THE PCCA BLOG

USP Chapter 795-Related Changes to Formulations

Wed, 28 Jun 2023 11:00:00 GMT

by Melissa Merrell Rhoads, PharmD, PCCA Director of Formulations

The revised USP Chapter 795 will become official on November 1, 2023. This chapter describes the full guidelines for pharmaceutical compounding of nonsterile preparations (CNSPs). Specifically looking at the revisions related to the beyond-use date (BUD), we will be updating all PCCA formulas for compliance.

USP states the BUDs presented “are based on the ability of the CNSP to maintain chemical and physical stability and to suppress microbial growth.” The dosage forms are described as aqueous and nonaqueous based on water activity (a_wor Aw). An aqueous preparation is one that has an a_w ≥ 0.6 (e.g., emulsions, gels, creams, solutions, sprays or suspensions). Nonaqueous dosage forms have an a_w < 0.6 and are separated into two categories: “nonaqueous oral liquid” and “other nonaqueous dosage forms” (e.g., capsules, tablets, granules, powders, nonaqueous topicals, suppositories, and troches or lozenges).

Below are the revised BUDs and notes that will be added to all nonsterile formulas.

Non-preserved aqueous (PF) – 14 days refrigerated

Note: According to USP guidelines, “in the absence of a USP-NF Compounded Preparation Monograph or CNSP-Specific Stability Information,” the maximum BUD for a CNSP that is a non-preserved aqueous dosage form with a water activity (Aw) of >/= 0.6 is 14 days stored in a refrigerator, unless such storage affects the physical or chemical properties of the CNSP.

For more information, refer to current USP Chapter 795.

Preserved aqueous – 35 days

Note: According to USP guidelines, “in the absence of a USP-NF Compounded Preparation Monograph or CNSP-Specific Stability Information,” the maximum BUD for a CNSP that is a preserved aqueous dosage form with a water activity (Aw) of >/= 0.6 is 35 days.

For more information, refer to current USP Chapter 795.

Nonaqueous (anhydrous) oral liquid – 90 days

Note: According to USP guidelines, “in the absence of a USP-NF Compounded Preparation Monograph or CNSP-Specific Stability Information,” the maximum BUD for a CNSP that is a nonaqueous oral liquid dosage form with a water activity (Aw) of < 0.6 is 90 days.

For more information, refer to current USP Chapter 795.

Nonaqueous (anhydrous) excluding nonaqueous oral liquids – 180 days

Note: According to USP guidelines, “in the absence of a USP-NF Compounded Preparation Monograph or CNSP-Specific Stability Information,” the maximum BUD for a compounded CNSP that is a nonaqueous dosage form (excluding nonaqueous oral liquids) with a water activity (Aw) of < 0.6 is 180 days.

For more information, refer to current USP Chapter 795.

Additional notes are also being added to the formulas to bring awareness to some of the guidelines that the USP Chapter 795 now requires during the compounding process. The notes below are not all encompassing of the chapter requirements, so we recommend that you become familiar with the chapter and that you are in compliance with all requirements.

Component evaluation before use

Note: USP Chapter 795 states guidelines regarding “component evaluation before use.” “Compounding personnel must visually re-inspect all components to detect any container breakage, looseness of the cap or closure, or deviation from the expected appearance or texture of the contents that might have occurred during storage.”

Visual inspection

Note: USP Chapter 795 states guidelines regarding “visual inspection.” After the completion of compounding, the preparation must be visually inspected to determine whether the physical appearance is as expected. The inspection must also include visual inspection of container closure integrity.

Establishing and extending BUD

Note: USP Chapter 795 sets forth parameters to consider when establishing a BUD and states, “BUDs for CNSPs should be established conservatively to ensure that the preparation maintains its required characteristics to minimize the risk of contamination or degradation.” Stability testing may be performed by a FDA-registered laboratory using a stability-indicating assay to extend the BUD.  An antimicrobial effectiveness test (see USP Chapter 51) must also be performed by a FDA-registered laboratory when extending the BUD of an aqueous CNSP.

PCCA Members with clinical services may contact our Clinical Services Team for additional information on PCCA Formulas and other compounding concerns.

The complete version of this article originally appeared in PCCA’s members-only magazine, the Apothagram.

Profile in Personalized Medicine - Stephanie Yang

Wed, 12 Apr 2023 11:00:00 GMT

This Profile in Personalized Medicine highlights Stephanie Yang, owner and co-founder of Accent Wellness Compounding Pharmacy in Subang Jaya, Selangor, Malaysia. She has been a proud PCCA member since 2011. Our new 2023 profiles ask pharmacy compounders how they incorporate PCCA’s Principles into their pharmacies.

What’s your favorite PCCA Principle?

To be honest, this is a little tough as all the Principles seem to resonate with who I am as a person and the values that I have instilled in the team. I am on the fence between "Do the Right Thing, Always" and "Be a Lifelong Learner.”

I am a firm believer of always doing what's right, not just for ourselves but for the people around us and the community we serve. In addition, as part of our commitment to excellence, the only way we can grow and move forward is to do it right from the start, improve and innovate, and always keep an open mind to learn. After all, life is a continuous learning experience.

How do you live these 3 PCCA Principles in your compounding practice?

Treat Everyone with Dignity and Respect — Everyone, from customers to staff, are treated the same: with utmost respect and courtesy, regardless of level, background, race or gender. Our customer service team is taught to “treat people the same way as you would like to be treated in their position.” This is also reflected in our culture, where we do not tolerate discrimination.

Listen Actively — Our approach involves not just listening, but also observing what verbal and non-verbal messages are being sent. This allows us to provide the best and most appropriate response, resulting in a mutual understanding between both parties.

Be Tenacious About Response Time — In our pharmacy, turnaround time is taken seriously. We measure as well as track it for further improvement. Our target is for patients to receive their compounded products in 3 working days from when the prescription is received. Apart from this, our response time to patient queries is within 1 day. These timelines are strictly upheld within our practice to ensure customer satisfaction. 

How did you start compounding? What led you to PCCA?

As a non-pharmacist, I was introduced to compounding when I was working with autistic children in Australia. Fast forward a couple of years; I moved back to Malaysia due to family commitments and was re-introduced to the idea of compounding by a family friend based in the U.S. My friend was from the same circle of friends who educated us about the gold standard for quality raw materials that PCCA supplies. What we learned from Dr. Neal Rouzier, who stressed heavily preparing only quality compounds with quality ingredients for patients, has proveneffective. We have since upheld our passion for excellence and promise to only deliver the best possible compounded preparations for the best patient results.

When was the last time a patient thanked you and why?

In my line of work, I find it personally fulfilling when I receive text messages from patients or doctors thanking me for the help or a suggested idea, which in turn improved the quality of a patient’s life. Just a few days ago, I received a message from a postmenopausal patient who had suffered from chronic insomnia for the past 15 years. The patient also had joint problems, which made climbing stairs difficult. Through the non-profit that I co-founded for women with PCOS, she came to know about the benefits of compounded hormones and had her daughter contact us for more information. From this very emotional conversation with both mother and daughter, I was able to educate them about what is happening with the mother’shealth and was able to point them in the right direction for a clearer diagnosis. She thanked me for giving her life back.

As a “Lifelong Learner” what’s your favorite PCCA education program or event and why?

I would have to say hands down that it’s International Seminar because, while I admit it can be a little overwhelming, I get so excited sitting in aroom filled with so many brilliant individuals who are equally passionate about compounding. PCCA compoundersare many steps ahead of current mindsets, with extraordinary brilliance and know-how. I appreciate the opportunity to learn about new compounding trends and, more importantly, how we can ensure continuity in this industry. I also appreciate how International Seminar helps to foster the bond we as compounders have, which enables us to grow and learn together.

How do you “Keep Things Fun” at your pharmacy?

At Accent Wellness, we are constantly looking for ways to keep things exciting and fresh for our customers and our team. For our customers, we involve them— we host live talks, and create games and quizzes for them to win prizes. For our team, we offer many activities, including trips (both locally and overseas) and meals outside of work. We do one activity at least once a month to strengthen our company culture, remind us of our core values and, most importantly, strengthen our team bond and spirit.  

As you strive to “Deliver Results,” what’s been your most satisfying patient experience and how did you solve it?

Our most satisfying patient experience would be a patient (one of many) who had a remarkable positive change in her life after starting compoundedtherapy. After reaching menopause, she lost her energy, had migraines, sleep problems and a poor immune system. After beginning theBHRT course prescribed to her, her energy levels were so good that she returned to the gym! She was able to sleep for a full 7 hours, her migraines disappeared and her health improved. Her amazing results and happiness at living her life to the fullest fueled our drive to do the same for other patients. We are delighted to attest to continuing that positive experience for other patients, within a supportive environment. We also have helped many pediatric patients whose parents come to us with a medication problem. We are able to help compound dosage forms that their children will take. We even compound pain medications for veterinary patients with cancer.

What’s a “WOW” moment you’ve had as a member of PCCA?

In terms of WOW-ness from the PCCA team, that would be the amount of support they provide — going the extra mile to support our business by coming all the way to Malaysia to coach our team and help us improve our compounding, even co-hosting talks to patients.

Whenever possible, we try to do things differently. We recently celebrated 8 years of excellence and sent a little cake to our loyal customers who have been with us throughout this journey as a token of appreciation for their unwavering support.

What’s your favorite PCCA base and why?

If I was asked this question in the early days, I would have said Lipoderm® because it seems to be the undefeated champion in delivering superb results. Currently, I might say XemaTop™, though it's not something we use as much as we do Lipoderm or VersaBase®. The uniqueness of XemaTop™ used on its own or combined with say, naltrexone, makes it a one-of-a-kind product that can really help improve serious skin conditions for many people. It isan excellent option for patients of any age, including babies. That is why, together with the PCCA seal of excellence, we are confident to market our compounding services to our prescribers and patients.

Profiles in Personalized Medicine – Steven Hoffart

Wed, 25 Jan 2023 12:00:00 GMT

This Profile in Personalized Medicine highlights PCCA’s 2022 Pharmacist of the Year, Steve Hoffart, PharmD, of Magnolia Pharmacy, Magnolia, Texas — a PCCA member since 2002.

We recognize your goal of including pharmacists in the “triad” of care (patient, physician and pharmacist). Is that what inspired you to get into compounding or was it something else?

Initially, care for patients on a more personal and customized level created my motivation to begin our compounding journey. As the years have gone by, developing and fostering deep and meaningful relationships with prescribers has become a larger part of our practice. It is powerful and rewarding as a pharmacist to have patients and physicians rely on you and achieve better outcomes through the high level of education and quality compounding we provide. These strong bonds create a solid backbone for the “triad” in our community.

You opened your pharmacy in 2002—the same year you became a PCCA member! Were you aware of PCCA before deciding to offer compounding services? Who or what made you aware of PCCA?

Before opening in 2002, I created a business plan and leaned heavily on my friend and mentor, Fred Emmite, RPh. As a personal friendof PCCA CEO Dave Sparks, Fred suggested I look into this compounding company in Houston, as it may hold the keys to success in my pharmacy future. Little did I know at the time he was so right. The knowledge and expertise that PCCA provided me and my staff from the day we opened set the stage for our personalized medicine journey. I cannot imagine our pharmacy operations and my life without PCCA.

We’re certain you’ve had many memorable patients. Is there one, however, who really stands out?

Several years back, we started compounding a combination of a low-dose steroid and low-dose antibiotic for eczema. The doctor who developed the theory behind its use has a large worldwide following and quite often we have patients reach out to us about this regimen for their infants and children who suffer horribly from eczema. One Friday afternoon, a father of a one-year-old infant called and told us the story of his child and how the eczema was so bad it prevented the child from sleeping, eating and even wearing clothes. Despite receiving the order for the compounded medication after 4:00 p.m., he begged us to get the medicine ready for his child before the weekend. Hearing the agony and distress in the father’s voice, we agreed to stay over and get the compound ready. On the way to pick up the prescription, he called and asked if my staff and I liked crawfish. We said that was a no-brainer! When he showed up to pick up the prescription, he brought 10 lbs. of boiled crawfish for us. After he left and we closed the pharmacy for the evening, my staff and I sat out on the tailgate of my truck and enjoyed the crawfish. We later found out from the father the compound cleared up the infant’s eczema and improved the entire family’s quality of life. A win-win for everyone.

Your pharmacy celebrated a milestone anniversary in 2022. What or who do you attribute your pharmacy’s longevity and success?

Our pharmacy has always operated under the motto: If you take care of patients, as a side effect, you can make a living. That simple principle has been the driving force for our operations. Another secret to our success is having a caring staff that comes to work each day treating the pharmacy as if they are the owner. Creating a culture that fosters an outward mindset and hiring employees that are empathic, compassionate and conscientious has made our growth and success possible.

You’ve received many awards—including PCCA’s 2022 Pharmacist of the Year (congratulations!). Given your professional success and recognition, what advice would you offer those who are either interested in or starting to compound?

Of all the accomplishments and rewards I have received in my career, being awarded Pharmacist of the Year highlights the dedication I (and my staff) have committed to quality compounds and improving the lives of our patients. No other area of pharmacy can truly change, heal and serve every patient need like that of a compounder. The current state of traditional pharmacy has made the avenue of starting or growing compounding services more important than ever. Being a compounder requires a tremendous level of commitment and dedication. Lifelong learning is a must and creating a culture for your staff to grow professionally will develop a positive and nurturing workplace. Today’s patients are looking for wellness and healing. Whether you call it functional, integrative or personalized medicine, providing a healthcare destination with unique solutions provides for a career that is professionally rewarding like no other.

Is there anything else you’d like to share?

The future of our profession as compounders will only be possible with advocacy. With PCCA’s guidance and support, we must stay engaged on a local, state and federal level to ensure our patients do not lose access to customized medicine.

ISTX22 Preview – Myth Busters: Fat Loss Edition

Wed, 07 Sep 2022 13:58:10 GMT

by Richard Harris, MD, PharmD, MBA, PCCA International Seminar 2022 Speaker

Welcome to the PCCA version of Myth Busters. Today, we are discussing weight loss. Many people have tried, struggled, failed and succeeded in their weight loss journeys using various techniques. So, there is a ton of information floating around online, in the gym, throughout social circles and on social media. But what is actually “evidence-based” information versus what is just “bro-science”?

As healthcare practitioners, we are uniquely suited to help patients steward through the misinformation to acquire science-based techniques that aid them on their health journeys. One of my favorite, or least favorite, weight-loss myths is: “I have to burn off the cupcake I just ate by working out for an hour in the gym.”

This type of thinking is insidious, can severely impair our fat-loss goals and even create negative associations with food. This is personal — I watched my mother and sister battle eating disorders. Eating disorders are the mental health disorder with the highest mortality rate outside substance abuse disorders.¹ As healthcare practitioners, we should teach people that there is no such thing as good food or bad food. We use the 80/20 rule to explain how to eat. The oversimplification of this rule is: 80% single ingredient whole foods; 20% whatever else you like to eat and drink.

Whoops, we got sidetracked; back to burning off the cupcake at the gym. There are other reasons why this line of thinking is problematic. The first is that the trackers we use to measure caloric expenditures are inaccurate. They tend to overestimate caloric burn at low intensity and underestimate caloric expenditure at high intensity.^2,3

Another compounding factor is a compensation effect in basal metabolic rate for exercise energy expenditure. This means we burn more calories during exercise, but then burn less throughout the rest of the day. It’s estimated that this accounts for a 28% lower calorie expenditure from exercise for lean individuals and a 50% reduction for obese individuals.⁴

We address this by teaching people to look at calorie intake as a budget. You have a cupcake, great! Enjoy it, love it, don’t feel like you have to earn it, but account for it in your calorie budget and adjust.

Learn even more from Richard Harris at this year’s PCCA International Seminar 2022, where he will share more Myth Busters: Fat Loss Edition! Check out the full agenda and register today at www.PCCAInternationalSeminar.com .

References

1. Chesney E, Goodwin GM, Fazel S. (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry,13(2):153-160. doi:10.1002/wps.20128

2. Passler S, Bohrer J, Blöchinger L, Senner V. (2019 Aug 22). Validity of Wrist-Worn Activity Trackers for Estimating VO2max and Energy Expenditure. Int J Environ Res Public Health, 16(17):3037. doi:10.3390/ijerph16173037

3. Germini F, Noronha N, Borg Debono V, et al. (2022 Jan 21). Accuracy and Acceptability of Wrist-Wearable Activity-Tracking Devices: Systematic Review of the Literature. J Med Internet Res., 24(1):e30791. doi:10.2196/30791

4. Careau V, Halsey LG, Pontzer H, et al. (2021). Energy compensation and adiposity in humans. Curr Biol.;31(20):4659-4666.e2. doi:10.1016/j.cub.2021.08.016

Profiles In Personalized Medicine - Colton Winder

Wed, 15 Sep 2021 12:32:20 GMT

This Profile in Personalized Medicine highlights Colton Winder, PharmD, RPh, of Utah Family Pharmacy in Hurricane, Utah, owned by Cliff Holt, RPh. They have been proud PCCA members since 2008.

How did you start compounding, and what led you to PCCA?

I was hired as a pharmacist right out of pharmacy school to work in the sterile compounding lab at Utah Family Pharmacy, which is owned by Cliff Holt. He was already a PCCA member at the time. I loved it, though, and loved being able to use more of my chemistry knowledge from school. With time, I began to supervise the nonsterile operations as well, and I worked up to the position of being our hybrid pharmacy organization's only compounding pharmacist. I was fortunate to learn so much from such a knowledgeable, patient mentor as Cliff.

What was one of your toughest patient problems, and how did you solve it?

As the only community pharmacy in southern Utah that provides sterile compounding services, we're often called on to prepare medications for unique cases. This has required creativity in formulations, while also making sure we stay within the guidelines of the various USP chapters and published scientific data. Some of the most difficult cases we've experienced have been patients with severe, vision-threatening eye infections. We've been able to work with local ophthalmologists to prepare anti-infective ocular injections as well as topical medications for follow-up treatment. It's satisfying for me to know that we've made a difference in the vision and lives of patients in our community.

What has been your most satisfying patient experience? What was their health challenge, and how did you assist them?

This is a tough question. Over the course of my short career, I've had so many opportunities to help patients with unique challenges. It's hard to pinpoint one experience, but one of my favorite patient populations to help are pediatric patients. We've had pediatric patients with organ transplants, eye problems, skin conditions, ear infections, almost any condition imaginable. I've been able to use my knowledge and resources to help these patients. Knowing that I've made a difference in not only the health care of a child, but in their quality of life when their family felt like they might not have any other options, is one of the greatest experiences in my career.

What is your favorite PCCA base?

I have loved working with Ellage^®. That has been a game-changer for us. It's great to have a vaginal base that is anhydrous, but also has great mucosal adhesion. The patients we've used it for so far have loved it.

What was the moment you realized that joining PCCA was going to make a difference for your pharmacy?

I came into a pharmacy that was already a member of PCCA. I have seen how much PCCA has helped us succeed in caring for our patients, though. Through educational conferences, Clinical Services, technical support, the considerate attention of sales representatives, and the quality of products and bases, our membership in PCCA has made a tremendous difference in the success of our compounding lab, and our pharmacy in general.

What is your favorite PCCA educational event?

I always enjoy International Seminar. I'm quiet by nature and don't mingle as much as I'd like to, but I do enjoy rubbing shoulders with other incredibly wise and skilled pharmacists and technicians, hearing what others are working on and developing, and bringing home concepts from presentations that I can use to better help and serve my community.

What advice do you have for new compounders?

Use the knowledge and experiences of other compounders, and establish close relationships with the physicians. And pharmacists, never underestimate the value of having strong technicians who care as much about taking care of patients as you do.

Profiles in Personalized Medicine - Ashley Nolan

Wed, 07 Apr 2021 12:48:35 GMT

This Profile in Personalized Medicine highlights Ashley Nolan, BSc, CPhT, a co-owner of Martin's Wellness & Compounding at Lamar Plaza Drug Store in Austin, Texas. They have been proud PCCA members since 2010.

How long have you been compounding?

I have worked in pharmacy for 23 years and spent the last 18 years as a compounder.

Did you always want to work in the field of pharmacy?

Yes. You could say pharmacy runs in my family. I grew up helping out at my mom's pharmacy in Sherman, Texas. She had a long-term care pharmacy at the time and often would be the on-call pharmacist. There were weekends where she would put me to work pulling all the medications and packing the orders. Then I would hop out of the car and deliver to the nurses’ stations at the local long-term care facilities.

It was an exciting time for me as a 10-year-old. Mom made it a family affair. As children, my brother and I always attended pharmacy conferences in exciting places — sort of like a vacation! I met many of the pioneers in Texas pharmacy and beyond. I learned about pharmacy operations before I even knew that was what I was doing. I enjoyed meeting the brightest and most influential people in the profession, and those relationships have led to great resources and provided me mentors during my career.

When did you learn about compounding?
I moved to Austin, Texas, in 2002 and started working for a local, independent compounding pharmacy. I was interested in learning the art of making customized medications, so they moved me into the compounding lab to begin training. I remember my first day: I made nothing but slow-release progesterone capsules all day long. I think the trainer wanted to make sure that I never forgot how to put together a capsule machine.

What do you find most fulfilling about compounding?

The most amazing part of my job is the joy of helping others — learning the latest developments, investigating and then creating a preparation that improves a patient’s quality of life. It's pretty incredible to be a part of a patient’s health care journey and help in their recovery or healing or maintaining better health.

“The most amazing part of my job is the joy of helping others — learning the latest developments, investigating and then creating a preparation that improves a patient’s quality of life.”

What are some of your favorite PCCA formulas?

Tetracaine popsicles using MucoLox^™ (PCCA Formula #11430) is a favorite formula of mine. Patients are typically prescribed these to use at home, between pain medication. We have also made this formulation into a MucoLox oral spray for adult use.

Another formula that I like is amitriptyline topical cream with Lipoderm ^® (PCCA Formula #9342). Some of my local veterinarians prescribe amitriptyline for felines needing pain management. I had one four-legged patient in particular who really couldn't tolerate oral amitriptyline because of the bitter flavor. This cat was not having it. He would stay up nights, meowing in pain, causing an issue with his owners. His pet-dad wasn't getting any sleep before long days at work, and kitty's mom was pleading. If we couldn't get kitty some relief, then her husband was going to have him put down.

I talked to George in Clinical Services at PCCA, and he recommended preparing it topically using a permeation-enhancing base. The veterinarian agreed, and the cat’s mom was on board. I checked with her the following day, and kitty slept all through the night.

What are some of your compounding pharmacy success stories?

We had a concerned parent reach out to us. Her 3-year-old had a neurological condition that caused his facial muscles not to work well, so he was constantly drooling, which was causing a rash. We worked with the child’s doctor and PCCA Clinical Services to create an oral paste with glycopyrrolate and flavored it so that it tasted like icing. The patient responded well and liked that taste so much that when his dad applied the medicine to his gums, Mom was happy, and the 3-year-old felt better.

Additionally, we have filled prescriptions for a patient for many years who suffered a terrible back injury more than 30 years ago. She is on multiple pain medications and suffered side effects like dizziness, which eventually caused a fall and broken collarbone. Her doctor wanted her off of the oral meds because of that. Working with the doctor, we came up with something that fit her perfectly. She is now off her former medication and using a lesser dose of narcotic with the application of a combination pain cream made with Lipoderm.

What advice would you give to a new compounder?

I have a few:

Always ask questions.
Take your time. It’s better to get it done right than right now.
Get to know your customers. People like to do business with people they like.
Cultivate relationships with your doctors and their office staff. They will rely on you to help their patients and them when prescribing compounds.

Profile In Personalized Medicine - David Lorenzo

Fri, 11 Dec 2020 14:11:54 GMT

This Profile in Personalized Medicine highlights David R. Lorenzo, RPh, owner of Lorenzo Apothecary in Sterling, Colorado. They have been proud PCCA members since 2017.

How did you start compounding? What led you to PCCA?

I grew up in a pharmacy watching my dad and other pharmacists make compounds for patients. When I got out of pharmacy school, I was interested in compounding. I worked for a big-box pharmacy for 15 years. I was the only pharmacist who would do any compounding. Finally, I decided it was time to go out on my own. I had heard about PCCA, so when I went out on my own, I knew what they offered would be helpful to me

What has been your most satisfying patient experience?

I had an adult female patient who had not been able to wear a pair of jeans for 10 years due to vaginal pain. We worked with her prescriber, who decided on a compound with diazepam in it. The next week, she came in crying and thanking me because she was so happy.

What’s the biggest “aha” moment you’ve had as a member of PCCA?

PCCA taught me how to help patients and keep them for life.

What’s your favorite PCCA base, and why?

PracaSil^®-Plus. It makes the skin feel smooth and is easy to work with.

What’s your favorite PCCA educational event, and why?

International Seminar. I am attending virtually this year. I also enjoyed C4 HRT online training and the subsequent HRT symposium.

What was the last time a patient thanked you, and why?

Today! We provide great customer service and truly great products.

What do you wish you could tell new compounders?

Ask all the questions you can.

What’s your personal motto or words to live by?

Always be thankful and kind.

Profile In Personalized Medicine - Adrianna Rodriguez

Wed, 04 Nov 2020 14:22:32 GMT

This Profile in Personalized Medicine highlights Adrianna Rodriguez, CPhT, a pharmacy technician at Stone Oak Pharmacy in San Antonio, Texas, owned by Ernesto Garza-Gongora, PharmD. They have been proud PCCA members since 2006.

Did you always want to work in the field of pharmacy?

I accidentally fell into pharmacy life. I was a line cook, barely able to buy diapers, and a friend told me to come tour a trade school with them because they didn't want to go alone. That friend didn't like the amount of work involved, but I loved everything I saw. I registered the following week and started working at a retail pharmacy. Before I knew it, I was falling more in love with the field of pharmacy at each place I was lucky enough to work.

When did you learn about compounding? Why did you start compounding?

I was working at a retail pharmacy with an intern who happened to come to us after finishing his rotation at Stone Oak Pharmacy. The way he talked about how the specialty pharmacy made medications intrigued me to the point that I had to look into it more. I enjoyed being a tech, but being a compounding technician seemed like a path I wanted to go on.

What do you find most fulfilling about compounding?

Compounding, for me, is very specific — the details, the steps, the learning. Everything makes a difference, and being able to compound medications makes me happy.

What are some of your favorite PCCA formulas? What do you like about them?

PCCA Formula #11432 (rectal rocket suppositories with lidocaine, hydrocortisone and tranexamic acid) is my favorite to make. Yes, the mold can be time consuming and takes some practice. But the challenge of making this formula is so much fun for me. The same can be said for PCCA Formula #6868 (oil-filled capsules). It isn't the standard formula. It isn't something that can be done quickly. These are formulas that make me want to learn more. The hard ones are the best ones.

What is a memorable story from your time in compounding?

This year has impacted everyone. In San Antonio, we not only struggled as a pharmacy but as a community. With the limitations on personal protective equipment (PPE), tests and personnel, the hospitals sought assistance from local compounders. We used PCCA formulas to meet those demands. Finding the formulas and learning the hows, whys and standards for them were not only fun and new for me, but we were also able to provide our community with much-needed preparations for their own protection. Supplying these preparations for our community was one of the best things I could be proud to be a part of. We were standing strong together and helping our health care family stay safe.

“Supplying these preparations for our community was one of the best things I could be proud to be a part of. We were standing strong together and helping our health care family stay safe.”

What advice would you give to a new compounder?

There is always something new to learn. Do not expect to know everything all at once. Take your time to not only understand the concepts and procedures, but also to be able to explain them to others. It makes everything easier for everyone.

Profile In Personalized Medicine - Your Discount Chemist in Port Macquarie

Wed, 07 Oct 2020 12:40:53 GMT

By PCCA

This Profile in Personalized Medicine highlights Your Discount Chemist Port Macquarie in Port Macquarie, New South Wales, Australia, owned by Fawaz Khodary, BPharm. They have been proud PCCA members since 2017.

How did you start compounding?

There was a genuine need in our community because there were no other compounding pharmacies in the immediate area. Since we already had a compounding lab in one of our other locations, we felt it just a continuation to go ahead and build a compounding lab in our pharmacy here. Then we made a business decision to build a second compounding lab. More and more, people are taking charge of their health, and that was becoming evident with the amount of compounding prescription requests we were receiving from prescribers.

What led you to PCCA?

Over time, we realized all the important aspects of being able to run and manage a successful compounding lab came from PCCA. Everything they did was cutting edge. From technical support to ordering support to event planning to PK Software, the team at PCCA is professional, and the support is second to none. In order to operate successfully, we needed the best support team providing the quality raw ingredients to provide our patients with the very best choices!

What has been your most satisfying patient experience?

This one happened very recently. We have been working with a patient who has had three unsuccessful attempts at in vitro fertilization. The fourth one worked, and her physician’s protocol included compounded progesterone pessaries, which we were able to help with. Recently, she brought her baby into the pharmacy. We were so genuinely happy for the family and proud to be part of their journey. She said thank you to our whole team.

What’s the biggest “aha” moment you’ve had as a member of PCCA?

Learning how all the calculations actually work — that moment that you get it!

What is your favorite PCCA base, and why?

LoxOral^® gives an option for patients with sensitivities. It reduces static and cuts capsule-packing time down by at least half, we would estimate. We also love SuspendIt^® with its unique thixotropic flow. We love ZoSil^® for animals as well.

When was the last time a patient thanked you, and why?

We get thanked every day from the patients who need compounds urgently, from the moms who haven’t slept because they have screaming babies needing omeprazole, to the local vets for whom we are able to provide fast, efficient service, to the patients who have let themselves run out of their medication, and when we say, “OK, well you can pick it up this afternoon,” and they say, “Oh thank you.”

What do you wish you could tell new compounders?

Take it one at a time; look after each and every patient; and in time, the business will build.

What’s your favorite thing about your job right now?

We love the environment we have, where there is a team involved in the whole process and we all look after each other.

What’s your personal motto or words to live by?

Be the change you wish to see in the world.

Profile In Personalized Medicine - Ginny Isbell and Terry Wingo

Wed, 02 Sep 2020 13:28:37 GMT

By PCCA

This Profile in Personalized Medicine highlights Ginny Isbell, PharmD, and Terry Wingo, RPh, FACA, owners of Madison Drugs in Huntsville, Alabama. They have been proud PCCA members since 1997.

How did you start compounding? What led you to PCCA?

Ginny: I had a conversation with my cousin, who had been a marketer for PCCA, that sparked my interest in compounding. I had researched and compounded a few suspensions, but I didn't really know how important and necessary patient-specific compounding was until that conversation. I was then introduced to Terry Wingo, who presented compounding as an opportunity to continue my pharmacy education. I began working with Terry in 2006. I worked one week before I was off to Houston for PCCA's Primary Training (now known as CORE Compounding Training). I came back to the pharmacy asking to go to PCCA's Endocrinology Symposium and have not grown tired of learning yet.

What was your toughest patient problem? How did you solve it? Please be as specific as possible.

We had a gastric-bypass patient who could not get the correct dose of her medication in a commercially available tablet. I worked with her and her doctor to formulate a suspension, but even with all of my flavoring tricks, I could not please her taste buds.

We discussed other options. I knew the medication would have to dissolve quickly and easily for her to be able to absorb it, but at the same time not so fast that she would taste it. The prescription required more active powder than would fit in a tablet triturate, and adding sugar was not the best option for her.

We spent quite a bit of time developing a base and finding a mold that would work. We ended up with a wax-like tablet that was easy to swallow without tasting it, but would also easily melt once it reached the stomach. She loved this option.

What has been your most satisfying patient experience?

That’s a hard question to answer. Is it the person who has had shingles for weeks and is just now finding relief (and sleep), is it the person with multiple allergies who can now take their medication, or is it the woman who was able to get pregnant or the one who was able to stay pregnant this time? I don't know how to choose my most satisfying patient experience, but I do always like helping people who have been fatigued for a period of time. I love watching them get their life back after we work on balancing their hormones and supporting them with nutrients.

What is your favorite PCCA base, and why?

VersaBase® Cream, because most people with sensitivities can tolerate it and it’s useful for multiple applications from BHRT, dermatological, and even vaginal use.

What is your favorite PCCA educational event, and why?

My introduction to hormones at the Endocrinology Symposium 2006 is still my favorite PCCA event. I am so thankful I was able to learn from David Brownstein, Eldred Taylor, James Wilson, Jim Paoletti, David Zava and more at my first hormone conference. This was a perfect introduction to the hormone symphony. This is also where I learned how much I did not know along with what I needed to do to try to catch up.

What do you wish you could tell new compounders?

Never stop learning.

What is your favorite thing about your job right now?

Most everything, and the fact that I never get bored.

What do you enjoy for fun?

Being outside ... especially near water.

Profile In Personalized Medicine - Laurie Hidalgo

Wed, 05 Aug 2020 19:03:40 GMT

By PCCA

This Profile in Personalized Medicine highlights Laurie Hidalgo, CPhT, of Prosperity Pharmacy Manassas in Manassas, Virginia, owned by Frank Odeh, RPh; Lisa Odeh, RPh; and Vinod Patel, PharmD. Prosperity Pharmacy has been a PCCA member since 2011.

Did you always want to work in the field of pharmacy?

I have always wanted to pursue a career in the medical field, so I first went to school and became a certified medical assistant. Later on, after a few years of working in a doctor's office, I became more interested in the science side of pharmaceuticals and went back to school to pursue a degree in pharmacy as a technician.

When did you learn about compounding? Why did you start compounding?

I had no idea about compounding medication until I started working at Prosperity Pharmacy. I was working in the retail aspect of the pharmacy for a few months until one day, the pharmacy needed another compounding technician. Then I took the opportunity for new challenges and accepted a position that allowed me to learn more about the job and myself. Afterward, I attended PCCA’s C3 training course (now known as CORE Compounding Training) that taught me to become a better compounder.

Attending this course helped me understand so much more about compounding. It covered everything –how to make suspensions, suppositories, lollipops, animal treats, rectal rockets and especially capsules, something that we do daily at the pharmacy. Since I was so new to compounding, this course helped me understand how to do capsule calculations and packing stats. I totally recommend PCCA’s CORE training course for any new compounders.

What do you find most fulfilling about compounding?

Our ability to customize medications to the patients’ specific needs. One thing that I love most is that every day is different with different scenarios, and we are capable of assessing each situation to provide the best medication for our patients.

What are some of your favorite PCCA formulas? What do you like about them?

I like PCCA’s Methimazole Formula #13215 because the inclusion of WO6 Anhydrous Topical Gel^® with the hydroquinone allows the medication to have a six-month beyond-use date without refrigeration. The feedback we have received from patients and prescribers has been favorable, and that is what makes me enjoy working with this formula.

What is a memorable story from your time in compounding?

We had a feline patient who refused multiple compounded suspension formulations. However, we were able to work with the veterinarian to determine the proper dosage using a topical Lipoderm^® option instead. After a few days, the owner called us and was very satisfied with the result. The cat was able to take the medication and slowly got better.

What advice would you give to a new compounder?

Be patient and ask questions. No matter how big or small the question is, it can make a difference in your learning process. There will be a lot of information at the beginning to absorb, so take notes and do your research. Every day is a learning experience.

Profile In Personalized Medicine - Bob Mehr

Wed, 01 Jul 2020 15:42:05 GMT

This Profile in Personalized Medicine highlights Bob Mehr, BScPharm, FAPC, President and CEO of Pure Integrative Pharmacy #25 in Fort Langley, British Columbia, Canada. He has been a proud PCCA member since 2000.

How did you start compounding? What led you to PCCA?

I became interested in compounding when I realized that many patients cannot tolerate certain commercially available pharmaceuticals, especially women suffering from symptoms of menopause. I could not imagine that one pill or one strength could look after everyone’s pharmaceutical needs.

I started to look into options. I started to do some research on the internet while also asking my colleagues in the U.S. where I could learn about the art of compounding. All signs pointed toward PCCA. So I made a call and made the commitment to attend the Primary Training course (now CORE Compounding Training) in Houston. After attending the training, I fell in love with PCCA and continued my educational path by attending all their seminars and courses, including aseptic training.

What was your toughest patient problem?

My toughest patient problem involved a postmenopausal woman unable to alleviate hot flashes, night sweats and all her other symptoms. We finally found a solution that worked for her using balanced dosing with unique formulations. I monitored her symptoms daily, and I was on the phone with PCCA clinical compounding pharmacists regularly trying to figure out how we could solve her problems. After three months of research and looking for a solution, while also working with her physician closely, we were able to relieve all her symptoms.

What has been your most satisfying patient experience?

It was back in 2003. I attended PCCA’s Aseptic Training course (now Sterility Assurance Training) in Houston. After learning all the techniques, I built a clean room in one of my pharmacies. This was a big step for me. There was a patient who had a spinal injury due to a motor vehicle accident. She would be wheelchair bound for rest of her life. Her doctor called me and asked if I could create a sterile compound for an intrathecal pain injection on a bi-weekly basis. I agreed to do it.

I just wanted to make sure I was doing all the right things to help this patient. The first time I made this sterile injection, I was so nervous. I was by the phone all day long until the doctor called me and said the procedure went well and helped the patient.

That was truly one of the moments that I will never forget in my life. I ended up making that compound every two weeks for four years. This patient came to our pharmacy every single week in her wheelchair and thanked me for giving her a higher quality of life. She still sends me thank-you letters on a regular basis.

What’s the biggest “aha” moment you’ve had as a member of PCCA?

When I first visited PCCA back in 2001, I was so impressed with the quality of experts they had and also the quality control for their ingredients.

What is your favorite PCCA base, and why?

VersaBase® Cream. It can be used in formulations for HRT, dermatological issues or cosmetics. It has no smell, is easy to work with and feels great on the skin. Our patients love this base.

What is your favorite PCCA educational event, and why?

The HRT Symposium in Las Vegas. There are always great speakers at this event, and I learn so much.

What advice would you give a new compounder?

Never, ever compromise your quality. Always buy the best ingredients, invest in your facility and equipment, and always provide your staff with ways to expand their education and training.

What is your favorite thing about your job right now?

Helping my patients to take control of their own health by educating them on what their options are.

What is your personal motto or words to live by?

"The greatest wealth is your health." – Virgil

What is the best word to describe your life?

Gratitude.

Clinical Services Spotlight - Jane Jones

Thu, 18 Jun 2020 13:01:11 GMT

by Seth Humble, Digital Content Specialist

A pharmacist's life involves precision. It requires meticulous preparation and accuracy. A steady hand, a measured approach and attention to detail — these are essential traits. For Jane Jones of PCCA’s Clinical Services team, these traits are what has allowed her to not only be a successful pharmacist, but also a tremendous cook.

“I love to cook in the Southern style,” she says, after I ask her to tell me something about herself that folks may not know. “My husband of 25 years is a pediatric neuroradiologist, but also a Georgia Southern boy, so I love cooking fried chicken in Crisco. Food ... well, cooking is an important part of community. Of family. I love to cook for my husband and our three children. I’m a good cook, and I think that’s because I’m precise.”

“What is the meal you like to make when the whole family is at home?” I ask. “What is the go-to Jane special?”

Her voice rings with excitement when she replies. “Oh, it has to be steak, potatoes and apple cobbler.”

As our conversation deepens, as we talk about what pharmacy compounding means to her, it becomes clear that cooking isn’t just about the recipes, preparation or execution. To Jane, cooking is an act of love for her family. And family means a great deal to Jane, it is a feeling directly tied to the events early in her life.

Jane’s story is one that is common in the American cultural landscape, and yet no less remarkable. Her life began in one country and ended up here because her parents hoped to provide a life of greater opportunity. Born in Seoul, South Korea, Jane’s parents took the long way to getting to the United States of America: Due to a three-year waiting period required for her father to obtain a work visa, they spent 10 years in Paraguay first. Jane is the daughter of an engineer, whom she describes as dedicated and hard-working, willing to provide her a life that allowed her to start her career in pharmacy. That’s where our conversation turns next.

“I was a retail and hospital pharmacist for 10 years,” Jane says of her career before she joined the PCCA team. “I worked at a drug store for my first job. That quickly became boring because it felt like all I was doing was pill-counting. I moved on from there to a children’s hospital because I thought I would get a better chance at patient interaction. That’s what I was interested in. But it was more of the same — count out prescriptions, rarely get to talk with the people the medications were for.”

“Was making medications the most virtuous aspect of that time?” I ask her.

“Every day, pharmacies are making medication,” she says. “There was a time, some years ago while speaking with a Canadian member, I was able to assist with a diaper rash formula for a very severe case, where all other conventional therapies failed. That was meaningful. It helps me remember how important formula innovation is. I also help lots of members with veterinary compounding questions. Vet compounding is a much larger patient group than most people realize.”

“You’ve worked at PCCA for 15 years. What does that 15 years mean to you?”

“I love my job. I am happy,” Jane says. “Lots of people say that, but I truly am. I love talking to our members every day, some of whom I talk to daily! I get excited to log on and really invest myself into the lives of patients and pharmacists.”

“Fifteen years must have come with some challenges, I would imagine,” I say.

Jane chuckles at that. I can hear in her voice the deep, happy sigh of someone who knows their job is difficult, but loves it too much to ever give it up.

“There are always challenges to everything,” she says. “There are little things, like catching the phone on the weekends. We want to be there for our member pharmacies, and sometimes that means weekend work, sometimes even after 7 p.m. But it’s important to be available. Many of us have deep relationships with their technicians, pharmacists and the owners because those pharmacies are helping people get better. Every day, they are helping people get well. Being a part of that makes a little work on the weekend worth it. Without question.”

Jane’s bright, jovial tone is infectious. I find myself smiling so much that the edges of my mouth are starting to ache. It is a good feeling. “Overcoming so many challenges, having such a rich experience in life and family — what would you say has been the most important notion that has kept you working in pharmacy?”

“Providing the right medication,” she says. “The right ingredients, precise ingredients. The right dosage. Those things help a patient. The patient is at the end of a long chain, and even though we may not get to interact with them, our members do. So it is so important to remember that there is always, always, always a patient at the end of each phone call. And the patient matters.”

This is Jane Jones.

She’s a loving wife to a Georgia boy and mother to their three children, who loves to cook food in the American fashion that she learned from her mother-in-law. A daughter to brave immigrant parents who exemplify much of what is best about the country we live in. And she is a part of PCCA’s Clinical Services team, where she represents 25 of the over 500 years of collective pharmacy experience her team brings to bear on any and every challenge. PCCA is proud to call her one of our own.

Key Takeaways from PCCA’s 2020 Marketing & Sales Virtual Conference

Wed, 10 Jun 2020 14:12:19 GMT

By Erin Michael, MBA, MS, CPhT, PCCA Director of Outside Sales

On two consecutive Saturdays in May 2020, PCCA hosted its first Marketing and Sales Virtual Conference (our first ever virtual conference overall, too). Considering how much the COVID-19 pandemic has affected independent compounding pharmacies, we chose to focus on strategies and tactics specifically designed to help them through this crisis and beyond. To accomplish this, we worked with experts in many aspects of sales, marketing, general business development, pharmacy and combinations of all the above — including presenters who currently own their own pharmacies. They guided and engaged with our virtual attendees while imparting countless pearls of business wisdom that they could implement immediately to rebuild business today and in the future. Below is a sample of the expert advice that our presenters offered.

Control What You Can Control during the COVID-19 Pandemic

COVID-19 has taken us from a “bear” market to a “bull” market; take advantage of this time when compounders are in a positive spotlight
Take control of what we can control: New prescriptions may be drying up, but prescription refills and supplement sales can be priorities
Move from a broad focus to a micro focus: Identify compounding specialties that are less affected by the pandemic and pursue them
You cannot over-communicate in a time like this (to staff, to patients, to doctors)
For doctors, you’re not providing one particular product; you’re providing solutions, innovation, hope when other therapies have failed — you’re providing your availability as a trusted resource
For patients, let them know you’re open and here to serve them during the COVID-19 pandemic; provide them peace of mind in addition to health care
Stay on top of refill reminder phone calls:
- Monitor data to see who is due for a refill in a certain timeframe
- Frame these calls as a check-in, and let the customer lead the conversation; be empathetic to their needs and concerns; offer other products when appropriate (e.g., nutritional supplements, hand sanitizer)
- Pick the right staff member(s) to do these calls; some people are naturals and some need coaching and a script
- Long-term benefits: This builds relationships with patients (and their doctors); it gives more control over what prescriptions are filled on which days
Use alternative ways to offer refill reminders, such as email or through a smartphone app
Consider creating “immunity kits” that patients can pick up with their prescriptions (hand sanitizer, mask, supplement, protein bar, etc. as a kit)
Consider “sidewalk shopping” (outdoor retail setup in front of pharmacy) if possible

Social Media Is Crucial during the Pandemic

The pharmacy needs a greater focus on social media marketing and patient communications
Communicate recent policy changes: curbside service or drive-thru/shipping procedures; updated hours of operation (on all platforms — Yelp, Google, Facebook, website, etc.)
Be transparent and reassure your patients that you have their safety in mind; be trusted, reliable and flexible
Share social media content that shows how you’re giving back to your community (such as the #CompoundingHandoff ) as well as fun things your staff is doing (which builds trust with your followers)
Share other social media content like relevant articles; Facebook Live videos on properly wearing masks, your reopening plans, etc.; or “Did you know?” video series of little-known pharmacy offerings
Live videos humanize your pharmacy; they are more candid and vulnerable. They get better placement on social feeds and have a higher potential for engagement than regular video
Live videos can and should be longer (the typical 2-minute-or-less rule doesn’t apply); followers get notified when you go live, so 5+ minutes gives them time to tune in
Optimize based on the channel. Your video will be more impactful for an Instagram user when you record in portrait (vertical) vs. landscape (horizontal) because Instagram users are primarily on mobile devices. Facebook has a more even split between mobile and desktop, so landscape is used more often
Feature retail products online, such as vitamins/supplements, gifts, cards, wrapping supplies, puzzles, tea, coffee, seasonal products

Virtual Meetings with Prescribers Are an Unprecedented Opportunity

The pharmacy salesperson/marketer needs a completely virtual transition for physician visits
You normally have 2–3 minutes with a doctor when you visit their office, but virtual meetings give you 30 minutes uninterrupted; virtual meetings are also more cost effective
Don’t forget: Your prescribers are going through the same situation that you are. They are business owners. They’re looking for new ways to reach out to their patients and provide for the future, too. Share your creative best practices and your knowledge of the economic resources available with them
Educate primarily, sell secondarily — provide guidance and insight right now as a trusted advisor because prescribers are hungry for education
What you need: Zoom (or similar) account; Outlook (or similar) calendar request; digital or print invitations with relevant materials (and goodies!); your compounding pharmacist/pharmacy team
- BONUS: PCCA Science research (public), FormulaPlus^™ formulas with extended beyond-use dates (for PCCA members with Clinical Services access)
Pro tips:
- Send them materials beforehand (email content or mail a binder)
- Support a local business by sending the doctor lunch during your meeting
- Turn on your camera and encourage doctors to do the same (it’s more personal)
Consider using clinical PowerPoints on Zoom
- BONUS: PCCA members can access our customizable presentations on the PCCA Marketing Resources page
If you’re a marketer, you could have the pharmacist join you on the call — you have a captive audience, and you are going the extra mile to earn their business
Scared of doctors turning down your meeting request?
- Invite them through a variety of channels (phone call, email, mail, fax)
- Practice your elevator pitch and tailor it to their specific needs
- Rejection is redirection; “no” means you need to get creative and find a different angle that works
Offer virtual workshops on key clinical topics to doctors (and patients)
A virtual meeting is not just a single opportunity. Keep meeting with doctors (build relationships, educate on new compounding specialties, etc.)
Always follow up:
- Find opportunities to reconnect with doctors, especially new doctors (for example, if you have a positive patient story to share)
- Share notes you took during the call
- Send a thank-you with links to your website and social media pages

Virtual Consultations with Patients Are a Must

Don’t just expect patients to come to you; advertise your consultation services (local interest groups, publications, social media, etc.)
Again, educate primarily, sell secondarily — continue to inform patients on why they need to maintain their medication regimens, and educate them on the importance of immune system support right now
Consultation set-up process:
- A customer requests an appointment (their health journey begins)
- Every staff member should be able to access the calendar and book a time slot
- Immediately share intake forms and request they be returned 72 hours prior to appointment
- At the beginning of each week, a staff member calls to confirm all appointments
- When the customer comes to pick up their initial therapy, schedule a follow-up consultation (2 months later is good generally); engage them, answer questions, review and adjust therapy as needed
Consider using FaceTime (or similar app) to help your customers have a personal virtual shopping experience from the comfort and safety of their home

And that was just a sample. I was honored to be a part of PCCA’s 2020 Marketing and Sales Virtual Conference. It was inspiring to see so many compounders and marketers come together to help navigate their pharmacies through the crisis that we all find ourselves in. And I hope that you’ve found some strategies and tactics here that you can implement in your own businesses right now.

PCCA members can watch our entire 2020 Marketing and Sales Virtual Conference on PCCA Play. It is free for subscribers, and it is available as a 12-month rental for non-subscribers.

Erin Michael, MBA, MS, CPhT, PCCA Director of Outside Sales, joined the PCCA staff in July 2006. She has been working in pharmacy for more than 25 years, of which 23 have been in compounding and promoting the practice of pharmacy. She previously worked for an independent pharmacy owner and was the general manager of multiple locations. Erin was instrumental in developing and implementing programs to promote and grow the compounding and traditional parts of that business. She holds an MBA in healthcare administration and an MS in hospitality management. She was recognized as PCCA Technician of the Month in August 1999 and California Pharmacists Association Technician of the Year in 2003.

Profile in Personalized Medicine - Angie Huff

Fri, 05 Jun 2020 13:09:55 GMT

This Profile in Personalized Medicine highlights Angie Huff, PharmD, owner of The Wellness Corner Compounding Specialist in Prairieville, Louisiana. She has been a proud PCCA member since 2009.

How did you start compounding? What led you to PCCA?

During my clinical rotations in pharmacy school, I was blessed to rotate at a wonderful compounding pharmacy in my area, Prescription Compounds. I was intrigued by the work they were doing in the realm of autism and hormone replacement therapy (HRT). After a short time in the retail pharmacy area, I opened my own independent pharmacy in 2005. I knew that I needed to join PCCA to set my compounding practice apart and to gain invaluable knowledge.

What was your toughest patient problem?

My toughest patient case recently involved a woman with severe issue that left her with multiple organ lesions and subsequent pain. We worked extensively with her and her doctor to formulate a customized preparation that provided pain relief. She is a mom of three and a wife, and could not afford to be drowsy. We successfully formulated a rectal formulation that relieves her pain and causes minimal side effects.

What has been your most satisfying patient experience?

Our HRT practice allows me to develop lasting relationships with so many ladies. Time after time, these women relay stories to me about how customized, compounded HRT has made a tremendous difference in their overall lives, relationships and health. That is such a strong statement! It brings me so much joy to be able to make such a difference in their lives.

We compound customized intrathecal pain preparations as well. During follow-up calls with our patients, we hear statements like: “I can now garden with my grandchildren,” “This customized pain therapy has given me my life back,” and “Before this therapy, I could just lay on the floor. Now, I am back to hunting and fishing.” Providing these patients with an effective alternative to oral opioids and the accompanying side effects is rewarding.

What is the biggest “aha” moment you’ve had as a member of PCCA?

Discovering Wellness Works— it enlightened me to the fact that there was an entirely different facet that I could offer in my pharmacy to help patients achieve optimal health and complement our compounding practice. It led me to my interest and current practice in holistic health, nutrition and supplements.

What is your favorite PCCA base, and why?

Lipoderm^® — the versatility allows us so many topical therapeutic options.

What is your favorite PCCA educational event, and why?

International Seminar. I always learn so many pearls to come back with and better my business. I always return from International refreshed and refocused on my business.

Tell us about a rewarding patient experience.

Yesterday, because I took the time to fully listen to a patient and her husband and offer them feasible solutions to better health.

In all honesty, the thank-yous are endless when you’re a compounding pharmacist. We are in such a position to help and serve.

What advice would you give to new compounders?

In the beginning of your practice, research, research, research. Call PCCA and ask questions, explore the formulas and attend the educational conferences. During the first couple of years, I called PCCA multiple times a day and spent hours browsing formulas and related studies. All of this time spent researching really led me to be a true problem-solver, which is what a compounder truly is.

What is your favorite thing about your job right now?

Serving patients, and my ability to be a resource for physicians. I love patient and physician interaction. I also love being a pharmacy owner. It allows me freedoms to explore many aspects of pharmacy and to be creative.

If you weren’t a compounder, what would you be?

A functional medicine physician. I love listening to patients and hearing their entire stories and showing them how, oftentimes, their symptoms are all related. I love holistic health care.

What is your personal motto or words to live by?

This motivational quote hangs in my office: “Enjoy Each Day; Be Present; Breathe Deeply; Show Gratitude; Live with Intention; Be Fearless; and Try New Things.”

What are the best words to describe your life?

Rewarding and balanced.

Permeation-Enhanced Topical Pain Therapy: A Literature Review

Wed, 13 May 2020 13:04:05 GMT

By Nat Jones, RPh, FAPC, PCCA Clinical Compounding Pharmacist

Topical preparations made of animal, mineral or plant extracts were in common use in ancient Egyptian and Babylonian medicine by 3000 BCE.¹ Humans have known for a very long time that products may be applied to the skin for either local or systemic effects, and as our understanding of the anatomy and physiology of the skin has improved, science has brought about the development of technologies to effectively and quantitatively deliver substances across this barrier to specific target sites in the skin and systemically in the body.² This brings us to modern health care, including pharmacy compounding.

Permeation Enhancement in Compounding

Compounding pharmacists have brought a variety of topical treatment options forward within the last 25 years in the field of pain therapy. Permeation-enhanced topical pain therapy (PETPT) has been commonly called transdermal pain therapy for a long time in our industry. More recently in the pharmaceutical industry, though, the word “transdermal” has primarily referred to manufactured patches (e.g., fentanyl) and not compounded creams or gels. With that being the case, the term “permeation-enhanced” seems appropriate.

In the practice of compounding, permeation enhancement can come from certain chemicals, some of which have dual function in formulating for topical applications. These agents can both increase penetration through the stratum corneum (permeation enhancers), and they can also improve incorporation of the active pharmaceutical ingredient (API) into the delivery base (wetting agents). Common examples would include propylene glycol, ethoxy diglycol or ethylene glycol monoethyl ether.³ It is also important when compounding to select a wetting agent that is compatible with the base, of course.

Over the years, compounding bases have become more advanced, with some having intrinsic permeation-enhancing properties. Compounders made the use of pluronic lecithin organogels (PLO gels) popular in the 1990s and early 2000s, but with the invention of Lipoderm^® in the early 2000s, the landscape of delivering small to medium-sized molecules through the stratum corneum changed. Lipoderm was the first proprietary permeation-enhancing vehicle in the compounding industry, and it showed increased delivery of ketoprofen versus a PLO gel with Franz finite permeation testing.⁴ Other APIs were successfully tested for permeation through the skin, including a four-drug study of both Lipoderm and Lipoderm ActiveMax^®proving delivery of ketamine, gabapentin, baclofen and clonidine simultaneously from the same permeation-enhancing topical base.⁵ More recently, PermE8^® Anhydrous Gel shows promise as another option. Initial in vitro testing revealed that it delivered ketoprofen into and through human skin tissue comparably to Lipoderm.⁶ This leads to a discussion of the evidence we have for PETPT.

Levels of Evidence in Medicine

Clinical data about the efficacy of PETPT has presented various levels of evidence that is useful in helping our medical colleagues to treat patients experiencing pain. Evidence-based medicine is the hierarchical system of classifying evidence in order to be able to make more logical clinical decisions. There are many different levels of evidence that can be used. At one extreme, there are systematic reviews of multiple clinical trials with homogeneity. At the other end, there is expert opinion without explicit critical appraisal or that is based on physiology bench research or fundamental information (“first principles”).⁷ Table 1 explains this range of evidence.

Table 1. Levels of Evidence for Studies⁷
Level	Type of Evidence
1A	Systematic review (with homogeneity) of randomized, controlled trials (RCTs)
1B	Individual RCT (with narrow confidence intervals)
1C	All-or-none study
2A	Systematic review (with homogeneity) of cohort studies
2B	Individual cohort study (including low quality RCT, e.g., <80% follow-up)
2C	“Outcomes” research; ecological studies
3A	Systematic review (with homogeneity) of case-control studies
3B	Individual case-control study
4	Case series (and poor-quality cohort and case-control study)
5	Expert opinion without explicit critical appraisal or based on physiology bench research or first principles

In the practice of medicine, there is not always a systematic review of homogeneous, randomized clinical trials available for us to use when making every clinical decision. In fact, in the compounding world, that level of evidence is essentially nonexistent. It has been stated many times that we are attempting the practice of medicine and not the exact science of medicine, and that on many occasions the only level of evidence we have is an expert opinion without explicit critical appraisal, or we must base our decision on physiology bench research or first principles. This does not mean we are not practicing evidence-based medicine. We are, but just not with the highest level of evidence that could exist in an ideal world. The practice of medicine is still far from being perfected, and we still make great use of the information we have.

Literature Review of PETPT

Last year, we at PCCA undertook a literature review of PETPT, totaling 168 single-API studies and 48 multi-API studies. We looked at the design and outcomes of these studies published from around the world. Their size and quality varied from single-patient case studies to larger randomized, placebo-controlled clinical trials. Most of them showed an effective outcome for the patients treated (153 out of 168 single-API studies, or 91%, and 38 out of the 48 multi-API studies, or 79%). The researchers used a variety of APIs in these studies, such as amitriptyline, baclofen, capsaicin, clonidine, diclofenac, doxepin, gabapentin, ibuprofen, ketamine, ketoprofen, lidocaine and piroxicam, along with others. Navigating this bulk of literature and deciding which articles to share with prescribers to help make clinical decisions can be difficult and time consuming. A brief summary of some selected studies from our review (Table 2 and Table 3) can serve as a reference guide for pharmacists and prescribers in choosing an effective API for incorporation into their PETPT for various types of patients. We hope it will make the selection process a little easier and, ultimately, help you to serve your patients.

Table 2. Single-API PETPT Studies
Clinical Use	Size	Ingredient	Outcomes	Citation
Central neuropathic pain	1	Amitriptyline	EFFECTIVE: Patient noted that in the week of using the active cream, no allodynia was present, with a carryover effect of one day. She did not need to use the escape medication in the week of using the active cream, though she frequently used the escape medication in the placebo weeks.	Kopsky, D. J., Liebregts, R., Keppel Hesselink, J. M. (2012). Central neuropathic pain in a patient with multiple sclerosis treated successfully with topical amitriptyline. Case Reports in Medicine, 2012. https://doi.org/10.1155/2012/471835
Chemotherapy-induced neuropathies	44	Amitriptyline	EFFECTIVE: The median VAS pain score decreased from 7 (4–9) at baseline to 2 (0–4) after 4-week topical treatment.	Rossignol, J., Cozzi, B., Liebaert, F., Hatton, S., Viallard, M.-L., Hermine, O., & Greco, C. (2019). High concentration of topical amitriptyline for treating chemotherapy-induced neuropathies. Supportive Care in Cancer, 27(8), 3053–3059. https://doi.org/10.1007/s00520-018-4618-y
Hemorrhoid post-op pain	66	Baclofen	EFFECTIVE: Baclofen group has significantly lower pain score on week 1 and week 2 than placebo. Baclofen group consumed significantly less analgesic agents on week 1 and week 2.	Ala, S., Alvandipour, M., Saeedi, M., Mansourifar, M., Monajati, M., & Shiva, A. (2020). Effect of topical baclofen 5% on post-hemorrhoidectomy pain: Randomized double blind placebo-controlled clinical trial. Journal of Gastrointestinal Surgery, 24, 405–410. https://doi.org/10.1007/s11605-019-04147-7
Diabetic Neuropathy	102	Amitriptyline vs. Capsaicin	EFFECTIVE: Both drugs significantly relieved pain in 12 weeks compared with baseline values. Treatment responders were similar in both groups (P = 0.545).	Kiani, J., Nasrollahi, S. A., Esna-Ashari, F., Fallah, P., & Sajedi, F. (2015). Amitriptyline 2% cream vs. capsaicin 0.75% cream in the treatment of painful diabetic neuropathy (Double blind, randomized clinical trial of efficacy and safety).Iranian Journal of Pharmaceutical Research, 14(4), 1263–1268.
Diabetic neuropathy	139	Clonidine, capsaicin	EFFECTIVE: Both drugs significantly relieved pain at 12 weeks, but no significant difference in the efficacy between the 2 treatments was observed.	Kiani, J., Sajedi, F., Nasrollahi, S. A., & Esna-Ashari, F. (2015). A randomized clinical trial of efficacy and safety of the topical clonidine and capsaicin in the treatment of painful diabetic neuropathy.Journal of Research in Medical Sciences, 20(4), 359–363.
Osteoarthritis of the knees	216	Diclofenac	EFFECTIVE: This topical diclofenac solution demonstrated relief of the symptoms of primary osteoarthritis of the knee at 6 weeks.	Baer, P. A., Thomas, L. M., & Shainhouse, Z. (2005). Treatment of osteoarthritis of the knee with a topical diclofenac solution: A randomised controlled, 6-week trial [ISRCTN53366886]. BMC Musculoskeletal Disorders, 6. https://dx.doi.org/10.1186%2F1471-2474-6-44
Central neuropathic pain	33	Ketamine	EFFECTIVE: Daily 75 mg S(+)-ketamine showed significant improvements on the Pain Disability Index, on the EQ-5D, and on the SF-36. Daily 50 mg was not effective.	Vranken, J. H., Dijkgraaf M. G. W., Kruis, M. R., van Dasselaar, N. T., & van der Vegt, M. H. (2005). Iontophoretic administration of S(+)-ketamine in patients with intractable central pain: A placebo-controlled trial. Pain, 118(1–2), 224–231. https://doi.org/10.1016/j.pain.2005.08.020
Complex regional pain syndrome, type 1 (CRPS I)	5	Ketamine	EFFECTIVE: Improvement of the report of pain intensity, measured by the visual analog scale, in 4 patients with acute early dystrophic stage of CRPS I. Swelling of the affected limbs subsided as well. No apparent changes were noticed in 1 patient with chronic atrophic stage of CRPS I and in both patients with CRPS II.	Ushida, T., Tani, T., Kanbara, T., Zinchuk, V. S., Kawasaki, M., Yamamoto, H. (2002). Analgesic effects of ketamine ointment in patients with complex regional pain syndrome type 1.Regional Anesthesia & Pain Medicine, 27(5), 524–528. https://doi.org/10.1053/rapm.2002.35517
Post herpetic neuralgia and neuropathic pain syndromes	23	Gabapentin	EFFECTIVE: Collectively, 20 of the 23 patients benefited from topical gabapentin, with a reduction in mean pain scores after 1 month, and 11 achieved a clinically meaningful 30% reduction in pain.	Hiom, S., Patel, G. K., Newcombe, R. G., Khot, S., & Martin, C. (2015). Severe postherpetic neuralgia and other neuropathic pain syndromes alleviated by topical gabapentin. British Journal of Dermatology, 173(1), 300–302. https://doi.org/10.1111/bjd.13624
Refractory, focal peripheral neuropathic pain	23	Gabapentin 6% in Lipoderm	EFFECTIVE: Topical gabapentin resulted in rapid improvement of symptoms (<1 month) when compared to the gradual titration required with oral administration (<8 weeks), with the associated patient and institution benefits. Results support anecdotal evidence that topical gabapentin is safe and efficacious for use in refractory focal peripheral neuropathic pain.	Hiom, S., Khot, S., Mogford, S., Hart, C., Patel, G., Roberts, G., Martin, C., & Newcombe, R. (2015). Topical delivery of gabapentin (GabaGel^™) for neuropathic pain: A ‘proof of concept’ study.International Journal of Pharmacy Practice, 23(Suppl. S2), 23–106. https://doi.org/10.1111/ijpp.12213

Table 3. Multi-API PETPT Studies
Clinical Use	Size	Ingredients	Outcomes	Citation
Radicular pain	Case series	Diclofenac, ibuprofen, baclofen, cyclobenzaprine, bupivacaine, gabapentin, pentoxifylline	EFFECTIVE: The topical formulation addresses both neuropathic and inflammatory components of radicular pain. It was found to be well tolerated, reduce radicular pain, and improve function and sleep in this case series of 3 patients who had failed other conservative or surgical treatment.	Safaeian, P., Mattie, R., Hahn, M., Plastaras, C. T., & McCormick, Z. L. (2016). Novel treatment of radicular pain with a multi-mechanistic combination topical agent: A case series and literature review. Anesthesiology and Pain Medicine, 6(2). http://dx.doi.org/10.5812/aapm.33322
Diabetic neuropathy and other chronic pain conditions	283	Ketamine, baclofen, gabapentin, amitriptyline, bupivacaine, clonidine, also a + nifedipine arm	EFFECTIVE: Both creams significantly decreased pain score. Also effective in all secondary outcomes.	Somberg, J. C., & Molnar, J. (2015). Retrospective study on the analgesic activity of a topical (TT-CTAC) cream in patients with diabetic neuropathy and other chronic pain conditions. American Journal of Therapeutics, 22(3), 214–221. https://doi.org/10.1097/mjt.0000000000000253
Chronic neuropathic pain	200	Doxepin, capsaicin, combination of doxepin and capsaicin	EFFECTIVE: Topical application of doxepin, capsaicin and doxepin/capsaicin produced analgesia of similar magnitude. However, the combination produced more rapid analgesia.	McCleane, G. (2000). Topical application of doxepin hydrochloride, capsaicin and a combination of both produces analgesia in chronic human neuropathic pain: A randomized, double-blind, placebo-controlled study.British Journal of Clinical Pharmacology, 49(6), 574–579. https://doi.org/10.1046/j.1365-2125.2000.00200.x
Neuropathic pain	16	Amitriptyline, ketamine, lidocaine	EFFECTIVE: The APIs significantly reduced (p<0.05) pain intensity, sharpness, burning, sensitivity, itchiness, unpleasantness and depth of pain levels on a short-term basis (i.e., between pre-treatment and 30 min post-treatment). They significantly reduced (p<0.05) burning levels on a long-term basis (i.e., between pretreatment and 2 weeks post-treatment).	Uzaraga, I., Gerbis, B., Holwerda, E., Gillis, D., & Wai, E. (2012). Topical amitriptyline, ketamine, and lidocaine in neuropathic pain caused by radiation skin reaction: A pilot study. Supportive Care in Cancer , 20(7), 1515–1524. https://doi.org/10.1007/s00520-011-1240-7

Nat Jones, RPh, FAPC, graduated from the Virginia Commonwealth University, Medical College of Virginia’s School of Pharmacy in 1979. In 2014, after 20 years of owning a compounding pharmacy, he joined PCCA’s staff. Nat has given continuing education lectures at medical professional seminars and webinars on numerous topics, including general compounding, wound care, pain management, nutrition, otolaryngology, women’s health, sexual dysfunction, insulin resistance, hormone replacement therapy, neurotransmitter imbalance and dermatology. He has published many articles and case studies in magazines and professional journals along with an open-access ebook titled Advances in Psoriasis with Avid Science. Since 2016, Nat has served on the Texas State Palliative Care Interdisciplinary Advisory Council.

A version of this article originally appeared in PCCA’s members-only magazine, the Apothagram.

References

1. Geller, M. J. (2010). Ancient Babylonian medicine. Malden, MA: Wiley-Blackwell.

2. Benson, H. A. E., Grice, J. E., Mohammed, Y., Namjoshi, S., & Roberts, M. S. (2019). Topical and transdermal drug delivery: From simple potions to smart technologies. Current Drug Delivery, 16 (5), 444–460. https://doi.org/10.2174/1567201816666190201143457

3. Osborne, D. W. (2011). Diethylene glycol monoethyl ether: An emerging solvent in topical dermatology products. Journal of Cosmetic Dermatology, 10(4), 324–329. https://doi.org/10.1111/j.1473-2165.2011.00590.x

4. Bassani, A. S., Banov, D., & Phan, H. (2016). Characterization of the percutaneous absorption of ketoprofen using the Franz skin finite dose model. Postgraduate Medicine, 128(2), 262–267. https://doi.org/10.1080/00325481.2016.1144448

5. Bassani, A. S., & Banov, D. (2015). Evaluation of the percutaneous absorption of ketamine HCl, gabapentin, clonidine HCl, and baclofen, in compounded transdermal pain formulations, using the Franz finite dose model. Pain Medicine, 17(2), 230–238. https://doi.org/10.1111/pme.12899

6. PCCA Science. (2019). Evaluation of the in vitro human skin percutaneous absorption of ketoprofen in PCCA PermE8 Anhydrous Gel vs. PCCA Lipoderm [PCCA Document #99732]. http://beta.pccarx.com/pdf_files/PCCA%20Science/Technical%20Reports/99732_TR_Ketoprof-PermE8-Lipoderm.pdf

7. Burns, P. B., Rohrich, R. J., & Chung, K. C. (2011). The levels of evidence and their role in evidence-based medicine. Plastic and Reconstructive Surgery, 128(1), 305–310. https://dx.doi.org/10.1097%2FPRS.0b013e318219c171

These statements are provided for educational purposes only. They have not been evaluated by the Food and Drug Administration, and are not to be interpreted as a promise, guarantee or claim of therapeutic efficacy or safety. The information contained herein is not intended to replace or substitute for conventional medical care, or encourage its abandonment.

Profile In Personalized Medicine - Masoud and Anna Rashidi

Thu, 07 May 2020 12:46:16 GMT

by PCCA

This Profile in Personalized Medicine highlights Masoud Rashidi, PharmD, RPh, and Anna Rashidi, PharmD, RPh, of Innovative Compounding Pharmacy in Folsom, California. They have enjoyed being PCCA members since 2006.

How did you start compounding? What led you to PCCA?
Anna attended a PCCA student boot camp in 2001, where she fell in love with compounding. This sparked her passion for compounding and led her to later work with Mark Gonzalez [former PCCA member, now full-time PCCA Clinical Compounding Pharmacist] where that passion blossomed.
Then in 2003, during pharmacy school, Anna and I had a rotation with Mark. He was a member of PCCA at the time and spoke highly of them. From the day we graduated pharmacy school, we wanted to open our own compounding pharmacy, and there was no question about being a member of PCCA.

What has been your toughest patient problem?
My toughest case was a patient with infected and painful chest wounds caused by radiation. Working with her doctor as well as Sebastian Denison in PCCA’s Clinical Services department, we created a formula using Spira-Wash® Gel and PracaSil®-Plus with phenytoin, misoprostol, diphenhydramine and metronidazole. In the end, she was very thankful.

What has been your most satisfying patient experience?
This goes back to 2008, when we had only been open for a year. We had a patient with multiple sclerosis who was looking for alternative options to what he had been prescribed before. I spoke with the patient’s doctor and one of PCCA’s clinical compounding pharmacists. Along with the patient, we all agreed to try low-dose naltrexone (LDN). When I first met the patient, he was in a wheelchair, and three months later, he walked into our pharmacy. I will never forget that moment. He told me that it had been the first time he walked after two years of being in the wheelchair and trying over six different medications. I got tears in my eyes.

What is your favorite PCCA base, and why?
VersaBase® Cream. It is elegant and easy to work with. It also helps that there are many bracketed, extended-BUD formulas for it in PCCA’s database.

What is your favorite PCCA educational event, and why?
Concierge Congress. Everyone shares info, and you get to see faces you have been on conference calls with all year. It’s a great way to learn and reconnect with colleagues.

Who was the last patient who thanked you?
The mom of a young child, after getting her son’s test results from the doctor and learning that his condition is under control because of a specific vancomycin suspension we have compounded for him every two weeks since 2016.

What advice would you give to new compounders?
Be compassionate and patient. It takes time to learn the art of compounding. Use good, trustworthy resources, and don’t cut corners.

What is your favorite thing about your jobs right now?
Helping patients, no matter how hard the regulations get. That one satisfied customer makes it all worth it.

What are your personal mottos or words to live by?
All good things come with hard work. Believe in yourself, and you can accomplish your dreams.

What is the best word to describe your lives?
Satisfied!

4 Steps to Maintain Revenue and Manage Expenses during COVID-19

Tue, 05 May 2020 12:36:41 GMT

By PCCA

This article was updated: June 22, 2020

We recently released a new episode of The Mortar & Pestle: A PCCA Podcast, in which Bryan Prescott, PharmD, MBA, Director of Management Coaching Services at PCCA, offered a game plan for sustaining independent pharmacies’ revenue and managing their expenses as they navigate the novel coronavirus pandemic. Below are Bryan’s four key steps that you can take to keep your community pharmacy practice financially healthy through the rest of 2020.

For an in-depth discussion of this COVID-19 strategy, you can listen to Bryan’s episode of The Mortar & Pestle on Apple Podcasts, Spotify, Stitcher and other podcast platforms.

Bryan also recently co-hosted the free PCCA Education webinar mentioned in Step 4 above. The webinar, Leveraging the CARES Act & FFCRA to Support Your Practice, features Cindy Moon of Hart Health Strategies as well and is available on YouTube. In it, Bryan breaks down new federal aid programs and Cindy shares detailed information on how prescribers can use telehealth options to serve patients during the pandemic. You can also find up-to-date information and customizable communications templates to help your pharmacy on the PCCA Coronavirus (COVID-19) Resource Center.

On June 3, 2020, Congress passed the Paycheck Protection Program Flexibility Act of 2020 (PPPFA), which should provide some additional benefits and ease some of the restrictions from the original PPP. Read more about it in our blog post, “Changes to the Paycheck Protection Program.”

Clinical Services Spotlight - Sara Hover

Thu, 23 Apr 2020 14:18:34 GMT

By Seth Humble, Digital Content Specialist

Sara Hover and I met each other for the first time via video conferencing. Sara is diligently working from home when we connect online. During our conversation, I can hear the front door open and close; people come and go. Even though Sara usually works from home, it puts into mind what a strange time we are living in with the novel coronavirus now a part of our world. For many people, their living room has become their front office. Despite the weirdness of our present day, I still enjoy learning about a PCCA clinical compounding pharmacist’s past.

“Evadale High School,” is the answer Sara gives me when I ask her where she went to school. She spells it out right after she says the name, a common trait among the folks who went to small, rural community schools.

“Just how small is Evadale?” I ask.

Sara laughs and shrugs her eyebrows when she says, “We had a graduating class of … 34 people.”

Evadale is a small, Texas town — a paper-mill town – and while Sara is fond of her time there, she was excited when she received a scholarship that allowed her to attend the University of Texas. During her time in Austin, that little slice of California in the Lone Star State, she earned her Bachelor of Science degree. While there, she found herself enjoying the enlightening experience unique to small-town pilgrims making their way to the big city.

The summer before her senior year, Sara’s life purpose came clearly into view when she took a job at Abrams Royal Compounding Pharmacy in Dallas, Texas.

“This is it. This is what I want to do. This is my purpose,” she says enthusiastically about her first days in the pharmacy. “That was a huge moment for me during my college independence. I knew, even before I got into pharmacy school, I wanted to work in pharmacy compounding. There was a clarity to it.”

Sara’s passion for pharmacy compounding is clear when she starts talking about her first interaction with PCCA when she was a student: “We went and had lunch with Dave Sparks, and for us, that was a big deal.”

“You opened and ran your own pharmacy for many years,” I said. “How did that shape that time in your life?”

Owning a pharmacy was a dream of mine. Having worked in my dad’s electrical contracting business, entrepreneur blood runs through my veins! Looking back, it was so perfect to be able to balance family and work. I brought my kids to work. Even though there were days I didn’t want to wear all the hats all at the same time, I wouldn’t trade it for a minute. I was truly blessed that I didn’t have to miss any milestones with my kids and still fulfill by dream and what I had worked so hard for. I realize that many women have to choose, and it’s a really tough one.
Years later, when she had a chance to join the company as a team member, it was an easy decision. “When the opportunity arose for me to work for PCCA, it felt like coming home,” she says.

“What does it mean to you to work with PCCA’s members?” I ask.

“It’s very meaningful for me,” Sara replies. “I feel like I am a part of this lifeline for pharmacies. And that it’s my responsibility, well, our responsibility, to give members more than they ask for — to go the extra mile for them. One of those reasons being because we cherish the pharmacies we talk to each and every day, but also because at the end of that discussion, there is a patient who needs help. For example, when I help a pharmacy work out a woman’s hormone imbalances, I’m not just helping that woman regulate her hormones and the symptoms that come with, say, menopause. I’m helping a mom or a sister, and by helping her, I’m helping a person’s whole family. Because a happier person, a healthier person, makes a happier and healthier home. That’s very meaningful for me, and for our team.”
Sara’s voice grows more and more excited the more she talks about helping patients and the pharmacies that serve them.

“I typically work with women’s hormone replacement therapy (HRT),” she continues. “I have many members who share their patients’ cases with me, and so we go along together on that journey. We discuss the patient’s symptoms, and we work together to build a plan that helps each particular patient the way they need. That’s what personalized medicine means: one person, one solution. The feedback from those patient stories is always so encouraging. To know that women who are going through difficult hormone issues come back and thank us for that help; that’s very special. Very meaningful for me, that success. Every member, every pharmacist who gives us those success stories, reminds us every day that this is why we do what we do.”

Sara gives me a specific example when she tells me about a female patient who began to experience a daisy chain of symptoms the patient couldn’t understand, from exhaustion to anxiety, depression to insomnia. Sara being a link in the chain of improving that patient’s life is an experience she describes as singularly “amazing.”

This is Sara Hover.

She is a woman who, because of her parents’ diligent hands, has a steadfast work ethic and can rewire her own electrical outlets. She believes her purpose in life will always involve helping people through pharmacy compounding. And for almost seven years, she has been a part of PCCA’s Clinical Services team — a journey, she says, that makes her feel blessed.

Profile In Personalized Medicine - Amy Hoefer

Wed, 01 Apr 2020 12:56:56 GMT

This Profile in Personalized Medicine highlights Amy Hoefer, CPhT, Laboratory Manager and Technician of O'Brien Pharmacy, owned by Eric Everett and Lisa Everett Anderson in Mission, Kansas. They have been proud PCCA members since 1984.

How long have you been compounding?
About 12 years.

Did you always want to work in the field of pharmacy? What led you to pursue it as a career?
I live in a small town, so there wasn't much available locally, and I felt very lucky to have found a position at the town drug store. I started there at 18 years old and found that I really enjoyed it. I started in retail, then eventually accepted a position with a hospital pharmacy, where I helped with IVs and total parenteral nutrition (TPN) bags, and from there went to O'Brien. I've been with O'Brien Pharmacy for about 17 years.

When did you learn about compounding, and why did you start doing it?
O'Brien Pharmacy was my first real experience with compounding. I had no idea it was a thing until I walked through those doors for the first time. It was very exciting to find out that we actually made prescriptions versus only counting out pills. The pharmacy was very small when I started, so everything was done by pharmacists — formulating, weighing, mixing and finishing. I was eventually part of the cleanup crew. Then I moved to mixing and finishing on the nonsterile side of the business. It was exhilarating! Now I no longer work with nonsterile, unless help is needed. I am a sterile trained technician and have done that for about six years now.

What do you find most fulfilling about compounding?
I love the fact that it's customizable. Being able to compound makes the relationship with the clients more personal. I truly feel that we, as compounders, are making a huge difference in people's lives.

What are some of the challenges you have been able to overcome?
We have a client thawho has issues related to drug absorption. They were on all sorts of medications, feeding tube and constant watch, and they were wheelchair bound when they first came to us. They spend a great deal of time in the hospital and have to carry around all sorts of machines wherever they go.
We started supplying a compounded medication in an IV bag that the patient’s doctor had prescribed to help with absorption, which eventually helped them get off some of the machines and medications, and they can also eat some regular food. They are able to get out of their wheelchair, be more mobile and visit the pharmacy to let us know how they're doing. This client has become very special to the staff at our pharmacy.

What advice would you give to a new compounder?
No matter what may be happening around you, always remember that you are making something with your own two hands, and that finished product is making someone better. Some compounds are tedious, but the results make it all worth it!