- This topic has 264 replies, 30 voices, and was last updated 7 years, 4 months ago by .
-
Posts
-
Borrower of Some Common Sense’s account:
This question may be coming ~20 years too late, and probably should have been asked way back when I was deciding career choices..anyway, how much of that course load does the typical pharmacist actually use in his/her daily job? I would imagine that the physiology is important – in terms of knowing drug side effects, combining medications, drug classifications and comparison of similar drugs would all be important, but are the other aspects that you mentioned relevant to the practicing (retail) pharmacist- like mechanism of action, formulation, etc. Does it stay interesting or does the routine of counting out pills, labeling bottles take over?
Some common sense -“Now that you’ve decided to bring it up”
I brought up Lipitor after you!
“- would you like me to take a few accurate guesses at your health conditions and other personal data based on that bit of info?”
Go ahead! Btw, I take other meds. also.
And most people are or should be on Statins.
I am not Some Common Sense.
Health – I have several corollaries I can derive but for your privacy, I won’t continue this.
WinnieThePooh – In retail/community pharmacy, most of the information relating to drug classification, adverse events, dosing, duplicate therapies and drug combinations are used daily. Most pharmacy systems have a tool to identify drug interaction and therapeutic duplications and it’s my job as the pharmacist to decide what is real and what is not, what I know to be a problem and what is not. Some interactions or duplicate therapies are not a problem. Some are major problems. That’s my call.
Some of the information learnt is not used on a day-to-day basis but will pop up when least expected. Just the other day, I was asked by a doctor to recommend a dose of a certain antibiotic and how the medication could be converted to a liquid. That requires knowledge of dosing, antibacterial coverage, drug formulation and compounding techniques. That is not a frequent question but one that I have to be prepared for.
Mind you, if I’m in a hospital, those types of questions come up much more frequently. Or if I’m industry, I’m going to have very few clinical question but will spend most of time doing drug formulations.
There is a system of counting and verifying that does take control of the day but there is always those few things that occur every shift that make it interesting. Be customer behavior, customer questions, be it a hilarious mistake in a prescription, be it a life-threatening mistake in a prescription or a life-threatening drug combination that occurs – there’s always something that throws off the monotony.
“Not some common sense”- your work sounds very interesting and complex, and glad to hear that it does not become monotonous. Sounds like you do have a bit more than common sense and get to apply it daily!
Can you answer this question- what are the functional cellular effects of resveratrol metabolites? Literature has not been helpful.
Sparkly- Thanks for the advice, but “been there, done that”, my school days are long over. I have B”H been learning/practicing science for more years than you are alive, I think, but not as a pharmacist. There is always more to learn, which is why I love my job, it gives me opportunity to learn and think all the time.
Sparkly -“WinnieThePooh – whats your job?”
E/o knows his job – he’s searching for Honey!!!
Health- do you have any? Been trying to make some in the lab by incubating sucrose with acridine orange, but while it gave off a nice glow under the microscope, it didn’t taste anything like honey. And then the people from Safety came and made a big fuss that I was eating inside the lab and wearing my red shirt and not a regular lab coat. Sigh. Life was easier back in the 100 Acre Wood.
Some Common Sense: fenofibrate Vs. Niacin as second tier choices to lower LDL, raise HDL, and lower triglycerides, in very old folk, go!!!!
That will keep you busy.
Also, which antipsychotics can be mixed into and taken with food so as to disguise it? Asking for a friend 🙂
WinniethePooh – from a medical standpoint, I have (worryingly) been told by PAs and doctors that they will sometimes rely on the pharmacist to “proofread” their orders. While this is very very wrong and medical personnel should be absolutely sure that what they are ordering is correct, this places the pharmacist in a sort of “watchdog” position and they need to know dosages perfectly as well as drug drug interactions.
Your job sounds kind of cool though. All I know about labs is, “If it looks like water, it probably isn’t!”
IP -“While this is very very wrong and medical personnel should be absolutely sure that what they are ordering is correct, this places the pharmacist in a sort of “watchdog” position and they need to know dosages perfectly as well as drug drug interactions.”
I would never do that!
The problem in this country is they make schooling very hard, so there’s a desperate need for med professionals. So many of them are foreigners.
“The problem in this country is they make schooling very hard, so there’s a desperate need for med professionals. So many of them are foreigners. “
So you are saying that the pharmacist needs to be a watchdog for the foreigners? Presumably for the foreigners to get licensed in the US they have to prove their competency. I heard from students that the boards for foreign-born students were harder than for US students. Don’t know what licensing procedures are for those already qualified doctors who want to practice in the US.
In any case, even if the doctor/PA is sure of what he wrote, it is still good to have another layer of review in place. That saying, do all pharmacists realize that they should be checking the dose etc?
Winnie
It has nothing to do with foreigners
Btw ” the boards for foreign-born students were harder than for US students” Isnt true. The boards are the same. Though since US schools/residences train for the boards US grads have an easier time passing, but it is the same test.
That said the Boards doesnt test dosing. Dosing doesnt depend opn how good you are there are practically infinite doses (ok not literally) when you consider all the meds available, some doses change based on age, kidney function, liver function, indication.
Of course every order should be checked before being entered but the reality is that this isnt practical. Especialy when you consider circumstnces chaneg in hospital setting (eEg Crcl is less than was a week ago, now dose needs to be changed)
So what Ironpenguin says is 100% true (again not that it should be that way) “PAs and doctors that they will sometimes rely on the pharmacist to “proofread” their orders.”
Of course this is further complicated by the fact that pharmacies rely on an out-dated measure of kidney function which is no longer considered accurate but when doses were studied they used that modality.
Health, what did you mean? That the problem is too many foreigners that don’t correctly write scripts, leaving the pharmacist as the watchdog? Or is the problem the shortage of medical professionals, they are over-worked, meaning more falls on the pharmacist, and the comment about the foreigners just another ramification of the problem.
In any case, the next time I am waiting in line for the pharmacist, wondering why it is taking so long to serve each customer, I will appreciate him/her more!
Wtp -“So you are saying that the pharmacist needs to be a watchdog for the foreigners? Presumably for the foreigners to get licensed in the US they have to prove their competency”
They have to be the watchdog for e/o! And it’s not just foreigners that are incompetent! But I think they have the most part in that group!
Borrowing Some Common Sense’s account again:
Sparky: how hard is pharmacy school? Remember tthat sense of “why this class is so hard” that you just expressed – that’s about standard for all clinical courses. Imagine two or three of those kinds of classes with two others that are only a bit easier and you have a reasonable expectation for what a semester is like. Find a job in a pharmacy and you’ll have a better idea of what happens.
Winnie: nice line about acridine orange. Current data is unclear about the effects of resvertrol metabolites but I still have a thirty some odd studies to sift through to find some info. Where did you look for literature?
Ironpenguin: niacin has a histamine related reaction and that is indicative of efficacy (one other drug will cause a headache and if it doesn’t the medication expired – which one?) but that reaction is very troublesome and usually requires premedication for a period of time. Few people take it, beside for the fact that many insurances will usually not cover it. So fenofibrate. Pop quiz – What wrong with gemfibrozil?
Antipsychotics – which class? There are several classes of antipsychotics – typicals, atypicals, SSRIs, SNRIs, mixed – which do you mean?
Health – foreigners are no different from American trained prescribers. They all try to be accurate but everyone makes mistakes. Dosing is only one of a battery of things we check for before a prescription leaves out hands. Rest assured, your prescriptions undergo a through review before you get them.
My experience is that prescribers try to titrate up a dose and exceed recommended levels (what’s wrong with Valtrex 2g twice daily for ten days? What should it be?). And we will call you out on it. It stems from a lack of knowledge of how far a certain drug can be pushed before becoming dangerous. What’s the maximum amount of Tylenol you can give in a day? Foreign trained or not, it’s the same issue across the board.
Remember – all substances (yes, even water) can be poisons, it’s the dose that matters. Nitroglycerin is an explosive but when dosed in micrograms, it is very helpful for reducing cardiac preload. Warfarin was originally designed as a rat poison but is extremely widely used as an anticoagulant. Even drinking alcohol has its place (what do you use it for?). Dose is extremely critical.
Ubiquitin – the doctors use the CrCl that shows up in the computer system and is automatically calculated from the patient’s height and weight. This can be erroneous because some CrCls need to be adjusted for various reasons as you pointed out. Medicine and Pharmacy use the same number, except that occasionally Pharmacy will hand calculate CrCl when doing high-risk medications (phenytoin, heparin, vancomycin…) Also, drugs are given dosing ranges precisely because of the factors you mentioned.
Common Sense’s Borrower….
Thanks for the info. Do you mind me picking your brain? Is it like asking your lawyer neighbor for free legal advice?
All I’ve done is simple PubMed searches. I have only come across studies describing effects on drug availability, or effects on metabolism of drugs applied as co-treatment. I’m trying to figure out if the unmodified drug has different cellular effects from its metabolite- specifically, why resveratrol is not lethal to lung cancer cells when glucurodination is blocked.
Thanks!
Common sense’s friend
No argument, though what I was referring to is that my understanding is that Meds are dosed based on the cockfort-gault model. MDRD is used by most EMR’s so there can be differences and MDRD is more accurate.
It gets trickier in an acute setting where a rising CR say was 0.6 yesterday today is 1.6 today and pt is anuric. GFR is essentially 0. Yet appear to be in the 50’s if dont take the entire pt’s picture into account
Borrowing Some Common Sense’s – “Health – foreigners are no different from American trained prescribers. They all try to be accurate but everyone makes mistakes.”
Why did you post to me – when I wrote this – “And it’s not just foreigners that are incompetent!”?
The Vilna Gaon wrote many books on trigonometry, maths astronomy and other stuff. A grandson published a some. And Rabbi Yitzchak of Acco 700yrs said the world was DATED AT 15 billion years – same as scientists now. And Rabbi Zacuto invented the boat compass.
What would the world be without Jewish people?
It has to do with how many atoms the electrons are spread over. A localized lone pair stays near one atom in a molecule, whereas a delocalized lone pair is spread between two, or even more, atoms. An example of a localized lone pair would be an ammonia molecule, NH3, because the lone pair on the N cannot be spread over the hydrogen atoms. An example of a delocalized lone pair would be in acetic acid (CH3-COO), where the lone pair on the oxygen can be spread over the entire carboxyl group. You need to know about resonance structures in order for this to make sense. In a nutshell, if you can draw a resonance structure, the lone pair is delocalized. If you cannot, it is localized.
Sparkly,
I am the true Some Common Sense. As a Professional Chemical Engineer, I had to take a LOT of chemistry, physics and math. OChem does not have to be hard except most people find it so because 1) there is a lot of material to memorize and 2) you must apply it. Most students learn to memorize and regurgitate what they memorize; this one of the first major classes they must apply what they learn. So, use this class to adapt to learn this skill; you will need to for your future.
This is the one borrowing Some Common Sense’s account.
WinnieThePooh – No, I don’t mind. Resveratrol seems to cause it’s antineoplastic effects in the G0/G1 – S phase transition via the induction of Caspase-3. The raw chemical has a very short half-life in circulation requiring gram doses to be effective in raw form. The glucuronidated form is more stable and has a greater Cmax resulting in a greater biological effect.
Mods – I wonder if there is a way to share emails. This is not the right forum for this discussion.
Ubiquitin – Your point is quite true. I was referring to medications such as vancomycin and aminoglycosides which individually dosed based on CrCl. The actual math behind the protocols is heavily based on various patient factors and an accurate CrCl is one of them. The situation you mentioned about an apart change in CrCl based on an increase in SCr become quite relevant.
Health – my comment was simply that neither group is incompetent. Each try to do their best but make mistakes. I don’t think that any prescriber tries to be incompetent no matter how it may seem to other people. But enough trivialities.
Sparky – 2-3 orgo-hard courses and 2 easier courses. Weekly exams. A teaching technique that is consistent with straight memorization but a testing format that demands application of said knowledge (oh and they never tell you how to apply what you learned plus many of the applications are based on the professor’s experience so you never really know if you have the right thought process). As Some Common Sense said, application is not something that many people are capable of in undergraduate study.
Borrower of Common Sense (funny that common sense can be loaned out- this would be wonderful if it could be loaned out on a large scale ;))
Thanks again. I am actually looking at Res. ability to induce autophagy, not apoptosis, in cell culture. Its stability in circulation doesn’t apply here, which is why I was wondering if there was still a difference between raw and modified. But it turns out on closer inspection that the difference in effect that were observed were not statistically significant, so I don’t think we will be continuing this line further. Thanks anyway…too bad we could not continue via private email, I guess we have bored everyone enough already.
Some common sense -“I don’t think that any prescriber tries to be incompetent no matter how it may seem to other people. But enough trivialities.”
No one tries to be incompetent!
“Health – my comment was simply that neither group is incompetent. Each try to do their best but make mistakes.”
And my comment was that both groups have incompetent practitioners!
Is a 70 bad? I’ve had plenty of classes where a 70 was good
“If you can draw a resonance structure, the lone pair is delocalized. If you cannot, it is localized.”
So the physical state of localization is dependent on my particular artistic ability!
That’s spookier than the double slit experiment!
That’s ok sparkly. The explanation is complex and on a need to know basis. And I don’t need to know.
Anymore.
Sparkly,
I humbly recommend that you memorize the naming, basic group and fundamental reactions; you will need them over and over again. That is how I got B’s in OChem 1 and 2; it is a lot of work and take 1-2 hours/hour of class. Also, be thankful that you do not need to take PChem or IChem!
The borrowed “Some Common Sense” is a very close relative who I trust.
Borrower of Common Sense -“Rest assured, your prescriptions undergo a through review before you get them.”
Your whole post is a joke! Your implication that you have to check up on us is ridiculous! Granted there are a lot of incompetent practitioners, but not all of us.
Today I had to waste my time because the pharmacy got mixed up between two meds beginning with the letter P.
I didn’t ask.
Although I did make an extremely funny joke.
But Health, how is the pharmacist supposed to know who is the competent one and who is not? Even if the incompetent are only, say, 1% – that is still a huge amount of potential error, especially for those whose Dr happens to be in that 1%. Isn’t it better to have the extra check in place? And even competent people can make mistakes.
And as you said, you are checking up on the pharmacist. Better to waste the Dr’s time, and the pharmacist’s time, then to harm a patient!
sparkly
“sorry cannot explain what resonance structures are especially since you havent even taken the gen chem basic classes required for organic! maybe someone else can explain it????”
force yourself to explain it. that is the best way to make sure you understand and remeber it. (Not necessarily here)
Feivel
I too thought it was an extremely funny joke
- You must be logged in to reply to this topic.