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					RX04-129-60 12/2/04

Phone: (800) 270-8878 Website: www.storeymarketing.com Fax: (888) 270-8878 E-mail: info@storeymarketing.com

8:50 AM

Patricia L. Storey, R.Ph., FACA, Owner

7400 N Oracle Road Tucson, AZ 85704

Marketing Materials for Compounding Pharmacies Since 1992

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Newsletters for Physicians, Vets, Dentists, and Patients Brochures & Targeted Marketing for

Bio-Identical HRT, Vet Compounding, Pain Management, Palliative Care, Dermatology, Sports Medicine, Pediatrics, Dentistry, Respiratory Care, & General Compounding

Ask for information about our economical brochure starter packs!

Weekly Newspaper Health Columns Booklets- indepth personalized presentations for physicians.

BHRT (also available in patient version), Veterinary, Palliative Care, Pain Management, Dentistry, & General Compounding

Display Ads for Newspaper and Magazines Presentation Materials and Display Boards Banners and Bag Clippers Postcard Mailings Telephone Message on Hold Calendars and Holiday Greeting Cards Mailing Service, and much more!

Contact Storey Marketing for a FREE catalog and product samples.

1-800-270-8878 – You will enjoy our prompt, reliable service!

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Compounding for BHRT
Jerry Greene, RPh, FACA Assistant Clinical Professor, UCSD School of Pharmacy & Pharmaceutical Sciences

request your copy today!

ASIDE FROM ALL OF THE CONTROVERSY surrounding Bio-Identical Hormone Replacement (BHRT), many women have found these medications to be effective with minimal side effects. One of the greatest benefits in using BHRT is the different dosage forms in which these entities are available. As many compounding pharmacists have experienced, having the availability for our patients to utilize either an oral, transdermal, or transvaginal dosage form allows the patient many options. Of course there are advantages and disadvantages of each dosage form. For example, taking an oral form of estrogen will lower cholesterol and raise HDL’s greater than a transdermal gel or cream. It is also more convenient for many patients to simply swallow a capsule than to use a daily transdermal. By contrast, there is a greater loss due to the first pass effect, there are greater “peaks and valleys,” as well as the possibility of raising liver enzymes. On the opposite side of the coin, the transdermal forms of BHRT may allow for a more even blood level, less likely to raise blood pressure, and if using a Bi-Est or Tri-Est preparation, there is less conversion to the controversial estrone. However, some patients may find this dosage form inconvenient as well as having a slower onset of action. This is primarily due to the fact that the topical dosage forms take longer to saturate receptors in the periphery. Keeping in mind that any dosage form may be used either daily or cyclically, each is equally effective in treating symptoms. One important thing to remember is that patients who may also be using Human Growth Hormone, must take their estrogen transdermally. Studies have shown that the oral form of estrogen may interfere with IGF-1 levels. I think at this point, we all realize that there are only two effective ways to deliver Testosterone; deep muscle injection and transdermal. Patients who are prescribed testosterone orally will see no positive results. This is pricon’t on pg. 2

New 2005 Product Catalog

> more chemicals

> more equipment

> more supplies

oct - dec 2004 volume 1 issue 3
Documentation, Documentation, Documentation!
Rob Standridge, DPh President RS Software DOCUMENTATION is the cornerstone to a good compounding practice. As I have heard time and time again “If you did not write it down, it did not happen”. This phrase applies to any business where accountability and liability are an issue. Certainly pharmacy fits these criteria. As the accreditation of compounding pharmacy looms closer we need to take a serious look at our practice and determine what the best standard operating procedures (SOPs) are for our profession. I believe each compounding pharmacy should develop its own SOPs in preparation for this upcoming accreditation. In developing these SOPs we should consider among other things quality control and documentation. Here is where Spectrum’s two software products, Compound Assist and Script Assist can help. With Compound Assist a pharmacy can easily maintain consistency in its formulations with a centralized database used by its entire pharmacy staff. Documentation is essentially automatic while quality control is inherent in the system. Compound Assist will provide computer documentation of each compound prepared thru logging the preparation. After a formula is
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spectrum’s quarterly

800.791.3210 www.spectrumrx.com

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Progesterone versus Medroxyprogesterone Acetate
Patricia L. Storey, RPh, FACA Progesterone is a term that is incorrectly used interchangeably to describe both natural bio-identical progesterone and synthetic substitutes. Synthetic progestins (also called progestogens or progestational agents) are analogues of bio-identical progesterone, and have been developed because they have a longer duration of action, and can be patented. Medroxyprogesterone acetate (MPA), the most commonly used synthetic progestin, was shown in a large study to cause significant lowering of HDL “good” cholesterol, thereby decreasing the cardioprotective benefit of estrogen therapy. Progestins can have significant and serious side effects at typical doses, including migraine headache, weight gain, mood swings, depression, irritability, acne, menstrual irregularities, and fluid retention. These side effects are a frequent cause for discontinuation of HRT. Only about 20% of women who start synthetic HRT remain on it two years later. However, bio-identical progesterone has never been shown to have any serious side effects. Mayo Clinic researchers surveyed 176 women taking natural micronized progesterone who had previously taken synthetic progestins. After one to six months, the women reported an overall 34% increase in satisfaction on micronized progesterone compared to their previous HRT, reporting these improvements: 50% in hot flashes, 42% in depression, and 47% in anxiety. Micronized progesterone was also more effective in controlling breakthrough bleeding. Vasomotor flushing is the most bothersome complaint of menopause, and is the most common reason women seek HRT and remain compliant. For over 40 years, estrogens have been the mainstay of treatment of hot flashes, but transdermal progesterone cream may be effective as well. Women who have had postpartum depression once have about a 68% chance of recurrence after another pregnancy, but trials using prophylactic progesterone have shown that it is possible to reduce this recurrence rate to 7%. A study conducted at three prestigious locations concluded that natural progesterone, but not MPA, enhances the beneficial effect of estrogen on exercise-induced myocardial ischemia in postmenopausal women. Miyagawa et al. of Oregon Health Sciences University and USC School of Medicine compared synthetic MPA with natural progesterone as the progestin in HRT and studied the corresponding effect on coronary artery vasospasm in ovariectomized primates. MPA was shown in primate studies to constrict coronary
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logged the pharmacy will have a computer generated lot number giving the pharmacist a quick reference to when that product was made. Now at anytime, the pharmacist can pull up that log entry in the software to determine the lot numbers and expiration dates of each chemical used to prepare it, and the initials of the persons compounding and verifying. The pharmacist can quickly generate reports of chemicals used, formulas compounded and much more data to help them operate their compounding practice more efficiently. Users of Script Assist can have the final piece of compounding computer documentation by establishing a computer link between the log entry (compounded formulation) and the patient prescription. RS Software, the makers of Compound Assist, has and is planning implementation of several software quality control mechanisms over the next year. Recently we completed the automation of the Unguator 2000 mixing device which allows each formula to always have the same mixing parameters providing a consistent and repeatable finished product. Borrowing from the manufacturing and cosmetic sector we want to provide tools and interfaces that allow the compounding pharmacy practice to reproduce the same pharmaceutically elegant products every time they are made. Even the smallest cosmetic company implements computer controlled mixing so that each time a lotion, cream, etc… is made it is exactly the same. We as pharmacists can learn something from this. Two other quality control mechanisms are already being developed for upcoming versions of Compound Assist. One of these involves the combination of manufacturer bar codes and scale interface to give an extra level of error reduction when pulling and weighing chemical ingredients. Spectrum, RS Software and their other partners are here to assist in moving the practice of compounding pharmacy forward and providing a turnkey solution for compounding. By working with and sponsoring national and state organizations we hope to continue to assist in improving the practice of compounding pharmacy while striving to maintain the stellar reputation pharmacists have in the community.

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marily due to the methylation of the drug in the liver. Once this transformation takes place, the active form (methyltestosterone) will not raise testosterone levels. Since the depo injection form of testosterone may be inconvenient as well as painful for some patients, I strongly suggest that as a compounding pharmacy you provide and promote an aesthetically pleasing transdermal for your patients. While counseling patients on transdermal testosterone, please remind them that although some patients may feel relief of symptoms sooner than others, most will not have a true physiological effect until after using their medication for 3-4 weeks. No mater which form of BHRT your patients choose, keep in mind there are pros and cons to each. This should also be seen as an opportunity to counsel both the patient as well as the physician on the positives of compounding.

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Continuing Education Classes
Certificate Program in Contemporary Prescription Compounding • January 21 – 22, 2005 • February 25 – 26, 2005 • April 1 – 2, 2005 • May 6 – 7, 2005 • July 22 – 23, 2005 • September 9 – 10, 2005 • November 18 – 19, 2005 Certificate Program in Aseptic Compounding Techniques • January 19 – 20, 2005 • February 23 – 24, 2005 • March 30 – 31, 2005 • May 4 – 5, 2005 • July 20 – 21, 2005 • September 7 – 8, 2005 • November 16 – 17, 2005 Certificate Program in Compounding for Pain Managment • June 8 – 9, 2005 • October 26 – 27, 2005 Certificate Program in Compounding for Women’s Health • June 10 – 11, 2005 • October 28 – 29, 2005 Please contact Spectrum for registration and any additional information.
These ACA Certificate Programs have each been approved for a total of 16 contact hours (1.6 CEUs) of continuing education credit, with 12 contact hours (1.2 CEUs) being obtained in the live programming and an additional 4 contact hours (.4 CEUs) being obtained by completing anindependent study component. Continuing education statements of credit will be awarded at the conclusion of the course and success-ful completion of the independent study course. The ACA is approved by the American Council on Pharmaceutical Education as aprovider of continuing pharmaceutical education.

Pharmacist Consultation Tid Bits
• Develop a standardized consultation form • Create a fax cover sheet with a blank prescription on it for you to fill out for the provider’s signature • Develop a system of follow up in order to track patient outcomes • Work with interns, residents or technicians to coordinate follow up with patients • Devise a filing system for patient charts • Keep a database of all patients whom you have consulted with • Enter notes about patient and dosage changes in the pharmacy computer profile/notes section so questions from patients can be addressed in a timely fashion without the chart present • Use brochures, business cards, handouts, bag stuffers and messaging on hold to promote your services • Give lectures in the community (bookstores, churches, hospitals, libraries, etc) • Set up in-services in provider’s offices over breakfast or lunch • Give providers referral pads to use when they want to refer a patient for your services (include fees, services available, and map to your location) • Create a provider information kit to deliver or mail out upon request from a provider or from a patient for their provider • Hire a marketing representative • Create a website to promote your practice • Develop a relationship with other pharmacists in the same area of expertise to network with and ask for advice The following recommendations were compiled as a summary from Dana Reed-Kane’s lecture on Marketing for Women’s Health at the Spectrum/ACA Hormone Replacement Therapy Seminar in Phoenix, Arizona in February 2004.

New Face in Technical Services
THERE’S A NEW VOICE answering the phone at extension 244, but never fear, your questions about supplies and equipment will be answered. My name is Holly Reynolds and I’m looking forward to assisting all of you with any questions or requests you may have. Some of the things we have planned for 2005 include the procurement of a broader variety of supplies and equipment relating to USP Chapter <797> requirements. Is there something you’d like to see available from Spectrum? We’re always looking for new things that would benefit the compounding community. Drop me a line at hreynolds@spectrumrx.com or call me at 800-791-3210, ext. 244. I’ll do my best to get you what you need. I look forward to speaking with you and working together with you to create a product line tailored to your needs.

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S u p p l i e s & E q u i p m e n t S p e c i a ls
Exakt 50 Ointment Mill
Catalog No. List Special

IKA Homogenizer
Catalog No. List Special

Dispersing Elements
Catalog No. List Special

340-61003P

3500.00

3200.00

340-12755P

1250.00

1050.00

(A) 330-13783P (B) 340-23776P

655.00 795.00

625.00 675.00

Free “squid” stirrer with purchase of homogenizer. ($184 value)

(A)

(B)

Tube Filler
Catalog No. List Special

PyroTest
Catalog No. List Special

PyroTest Vial Block
Catalog No. List Special

550-10004P

175.00

150.00

550-80188P

197.00

188.00

550-80191P

24.50

22.50

includes 5 tests

Hot Plate/Stirrers
Catalog No. List Special

Ohaus Balance
Catalog No. List Special

Mettler-Toledo Balance
Catalog No. List Special

(A) 439-10019P (B) 439-10022P (C) 439-10025P

350.00 375.00 482.00

295.00 325.00 450.00

449-21776P

1795.00

1650.00

447-21155P

1995.00

1845.00*

(B) (C) (A) *After direct mfg rebate of $150

Boekel Incubator
Catalog No. List Special

Buffer Solutions
Catalog No. List Special

IQ Scientific pH meter
Catalog No. List Special

330-21814P

535.00

450.00

B1555P

50.00

35.00

241-67673P

211.00

195.45

variety pack; contains two bottles of each

800.791.3210

www.spectrumrx.com
QT404E expires 02/28/05

Please mention flyer to receive special prices. All prices net, no additional discounts apply. F.O.B. shipping point.

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C h e m i c a l S p e c i a ls
CATALOG NO. C1402P C1402P C1402P F1147P F1147P F1147P H1067P H1067P H1067P H1067P H1067P H1107P H1107P H1107P H1107P M1167P M1167P M1167P M1167P M1167P M1167P 01169P 01169P 01169P 01169P 01169P S1810P S1810P S1810P CHEMICAL NAME Codeine Phosphate USP (CII) Codeine Phosphate USP (CII) Codeine Phosphate USP (CII) Fentanyl Citrate USP (CII) Fentanyl Citrate USP (CII) Fentanyl Citrate USP (CII) Hydrocodone Bitartrate USP (CII) Hydrocodone Bitartrate USP (CII) Hydrocodone Bitartrate USP (CII) Hydrocodone Bitartrate USP (CII) Hydrocodone Bitartrate USP (CII) Hydromorphone Hydrochloride USP (CII) Hydromorphone Hydrochloride USP (CII) Hydromorphone Hydrochloride USP (CII) Hydromorphone Hydrochloride USP (CII) Morphine Sulfate USP (CII) Morphine Sulfate USP (CII) Morphine Sulfate USP (CII) Morphine Sulfate USP (CII) Morphine Sulfate USP (CII) Morphine Sulfate USP (CII) Oxycodone Hydrochloride USP (CII) Oxycodone Hydrochloride USP (CII) Oxycodone Hydrochloride USP (CII) Oxycodone Hydrochloride USP (CII) Oxycodone Hydrochloride USP (CII) Sufentanil Citrate USP (CII) Sufentanil Citrate USP (CII) Sufentanil Citrate USP (CII) SIZE 5g 25 g 100 g 100 mg 1g 5g 1g 5g 25 g 100 g 1 kg 1g 5g 25 g 100 g 1g 5g 25 g 100 g 250 g 500 g 1g 5g 25 g 100 g 500 g 10 mg 100 mg 1g PRICE 25.00 89.00 290.00 90.00 285.00 1250.00 16.00 38.00 140.00 495.00 4800.00 60.00 240.00 795.00 2800.00 27.00 25.00 83.00 235.00 470.00 938.00 17.50 82.00 317.00 1075.00 4800.00 185.00 975.00 6800.00

All Schedule II Drugs require DEA license and 222 form. Refer to page VII in our 2005 catalog.

800.791.3210

www.spectrumrx.com
QT404C expires 12/31/04

Please mention flyer to receive special prices. All prices net, no additional discounts apply. F.O.B. shipping point.

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“Progesterone...” con’t from pg. 2

arteries, causing vasospasm and myocardial infarction, while natural progesterone dilated coronary arteries. Progesterone plus estradiol protected against vasospasm, but MPA plus estradiol did not. Studies have also demonstrated arterial plaque formation in ovariectomized primates. However, the group treated with bio-identical estrogen had 50% less plaque formation than the control group. In the past, the choice of MPA over progesterone has been based on familiarity and convenience. Based on these results, formulations of natural bio-identical progesterone would appear to offer the wiser alternative. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial, a 3-year multicenter, randomized, double-blind, placebo-controlled study of 875 healthy postmenopausal women, confirmed that synthetic progestins partially negate the beneficial effects on cholesterol levels that result from taking estrogen. Natural progesterone, on the other hand, maintains all the benefits of estrogen on cholesterol while minimizing the side effects associated with synthetic progestins, such as MPA. Perimenopause is the time between the onset of changes in hormonal secretions and menopause, and is characterized by fluctuating hormones. Progesterone is commonly prescribed for perimenopausal women to counteract “estrogen dominance.” Estrogen dominance occurs when a woman produces smaller amounts of progesterone than normal relative to estrogen levels. The benefits of progesterone are not limited to prevention of endometrial cancer in women who are receiving estrogen replacement. Progesterone therapy is not only needed by women who have an “intact uterus”, but is also valuable for women who have had a hysterectomy. Progesterone builds bone density, promotes glucose utilization, and improves sleep patterns and libido. The role of natural progesterone as a bone-building hormone has received considerable attention. Many individuals associate osteoporosis with low estrogen levels. However, significant bone loss occurs during the 10 to 15 years before menopause when estrogen levels are still normal. Jerilynn Prior, M.D., of the University of British Columbia, has presented evidence that progesterone can stimulate new bone formation in women with osteoporosis. Dr. Prior measured estrogen and progesterone levels in female marathon runners who had osteoporosis. Although their estrogen levels were still high, they had stopped ovulating (common in female athletes) and progesterone levels had fallen, triggering the onset of osteoporosis. This can indicate a role for progesterone use, alone or combined with estrogen, to reduce bone loss and improve Bone Mineral Density. Influence of Route of Administration on Progesterone Metabolism The sedative and hypnotic effects of oral administration of progesterone may be mediated through various metabolites which dramatically increased after oral as opposed to vaginal administration. Therefore, “specific benefit may be expected from oral administration on mood and sleep disturbances in postmenopausal women or in women suffering from premenstrual symptoms of anxiety, while vaginal administration may induce more predictable endometrial

secretory changes without detectable influence on the central nervous system.” (Am J Obstet Gynecol 1988 Nov;159(5):12039; Maturitas 1995 Apr;21(3):251-7) Customized Medications Bio-identical progesterone can be administered in a variety of dosage forms and by numerous routes, such as a micronized powder in an oral capsule, or a lozenge or troche, transdermal cream or gel, vaginal or rectal suppository, or intramuscular injection. All of these dosage forms are available by prescription through our compounding pharmacy. Bio-Identical Hormone Replacement Therapy and Monitoring Medications, dosage form, dose, and route of administration should be customized to meet specific needs and solve individual problem, and the patient should be regularly monitored and therapy should be modified as indicated. In order to provide optimal Bio-identical HRT, the prescriber or consultant should keep current on the latest medical literature. Much useful information can be gained by attending an educational program which addresses current theory and presents an opportunity for discussion of numerous clinical scenarios and therapeutic options.

Progesterone Transdermal Cream 25 mg/0.1 mL (250 mg/mL)
Quantity: 100 mL Ingredients: Progesterone Micronized, USP....................................25 g Ethoxy Diglycol or Ethyl Alcohol......................25.00 mL Simethicone, USP.....................................................0.5 mL Lecithin/Isopropyl Palmitate Solution ......................7 mL Vanishing cream, Base........................................qs 100 mL Preparation Instructions: 1. Calculate amount of ingredients needed. 2. Accurately weigh and measure each ingredient. 3. Place Progesterone into mortar. 4. Add Ethoxy Diglycol, levigate fully. 5. Add Simethicone and Lecithin oil solution, mix well. 6. Add vanishing cream geometrically. Mix until homogenous. Beyond-Use Date: 90 days Storage: Protect from light and excess moisture; store at room temperature

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Unguator vs Ointment Mill
A VERY COMMON QUESTION that we get asked at Spectrum is whether to purchase an Ointment Mill or an Unguator. The answer is not so simple. Although you may use these pieces of equipment on the same formulations, what they do for these formulations is very different. The Unguator is a great tool for mixing ointments, creams, suspensions, emulsions, and other preparations. Using the Unguator will give much better dispersion of your active ingredient than you would be able to achieve by hand mixing. It also greatly reduces the time required to achieve this task. The superior dispersion achieved with the Unguator provides a more consistent, even dose. However, we have found that the Ointment Mill will provide better particle size reduction than the Unguator. According to literature provided by the manufacturer, the Ointment Mill can process formulations to a particle fineness of approximately 20 microns. This reduction in particle size will enhance the absorption characteristics of your product to allow optimal therapeutic benefit to your patient. The manufacturer of the Unguator does mention particle reduction in their literature, but specific numbers are not included. As you can see, this is not an easy choice and the salesman in me says you should buy both. The combination of both pieces of equipment will help you provide quality products in less time than is possible by hand preparation. If you would like more information on either of these products, please call your Spectrum representative and we will be more than happy to assist you.

vs
552-57899P 340-61003P

Help Wanted:
Compounding Pharmacist Are you ready for a challenge? Are you ready for sunshine 300 days a year? Spectrum Pharmacy Products is looking for a Compounding Pharmacist to provide technical support. Compounding experience is required and drug information experience is preferred. Bilingual (Spanish) is a plus. Relocation to Tucson, AZ is required. Call 800-791-3210 x227 and speak with Remay McNally, Human Resources, or email your resume to rmcnally@spectrumrx.com. Compounding Pharmacy Technician Are you a compounding technician looking to get out of the “kitchen”? Spectrum Pharmacy Products is looking for highly skilled, certified pharmacy technicians to work in the Technical Support department. Compounding experience is required and drug information experience is helpful. Bilingual (Spanish) is a plus. Relocation to Tucson, AZ is required. Call 800-791-3210 x227 and speak with Remay McNally, Human Resources, or email your resume to rmcnally@spectrumrx.com.

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