Wednesday, September 24, 2014

Compounding in Pharmacy School

One of the more stressful parts of Pharmacy School so far has been compounding.  Compounding prepares a specific product for a specific patient.  As opposed to manufacturing that provides a more generalized approach.  You can remove excipients that might cause allergic reactions or you can simply change one formulation for another.  A lot of this is done for pediatrics turning a large tablet into a liquid.  So far in three semesters, we have made creams, sticks, solutions, and suppositories.

The actual compounding can be fun.  Manipulating ingredients to help a patient.  The stress comes from rest of the process.  We have a quiz on the various formulations in the form of questions written by the man who wrote the textbook regarding compounding.  We must complete a compounding record that includes the manufacturer, lot number, and exact amounts of every ingredient.  We counsel our TA as if s/he were the patient, so we memorize the major counseling points.  And every product is tested to make sure it is within 10% for the stated strength.  If your products falls outside of 10%, you have to come back and remake it.  If you are too far outside, especially too high, you have "killed the patient" and receive a zero without the option to remake it.

But I learned last week that not every pharmacy student goes through this.  In fact, only half of the pharmacy schools do any compounding at all!!!  For some, compounding is little more than an elective course that students take for a semester.  Few compound as regularly as we do.  Of those, very few routinely test the products for accuracy.  And we seem to be the only school that tests every product that gets made.  That means that they just go through the motions and hope that the products are good.

Much of this comes from budgeting concerns.  Compounding is expensive.  I know.  I bought lab supplies for my classroom.  It's not easy.  Checking the products takes more money and time.  Things that can be rare in a pharmacy school.

But compounding is important.  A study randomly checked some compounded products from some pharmacies and found a wide range of accuracy, from drastically underdosing (essentially a placebo) to dramatically overdosing (more than 400%).   A lot of the range comes from technique.  We hear a lot about quantitative transfer.  We routinely make 10% extra product to account for loss.  But in all, compounding is an important skill.  A licensed pharmacist may never, ever compound during there career.  But all pharmacists should know how to do it.  It's like parallel parking.  I avoid parking that way, but to get my driver's license I had to display enough control of a car to complete the task.  Maybe compounding should become an essential part of a PharmD degree.

Monday, September 22, 2014

A Different Timeline of Earth

One difficulty in teaching biology was explaining the history of Earth.  How do you effectively show 4.6 billion years to 15-year-olds?  I have used timelines, football fields, and even a piano to represent deep time.  There was a great TED talk on the subject as well.

I think that I like this one the best.  The details would be hard to show, but everyone would understand it.  Just use your arm!
It would be like a built in cheat sheet.  Everyone can bring their arm to the test.  I don't know if it would work, but it is an interesting way to think about time.

Friday, September 19, 2014

Fall PY2 - Week 6

It was another crazy week, so I apologize for failing to post this week.  Let's get right to it.

Monday
The first test of the week happened after lunch.  I had the joy of coming in early to remake my Coal Tar solution.  My first attempt had too many particles in it, so I spent an hour with two spatulas and yellow goo.  Then came the Diabetes test.  I did not do as well as I thought that I should have.  That came from complacency.  The dermatology test was so easy and my team tied for first in diabetes jeopardy, so I went into the test expecting it to be easy.  But it was much more about memorization than rationalizing.  The questions I missed were bullet points on the different drugs instead of other parts.  It is completely my fault.  I definitely should have studied much, much more.  Now I will have to make up for it on the test test.

Tuesday
Norepinephrine
The second test of the week happened first thing in the morning.  Exam #1 for Drug Lit was a mystery to me.  I did not really know what to study for it.  I decided to go back over the objectives, and I felt that it went much better than the previous diabetes test.  I still don't know how I did, but I felt pretty good about it.

Med chem has changed from histamine to adrenaline.  We reviewed the structure of norepinephrine and epinephrine.  This section will really get into all of our heart medicines.

Therapy was a divided class that began with more medicinal chemistry related to sex hormones.  Afterwards we started the next unit about contraceptives.  Lots about contraceptives.  In the remaining 30 minutes of the class, we flew through 90 slides about contraceptives.

Wednesday
More contraceptives.  Lab started by reviewing the brand and generic names of contraceptives and looked at two bags of examples.  I had to explain the advantages and disadvantages of Plan B and Novum.  Then we went to compound misoprostol vaginal suppositories.  Used to induce labor, the compound might have been the easiest formulation yet.  You just had to wait for the base to melt, mix and harden.

Kinetics went through the concepts related to multiple dosing.  If you don't know, steady state concentrations are reached within 5 half-lives.  If you have any doubt just multiply by five.  It was less about actually calculating things and more about the concepts.  Change the clearance, what do you expect to happen.

Thursday
More statistics for drug lit.  This time about risk assessments.  The students succumbed to a common mistake.  Would you take a drug that increased the incidence of something bad from 2 in 1000 to 4 in 1000?  Would you take a drug that doubles your risk of an adverse reaction.  Most people would say yes to the first but a definite no to the second.  Except the two are exactly the same.  Doubling your risk of something of something incredibly rare doesn't put you at a lot of danger.  Statistics are fun.

Med chem went into more about adrenergic receptors.  I like the new professor, but I could not understand him a few times.  He was very funny and trying to engage the students.
Norepinephrine in the binding pocket of its receptor.

After lunch, we had a professor from Asheville to come and talk to use about Contraceptives.  Instead of a lecture about the different types, we did a case about a patient who wanted to start using something.  We went through each category to see which would work for her and which wouldn't.  You do have to be careful.

Thursday night was a scholarship dinner at the Alumni Hall.  The Chancellor spoke to the crowd, the food was great, the conversations were better.  I don't know how you get on a board for a foundation, but I would be interested in doing something like that.  Overall it was a great evening celebrating the scholarship recipients and their donors.  I was most excited by meeting with the Chancellor.  I made sure to go up and talk to her.  She is incredibly nice and enthusiastic about Carolina.  She's doing a great job.

I had one last event on Friday.  As a Recruitment Ambassador, I gave a tour of the pharmacy school to prospective high school students.  They came from all over the state.  We gave them a quick tour and taught them how to take blood pressure.  That's it for the week.  No exams next week, but two quizzes.  I should get to do some relaxing this weekend.  We;ll see.

Friday, September 12, 2014

Fall PY2 - Week 5

Bryant Park, New York City at 11 pm
That was a heck of a week.  I apologize for not posting but everything got a bit hectic.  When things
get crazy, I will probably resort to only posting on Fridays.  The most important thing for me was coming back from New York City!!!  It was my first time in the Big City.  My wife and I went for our 5th wedding anniversary to see the sites and Manhattan and the Broadway play, Book of Mormon. It was a great weekend, with lots of walking.  But I felt a little behind all week, of course so did everyone else who didn't spend a weekend elsewhere.  So let's get to the events of Week 5:

Monday
This Monday started differently with an hour of Med Chem before therapy.  The professor wrapped up Second Generation Antihistamines and Mast Cell Stabilizers for our exam on Thursday.

If you can guess, in therapy we talked about diabetes!  This time we went over some different insulin regimens that people use.  We had a very hard pre-class quiz that took me 9 tries to finally get a 100.

Prelab was also about diabetes - specifically our MTM for a diabetic patient.  We were given prescriptions and we talked about what might be wrong with them and what we should prepare to ask the patient in Lab.

Later that night, I attended the training session for the Recruitment Ambassadors Program.  Now I can give tours to people, talk up the school of pharmacy, talk up pharmacy in general.  I could do that before, but now I get credit that I can put on my CV.

Tuesday
More statistics in Drug Lit.  Probabilities and Power were the main focus.  You show know that studies are powered (by sample size) to find the correct answer, but there is always a possibility of finding an answer that isn't there (Type I Error) or missing the answer that is (Type II Error).  The best part was the quiz halfway through which I passed to give myself a few hour to work on the other things due this week.

Med Chem brought in one of my favorite professors to provide the clinical details of antihistamines.  The main goal of antihistamines is to block H1-receptors which cause inflammation.  But the G1s are non-selective and easily enter the brain that they cause many side effects: sedation, dry mouth, increased appetite, etc.  So clinically, you can use those side effects as a potential treatment.  Colds do not have anything to do with histamine, but cold medicine usually contains an antihistamine.  The small molecules also block ACh receptors which dry out the sinuses to relieve your runny nose.

Therapy finished up the diabetes module.  We finished going over the insulins for both type 1 and type 2 diabetes.

Wednesday
This was going to be the rough day.  Two quizzes, a SOAP note and an MTM all were on the schedule.  So lab begins by going over our SOAP note for a diabetic patient.  My answers were similar to everyone else so I feel okay about it.  I might not get a 100, but I should at least earn an A.  I did the worst I have ever done on a lab quiz - worst of all it was because of the calculations.  I worked everything out to discover my two answers were off by 1000x.  In finding a mass, I messed up the Weight Percent (like 3% NaCl) as mg/mL instead of the correct g/mL.  I got cocky and it cost me 5 points out of 25.  The rest of lab was just talking about insulins.  We took a look at insulin pens and the subcutaneous needles.  Then we actually gave ourselves the shots we will have to teach patients to give, but with saline.  I did not feel a thing.

Kinetics was another quiz about continuous infusions and multiple dosing.  I was worried about this one because I tried to read the chapter on the plane headed to NYC.  That environment and the anticipation meant that I did not really grasp the fine details from the book.  When I got back to it on Monday and Tuesday, it made sense leading to a redemptive 100.

Thursday
Drug Lit was another article class.  The article was about? Diabetes!  Specifically a controlled, phase 3 trial for Canaflagozin, an SGLT2-inhibitor.  We went through the article in tedious detail (professor's words).  The major concern is the first drug lit test next week.

Med Chem was our first big exam of the semester.  GPCRs and Histamine.  I studied off and on all week.  That included taking the practice test on the plane ride home, when I only missed 2.  I was pretty confident.  Comparing answers with other people, there is a high probablity of a perfect score.

Therapy was an Q and A session on diabetes before our Monday exam.  I kind of didn't pay attention but instead focused on making a study guide for me to work on this week.  After the questions, a new professor flew through 90 slides about contraceptives.  It was so fast!  Some of it sunk in, but I will be looking over that again.  Any time she mentioned copper IUDs, all I could think about was the House episode with the nuns.

Thursday night included Diabetes Jeopardy for a CAPS event.  We got some CAPS points, but most importantly was review of diabetes and questions from previous exams.  I missed more questions than I thought I should have, but somehow we ended up tied for first place!!!  We both missed the first tie breaker, and then the other group got the next one right.  So we technically ended in second place without the certificate or mug.  I don't like losing, but we did beat everyone else!  Hopefully that bodes well for the test next week.

Well, that is all for a hectic week.  Next week will probably be the same with two exams on Monday and Tuesday.  I am looking forward to it.

Tuesday, September 9, 2014

TED Talk Tuesday: Andy Puddicombe

10 mindful minutes to clear your brain of everything.  Do nothing.  At all!  Get away from the world for a few minutes to recharge.  Andy Puddicombe spoke at a TEDx in London about mediation.

Enjoy!