sweetener would be left without one. More than
100,000 public comments against the ban were
documented.
So that the public would be warned of
potential toxicity from using the product, labeling
statements were required on each food item that
contained saccharin. Another warning was to be
posted in each establishment that sold food items
containing saccharin.
Canada banned all commercial uses of
saccharin, but permitted it to be sold in
pharmacies only. It had to bear a warning of its
cancer-causing potential.
The Joint Food and Agricultural Organiza-
tion/World Health Organzaiton (FAO/WHO)
Expert Committee on Food Additives
recommends a maximum of 2.5 mg/kg/day of
potassium or sodium saccharin as a safe intake. It
is approved for use in over 80 countries.
Cyclamate
Cyclamate was approved for commercial food
November, 1987
THE CAROLINA JOURNAL OF PHARMACY
25
use in 1951. The sodium and potassium salts
were later marketed for use as tabletop sweetener
under the trade name Sucaryl®.
Cyclamate was reported to be 30 times sweeter
than sucrose, less sweet than saccharin, and non-
caloric. Sucaryl® was a mixture containing 10
parts cyclamate and 1 part saccharin. The
saccharin provided sweetness, while the
cyclamate masked the bitter aftertaste.
The product was, therefore, widely used in
canned foods, chewing gum and mouthwashes,
and quickly became the leading artificial
sweetener in America. It dominated the market
throughout the 1950's and 1960's; Americans
were reportedly consuming 18 million pounds
annually in the late 1960's.
Cyclamate had been thoroughly evaluated for
toxicity problems prior to its marketing approval
and FDA pronounced it safe for use. When levels
of approximately 5 gm/day (equivalent to about
three quarts of diet soda) are consumed, a
laxative adverse effect is possible.
Toxicity studies continued following
marketing. While originally reported to be
excreted unchanged, subsequent work showed
that up to one-third of all humans metabolized it
to cyclohexylamine. Cyclohexylamine was a
known toxicant capable of causing dermatitis,
convulsions and chromosomal damage in
animals.
Continued investigation eventually revealed
that 1 2 of 80 rats fed cyclamate and saccharin in a
10:1 ratio (the popular mixture) developed
bladder tumors. To balance these studies,
however, dozens of other studies revealed that
cyclamate did not induce bladder tumor
formation. Nevertheless, FDA banned cyclamate
from use as a food additive in 1 970, again, due to
the Delaney Amendment. With this action, the
artificial sweetener market once more belonged
to saccharin.
There may still be hope for the return of
cyclamate to the American marketplace. FDA is
reportedly studying new data that substantiate
cyclamate's safety. FDA has also re-evaluated the
original studies that suggested cyclamates cause
cancer in rodents, and reported that the Canadian
rat data were in error. It further contended that
the strain of rats that responded with tumor
growth developed them spontaneously.
The WHO recognizes cyclamates as safe, and
recommends an acceptable daily intake of 4
mg/kg. Cyclamate is currently used in over 40
countries.
Aspartame
Aspartame was accidentally discovered in
1965 while scientists searched for potential anti-
ulcer drugs. Following extensive safety
Continued on page 26
TABLE 2
Natural Sources of Aspartame Components
Aspartic
Typical Serving
Acid
phenylalanine
Methanol
Aspartame
8.5 mg
10.6
2.0 mg
Meat-dairy
Hamburger 4 oz
1803.0 mg
882.0 mg
—
Chicken 4 oz
2079.0 mg
907.0 mg
—
Egg 1
542.0 mg
323.0 mg
—
Milk 8 oz
528.0 mg
542.0 mg
—
Vegetables
Spinach 4 oz
246.0 mg
150.0 mg
—
Lima Beans 4 oz
1745.0 mg
1355.0 mg
trace
Soybeans 4 oz
5512.0 mg
2330.0 mg
trace
Tomato Juice 8 oz
291.0 mg
45.0 mg
47.0 mg
Fruit
Banana 4 oz
134.0 mg
49.0 mg
21.0 mg
Cherries 4 oz
95.0 mg
16.0 mg
20.0 mg
Pear
254.0 mg
13.0 mg
0.04 mg
Source: G. D. Searle and Co., Chicago, IL
November, 1987
26
THE CAROLINA JOURNAL OF PHARMACY
Correspondence Course
Continued from page 25
evaluation, it was approved for marketing in
1973.
However, one month later, it was reported that
aspartame may cause hypothalmic lesions. FDA,
therefore, postponed its introduction date.
Although evidence that aspartame was toxic
was not substantiated, the manufacturers of food
additives must bear the burden of establishing
safety. This marked the beginning of a long
investigation that took nearly eight years to
complete.
It was finally released in 1981 for sale as a
tabletop sweetener and for use in prepared foods
such as cold cereals and instant teas, and in 1983
for use in carbonated beverages. It was one of the
most thoroughly studied food additives ever to be
marketed in the U.S. Today aspartame is sold to
food processors as NutraSweet®, and to
consumers as Equal®.
Characteristics. Aspartame contains two
amino acids, 1-aspartic acid and 1-phenylanine.
The latter is present as its methyl ester. The
sweetener is metabolized in the intestine as
illustrated in Figure 1 .
Both of the amino acids and the methanol are
common constituents of many foods as listed in
Table 2. A quantity of aspartame equivalent in
sweetness to a teaspoon of sugar yields 8.5 mg
aspartic acid, 10.6 mg. phenylalanine, and 2 mg
methanol. To compare this with food, an eight-
ounce serving of milk contains about fifty times
this amount of phenylalanine and aspartic acid. A
four-ounce banana contains ten times the
methanol.
Individually, the components are not sweet.
This is not a problem as long as the aspartame is
not degraded. Sweetness is detected only while
the substance is in contact with the taste buds on
the tongue.
Aspartame is 1 80 to 200 times sweeter than
sucrose. Unlike saccharin, it does not cause an
aftertaste. It is only slightly water soluble ( 1 gm
dissolves in 100 ml water at 24°C). Solubility
increases with decreasing pH and increasing
temperature.
Because it is metabolized to amino acids and
methanol, a teaspoonful of aspartame has a food
value of 4 calories, the same as sucrose. But,
because it is also approximately 200 times
sweeter than sucrose, aspartame, which is
equivalent in sweetness to a teaspoonful of sugar,
has 0. 1 calories.
The powdered form of aspartame, Equal®,
contains lactose as a bulk former. Equal®
contains 2 calories per teaspoonful.
Aspartame is unstable in hot foods. It is,
therefore, not suitable for use in items that must
be cooked or require sterilization.
It decomposes slowly in beverages, the rate
determined by the temperature and pH. The shelf
life of a can of carbonated beverage to maintain
sweetness is approximately one year.
In dry form it is stable at 40°C ( 1 04°F) for over
esterases
ASP-PHE-Me ^ ASP-PHE + MeOH
(intestine)
MeOH
oxidases
(liver)
HCHO
HCOOH
C02 + H20
dipeptidases
ASP-PHE
(liver)
ASP + PHE
free ASP + PHE
enter usual metabolic pathways
Figure 1. Metabolic pathways of aspartame. ASP: aspartic acid; PHE: phenylalanine; Me: methyl
ester; MeOH: methanol; HCHO: formaldehyde; HCOOH: formic acid.
November, 1987
THE CAROLINA JOURNAL OF PHARMACY
27
a year. In alkaline solution, a small amount of
aspartame may be converted to a cyclic substance
called diketopiperazine. This is neither sweet nor
toxic.
The FAO/WHO Expert Committee on Food
Additives has suggested 40 mg/kg/day as an
acceptable daily intake. The projected
consumption for Americans is 34 mg/kg/day.
Studies have shown that ingesting 34 mg/kg/day
does not raise plasma or erythrocyte levels of
aspartic acid or phenylalanine above levels
reached after consuming an average meal.
Diketopiperazine is usually present in a
concentration of 1 percent or less. Its safe daily
intake is 7.5 mg/kg.
Specific Safety Concerns. The aspartic acid
component of aspartame is partially metabolized
to glutamic acid, another dicarboxylic amino
acid. Glutamic acid (as monosodium glutamate,
MSG) has been shown experimentally to cause
hypothalamic brain lesions in young monkeys.
Although articles still occasionally associate
aspartame with brain damage due to its
decomposition to aspartic acid, this correlation
remains to be proven. Some authorities report
that the issue is moot in that the sweetener has not
been proven to cause central nervous system
pathology.
Phenylalanine must be avoided by persons
with phenylketonuria. This familial disorder is
rare, occurring in 1 of 15,000 persons. Affected
individuals have a deficiency of the enzyme
phenylalanine hydroxylase. As a result, blood
levels of phenylalanine rise, allowing toxic
concentrations to enter the brain. Left untreated,
symptoms include mental retardation, epileptic
seizures, and chronic dermatitis.
Phenylalanine is reported to harm the fetus
when pregnant women who are carriers of
phenylketonuria ingest it. There is currently no
evidence to support this. Studies have clearly
shown that when these women ingest aspartame
in doses exceeding average, there is no increase,
even transiently, in plasma phenylalanine to toxic
levels. If victims restrict intake of phenylalanine ,
they can lead normal lives. Therefore, foods
containing phenylalanine must be so labeled.
Equal® tablets and packets both state,
"Phenylketonurics: Contains phenylalanine."
Phenylalanine is also purported to block the
entrance of tryptophan into brain cells.
Tryptophan is the precursor of serotonin (5-
hydroxytryptamine), a CNS neurotransmitter. A
decrease in CNS serotonin level is associated with
behavioral abnormalities. Aspartame's effect on
tryptophan or serotonin is unclear. Thus, there is
no solid eveidence that decreased serotonin, if it
does indeed occur following aspartame ingestion,
causes behavioral changes.
Methanol is also suspected to cause potential
toxicity problems to the retina. Methanol-
induced damage is due primarily to its oxidation
products formaldehyde and formic acid, leading
to accumulation of formates.
The amount of methanol in aspartame is
insignificant. For example, 36 mg aspartame (i.e.,
one packet of Equal®) contains 3.49 mg
methanol. Eight-ounces of tomato juice or a four-
ounce banana contain 47 and 2 1 mg of methanol
respectively. When 200 mg/kg aspartame was
ingested in one study (approximately six times
the expected daily average intake), no formate
was found in blood or urine.
Aspartame is also reported to be safe for
diabetics. No abnormalities in glucose tolerance
have been reported with diabetics ingesting
aspartame. It causes no significant elevation in
amino acid content of breast milk at normally
ingested quantities. It has been shown to be
noncarcinogenic.
Other Sweetening Substances
Some sugars other than sucrose are also used as
sweetening agents. They include fructose,
sorbitol, mannitol, and xylitol. Some of these
contain as many calories as sucrose.
Fructose. Frustose is a metabolite of sucrose.
It is 1 .2 to 2.8 times as sweet as sucrose and has
the same caloric value. Fructose is less readily
absorbed than glucose and, therfore, causes a less
intense insulin response in well controlled
diabetics. Cells still require insulin to transport
fructose within them. So fructose-based foods are
far from ideal for diabetics.
Sorbitol. Sorbitol is 0.5 to 0.7 times as sweet
as sucrose. It is reported to be one of the most
frequently used sweeteners, commonly found in
breath mints and dietetic candies.
Sorbitol is poorly absorbed from the intestine
and, therefore, may ferment there. Ingestion of 5
gm can produce gas and bloating. Twenty grams
may cause diarrhea. In fact, sorbitol has been
proven to be a safe and effective laxative for OTC
use.
Consumers reporting gastrointestinal dis-
comfort from an otherwise unidentifiable cause
should be asked about their use of products
containing sorbitol. A single sorbitol-containing
Continued on page 28
November, 1987
28
THE CAROLINA JOURNAL OF PHARMACY
Correspondence Course
Continued from page 27
candy mint may contain as much as 2 mg of
sorbitol. Table 3 lists the sorbitol content of
various food items.
Mannitol. Mannitol is 0.7 times as sweet as
sucrose. It is used to dust chewing gums, and to
give bulk to powdered foods.
Xylitol. Xylitol was formerly used in chewing
gum to sweeten it and provide a cool sensation in
the mouth. It also reportedly reduces the chance
for developing dental caries. Toxicological
studies show it increases the incidence of bladder
stones and adrenal gland tumors in mice fed large
doses. Most products that contained xylitol have
been voluntarily withdrawn or reformulated by
their manufacturers.
New Sweetener. Acesulfame potassium is still
under investigation in America but approved for
use elsewhere. It is 200 times sweeeter than sugar.
Its sponsor has petitioned FDA for approval to
market the sweetener for use in chewing gum, dry
beverage mixes and foods, and as a tabletop
sweetener. It is reported that the substance is not
metabolized and contains no calories. It is more
stable than aspartame and has not shown any
toxicity thus far.
TABLE 3
Sorbitol Content of Various "Sugar-
Free" Products and Foods
"Sugar-free" gum
"Sugar-free" mints
Pears
Prunes
Peaches
Apple Juice
1.3-2.2 g/piece
1.7-2.0 g/piece
4.6 g
2.4 g
1.0 g
0.3-0.9 g
Ref: Hyams JS: Gastroenterology 84:30,
1983
The Cancer Issue
The artificial sweeteners, including saccharin,
cyclamates, and aspartame, have undergone
more intensive testing for safety than any other
food additive. By law, if any food additive causes
cancer in any laboratory animal, at any dose, by
any route of administration, the substance cannot
be used in food items. This restriction, known as
the Delaney Amendment, is essentially an
absolute zero risk standard.
However, many experts believe that the clause
is now obsolete. They argue that if it were applied
to all chemicals, it would ban most of the world's
food supply, many drugs, occupations,
recreations, and even the air we breathe. But the
results of this testing have still failed to answer all
questions that have been raised about the
compounds' safety.
The primary deficiency that currently exists is
the method of testing for potential carcino-
genicity. By definition, cancer tests mandated by
FDA require testing at the highest tolerated
doses. This means that animals are given the
maximum dose that causes no overt toxicity over
a 13-week trial. These doses are generally much
higher than any human could possibly consume.
The issue of whether smaller doses, closer to
human intake, should also be studied is currently
under consideration.
The issue of whether artificial sweeteners cause
cancer cannot yet be settled. The unreliability of
animal studies has already been mentioned.
Furthermore, there might be human subpopula-
tions or persons of certain ages that are
susceptible to carcinogenesis. The role of
occupation, smoking, alcohol, and consumption
of other foods and beverages such as coffee and
tea must also be assessed along with artificial
sweetener use.
The increased tumor incidence may be too
small to detect in a clinical study, but when
extrapolated to a general population, it could be
quite significant. There may also be biological
systems which are even more sensitive to tumor
development than the bladder, but not yet
thoroughly studied. Artificial sweeteners may
cause tumor formation that requires decades to
be fully revealed. Their widespread use in large
quantities did not actually occur until the early
1960's when the diet cola craze began.
The role of disease factors needs to be assessed.
For example, diabetics use more artificial
sweeteners on the average than nondiabetics. It is
possible that diabetics per se, or diabetics who use
artificial sweeteners increase the risk for tumor
formation.
Finally, another very important variable has
not yet been considered. Most animal studies
have employed the sodium salt of saccharin or
cyclamate, rather than the less soluble base
saccharin or cyclamate. Sodium intake in the
animals' diets has not been restricted.
Sodium is a known cause of hypertension, and
renal and urinary bladder stones. It is not
associated with causing cancer, but it damages
renal and bladder tissues, perhaps because it
serves as the initial stimulus for saccharin-
November, 1987
THE CAROLINA JOURNAL OF PHARMACY
29
induced toxicity. Therefore, it should at least be
considered and studied.
Overview
Artificial sweeteners have afforded Americans
a convenient means of avoiding sucrose and
calories. The artificial sweeteners in use today
have been thoroughly tested for safety and, when
used as directed, are undoubtedly safe. But
certain questions concerning their safe use have
been raised. Articles reporting new data for and
against the use of artificial sweeteners continue to
appear in the scientific literature. As is the case
with the use of all chemicals, moderation is the
best policy.
The ultimate fate of saccharin and cyclamate
remains to be determined. Cyclamate appears to
have a chance of returning to the American
market. Saccharin currently remains on the
market under repeated extensions of a
Congressional moratorium against the Delaney
Amendment restrictions on the sweetener. These
restrictions may be lessened to permit its
continued availability. On the other hand, if
acesulfame potassium continues to remain free of
toxicity and is approved for use in the U.S., this
may signal the end for saccharin.
Is there value in mixing artificial
sweeteners? Perhaps! Detection of sweetness
appears to be a function of more than one type of
taste bud. For example, the site of detection of
sweetness of saccharin is different from that of
aspartame. Likewise, cyclamate and saccharin
mixed together and tasted seem to have a
synergistic effect.
From an economical standpoint for food
manufacturers, mixing aspartame and saccharin
makes sense. The wholesale cost of saccharin is
reported to be less than one-tenth the expense of
aspartame. Adding saccharin would permit food
prices to remain lower.
Aspartame has been casually associated with
several toxic reactions, some potentially serious.
However, these charges have not been
substantiated. Individuals with phenylketonuria
should avoid products containing it.
Consumers should be advised to avoid
cooking with aspartame, and adding it to hot
foods or beverages that will not be consumed
quickly. Some persons report that significant
sweetness is lost in the few minutes required for
hot cereal or coffee to cool sufficiently for
consumption. Up to half of its sweetness may also
be lost in a couple of hours when aspartame is
added to neutral solutions at room temperature.
Aspartame use will continue to expand as
more and more manufacturers and food
processors add it to their products. Already FDA
is proposing a rule which will permit it to be used
as a sweetening agent in drug products.
Correspondence
Course Quiz
Artificial Sweeteners
1 . Which of the following is reported to be 1 80
to 200 times sweeter than sucrose?
a. Aspartame
b. Cyclamate
c. Saccharin
d. Sorbitol
2. All of the following sugars are used to
sweeten food and drug products EXCEPT:
a. fructose.
b. galactose.
c. mannitol.
d. sorbitol.
3. Products containing which of the following
must include a warning on their labels
advising against use in persons with
phenylketonuria?
a. Asceulfame
b. Aspartame
c. Saccharin
d. Sorbitol
4. Dietary intake of excess sugar has been
medically linked to the development of all of
the following EXCEPT:
a. dental cavities.
b. diabetes.
c. hypertriglyceridemia.
d. obesity.
5. Which of the following is metabolized to
cyclohexylamine, a substance known to
cause dermatitis, convulsions, and chromo-
somal damage in animals?
a. Acesulfame
b. Aspartame
c. Cyclamate
d. Saccharin
6. Aspartame is metabolized in the intestine to
all of the following EXCEPT:
a. acesulfame.
b. aspartic acid.
c. methanol.
d. phenylalanine.
Continued on page 32
November, 1987
Human insulin for all. Humuliri
human insulin
[recombinant DNA origin]
Identical to human Insulin. Humulin is the only insulin not
derived from animal pancreases.
Recombinant DNA technology makes the production of
Humulin possible and virtually assures every insulin user of a
lifetime supply
From Lilly ... a dependable source of insulin for
generations. Since 1922, when we became the first company
to manufacture insulin, we have led the search for the best
diabetes care products and, at the same time, maintained a
constant supply of insulin for all insulin users
Our 24 formulations of insulin— including Humulin and all
forms of lletin® (insulin)— are available through the widest retail
distribution of insulin in the United States
Beyond that, we will continue to provide a wide range of
diabetes service and educational materials for use by physi
cians, pharmacists, and diabetes educators
S 1986 ELI LILLY ANDCOMPANV
Our Medical Division is on call. Our Medical Division staff
is only a phone call away Please contact them if you have any
questions about our diabetes care products
Any change of Insulin should be made cautiously and
only under medical supervision. Changes in refinement,
purity, strength, brand (manufacturer), type (regular, NPH,
Lente*, etc), and/or method of manufacture (recombinant DNA
versus animal-source insulin) may result in the need for a change
in dosage
Lilly Leadership
For information on insulin delivery systems, contact CPI 1 (800)-227-3422
Eli Lilly and Company
Indianapolis, Indiana 46285
THE CAROLINA JOURNAL OF PHARMACY
31
DICKINSON'S PHARMACY
by Jim Dickinson
New face of pharmacy. It used to be that folks
could tell the best pharmacy in town by the
quality of its ham sandwiches. It was a
neighborhood institution, inhabited by teenagers.
Only Norman Rockwell can remember those
days, and he's dead.
Then the pharmacy came to be a hidey-hole in
the back of a big store full of general
merchandise, and it was no longer an institution.
The public, which makes and breaks social
institutions, a few years ago accorded
pharmacists (as distinct from the hidey holes in
which they work) No. 2 status behind clergy as its
most-trusted professionals.
And then came dispensing physicians, HMOs,
mail-order options and the syndrome that's
become known as "the graying of America."
Where the average Joe Citizen places
pharmacy in all of this is questionable. But when
he takes a look, he will surely see that pharmacy
has a new face.
It's not the kindly, "old doc" face of Rockwell
paintings. It's a businesslike, professional face and
it belongs to a highly knowledgeable expert who
has been toughened by the years since Rockwell's
time.
This face of pharmacy may be white or black
(or, increasingly, yellow), young or old, male or
female (more likely female, if young).
But whatever it is, it's not likely to be kindly.
Today's pharmacist is under siege, and the face
that's shown to the public is likely to show it.
It's "Operation Fight-Back" time, as the boom
in PSAO (pharmacy service administrative
organization) activity across the country is
showing. The number of third-party plan
beneficiaries covered by PSAO programs of one
kind or another is increasing at a 64% annual rate.
Put another way, 4.3 million Americans get
their third-party program prescriptions through a
contract that allows freedom-of-choice of
participating independent pharmacy, rather than
Continued on page 32
Cut Out or Reproduce and Mail
CONTINUING PHARMACEUTICAL EDUCATION
Artificial Sweeteners
Attach mailing label from The Carolina Journal of Pharmacy or print your name
and address and mail to CE Test, NCPhA, P.O. Box 151 , Chapel Hill NC 27514
Completed answer sheets may be returned on a monthly or less frequent basis
for grading.
This is a member service. Non-members responses will not be graded nor
CPE credit provided.
NCPhA will maintain a copy of your completed CPE tests and upon successful
completion of each program, will issue a certificate for one (1 ) hour of board-
approved CPE.
If more than two questions are answered incorrectly, the test is failed. You
will be given one opportunity to submit a second answer sheet.
Please circle correct answers
1. a b
2. a b
3. a b
Evaluation:
Excellent
abed
abed
abed
Good
7.
8.
9.
10.
Fair
abed
abed
abed
abed
Poor
address
November, 1987
32
THE CAROLINA JOURNAL OF PHARMACY
Dickinson's Pharmacy
Continued from page 31
be locked into a single chain, HMO or mail-order
pharmacy.
It isn't unfettered open access to anything, and
there are price controls. But at a 64% growth rate,
it's evidence of pharmacy's collective fight-back.
Five years ago, the PSAO idea would have
been unthinkable. First, every legally-wise person
pharmacists consulted said PSAOs would be
illegal under the anti-trust laws. Second, it was
conventional wisdom that pharmacy was just too
plain divided to get its act together for such a
concept.
Two Justice Department advisory letters last
year changed that, and at a time when many
people were gloomily predicting the extinction of
independent pharmacy by the year 2001, the
PSAO revolution began.
Today there are 53 active PSAOs, the latest
being the national RxNet, a subsidiary of the
National Association of Retail Druggists. RxNet
serves as a national clearing house and marketing
organization for the other, affiliated PSAOs in
the states.
A central theme of the PSAO, whether
national, state or local, is quality of care — hands-
on, personal attention by a live pharmacist who
knows his or her patients, and who keeps
patient profiles for effective drug utilization
review.
Many PSAO plans actually pay the
pharmacist to not dispense, thereby curbing
waste (the incentive in capitation plans can be to
share surpluses in the pool at the end of the
contract term, helping focus pharmacists on the
need to question irrational prescribing through
the PSAO).
This is, admittedly, controversial. Many
pharmacists do not yet belong to PSAOs, and
many who do simply hate they very idea of
capitation. Certainly, contracts that leave
pharmacy with all the risk are not worth signing
up for, especially when the underlying data upon
which that risk is based have holes in them.
And some pharmacists would rather pay no
attention to DUR, and leave all accountability
with the prescriber.
Three of those 53 PSAOs have already gone
bankrupt, and many more are likely to fail for
want of getting (or keeping) a single contract.
Pharmacists can be inpatient, and not give their
PSAO time to get its feet or prove itself, and that
syndrome will kill some PSAOs.
It's early days yet, for the PSAO movement. Its
growth has been electric, and the results are not
yet in. But a 64% annual growth rate in an
environment in which managed health care plans
and HMOs are in desperate financial turbulence
is a ringing endorsement of the way pharmacy
has begun to fight back.
The face of pharmacy has changed.
This feature is presented on a grant from G.D.
Searle & Co., in the interests of promoting the
open discussion of professional issues in
pharmacy. G.D. Searle & Co. accepts no
responsiblity for the views expressed herein as
they are those of the author and not necessarily
those of G.D. Searle & Co.
Correspondence Quiz
Continued from page 29
7. The amendment to the Federal Pure Food,
Drug and Cosmetic Act that requires market
removal of any food additive that is shown to
cause cancer in animals is the:
a. Delaney Amendment.
b. Durham-Humphrey Amendment.
c. Kefauver Amendment.
d. Proximire Amendment.
8. Which of the following was originally used
as an antiseptic and food preservative rather
than as an artificial sweetener?
a. Acesulfame.
b. Aspartame.
c. Cyclamate.
d. Saccharin.
9. After initial approval by FDA, aspartame
was withheld from the food additive market
for approximately eight years because of a
report that it caused which of the following?
a. Bladder cancer
b. Diabetes insipidus
c. Hypothalmic lesions
d. Peptic ulcer disease
10. Which of the following has the greatest
caloric value per usual serving?
a. Acesulfame
b. Aspartame
c. Cyclamate
d. Saccharin
November, 1987
THE CAROLINA JOURNAL OF PHARMACY
33
NEWS ABOUT PEOPLE
WEDDINGS CONGRATULATIONS
CATHERINE JANE CHITTY and
EUGENE STREET SIMMONS were married
on October 3, 1987 at First Baptist Church in
New Bern.
The bride and groom are both graduates of the
UNC School of Pharmacy (Class of '82 and '84).
The bride is a pharmacist at Rite Aid in Asheboro
and the bridegroom is a pharmacist at Chatham
Hospital in Siler City. The couple live in Siler
City.
KIMBERLY DAWN HUDSON and
Stephen Ray Long, Jr. were married November
7, 1987 in the South Point Baptist Church in
Belmont. The bride is a 1987 graduate of the
UNC School of Pharmacy and is employed as
pharmacist-manager of Kerr Drug Store in
Southern Pines. The groom is an NC State
graduate and is employed by Resorts of
Pinehurst.
SUSAN ELIZABETH CURRIN and Michael
Hughes Hill were married in Oxford Baptist
Church Saturday afternoon, November 14,
1987. A 1985 graduate of the UNC School of
Pharmacy, the bride is employed by Rite Aid
Discount Drug Center. The groom is co-owner of
Video to Go in Oxford.
Congratulations to Fred M. Eckel, Chapel
Hill, who was elected Secretary of the Christian
Pharmacists Fellowship, International for 1988
and 1 989 at the meeting in Atlanta.
Congratulations to W. Whitaker Moose,
Mount Pleasant, who was elected Third Vice
President of NARD at the Annual Convention in
Las Vegas.
Durham-Orange — Officers of the Durham-
Orange Pharmaceutical Association are Dennis
Williams, President; LaRue Dedrick, Secretary-
Treasurer; and Betsy Ramsay, Past President.
BIRTHS
JOHN F. WATTS and Susan C. Watts,
Taylorsville, announce the birth of Jonathan
Clifford on October 31,1987. Jonathan weighed
in at 7 lbs. 1 5 oz. and his first words were "Go Tar
Heels." His dad is a 1977 graduate of the UNC
School of Pharmacy.
Diabetes
Continued from page 21
whose more than 700 chapters are scattered
across all 50 states, has undertaken a national
program to uncover the estimated five million
undiagnosed diabetic Americans and to further
educate clinicians about the latest advances in
treatment. The key lies in finding those who have
diabetes, by teaching people to spot one of the
warning signs of the disease — and then inform
his or her doctor. Diabetes can be effectively
treated, but only after it is diagnosed.
MEDI-SPAN
Preferred ]f Vendor
Rx Software $1,248
Try Before You Buy:
Use our software for 90 days If you are not
completely satisfied, return it with no obligation to
purchase.
Performs These Functions:
Rx Labels — Patient Profiles — Counseling Messages
Interactions — Generic Substitutions — Discounts
IRS and Insurance Summaries — Accounts Receivable
Daily Logs — 1 hird Party Billing — Inventory Control
Nursing Home
Medi-Span Services:
Price Updates — Drug Base — Interaction Base
Competitive Pricing Guide
For Information Call:
1-800-423-0276 ext.
4706
November, 1987
34
THE CAROLINA JOURNAL OF PHARMACY
CLASSIFIED ADVERTISING
Classified advertising (single issue insertion) 25 cents a word with a minimum charge of $5.00 per
insertion. Payment to acompany order.
Names and addresses will be published unless a box number is requested.
In replying to "blind" ads, address Ad. No., Carolina Journal of Pharmacy, P.O. Box 151, Chapel
Hill, NC 27514. Telephone (919) 967-2237.
PHARMACIST WANTED: We are
seeking an ambitious, and professional
career-minded individual for a pharmacist
position in Greensboro, High Point and
Winston-Salem, NC. We offer excellent
salary, stock ownership, educational
subsidy, extensive benefits, retirement
plan, 401 K tax plan, annual salary merit
reviews. "Pure pharmacy setting." If
interested call Lew Thompson 1 -800-233-
7018 or send resume to: The Kroger
Company, Attn: Personnel, PO Box
14002, Roanoke VA 24038. EOE.
Pharmacists Wanted: Farmco Drug
Centers have present positions available
in Rocky Mount, Elizabeth City, Roanoke
Rapids, and Goldsboro North Carolina.
For more information call collect Buddy
Liebowitz at (804) 858-6063.
STAFF PHARMACIST WANTED: Posi-
tion at Kings Mountain Hospital. Modern
102-bed facility with computerized unit
dosage. Hospital experience preferred
but not necessary. Will consider a May
graduate. Contact Jerry McKee at (704)
739-3601 Ext. 472.
Want to Buy: Profitable Drugstore on
Contract. Prefer Eastern/Central North
Carolina. Would consider other areas of
the state and other types of financing with
low money down. Reply to Box PDQ, c/o
NCPhA, P.O. Box 151, Chapel Hill, NC
27514.
PHARMACIST: Professional Services/
Consultation — Temporary and/or
Continual. Contact: L.W. Matthews at
(919) 967-0333 or 929-1783. 1608 Smith
Level Road, Chapel Hill, NC 27514.
The Department of Pharmacy Services
at Sampson County Memorial Hospital
has opportunities available for hospital
pharmacy practice. This 145 bed JCAH
approved hospital is located within 1 hour
drive of the coast. Good working
conditions with Nursing and Medical
Staff. Excellent starting salary, plus
comprehensive benefit package. Activi-
ties include complete computerization,
unit dose, IV admixture, patient profile
and inventory control. Patient care
services include: antibiotic monitoring,
TPN, Aminoglycoside dosing and support
for continuing education. Contact:
Patricia Britt, director, Personnel or Jenny
Strickland, Director Pharmacy at (919)
592-8511.
Pharmacists Wanted: Greensboro and
Greensboro market area. Contact David
Cox, Revco Drug Stores, at (919) 766-
6252.
PHARMACIST WANTED: Call Norwood
at 259-2676.
PHARMACIST NEEDED: Pharmacist
for Community Pharmacy located in
Carrboro. Approximately 45 hours a week
with alternate weekends off. Must be
willing to live in Chapel Hill or Carrboro
telephone area. Send resume to Vaughn
Independent Pharmacy, 503 W. Main
Street, Carrboro, NC 27510 or call 919-
967-3766.
OLD SODA FOUNTAIN WANTED. Send
specifics or call: John Cooper, Mast
Store, Box 714, Valle Crucis, NC 28691,
(704)963-65511.
November, 1987
THE CAROLINA JOURNAL OF PHARMACY
35
RELIEF PHARMACIST AVAILABLE:
Central & Eastern North Carolina. Contact
Pharmacy Relief, PO Box 2064, Chapel
Hill NC 27515 or call 919-481-1272
evenings.
Fixtures Available after January 31.
Complete store fixtures for a 5,000 square
foot store in excellent condition including
wall, gondolas, end pieces, one or more
glass showcases and Rx department.
Contact Hamp Langdon, Kernersville at
919 993-2195
PHARMACIST WANTED: Pharmacy II
position available at Piedmont Correction
Center in Salisbury. Rowan County. One
year experience. Salary grade: 75. Salary
range; 26,892-43,728. Call Sylvia Mat-
thews at (704) 637-1421 Ext. 501 or 507.
PHARMACY FOR SALE: Owner wishes
to retire: 25 yr same location. 30 miles
from Charlotte. $270,000 Annual Sales,
Inventory $85,000. Sales Price $80,000.
Includes inventory, fixtures etc, $11,000
Accts Recv. & delivery Car. 75% Rx 40%
chg Accts. Reply JNR c/o NCPHA PO
Box 151 Chapel Hill, NC 27514 or call 1-
704-933-6551 after 6 PM
Pharmacist Owner relocating. Seeking
position in community pharmacy (inde-
pendent or chain). Open to partnership
from Statesville and Charlotte area west.
Call or write David deChester, 546
Uniondale Avenue, Uniondale, NY 11553.
(516)481-0816.
PHARMACIST WANTED: Pharmacist
wanted for new store in medical complex
located in Red Springs, NC. Projected
opening date is May 1988. Competitive
salary. Send resumes to Hunters Bay
Drugs, Rt. 2 Box 180, Red Springs, NC
28377.
Streater fixtures for sale — only 2Vi
years old. 20- 4 ft. wall sections with
cornice. 10- 4 ft. island sections. Rx work
counter/front. Available approximately
April 1988. $4,000.00 Contact Roland
Thomas or R. Bivens 704-525-5300.
FOR SALE: Henderson's pharmacy in
Franklinton, NC. Owners wish to retire.
Sales price; $55,000 (inventory + $5,000).
Call (919) 494-2321 days.
Fixtures For Sale: Streater Fixtures, 24
years old. 2 cash registers, balance, card
racks. Call Albert Clay at (919) 552-2838.
Pharmacist Wanted: For retail and
consultant practice. Excellent salary and
benefits. Located in Western N.C. Call Bill
Morris at (704) 456-8607.
Relief Pharmacist Available: Available
for all of NC. Call Albert Clay at (919) 552-
2838.
Relief Pharmacist Wanted: Relief
Pharmacist Available. Has RV, will travel.
Call Robert Lucas at (919) 383-1421.
PHARMACIST WANTED: Pharmacist
for local independent pharmacy, approx-
imately 45 hours a week with alternate
weekends off. Send resume to: Executive
Drug Care, P.O. Box 996 Yadkinville NC
27055 or call 1-800-422-0349.
Wanted full time pharmacist. Western
Part of the State. Two 10 hour days in two
different locations. Three consecutive
days off, no Sundays, no nights. Both in
resort setting. Contact Jack Alexander,
(704) 526-2366.
Columbus Store Fixtures for Sale.
Complete Prescription Department, and
30 foot greeting card fixtures. Contact
Bud O'Neal, Work: 919-943-2462, Home:
919-943-3751.
PHARMACIST WANTED. Director of
Pharmacy for 64-bed hospital in South-
eastern North Carolina. Excellent hours,
salary negotiable, and good fringe
benefits. Contact Tom Smart at (91 9) 582-
2026.
Pharmacy Wanted. Pharmacist wants
to buy an Eastern or Piedmont NC
pharmacy. Strictly confidential. If you are
interested in selling your pharmacy,
contact Box JGM, NCPhA
Pharmacist Wanted: Strong inde-
pendent in northeastern NC seeking
energetic professional pharmacist.
Excellent salary and benefits and working
conditions. Contact NCPhA, PO Box
MAA. Continued on page 36
November, 1987
36
THE CAROLINA JOURNAL OF PHARMACY
Classifieds
Continued from page 35
CLINICAL — STAFF PHARMACIST
POSITION — located on the beautiful
N.C. coast in Morehead City. Some
advanced training preferred. Will have
responsibilities in unit dose, IV-Admix-
tures, chemotherapy, patient education,
nursing inservice, pharmacy newsletter,
pharmakinetic dosing, drug evaluation
and other evolving clinical applications. If
interested and qualified please send
resume to Director of Personnel, Carteret
General Hospital, P.O. Box Drawer 1619,
Morehead City, NC 28557 or call Beth
Beswick (919) 247-1547. EOE.
STAFF PHARMACIST — Moore Re-
gional Hospital, a 316-bed, acute care
facility has an opening for a staff
pharmacist. This pharmacy offers unit
dose, IV Admixture, chemotherapy,
support for C.E. education, patient profile,
and a mobile medication service. Moore
Regional Hospital is located in Pinehurst,
a beautiful part of the Sandhills. Excellent
starting salary, on-site Day Care, plus
comprehensive benefit package. Contact
Cornelia Perry, Vice President Human
Resources, 919-295-7808 or Robert
Beddingfield, Director of Pharmacy, 919-
295-7112 or send resume to: Moore
Regional Hospital, Human Resources,
P.O. Box 3000, Pinehurst, NC 28374. EOE.
We are seeking an ambitious and
professional career-minded individual for
Pharmacy-manager position in south-
eastern North Carolina near the coast.
Computerized prescriptions, excellent
salary, hospitalization and life insurance,
paid vacations. Small professional
pharmacy located in the center of a
medical complex. Contact Box CDD, c/o
NCPhA, P.O. Box 151, Chapel Hill, NC
27514.
PHARMACIST WANTED: Drug Em-
porium, Greensboro, NC now hiring
pharmacist. Excellent starting salary.
Complete benefit package, plus bonuses
included. Call Kent Huffman for details at
(919)282-3993.
PROFESSIONAL PHARMACIES: Sev-
eral small prescription-oriented pharma-
cies are currently available for individual
ownership in North Carolina. These
opportunities provide the vehicle to
practice pharmacy the way you were
taught, while offering an attractive income
and more time to be with your family. In
some of these cases, financing is also
available to qualified candidates. For
more information write: Jan Patrick,
10121 Paget Dr., St. Louis MO 63132.
Order Form
Name
A ddress
City Slate Zip
Please send me copies of
the Return Goods Policy Manual.
Enclosed is a check for $30
for each copy.
Please charge my Mastercard
U exp. date
Please charge my Visa
# exp. date
Mail this form with payment to:
N Carolina Pharmaceutical Association
PO Box 151
Chapel Hill. NC 27514
Return Goods
Policy Manual, 4th Ed.
To make up the loss for just one out-
dated bottle of a product, you would
have to sell over 33 times its cost.
The Return Goods Policy Manual
can help expedite the process of re-
turning your unsalable inventory.
(Please allow 4 - 6 weeks for delivery)
November, 1987
Savage
Richmond
Norfolki
■
Raleigh ■ aWilson
Santa
Augustas
Jacksonville*
Fort
Lauderdale
insure responsive,
efficient healthcare
distribution. . .
Owens & Minor.
MmmMm
Minor, Inc.
2727 Enterprise Parkway Richmond, Virginia 23229
For additional information, please contact:
Hugh F. Gouldthorpe, jr. or Hue Thomas, III
804/747-9794
Dr.T.C.Smith Co./ W.H.King Drug
ASHEVILLE, N.C. 28806 • 704/258-2645 / RALEIGH, N.C. 27622 • 919/782-8400
ij&Sbi' -;*?
TOTAL
HOMESPUN
SERVICE
In today's business rush we take the time to help
you with your management decisions . . . whether its
over coffee or part of a regular sales call. We will fill
your order with care and with dispatch today. Just as
we did in 1869.
We use advanced technology to lead in service to our
customers.
Some of our available programs are Electronic Order
Entry • Merchandising and Programming • Valurex
Advertising & Promotion • Retail Pricing • Micro-
fiche • Pharmacy Computer Systems • Home
Health Care and much more.
Whether you take your coffee
black or with cream,
call us to find
out more details.
VALUREXJNDEPENDENT
VALUREX
PHARMACY
ADVERTISING & PROMOTIONAL
PROGRAMS
91
"TO HELP YOUR BUSINESS IS OUR BUSINESS'
THE OIROUNk
JOURNN_ofPHN*MkCY
CM
or
LU
GO
O
>
oo
O
LU
CO
LU
u
LU
Q
MAR -4 m
NCPhA Asheville Vacation Convention
Grove Park Inn
May 18-21, 1988
Health S ■- e s u l J l a- r ^
2 2-:
Thank You,
Kendall Customers!
For over 65 years, Kendall has been
serving pharmacists in the Southeast.
Your changing needs and ideas have
helped us grow into the service
oriented wholesaler we are today.
We appreciate your loyalty and
support, and we strive to provide
Kendall Staff:
continued excellent service. This
includes evening order taking, accurate
order filling, fast delivery, and a 95+%
service level.
Thanks again, Kendall customers,
for making us your full-line
pharmaceutical wholesaler.
(left to right) Front Row: Walter Laughridge (Order Assembler); Lynda Lovelace
(Order Assembler); Sarah Owens (Order Assembler); Jimmy Lovelace (Night
Supervisor)
Back Row: Kevin Bridges (Warehouse); Kate Jackson (Order Assembler); Sandra
Bostic (Order Assembler); Beth Rogers (Order Assembler); David Bridges (Order
Assembler)
117
ill > DRUG COCVIF*\l\JV
1305 Frederick St. • P.O. Box 1060 • Shelby, N.C. 28150
NC 1-800-222-3856 • SC 1-800-438-5330
Justice Drug Company
P.O. Box 22025
Greensboro, NC 27420
AN ALCO STANDARD COMPANY
Now in our 88th Year of Service to the North Carolina Pharmacists
UiJv Partnership
For Profit
Family
Independent
Pharmacy
Total Retail Concept
The Family Independent Pharmacy program provides an
all-inclusive plan covering every aspect of marketing,
merchandising, and management of drug store opera-
tions. It is a wholesaler-sponsored voluntary, and it
embraces the total retail concept in all its forms.
SHHC
TOTAL HOME HEALTH CARE
Our Total Home Health Care" Program offers Durable
Medical Equipmentfor Rent or Resale. Third Party Billing
for Medicare/Medicaid.
Additional
* Services & Programs Offered *
Store Plan-O-Gram: Complete Store Layout & Design
including Fixtures, Merchandise Plan-o-graming,
and Pricing Strategies
Specialty Qift Departments including Arts & Crafts
Affordable Pharmacy Computer Systems
LIBERTY DRUG SYSTEMS, INC.
QS/1 PHARMACY SYSTEMS
Merchandise Racking Service
Group Life
And Health
Insurance
Benefits
For Members Of
North Carolina
Pharmaceutical
Association
Jefferson-Pilot Life Insurance Company is pleased to
have been selected as the Group insurance carrier for
the North Carolina Pharmaceutical Association. It would
be to your advantage to become thoroughly acquainted
with the benefits of this program.
You can expect the best possible service from
Jefferson-Pilot, one of the nation's leading Group
insurance carriers. For full information, contact Mr. Al
Mebane, Executive Director, North Carolina
Pharmaceutical Association.
Write or call:
Sam P. Stuart, CLU
P. O. Box 595
Winston-Salem, NC 27102
Telephone 919/723-8811
Jefferson
Pilot
INSURANCE / FINANCIAL SERVICES
1HE GIROLINK
JOURNN-OfPHN^MkCY
(USPS 091-280)
DECEMBER 1 987 VOLUME 67
ISSN 0528-1725
NUMBER 12
Officers
NORTH CAROLINA
PHARMACEUTICAL
ASSOCIATION
President
Julian E. Upchurch
5201 Pine Way
Durham, NC 27712
(919)477-7325
Vice Presidents
Albert F. Lockamy, Jr.
6708 Candlewood Drive
Raleigh, NC 27612
(919) 876-5600
W. Robert Bizzell
1007 Rhem Street
Kinston, NC 28501
(919) 527-6929
Loni T. Garcia
5210 McLeod Road
Lumberton, NC 28358
(919) 738-644, Ext. 7317
Executive Director
& Editor
A. H. Mebane, III
P.O. Box 151
Chapel Hill, N.C. 27514
NCPhA Office
(919)967-2237
or
1-800-852-7343
CONTENTS
Yarborough Selected for APHA Smith Award 5
Mail Order Pharmacy 7
1987 Lilly Digest Statistics 15
Fragmented Sleep — A Health Hazard 17
Cardiovascular Medicines Impact 22
Dickinson's Pharmacy 25
Genes and Viruses 27
Review of Hospital Pharmacy Operations 31
Classified Advertising 34
ADVERTISERS
Colorcraft 14
Dr. T.C. Smith Co./W.H. King Drug Back Cover
Geer Drug 20
Gene Minton Consulting Services 30
Jefferson Pilot 2
Justice Drug Company 1
Kendall Drug Company Inside Front Cover
Lawrence Pharmaceuticals 16
Lilly 6
Medi-Span 8
Owens & Minor, Inc Inside Back Cover
Savage Laboratories 10
Upjohn 12
USPDI 24
Washington National Insurance Company 28
The Carolina Journal of Pharmacy is published monthly by the
North Carolina Pharmaceutical Association, P. O. Box 151,
Chapel Hill, NC 27514. The Journal is provided to NCPhA
members through allocation of annual dues. Subscription rate to
non-pharmacists (continental US) $20.00. Single copy price
$2.00. Overseas rates on request. Second class postage paid at
Chapel Hill, NC.
Human insulin for all,
Humuliri
human insulin
[recombinant DNA origin]
Identical to human insulin. Humuhn is the only insulin not
derived from animal pancreases.
Recombinant DNA technology makes the production of
Humuhn possible and virtually assures every insulin user of a
lifetime supply
From Lilly . . . a dependable source of insulin for
generations. Since 1922. when we became the first company
to manufacture insulin, we have led the search for the best
diabetes care products and. at the same time, maintained a
constant supply of insulin for all insulin users
Our 24 formulations of insulin— including Humulin and all
forms of lletm? (insulin)— are available through the widest retail
distribution of insulin in the United States.
Beyond that, we will continue to provide a wide range of
diabetes service and educational materials for use by physi-
cians, pharmacists, and diabetes educators
© 1986 ELI LILLY AND COMPANY
Our Medical Division Is on call. Our Medical Division staff
is only a phone call away Please contact them if you have any
questions about our diabetes care products
Any change of Insulin should be made cautiously and
only under medical supervision. Changes in refinement,
purity, strength, brand (manufacturer), type (regular, NPH,
Lente51, etc), and/or method of manufacture (recombinant DNA
versus animal-source insulin) may result in the need for a change
in dosage
Lilly Leadership
IN DIABETES CARE
For information on insulin delivery systems, contact CPI 1-(800)-227-3422
Sfay
Eli Lilly and Company
Indianapolis, Indiana 46285
THE NORTH CAROLINA JOURNAL OF PHARMACY
YARBOROUGH SELECTED FOR APHA'S
DANIEL B. SMITH AWARD
Margaret C. Yarborough
Cary, North Carolina
Margaret C. (Peggy) Yarborough, Cary, has
been selected by the American Pharmaceutical
Association as the 1 988 recipient of the Daniel B.
Smith Award. The award will be presented at the
APHA Annual Meeting and Exhibit in Atlanta,
March 12-16, 1988. The award, named after the
first president of APHA, is presented annually to
recognize a community pharmacist who has
devoted significant time and effort to improving
the quality of life in the community and is
considered an exemplary practitioner.
Yarborough was selected for her work in the
field of diabetes and diabetes education. She is the
director of the Diabetes Care Center in Cary and
has conducted many educational programs for
diabetes patients and health care professionals
over the years. She is the most sought-after
speaker on diabetes and diabetes education in the
country.
The American Diabetes Association named
her the Outstanding Health Professional in the
field of diabetes in 1984. She is the first
pharmacist to receive this recognition, in the form
of the Ames Award. The same year she was
chosen as the first recipient of the Patient Care
A ward for excellence in patient education by a
pharmacist, given by the Family Practice
Residency and the Research and Development
Center of St. Mary's Hospital in Kansas City.
A native of Charlotte, Mrs. Yarborough was
graduated from the UNC-CH School of
Pharmacy in 1966 with a B.S. in Pharmacy and
was class valedictorian. She earned her M.S.
degree in 1978. Her professional work
experience includes Pharmacy Coordinator for
Greensboro AHEC; Clinical Assistant Professor
of Pharmacy, UNC School of Pharmacy;
pharmacist at Rex Hospital, Raleigh; Director of
Drug Information at NC Memorial Hospital; and
Clinical Pharmacy Specialist in Total Parenteral
Nutrition at Washington Hospital, Washington,
DC.
She and her husband, Frank, own and operate
Yarborough's Pharmacy as well as the Diabetes
Care Center in Cary.
Her involvement and efforts in diabetes
education have led to recognition from many
continued on page 6
December, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
YARBOROUGH
Continued from page 5
sources. She has written articles for journals and
periodicals, including The Apothecary, Drug
Intelligence and Clinical Care, Clinical
Pharmacy Handbook, Diabetes Forecast and
Diabetes Care. She is a recent appointee to the
Eastern Regional Diabetes Advisory Committee,
an organization established to work with the
Centers for Disease Control to help control
diabetes.
She has been awarded a major grant from the
National Institutes of Health Small Business
Innovation Research Program to develop
computer-assisted educational modules for teen-
age diabetics. These modules will help the young
people learn about their disease and how they can
be more responsible for their selfcare. The grant is
for $427,000 over two years, and she will be
assisted by a psychologist, special educational
counselor, another diabetes educator and a
computer programer.
Honors Peggy has received include the 1986
A.H. Robins "Bowl of Hygeia" for outstanding
community service; the 1976 N.C. Society of
Hospital Pharmacists "Achievement Award"
and "Hospital Pharmacist of the Year Award";
the first University of North Carolina School of
Pharmacy Alumni Association "Distinguished
Service Award" given in 1986; and the Charles
W. Styron Award of the Triangle Chapter of the
North Carolina Diabetes Association in 1982.
Her service to the field of diabetes has led her
to serve on numerous boards, commissions and
panels. She has been president of the Triangle
Diabetes Association, on the Therapeutics
Committee of the American Diabetes Associa-
tion, and a member of the Board of Directors of
the North Carolina Diabetes Association.
DIABETES FACTS
HEART DISEASE FACTS
• Approximately 5.8 million people in the
• Heart and circulatory disease, the
United States have been diagnosed as
nation's major cause of death, will kill
having diabetes.
almost one million Americans this year.
• An additional 4 to 5 million people have
the disease but have not yet been
diagnosed.
• Nearly 540,000 of the deaths will occur
among 1.5 million heart attack victims.
• Eight or nine of every ten patients with
diabetes have non-insulin-dependent
diabetes, which usually can be controlled
• About 350,000 heart attack victims will
through a combination of diet, exercise
and/or oral antidiabetes agents. The
die before reaching a hospital because
the average victim waits three hours
remaining patients have insulin-
dependent diabetes and must take insulin
before seeking help.
shots to stay alive.
• Diabetes and its complications are listed
• Heart and circulatory disease will cost
as the third leading cause of death by
the nation an estimated $85.2 billion in
disease in the U.S., believed to cost
1987.
Americans more than $13.8 billion
annually.
— American Diabetes Association
— American Heart Association
December, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
MAIL ORDER PHARMACY: A Real or Perceived Threat
to the Economic Future of Retail Pharmacy
by Abraham G. Hartzema, Ph.D., M.S.P.H., and Jan Hirsch Phillips, Ph.D.
Division of Pharmacy Administration, School of Pharmacy, University of North Carolina
Chapel Hill, NC 27514
Current Focus of the Political
Discussion on the Distribution
of Pharmaceuticals
New distribution channels through which drug
products move from the manufacturer to the
patient are opening up, it seems, almost every
day. Once, the community pharmacist was the
exclusive distributive agent for pharmaceuticals.
Today, hospitals, HMOs, mail order pharmacies,
physicians and others have gained a place in the
distribution chain for pharmaceuticals. Increas-
ingly, the competition between the different dis-
tribution outlets puts pressure on the profit
margins of the community pharmacy.
Of all these new distribution channels, mail
order pharmacies and dispensing physician's of-
fices have created the most controversy. Widely
publicized attempts to limit physician dispensing
on the grounds of conflict of interest, patient
safety, etc. have been the topic of recent con-
gressional hearings. However, the movement at
the federal level to restrict physician dispensing
appears dead, at least until the next session of
congress. Congressional attention directed
toward the effects of mail order pharmacy ser-
vices has been less direct and adamant. Mail
order pharmacy services as a political issue has
received much more focused attention from legis-
lators at the state level than from congress. One
reason may be that primary licensing require-
ments and inspections are regulated at the state
level.
Analysis of the Issues
Surrounding Mail Order
Pharmacies
Mail order pharmacies have awakened an
emotional outcry in the pharmacy community.
These vocalized emotions have centered around
two main issues, namely patient care issues and
economic issues. While patient care issues domi-
nate much of the discussion, very real issues relate
to the perceived threat of mail order pharmacies
to the economic survival of the independent
pharmacist.
The issue of mail order pharmacy services, just
as physician dispensing, remains unresolved to
the satisfaction of the pharmacy profession. Un-
like the physician dispensing issue, the mail order
pharmacy controversy has not been as clearly
defined and attempts to curtail the practice have
taken on different forms. Since attempts to limit
mail order pharmacy services have been orches-
trated by a number of diverse groups, an overall
picture of the mail order controversy does not
become clear until an analysis of the different
arguments is provided. The remainder of this
article attempts to put together the arguments by
answering the following questions:
Who are these mail order pharmacies?
Why is the mail order pharmacy service industry
growing?
How has the profession of pharmacy reacted?
What are the promising strategies to counteract
these developments for the pharmacy pro-
fession?
Who Are These Mail Order
Pharmacies?
Three distinct categories of pharmacy mail
order providers can be defined. The first group
includes the closed systems represented by gov-
ernment sponsored programs. The oldest and
largest of such programs is the Veterans Admin-
istration ( VA) mail order program, with 40 years
in the mail order prescription business. About
two thirds of all mail order prescriptions are
dispensed by the VA. The VA mail order system
was implemented to serve those veterans with
service connected disabilities who lived long
distances from the VA facilities. Currently, the
VA encourages (by mandating) all patients to use
the mail order system for refills instead of picking
up the prescriptions at VA pharmacies.
The second category of pharmacy mail order
systems includes those sponsored by non-profit
organizations, most notably the 28-year old
American Association of Retired Persons
(AARP) pharmacy mail order system and a
younger counterpart, Elder Med. AARP Phar-
macy Service dispenses about lxh million prescrip-
continued on page 8
December, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
MAIL ORDER PHARMACY
Continued from page 7
tions from its facilities each year. The AARP uses
the mail order prescription program as a mem-
bership benefit, just as it offers travel and in-
surance program membership benefits. Patients
are not automatically enrolled and individual
patients opt to use the program on a voluntary
basis. AARP reports that it mails prescription
drugs to approximately ten percent of its mem-
bers. The percentage of mail order prescriptions
reimbursed by third party payers is quite low.
The majority of prescriptions are paid for out of
pocket. This type of mail order program is open
to the general public, and is most beneficial for
those elderly patients who are heavy users of
maintenance prescription drugs.
A third category of mail order providers is
composed of for profit mail order companies.
The significant growth observed in the mail order
prescription business has been propelled by the
increased number of for profit mail order firms
entering the market and an increase in the num-
ber of their enrollees. The largest firm in this
category is Medco Containment Services. Medco
reports that its mail order pharmacy fills 200,000
prescriptions per week. Medco management esti-
mates that this volume represents 50% of the
prescriptions that are filled through the mail in
the U.S., excluding the VA and AARP system.
Firms presently entering the market include
such diverse entities as drug manufacturers, drug
chains and hospitals. Firms entering the market
include Baxter-Travenol, through its Preferred
Prescription Services; major drug chains such as
FAY's Postscript and Thrift Drug Stores; Rush
Presbyterian - St. Luke's Medical Center hos-
pitals under the name ARC Ventures; and others,
such as Medicare-Glaser Corporation through its
Express Script, Inc.
For profit mail order programs contract with
large companies such as Ford, Kodak, Amoco,
etc., who want to offer a drug benefit program to
their employees. Similar contracts are made by
Blue Cross and Blue Shield organizations with
National Pharmacy Services for federal em-
ployees and Washington state employees. The
pressure some larger employers have faced to
provide enhanced fringe benefits (including out
patient drug benefits) in their compensation
package has fostered the growth of the for profit
firms in the pharmacy mail order business. In
some prescription drug benefit packages, em-
ployees are required to use mail order services
exclusively. Other contracts allow the choice
between community pharmacies and mail order
pharmacy services. Incentives such as reducing
co-payments for the use of mail order pharmacies
are usually offered in the latter case.
In summary, there are three distinct groups of
mail order programs with different character-
istics. These are government sponsored, closed
system programs (e.g. VA), mail order programs
sponsored by non-profit organizations and of-
fered as member benefits to enrolling individual
patients (e.g. AARP), and the for profit mail
order programs contracting with larger organi-
zations and companies (e.g. Medco).
Why Is the Mail Order
Pharmacy Service Industry
Growing?
Changing forces in the health care market
place have created a comfortable niche for mail
order pharmacy services. The industry is growing
in numbers of providers and customers because
of: (1) the increasing influence of third party
payers in the drug buying decision making chain,
(2) increased emphasis on cost containment by
all drug purchasers (individuals and organiza-
tions) and (3) the increasing demand for a more
convenient drug delivery system by influential
segments of the U.S. population.
Continued on page 9
MEDI-SPAN
Preferred if Vendor
Rx Software $1,248
Try Before You Buy:
Use our software for 90 days If you are not
completely satisfied, return it with no obligation to
purchase
Performs These Functions:
Rx Labels — Patient Profiles — Counseling Messages
Interactions — Generic Substitutions — Discounts
IRS and Insurance Summaries— Accounts Receivable
Daily Logs — 1 hird Party Billing — Inventory Control
Nursing Home.
Medi-Span Services:
Price Updates — Drug Base — Interaction Base
Competitive Pricing Guide
For Information Call:
1-800-423-0276 ext. 4706
December, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
MAIL ORDER PHARMACY
Continued from page 8
Third Party Payers. Today, powerful new
gatekeepers stand between the pharmaceutical
industry and the patient. New decision makers
have an economic stake in, and thus, a major
influence on drug selection, utilization and the
pharmacy distribution channel selected. Al-
though percentage-wise, drugs are still the highest
out-of-pocket expenditure, estimates suggest that
between 60 and 70% of drug costs are still paid
out-of-pocket, an increasingly larger percentage
of drug costs is paid by third party payers.
Consequently, the nature of the drug market is
shifting from a market represented by many in-
dividual purchasers of pharmaceutical services to
a few large buyers, in economical terms, a more
monopsonic market. These few large buyers have
a much greater influence on the pharmaceutical
distribution system than many individual buyers
had in the past.
Mail order pharmacy services are attractive to
large buyers who are pressed by labor organi-
zations for increased benefits and realize that
providing drug benefits to their employees may
raise their company's health care bill only be-
tween 5 and 10%. Employees negotiating such
benefits are, for example, the postal supervisors,
federal employees in Washington State and
others. Mail order pharmacy services are attrac-
tive because they address the need to serve an
often geographically widely dispersed patient
population for companies lacking the adminis-
trative capacity to deal with many retail outlets.
In addition, the low cost image of mail order
pharmacies is appealing to corporations and
other third parties concerned with providing
extra benefits at a reasonable cost.
Cost Savings. Mail order pharmacies extend
cost savings not only to large third party payers,
but to individual patients as well. Mail order
pharmacies are generally located in states with
more lenient substitution regulations. Therefore,
not surprisingly, the largest cost savings in mail
order pharmacies, 30-50% of total cost savings, is
achieved by a high level of generic substitution.
Other cost savings result from large volume buy-
ing power, lower overhead expense, use of sup-
portive personnel and dispensing automations
which result in reported pharmacist productivity
ranging from 285 to 400 prescriptions per 8 hour
workday.
Large third party payers certainly have a
vested interest in controlling the cost of providing
drug benefits. These new payers also have the
scope and force of influence to demand more cost
effective drug delivery systems. This pressure
from third party payers has created the atmos-
phere which has allowed the development and
growth of for profit mail order firms which
account for the majority of the recent growth in
the mail order prescription market.
Although the structure and organization of
mail order pharmacies allow for considerable
cost savings, studies have found that the use of
mail order pharmacies does not always translate
in cost savings for third party payers. A study by
Pharmaceutical Card System, Inc. found that al-
though a 4% program savings was obtained in
unit cost, a 9% increase in volume cost was found,
causing the average cost of a mail order program
to be 5% higher than a community pharmacy
program would have been. Ford Motor Com-
pany reported that the costs of its mail order
program was approximately 1.5 - 1.7% higher
than a comparable community pharmacy pro-
gram would cost.
As would be expected, these results have been
challenged on the grounds of methodological
errors and restrictive program requirements (e.g.
90 supply minimums and automatic refill
mailings). However, these results do indicate that
mail order pharmacy services are not an auto-
matic panacea for controlling prescription drug
program costs. Even with the cost advantages
enjoyed by mail order firms, prudent man-
agement of the scope and delivery of benefits is
needed for a company to realize a cost savings
over the traditional pharmacy distributive
system.
Mail order pharmacy services also offer cost
savings to individuals. In cases where companies
such as GM or Ford have contracted with mail
order firms to provide drug benefits, and en-
rollees are given the choice between mail order
and community pharmacies, frequently incen-
tives are offered in the form of lower co-pays for
the use of mail order. However, it has been
reported that the results of these incentives are
negligible; only between one and five percent of
the enrollees offered the choice of mail order
selected this option. One explanation may be the
increasingly common practice of discounting the
co-pay for third party prescriptions filled in
community pharmacies, thereby reducing the
effectiveness of a lowered mail order co-pay.
AARP offers the private patient insight into the
pricing structure of pharmaceuticals and savings
that can be achieved by requesting generic drugs
Continued on page 11
December, 1987
Kelly Jenkins
His responsibility is to
do the best job possible. ..for you
...wherever you are in North Carolina.
How specially-trained
Savage professional representatives
can serve you and your business:
• Help maximize inventory turnover for greater
profitability
• Rapid-response order taking and delivery
...and a fair product -return policy
• Close liaison for you with wholesalers,
physicians, and headquarters customer
service at Savage
• Help to keep you informed about current
trends and competitive strategies
• Promotion specialist: Not only helps make the
deals, but helps build traffic
Savage products...
They help build customer traffic
for your pharmacy
The right strengths, the right formulations,
the right quality, at the right price. . .
to help you serve your customers and
maintain your profits
22 high-quality products
from a single source
9
Allergy: BREXIN" LA CAPSULES chlorpheniramine maleate8mg.
pseudoephednne hydrochloride I20mg •
Antiprotozoal: SATRIC" TABLETS - 250mg (metronidazole USP) •
SATRIC" -500 TABLETS (metronidazole USP) •
Bronchodilators: DILOR® ELIXIR (dyphylline) •
DILOR" INJECTABLE (dyphylline) • DILOR' TABLETS - 200mg (dyphylline) ■
DILOR"- 400 TABLETS (dyphylline) • DILOR-G" LIQUID
dyphylline 100mg guaifenesin USP lOOmg • DILOR-G" TABLETS
dyphylline 200mg. guaifenesin USP 200mg •
Contrast Medium: ETHIODOV (ethiodized oil for miection) •
Cough/Cold: BREXIN" E-X (pseudoephedrine HCI and guaifenesin) •
Hormone: DITATE* -DS (testosterone enanthate and
estradiol valerate injection) ■
Topicals: alphatrex* CREAM, ointment AND LOTION 0 05%
(betamethasone dipropionate USP) •
BETATREX" CREAM, OINTMENT AND LOTION 0 1%
(betamethasone valerate USP) •
MYTREX* F CREAM AND OINTMENT (nystatin -triamcinolone acetonide) •
NYSTEX'" CREAM AND OINTMENT (nystatin USP) ■
NYSTEX" ORAL SUSPENSION (nystatin oral suspension USP) •
TRYMEX CREAM AND OINTMENT 0 025% (triamcinolone acetonide USP) •
TRYMEX CREAM AND OINTMENT 0 1% (triamcinolone acetonide USP) •
Vaginal Preparations: TRYSUL'" (triple sulfa vaginal cream)
(sullathiazole 3 42%. sulfacetamide 2 86%. sullabenzamine 3 70%) •
Vitamins: CHROMAGEN* CAPSULES ferrous fumarate USP 200mg.
ascorbic acid USP 250mg. cyanocobalamm USP 1 0mcg. desiccated
stomach substance 100mg •
CHROMAGEN* 0B CAPSULES a phosphorus- tree vitamin and mineral
dietary supplement lor use during pregnancy and lactation
SAVAGE
LABORATORIES
a division of Altana Inc • Melville. New York 1 1 747
People and products to serve your needs.
THE NORTH CAROLINA JOURNAL OF PHARMACY
11
MAIL ORDER PHARMACY
Continued from page 9
to be dispensed by way of regular catalog publi-
cations.
Patient Convenience. Patients themselves
can decide to use or not to use mail order phar-
macies in the programs offered as membership
benefits and in the for profit programs which
offer a choice between mail order pharmacy
services and community pharmacies. Although
there are reasons which may explain why patients
voluntarily choose mail order pharmacy services,
a survey of pharmacy mail order users revealed
that the primary motive for mail order use was
convenience. Economic motives placed second.
Although pharmacies are more widely distri-
buted than physician offices, both patients in
rural areas as well as in inner cities may encounter
barriers which limit their access to pharmacies,
thereby making mail order pharmacy services
more convenient. In the inner cities, patiens may
face access problems because of the fear (a
psychological barrier) of visiting a downtown
pharmacy in an undesirable area. Mail order
pharmacy services may be an attractive, more
convenient alternative. In the rural areas, the
distance or lack of transportation may be the
motivating factor for the patient to use mail order
pharmacies. These geographical barriers may be
even more difficult to overcome for the elderly
because of the high prevalence of physical handi-
caps in this population. The growing proportion
of elderly in our society, and a higher level of
organization and education among the elderly
will provide ample opportunities for mail order
pharmacies to promote convenient pharmacy
services to this profitable market.
American Pharmaceutical Association
135th Annual Meeting and Exhibit
March 12-16, 1988
Another reason patients may perceive mail
order pharmacy services as more convenient is
that the service offers anonymity. Although phar-
macists consider patient information as con-
fidential, some patients may not be convinced of
this fact and therefore have misgivings about
filling their prescriptions at their local pharmacy.
Patients may also avoid inquisition by other
waiting patients (possible acquaintances) by uti-
lizing mail order pharmacy services. Patient
surveys have also indicated that some patients
have turned to mail order pharmacies because of
a real or perceived differential treatment of pri-
vate pay and third party pay patients in com-
munity pharmacies.
How Has the Profession of
Pharmacy Reacted?
Many state pharmacy associations have been
actively lobbying against out of state mail order
pharmacies dispensing to consumers in their
state. The strategies proposed to limit mail order
dispensing have generally revolved around three
tactics:
1) requiring pharmacists on staff at a mail
order pharmacy to be licensed in the state(s) that
prescriptions are being mailed to.
2) requiring mail order pharmacies to be fully
licensed in the states thay are mailing prescrip-
tions to.
3) applying special restrictions on out of state
mail order pharmacies, (e.g. 24 hour WATS line)
Attempts to regulate mail order pharmacies
have met with varying degrees of success. Ar-
kansas, Florida, Louisiana, South Dakota, and
West Virginia have enacted laws or regulations
which control or prohibit mail order pharmacy
services. An issue which has hindered widespread
adoption of restrictive laws or regulations is the
interpretation of the state's authority to impede
the constitutional right of interstate commerce.
Also at issue is the practice of applying restric-
tions to out of state mail order pharmacies for the
benefit of in state economic concerns, thus re-
stricting competition.
Several other states have received opinions
from their attorney general's office regarding the
constitutionality of regulating out of state maii
order pharmacies. Although some have received
favorable rulings, others have not. Even in states
where legislation has been passed or favorable
opinions registered, the issue remains of how to
finance and enforce compliance with regulations
in out of state pharmacies. Also, determining
Continued on page 13
December, 1987
^^HMHPHflMt' '
Through their experience
ycxjr concerns
Through their insights
is panehjts, we discovered
fcw ideas.
The members of our 1987 Pharmacy Consultant Panel
spoke from personal experience. But their ideas and concerns
spanned the breadth ot our profession. We thank them
for sharing their wisdom, experience and advice. Most
of all, we look forward to putting their ideas to work
to serve pharmacy professionals better.
r«WJ W**m «Mim.«.«)
Mm*! HhuJ,, Phwmacul
) Mew Wwmaudl I w,s k- nl f*\.vn
Copyngni 1987, The Upjohn Company. Kalamazoo. Michigan 49001
THE NORTH CAROLINA JOURNAL OF PHARMACY
13
MAIL ORDER PHARMACY
Continued from page 11
which out of state mail order pharmacies are
actually dispensing prescriptions to consumers in
a particular state (and therefore should be com-
pliant with that state's regulations) presents a
formidable task in and of itself.
At the national level, two pharmacy associ-
ations have assumed an active role in curtailing
mail order pharmacy services. The Public and
Scientific Affairs Policy Committee of the
American Pharmaceutical Association (APhA)
formulated recommendations which were dis-
cussed during the 1987 annual meeting. The four
recommendations were:
(1) APhA should adopt the position that a
direct and personal pharmacist-patient relation-
ship is as important in providing pharmaceutical
services as it is in every other field of health care.
(2) APhA should educate the public and third
party payers of benefits of such direct and per-
sonal relationships.
(3) APhA should support requirements for all
pharmaceutical services to meet practice stand-
ards (e.g., labeling, drug product selection, and
use of supportive personnel) established by laws
and regulations of the patient's state of residence.
(4) APhA should support third party contrac-
tual agreement provisions that do not penalize
patients by limiting their selection of providers of
prescription medication.
Interestingly, the resolutions were not ac-
cepted by the House of Delegates. Instead they
were sent back to committee for the language to
be strengthened.
While APhA's recommendations center
around drug therapy monitoring activities, in
particular, the flow of information between
physicians, patients and pharmacists, NARD's
considerations can be summarized as public
health concerns, and include the importance of
the pharmacist's role in patient health status
assessment, patient education, emergency pro-
visions and compliance reinforcement. NARD
created a Mail Order Task Force for the purposes
of investigating and proposing possible state
regulations and legislation, establishing a Mail
Order Clearinghouse for collecting information
on mail order programs and legislative actions,
and distributing an anti-mail order brochure to
consumers. Although neither national organiza-
tion has chosen to focus on economic issues,
economic incentives and constraints will most
likely feel the current controversy and determine
the pace of future growth of the pharmacy mail
order industry.
Strategies for Change
Last fall during a conference sponsored by
American Druggist and Stuart Pharmaceuticals,
Del Konnor, AARP's mail order pharmacy's
Vice-president for Professional Affairs, told his
audience that mail order pharmacies would in-
crease their current market penetration from less
than 3% to a market penetration of 10%. Is the
future of community retail pharmacy that dark?
It almost seems so, if we look at the lack of
success to date of many state pharmacy associa-
tions in implementing state regulatory and legis-
lative measures to restrict out of state mail order
firms from conducting business in their state.
As stated earlier, the current growth in phar-
macy mail order business is not due to an increase
in individual patients participating in non-profit
systems. Instead, the growth is fostered by com-
panies seeking to increase their employee's health
benefit plans by contracting with for-profit phar-
macy mail order companies for a prescription
drug plan. These companies are looking for one
claims processor and provider who can serve
their geographically dispersed constituency.
There being no apparent alternative, mail order
pharmacies have necessarily been their choice.
However, community retail pharmacy has
developed such an alternative to mail order phar-
macy services in the form of Preferred Provider
Organizations (PPOs) and Pharmacy Services
Administrative Organizations (PSAOs). These
organizational structures offer third party payers
an attractive alternative to mail order phar-
macies. PPOs and PSAOs offer centralized claim
processing and widespread geographic coverage
just as mail order pharmacy services. PPOs and
PSAOs also offer the added advantages of con-
tinuity of patient care, provision of acute illness
medicines, provision of drugs with limited shelf
lives such as liquid medicine or insulin and
controlled dispensing of narcotics and other po-
tentially abusive substances. Pharmacy networks
are community retail pharmacy's answer to the
mail order dilemma.
Many states have formed PSAOs or PPOs and
are currently pursuing and servicing contracts
with major employers. A national PSAO,
RxNET (sponsored by NARD), has begun mar-
keting services to individual PSAOs and expects
to begin operation in the latter part of this year. In
order for these networks to be successful and
become integrated into the health care system,
third party payers must view them not only as an
Continued on page 14
December, 1987
14
THE NORTH CAROLINA JOURNAL OF PHARMACY
Return Goods
Policy Manual, 4th Ed.
To make up the loss for just one
outdated bottle of a product, you
would have to sell over 33 times
its cost.
The Return Goods Policy Manual
can expedite the process of re-
turning your unsalable inventory.
Don't leave profits sitting on the
shelf!
Order Form
Name
Address_
City
State Zip_
Please send me copies of the Return
Goods Policy Manual.
/ have enclosed a check for $30 for each
copy.
Please bill my Mastercard.
Card# exp.date
Please bill my Visa.
Cardft exp .date
Send this form with payment to:
N Carolina Pharmaceutical Association
PO Box 151
Chapel Hill. NC 27514
(Please allow 4 - 6 weeks for delivery)
MAIL ORDER PHARMACY
Continued from page 13
equivalent alternative to mail order pharmacy
services but as an alternative that offers distinct
advantages over mail order pharmacy services.
Pharmacy network administrators and indi-
vidual pharmacists must also address the con-
venience factor that is attractive to many mail
order consumers. Pharmacy services in the com-
munity retail setting must be made as accessible
as possible to consumers. This may entail the
resurrection of delivery services or institution of
community pharmacy based mailed prescription
services for consumers with special needs. The
underlying philosophy of a pharmacy network
should be to provide quality professional pro-
ducts and services at a reasonable price in a
timely and convenient manner. The added ad-
vantages of community based pharmacy services
must be clearly communicated and marketed to
third party decision makers, large health care
buyers, and self-funded benefit plans. More im-
portantly, in order for community based phar-
macy services to effectively compete with mail
order services, these advantages must be effec-
tively and consistently delivered by each com-
munity pharmacist.
Remember the ^Day
...in^'ctures
COLORCRAFT
North Carolina's Most Complete
Film Processing Service
There Is A Plant Located
Near You
For the Finest Quality Plus Fast
Dependable Service on All Your
Photo Needs, Contact the Plant
Nearest You.
CHARLOTTE WILMINGTON
KERNERSVILLE RALEIGH
FAYETTEVILLE DURHAM
If You Don't Know Photofinishing
Know Your Photofinisher
December, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
15
&s
o
oo
nS no
vO CO
1 1
o
o
vO
1
in oo
ON OS
00 \©
co
OS
in
O
ON
r~ in
— co
oo
ro
IT,
co*
6§
o
o< o
no co
1 |
d
o
NO
1
(N Tt
IT,
DC
on
O r-~
OO
oc'
iri
oo
oC
oc
co
&S
S§
BS
6?
—
o
o
■ —
— ,
oo
o
CO
1
1
©
1
DC
oo
^o
rj
r)
n
ID
"1
in
o
sOr
oo'
oc
r-~"
r>
oo
Os
■oo
NO
OO
oo
Tf
c
,_
y.
■_i
u
tu
-j
-;=
-J
<
£
0
v.
Q
z
C
5
0
as:
O
<
u.
^
O
y
C
C
Cg
u
a
e§ s§ e§ e§
ONOnn
V",
r-- on
On'
04
<n in
g
1 1
on m
On O
t~-_VO
ci
ON
OO
r-'oo'
— ro
oo
NO 00
ON >/">
(N CnI
6% 6s? feS S§
CO NO — ON
\d On r-j ©
O Cn) cm OO
— in ■* oo
ro no — r»
es
e§ e§
•*
■* CO
o<
ro no
C)
1
1 1
^ O
O
sO —
oc
no co
ON
On On
vO
— ro
oo
OO
— sO On <N ON
in no — co
_ CO — ON
fcS
S§ S§
in
"* nO
oo
ro NO
rj
1
ir,
1 1
on in
ON
Tf i-
o_
Tfr -*
in
rO in
ON
(N Tf-
oo
OO
o£
C/3 Q
53.2
Z g.
1"? *
S w
— u __
4: ^
on «
O S B w
°-3 <D-
8 fi.o
:<■■=
■in "*
55 ON uH
a „ <N
O no
CO (N
P.O.
NO'r^-T
in m
cs
O fN
— Cs|
| I
■*
e
E
sq. ft.
7.56
4.76
ro NO
m •>*■
| |
O f-
ON ro
CS no
cnTos
Os
oc
ON
£3
CO ■*
■* —
CM rn
irTro
on m
6S
co
ON — 1
O r^
| |
ri
a
sq. ft.
9.87
6.10
in ■*
| |
m no
CO o
in Pi
oo
ON
OO
oo
5^
CO <N
in rn
oo'no'
6 5
Pi
>
O
z
ps!
D
H
u.
O
2 H^
c <P
8 Qifc
(3 _J
E w<
Oci
HO,
° 2
<>
2 Z
z-
ZU.
<o
z <
^SS o
2^^
zee:
o- 5
Qi C - C
3 8.-SI
o - - '
•x.
a.
O
D.-Q.
£3 § »
g a. u
15 2 « S 1 1 J
1^3:
a. z
d. e
1 c
03 C/
December, 1987
Now you don't Now you
see it...
Customers won't buy what
they don't see. And when the
merchandise in the front of your
pharmacy is poorly arranged,
you're doing your customers a
disservice as well as yourself.
That's why the professionally
trained Merchandising Specialists
at Lawrence are so important. At
no cost to you, they will survey
your store and then work with
you in rearranging shelves and
displays to market your products
most effectively. They'll also
provide you with the latest
information about special product
promotions, couponing, adver-
tising and trial size merchandise.
This helps you run a more
successful store. And your
customers find the products at
the best available price.
To arrange an appointment
with a Lawrence Merchandising
Specialist, call our Sales/Service
Department at the number below.
_, A FoxMeyer Company / Ij^J j
Pharmaeeuiieals
6100 Phillips Highway • Post Office Box 5386
Jacksonville, Florida 32207-0386 • (904)731-4610
Toll Free 800/682-2270
THE NORTH CAROLINA JOURNAL OF PHARMACY
17
FRAGMENTED SLEEP —
A HIDDEN HEALTH HAZARD
By Martin A. Cohn, M.D.
Chief, Sleep Disorders Center
Mount Sinai Medical Center, Miami, Florida;
Assistant Professor of Medicine
University of Miami School of Medicine
Melvile in Moby Dick admired seagulls far
from land who could sit on turbulent waves and
be rocked to sleep, or the sailor sleeping
peacefully at sea, oblivious to herds of whales and
walruses rushing beneath his pillow.
Many of us aren't so blissfully insulated during
sleep. In fact, our sleep is interrupted constantly
— by our own coughs, aches, worries that won't
quit and a variety of physical conditions. The
truly bad news is that these brief awakenings —
which the sleeper may not even remember in the
morning — can prevent much of the good that
sleep accomplishes.
Researchers now tell us that millions of people
who may believe they're sleeping eight or even
nine hours a night are actually getting
considerably less. While we're all awakened ever
so slightly perhaps 30 to 50 times each night
without being aware of it, some are awakened
hundreds of times. Scientists find this may leave
them as unrested as someone who hasn't slept at
all! What's more, fragmented sleep may have
dramatic impact on daytime functioning and
health.
What Keeps People Awake?
Many in today's world choose to get less than
the usual seven to eight hours' sleep. They watch
late-night TV or socialize. But others, who aim
for their full allotment of sleep, are foiled.
Discontinuous sleep becomes especially
common as people age, in part because pauses
between breaths grow longer. As the brain senses
the demand for oxygen, the individual is
momentarily aroused to draw a full breath. From
50 to 1 50 such little "alarms" may punctuate the
sleep of older persons. These can make sleep less
restorative — particularly since older people
have greater trouble than young people falling
back to sleep.
Continued on page 18
(CO
^^K^^At***^^)
Nocturnal myoclonus - involuntary leg kicking during sleep - is one ol the sleep disorders that grow more common with age Though victims
may be unaware they have this problem, their sleep is fragmented, leaving them tired and often depressed during the day.
December, 1987
it
THE NORTH CAROLINA JOURNAL OF PHARMACY
FRAGMENTED SLEEP
Continued from page 17
Halts in breathing especially plague the
slumber of people with a condition called sleep
apnea. A misfunction of the sleep respiratory
control center in the brain causes them to
periodically stop breathing for 10 seconds to a
minute or longer. They may wake up gasping for
air 200 or 300 times a night.
People who snore because of an upper airway
obstruction also awaken frequently to catch their
breath. Since half of all people in their sixties
snore regularly, this is a major cause of distrupted
sleep.
Heart conditions and cerebrovascular disease
— hardening of the arteries supplying blood and
oxygen to the brain — can lead to fragmented
sleep too. Sluggish circulation causes the brain to.
emit a distress call for more oxygen. The sleeper
becomes somewhat alert while taking deep
breaths, this "waking up" is evident on brain
wave patterns but may not be recalled by the
person. Coughing while asleep, because of
respiratory problems and also gastrointestinal
disorders in which stomach acids rise to the
throat, adds to the multitudes whose sleep is
interrupted.
In addition to those who can't breathe freely
are people with the sleep disorder nocturnal
myoclonus. They automatically tense their leg
muscles every 30 seconds or so during sleep. The
muscle twitching leads to kicking and shifting of
the legs plus many brief arousals.
Painful ailments such as arthritis and back
problems often disturb sleep. Another painful
condition is fibrositis, marked by muscle and
bone pain as well as fatigue. Individuals with this
muscle inflammation experience unusual
nervous system activity while sleeping. Further-
more, sleep does not have its usual refreshing
effect. The night-long discomfort from any
painful affliction can leave a person weary even
after nine hours of fitful sleep.
Anxious and depressed individuals comprise
another large group who often can't sleep
soundly or continuously. Those who are
depressed may awaken at 3 A.M. and not
recapture sleep until it is almost time to get up for
work. Anxiety sufferers may toss and turn.
Fragmented Sleep
Tiredness during the day and deteriorated
physical and mental performance are the chief
effects of fragmented sleep. At Mount Sinai
Hospital, we recently studied sleep apnea patients
who go through each day in a fog, often not
remembering things they have done. They fill out
forms at work but don't recall doing so, or drive
somewhere only to wonder how they got there.
We all engage in daydreaming and some
automatic behavior, but these people are almost
sleepwalking. Their reflexes are slower,
presenting driving dangers. Red lights may be
missed. Inattentiveness can make them appear
lazy or indifferent, especially if they're making
frequent mistakes. An employer may fire them.
Fragmented sleep often leads to emotional and
behavioral disturbances. Irritability and temper
outbursts are common, with damaging
consequences to personal and professional
relationships.
In addition, medical studies support the
popular belief that someone who doesn't get
enough sleep will be "run down." During sleep,
the immune system that protects the body against
disease is fortified by production of new
protective substances. Without sufficient sleep,
people may have less resistance to disease.
People who already are ill may have greater
difficulty recovering without sound sleep.
Patients in a hospital's intensive care unit (ICU),
who are monitored constantly and frequently
awakened for tests and examinations, offer a
dramatic demonstration of this. These patients
are extremely sleep-deprived. They're also
deprived of the full supply of hormones
responsible for body tissue healing that are
produced during deep sleep. Patients may
develop psychological problems, informally
known in the hospital as "intensive care unit
psychosis." But when patients are taken from
ICU and allowed three hours of interrupted sleep,
they feel better and need smaller amounts of
pain-killing narcotics or other medications.
Being well-rested, of course, reduces
discomfort and increases people's ability to cope
with a wide range of illnesses — from the
common cold to arthritis and asthma. Extensive
studies in Scandinavia show higher death rates
for people who regularly sleep less than six, or
more than nine, hours per night. While too little
sleep may be a form of stress that aggravates heart
disease and other illnesses, other factors actually
may be to blame for these early deaths.
Fascinating studies have shown that rats
deprived completelyof REM (rapid eye
movement) sleep will become ill and die, usually
in about a month. The rats studied lost only about
Continued on page 19
December, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
19
FRAGMENTED SLEEP
Continued from page 18
a quarter of total sleep time yet were profoundly
affected. REM sleep in humans is when dreaming
occurs along with other physical events while the
eyes move under closed lids. Implications for
humans are not clear; while many sufferers of
fragmented sleep tend to be awakened only
during REM periods, fortunately they still retain
much such sleep.
Studies of people and animals subjected to
extensive sleep deprivation may have relevance
for those who suffer fragmented sleep —
especially in light of findings that a great many
sleep interruptions are comparable in effect to
total deprivation. For example, epileptic rats
have seizures more easily when sleep-deprived
than when well-rested. Some people who have
panic disorder — an anxiety disorder
characterized by sudden attacks of irrational
terror and accompanying feelings of choking,
pounding heart, dizziness and sweating — had
these attacks more often on the day after being
deprived of a night's sleep.
Getting a Full Night's Sleep
The best recipe for sleeping well is living well
— cultivating habits that invite a full night of
restful sleep. These include getting to bed and
awakening eight or so hours later on a regular
schedule, since changing bedtimes can confuse a
person's "inner clock"; exercising moderately
(but not just before sleep); avoiding naps; refusing
caffeine and alcohol in late evening; and
refraining from upsetting activities such as violent
TV programs or paying bills just before bedtime.
When something does interfere with a night's
sleep, a strategic nap sometimes can undo the
harm and allow people to function as if they had
slept well — but, as a rule, it's best not to make a
habit of naps.
Light sleepers can use some commonsense
measures. If sleep is fragmented by a husband or
wife's snoring, the nonsnorer should go to sleep
first. A person is not as apt to be awakened from
sleep as to be prevented from falling asleep. If
exterior noise intrudes, sound-screening curtains,
acoustic tiles or earplugs can solve the problem.
Those who suffer fragmented sleep for any of
the causes discussed should seek professional
help. A personal physician may be able to treat
insomnia as well as anxiety and depression,
prescribing effective medications as well as
providing, or referring the patient for, helpful
counseling. Specialized sleep disorders centers
can evaluate problems such as sleep apnea, leg
muscle spasms and snoring and guide the patients
to effective treatments.
Primarily, one should be aware that agitated,
fragmented sleep can have serious repercussions.
Take the necessary steps to get a good night's
sleep on a regular basis. It's important!
=i
Inability to get a full night's sleep can lead to drowsiness the next
day and perhaps even undermine health.
December, 1987
WE BRING YOU THE BEST
CHARLESTON, S.C.
GREENVILLE, S.C.
THE NORTH CAROLINA JOURNAL OF PHARMACY
21
LIGHTING ASA
MERCHANDISING TOOL
by Warren Spear, R.Ph.
We are creatures of light. We wake up with
light. We shorten our day when there is less
daytime. We are affected in many ways by light.
All too often we fail to use light to our advantage
as a merchandising tool.
What Messages Do You Send
To Your Customer
With Your Lighting?
An even, high intensity of a single color light
tells the customer that he or she is looking at a
commodity retailer. This is the type of lighting
generally used by chains in an attempt to convey
a low price image. Conversely, lowered total
foot candles with the use of spot or flood
incandescent lights can provide varying light
intensities give the customer the message of
specialty items and higher perceived value.
Note the next time you are in a well planned
jewelry store or fine specialty shop that track
lighting with spots are used to create shadows
and emphasize texture. We can use these
concepts in community pharmacy. Use track
lighting with incandescent spot and/or flood
lights to present special products to your
customer. Light can give greater emphasis to gift
displays and feature ends. The checkout (where
we have our last opportunity sell impulse items)
should also have special lighting. Next we find
that people are attracted to light. We use this to
advantage to bring people into our store.
Sidewalks and entry ways should get special care
in regard to lighting. Increase light intensity as
you get to the entry with greater light inside to
make your store more inviting. The light
people recommend changing all lamps at the
same time. A store with many burned out lamps
can look shoddy. This shoddy look can occur
when individual lamps are changed on an "as
need" basis. Most fluorescent lights can do
strange things to the colors we see. For true colors
consider cool white deluxe (CWX) lamps white
provide excellent color rendition simulating a
cloudy day, C50 lamps which simulate a partly
cloudy day or C75 lamps which simulate north
sky light.
Good lighting makes good sense because it
helps to put more dollars in the till.
September, 1987
EXECUTIVE DIRECTOR
POSITIONS OPEN
The Arizona Pharmacy Association is seeking
qualified candidates for the position of Executive
Director. This is a full time, salaried position,
requiring knowledge of the pharmacy profession
and management experience. Prior association
management experience helpful. Candidates
must demonstrate executive leadership abilities,
excellent oral and written communication skills,
and knowledge of the political-legislative-
regulatory process. Applicants will be
interviewed by the Search Committee, which
will make recommendations to the association's
board of directors for final interview and
approval. Qualified applicants should submit
resume, references and compensation require-
ments to:
Randy Stephens
Executive Search Committee
931 E. Stanford Avenue
Gilbert, AZ 85234
Deadline for applications is March 1, 1988.
The Maryland Pharmacists Association is
seeking qualified candidates for the position of
Executive Director. This is a full time, salaried
position requiring association management skills.
Knowledge of the pharmacy profession and prior
association experience would be helpful.
Candidates must demonstrate executive
leadership abilities, excellent oral and written
communication skills and knowledge of the
legislative process.
Applicants will be interviewed by the Search
Committee, which will make recommendations
to the Association's Board of Trustees for final
approval.
Qualified applicants should submit resume,
references and compensation requirements to:
Search Committee
650 West Lombard Street
Baltimore, Maryland 21201
Deadline for applications is March 15, 1988
and the position is expected to be filled no later
than July 1, 1988.
22
THE NORTH CAROLINA JOURNAL OF PHARMACY
FUTURE DIRECTIONS IN
CARDIOVASCULAR MEDICINE HAVE EXPECTED IMPACT
ON LONGEVITY AND QUALITY OF LIFE
The magnitude of the role the artificial heart
will play as either a permanent implant or as a
bridge to a human heart is still a subject of
considerable controversy.
Robert Jarvik, M.D., developer of the Jarvik-
7 artificial heart and president of Symbion, Inc.,
in Salt Lake City, Utah, offers his forecast.
"The artificial heart is both an important
research tool and a significant clinical advance-
ment," says Jarvik. "There will never be enough
human hearts available to meet the needs of
transplant patients. The artificial heart should be
developed into a permanently implantable unit."
While this work stirs controversy, other,
cardiovascular disease research continues.
Cardiovascular Disease
in the Age of the Artificial Heart
Diseases of the heart and blood vessels remain
the leading cause of death in the United States
and Europe. However, in the United States since
1964 there has been a significant decline in the
overall death rate. Seventy-six percent of the
decline can be attributed to a reduction in
cardiovascular disease. (See Figure #1 — Heart
Attack and Stroke: Twenty- Year Retrospective.)
"Public education on cardiac risk factors is one
element credited for the improved statistics," says
Michael DeBakey, M.D., chancellor of Baylor
College of Medicine in Houston.
In 1985, the American Heart Association
lowered the minimum blood pressure readings to
be diagnosed as high blood pressure from 160
over 95 to 140 over 90. The revision significantly
increased the number of people considered
hypertensive. According to AHA, a rationale for
the change is that people with blood pressure
readings of 1 40 over 90 and above are at a higher
risk of premature death.
Advances in Diagnosis:
Early Detection in the
High Risk Patient
The exercise electrocardiogram (EKG), more
commonly referred to as the stress test, is a
frequently used diagnostic tool. But its reliability
in detecting the presence of coronary artery
disease and predicting heart attack risk has been
critically questioned in recent years.
The stress test fared poorly in studies
comparing it to cardiac catheterization and
angiography. Cardiac catheterization involves
insertion of a hollow, flexible tube into a
peripheral blood vessel and threading it into the
heart. In angiography, contrast dye is injected
through the catheter into the heart's blood vessels
to give a better X-ray view of coronary blood
vessels. Tissue samples may be removed for
analysis at the same time.
Echocardiography is a noninvasive diagnostic
procedure in which ultrasonic waves are directed
toward the heart and reflected (echoed) back for
visualization. The procedure depicts the structure
and motion of the heart. Exercise followed by
echocardiography detects cardiac abnormality
with 94 percent accuracy.
Magnetic resonance imaging (MRI) and
computerized tomography (CT) are "high tech"
noninvasive diagnostic techniques. Although still
experimental, they promise to be exciting
developments in cardiac medicine. These devices
may enable rapid and reliable image analysis of
the heart and arteries. MRI utilizes magnetic
fields to construct images of the heart. The CT is a
technique in which a series of X-rays is used to
create detailed three-dimensional pictures of an
organ.
New Drugs Affecting Kidney
Regulation of Blood Pressure
Renin, an enzyme produced in the kidney,
converts angiotensinogen to angiotensin I. Then
angiotensin converting enzyme (ACE) further
transforms it to angiotensin II, the most potent
vasoconstrictor known. The latter increases
arterial blood pressure and stimulates production
of aldosterone, a steroid hormone that causes
sodium and water retention. Excess activity in the
renin/angiotensin system is suspected in many
cases of severe hypertension, especially in
patients who do not respond to standard
antihypertensive medication. Drugs that inhibit
renin synthesis are being developed to treat
resistant hypertension.
"Renin inhibitors block the key step in
Continued on page 23
December, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
23
FUTURE DIRECTIONS
Continued from page 22
angiotensin II synthesis," says Norman Nelson,
Ph.D., associated director of cardiovascular
disease research at The Upjohn Company. "We
have developed a stable, orally effective renin
inhibitor, which is now in early stages of clinical
testing."
Already on the market, the ACE inhibitor
captopril (Capoten, Squibb) blocks angiotensin
II production, leading to a decrease in vaso-
constriction and aldosterone release. Because of
potentially serious side effects, captopril is
reserved for treatment of individuals who do not
respond to more moderate therapy, however, in
lower doses it may be used for mild hypertension.
Newer ACE inhibitors such as enalapril
(Vasotec, Merck) with fewer side effects are now
available.
Preventing Sudden Cardiac
Death with New Anti-
Arrhythmic Drugs
Sudden death due to cardiac arrest may be
triggered by an episode of a type of arrhythmia
known as ventricular fibrillation — an uncoordi-
nated twitching of the ventricles. Standard anti-
arrhythmic drugs reduce the heart's electrical
excitability and help to control heart rhythm.
However, they also reduce cardiac pumping
efficiency — an undesirable side effect in a
recuperating heart attack victim.
Dissolving Life-Threatening
Blood Clots
Tissue-type plasminogen activator (tPA), an
enzyme produced by a variety of tissues, dissolves
blood clots that block arteries. Tissue
plasminogen activator, extracted from human
uterine tissue and now also a product of
recombinant DNA technology, circulates
through the bloodstream until it encounters a
blood clot. It then acts specifically on the blood
clot to dissolve it.
"Unlike the nonspecific thrombolytic agent
streptokinase, tPA acts locally and does not
produce as much bleeding," says Desire Collen,
M.D., Ph.D., professor of medicine at the
University of Leuven in Belgium. "In the
European trials, recanalization (opening of
clogged artery) occurred in about two-thirds of
the heart attack patients treated with tPA."
In the past two years, clinical testing with tPA
has demonstrated that it is twice as effective as
streptokinase in opening clogged coronary
arteries of heart attack victims. A multicenter
clinical study under the direction of the U.S.
National Heart, Lung and Blood Institute is under
way to further evaluate tPA in the treatment of
myocardial infarction.
Fish Oil and the Prevention
of Coronary Artery Disease
Diets rich in certain polyunsaturated fatty
acids, such as eicosapentaenoic acid (EPA) may
lower serum cholesterol. Greenland Eskimos
who eat oily cold-water fish have a lower
incidence of cardiovascular disease than people
who eat a dairy- and meat-rich diet. Researchers
have concluded that increasing the consumption
of cold-water fish, such as salmon, mackerel and
sardines, which contain large amounts of EPA,
may help to reduce the development of
atherosclerosis. EPA inhibits the formation of
certain prostaglandins that enhance platelet
aggregation (clot formation).
Regulation of Hypertension
with Dietary Calcium
Diet plays a pivotal role in blood pressure
regulation. The advantages for a significant
number of hypertensive patients of restricting
dietary sodium and reducing weight are now well
established. There may also be an association
between reduced calcium intake and elevated
blood pressure.
Supplementing daily diets with calcium
resulted in a 5 percent lowering of diastolic pres-
sure in young borderline hypertensive women
and a 9 percent reduction in a similar group of
men. Even small changes in blood pressure can
yield big health gains in the general population.
Long-term studies are needed, however, before
researchers can advise the average person to
increase dietary calcium.
An Aging Population:
Ethical Dilemmas and
New Technologies
Prevention — checking, or at least limiting and
slowing the development of atherosclerosis — is
the most cost-effective way to combat heart
Continued on page 24
December, 1987
24
THE NORTH CAROLINA JOURNAL OF PHARMACY
FUTURE DIRECTIONS
Continued from page 23
disease. Reducing risk factors has proved to be a
basic component of preventive medicine over the
past 20 years. To date, the greatest costs of
prevention have involved large public education
campaigns. In contrast, new technologies,
developed at tremendous cost — have reached
comparatively few critically ill individuals.
On what basis, then, do we decide whether or
not to support basic research programs? How do
we balance long- and short-term costs and
benefits? There are still many unanswered
questions that must be addressed. For example,
scientists do not know why some people can eat
all the cholesterol, saturated fat and salt they
desire and never develop hypertension or heart
disease. Nor do they understand why certain
individuals free of known nongenetic risk factors
develop heart disease at an early age.
Clearly, heredity plays a role, but how?
National statistics do not necessarily have
meaning in individual cases, though such cases
can help reveal answers to far-reaching problems.
"It is vital that basic research into the causes
and treatment of cardiovascular disease
continue," concludes Michael DeBakey, M.D.,
chairman of the department of surgery and
chancellor of Baylor College of Medicine in
Houston. "In considering the future of
cardiovascular medicine, prevention — reducing
risk factors — must remain our primary focus."
Likewise, artificial heart research, while
having had its share of setbacks, may uncover as
yet unknown aspects of human physiology that
could have a profound impact on the future of
cardiovascular medicine.
To All Kappa Epsilon Collegiate
and Alumni Members
The Lambda Chapter at the University of
North Carolina at Chapel Hill will be hosting the
Province A meeting of the fraternity March 1 8
through March 20, 1988. Many exciting plans
have been made to make this a rewarding and
successful convention. Continuing pharma-
ceutical education (CPE) will also be offered. For
more information about registration, contact
Lauren Bunting at (919) 967-1758 or Mae
Jackson at (919) 846-5799.
WHY BUY JUST A BOOK
. . . when you can subscribe to USPDH
USPDI* - a clinically relevant drug-use. patient education information
service providing health care professionals with continuously updated,
unbiased drug data throughout the year
Bimonthly Updates provide new and revised information in a bound.
cumulatively indexed "newsletter" format, avoiding the inconvenience of
replacing, or worse, losing pages.
NEW FEATURES IN 1988 EDITION:
■ 16-page drug product I D. directory. Includes approximately 800 color
photographs of the most widely used medications, both brand and genenc.
■ Indications separated into "accepted" and "unaccepted" sections in each
drug monograph. ■ USP legal requirements for quality, labeling, storage, and
packaging important to the dispensing situation. I Patient drug-use
counseling guidelines.
Start a calendar year subscnption to the USPDI. two-volume set ^three books
with slip case organizer) and six bimonthly Updatesiot $1 15.00.
Continue your subscnption annually at the lower renewal rate (billed each
December) so you are assured of receiving revised main volumes and a
continuous flow of Updates.
I
YES' I want to |0in the U5?D/ subscnption service Startmy 19S3 calendar year subscnption
- GSPO;two-TOlumeset.withslipcaseandsix6Wjr«.511S.OO,
volume I. Dnif Information for the Health Ore Professional, with six Updates. $95 00
1 Voiumen. Advice fonhe Patient. mtk<a Updates WOO
: Add $5 00 to each subscnption for UPS (or equivalent! delivery of the main volumes.
FULL MONEY BACK GUARANTEE: If for any reason vou are not satisfied after
receipt of your first subscription publication, return vour purchase ,in resaleable
condition) within JO days for a full refund.
.. Enclosed is my check or monev order payable to USPC for i
iPA residents add n% sales tax M D residents add S% sales tax i
Z Charge mv ~ MasterCard \ VISA
2,p
Pleast allow 4 - 6 weeks for book rate postal delivery
SEND ?RD£P It) North Carotin. Pbarmaceuiical Association
109 Church Street. P.O. Box 151
Chapel Hill. North Carolina 27514
December, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
DICKINSONS PHARMACY
by Jim Dickinson
25
Independents are back. In his best seller, "The
Closing of the American Mind," Chicago pro-
fessor of philosophy Allan Bloom observes "rela-
tivist" thinking among the post- 1960s graduates.
That means people are unsure of right and
wrong any more, and tend to see things as being
"relatively" right or wrong. Any opinion is as
good (or bad) as any other, and all are of equal
importance (or unimportance).
You know what he means when you hear
terms like, "different strokes for different folks."
Professor Bloom thinks this has come about
because in the 1960s the colleges stopped giving
everyone enough classical studies in the liberal
arts. Without that foundation, some folks don't
know how to reason things out properly.
Now, I'll admit that I didn't do any classical
studies, either — so when I assert that inde-
pendents have turned the corner, and that the
National Association of Retail Druggists has
finally shown itself to be the leading pharmacy
organization, there may be a temptation to
dismiss this as just another equal, "relativist"
opinion.
But think about the evidence.
I saw Robert J. Bolger, retiring president of the
National Association of Chain Drug Stores,
strolling with his wife, Helen, through the ex-
hibits hall of the National Association of Retail
Druggists annual convention in Las Vegas.
It was a record (34% bigger than last year), so I
asked the head of all chains what he thought.
"It's impressive," he said, without restraint. It
would have been tacky to ask for comparisons, so
I left it at that. Other pharmacy convention
veterans said the same thing, and did make
comparisons.
The spirit among the convention attendees —
the youngest-looking NARD crowd I can re-
member — was buoyant and businesslike. Even
the old-timers had a new glow in their eye.
But you don't go by conventions alone. It
might have been the glamorous city that drew the
crowds — or the weather.
Consider other factors. Consider all the floun-
dering that's been going on in the chains —
takeovers, mergers, franchising, leveraged
employee buyouts . . .
Consider the unifying effects of dire, common
perils like physician dispensing, mail-order phar-
macy, HMOs . . .
Consider the rapid aging of the American
population — any way you look at it, it has to
mean a larger pharmaceutical market "pie" . . .
Consider bad service and shoddy merchandise
that came to typify mass merchandisers of every
kind, and indeed, consider the drug chains (like
Washington-based Dart) that foundered because
of their grubbiness.
Consider the NARD's slicker, fatter monthly
journal and its 10% membership growth in the
last 18 months . . .
Indeed, consider the NARD itself. Slumped in
the doldrums just over a decade ago, it has be-
come the most important and effective of the
drug-oriented associations — including the cor-
porate-based ones.
(I can hear the "relativists" muttering that
that's only my opinion, equal to any other — but
that's only their opinion!)
NARD'S recovery is proof of an ancient
wisdom — that adversity is the test of strong men,
and necessity the mother of invention. By the end
of the 70's, government and marketplace op-
pression had so pressed independents that they
gave NARD the energized support most asso-
ciations can only dream about. Too much was at
stake for it to be otherwise.
First, as the official custodian of the pharmacy
heritage (the corner drug store), NARD has the
important work of keeping the profession's roots
alive. The graying Americans who most depend
on pharmacy appreciate that, and will see to it
that the modern version of the corner drug store
(independent-owned and operated) will have
patrons wherever it can be found.
Second, NARD has attracted the best staff in
the Washington drug association world.
Third, unlike counterparts in many of the
Washington associations (not just the pharmacy
ones), executive vice president Charles M. West
has not succumbed to "Potomac fever." He at-
tributes much of NARD's success to the grass-
roots and to a strong, involved executive
committee and "official family," all of whom
work in their own pharmacies for a living.
Fourth, NARD's leadership believes in
Continued on page 26
December, 1987
26
THE NORTH CAROLINA JOURNAL OF PHARMACY
AN OLD CONTROVERSY
OVER TRANSIENT GLOBAL
AMNESIA APPEARS
SETTLED: RECURRENCE
LOW, PROGNOSIS GOOD
Transient global amnesia (TGA), is a self-
limited disorder, characterized by a sudden loss
of memory of recent events and a transient
inability to retain new information. (TGA
victims do not forget their identities.) The basic
message from a new study is if you suffer from
TGA, you can probably forget about any
potential complications.
Most investigators agree that episodes of
TGA are caused by transient ischemic attacks
(temporary oxygen deficiency in certain regions
of the brain). But there has been a long-standing
difference of opinion about the seriousness of
TGA. Some physicians have reported that it
carries a high risk of subsequent mini-strokes as
well as a high incidence of more complicated
stroke or mental deterioration. Others consider
it an essentially benign condition with little
subsequent risk.
According to a multicenter Danish study, the
latter assessment is more likely. A report in the
A rchives of Neurology says TGA is unrelated to
cerebrovascular disease in general. Although it
can recur, the risk of recurrence is very low. At
least, that's true with "pure" TGA. When it
occurs in combination with a major
neurological deficit, the prognosis is much
grimmer.
This study of 74 patients over a follow-up
period ranging from seven months to 18 years
showed that if no other neurological deficit is
present, the problem is basically a benign one,
and full recovery can be expected.
Previously, four cited studies had warned of
dire consequences following transient global
amnesia. But four others concluded it was not a
serious problem. Why the discrepancy?
Probably, the investigators in this study
speculate, because the earlier studies were quite
small, and some of them had included patients
with associated major neurological compli-
cations.
"The Prognosis of Transient Global
Amnesia," Hans-H. Hinge, M.D., et ai,
Department of Neurology, Aarhus University
Hospital, Hellerup, Denmark, Archives of
Neurology, 43:6, July 1986, pp. 673-676.
DICKINSONS PHARMACY
Continued from page 25
reaching reach out to the grassroots pharmacist.
NARD now has affiliations with 49 state as-
sociations, plus the District of Columbia and
Puerto Rico — and NARD's annual legislative
conference in Washington brings the grassroots
pharmacy interests of state associations to the
Capitol for political networking of bread-and-
butter pharmacy issues.
"We will be doing more with the states in
1988," West says. "We've just been through a
heavy year with burning issues in Washington,
and while we're not turning down the flame on
those issues, we expect to expand our activities
with the states. Our first priority there will be to
assure RxNet's success."
West's "burning issues," obviously, are dis-
pensing physicians and mail-order pharmacies
championed by ideological fanatics at the Fed-
eral Trade Commission who have forgotten
what America is all about (they could do with a
dose of Allan Bloom).
This column is not meant to sing the praises
of one "relativist" association over others to
which it is equal, but to observe that the
independents' association currently has made
itself not equal.
Above all, the discussion is meant to honestly
reinforce the welcome news that independents
are back.
To West, their re-emergence responds to a
rising public demand for service, and it is in the
marketplace — once the competitive playing-
field is leveled (for example, by eliminating
bribes to abandon neighborhood pharmacies)
— that service will triumph on its own merits.
That isn't good news just for pharmacy and
its unequal heritage. It's good news for America
as well.
This feature is presented on a grant from
G.D. Searle & Co., in the interests of promoting
the open discussion of professional issues in
pharmacy. G.D. Searle & Co. accepts no
responsibility for the views expressed herein as
they are those of the author and not necessarily
those of G.D. Searle & Co.
December, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY 27
GENES AND VIRUSES — How Are They Linked to Cancer?
Cancer starts with one lone cell. Just what it is
that transforms a healthy cell into a cancer cell
has been the subject of increasingly promising
research in recent years.
Genes That Cause Cancer
Several different genes that appear to play a
key role in the formation of tumors have now
been isolated from the DNA of human tumor
cells. These genes are called oncogenes. Onco-
genes are very different from each other in terms
of structure, location and function. What they
have in common is that they all arise from the
normal genes present in all healthy cells.
In their normal form, these genes, called proto-
oncogenes, control the proteins important to
normal cell growth and development. Some-
where along the way, however, these normal
genes are damaged and assume a dangerous role.
The proteins controlled by oncogenes function
abnormally and lead to the uncontrolled growth
and spread of abnormal cells that are charac-
teristic of cancer.
"More than 25 of these oncogenes have now
been isolated, and much evidence exists to sup-
port the current hypothesis that changes in the
structure of these cellular genes represent the
fundamental cellular alterations that result in the
development of cancer," says Robert A.
Weinberg, Ph.D., professor of biology at the
Center for Cancer Research, Massachusetts
Institute of Technology, Whitehead Institute for
Biomedical Research, in Cambridge.
Oncogenes were discovered by two different
lines of research that eventually converged.
The first was the study of retroviruses (viruses
whose genetic material is RNA, ribonucleic acid,
instead of DNA, deoxyribonucleic acid). Retro-
viruses have an unusual property: They can make
a DNA copy of their genetic material that can
then be integrated into the chromosomal DNA of
the cell being infected. Some retroviruses carry
among their genes a single gene that is responsible
for transforming a normal cell into a cancer cell.
Such a gene was first identified about 1 5 years
ago in Rous sarcoma virus (RSV), which causes
cancer in chickens. This gene was named src,
which stands for sarcoma. Subsequently dis-
covered oncogenes were also given three-letter
abbreviations.
It was then found, however, that src was not a
true viral gene but that it was almost identical to a
normal gene found in all chicken cells. This nor-
mal proto-oncogene had been picked up by a
slightly oncogenic (capable of producing cancer)
retrovirus during the course of infection. Some-
how along the way the proto-oncogene became a
cancer gene.
At least 20 oncogenes have now been isolated
from various retroviruses that cause several dif-
ferent types of cancer in experimental animals. In
each case, the oncogene was found to be very
similar to a normal gene and to regulate an on-
cogenic protein similar to a normal protein.
Tumor oncogenes: The second, more recent
line of research involving oncogenes focused on
human and animal cells rather than retroviruses.
Genes in the DNA of various kinds of tumor cells
were found that could transform normal cultured
cells into cancer cells.
The ras oncogene: The most frequently iso-
lated tumor oncogene is very similar to the
retroviral oncogene known as ras, a family of
genes found in vertebrate cells.
"Damaged ras genes have been found asso-
ciated with about 20 percent of human cancers,"
says W. Gary Tarpley, Ph.D., research scientist at
The Upjohn Company in Kalamazoo, Mich.
"We are now studying the biochemical prop-
erties of the damaged product of the ras gene,
called p-21, to determine exactly how it differs
from normal and how it leads to the transform-
ation of a normal cell to a cancer cell. If we could
answer these questions, the hope is that it would
then be possible to target this aberrant
biochemical process selectively with anticancer
drugs and ultimately halt the entire process," Dr.
Tarpley says.
It has now been determined that p-21 is a
member of the so-called G family of proteins,
present in the cell's fluid, that mediate the signals
which help regulate cell growth. "When a ras
gene is damaged, the signal mechanism is altered,
and the cells receive incorrect information that
leads them to behave in an aberrant way," he
says.
The retinoblastoma oncogene: Scientists have
recently isolated the oncogene responsible for
retinoblastoma (a cancer of the eye's retina that
occurs in young children). This oncogene is of
continued on page 29
December, 1987
We're not
rjj. strangers...
uuasnincjton
national
INSURANCE COMPANY
NCPhA-Endorsed Insurance Plans
Which Merit Member Participation
DISABILITY INCOME PLAN HOSPITAL INCOME PLAN
MAJOR MEDICAL EXPENSE PLAN TERM LIFE PLAN
RETIREMENT AND PROFIT SHARING PLANS
FOR DETAILS WRITE OR TELEPHONE:
HOYT W. SHORE, CLU and Associates
821 Baxter Street-Suite 316
Charlotte, North Carolina 28202
O
Telephone (704) 333-3764
UJasninpcon
national
INSURANCE COMPANY
Evanston. Illinois 60201 • A Washington National Corporation Financial Service Company
THE NORTH CAROLINA JOURNAL OF PHARMACY
29
GENES AND VIRUSES
Continued from page 27
particular interest because, contrary to all other
known oncogenes, it is a recessive, rather than a
dominant, gene. This means that a child will not
develop the disease unless both parents have the
gene; for other oncogenes, only one parent need
have the gene.
Viruses and Cancer:
Making the Connection
Scientists have long known that viruses can
cause both natural and experimental tumors in
animals. Only recently has a connection been for
several different viruses and cancer in humans.
The evidence to date is only indirect, however,
because it would be unethical to infect a human
subject experimentally with a suspected virus to
see if it caused cancer.
Some such evidence may have become avail-
able inadvertently in relation to human immuno-
deficiency virus (HIV), a virus believed to be a
cause of acquired immune deficiency syndrome
(AIDS).
"The unfortunate people who have become
infected with the virus after blood transfusions
give a clear indication that the virus is responsible
for their subsequent development of AIDS," says
Robert C. Gallo, M.D., chief of the laboratory of
tumor cell biology at the National Cancer
Institute and the co-discoverer with Dr. Luc
Montagnier of the Institut Pasteur in Paris of the
virus now known as HIV.
Although AIDS itself is not a cancer, it does
lead frequently to the development of several
types of cancer — Kaposi's sarcoma, Burkitt's
lymphoma and chronic myelogenous leukemia.
HIV is actualy the third of a group of retro-
viruses called human T-cell leukemia viruses
(HTLV), discovered by Dr. Gallo and others.
The first one, called HTLV-I was discovered in
1979 and leads to a form of leukemia and
lymphoma.
The second virus, HTLV-II was discovered in
1 982 and causes a rare form of leukemia called
hairy-cell leukemia. This disease has been the
subject of much recent interest because nearly 90
percent of patients experienced remission when
treated with alpha interferon, a type of biological
therapy using agents derived from or similar to
immune system agents.
Other viruses that show varying degrees of
evidence of causing human cancers include the
Epstein-Barr virus, linked to infectious mono-
nucleosis, to a type of lymphoma called Burkitt's
and to nasopharyngeal cancer; hepatitis B virus,
linked to liver cancer; human papilloma virus,
linked to genital warts and to cervical cancer; and
herpes simplex virus type 2, possibly also linked
to cervical cancer.
Human cancer viruses appear not to cause
cancer by themselves, however. Other factors
(called cofactors) are almost certainly involved,
including cigarette smoking, diet, heredity, vari-
ous carcinogens (cancer-causing agents),
additional infections and the effectiveness of the
individual's immune system.
Genetic Engineering:
Hope for the Future?
"Remarkable advances have recently been
made in genetic engineering that may relate to
patients who inherit a tendency to develop
cancer," says Henry T. Lynch, M.D., director of
the Hereditary Cancer Consultation Center at
Creighton University Medical Center in Omaha,
Neb.
For example, the technology is now available
to take from chick embryos the genetic material
necessary for production of a specific enzyme (a
substance that promotes a chemical reaction in
the body) and insert it into cultures of mouse cells
that are low in the same enzyme.
"If we could isolate cancer-resistant genes and
transplant them into human cells that are
deficient in them," says Dr. Lynch, "we could
conceivably prevent the influence of the cancer-
prone genes and produce a higher degree of
resistance to carcinogens."
Researchers have yet to prove that cancer
actually can be prevented in this way. It remains a
question for the future.
This is the first in a series of ESP (Education
Support for Pharmacy) articles, which is provided
as a service to pharmacists by The Upjohn
Company.
For more information on this topic, please
write The Upjohn Company, 7000 Portage Road,
9812-88-99, Kalamazoo, MI, 49001 or call
(616) 323-6902.
December, 1987
30
THE NORTH CAROLINA JOURNAL OF PHARMACY
NOTICE OF PUBLIC HEARING
The North Carolina Board of Agriculture has
announced a public hearing to receive statments
on the implementation of rules and regulations
pertaining to the registration of manufacturers,
wholesalers and repackages as authorized in
G.S. 106-140.1, enacted in the 1987 session of
the General Assembly. The public hearing is to be
held March 9, 1988, at 10:00 a.m. in the Board
Room, Agricultural Building, 1 West Edenton
Street, Raleigh. Interested persons may present
statements either orally or in writing at the public
hearing by mail addressed to David S. McLeod,
Secretary of the North Carolina Board of
Agriculture, P.O. Box 27647, Raleigh, NC
27611.
The proposed regulations are:
2 NCAC 9M .0001; REGISTRATION
PROCEDURES AND FORMS; is proposed for
adoption as follows:
CHAPTER 9 — FOOD AND DRUG
PROTECTION DIVISION
SUBCHAPTER 9M - DRUGS
.0001 MANUFACTURER REGISTRATION
(a) Every person doing business in North
Carolina and operating as a prescription drug
manufacturer, repackager or wholesaler shall
submit a completed prescription drug registration
form to the Department. A separate registration
form shall be submitted for each establishment
operating in the State of North Carolina. Each
registration form shall be signed by the owner or
individual in charge.
(b) A registration fee of one hundred dollars
($100.00) shall be submitted with each
prescription drug registration form.
(c) On or before December 3 1 of each year,
every person registered in accordance with (a) of
this Requisition shall submit a renewal form
furnished by the Division.
(d) A fee of one hundred dollars ($100.00)
shall be submitted with each renewal form.
(e) Prescription Drug Registration Forms may
be obtained from the Food and Drug Protection
Division.
Statutory Authority G.S. 106-140.1
LKS Plans For 75th Anniversary
Preparations are well underway for the
Diamond anniversary of Lambda Kappa Sigma,
to be celebrated August 2-6, 1988 at the biennial
convention. Boston is the host city for this
exciting event and accommodations have been
reserved at the luxurious Copley Plaza Hotel.
Along with the business and educational
meetings, many fun-filled activities have been
planned. Among these are a harbor cruise and
clambake which promise to make this an
outstanding convention. All LKS sisters are
encouraged to come and enjoy a week of
excitement as we celebrate 75 years of history
and look forward to the future of LKS and
women in pharmacy practice.
For more details, contact Mary Greer at: Lamb-
da Kappa Sigma, International Pharmacy Frater-
nity, P.O. Box 981, Claremont, OK 74018.
A NEW SERVICE TO THE INDEPENDENT AND SMALL
CHAIN PHARMACY OWNER
Professional Management Consulting by
Gene Minton, RPH
. . . Now you can benefit from 10 years experience in supervisory management of
high volume drug stores on an individual and group basis.
. . . Consultation in all areas of decision making such as product mix, pricing,
merchandising, remodeling, site selection, computer applications (and selection),
Rx pricing, advertising, personnel management, etc. with emphasis on results and
the bottom line.
. . . Let us plan your next remodel, design your new store, show you how to save
money on fixtures, evaluate wholesalers, analyze your p&l, and many other
services to make you happier with your store & your profits.
. . . Can you afford not to call?
contact Gene Minton at Gene Minton Consulting Services, 6 Lake Shores, Littleton,
NC 919-586-5465. (All client information held in strict confidence).
December, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
31
REVIEW OF 1984-1986
HOSPITAL PHARMACY OPERATIONS
James R. Talley, M.S.
School of Pharmacy
Northeast Louisiana University
Monroe, LA 71209-0470
Lilly Survey:
This review of 1984-1986 hospital pharmacy
operations was abstracted from editions of the
Lilly Hospital Pharmacy Survey. Table 1 lists
summary information for the years 1984-1986.
The average hospital has had a reduction of 4.1%
beds ( 10 beds) from 1984 with a census decrease
of 4%. The average census has been falling
consistently since 1982 and is approximately 14%
less than the 73% average rate observed from
1975-1981.
The average length of patient stay continued to
decline from previous years to 6.0 days in 1986
which represented a 9.1 decrease since 1984.
Although the number of hours the central
pharmacy was open slightly declined in 1 986, the
figure is constant with the 1984 figure of 97
hours. The hours worked by pharmacists,
technicians, and support personnel have slightly
increased since 1984 (+1.4%, +3.8%, & +5.5%).
For the third year, total inventory showed a
slight decrease (-.07%). However, inventory
based on per patient day, per bed, per occupied
bed, and per admission all increased (+4.8%,
+3.0%, +4.8%, & +1.1%). It is interesting to note
that purchases increased for all of these categories
(+7.7%, +5.9%, +7.7%, & +3.8%). Once again the
inventory turnover rate increased and was 8.7 in
1986 compared to 7.8 in 1984.
The ranking of services provided by pharmacy
departments was the same in 1986 as in 1985
(Table 2). However, in 1985 these services were
offered by over 70% of pharmacies compared to
1986 where they were offered by over 60% of
pharmacies.
Effects of Cost Containment:
Current cost-containment for health care was
initiated by the implementation of Medicare
prospective pricing in 1984. The pressure
continues for hospitals to further reduce costs and
be more efficient in treating patients. The results
are that length of patient stays have declined
whereas the intensity of care has increased. Thus,
the average hospital admissions have decreased.
In 1985, peer review organizations (PROs)
were implemented which focused on unnecessary
Medicare hospital use. These aspects of cost
containment for Medicare patients created
similar pressure for cost containment in the
private sector of health care. It is possible that
private use-review programs may have an even
more profound effect than Medicare prospective
pricing and PROs on hospital admissions, patient
days, and average occupancy.
A number of insurance companies and
employers are promoting the concept of private
use-review programs. These programs include
preadmission review, second-surgical-opinions,
continued-stay review, and case-management
services. Companies engaged in preadmission
and concurrent review are predicting reductions
of 15%) to 20% for the number of hospital patient
days.
These factors are resulting in a decreased use of
hospital inpatient services. One report stated that
in 1985, hospital out-patient visits increased by
4.7%, in-patient admissions decreased by 4.4%,
and average hospital occupancy attained a new
low of 64%. This decrease in the use of hospital
in-patient services has resulted in a decline of
revenue for hospitals. In an attempt to off-set this
decline in revenue, hospitals are engaging in
alternative-care (home-care) services and for-
profit subsidiary corporations. These include
home infusion therapy programs, durable
medical equipment, and joint ventures with
physicians.
This decrease in the length of patient stay has
resulted in an increase in the intensity of care
provided patients. These aspects are directly
affecting pharmacy services in hospitals because
aggressive drug therapy is resulting in an increase
use of injectable dosage forms. The increased
costs of using parenteral products results in a
disproportionate increase in costs for pharmacy
services. Unfortunately, hospital administrators
may exert even greater pressure on pharmacy
managers to obtain a proportionate decrease in
Continued on page 32
December, 1987
32
THE NORTH CAROLINA JOURNAL OF PHARMACY
Table 1 Average hospital pharmacy (general private nonprofit)
1984
1985
1986
Change
1984-85
Change
1985-86
Change
1984-86
Bed capacity
245
244
235
■ .4%
-3.8%
- 4.1%
Census
(occupied beds)
64%
60%
59%
-3%
-1%
-4%
Admissions
8582
8566
8416
- 0.2%
-1.8%
- 1.9%
Patient days
56338
53436
50607
- 5.2%
-5.3%
-10.2%
Length of
patient stay (days)
6.6
6.2
6.0
- 6.1%
-3.2%
- 9.1%
Hours central
pharmacy
open/week
97
100
97
+ 3.1%
-3.1%
0%
Pharmacist
hours/week
(FTE)
290
7.3
309
7.7
294
7.3
+ 6.6%
-5.1%
- 1.4%
Technician
hours/week
(FTE)
260
6.5
276
6.9
268
6.7
+ 6.2%
-3.0%
+ 3.1%
Support personnel
hours/ week
(FTE)
109
2.7
114
2.9
115
2.9
+ 4.6%
+0.9%
+ 5.5%
Inventory
/patient day
/bed
/occupied bed
/admission
$121414
$2.16
$498
$786
$14.15
$121198
$2.27
$497
$828
$14.15
$120397
$2.38
$512
$868
$14.31
- 0.2%
+ 5.1%
- 0.2%
+ 5.4%
0%
-0.7%
+4.8%
+3.0%
+4.8%
+1.1%
- 0.8%
+ 10.2%
+ 2.8%
+ 10.4%
+ 1.1%
Purchases
/patient day
/bed
/occupied bed
/admission
$944569
$16.77
$3855
$6118
$110.06
$1032831
$19.33
$4233
$7055
$120.57
$1053736
$20.82
$4484
$7600
$125.21
+ 9.4%
+ 15.3%
+ 9.8%
+ 15.3%
+ 9.6%
+2.0%
+7.7%
+5.9%
+7.7%
+3.8%
+ 11.6%
+24.2%
+ 16.3%
+24.2%
+ 13.8%
Inventory
turnover rate
7.8
8.5
8.7
+ 9.0%
+2.4%
+ 11.5%
Floor area
central pharmacy
(square feet)
1734
1799
1712
REVIEW OF 1984-1986
Continued from page 31
pharmacy expenses as compared to other
departments. A task which may be almost
impossible. Thus, hospital pharmacy managers
are being forced to reevaluate pharmacy services.
This reevaluation may equate to a decrease in
pharmacy services to patients.
Conclusion:
The pressure on pharmacy to reduce costs is
tremendous. Hopefully, the pharmacy profession
will create innovative cost-reduction programs
which will not sacrifice patient care. Our goal
must remain, "to deliver the highest level of
patient care at the least possible costs."
Table 2. Services offered by Pharmacies
1986 1985
% pharmacies offering services >60% >70%
Monitoring patient profiles 94.4% 96.5%
Monitoring drug interactions 91.2% 92.6%
Providing drug information
services 74.6% 82.5%
Drug therapy consultation 67.9% 71.25
December, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
HYPOTHERMIA IN ELDERLY
33
With the onset of cold weather the National
Institute on Aging issues a reminder about
accidental hypothermia. Hypothermia can afflict
anyone — but older people are at particular risk
from this potentially fatal condition. It often takes
a victim by surprise because the weather need not
be bitter cold for it to strik the vulnerable.
Medicallly the condition exists when the inner
body temperture falls to 95° F or below. In
addition to cold weather, other factors that can
affect control of body temperature include
certain medications, chronic illness, and/or lack
of warm clothing and heat. Fortunately, this
condition can be prevented. Older people should
be encouraged to dress warmly, turn thermostats
to at least 65°, and eat properly.
Winter is also a good time to be a good
neighbor and check in on those living alone.
While only a special low-reading thermometer
can truly diagnose hypothermia, other signs may
help to identify the condition: an uncontrollable
shivering, stiff muscles, slurred speech, slow and
labored breathing, a weakened pulse, and
sometimes even confusion and disorientation.
Any suspicion that hypothermia exists should be
referred without delay for medical attention.
A brochure published by the National Institute
on Aging entitled "Accidental Hypothermia — A
Winter Hazard for Older People," summarizes
risk factors, signs, and symptoms, as well as
precautions and treatment. For a free copy you
may write to: Hypothermia, NIA Information
Center, 2209 Distribution Circle, Silver Spring,
MD 20910.
HIGHLIGHTS OF NARD CONVENTION
The National Association of Retail Druggists
is now NARD. The association's House of
Delegates, in its meeting on Thursday, October
22, voted to discontinue the association's full
name in favor of the acronym that has long been
synonymous with independent retail pharmacy
and with political action in Washington, DC.
The vote came on the final day of NARD's 89th
Annual Convention and Trade Exposition, held
October 18-22 in Las Vegas, NV.
The vote to adopt NARD as the association's
full name, said incoming NARD President
Darwyn Williams, "is the best kind of
compromise. It enables us both to maintain that
which is synonymous with out 89-year tradition
of service and political action on behalf of the
independent — the acronym NARD — and to
be responsive as well to the growing numbers in
our profesion for whom the word pharmacist
most accurately reflects their current role and
stature as health professionals in the
community."
The mission of NARD, however, remains
unchanged, stressed Williams. "We are and will
continue to be the national association
representing the professional and proprietary
interests of the nation's independent retail
pharmacists."
The House of Delegates also approved another
important change in the association's constitution
and by-laws during the Las Vegas convention.
The NARD membership category for employee
pharmacists was changed from Association
Member to Pharmacist Member. Employee
pharmacists in all practice settings are eligible to
be Pharmacist Members of NARD. The Active
Member category continues to be for the owners
and managers of independent pharmacies.
The NARD convention drew a record number
of 4,500 attendees, including more first-time
registrants than ever before, the trade exposition
was also again a sell-out.
December, 1987
34
THE NORTH CAROLINA JOURNAL OF PHARMACY
CLASSIFIED ADVERTISING
Classified advertising (single issue insertion) 25 cents a word with a minimum charge of $5.00 per
insertion. Payment to accompany order.
Names and addresses will be published unless a box number is requested.
In replying to "blind" ads, address Ad. No., Carolina Journal of Pharmacy, P.O. Box dl51, Chapel
Hill, NC 275 1 4. Telephone (9 1 9) 967-2237.
HOSPITAL POSITIONS OPEN
The Department of Pharmacy Services
at Sampson County Memorial Hospital
has opportunities available for hospital
pharmacy practice. This 145 bed JCAH
approved hospital is located within 1 hour
drive of the coast. Good working condi-
tions with Nursing and Medical Staff. Ex-
cellent starting salary, plus comprehen-
sive benefit package. Activities include
complete computerization, unit dose, IV
admixture, patient profile and inventory
control. Patient care services include:
antibiotic monitoring, TPN, Aminoglyco-
side dosing and support for continuing
education. Contact Patricia Britt, director,
Personnel or Jenny Strickland, Director
Pharmacy at (919) 592-8511.
STAFF PHARMACIST WANTED: Posi-
tion at Kings Mountain Hospital. Modern
102-bed facility with computerized unit
dosage. Hospital experience preferred
but not necessary. Will consider a May
graduate. Contact Jerry McKee at (704)
739-3601 Ext. 472.
STAFF PHARMACIST: Moore Regional
Hospital, a 316-bed, acute care facility
has an opening for a staff pharmacist.
This pharmacy offers unit dose, IV
Admixture, chemotherapy, support for
C.E. education, patient profile, and a
mobile medication service. Moore
Regional Hospital is located in Pinehurst,
a beautiful part of the Sandhills. Excellent
starting salary, on-site Day Care, plus
comprehensive benefit package. Contact
Cornelia Perry, Vice President Human
Resources, 919-295-7808 or Robert
Beddingfield, Director of Pharmacy, 919-
295-7112 or send resume to: Moore
Regional Hospital, Human Resources,
P.O. Box 3000, Pinehurst, NC 28374. EOE.
PHARMACIST WANTED: Director of
Pharmacy for 64-bed hospital in South-
eastern North Carolina. Excellent hours,
salary negotiable, and good fringe
benefits. Contact Tom Smart at (919)
582-2026.
PHARMACISTS NEEDED: Due to
expansion, pharmacists are needed 1st
and 2nd shifts. Pharmacy is decentralized
with unit dose and IV-Admixtures. Other
services include: nutrition support and
drug information. Salaries are negotiable
depending on experience. For more
information send resume or call collect:
Letha Huffman, NC Baptist Hospital, 300
S. Hawthorne Road, Winston-Salem, NC
27103. (919) 748-4717. EOE.
HOSPITAL PHARMACIST WANTED:
Staff position at Humana Hospital-
Greensboro, includes unit dose, IV
admixture, and clinical services, e.g.
antibiotic monitoring, heparin and
aminoglycoside pharmacy protocols.
Rotating shifts, no third. For more
information, call or write: Dir/Pharmacy,
Humana Hospital Greensboro, 801 Green
Valley Road, Greensboro, NC 27408,
(919)378-2826.
HOSPITAL PHARMACIST WANTED:
Contact Doris Osborne, Randolph
Hospital, Asheboro. (919) 625-5151.
PHARMACIST WANTED: Pharmacist
position available at Cabarrus Memorial
Hospital located in Concord. Seeking full-
time pharmacist position with competitive
salary with generous shift and work dif-
ferentials. Contact Emmett Robertson,
Human Resources, (704) 786-2111
Ext. 5995.
December, 1987
THE NORTH CAROLINA JOURNAL OF PHARMACY
35
RETAIL POSITIONS OPEN
STAFF PHARMACISTS needed for
retail grocery chain in Elizabeth City,
Rocky Mount and Goldsboro, NC.
Pharmacy degree required. Salary ranges
from $37K (40 hour work week),
comprehensive benefit package. Moving
expenses covered by client. Call
Marybeth Gaiani (704) 529-1940.
PHARMACY MANAGER needed for
retail grocery chain in Elizabeth City, NC.
Pharmacy degreed, license and some
managerial experience required. Salary
ranges from $41 K (42 hour work week),
30% bonus, and comprehensive benefits
package. Moving expenses covered by
client. Please call Marybeth Gaiani (704)
529-1940.
PHARMACIST WANTED: Excellent op-
portunity to work in independent profes-
sional pharmacy (80% Rxs) in large
medical complex in Sandhills. No nights
or Sundays. Excellent salary & benefits.
Box 1119, Pinehurst, NC 28374. (919)
295-2222 (day or night)
PHARMACIST WANTED: Call Norwood
at 259-2676.
PHARMACIST WANTED: Pharmacist
wanted for new store in medical complex
located in Red Springs, NC. Projected
opening date is May 1988. Competitive
salary. Send resumes to Hunters Bay
Drugs, Rt. 2 Box 180, Red Springs, NC
28377.
WANTED: Full time pharmacist. West-
ern part of the state. Two 10 hour days in
two different locations. Three consecutive
days off, no Sundays, no nights. Both in
resort setting. Contact Jack Alexander,
(704) 526-2366.
PHARMACIST WANTED: We are
seeking an ambitious, and professional
career-minded individual for a pharmacist
position in Greensboro, High Point and
Winston-Salem, NC. We offer excellent
salary, stock ownership, educational
subsidy, extensive benefits, retirement
plan, 401 K tax plan, annual salary merit
reviews. "Pure pharmacy setting." If
interested call Lew Thompson 1 -800-233-
7018 or send resume to: The Kroger
Company, Attn: Personnel, PO Box
14002, Roanoke VA 24038. EOE.
PHARMACISTS WANTED: Greensboro
and Greensboro market area. Contact
David Cox, Revco Drug Stores, at (919)
766-6252.
PHARMACIST WANTED: For retail and
consultant practice. Excellent salary and
benefits. Located in Western NC. Call Bill
Morris at (704) 456-8607.
PHARMACISTS NEEDED: For Rite-Aid
stores in Greensboro, High Point and
Asheboro. For more information contact
Sharon Reynolds at (803) 582-0982.
PHARMACIST MANAGER AND STAFF
PHARMACISTS WANTED: For Kroger
stores in Fayetteville and Southern Pines.
Pharmacist Manager and 1 Staff Pharma-
cist is needed in Fayetteville and 1 staff
pharmacist is needed in Southern Pines.
For more information contact: April Clifton
or Frank Delvero at (919) 864-3340 or
Mike Spector at (704) 572-5830.
PHARMACIST WANTED: Pharmacist
position available at Reynolds Health
Center Pharmacy in Winston-Salem.
Pharmacy hours 8-5, Monday through
Friday. Salary negotiable. Excellent
benefits. Contact Forsyth County Person-
nel at (919) 727-2851 or Janet Foster,
Pharmacy Director at (919) 727-8264, for
further information.
PHARMACISTS: Due to rapid growth
Kerr Drug Stores now have positions
available for pharmacists in Rocky Mount,
Tarboro and Fayetteville. Kerr Drugs
offers opportunity for growth and in store
management. Excellent benefits. Send
resume to Jackie Gupton, P.O. Box
61000, Raleigh, NC 27661, or call (919)
872-5710.
FIXTURES
FIXTURES FOR SALE: Streater fixtures
for sale. 21/z years old, like new. 40 ft full
islands with end caps; 80 ft wall w/lighted
cornice. Available approximately 5/1/88
— $3,200.00. Call or write: Roland
Thomas — 3555 Tryclan Drive, Charlotte,
NC 28217. (704)525-5300.
Rx SHELVING FOR SALE: Used metal
Rx shelving, approximately 50 ft. $700.00.
Available now. Call or write: Roland
Thomas, 3555 Tryclan Drive, Charlotte,
NC 28217. (704)525-5300.
(Continued on page 36)
December, 1987
36
THE NORTH CAROLINA JOURNAL OF PHARMACY
CLASSIFIEDS
(Continued from page 35)
ANTIQUE STORE FIXTURES FOR
SALE: includes display cases, soda
fountain, wall fixtures. Contact Charles
Chapman at (704) 933-7775.
COSMETIC FIXTURES FOR SALE:
Noxell wall units. These are the most
popular cosmetic fixtures on the market
today. Expandable to 36" length. Black &
chrome finish. Comes with interchange-
able manufacturer signs. Both peg and
shelves. Excellent condition. Priced to sell
quick. Contact Micky Whitehead at R&M
Mutual Discount Drugs, Ramseur, NC
(919)824-2151.
WANT TO BUY: Pharmacy Collectibles,
Apothecary Jars, Show Globes, Soda
Fountain, Mahogany Pharmacy Center,
or Fixtures. Contact G.C. Jones, Knight-
dale Pharmacy, P.O. Box 370, Knightdale,
NC 27545 or (919) 266-3369.
COLUMBUS STORE FIXTURES FOR
SALE: Complete Prescription Depart-
ment, and 30 foot greeting card fixtures.
Contact Bud O'Neal, Work: 919-943-
2462, Home: 919-943-3751.
FIXTURES FOR SALE: Streater Fix-
tures, 24 years old. 2 cash registers,
balance, card racks. Call Albert Clay at
(919)552-2838.
FIXTURES AVAILABLE AFTER JAN.
31. Complete store fixtures for a 5,000
square foot store in excellent condition
including wall, gondolas, end pieces, one
or more glass showcases and Rx
department. Contact Hamp Langdon,
Kernersville at 919-993-2195.
OLD SODA FOUNTAIN WANTED: Send
specifics or call: John Cooper, Mast
Store, Box 714, Valle Crucis, NC 28691,
(704)963-6551.
RELIEF
RELIEF PHARMACIST: Relief Phar-
macist available. Has RV, will travel. Call
Robert Lucas at (919) 383-1421.
PHARMACIST: Professional Services/ -
Consultation — Temporary and/or
continual. Contact: L.W. Matthews at
(919) 967-0333 or 929-1783. 1608 Smith
Level Road, Chapel Hill, NC 27514.
RELIEF PHARMACIST AVAILABLE:
Available for all of NC. Call Albert Clay at
(919)552-2838.
MISCELLANEOUS
How much is a pharmacy really worth?
Buyers, sellers, estate and financial
planners need to know more than the
numbers "on the books". Professional
evaluation services available as well as
full service representation for buyers and
sellers. Get the most for your money and
your business. Contact Alan Senfer,
pharmacy specialist, VR Business
Brokers, 3717 National Drive, Suite 208,
Raleigh, NC 27612. Call: (919) 787-2945.
ADVERTISING experience and PR
savvy. Familiar company offers 17 years
experience. Program engineered for
professional-minded independents. Effec-
tively utilizes hometown newspaper and
in-pharmacy goodwill. Cost per family
impacted lowest of any media. Person-
alized formats and frequency fit any
budget. $95 initiates your exclusive use.
Contact W. Joe Davis, (919) 946-
0232/1553, any hour, any day.
PHARMACIES FOR SALE
FOR SALE: Henderson's pharmacy in
Franklinton, NC. Owners wish to retire.
Sales price: $55,000 (inventory + $5,000).
Call (919) 494-2321 days.
PHARMACY FOR SALE: Owner wishes
to retire: 25 yr. same location. 30 miles
from Charlotte. $270,000 Annual Sales,
Inventory $85,000. Sales Price $80,000.
Includes inventory, fixtures etc. $11,000
Accts Recv & Delivery Car. 75% Rx 40%
Chg. Accts. Reply JNR c/o NCPHA PO
Box 151 Chapel Hill, NC 27514 or call 1-
704-933-6551 after 6 PM.
PROFESSIONAL PHARMACIES: Sev-
eral small prescription-oriented pharma-
cies are currently available for individual
ownership in North Carolina. These
opportunities provide the vehicle to
practice pharmacy the way you were
taught, while offering an attractive income
and more time to be with your family. In
some of these cases, financing is also
available to qualified candidates. For
more information write: Jan Patrick,
10121 Paget Dr., St. Louis MO 63132.
December, 1987
Savage
■
Richmond ■
Norfolki
Raleigh ■ ■ Wilson
danta
Augustai
Jacksonville*
Orlando
In Delaware,
Maryland,
Virginia, the
District of Columbia,
North Carolina,
South Carolina,
Georgia,
and Florida,
two words
insure responsive,
efficient healthcare
distribution. . .
Owens & Minor.
Fort
Lauderdale
Minor, Inc.
2727 Enterprise Parkway Richmond, Virginia 23229
For additional information, please contact:
Hugh F. Gouldthorpe, Jr. or Hue Thomas, III
804/747-9794
Dr.T.C.Smith Co./ W.H.King Drug
ASHEVILLE, N.C. 28806 • 704/258-2645 / RALEIGH, N.C. 27622 • 919/782-8400
* if ?£3m
TOTAL
HOMESPUN
SERVICE
In today's business rush we take the time to help
you with your management decisions . . . whether its
over coffee or part of a regular sales call. We will fill
your order with care and with dispatch today. Just as
we did in 1869.
We use advanced technology to lead in service to our
customers.
Some of our available programs are Electronic Order
Entry • Merchandising and Programming • Valurex
Advertising & Promotion • Retail Pricing • Micro-
fiche • Pharmacy Computer Systems • Home
Health Care and much more.
Whether you take your coffee
black or with cream,
call us to find
out more details.
VALUREX INDEPENDENT
VALURex
PHARMACY
ADVERTISING & PROMOTIONAL
PROGRAMS
"TO HELP YOUR BUSINESS IS OUR BUSINESS'
Live Music Archive
Librivox Free Audio
Metropolitan Museum
Cleveland Museum of Art
Internet Arcade
Console Living Room
Books to Borrow
Open Library
TV News
Understanding 9/11