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  • March 19, 2012 1:56 PM | Brad Miller (Administrator)

    The recent record setting temperatures have most people enjoying backyard barbeques and fun in the sun.  But don’t forget to enjoy the wonderful things Spring has to offer including the last two meetings before WMSHP takes a break from monthly meetings to enjoy the summer.

    Be sure to join WMSHP on Friday, April 13 to support two area pharmacy practice residents as they each present their residency project.   The scheduled presenters and their project titles are listed below.

    • “A comparison of extended infusion versus traditional infusion piperacillin-tazobactam: a retrospective study”, presented by Katie Wenzel, PharmD (Bronson Methodist Hospital)
    • “Evaluation of Fixed Dose Recombinant Factor VII for Warfarin Reversal in Neurosurgical Patients”, presented by Gregory F. Blank II, PharmD (Spectrum Health)

    Immediately following the presentations, join us at the last Grand Rapids Griffins game of the year at Van Andel Arena.  Family and friends are welcome to attend the game.  More information on how to order tickets is available on the meeting's RSVP page on WMSHP.net.

    WMSHP is still accepting applications for the annual WMSHP Scholarship.  This year, one $1,000 scholarship will be awarded.  Deadline for scholarship applications is March 31, 2012.

    Save the Date
    Don’t forget to mark your calendar for WMSHP’s Spring Seminar scheduled for Monday, May 14, 2012 at the Prince Conference Center on the campus of Calvin College in Grand Rapids.  Registration should be available soon!

  • February 22, 2012 1:57 PM | Brad Miller (Administrator)

    As I watched my dog run around our yard this morning, I was able to take a minute and realize that February is almost over and the signs of spring are all around. The snow has melted, the days are growing longer, and my flowers are starting to grow. With spring right around the corner, WMSHP is getting ready for our busiest time of the year.

    Our next meeting will be held on March 15 at the Lawrence Education Center Auditorium on the campus of Borgess Medical Center. Tracey Mersfelder, PharmD will be presenting a topic entitled "Grow to Your Health".

    Congratulations to Katie Wenzel and Gregory Blank II! Dr. Wenzel and Dr. Blank were selected by the board out of over 20 entries to present their residency projects at our meeting on Friday, April 13 to be held at the last Grand Rapids Griffins game of the year. Mark your calendars and watch for the RSVP to come out earlier than usual so that we can ensure enough seats for everyone who wants to attend. Family and friends are welcome!

    WMSHP is now accepting applications for the annual WMSHP Scholarship. Deadline for scholarship applications is March 31, 2012.

  • January 24, 2012 1:57 PM | Brad Miller (Administrator)

    Well, it appears Old Man Winter did not forget about us after all. Snow and frigid temperatures are back and winter has officially begun but that isn't stopping WMSHP.

    The January meeting resulted in good attendance and a very informative talk on heart failure by Dr. Michael Mitchuka. Despite the threat of dangerous roads and heavy snowfall, many members were able to attend. I can only hope for similar results for the remainder of the winter months.

    Brad Miller, PharmD will updating us on recent happenings in Emergency Medicine. The meeting will be held at Saint Mary's Lacks Cancer Center on February 9.

    Attention Pharmacy Residents!  Don't forget to submit your Great Lakes Project abstract to WMSHP if you would like the opportunity to present your project to our members at our April meeting. Two residents will be selected to present their projects on Friday, April 13 prior to everyone attending the last Grand Rapids Griffins game of the year. This is a great opportunity to practice your presentation before attending the Great Lakes Conference.

  • December 22, 2011 1:58 PM | Brad Miller (Administrator)

    In the January 2012 WMSHP Newsletter, Chelsey Timmer, a PGY1 pharmacy resident at Spectrum Health, writes about therapy for suspected cyanide poisoning.


    Use of Cyanokit® for Suspected Cyanide Poisoning

    Chelsey Timmer, Pharm.D.

    Poisoning due to cyanide can cause severe harm and death within minutes to hours. For this reason, it is critical that clinicians are aware of common sources of cyanide exposure. Exposed patients must be quickly assessed for signs and symptoms of toxicity, and clinicians must be able to identify how and when to appropriately use the available cyanide antidotes.

    The major source of cyanide exposure in the United States is via smoke inhalation from structural fires1,2,3. Cyanide gas is produced when materials such as wool, silk, polyurethane, and synthetic polymers combust2. During a fire, inhaled cyanide gas can rapidly diffuse into tissues, causing signs and symptoms of toxicity within minutes. Other sources of cyanide poisoning include intentional ingestion in an attempt to commit suicide, accidental ingestion, and occupational or industrial exposures to the chemical. The anti-hypertensive medication sodium nitroprusside, which contains 44% cyanide by molar weight, can also lead to cyanide accumulation in select patient populations such as those with a defect in cyanide metabolism or renal dysfunction1.

    Cyanide binds to the ferric ion of cytochrome oxidase a3, a component of the mitochondria that is essential for oxidative phosphorylation. When cyanide levels rise, the normal elimination pathway is overwhelmed, oxidative phosphorylation is inhibited, and levels of lactate rise to cause a metabolic acidosis1,4. This may manifest initially as an anxiety, headache, giddiness, tachycardia, and tachypnea. As the toxicity progresses, hypotension, arrhythmias, seizures, and coma may occur1,3.

    It is imperative that practitioners recognize that cyanide exposure needs to be assessed and promptly treated. The two antidote kits currently available for treatment are the cyanide antidote kit and Cyanokit®. Quick Drug References are available on Insite for both products5,6. The cyanide antidote kit consists of 3 drugs: amyl nitrite, sodium nitrite, and sodium thiosulfate. Amyl nitrite is to be administered via inhalation while IV access is obtained; if IV access is already established, sodium nitrite should be administered first. Amyl nitrite and sodium nitrite work to oxidize hemoglobin to methemoglobin. Cyanide will preferentially bind to methemoglobin, freeing cytochrome oxidase a3 and allowing the resumption of ATP generation and cellular respiration. Sodium thiosulfate is administered immediately following sodium nitrite. It facilitates excretion by acting as a sulfhydral group donor to cyanide. This forms the compound thiocyanate, which is renally eliminated1,5.

    The cyanide antidote kit is associated with multiple adverse events as well as administration difficulties, making it the non-preferred treatment for cyanide poisoning. The major side effect is hypotension, due to both the nitrites and the sodium thiosulfate portions of the kit. Sodium nitrite should be administered slowly over at least two minutes, and sodium thiosulfate over at least 10 minutes to minimize the risk of hypotension. The production of excessive amounts of methemoglobin can also be concerning in patients who may already have low levels of functioning hemoglobin due to concurrent carbon monoxide poisoning. Patients should be observed for signs of methemoglobinemia, including a blue color of the skin or mucus membranes, vomiting, shock, and coma5.

    Cyanokit®, which contains hydroxocobalamin, is the preferred treatment for suspected cyanide poisoning due to its comparative ease of administration and less severe side effects. Hydroxocobalamin works by binding to cyanide to form cyanocobalamin (vitamin B12). Cyanocobalamin is renally eliminated, freeing cytochrome oxidase a3 for cellular respiration. Each Cyanokit® contains two 2.5 g vials of hydroxocobalamin, two sterile transfer spikes, and one sterile intravenous infusion set. The starting dose for adults is 5 g (two 2.5 g vials), which should be reconstituted in 200 mL 0.9% sodium chloride. A second dose of 5 g may be administered if signs and symptoms of cyanide poisoning persist. For children, the starting dose is 70 mg/kg IV. The first dose should be administered over 15 minutes, the second dose over 15 minutes to 2 hours6.

    Side effects of hydroxocobalamin include discoloration of skin and body fluids as well as hypertension. In a prospective, open-label trial, diastolic blood pressure increased by an average of 10 mmHg, while systolic increased an average of 7.5 mmHg. This transient increase may actually benefit patients who are hypotensive due to cyanide poisoning. Blood pressure returned to baseline without treatment in all patients3. Red discoloration of the skin and urine are the most common side effects of hydroxocobalamin. Skin redness may last up to 2 weeks, urine redness up to 5 weeks6. Hydroxocobalamin can also interfere with colorimetric laboratory tests, including bilirubin, creatinine, magnesium, serum iron, oxyhemoglobin and methemoglobin1.

    Whether or not to empirically treat fire victims for cyanide poisoning is a long-debated issue, with some clinicians arguing that cyanide poisoning is over-diagnosed and treated, and others in favor of treating all patients who have potential symptoms of cyanide poisoning2. One reasonable approach is to administer hydroxocobalamin to any patient who has been in a structural fire and has mental status changes. If it is an available service, toxicology should also be consulted for these patients.


    1. Hammel J. A review of acute cyanide poisoning with a treatment update. Crit Care Nurse. 2011 Feb;31(1):72-82.
    2. Barillo DJ. Diagnosis and treatment of cyanide toxicity. J Burn Care Res. 2009;30(1):148-152.
    3. Borron SW, Baud FJ, Barriot P, Imbert M, Bisumth C. Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation. Ann Emerg Med. 2007 Jun;49(6):794-801.
    4. Hall AH, Dart R, Bogdan G. Sodium thiosulfate or hydroxocobalamin for the empiric treatment of cyanide poisoning? Ann Emerg Med. 2007 Jun;49(6):806-813.
    5. Posey J, Thomas W. Amyl nitrite, sodium nitrite, sodium thiosulfate kit (Cyanide Antidote Kit®). Spectrum Health Drug Quick Reference. Updated 2011 Jan; pp 1-2.
    6. Posey J, Thomas W. Hydroxocobalamin (Cyanokit®). Spectrum Health Drug Quick Reference. Updated 2011 Jan; pp 1-2.
  • December 22, 2011 1:58 PM | Brad Miller (Administrator)

    The holidays are upon us once again and it is hard to believe that another year is over. As we get ready to welcome 2012, it is also time to welcome a new set of board members to the WMSHP family.

    First, I would like to welcome back Dana Staat as President-Elect. Dana served as WMSHP president in 2008 and returned as a Board Member in 2011. Thank you to Dana for agreeing to serve as President-Elect again.

    I would also like to thank Kim Melgarejo (Treasurer), Ciji Marckini (Technician), and Kristina Rak (Board Member) who all agreed to continue in their previous positions and survived the tight election this year.

    Our newest board members are Kasey Bucher and Abby Sturm from Saint Mary's Health Care in Grand Rapids and Kari Vavra, PharmD of Ferris State University.

    The next monthly meeting will be held on January 12, 2012 at Borgess Medical center in the Lawrence Education Center Auditorium. Michael Mitchutka, PharmD will be presenting "From Heart Failure to Heart Success".

    Save the Date! This year's WMSHP Spring Seminar will be held on May 14, 2012 at the Prince Conference Center on the campus of Calvin College in Grand Rapids.

  • December 01, 2011 1:59 PM | Brad Miller (Administrator)

    Congratulations to our new and returning board members for 2012!

    President-Elect: Dana Staat

    Treasurer: Kim Melgarejo

    Technician: Ciji Marckini

    Board Members: Kasey Bucher, Kristina Rowley, Abby Sturm, & Kari Vavra

  • October 30, 2011 2:00 PM | Brad Miller (Administrator)

    Listed below are the nominees for next year's new WMSHP officers.  Each active WMSHP member will receive an official ballot in the mail within the next few days.  This ballot should be completed and either mailed back to us, or given directly to a current WMSHP board member.  All votes must be received before the November General Meeting on November 10, 2011.  Results will be announced at the meeting.

    Proposed Addition to the WMSHP By-Laws:

    It is proposed that the following definition be added to Chapter II, Article I, Section 1 of the WMSHP By-Laws:

    D. "STUDENT" MEMBER: A person enrolled at a college or university in a pharmacy or pharmacy technician curriculum who supports the objectives of the Society may apply for a Student membership. A Student member shall be eligible for the services of the Society, but is not eligible to vote or hold an elected office. Student members shall be exempt from payment of annual dues.


    Dana Staat, Pharm.D. is a Clinical Pharmacist in Internal Medicine at Spectrum Health in Grand Rapids, MI. Dana attended Ferris State University for her Pharm.D. degree and completed a PGY1 residency at Spectrum Health. Dana's interest areas include infectious disease, cystic fibrosis, and pugs.


    Kim Melgarejo (INCUMBENT) is currently a Pharmacy Manager at Borgess Medical Center and Borgess Pipp Hospital. She been a member of WMSHP since 2005 and treasurer since 2007.


    Ciji Marckini (INCUMBENT) has been a certified pharmacy technician for 6 years and is currently working at Spectrum Health as lead medication reconciliation technician. She have a biomedical science degree from Grand Valley State University. While going to school at GVSU she started working at Walgreens pharmacy and became certified. After becoming certified, she started teaching technician certification classes for the Grand Rapids Walgreens district. She started working at Spectrum health 4 years ago as an inpatient technician and then a medication reconciliation technician. In October of 2010 she became lead medication reconciliation technician.

    Patty Vander Hoff is currently Program Chair at Sanford Brown College Grand Rapids campus for the Medical Billing/Coding, Medical Billing and Administrative Specialist, and Health Information Technology with possible Pharmacy Technician certification program. She has been a Certified Pharmacy Technician since 2000, and has 23 years experience in retail pharmacy and 13 years in a hospital pharmacy. She was a Pharmacy Technician Educator at West Michigan Center for Arts & Technology (WMCAT 2/09 -11/09). She has been a member of the Pharmacy Technician Certification Board since 2000, and a previous member of Pharmacy Technician Educator Council (PTEC 2009-2010) and National Pharmacy Technician Association (NPTA 2009-2010).


    Kristina Rowley (INCUMBENT) completed her Pharm.D. training at Ferris State University. She completed her PGY1 residency at Borgess Medical Center in Kalamazoo, MI. Then, she completed her PGY2 residency with a specialty in Ambulatory Care at William Beaumont Hospital in Royal Oak, MI. She currently practices at the Kalamazoo Center for Medical Studies Clinic as an Assistant Professor of Pharmacy Practice with Ferris State University.

    Kasey Bucher graduated from the Ferris State University College of Pharmacy in 2008 and then went on to complete a PGY-1 Pharmacy Residency and a PGY-2 Specialty Residency in Critical Care. Kasey recently joined the clinical pharmacy team at St. Mary's Health Care in Grand Rapids, Michigan as an Emergency Medicine Clinical Specialist.

    Louis Kynard MBA, Pharm D. has practiced in the profession of pharmacy since 1984. He has served in various roles throughout his career in pharmacy as Informatics Pharmacist, Purchasing Supervisor, Pharmacy Site Manager, Regional Director of Pharmaceutical Care and Respiratory Care and currently serves as the Director of Pharmacy Services at Bronson Methodist Hospital. Dr. Kynard's primary focus as a leader has been Patient Safety, and was involved in the implementation of Automation and Progressive Pharmacist Clinical models at several hospitals prior to joining the Pharmacy Team at Bronson.

    Michael Michutka is a clinical pharmacy specialist in Internal Medicine at Borgess Medical Center. He graduated with his Doctor of Pharmacy in 2009 from Ferris State University and completed an ASHP accredited PGY-1 at Borgess in 2010. Michael's professional interests include heart failure, acute coronary syndrome and public health.

    Abby Sturm graduated with a Pharm.D. from Butler University in 2004, and then completed 2 years of residency experience at Clarian/IU Health Partners in Indianapolis,Indiana with a focus in IM/Family Medicine. Following residency, she worked in as a clinical pharmacist and adjunct faculty for the University of Cincinnati. In 2008, she began working as a staff pharmacist at St. Mary's Hospital after she and her husband moved to Grand Rapids. Currently, she is a part-time clinical pharmacist at St. Mary's and full-time mother of 2 kids.

    Kari Vavra, Pharm.D. is an Assistant Professor of Pharmacy Practice at Ferris State University College of Pharmacy. Her General Medicine clinical practice site is at Spectrum Health-Butterworth Hospital in Grand Rapids, Michigan. She received her Doctor of Pharmacy degree in May 2009 from Ferris State University College of Pharmacy. After obtaining her Pharm.D., she completed a Pharmacy Practice Residency at Sparrow Health System in Lansing, Michigan. Kari is a current member of several professional organizations, including MPA and MSHP, and hopes to become more actively involved as a member of WMSHP!

    Cherie Woodhams is a graduate of Ferris State University and currently practices as a Pharmacy Educator at Bronson Methodist Hospital in Kalamazoo, MI. Cherie currently holds the position of WMSHP's Past President and is also a MSHP Board Member. She looks forward to continue to serve the members of WMSHP.

  • October 28, 2011 2:04 PM | Brad Miller (Administrator)

    In the October WMSHP Newsletter, Julie Pardy, a PGY-1 Pharmacy Resident at Spectrum Health, reviews the use of lacosamise for partial onset seizures.


    Lacosamide (Vimpat®) for Partial Onset Seizures

    Julie Pardy, PharmD, PGY-1 Pharmacy Resident

    Despite extensive research and multiple treatment options, the ideal anti-epileptic is yet to be found. Patients that suffer from epilepsy often find themselves taking multiple medications, experiencing adverse reactions, requiring serum drug monitoring, and still experiencing seizures.

    In October of 2008, Lacosamide (Vimpat®) was approved as an adjunctive treatment for partial onset seizures in patients 17 years of age and older. Lacosamide is available as an oral tablet (50 mg, 100 mg, 150 mg, and 200 mg), oral solution (10 mg/mL), and solution for injection (10 mg/mL). Lacosamide has a novel mechanism of action. Lacosamide selectively enhances slow inactivation of sodium channels, this causes decreased neuronal hyperactivity while preserving physiological activity. Additionally, lacosamide has shown evidence of activity at the collapsing response mediator protein 2 (CRMP-2). CRMP-2 has multiple actions including neuronal differentiation and regulation of gene expression. However, the clinical significance of CRMP-2 in seizure control is unknown. There is some evidence in animal models that CRMP-2 inhibition may prevent neuronal development and this is why in Helen DeVos Children’s Hospital (HDVCH) we are not recommending lacosamide for infants less than 1 year old.

    Many aspects of lacosamide’s pharmacokinetic profile are favorable. It has 100% oral bioavailability, it has rapid absorption that is not affected by food, and it has a long half life allowing for twice daily dosing. Its 100% bioavailability allows for equivalent daily doses when switching from IV to oral formulations. Additionally, it has low protein binding and has predominately renal elimination as unchanged drug (>40%). Lacosamide has minimal CYP 450 interactions.

    Lacosamide is generally well tolerated by patients. The most common adverse effects with the oral formulations include dizziness, headache, nausea and diplopia. All of these adverse effects were dose related except for headache, which was more predominant during dosage titration. Adverse effects associated with the IV formulation include those of the oral formulation as well as injection site pain. The most predominant adverse effect and most likely cause for discontinuation is dizziness. Of note, lacosamide may prolong the PR interval, so patients at risk for arrhythmias should have cardiac monitoring performed prior to therapy.

    Lacosamide is initially dosed in adults at 50 mg twice daily with dose titrations at weekly intervals by 100 mg/day. The maintenance dose is usually between 200 to 400 mg/day for most patients. In a human abuse study, lacosamide produced euphoria in 15% of patients when dosed at 800 mg leading to its schedule V status. The incidence of euphoria was minimal (<1%) in clinical trials at therapeutic doses.

    As stated previously, lacosamide is only indicated as adjunctive therapy of partial onset seizures in patients 17 years of age and older. However, ongoing research suggests that lacosamide may have a role in other types of seizures as well as treatment refractory status epilepticus. Currently there is a lack of data and dosing recommendations for pediatric patients, although there are two ongoing multicenter dose-ranging pharmacokinetic trials for this population. The dosing recommended and approved for use in HDVCH is provided in the table below and is based on the on-going studies.

    Lacosamide is being investigated as a treatment option for diabetic neuropathic pain, fibromyalgia, and migraine prophylaxis. With its novel mechanism of action and favorable pharmacokinetic and safety profile, there is no doubt that we will be seeing more of this drug in the future.


    Pediatric Lacosamide (Vimpat®) Dosing
    Loading Dosing (oral or IV): 2-4 mg/kg/dose (max dose of 200 mg)
    Maintenance Dosing (oral or IV): 4-6 mg/kg BID (max 400 mg/day)
    Note: Pharmacokinetic and efficacy studies are not available in children. Dosing is provided per clinicaltrials.gov on-going investigational studies.



    1. Halford et al. Clinical Perspectives on Lacosamide. Epilepsy Currents. 2009; 9(1): 1-9.
    2. Kelemen and Halasz. Lacosamide for the Prevention of Partial Onset Seizures in Epileptic Adults. Neuropsychiatric Disease and Treatment. 2010; 6: 465-471.
    3. Vimpat [package insert]. Smyrna, GA: UCB, Inc; 2011.
    4. Chung. New Treatment Option for Partial-Onset Seizures: Efficacy and Safety of Lacosamide. Ther Adv Neurol Disord. 2010: 3(2): 77-83.
    5. Kellinghaus. Lacosamide as Treatment for Partial Epilepsy: Mechanisms of Action, Pharmacology, Effects and Safety. Therapeutics and Clinical Risk Management. 2009; 5: 757-766.
    6. Abou-Kalil. Lacosamide: What can be expeted from the next new antiepileptic drug? Epilepsy Currents. 2009; 9(5): 133-134.
    7. A Multicenter, Open-Label Study to Investigate the Safety and Pharmacokinetics of Lacosamide in Children with Partial Seizures. NCT00938431. Last updated on July 25, 2011.
    8. The Safety of Intravenous Lacosamide. NCT00832884. Last updated on Mar 5, 2010.
    9. An Open-label Extension Study to Determine Long-Term Safety, NCT00938912. Last updated 25, 2011.
  • October 28, 2011 2:01 PM | Brad Miller (Administrator)

    WMSHP elections are coming this month.  Please take time to review the candidate biographies and vote!  I am pleased that we have more candidates than positions, and want to thank everyone for showing interest.  I especially want to acknowledge Dana Staat for stepping forward to accept the position of president-elect. 

    The next meeting is scheduled for November 10th at the Wege Institute on the campus of St. Mary’s in Grand Rapids.  The topic this month is on Parkinson’s Disease.  Please RSVP as soon as possible and join us for an exciting presentation.

  • September 22, 2011 2:05 PM | Brad Miller (Administrator)

    We had a great meeting in September to kick off WMSHP’s return to monthly meetings after the summer break.  The attendance at the meeting was quite impressive.  Hopefully everyone enjoyed the great pain talk and good dinner!

    I want to share a few things with you regarding our monthly meetings.  As most of you are aware, WMSHP pays for the majority of our monthly meetings.  It is very difficult to find grants or industry sponsorship for these meetings.  The board meets after Spring Seminar and sets a budget for each meeting in the upcoming year.  The budget includes the cost of food, speaker honorarium, and the charge for ACPE continuing education credits.  The board has attempted to hold down the cost of food by not holding meetings at restaurants.  This year it was decided to hold one WMSHP funded meeting at a restaurant in Grand Rapids and another in Kalamazoo.  We are working diligently as a board to come up with ways to expand the space available at these meetings.  If you aren’t able to get a RSVP in before the deadline or if the meeting is full, please email the meeting planner.  This information is always found on the website or in the newsletter.  Typically we can add your name to a waiting list, or add you directly.  In addition, please be considerate of your fellow members and email if you are unable to attend the meeting.  This will allow us to invite those on the waiting list.  To assist in this, we will begin sending reminders to each person that has registered on the Monday prior to the meeting.  Please let us know if you can no longer attend the meeting!

    The next meeting is scheduled for October 13th at the Lawrence Education Center on the campus of Borgess Medical Center.  The topic being presented is "Trauma Induced Coagulopathy: A Review" by  Shanna Cole, Pharm.D..  Shanna is a Clinical Pharmacy Specialist practicing in the intensive care units at Borgess.  Food is being catered by Chinn Chinn Asian Bistro, so plan on attending the great food and exciting presentation!

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