The future

So I just finished reading Drugmonkey's latest on Walgreen's POWER program, and I had a few thoughts...

Do you know what's most annoying? I'm sitting in school today writing SOAP notes and making recommendations to doctors based on pre-written interviews with patients. I literally get a typed up interview of the patient and every lab and clinical value I could ever ask for.

Do I learn? Yes.

Is it practical? No.

As of now, I like it, because it strengthens my learning - but I seem to be one of the few who realize this type of stuff doesn't happen all too often in the actual workplace.

I also am required to counsel on random medications throughout the semester - I get to look at the script (and only the script) and I also get as much time as I want to collect my thoughts before I start counseling.

Real world application? 1 out of 10.

Will I have infinite time to "collect my thoughts", without being able to look anything up? No. I'll have seconds - minutes maybe, and numerous resources to glance at. (Should I need the resources? No, absolutely not - not for common drugs.) My time is limited. I understand this is a learning exercise though, so I'm giving a pass on all this.

HOWEVER, having the bottle right there improves consultation immensely. You can point out how many refills, when to take, how often to take ect. ect. blah blah blah. Most importantly, special considerations (take with food, refrigerate, or do not drink grapefruit juice ect.) are almost always included on the bottle, which is a great resource to both us and the patient.

Now, should we know the special considerations for common drugs? Of course! However, we're all human and forget things from time to time.

So throughout my education I've been given:

1. More information about a patient than can be expected in a community pharmacy

2. Adequate time to review the patient's medications and comorbidities.

3. Inadequate prescription information for counseling

As far as my experience goes and from what I've read - my school is doing the opposite of what happens in the real world in at least these three categories I arbitrarily came up with.

My future job scares me - I'm not going to lie. I want to help this stupid population of people, but I'd rather do nothing than start harming it - and I'm scared I'll be rushed and eventually harm it.

Crap.

So P3 year kinda blows

Hello there,

This isn't exactly new to me, but I haven't posted much in the past year - mostly because I had no pharmacy news/too busy doing pharmacy/work stuff to write my opinions blah blah blah.

This year has been interesting - in that I'm busy *all the time* with school work. Yes, I have days off, but I have 2 jobs because someone has to pay tuition and well, let's face it, my roommates aren't gonna do it. It's been interesting because I've been doing everything I can to keep my life in balance - I still go hunting with my best friend on the weekends and I still talk to my girlfriend as much as I can.

But it's taken a toll on my grades. I've got a B in one class and a C in another. While this isn't a big deal at all, it's a bit of a wake-up call to me. I view this year as the year I decide what is actually important to me and what I can slack off on - and time and time again I choose my friends and girlfriend above my school-work.

Maybe it's because I know I'll be fine with school. It's not like I'm going to fail - I'm still getting A's in most my classes, it's just the classes that require extra work that I'm struggling a bit in - It's that I would rather spend my time shooting ducks with my roommate or Skyping with my girlfriend than memorizing chemo treatments for NSCLC (non-small cell lung cancer).

So... No, I'm not going to be the encyclopedia of knowledge my professors want me to be when I get out of school. However, I will know where to find/look up all that information, AND I'll still have my best friends and girlfriend in my life.

I think I'll be OK. Don't you?

There's gotta be a retarded centaur

Think about it...

I was reading up on my diabetes notes and there's an actual brand-name drug named "Mixtard".

Tell me you don't read that and think of a retarded centaur and I'll give you a dollar. All I can picture is a horse with a human torso who just happens to have Down's syndrome trying to walk and yeah...

But realistically, if centaurs exist - as in humans with horse bodies - there's bound to be a mentally challenged one here and there, and as intelligent/caring creatures, they aren't going to make like lions and eat their retarded babies. So, eventually, there will be a fully grown mentally retarded centaur.

I believe one of those centaurs was diabetic, and the other centaurs figured out a drug to save him, and we humans discovered it from them. So, of course, we called it Mixtard, as a homage to the true genius who discovered it - the centaurs.

Or maybe we homo sapiens are just a bunch of fucking idiots.

Do you know what pisses me off?

Shitty teachers.

We have all had them. We all know who they are and we knew it three years before we were going to have them because every single person we know in the classes above us complained about them.

I have had many shitty teachers in pharmacy school. I'm taking a course right now that focuses on drugs that treat blood clotting diseases and hyperlipidemia and chronic heart failure, among other things. Pretty interesting stuff, right?

I mean, just look at blood coagulation. There are 13 different factors in platelet aggregation (not counting PF3). They are almost all affected by at least one other factor. There are numerous receptors on each factor and the platelets themselves, which are bound by one of the other factors. And they all have to work for your wounds to heal properly.

It's amazing stuff, and we have drugs upon drugs that treat someone who has a problem with their platelets over-doing it. We have drugs specifically designed to target one little receptor in your body that screws up what your body wants to do so badly that you won't die from acute pulmonary thromboembolism.

It's crazy, and it's downright interesting, and yet, I cannot stay awake in class. Despite the absolute awesomeness of the material I cannot stay awake, and it's because my teacher is shitty. He is boring. He is unprepared for class. He is probably a genius and most likely makes a shit-load of money for my college with the amount of research he does, but when it comes to teaching, he doesn't know squat.

Yes, he is Asian and English is his second language but I don't think that's the problem. He's about 40 years old and he acts like teaching us is a waste of his time. He walks in, reads off his slides and answers almost every question with "uh, yeah... sure."

I can't stand it. I'm supposed to be learning from this guy and one kid in class once said that extra bile goes to the pancreas and the teacher just said "yeah," and moved on. For those of you who don't know, extra bile is stored in the gall bladder, not the pancreas.

I have had a few great teachers, just like all of you had, and I wish I could say that the majority of teachers in my pharmacy school are good teachers, but I can't. Most of my teachers suck. I usually end up learning, not studying, the night before a test.

I hate it.

Where are all the Finnish Fish?

Think about it.

So You Want To Survive Your Second Year

Good luck.

After your first year, with biochem and all those other seemingly pointless, ridiculously demanding, and let's face it, stupid classes that stress the importance of <797> and OBRA 90 when in practice those regulations are put on for show once in a while when the inspectors show up, you can almost guarantee you can bullshit your way through class, like you've done before.

Wrong. This year, the college will finally teach you about drugs. There's no bullshitting when it comes to drugs. Ah yes, you may think just any NSAID will work for gout, since that's what you read when you skimmed the notes, that NSAIDs are a treatment for gout. What you didn't read was that indomethacin is pretty much the only NSAID good at treating acute gout attacks, and that a xanthine oxidase inhibitor (allopurinol) can prevent pretty much any gout attack, as long as it's taken regularly.

Have fun trying to convince your professor that aspirin can treat gout, because they ain't happening. Besides, why the hell do you think aspirin is a traditional NSAID in the first place? Get your damn act together.

This is the world of second-year pharmacy. We get into pharmacy because we are Type-A folks who love black/white. Take this, not that. This will work, this won't. And yet, aspirin is an NSAID but kinda-sorta-not-really. Trust me, the aspirin example is bush-league. There are exceptions to every damn rule you'll ever learn.

Apparently pharmacy is more like English than I thought.

To survive your second year of pharmacy school, you'll probably have to put down the booze except on rare occasions, and study your ass off. This is the year the teachers finally decide you can learn about drugs, and they throw them all at you in quick succession. There's no warning, no "Hey we're going to teach you about real stuff now."

It's just a relentless bombardment of drug facts with grey areas, and you're expected to know everything about everything. No exceptions, no excuses.

Sure, you can still graduate with a C in a couple classes, as long as your cumulative GPA stays above 3.0, but let's face it, you're an obsessive, controlling neurotic that strives for perfection, and a C will probably send you into a shame spiral resulting in a nervous breakdown.

Put down the bottle, grab a packet of notes, and get reading. Your sanity depends on it.

Good luck.

Holy Shit I Forgot About My Blog

Hello everyone,

I literally, totally forgot I had a blog. Does anyone want to guess why?

Ah, I see you guessed, "Because supporting yourself with two jobs while attending pharmacy school makes pretty much everything else in life irrelevant." You are correct sir/madam.

Ok, with that being said, look forward to my post about surviving the second year of pharmacy school (Protip: it involves NOT getting drunk... like... ever...).

It's a sad year.

The Difference

Every single day, I wonder about how my life would turn out if I went into retail.

I read Drugmonkey's blog regularly, and I enjoy most of his posts. I read Jim Plagakis just as much, and I enjoy most of his posts. I read Angry and Angriest and Pharmacy Chick and Pharmacy Mike and I Want To Be A Pharmacist and around twenty other pharmacy blogs irregularly, but I don't think I've ever read a pharmacy blog about the experience of some pharmacist in any other position other than retail.

Of course, I understand why, retail is frustrating. It's infuriating . John Q. Public is either an asshole or ignorant, and it's hard to excuse either of those categories.

Fortunately for me, I got out of the retail business, at least temporarily. I now do research with Aspergillus fumigatus and the allergic response. I've done this for a few weeks now, and I can tell you that it is much better than retail. However, I'm a mere first-time research assistant so I get the shaft. A lot.

I spent three hours the other day washing mice containers. They do not smell good. They are not even remotely clean. They need scrubbing by hand. It takes effort.

Another day I spent four hours sitting on my ass doing nothing. I stared at the wall. I was waiting for the proteinases to do their job to help purify our DNA sample. It's literally a "hurry up and wait" type of business.

So far though, if asked if I would do the same thing again, if I would leave retail and go to research, I would. In both jobs I worked with smart people who care about what they are doing, and both jobs have their downfalls. However, research doesn't have the general public. I never have to explain to a woman who is hard of hearing that she needs to see her doctor because she's out of refills.

It's nice. I like it, so at the end of the day, when I think about how my life would be if I went into retail, I look at my past experiences and my current ones and the scales are tipped disproportionately toward research. Despite it's boring moments, there are absolutely zero frustrating encounters with the general public, and I love that.

When they don't listen to you, what do you do?

Oh my fucking god I want to kill my girlfriend right now.

What do you think of when you hear these symptoms: eye pain, blurry peripheral vision (some of you have already figured it out), nausea, redness of the eye, and the big one: halos around lights?

These are all symptoms my girlfriend is experiencing right now. If you're thinking glaucoma right now, thank you. You have proven my point.

I know, she probably just needs a new prescription for the lenses she doesn't wear on a usual basis. But according to the pathophysiology class I'm forced to attend to learn about the causes of disease rather than the treatment of them (but that's a different post), all of those symptoms are completely classic for glaucoma.

If your girlfriend showed these signs and you didn't say anything, didn't make her go to the doctor, didn't try to help, and she wound up blind, how would you feel?

Now if you did show your concerns, showed her the evidence, showed her every possible thing you could to get her to go to the doctor, and she still didn't listen to you?

Exactly how would you feel?

Because I'm frustrated.

The Last Monday

Last Monday I woke up to my alarm clock, and I instantly knew something was wrong. Normally when I wake up there’s a bright ray of just-risen sun shining through the edges of the Venetian blinds that cover the East-facing windows of my bedroom. Not on Monday though. No, my room was void of any bright light. However, a dull red light seeped through the cracks of the blinds.

I looked out my window to see what was the matter, and lo and behold, I saw what had become of this world. After passing health care reform, the now Socialist nation that was once the world’s only super-power had turned the world upside down. I should have known that allowing our government to levy taxes on its people to allow the less fortunate to purchase life-saving health insurance from private companies – the very definition of Socialism – would create the world I saw from my bedroom window.

What I saw was the beginning of The End. The Apocalypse had begun. The sky was blood red and had ripped open. I saw the Four Horsemen galloping through the sky, creating war, famine, death, and conquest in their wake. I should have known, for the very first sign that The Apocalypse was near would be the complete government take over of the freedoms of the American people.

I wept for my lost freedoms. I wept for my freedom to be booted from my health insurance the minute I contracted the HIV virus. I sobbed for my freedom to be denied coverage because my mother was so inconsiderate to let me be born with a cleft palate. I fell to my knees and shook, because I knew my freedom to file for bankruptcy because of health care expenses was no longer an option.

As I came to grips with the knowledge that the world was ending, all because some majority-elected officials decided they would like it if 32 million more people, people that could potentially vote for them in the future, were granted affordable access to one of the best health care systems in the world, I heard a ringing.

It was my cell phone, and the 7:15am alarm was ringing, telling me it was time to wake up for the day. The sun shone through the edges of my Venetian blinds straight into my eyes, and when I closed them against the harsh light of day the light still reached my retina, although stained red by my eyelids.

I rubbed the sleep from my eyes, and smiled, knowing I had lost the freedom to be forced off my parents’ insurance plan for four more years.

A sigh of relief

I've never been so happy to hear about vaginal bleeding. That is all.

Planning

I have found that whenever my life deals me a hefty dose of stress I tend to completely shut down and think out every single option I have and mentally travel through each option.

Notice I said "life." Not work or school. When work or school throw stress at me I start working faster and just power through what usually amounts to a bunch of repetetive tasks done on autopilot (counting pills, taking notes). My brain is completely focused on one thing: 5, 10, 15, 20, 25, 30; "children taking steroids can experience slower growth." Ok - Got it.

However, when life throws me problems my mind goes everywhere. Life isn't black and white, there are so many shades of grey they turn into colors, and my brain wants to know every color, now.

Anytime I have to make a big decision I talk about it with everyone I trust in my life, but in my head. I don't actually speak to them, but I definitely have conversations with them; they just don't know it. My parents and sister have given me an insane amount of advice that they never actually gave, and it seems to always lead me in the right direction.

Sometimes, if I have a seriously big issue, like "oh shit my girlfriend might be pregnant," I'll end up working out solutions in my sleep. I kid you not. I'll plan and figure out exactly how I'm going to solve each problem, all while I'm asleep. It's not a very good sleep; I constantly wake up and rehash things in my head, but I usually wake up in the morning feeling... great.

Not because I'm refreshed and ready to face the day, but because I've figured everything out. No situation is hopeless, and it seems like my sleeping brain can figure out the simplest solutions to the toughest problems.

Last night, I woke up around 15 times between midnight and 5am, and each time I seemed to have another piece of the absolute worst case senario worked out. If she is pregnant and if does does decide to keep it (which is completely her decision), I have a battle plan.

If I'm a father in 9 months, I know I will be prepared for the challenge. I know my parents, grandparents, and friends will help me in every way they can (because I asked them, in my head), and I know my kid will grow up right.

Of course, there are 1,000s of variables I can't even begin to identify, but if we keep the kid and raise it ourselves, I will know what to do. At least my brain thinks I do. I'll always be thankful that my brain can make quick decisions without me even knowing it.

Incidentally, sometimes my brain figures out plans of action to problems I didn't even know I had. One night, I jumped out of bed at 3am with a strategic plan with one end goal: buy gas. The gas station closest to my house was closed but the Holiday just a few more blocks away would be open. I threw on some clothes and was opening my car door before I realized it was 3am and I could literally buy gas at any other time of the day.

I can only hope that this pregnancy scare is exactly like my gasoline situation. Just a made-up problem my brain decided to fix on its own.

I'm worried

If there's one thing that scares me the most, it's having a kid.

Don't get me wrong, I want to have kids someday, but just not anytime soon. I want to be able to go out to the bars or go to a movie whenever I want to. Once I graduate, I want to become some sort of pharmacist (not retail) and have more money than one person from a frugal background like mine could possibly know what to do with. I want to take vacations and see parts of the world I've always wanted to see (Ireland, London, Seal Island off South Africa).

I'm still young; I have plenty of time to raise kids.

Right now my girlfriend and I are having a bit of a pregnancy scare. She was supposed to have her period 2 weeks ago, but she started birth control 3 weeks ago. As a pharmacy student, I know that it can only take a couple days for birth control to be effective, but it can also take up to a month. Consequently, I have used condoms each and every time we've had sex.

It would seem that we did everything right, but last week she started having some pretty bad cramps, and she's been nauseous for the past couple days. I know all of you are thinking that these two symptoms don't mean jack, considering both are very common side effects of birth control. I agree, but they are also two very common side effects of being pregnant.

What makes it even worse is that I know the timing of periods can get a little funky once a woman starts on the pill. This means we might possibly have to worry about this for the week for even longer.

Everyone I have talked to told me not to worry about it. I've told myself not to worry about it. With birth control being around 95% effective (due to noncompliance) and condoms being something like 95% effective, the odds are absolutely astronomical that she's pregnant. My best pharmacy friend, who's a P3, told me she's had this same exact scare more than a few times with her husband. I shouldn't be worried.

But put yourself in my shoes. I've got 3.5 years left of school. Expensive school. I work 20-40 hours a week (depending on the weekend schedule). I don't have the time or money to raise a kid.

I shouldn't be worried, but my girlfriend is having bad cramps and puking.

I'm worried.

IPPE

As part of the pharmacy curriculum, we have to do 100 hours of Introductory Pharmacy Practice Experience (IPPE) for the first two years of pharmacy school. This involves us students getting matched with a contracted practice site by some crazy algorithm program that not a single professor at our college can accurately describe.

The program allows us to choose which sites we want to go to in preferential order, but the problem is there's only a total of eight rotations in my college city. That means that less than 10% of my class will get to do their IPPE in our city this summer, which, if my math is correct, means over 90% of us will have to go out of town.

Not that that's a big deal, many of the practice sites are in or near our respective hometowns, but what peeves me is this - they asked us to tell them where we wanted to go, and that they would do everything in their power to get those sites available to us. They didn't though. The list of practice sites are the same as they were last year. Not a single new site was added.

Unfortunately for me, my hometown isn't one of the towns that was on the list last year. I told them about four different sites near my hometown that I would be willing to do my IPPE in this summer, and not a single one became a site that's available. This seems to be a tad bit insane, considering there really isn't another pharmacy school near my hometown, so it's not like those places need to reserve spots for other colleges. I really, truly think that the professor that was in charge of contacting these places really just didn't care one way or the other.

My guess would be that she sent an email to the HR department or something and then just waited for a response. If she didn't get one, oh well. If she did, cool. I'd be willing to bet her total amount of time and effort put into getting us practice sites amounted to the same effort I put into this blog.

It looks like I'm going to have to battle for one of those eight spots in my current city, and if my luck in the past is any indicator of how that will go, I'll end up in East-Jesus nowhere.

Top 200: Part 2

I was going to write these down sooner, but I had some things I had to deal with. Well, no, I didn't, but that sounds better than saying I was lazy and didn't feel like it.

Plavix = clopidogrel "A vixen is a girl, and Vulpix is a horse thing Pokemon so it clops when it walks."

Seroquel = quetiapine "Sarah quelled rumors by being quiet."

Proscar = finasteride "The pro car finished on steroids"

Flomax = tamsulosin "Tamiflu flows to the max, and it's a sin."

Cardura = doxazosin "The durable car drove off the zoo's dock."

Tessalon = benzonatate "Ben and Tess zonked out after they ate them." I fucking hate counting this drug.

Actonel = risedronate "The drones rise when I act on them."

Evista = raloxifene "Relax and look at that beautiful vista."

Detrol LA = tolterodine "I'm totally in debt living in LA"

Aricept = donepezil "Don't nap in the air except with a Pez dispenser."

Namenda = mementine "NAMBLA (North American Man/Boy Love Association) = me + men."

Soma = carisoprodol "So, ma, can I have a car lease and a pro doll?"

My two favorite:
Viagra = sildenafil "Slide in and fill."

Cialis = tadalafil "TADA!"

That's about it. Even after all of this, I still screw up on the Top 200 tests. I somehow manage to switch around the vowels during the tests, and it annoys the bejesus out of me. If any of you out there have some tricks to remember the vowels of all these drugs, I'd gladly listen.

Winter Break is Finally Here

Well, finals week is officially over. My transcript is going to show a GPA lower than ever, but a couple of Bs never hurt anyone, especially pharmacy students.

While my GPA may have suffered a bit this semester, every thing else in my life seems to be going abnormally well. I don't hate my job all the time, I've been getting in better shape, and I actually met someone.

Amazingly, this girl became interested in me not because of my extreme good looks or ridiculously hot body, but because of my writing. That's right people, I have started dating someone because of my writing skills.

Un-freaking-believable. I'm not complaining.

Now I can look forward to three weeks of reading for fun, being lazy, and hanging out with this girl while not trying to learn anything new.

Awesome.

A Complete Waste of Money

As I watched the robot fill the 20th prescription for zolpidem for the day, I wondered exactly why so many members of the ever shrinking middle class insist on using it to fall asleep.

Granted, they aren't on the useless products of Zolpimist or Ambien CR, and they aren't spending an extra arm and a leg for Lunesta (eszopiclone - oh yeah, I've been studying up on the Top 200).

But still, why waste the money each month when, for a one-time payment of $180, a patient could get the best sleep aid I have ever come across? This sleep-aid can be used over and over again and never lose its effectiveness. Actually, I only paid $60 for mine, and it's even more effective at putting me to sleep than the $180 version.

That sleep aid is my Biochem textbook. I seriously believe that Lehninger could make much more money by marketing his book as a sleep aid.

He could even mark the international version (the one I own) as a fast-acting version, because nothing puts a person to sleep faster than an all black and white Biochem textbook.

I have a quiz tomorrow. I'm sure I'll be asleep in 20 minutes. Goodnight.

Misinformed Doctor

We have one doctor in the children's clinic that seems to be a tad bit... slow. For one thing, she refuses to write for any amoxicillin strength except 250mg/5mL. Even if she wants 400mg PO BID 10D, she'll still write for amoxicillin 250mg/5ML, when every other doctor would write for 400mg/5mL.

I once called down and informed her that the 400mg/5mL existed, and she told me she knew that, but had been informed that the 250mg/5mL tasted better.

I informed her that we get the two different strengths from the same manufacturer and they taste exactly the same, but still to this day she still will not write for the 400.

While this is just a minor annoyance, seeing that we can fill the prescriptions with whatever strength we please, it is when the doctor writes incorrect instructions that obviously means she does not look at the prescription she writes that pisses me off. An example:

Zithromax 100mg/5mL
Take 6mL tsp today, then 3mL tsp days 2,3,4,and 5.

Now, anyone with a brain would know that she accidentally put the tsp in there, but according to the law I had to call and confirm the prescription. Unfortunately, that took about 10 minutes. 10 minutes I had to stand there and listen to the little kid cry and cry and cry and cry and cry while his mom tried without success to calm the little womb fruit down.

*Sigh*

Oh well, it really isn't anything to get all worked up about, but it still gets on my nerves when I have to listen to a screaming kid because some doctor does not check the prescriptions she writes.

Pulling It Back Together

Well folks, it looks like the whole not getting wasted 3-4 times a week and actually applying myself to pharmacy school is working.

I'm happy to say I have an A in every class except Biochem, but after this last test, I'm hopeful I can scrape by with a low-low A if I do well on the final, and a 90% is the same as a 99% when it hits the transcript. I don't think I'll manage to pull off the A, but a B isn't bad either.

I would apologize for my lack of posts, but all the writing I've been doing has been for my school newspaper, because I get paid to do that.

So... I've got another batch of ways to remember the Top 200, and I'll get to that in a couple days.

Smart-Ass Comment of the Week

I work on Friday, but I don't think I'll get a better chance to be a smart-ass than I did on Tuesday.

A mother comes in with a prescription for her daughter. I ask if we've filled for her before.

"Yes."

Awesome. I pull up the profile and see we haven't filled for her since 2007. I then ask if she got new insurance since then.

"No, it's the same."

Awesome. I enter in the prescription, it gets rejected by insurance claiming "FILLED AFTER COVERAGE TERMINATED."

Ok, the patient obviously has new insurance information. I ask to see her card. She hands me a card from a different state than her old one was from. I give her a look that I hope conveys my feelings toward her. It was my "You're a fucking idiot," look.

I'm about to enter in the information when the woman pipes up and says:

"In the past, most pharmacies have found that it only works when you don't put the letters in for the ID number."

Oh holy shit, by the time she was half finished with that sentence I was smiling my sarcastic I-want-you-to-be-hurt-by-what-I'm-going-to-say-next smile. I said:

"Oh, really? Huh, because -"
"Yeah we know all those little tricks," the pharmacist bursts out, completely interrupting me, which is probably a good thing.

I was planning on finishing the sentence with something like, "I've been working in this pharmacy for a while now, and I've never seen that. Weird."

Of course, the patient might still have thought that I was being serious. Oh well. Maybe I'll get another chance to ridicule a patient on Friday.

One can only hope.