Catch-Up: Utah School of Alcoholism and Other Drug Dependencies

So many things happened this summer, and school started so busy so quickly that I have tons of catching up to do! 

Out of the many adventures I had, one of the most life-changing ones was my trip to Salt Lake City, Utah for the Utah School of Alcoholism and Other Drug Dependencies. 

It is a whole week of lectures about the pathophysiology of addiction, anonymous meetings (alcoholics, narcotics, al-anon), and speakers. There are so many disciplines in attendance (pharmacy, medicine, social work, etc.) and each have their individual sessions along with large sessions where everyone comes together. 

The pharmacy section is hosted in partnership with APhA-ASP. The UNC chapter placed 3rd place nationally as part of the Generation Rx Community Outreach Project, and each of the top 3 schools sponsored 2 students to attend the meeting. I was one of the lucky 2 to represent our school! Five students total attended from UNC. It was an honor to be a part of this session and to be surrounded by pharmacists in recovery from addiction, and fellow student pharmacists eager to learn about the disease. 

I stayed in a dorm for the first time in many years! It was pretty chilly at night, since the air is so dry that it doesn't retain any heat. The temperature rose tons once the sun came out again, though! 

The walk every morning from the dorms to the lectures was extremely beautiful. As a Floridian, my eyes still widen at the site of mountains. And while North Carolina has the Appalachian, there's no comparison to the Utah mountains! The suspension bridge on the way makes for a perfect photo op. 

Unique to the pharmacy programming, the Generation Rx nationally ranked schools presented their year to inspire other chapters and share their successes. It was tons of fun creating a poster and developing a presentation in front of student pharmacists from all over the country. I'm incredibly proud of our school and the Generation Rx leaders who made the project one of the best! 

One of the biggest treats was a performance from the Utes, a Native American tribe from Utah. Check out the video of the finale - it's amazing! 

This week opened my eyes to the fact that addiction is a disease, not a choice. Addiction is a disease with no cure, just like any other chronic disease (hypertension, diabetes, asthma, etc.). It's our responsibility to be informed about addiction to create a movement of erasing its negative stigma. 

For more information, see these websites:
http://www.pharmacist.com/apha-asp-generation-rx
http://www.drugabuse.gov/
http://medicine.utah.edu/uas/

Summertime

Another free moment means another promise to keep up with blogging again. I swear this time to be true (as I always say)!

But really, this past year kicked my butt, and I can honestly say I'm a better person for it, and will hopefully be a better pharmacist too. Unfortunately any mental break I had this past semester all I wanted to do was lay in bed, watch TV, and mindlessly look around Facebook in 3 different tabs.

Some things I did this year:

1) Racked up thousands of Delta Skymiles and Southwest Rewards Points. Glory of pharmacy conferences and a long distance relationship.
2) Took 21 exams + 4 finals in the span of 4 months (minus Spring Break)
3) Somehow got the clutch factor. Three classes this semester ended up with final grades between 89.5 - 90%
4) Learned the significance of "Just keep swimming". Had a few breakdowns this year from the stress, workload, etc. But my friends (and not necessarily willpower) helped get me through because we were all in the same boat together.

But the year is now over, and will just be a distant memory. Because in just a few weeks, Errol and I will be embarking on our first Eurotrip! Two weeks in Italy; I can't wait for you all to share the experience with me!

Transitions

It's currently Spring Break, in which I am spending in a study room of UCF School of Medicine as Errol studies for his exam tomorrow. It's crazy to think that after this week is over, we will be well into March, and less than 2 months away from being the oldest class residing in UNC Eshelman School of Pharmacy.

Organizations have a large role in student pharmacist lives. This is the time of year of election season, and officer transition. It's the time when first year students step up and strive to become elected, second year students begin to realize that that they need some leadership to get residencies, and third years start mentally preparing to interact daily with patients.

With two Elect positions (2-year commitments), I started this year wondering how I could possibly take over in my third year. Thanks to great mentorship, I feel confident that next year I will be able to take over and maintain the legacy.

That's all for now... onto trying to survive second year!

Pharmacists Save Lives Too

Last night was an incredibly busy day at the CVS where I work. It was only a 5-hour shift, but Mondays are always busy. From 8 to 10 PM, it was just myself and my pharmacist, but we were able to manage decently. It was a few hours before I was able to take a bite of dinner, or even go to the bathroom. But that's the life of community retail.

Around 8:30PM, a mother and her daughter approached the counter asking where the Benadryl was. Before pharmacy school, when it was busy and a patient asked me where something was, I would point them to the aisle and get back to my work. However, it seems that my way of thinking has changed completely from getting tasks accomplished, to maximizing health outcomes. 

We are taught in school systematic approaches to asking patients questions in order to extract the most appropriate information.

Me: Are you looking for tablet or liquid?

Mother: Probably liquid because my daughter says she is having trouble swallowing.

I turn to the daughter, and say: Do you feel like your throat is closing up?

Daughter: Yes

Me: Have you eaten anything recently? Or come into contact with anything foreign?

Daughter: I had something with peanuts.

Me: When did you eat it?

Daughter: About 5 minutes ago

It was at that point I immediately got the pharmacist to assess her. She was unaware she had any food allergy, but it was clear she was going through anaphylactic shock. We offered to call 911 for her, but she was refusing (some sort of psychological trauma from her past, when her grandmother died in an ambulance). Instead, we had her sit in the waiting room for about 20 minutes after she drank 4 tablespoons of Benadryl to monitor her status. 

We debated taking an EpiPen off the shelf to use for her, but my pharmacist wasn't quite sure because she wasn't aware she had any allergy at all. So instead, we called Urgent Care centers to see if they were still open. We found a couple and gave her the phone number/address, and they drove off. 

This may not sound as exciting to you all, but when I think about how I could have just told her where the Benadryl was and let her go off, she could have been in a very bad situation. 

Hey, pharmacists save lives too :) 

First 2 weeks of PY2

The first two weeks of PY2 have been a stressful test of the year to come. There have been lots of lecture, lots of organization responsibilities, and our first exam is already tomorrow!

But in the midst of all the work, there has been a lot of good times with great friends.

On the last day of summer was PY1 Orientation, where I was one of the many representing CAPS and all of its wonder. It was so nice seeing the new class, and introducing them to all of the organizations at the School.

That night was also the first Dose of Franklin! It was so much fun seeing everyone again after all summer apart; at the same time, it felt like there was never a break! It seems just like yesterday was my very first Dose.

Classes have been great so far; our therapy course right now is dermatology (which is what our test is tomorrow). It's exciting to go to work and waiting for someone to ask the pharmacist how to help treat their poison ivy symptoms (nerdy, I know). Next up! Diabetes. 

Phi Delta Chi rush has also been going on, and there are so many great potential pledges! I can't wait for bids to go out and the pinning ceremony this Friday! 

Until next time...

Disclaimer

This is probably my 50th apology post in this blog, but I'm so sorry that I never finished writing about my IPPE. It eventually became very repetitive, and very busy in my life that I just didn't have time.

Overall, it was an amazing experience! Learned so much, and can't wait to start learning more therapy next year! 

Day 9: Special Formulations

There are times that a medication is needed in a route/dose/mixture that isn't available through a manufacturer. Most of them are ordered solutions for pediatric patients.

Today I got to compound sildenafil solution, hydrocortisone solution, enalapril solution, etc. Lots of crushing tablets which required some arm muscles. But I also opened up 50 capsules of ursodiol, which was much easier! 

The pharmacy looked a lot like a chemistry lab, with lots of drugs but also chemical ingredients necessary for a formulation. They don't just make solutions, but also tablets, capsules, suppositories, etc. 

This was a shorter day, but lots of fun!

Day 8: Drug Information/Medication Safety

Today was a different change of pace. About 8 of us (HIPPE students) were together in a conference room and were led through various activities.

First up was Drug Information (DI):
The speaker for the day was the DI pharmacist, who is available in the hospital to answer any and all questions regarding medications. She is usually saved for questions very rare adverse side effects or anything else that a physician and/or pharmacist can't look up right away or cannot find. She emphasized that every pharmacist should be knowledgable of all the ways to look up information. According to her, if you only look at LexiComp for your drug information, you're not optimizing patient care.

We were lead through various books that she has on hand. Here's a glimpse:

This book was HUGE, and claims to have information regarding every single-drug entity available in the U.S. It's a collection of monographs organized by drug class, so you can compare/contrast drugs within the same class, amongst other things. It is very informative; however, it is not good for quick reference or for specific cases in which you would use the books below. 

This book should be on hand in every retail/community pharmacy and family clinic. It's a guide specifically for contraceptives. It can help guide changing from one pill to another, has an overview of side effects, guidelines on missed doses (always a big question!), and more. It's also small, handbook-sized so it can fit in the white coat pockets. 

The pharmacist said that when she was in residency, she was on call some days for 24 hours at a time, and would sleep with this next to her because most of the calls were about drugs and kidney dysfunction. Because most drugs are filtered through the kidney, it's extremely important to take this into account, especially with doses. This book is helpful for pediatric and adult patients. There are lots of tables for quick reference. 

This was an interesting book that focused on just adverse effects caused by medications. It was written by pharmacists, which makes it even better! It doesn't have information about drugs (regarding dose, administration, indications, etc.). It is organized by disease and body systems and focuses on the more severe adverse effects, not every single adverse effect possible. 

We are exposed to this book in lab, so we were familiar with it. It's a reference for if a drug is compatible with a pregnant or lactating woman. It's also available online, which is good (not all books are available online). It also specifies if a drug is compatible in certain trimesters only. 

ImmunoFacts has information regarding vaccines, antibodies, interferons, interleukins, etc. It's organized by class, and has tables inside with dosing schedules for vaccines, etc. A good second source would be the CDC website. 

This is a very interesting book that focuses on toxicology (obviously) regarding drugs, radiation, metals, household products, occupational hazards (i.e., methylene blue, smoke, etc.), nature (i.e., poisonous plants, snake venom, spider venom, etc.). It specifically focuses on antidotes and managing toxic events, such as drug overdoses. We also were introduced to the term "toxicokinetics", which is similar to pharmacokinetics but specifically how your body handles drugs when in a toxic state. 

This book is specifically for managing bacterial, fungal, viral, etc. infections. It's organized by site of infection, and includes a vaccination section. It has primary therapy, and secondary options if the patient has allergy to the antibiotic or has developed resistance. 

Next up was Medication Safety:
The hospital's Medication Safety Officer, Dr. Kayla Hansen, is a pharmacist who specializes in medication safety. She analyzes reported medication errors that happen in the hospital and figures out ways to prevent them by implementing procedural changes and educating.

It seems like something that is obvious, but errors happen every single day, especially in institutions with so much interdisciplinary communication, and patients receive the consequences. More than half of all errors in a hospital are medication-related, and pharmacists have a key role in preventing them throughout the medication use process.

The most interesting fact is that at UNC Hospitals, the most errors are done by nurses, with pharmacists coming in second. HOWEVER, because error reporting is voluntary, this is not by any means comprehensive. What it does mean is that nurses care enough about patient safety that they will even report themselves doing an error. Many are afraid to report errors because of fear of punishment, but without reporting errors, we wouldn't know how to improve. The ultimate goal is to minimize errors to optimize patient care and safety! 

Day 7: Emergency Department

On this day I finally got the opportunity to speak to patients! In the emergency department of UNC Hospitals, there are pharmacy technicians that take medication histories of patients who will be admitted to one of the other floors.

Taking a medication history consists of asking patients what medications they are currently taking, how they are taking it, the dose, etc. You also ask about medication allergies, food allergies, and over-the-counter medications (i.e., vitamins)/herbal supplements. This information is reconciled with what the patient has in his or her profile. This is an essential step in ensuring a patient is on all of the medications he/she needs while in the hospital. Also, it is necessary to have the most updated information to make sure there are no drug/food interactions that can cause harm.

I got to take 3 medication histories, and it was quite a challenge in some cases because, being in the ED, they aren't exactly calm. But it's so important that we have to push through and get all of the necessary information.

It was so great talking to patients today! We have two days in the ED, so I'll have another opportunity later this week!

Day 6: Round with a Resident

Today was another great day! I got to round with the PGY2 hematology/oncology pharmacy resident. We spoke to patients who were in the hospital post-bone marrow transplant and/or for complications regarding the transplant.

The medical team consisted of the attending, resident, 2 interns, a 4th year medical student, and the pharmacy resident. Each of the doctors had a few cases each to present to the team. The reason the patient was in the hospital, any issues/complications over the past 24 hours, remarkable lab values, etc. were amongst the topics presented and discussed outside of the patient's room. After the presentation, the team went inside to speak with the patient. The attending was mainly who spoke to the patients.

This was my first experience seeing communication amongst medical professionals, and communication to patients. One of the required readings before the start of pharmacy school was The Anatomy of Hope, which was written by an M.D. to describe the very delicate process of delivery good/bad news to patients. and his experiences with trying to give false hope, being overly optimistic, or even to negative. The different scenarios even had different results in terms of patient outcome. I highly recommend reading it.

But I digress...

There was a large variety of patients that we saw, from ones who could be discharged the next day, to ones where we couldn't give any good or bad news (unchanged progress), and even ones who needed to go to Hospice. The dialogue used by the physicians were very deliberate.

The pharmacy resident provided input when necessary regarding a patient's medication regimen. A lot of things were recommendations in antibiotic regimens (especially vancomycin). Some of the other roles the pharmacy clinical specialist are to answer questions about adverse reactions, recommendations about drug substitutions or dosing, etc. According to the pharmacy resident, one of the things he learned is that sometimes a question can't be answered right away, and that's okay. Most questions asked are about very rare reactions (<10% of cases), but one of the skills we learn in school is how to look up drug information and support decisions based on primary literature (i.e., clinical trials).

Learned so much today! Starting to think maybe I want to do a residency...

On deck for tomorrow: Emergency Department

Day 5: Surgical Services

Today I thought I would observe the pharmacist of the Surgical Services pharmacy satellite. I arrived and watched the pharmacist and technicians catch up on the morning orders. Surgeons stopped by the window asking for bags of normal saline, ephedrine, heparin, etc., to prepare for their morning cases.

Then, I was given scrubs and was informed that I would be watching surgeries!

I saw a total of 3 in a 4-hour span. The first was a skin graft after removing melanoma. I'm glad that was first because this was my first surgical experience. While I don't normally get squeamish and I'm not afraid of needles, I wasn't sure how I would handle this much. But I was fine, and you actually get used to it once you think of the patient as a body you are trying to fix instead of the pain they will probably feel post-anesthesia.

The second was a transurethral resection of the prostate (TURP). I won't go into the gory details, but the surgery lasted about 2 hours. During this case, I mostly stayed with the Certified Registered Nurse Anesthesist (CRNA) and spoke to him about how he sedates patients, maintains sedation, and then wakes them up. There are a combination of infusions used to sedate the patient, relax the muscles, and control blood pressure (which tends to drop). It was interesting to be around so much medicine administration and not have any sort of pharmacist intervention any step of the way. Maybe it's a future niche to be filled?

As the second case finished, it was 11:30AM, and a discussion was scheduled at noon for all of the students. I walked out of the room and there was a Da Vinci surgical robot being used in the hallway. The big screen TV on the wall showed what was happening in a whole separate room. This case was removing a large fibroid from the uterus, and I watched for about 20 minutes. I couldn't believe I got to see such amazing technology being used first hand!

Scheduled for tomorrow: Round with a pharmacy resident - Bone Marrow Transplant

Day 4: Pediatric Pharmacy

Sorry I've gotten behind, I am determined to document this whole month!

I was in the pediatric satellite pharmacy today, and shadowed the pharmacist. What's different about a pediatric pharmacy is that 90% of all the medicines are in liquid formulation. Very different from what I'm used to at CVS!

One of the challenges of pediatrics is that some drugs may not have a liquid formulation. There was an example of one while I was there with phenoxybenzamine. We talked to the Special Formulations pharmacy to see if they would be able to create a new recipe in house.

The pharmacist and I took a walk up to the floor to talk to the nurse taking care of the patient to let them know it would be a few hours for Special Formulations to get the medicine prepared. The nurse said that was fine, and that during rounds it was inquired the onset of action of the medicine, and I looked it up. This was my first experience communication drug information to part of the health care team (that wasn't another pharmacist).

It took some thought to figure out how to convert "The half life of the drug is 24 hours because it is partially excreted in the bile and therefore is subject to enterohepatic recycling" to "The half life of the drug is 24 hours because it gets reabsorbed, so it stays in the patient's system longer".

For tomorrow: Surgical Services Pharmacy

Day 3: Oncology Pharmacy

I was all gowned up today in the clean room for my 8AM-4PM shift. Most clean rooms and IV rooms are in the basement of a hospital, with zero windows. In the Cancer Hospital, however, the whole back wall is open to the vast North Carolina landscape. It's a wonderful atmosphere!

Before lunch, I shadowed the technician and watched him mix bag after bag of chemo- and non-chemotherapy medications. The clean room of the Cancer Hospital takes orders from the oncology inpatient, infusion outpatient clinic, rheumatology, IDS, pediatric floors, solid organ transplant, rheumatology clinic, etc. It was exciting to see all the antineoplastic medications we learned in pharmaceutics and biochemistry. It's so refreshing to see all of the things we learned in just one year being applied in all aspects of the hospital.

After lunch, I shadowed the pharmacist, who happened to be a resident today. A graduate of UNC, he told me all about his path to residency which was good perspective. I learned how to verify IV's, and it is much different from verifying medicines in the community. The only way to check if an IV bag has been made properly is to verify the vial, concentration, correct volume(s) injected into the bags. The volume injected is determined by providing the syringes used marked or pulled out to the point that was drawn up. We also had to verify Body Surface Area (BSA) for each patient, which is used a lot for chemotherapy drugs.

Today was the first opportunity I got to see drugs I learned in class used as therapy. So exciting!!!

On Monday: Pediatric Pharmacy

Day 2: Transitions of Care

Today's main theme was making the transition from hospital inpatient to home outpatient as smooth and beneficial to the patient as possible. There are many times patients go from a hospital bed to discharge with a stack of prescriptions and quite possibly not be able to fill their medications right away due to the state they are in. In addition, he or she may not receive adequate counseling from the community pharmacist because of time issues and lack of knowledge of what happened within the hospital.

UNC Hospitals is therefore trying to improve the issue by launching Carolina Care at Home. Today I shadowed the transitions technician who took me step-by-step through the process. Right now it's still very new; the program launched October 2011 and is slowly being incorporated into various acute adult units, including cardiac intensive care unit, solid organ transplant unit, and hematology/oncology (the newest unit).

Every morning, the technician goes through the list of patients in the units and looks at the prescription insurance the patients have. Currently, the program is not going to enroll self-pay (no insurance) and Medicaid-covered patients. Another goal of the program is to create some revenue for the hospital, because most of the patients that get prescriptions at the hospital are helped with Medical Assistance Programs. By getting fills that are reimbursed by third party payers, it helps the hospital pharmacies too.

Once she has a list of patients with insurance, we go to the floor and see who on the list will be getting discharged. If a patient is getting discharged, we talk to the nurse and ask if he/she will be going home with new medication prescriptions. If so, we speak with the patient.

We got to talk to one patient. She asked him if he would like to fill his first fill (30 days) at the hospital; we would have them delivered to his room and billed by the discharge pharmacist and he would pay his normal copay. The refills would be sent to his home community pharmacy. He accepted enrollment in the program and we talked to the discharge pharmacist about the prescriptions that were being sent to him.

The ultimate goal of Carolina Care at home is to be incorporated into the whole hospital and enrolling 30 patients a day into the program. I feel this was a great experience to see a brand new initiative being implemented in the hospital. Transitions of care is a very crucial part of a patient's overall health!

On deck for tomorrow: Oncology Pharmacy

Day 1: Investigational Drug Services

Yesterday was technically "day 1" but it was just orientation. Today was the first experience we had in the pharmacies of UNC Hospitals.

My shadowing today exposed me to a type of pharmacy I had never heard of before. The Investigational Drug Services (IDS) is a pharmacy that dispenses medications like any other. However, the difference is that it only dispenses drugs that are for patients in clinical trials being conducted by hospital clinicians. There are about 450 trials currently being conducted within all the hospitals. While the pharmacy I was in today was in the Neurosciences Hospital (just by chance because the space was available), there is another one in the Cancer Hospital that specializes in oncology drugs because there are so many new drugs coming out for cancer. Around 150 trials alone are in the Cancer Hospital.

I found it very interesting to observe what happens in a research-oriented pharmacy. Clinical trial protocols are given to the pharmacists of IDS, who order the drugs (some of which aren't on the market yet because they are Phase 2 and 3 drugs, and some which are on the market and are being studied for a different indication), and dispense either placebo or drug based on the particular trial design.

It turns out that trials can get very complicated with many layers of comparisons. I was able to read through at least 10 trial notebooks during my 8AM-2:30PM shift. Some were placebo vs. active drug, some where 2 active drug comparisons, some were placebo vs. brand drug vs. generic drug, etc. Whatever you can imagine, there is probably a study design for it.

I learned a lot from today's experience, and was very excited to see the type of pharmacy that acts as a bridge between bench research and clinical application.

On deck for tomorrow: Transitions of Care

End-of-semester Wrap-Up/H-IPPE Orientation

I can't believe I never posted since March, but this semester was one of the toughest I have experienced. Last week was finals week, and there were 5 finals, 5 days in a row. Four of them were cumulative. It was the most intense week of my life, but I survived.

Final Report Card: 
Pharmaceutics 2 - A
Pharmacodynamics - A
Pharmaceutical Care Lab - A
Introduction to Therapy 1 - B
Biochemistry - B

Overall, I am very pleased! I finally figured out my study groove, and any B's I had were a painful 88%. I worked harder than I ever have before and it paid off! I am excited for next year when we are exposed to more medicinal chemistry and therapy.

My school positions for next year: 
APhA-ASP President/Liaison-Elect
Recruitment Ambassadors Program Secretary-Elect
Pre-Pharmacy Club Secretary

Another project I'll be working on this summer is writing a proposal to start a dual degree program with Masters in Public Health!

Today was also a big day! My Hospital Introductory Pharmacy Practice Experience (H-IPPE) orientation was today. We took a tour of the vast UNC Hospitals and became familiar with the expectations of the month. I feel so lucky to be rotating at UNC Hospitals. I hope that my classmates have the same great experience wherever they are in North Carolina. The class is spread out into various regions of the state, from Wilmington to Asheville. I will definitely update every day to account for my experience! Here is a list of things I will be exposed to:

-Investigational Drugs
-Transitions of Care (inpatient --> outpatient)
-Oncology Pharmacy
-Pediatric Pharmacy
-OR Satellite pharmacy
-Round with Resident (very excited about this!)
-Emergency Department (twice!)
-Drug Information and Medication Safety
-Special Formulations
-Decentral Pharmacist (twice!)
-Inpatient Pharmacist (twice!)
-Controlled Substances
-Sterile Products
-Administration
-Outpatient Pharmacy
-Pharmacy Support Services

We also have 2 projects. One New Drug presentation, and a special formulations assignment where we analyze a drug that is specially made in the pharmacies and if it's more feasible to buy it commercially.

Tomorrow is Investigational Drugs! Cheers to the month :)

Gatlinburg

It's been a while since the last post... or at least it seems like it!

This past MLK weekend, I went to Gatlinburg, TN with my pharmacy fraternity: Phi Delta Chi. We had an amazing time with about 30 of us in a HUGE 3-story wooden cabin. It was complete with 2 hot tubs, a HUGE kitchen (it reminds me of Pioneer Woman's), pinball and arcade machines, movie theater room, and pool table. I could seriously live there.

Every night there was a huge party in the cabin with Brothers from other chapters (it was a Phi Delta Chi retreat) and it was cool to meet a lot of people, plus bond with our own chapter Brothers.

Unfortunately, after many nights of drinking, bad nutrition, and not enough sleep, I got sick. It's the first time i've gotten sick all year though so I guess I'll take it now and not during a whole bunch of exams. At least half of us got sick, so we have dubbed it: Gatlinburgitis.

Totally worth it though :)

And now this is my first (and probably only) free weekend where I don't have any big assignments, exams, etc. to study for. And no CVS!

But it really is the silence before the storm because after this coming week, all hell breaks loose.

Keep you posted :)

Pharm Care Lab

Today was my first day of lab, and I'm excited about the group we have and our TA. As I mentioned before, this lab is nothing like the chemistry or biology labs from undergrad. Here, we learn practical skills, medical terminology, top 200 drugs, compounding, etc.

Today, we did the usual ice breakers (even though we already knew each other pretty much). We also did an exercise in gathering information with a paper chart (practice for our hospital rotations this summer), reviewed how to take blood pressure with the sphygmomanometer, and did our first practice getting a patient's medical history.

It was short and sweet (2.5 hours instead of 4), so I was very happy about that.

Tonight is the first Phi Delta Chi meeting of the semester! We will be discussing the trip to Gatlinburg this weekend. So much fun!!!

Make the Most of Your Internship

One of the student forums on the American Society of Health Systems Pharmacists had a post that said this:

"I was so grateful when I was chosen to be a retail Intern for a large retail store in my area.  I have a limited pharmacy background and thought this would enhance my Pharmacy education.  I spent two summers primarily counting pills and cashing out customers.  When I arrived in the morning, all the techs scattered and the Pharmacist told me to count for a while.  Eight hours later, I was still counting.  On my last day, a temporary pharmacist arrived.  She was amazed I had not done some basic pharmacist's duties.  It is very obvious how frustrated I became during this time.

I agree an Internship should have specific goals for both the Intern and the Pharmacist.  Both should be accountable for what the Intern is learning or not learning."


Having been a pharmacy technician for just over 2 years before being promoted to intern, I felt I had to respond with my 2 cents. I think it's a very important lesson as a professional to make the most of your situation.

When you're in community pharmacy, it's [mostly] all about pushing scripts, making budget, meeting metrics. And while most people feel that in a retail setting, pharmacists are just verification robots that don't use any of their clinical knowledge, that couldn't be more false. In fact, community pharmacists must utilize a much broader range of their knowledge than those in a clinical specialty.

But I digress...

When I was promoted to intern, there were only a couple more additional duties I was allowed to do: prescription transfers, taking phone-in prescriptions, and taking voicemail prescriptions.

However, it's not just additional duties, but the status of Intern and PharmD Candidate that indicates you are a professional. Pharmacists expect you to have the initiative and drive to work at a higher level. You are lucky to be in the presence of your own personal tutor for 6-8 hours at a time. In many instances, your pharmacist is easier to talk to than your professors.

Here is a list of ways to get out of the "technician rutt":
-Come to work with a couple of questions in mind from class.
-Ask about your pharmacist's personal experiences
-When filling scripts, quiz yourself on brand/generic/classes/indications
-When the pharmacist is counseling/answering a question, stop what you're doing and listen
-If a patient asks you a question, practice your communication skills
-When typing multiple scripts for a patient, try to think about their disease states (diabetes, high blood pressure, high cholesterol, hormone replacement, HIV, etc.)
-Look past "corporate policy" attitude and figure out the health care advantages to them.

As you can see, there are a number of things you can do to make the most of what may seem like a monotonous, repetitive job.

Remember that when you become a pharmacist, in order to effectively lead, you need to know every position.

Might as well start at the bottom :)

First Day of Spring Semester!

This semester started off with a freeze. 

Woke up at 7AM and it was a chilly 19 degrees. Normally, I would skip class until the sun came out if it was this cold, but I'm a professional now! Plus, our first class of the day this semester has mandatory attendance. But that's good for me because it gives me the motivation to go. 

I can't express enough how much of a learning experience last semester was for me. I finally figured out my study method, I paid the price for being lazy and procrastinating, and now I fully understand the phrase "keeping your head above water". 

So this semester I have read each syllabus multiple times so I understand every project, assignment, exam, and quiz. I used to hate knowing my grades and just wanted to do my best for every test. But it's definitely a study-motivator to know the grade you need, and a booster to know if a good grade is still possible. I made an Excel spreadsheet with all of my courses and each assignment with point values. All I have to do is input the grades and my final grade is calculated automatically! I got the idea from my Student Mentor, Whitney. It'll help when I need to figure out what I need to get that A! Haha. 

Screen shot of my spreadsheet. I'm so proud of it! 

Here's a short summary of each of my classes this semester: 

1) Pharmaceutical Care Lab: 2nd in the 5-semester series. In this class we learn top 200 drugs, medical terms, calculations, compounding, counseling, and much more! Lots of work, but we learn very valuable skills and knowledge. 

2) Pharmaceutics 2: Last semester we learned a lot about diffusion and physical properties (hydrophilic vs. lipophilic) properties that affect drug absorption, along with an introduction to different drug delivery systems. This course will emphasize the different dosage forms (tablet, capsule, vaginal suppository, rectal suppository, nasal sprays, ophthalmic and otic drops, transdermal patches, etc.) and how drugs get into the system with each different form. 

3) Biochemistry 2: Last semester, we learned about proteins, energy utilization in the cell, and lipid synthesis (among other things). This semester will emphasize gene therapy and drugs related to that. Drugs have shifted from low molecular weight molecules to monoclonal antibodies. We will learn about challenges to this. 

4) Pharmacodynamics: Our first taste of pharmacokinetics. We will learn about how drugs process and eliminate drugs through liver, kidney, cytochrome P450, etc. Sounds interesting and different. 

5) Intro to Pharmaceutical Care: Our first exposure to the Pharmacotherapy that we'll get in full force next year! We will learn how to do SOAP notes and how to interview patients in preparation for OSCE's. 

This semester promises to be MUCH harder than last semester, so the gloves are off! 

I pledge to:

1) Not be lazy

2) Go to class

3) Prepare for class beforehand 

4) Don't procrastinate 

5) Eat healthy 

6) Get enough sleep

What do you pledge to do this semester?