Attacking the Press

Any politician that attacks the media is afraid of what the media can uncover. That politician is doing something embarrassing, unethical, or illegal that they do not want you to know about. You should vote for the other candidate immediately. Calling the press “the enemy of the people” is a tried and true technique from the dictator’s handbook, a tactic used by Hitler, Stalin, Sadaam, etc. This is not metaphorical or hyperbolic. Trump is AFRAID of what the press has uncovered, what the press will uncover and that the American people will understand just how corrupt he, his family and his administration are. 

There are few things as American as a free press and this is yet another American value the Trump/Republicans have degraded. 

H/T to /u/jaydawg69

This week the White House has gone to great lengths to help the Saudi’s cover up the murder of a journalist. The journalist was an American resident and worked for this country. Interestingly, he wasn’t put on a Saudi blacklist until AFTER HE CRITICIZED President Trump. Meanwhile, Saudi money flows into the US to pay for our obliviousness. A question that has not been asked about previous presidents must now be asked - how much of that money is going directly into the Trump family?

And still, the President encourages and celebrates violence against the media. Trump praised the Congressman that pled GUILTY TO ASSAULT on a journalist last year. Where’s the decency, the civility, the respect?  It doesn’t exist. Trump and his supporters don’t actually appear to support anything America actually stands for. 

The Importance of Pre-Existing Conditions

At this very moment, it is illegal for insurance companies to deny you or your loved ones health coverage is you have a pre-existing condition. They can’t, it is a popular part of the ACA, or ObamaCare. The Republicans have voted 72 times to remove protections for patients with chronic health conditions. The Republican Party will allow insurers to deny coverage for pre-existing conditions. Apparently some candidates are blatantly lying in adds to make you think that they won’t. But they will. They will do it quickly and quietly as they pocket donations from the insurance companies. 

Conditions which include diabetes, high blood pressure, cancer, childhood cancer, and pregnancy. If Republicans succeed, if you fit in these categories, the insurers can either outright deny you or increase your price beyond what you could pay. 

This is not a hypothetical situation - this is how it worked before the ACA was passed. This is why we had so many medical bankruptcies. This why people were stuck in jobs they hated to maintain health coverage - preventing people from find the jobs they love or taking a risk on the next big idea and starting their own business.  Now, bankruptcy filings have been cut by 50%, thanks to Obamacare and the Obama Economy.

But hey, if you are okay with a child cancer survivor being denied the coverage they need later in life, then vote Republican. If you think that health care is a right, described in our Declaration of Life, Liberty, and the Pursuit of Happiness, then vote Democrat. The choice is not that hard. 

https://cdn.cnn.com/cnnnext/dam/assets/170504112456-gfc-healthcare-states-with-highest-pre-existing-conditions-exlarge-169.png

Fear and Immigration

As with nearly every subject, the Republican Party is dreadfully wrong on immigration.  It seems to me their entire is FEAR - be afraid of immigrants, be afraid of Hispanics, be afraid of Muslims, be afraid of children, no matter what, be afraid, be very afraid. But the only thing to fear is exactly how many Americans subscribe to this fear mongering and racism.

And yes, the party’s attitude on immigration is completely and totally racist. Why? Because the only immigration that the ever care about involves people with darker colored skin.  In fact, the second part to Trump referring to “shithole countries” was a remark about why don’t we get more people from Norway.  “Shithole countries” as a term to describe human beings who want to make a better life for themselves, people who go through an extensive vetting process and on average turn out more successful.

It’s also not about illegal immigration at all, because the Stephen Millers of the administration also want to restrict legal immigration. That’s what the “shithole” discussion was about. They simply don’t want more browns in this country.  Even to the point of arguing against reuniting families.  Supposedly the party of “family values” want to end what they call chain migration, but what is really called family reunification.  Because what we know is that people who immigrate with family members around do better. They integrate better, they succeed more, which is why this process exists.

Speaking of families, let’s not for get that the Trump administration has been systematically orphaning the children of people trying to come here.  Let’s make that more clear - TAKING CHILDREN FROM THEIR PARENTS AND PUTTING KIDS IN CAGES.  That whole process hasn’t been resolved.  We took the kids, deported their parents, kept the kids, and then claimed we couldn’t find the parents.  I do mean “we”.  Because it was done in your name, in my name, in our name.  The kids that are return have suffered severe mental trauma at our hands.  The “family values” party really, really sucks at “family values”.  Which is really odd considering how many times the Bible tells us to care for the immigrants among us.

A lot of the families that the Republican Party so gleefully ripped apart were seeking asylum.  Asylum is an entirely legal process where you come to the border, turn yourself in to an immigration officer and request asylum on the basis of persecution or fear of your home country.  It’s legal.  We destroyed families who tried to do things the legal way.  Not every petition for asylum is granted and those people are sent away. But it a legal process, agreed to by international treaties.  I make the point about asylum, because the “terrifying caravan” that has WALKED from Guatemala is the current fear mongering of the President and the reason 11 Jews are dead.

https://bloximages.chicago2.vip.townnews.com/claremoreprogress.com/content/tncms/assets/v3/editorial/5/97/597263bf-791e-5e26-b1b6-c9f6395504a6/5bdbe31ba74e8.image.jpg?resize=1200%2C800

The Caravan started walking during Holy Week to leave their home marred with violence to seek a better life in America. It started as like 7000 men, women, and children. That whole number won’t make it here - they receive asylum in the other countries along the way or give up.  But the ones that do, turn themselves in and request asylum.  Poor, tired men, women and children are now a political scare tactic of the President and Republicans.  For this, the President wants to send more troops to the border than we have in Afghanistan and has said that we could “open fire” on the children.  ON CHILDREN. I would rather send blankets, water and food, and let an immigration judge hear their request for asylum.  

But then again, I’m not the racist asshole sitting behind a Presidential desk.  Nor am I sitting on a couch on Fox & Friends continuing to spew this hateful garbage.  Recently, the President said that George Soros was paying for this caravan.  He’s not. But let’s look at it.  George Soros is a prominent Jew - most people don’t know who he is, but the white supremacists do.  The President’s lie was previously being spread around on Neo-nazi websites and one guy decided he would do something about it and killed 11 Jews in a synagogue and wounded 4 police officers.  That horrific event happened before the President gave it a megaphone.  You can’t say he didn’t know that it was dangerous rhetoric.  People have died and he supported the argument of the crazy guy.  Because he wants to pander to white supremacists.  He thinks that if he gets the white supremacists and you on the same side, then he will win.  That’s who he is grouping you with.  

That’s were the birthright citizenship comes from.  The 14th Amendment is clear.  If you are born in the United States, then you are a US citizen by birth.  It is clear as can be.  The Neo-nazis and the president point to the “jurisdiction clause” saying that illegal immigrants are within our jurisdiction.  Except that they most certainly are.  If an undocumented person commits a crime (which they do are a far lower rate than the current administration), then they can be prosecuted as they are within the jurisdiction of the US.  If they have a child here, then that child is a US citizen. It also comes down to this.  Even if you disagree with how the parents got here.  It has nothing to do with the child.  We do not punish children for their parent’s sins.  Now, if Trump can write an executive order striping the citizenship away from the children of undocumented parents, what is to stop him from striping the citizenship from legal immigrants? But it doesn’t seem like a good idea to argue that you can change the Constitution with a pen.  If he did it, it would be struck down immediately.  But that’s not the point.  It is a hat tip to racists.  It’s using their language.  Giving their arguments the appearance of legitimacy.  This is why white supremacists have become so emboldened under the Trump administration.

We can have a legitimate discussion about immigration, numbers, etc. We can debate an unnecessary $25 billion wall paid for by American tax dollars. But unfortunately, you have to get through all of this other crap first.  Because real debate aren’t the arguments the Republicans are making.  Republicans want you to be afraid of brown people.  They think that you will vote for them if you are afraid.  These choices aren’t hard.  Do you want to be a part of the party of fear and hate, or the party of hope?  Unfortunately, the Republican Party is no longer the party of Lincoln, Reagan, McCain or even the Bushes.  It’s the party of Trump and his hate is their hate.  Again. You might not hate immigrants, you might be mad about tearing families apart, or disgusted with the racist rhetoric.  But if you vote for the Republicans, then you are affirming exactly that.

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.

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.

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.

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.

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!

Back from New York

I just returned from a weekend trip to New York City.  We did lots of walking up and down Manhattan.  Saturday along included 38,000 steps on my FitBit.  The sights and sounds of the city were amazing, but one of the best parts was a Broadway show.  We saw The Book of Mormon, written by the guys from South Park.  I didn't know what to really expect, but if you go to any show, this one is worth it.

Here is their performance from the 2011 Tony Awards:

Fall PY2 - Week 4

Week 4!  The Labor Day Edition.  The week went easily with only 3 days of class and something to look forward to this weekend.  So let's see how it was:

Monday - Labor Day
No classes today which meant some quality time with the wife.  And a little preparation for this week's classes.

Tuesday
Drug Lit actually turned out to be pretty painful.  We were assigned two articles to read and then discuss in class.  The idea was that they were random controlled trials and we would analyze them and discuss how they worked.  But it did not feel like many people actually read the articles as the professor worked to pull 150 students along.  I really liked the step-by-step method of going through the articles from the title to the abstract and then into the body.  There were many layers to breaking down what was in a paper.  In the end, we only got through one of the articles.  It was about the use of long term hypertonic saline in patients with cystic fibrosis.  They thought that their lung function, measured by FEV1, should improve significantly.  It didn't, so the authors added a couple of numbers together to force in some significance.  While it wasn't their goal, they did show that hypertonic saline correlated with less infections in CF patients.

Med Chem was also a difficult class with another new professor talking about histamines.

Diphenhydramine - popular antihistamine

 Specifically at this time we are focusing on the antihistamines that block the H1 receptors mostly responsible for allergic reactions.  Mast cells in your skin release histamine when they sense injury which causes inflammation by triggering H1 receptors.  The first generation of antihistamines do a good job of blocking this reaction, but they can also cross into the brain which also has some H1-receptors.  This makes a person drowsy and we can use something like Benadryll (diphenhydramine) to help people sleep.  Newer, or second generation, antihistimines are designed to stay out of the brain.  Zyrtec (cetirizine) reduces inflammation but is also non-drowsy.

Therapy in the afternoon focused on the management of Type 2 Diabetes.  As it runs through my family, I have an interest in Diabetes.  The first treatment is easy - diet and exercise.  Then you get into the drugs - primarily metformin.  After that, things get complicated.  What do you add and when do you add it.

Wednesday
Lab was also about diabetes.  We checked our feet with a monofilament for neuropathy.  We checked our blood sugars - 95 after breakfast.  And we made an ointment for a foot ulcer.  The product took four hours to produce.  Lots of melting, mixing, and stirring.  Lots of stirring.  I stirred the mixture fairly constantly for an hour.  We had to come back later to package the ointment into a jar.

We didn't do any calculations this week in kinetics, but talked about the concepts of the equations.  I liked it better than the calculations which I could have just done on my own time.  These actually sparked intense discussions within our groups and as a class.

Thursday
Statistics in Drug Lit.  Only an hour going over descriptive statistics like mean, median and standard deviations.  A quiz determined if you needed to come back for the second hour.  Since I got all six right, I could go work on other things.

Med chem focused more details on the structures of first-generation antihistamines.  I had read the book on the section and felt a little lost.  But class really helped focus on the important details.

Therapy wrapped up the non-insulin portion of diabetes.  Start on metformin, add another drug, add another drug, start on insulin.  There are a lot of choices when it comes to diabetic meds and a lot to consider.

So that's the week of class.  I actually did a lot more for getting ready for next week when we have MTM, SOAP note, diabetes quiz, kinetics homework, kinetic quiz, lab preparation, and exam #1 for med chem.  My wife and I head to New York for our anniversary so I won't be doing to much school work.  I got many things done, but next week might be rough.  Until then, Have a great weekend!

Measuring Medicine

Just a spoonful of sugar can help the medicine go down.  But how much medicine are you taking.  Most of the time, that is an easy question.  The tablets come presized with 200 mg or 25 mg.  They might be scored for turning into half-sized tablets.  But what about liquids?  And more importantly, what about kids?

NPR published a story on the dangers of ineffective measurements.  Pediatric medicines require specific doses.  This is because kids come in all different sizes and side effects can cause serious problems.  But because kids don't like to swallow pills (even mixed up in apple sauce), many medicines are give as liquids.  Cough syrup, Tylenol, and Vancomycin all have versions as oral solutions.  So how much are you supposed to give the kid?  A teaspoon?  Tablespoon?  This can be a very important detail that leads to drastically different outcomes.  Studies show that neither teaspoon nor table spoon should be the best answer.  They are unreliable can mess up a child's therapy.

Instead, we turn to the more structured metric system.  You don't give the kid a teaspoon, but rather 5 mL.  You can give a syringe or graduated cylinder to help measure.  It's easier to measure, visualize and gives the right dose.  No matter what Mary Poppins says, the answer is not a spoonful.

The College Football Playoff is Real!!!

I have been waiting a long time for this.  Every year since 2006, I have drafted my own fictional College Football Playoff system that I believed should have determined the true National Champions.  At the end of this season, that dream becomes reality.  Well, almost.  The NCAA playoff will only feature the 4 teams at the top of a poll determined by a committee.  So close.  They have have control of 6 bowl games, that sounds pretty easy to get a 12 team playoff.  But hey, one step at a time.  The popularity of the College Football Playoff will generate enormous profits which will quickly lead to its expansion to include 8 and then hopefully 16 teams.  It never hurts to keep dreaming.

If you don't understand how the new system works, Slate put together this nice summary for you:

TED Talk Tuesday: Tony Robbins

Tony Robbins brings his powerful speaking ability as a life coach to TED.  He helps people make their invisible dreams become a physical reality.  Focus on the right details can make all the difference.  I told my players all the time that little things can make a big impact.

Enjoy!

Happy Labor Day!

Fall PY2 - Week 3

It has been a long strange week, but it is coming to an end with a long Labor Day Weekend.  So here's what happened in Pharmacy School this week:

Monday - Exam #1
With the morning off, I spent a good deal of time studying for the first exam of the year - Dermatology.  I didn't think the test was that bad.  Rumors were spread about the impossibility of this first exam.  But the professors anticipated it and seemed to have changed the format.  Then again, I never expected it to be too hard because the answer should usually be hydrocortisone, moisturizer, sunscreen, and/or antihistamine.  I will admit that because of this section, I used moisturizer on my face for the first time.  The result: several pimples on my nose.  No thanks!

By the way, the exam took about 30 minutes which meant a 90 minute break before the next class.  Jumping on a bus to head home was a thought that crossed my mind.  But I stayed for our Pre-Lab.  We had our first MRAP - an action plan for the patient's medication problems - due this week.  I wanted to make sure that I knew what I was doing.  I am still not sure, but it is done and I have three more this semester.

Tuesday
Back in Drug Lit we went through examples of searches through Secondary Resources.  We answered some questions by searching PubMed, EMBASE or Google (jk).  Simple process.  I like MeSH terms when applicable and I need to remember when to filter out options.  I particularly liked the article about the professionalism of pharmacy students on Facebook.  Hint: They are not too professional.  But then again, is this?

Med Chem finished up a lecture about G-Protein Coupled Receptors (GPCR).  Essentially a specific drug will either turn the receptor up, down or off.  Therapy returned with our first day on Diabetes.  It is a big section, and getting bigger.  A full 40% of Americans will be diagnosed with Diabetes during their lifetime.  Even more will have a loved one with Diabetes.  I expect a lot of future questions about managing the disease.

Wednesday - 2 Quizzes, Again
Today we made Coal Tar in lab.  We started with a quick quiz and more practice with Drug Information questions.  In the lab, we combined coal tar and salicylic acid into a cream/ointment to treat a patient's psoriasis.  The mixing process took a long time.  It looked and sounded like a training session to work at Coldstone.  We also made another batch using an unguator that only took 90 seconds.  Much easier.

At lunch we had a CAPS meeting and I was forced to do a Phlash Mob dance.  I ended up on the side out of the way expecting to follow the person next to me.  But she didn't know it either.  Oh well.  It was all good fun.  Afterwards we had another quiz in Kinetics about the basic equations that we used last semester - V, Cl, X, etc.  I think that I will like kinetics.  It's a math class.  Basically plug and chug.  But sitting in the class reminds me of my first year teaching physics.  While I might think that the algebra is intuitive and easy.  You have to go through everything step by step.  I worked my way through the practice problems for the day and then worked on the crossword puzzle.

Thursday
Drug lit featured one of my favorite professors giving the classic scientific method lecture about randomized control trials.  Instead of lima beans in saltwater, we talked about Cystic Fibrosis patients and hypertonic saline.  Med chem flew through Histamine receptors and their role in the body.  Histamine is released during an allergic reaction, but it also controls the acidity of your stomach and even your wakefulness.  That's why Benadryl makes you sleepy and Prilosec treats acid reflux.  After lunch, we had a second med chem presentation on diabetes drugs.  The number of medications just to treat a diabetic patient's blood sugar keeps going up.  They all have different methods of affecting the body.  We get to learn/memorize all of them.  Yeah!

It was a good week of classes.  I get a bonus day by working in the Inpatient Pharmacy on Friday.  I will be pulling drugs from the large, turning carousel from 7 until 3:30.  But after that it is Labor Day Weekend and the beginning of College Football!!!

National Immunization Awareness Month

As August comes to a close, so does National Immunization Awareness Month.
Unfortunately, I was unaware that vaccines received a whole month of education until the last week.  One of our Pharmacy Organizations has us posting Immunization Facts each day on Facebook and/or Twitter.  I support it.  Mostly because I believe in the proper education of patients about vaccines.  But also because I am allowed to immunize people as a PharmD student - which will be doing either at the Student Union or hopefully at the NC State Fair!

I stand by my claim that vaccines are the most important breakthrough in medical history.  We can actually prevent disease by taking the buggers, stripping them of their nastiness, and putting into a person.  Then the patient's own immune system can develop the defenses to fight off any attacks.  We have eradicated polio and small pox and made it so people don't die from the common infectious diseases of our past.  If you don't care about that, realize that kids don't have to get chicken pox anymore!  There a lots of other facts swarming Facebook, like Women should get a flu shots and a Tdap while pregnant to protect their babies.  If you want anymore factual information about vaccinations go to this CDC site.  It is a great resource.

Sadly there is still a thread of people who became convinced that vaccines give children autism.  There are even some Facebook threads spreading their "information" as well during NIAM.  Thankfully, Penn and Teller devoted an entire show to proving why their claims are "Bullsh!t".

Please go out and get vaccinated and help teach others about immunizations.

How Are You Still Alive?

The Universe is conspiring to kill you.  You body is under constant attack.  But most days, you don't die.  You don't even get sick.  This is thanks to your enormously complex immune system.  Full of B cells, T cells and antibodies, your immune system fights off invading armies of bacteria and viruses.


This video by Kurzgesagt explains the basics of keeping you alive.  I could have used this during PY1.

TED Talk Tuesday: David Kwong

David Kwong writes crossword puzzles for the New York Times.  And he's a magician.  Sounds like my kind of guy.  He spoke at TED about why we like puzzles.  Remember, we are all natural scientists.  We want to figure out what's going on.  We want to solve puzzles.  And we all want to know how the magician did that amazing trick.  Kwong performs such a feat on the stage that leaves you wondering about how he could possibly pull it off.

Enjoy!
 

Black Dog Syndrome

I have heard about this before, but Slate reminded me of the Black Dog Syndrome.  Americans love our pets.  And I love mine.  But there is a serious form of discrimination in the pet world.  People do not adopt black dogs.  Compared to their brown or golden cousins, the black dogs remain in the pounds and sadly end up being euthanized far more frequently.

Cultural stories cast black dogs (and black cats) in a negative light but it has a lot to do with the aspects of being a black dog.  Black dogs do not take good pictures.  We have far more pictures of the photogenic Augi than of the monochrome Charlie.  That's because Charlie's pictures don't turn out very well.  You only see his tongue or his outline.  I have to use the special filters on Instagram to get anything to show up.  This is true to animal shelter websites.  They post pictures of the animals up for adoption and people make their choices based on those images.  Making it hard for the black puppies.

So is it blatant racism?  Well not really.  It is all about connections - immediate connections.  Especially in the form of facial expressions.  Humans are hardwired to recognized faces and to understand what those expressions mean.  A brown dog can show a wider range of facial expressions which take advantage of our evolution.  It's also why puppies have big eyes.  Black pups simply can't demonstrate many facial expressions through their dark fur.  But that doesn't mean they don't feel or can't make great pets.  They have a marketing problem.

And now for gratuitous pictures of my dogs.

Charlie (Charles Robert Darwin)

Augi (Augustus Caesar)

Fall PY2 - Week 2

Made it through another week.  It still feels like they are easing us in a bit.  My week was easier that it didn't involve a dog emergency.  Augi is doing much better now.  His liver enzymes dropped from almost 8,000 to about 1,500.  Still above the 700 value of a normal, healthy dog, but he is headed in the right direction.  So let's look at how the week went.

Monday was a half-day.  We had the morning off, which I appreciated to get some work done.  I really only go 3.5 days on and 3.5 days off this entire semester.  I am going to enjoy it.  The first class of the afternoon was some more pharmacotherapy of dermatology.  Just so you know, the answer is always sunscreen and/or moisturize.  Has to be.  We talked about sunburns which was helpful for our SOAP note due on Wednesday.  The Large-group Lab class was more introductory and prepping for the labs this week.  There was much concern over how much we needed to learn about how the drugs work.  Since it is supposed to be about explaining things to patients, you didn't have to go into too much detail.  Instead of "amoxicillin inhibits the penicillin-binding proteins which damages the cell wall and leads to cell lysis due to osmotic pressures", you just needed to say "amoxicillin is a bacteriocidal antibiotic".  Done.

Tuesday went back to a full day.  We went through some cases (or applications) of tertiary sources in drug literature.  The type of question determines the source, but most of the time you should use Micromedex.  IV questions go the Handbook of Injectable Drugs.  Pregnancy questions go to Brigg's Guide to Pregnancy and Lactation.  Otherwise, go to Micromedex.  Med Chem was more about receptor signaling.  Specifically, about turning off the signal.  Cyclic GMP is turned off by
Phosphodiesterase (PDE) into GMP.  Viagra blocks PDE to keep cGMP on and help with erectile dysfunction.  The professor also talked about oxytocin.  It is such a weird hormone to me.  Oxytocin manages milk production and uterine contractions - both female jobs.  But males make it too, plenty of it.  That's because it is also related to trust and stress relief.  An increase of oxytocin makes us feel more relaxed and the easiest way to release the hormone is through hugging.  Which is why a good hug can make all of our problems fade away.  After lunch we had more therapy and more about sunburns and sun cancers.

Wednesday is lab day which means dressing up.  Or at least I thought so.  The number of ties on the male population dropped dramatically from week one to week two.  I will continue to represent.  We talked about our answers to the SOAP notes about a 20-year-old female with severe sunburn and acne.  I felt like I had all of the right answers, but I didn't give enough information.  Last semester's intense notes got Eurostile font to give myself more room.  I will have to go back to that.  Our quiz was straight forward.  The drugs aren't that difficult and the calculations are all review from last year.  After some other work, we looked at ourselves under the UV light (like the post from Monday).  I was scared.  I've coached outside through the middle of summer for a long time and very rarely ever used sunscreen.  A lot of freckles and clogged pores showed up, but nothing too bad.  There will not be a dermatologist trip in the near future.  After lunch came Pharmacokinetics and our first quiz - a review of pharmacodynamics.  Straightforward.  We answered some cases as a group by holding up letters to our choice.

Thursday rounds out the week.  Drug lit introduced secondary resources.  Pubmed and the Cochrane Review are my favorites.  I feel confident searching a database for articles.  But the term Boolean search through me off.  I could only think of boullion - the cubes of dehydrated meat stock - or boulliabase - French stew.  It only means the use of conjunctions to make to search broader.  Med Chem dove more into the important GPCR, receptors that make up about 1/3 of drug targets on the market and the most of drugs in the research pipeline.  Therapy, after lunch, returned to more about skin cancers.  I shared the UV video with the lab professor who sent it to the derm professor, who wanted me to introduce and show the video to the class.  Now, we have to get ready for the first exam of the year on Monday.  Thirty-six questions about dermatology.  That will make up a large chuck of my Friday.