Tuesday, April 27, 2010

A month away from the "lower 48"

Posted by Akin at Tuesday, April 27, 2010

Mary and I were two of five UM students who decided to brave the wild frontier this April and head to the Providence Alaska Medical Center in Anchorage, Alaska. Here are some of our experiences:

In the hospital

Akin: I learned a great deal during my inpatient cardiology rotation. I enjoyed that the emphasis was on 'quality over quantity'. Some days we would work up no more than 2 or 3 patients. This gave us the opportunity to really go in to depth about the therapeutic regimen of a patient and to review entire disease states and guidelines.

Mary: This rotation has been one of the most memorable experiences I have had in pharmacy school; and I am sad knowing that this is our last week here. Our preceptor, Dr. Bert Iaderosa, is very knowledgeable and well-versed in the cardiology guidelines at the hospital. He challenges us to not only master the cardiology guidelines, but to constantly apply ourselves as critically-thinking pharmacists in the clinical setting. He also understands that the students come to this rotation not only to learn about cardiology, but to experience "the essence of Alaska" as well. With Dr. Iaderosa's advice on all sorts of fun activities to do and places to go, we were able to take advantage of our time here in Alaska.

A memorable moment outside of the hospital

Mary: I have so many memorable moments. One that comes to mind is cross-country skiing at Hilltop. It was the first time cross-country skiing for all of us, so we were all pretty bruised up and exhausted at the end of the day. But the views at various points of the hill and trying something completely new was well worth it.

Akin: I had never done any type of skiing before, but when cross-country skiing for the first time I got the hang of it pretty quickly on the groomed trails. Feeling confident, a week later I decided to try back-country skiing where everything is completely ungroomed and there are no trails. I fell so many times that the binding connecting my boot to the ski detached and got clogged with ice and snow. I had to march 2 miles back to the base in waist high snow carrying the skis in my arms. I was also only in sweat pants. At the time it wasn't the greatest experience. But now I can look back and laugh. Haha. I was so miserable.

Final words

Akin: I've had adventures both inside and outside of the hospital in Anchorage. Years from now, when I think back to P4 year, there is no doubt that my moments in Alaska will be one of the first things that will come to mind.

Mary: This rotation is an incredible opportunity for students to be adventurous, challenge themselves, and explore Alaska. This experience is truly what you make of it, so take complete advantage and be outdoors as much as you can! :)

Sunday, April 25, 2010

"From soup to nuts"

Posted by Jeffrey Huang at Sunday, April 25, 2010

I really did not know what this saying meant until Stephen Smith, Director of Pharmacy used it a couple times to describe the rotation I would be experiencing at Karmanos Cancer Center.

This phrase really embodied the experience I would be getting at Karmanos, working in the many different areas of pharmacy that support the sensitive, meticulous, and careful preparation of pharmaceuticals surrounding chemotherapeutic care. I have always been fascinated with bone marrow transplant (BMT) and hematology/oncology, and my experience at Karmanos was a great segway into my next two inpatient rotations in these respective areas back at UMHS.

From beginning to end, as the phrase describes, and my rotation began with order entry and dispensing. It progressed to working in the IV and chemo room, where the chemotherapies were compounded by highly trained technicians and pharmacists. Towards the end of my rotation, I rounded with both the BMT and heme/onc pharmacists and visited the patients on the floor, and finally finished the month with investigational drug services (IDS). I was particularly interested in IDS at Karmanos as I will likely be on the other end of the service next year at GlaxoSmithKline.

In quick summary: I loved the rotation. The people really made the experience quite amazing. As Steve and others described, the group is really like one big family. People teased each other, cracked jokes, and played pranks like you would see with siblings. But everyone also really cared for each other and helped each other when in need. I feel like the lighter atmosphere the staff kept was vital for how somber the words "cancer" and "chemotherapy" can be for people. And after some testing of the waters, they happily welcomed me to the group. I really hope to keep in touch with everyone and have our paths cross again in the near future.

Sunday, April 18, 2010

Working on your behalf

Posted by Kendra Yum at Sunday, April 18, 2010

Ask any pharmacy student about what the FDA does, and you’ll likely receive a description of the agency’s role in the drug approval process. But exactly who are the pharmacists and scientists who work at the FDA? To find out, I hopped in a car and drove 500 miles to the FDA office in Maryland.
I had the opportunity to complete a rotation in a non-traditional pharmacy career and interned at the Office of Policy in Silver Spring, Maryland.

Here are a few highlights:
  • Meet & Greet Lecture Series – Each week, FDA pharmacy interns are invited to talks given by pharmacists and scientists about the Office that they work at. I met with pharmacists who are involved in the regulations of prescription drug advertising, prevention of medication errors, approval processes for over-the-counter, generic and prescription drugs. We also met with scientists who evaluate the safety of drugs during the development phase. It requires a tremendous amount of talent and efforts to ensure the safety of drugs from the start of clinical trials to after its marketing. Every step of the way necessitates safety assessments by the FDA to determine if the benefits of a drug outweigh the risk of its use.

  • Pharmacy “Field Trips” – For most pharmacy students, “US Pharmacopeia” brings to mind a thick red textbook on the shelf. I never would have imagined I could step inside the USP headquarters and see the laboratories that set the standards for all drug products sold in the US! (I also found out that Dean Ascione is part of the Convention membership that governs the USP.) Over the course of the FDA rotation, I went on multiple “field trips” to the headquarters of various pharmacy organizations. Seeing these national pharmacy organizations working to advance pharmacy interests gave me a greater understanding and appreciation of our profession.
  • Office of Policy – Within an agency as large as the FDA, how would you coordinate projects that require the collaboration of various offices and centers? Such a task is one of the many roles of the Office of Policy. One such project involves securing the drug supply chain to combat counterfeit drugs. The FDA is looking into the development of standardized numerical identifiers (SNIs) for the tracking and tracing of prescription drug packages. Securing the drug supply chain can prevent adulterated and subpotent drugs from reaching patients and compromising medication therapy.

This rotation has been truly unique in providing me with a new paradigm regarding the pharmacy profession. I had the opportunity to learn about the roles and responsibilities of the FDA and to speak directly with the many pharmacists working everyday to protect the public health by assuring the safety, effectiveness, and security of medications.

The Month of March on 9C

Posted by Shannon Hough at Sunday, April 18, 2010

I spent the month of March back at UMHS, on 9C, the inpatient psychiatry unit. Like most people, I was unsure of what to expect. The unit is a locked unit, and some patients are admitted via court orders or after being certified by a physician involuntarily. I spent the first few days becoming acquainted with the team and the unit staff and refreshing up on the side effects of psych drugs. Early on, my preceptor asked me what I would like to focus on during the rotation. I tried to think of things that I had done little of thus far. I chose patient counseling and journal club presentations. I may have regretted those journal clubs, but am glad that I had a chance to do some patient counseling.

I know, you think that patient counseling sounds like the last thing you would do with a patient who is requiring a psychiatric hospitalization. But I'm pretty sure that if you can counsel a patient during an acute psychiatric episode, you're pretty well equipped to provide good patient counseling!

True to my blogging form, I have story about a patient that I met while on this rotation. I met Mr. X during one of my first days. As some background information, he was not hospitalized voluntarily and had a number of personality disorders, as well as schizophrenia. He also had a court order to take his medications, after some legal proceedings. I will never forget the first time that we entered his room. The medical student taking care of Mr. X introduced the team and asked the patient, "How are you feeling today?". This question prompted the patient to speak for about 10 minutes on a number of unrelated topics ranging from his perceived history as a recording artist, relationship with a pop star, religious convictions, telepathic abilities, and his opinion regarding antipsychotic medications.

Our goal as a team was to get the patient to voluntarily take oral medications, which worked better for him than a long-acting injectable medication that we would be forced to give him if he refused. His list of previous medication trials was lengthy, and were either related to "that didn't work" or "that gave me side effect X". Many of the side effects were surprisingly accurate (although, I'm still not sure about his complaint of "itchy bone marrow").

I felt that the role of the pharmacist to care for this patient was huge. Even once the patient agreed to take the medication, and the orders were written, if the nurse came to administer the medications at a bad time, he could potentially refuse them based upon any ideas in his head. So I made recommendations right away for side effect prevention in this particular patient. Any adverse effects related to the medications could then cause Mr. X to put this agent on his list of medications that he would not take. I wanted to be sure the medication had a fair chance to work.

My patient counseling moment with Mr. X came related to a side effect concern as well. He was taking Depakote, which in his experience had led to hair loss. The mechanism for this side effect is through zinc and selenium deficiency from the medication, so supplementation with zinc and selenium may help to reduce the hair loss.

One afternoon, my preceptor and I approached Mr. X over his afternoon dish of ice cream. I introduced myself as part of the team, who had heard his concerns about hair loss with Depakote. This provoked Mr. X to tell me about something with his legs, but then eventually circle back to agreeing to talk about the topic. I then told him that the zinc and selenium could help to reduce his hair loss. He then told me medications did not make any sense at all and that he didn't need to take any. Some yelling (par for the course) may have occurred. I was a little bit flustered, but continued to ask him if he'd like to try the zinc and selenium. To my surprise, he calmly said yes, that he would like to try it, and thanked me for talking to him. We definitely called it a success!

Back to the lab

Posted by Akin at Sunday, April 18, 2010

When I was on my hematology/oncology rotation in August, I noticed that many of the patients had refractory disease. The nationally recognized NCCN guidelines has a treatment algorithm that often recommends "clinical trials" for these patients (depending on the disease and other factors) after first and second line therapies fail. I noticed that instead of enrollment in clinical trials, some of these patients were being put on chemotherapy regimens that I had never learned in therapeutics and didn't find in the literature (i.e. instead of RVD or VDT-PACE for multiple myeloma, a patient was getting RVD-ACE + vorinostat).

On my pediatrics rotation, when checking for proper dosing, I noticed that many of the medications had no dosage recommendations in pediatric drug handbooks due to lack of data. A specific example than comes to mind is when I realized that a child I was working up was knowingly receiving doses of a blood pressure medication that was 5 times the maximum adult dose. Despite lack of long term data of this dose in children, it was still being used mainly because there was really no other option.

My point is that that there were many drug questions that came up while rounding, but often no studies out there that answered them. The responsibilities of working up patients and preparing for topic discussions prevented me from looking more into these issues.

My March, nontraditional research rotation with Dr. Vicki Ellingrod involving pharmacogenomics allowed me to delve into issues like these. The specific project that I worked on involved the possible association between a genotype and weight gain/insulin resistance in patients who are taking certain antipyschotics. I started off doing lots of reading on background information, reviewing molecular genetics, and attending seminars around campus that were related to the research. But this rotation also allowed me to be as curious as I wanted to be. By the end of the month, I was developing my own initiative: looking up information that I happened to think was relevant or even information that just seemed interesting. Finally, I was able to learn a few lab techniques and get a glimpse of some of the neat research being done around the university.