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Exam Block 3 Finished

The third set of block exams is over, and I have never been so glad to put something behind me since the last time I said I've never been so glad to put something behind me. It has been the most stressful test-taking experience ever (but they tell me it gets even worse). Six classes, and studying for five of them is like studying for organic chemistry. Seriously, it's like every class in pharmacy school is on the same level as the hardest class you ever took in undergrad. My MBA classes don't even come close.

I was going to write a post after taking the tests and before getting the grades back, but this didn't happen for two reasons. First, I was too exhausted and slept, instead. Second, the UK Pharmacy professors are awesome and started returning grades the day after block exams were over.

But I knew exactly what I was going to say if I had written that post. I was going to tell you I knew I had done poorly on 4 of 6 tests. I had to guess at numerous questions and was certain of my answers for a handful of questions. Block 3's were "Come to Jesus" tests, and I was going to say that I needed to start studying at the beginning of a test cycle instead of one week before the tests... which is still true.

I finished blocks on Monday feeling these were dark times, indeed. I wasn't the only one. No one had been getting much sleep. Several classmates walked out of tests in tears. One guy was so scared, he called his parents every day the week before the exams; his parents drove to Lexington for the weekend because they were so worried about his well-being. Those are good parents.

Then we began getting our tests back. The first two exams were Physiology and Drug Design. I was prepared and confident for these. After the tests, I expected a B on the Physiology test and an A in Drug Design. I got a high A in Physiology and 100% in Drug Design. I was ecstatic with these, and as far as I was concerned, there was no rush for the other 4 tests, because they were blood baths, for sure.

By the grace of God, I dodged the bullet, and the blood bath never came. Somehow I pulled through. A in Antibiotics, tying for 3rd highest score in the class; this struck me as odd because I guessed at more questions on the Antibiotics test than any of the others. A in Pharmacy Practice. B's in OTC and Biochemistry. My average is an A in all courses except for a high B in Biochemistry.

I don't know what happened, but let me tell ya, what a relief.

:: Bryan Travis :: 11/30/2004 @ 14:23 :: [link] ::
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Thanksgiving 2004

I am thankful for:

  • My wonderful wife
  • Our families and their love
  • Loyal friends and their support
  • The opportunity to attend pharmacy school, and
  • Everyone who helped me get in
  • A good home and the realtors when the closing got bumpy
  • A great honeymoon
  • Being blessed with a good mind

It has been a very good year.

:: Bryan Travis :: 11/25/2004 @ 23:59 :: [link] ::
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The Jury's Still Out

During biochemistry lecture a few days ago, someone asked if the universal coding of nucleic acid codons to amino acids across all but a few species supported evolution theory. Our professor wouldn't come near that one for fear of sparking a Creationism versus Evolution debate.

Silly me. I had assumed virtually everyone in an intensive biological sciences program like pharmacy with strong religious faith had come to terms with evolution in such a way as to prevent it from undermining and collapsing their religious beliefs. Religion and evolution can co-exist, believe it or not. For the same reason that religious texts don't mention undisputable biological facts like gene regulation and enzyme function (which is to say, such things have no bearing whatsoever in religious practice), they don't go into detail explaining the development of life. And evolution theory has never attempted to postulate on whether or not humans have souls or spiritual existence.

The sad thing on my part is that I don't have much empathy for creationists in a science-based profession. I was brought up in a very conservative, rural Southern Baptist church in Kentucky. I know where they're coming from because I used to share their beliefs. For someone without much science education, I can understand. I loved science as a kid, and had to deal with the creation versus evolution issue around the time I hit puberty. It was the first time in my life my religion and science crossed paths. It set a precedent for me; I reasoned through the conflict, and the thought process for subsequent conflicts has been the same. I chose reason over faith on the grounds that faith provides answers where there is no plausible explanation.

Under different circumstances I might have resolved this internal conflict by siding in the creationist camp, set the precedent, and made up my mind never to be swayed again, which is probably what some of my classmates have done. Except for the choice itself, we're not so different, those creationists and me. After making the decision, everything else is the same - setting the precedent and being very resistant to change views - and that stubborness is what puts us at odds.

Thus, I've failed to empathize with those who've taken the opposing view, which is ironic given my early religious background and the realization that apart from this one belief, our behaviors and stubborness make us virtually identical and equally frustrating to one another.

:: Bryan Travis :: 11/23/2004 @ 17:34 :: [link] ::
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Wowsers

Oh, my... this is rather bizarre:

A P-shift is the event of biological transformation from one species to another. Many shifters desire this yet fail to achieve it. But P-shifting is NOT impossible! There are loopholes in the Bible that may allow this!

[...]

Now some people say that I have to pray within God's will to get my prayers answered, but that's crap. If that were so, then God wouldn't have said over and over again in the Gospel of John that He would do anything for us if we asked for it in Jesus Name, because we'd always be asking for things that He wanted to give us anyways. ANYTHING means ANYTHING.

Oooooo-kay. Call me a faithless non-believer, but this person's grasp on reality is about as tenuous as a four year-old's. Remember watching Mr. Rogers' Neighborhood and thinking the little red trolley went through the tunnel in Mr. Rogers' house and really did emerge in the Land of Make Believe without ever really noticing the puppet characters suspiciously sounded like Mr. Rogers?

Sure you do, and it's okay, because you were four. It's sort of like how this person uses Bible verses to logically conclude (via "loopholes," no less!) that a human being can channel God's power and turn into an animal.

Taking a literal interpretation of the Bible is likely to raise a few eyebrows. Arguing that "loopholes" in Biblical text are irrefutable proof of exotic phenomena will surely get you ostracized even by those who favor a literal interpretation of the Bible. The thought process runs something like this:

There is no greater truth than the Bible. If the Bible says something, it is therefore true, Q.E.D.. Anyone who says otherwise doesn't truly believe in God; such people are ignorant, their words are false, and they should be ignored.

The practical upshot is that my next statements will fall on deaf ears. Religion is often distorted in ways it was never intended to be. For example, a few hundred years ago, religion was used to argue the earth was at the center of the solar system and even the universe. Even more recently, some have used religion to justify slavery. When religion and demonstrable science come into conflict, religion should not trump science. Then it becomes the stuff of superstition.

:: Bryan Travis :: 11/20/2004 @ 19:53 :: [link] ::
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Dear Diary #5 - Divided Powders and Hand-punching Capsules

Dear Pharmacy School Diary,

We compounded two prescriptions in our fifth pharmacy school lab. Completing both prescriptions in two hours was an exciting race against time in the hallowed halls of Lesshafft Lab.

The first prescription was for a foot powder, probably an antifungal powder for athlete's foot, but the MD didn't specify, so we were left to guess. A humble request to prescribers: include the therapeutic intent on the prescription; it helps the pharmacist counsel your patient and ensure proper dosage. Thanks!

Prescription #1
Inscription:
     Benzocaine
     Salicylic Acid aa 0.15 g
     Benzoic Acid 0.3 g
     Camphor 0.2 g
     Methyl Salicylate qs
     Talc qs ad 3 g

Subscription: M et Ft divided powders #5
Sig: Apply contents of one powder packet to feet ud qam

Multiply these amounts by 6 (5 powders plus 1 for compounding loss)

We reduced the camphor first, unleashing the smell of Vick's VapoRub throughout the lab. Pulverization by intervention is the technique of choice to reduce camphor crystals, but alas, we didn't have time to dissolve the camphor in alcohol and then evaporate it to leave behind a powdery camphor powder. So we triturated it in a glass pestle with limited success.

Camphor and salicylic acid form eutectic mixtures, so it wasn't necessary to completely reduce the camphor. Not since methylcellulose have we witnessed such a peculiar physical property. When certain solid compounds are mixed together, such as camphor and salicylic acid, the resulting mixture has a lower melting point than the ingredients (you'd expect the mixture's melting point to fall somewhere in between the melting point of the ingredients). If it liquefies at room temperature, it's a eutectic mixture. Add benzocaine for numbness and benzoic acid for antisepsis, and the eutectic is complete.

To this 4.8 gram eutectic mixture we added 13.2 grams of talc, which must be done gradually to avoid sending mushroom clouds of talc into eyeshot of the lab instructors as we triturated in our mortars. Talc mushroom clouds guarantee point deductions.

The mixture resembles very dry dough after incorporating the talc, more crumbly than adhesive. A few drops of methyl salicylate for a wintergreen scent, and the powder is ready for packaging.

We dispensed the powder in handmade powder papers (aka chartulae or divided papers). I wasn't sure I folded the papers correctly; I later found this video (complements of UNC). I think that's how I folded them. It's so difficult to find instructions for folding chartulae... it's such a rare dosage form and pre-folded papers are commercially available. Much like the apothecary system, folding charts is an obsolete practice propagated by pharmacy schools. Such old school practices make me think of pharmacy less as an allied healthcare profession firmly rooted in science, and more as alchemy. Read this witch's spell for breaking up a relationship. It bears a striking resemblance to working in the apothecary system.

Oh, well. Let's move on to the second prescription, in which we hand punched capsules. Hand-punching capsules is another thing pharmacists rarely do unless they work in a compounding pharmacy, but it's a convenient way to introduce the aliquots. Although aliquots are really quite simple with practice, there is no single "right way" to solve an aliquot problem, which makes them horrifying to the first year pharmacy student.

Fortunately, though, no aliquotting on this prescription because it was a placebo:

Prescription #2
Inscription:
     For Blind Study
     Lactose qs

Subscription: Dispense #5 caps
Sig: 1 po hs M-F during week 4
Label: Phenobarbital 8mg

Ah, yes, the old bait and switch blind study. This patient thought she was getting the study drug, but she walked out with a placebo. 8mg phenobarbital is a sub-therapeutic dose, anyway. 80mg would have been expected, but the MD confirmed 8mg was correct.

The goal of this prescription was to learn capsule hand punching. We used #3 capsules; each #3 capsule holds 280mg lactose. The prescription was for 5 capsules plus 2 capsules for compounding waste. 280mg x 7 capsules = 1.96 g lactose.

The instructor told us to add a few drops of food coloring to help her inspect the quality of our trituration. White specks in the colored lactose indicated incomplete trituration. Most people used blue (the school color). While it showed school spirit, blue also made it easy to see white specks. I used yellow food coloring to make any white specks nearly impossible to see. I aimed for a pale yellow powder, but it was radioactive yellow, instead. No matter - it's hard to distinguish white from any hue of yellow.

The instructor commented on my lemony powder, apparently pleased to see a color no one else had selected. I couldn't resist... with a toothy grin, I told her I chose yellow because it would hide trituration flaws. She smiled.

I got 10 out of 10 points for that lab.

:: Bryan Travis :: 11/18/2004 @ 23:20 :: [link] ::
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Exam Block 3 Approaching

Another four weeks have passed, and that means it's time for the third round of block exams! Giddyup!

The sheer volume of material is staggering, which I say before every round of blocks, but that's because each round is worse than the last. We are being ramped up, and how I wish we'd reach the peak of this mountain soon... but I hear second year is worse than the first.

It's much easier to be a pessimist than an optimist, or at least it is for me, because my emotional midpoint tends toward the more sullen side of normal. So I frequently remind myself that I intentionally left GE to pursue this. The choice was mine to make, and aren't I so lucky to have had several opportunities to change the course of my life. So when I catch myself wondering why I signed up for four more years of school in a Pharm.D. program, I feel kind of guilty complaining about the coursework, even though I'm mostly doing it out of jest and stress relief... especially when considering that less than 20% of pharmacy school applicants are accepted.

There is no greater empowerment than the freedom to chose one's own path.

Okay, enough pep talk. Let's list what's in this round of block exams so the immensity of it all can send me into a panic attack:

    Physiology:

  • Sensory Receptors
  • Anatomy and Physiology of the Eye
  • Somatosensory Receptors
  • Chemical Senses (Taste and Smell)
  • Vestibular and Auditory Systems
  • Blood Brain Barrier and Cerebrospinal Fluid
  • Spinal Reflexes
  • Voluntary Movement
  • Movement Disorders

    Antibiotics:

  • Sulfonamides
  • Fluoroquinolines
  • Macrolides
  • Aminoglycosides
  • Glycopeptides (Vancomycin)
  • Lincosamides (Clindamycin)
  • Oxazolidinones (Linezolid)
  • Nitroimidazoles (Metronidazole)

    Drug Design:

  • Gastrointestinal Physiology
  • Diffusion and Partition Coefficients
  • pH and Effects on Ionization
  • pH and Effects on Solubility
  • Colligative Properties

    Biochemistry:

  • Enzyme Kinetics
  • Proteolytic Enzymes
  • Enzyme Regulation
  • Nucleic Acid Structure
  • DNA Replication
  • RNA Transcription
  • Protein Translation

    OTC:

  • Internal Analgesics
  • Pediatric Internal Analgesics
  • External Analgesics
  • Antacids

    Pharmacy Practice:

  • Legal - Board of Pharmacy
  • Legal - Kentucky Controlled Substances Act
  • Legal - Generic Drug Law
  • Case Study - UTI
  • Lab - Eutectic Mixtures
  • Lab - Capsule Hand Punching
  • Math - Dry and Liquid Aliquots
  • Drug Information - Azithromycin, Ciprofloxacin, Clarithromycin, Doxycycline, Levofloxacin, Trimethroprim-Sulfamethoxazole

I'll be tested on all this Friday, Saturday, and Monday.

Yes, my friends, this is why I freak out every four weeks before block exams. Somehow, I have miraculously managed to keep all A's. But good luck can't last a lifetime unless you die young, and that's why I fully expect to lose some of those A's this weekend.

Okay, time to study. This may be my last entry for a few days.

:: Bryan Travis :: 11/09/2004 @ 00:09 :: [link] ::
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Four Years

In the battle between the Incompetent and the Incoherent, voters chose the Incompetent.

I'd like to say that I'll remain silent as Bush & Co. do whatever their lame duck selves desire, because he legitimately won this time, and no amount of dwelling on our fundamental differences in philosophy will change anything. I'd like to say that I'm going to enjoy my taxcuts, especially after I'm out of school when my wife and I can enjoy the extra benefits afforded to the wealthiest Americans. And part of me is glad that Bush & Co. must deal with their own mess in Iraq instead of Kerry taking the fall for it.

Yes, I'd like to let go of my appallment and support the President. See? I actually referred to him as "the President." You probably hadn't noticed, but if you peruse the archives, you'll find this is the first time I've used the word "President" to refer to Bush. He may have only had 51% of the popular vote, but it was a majority, nevertheless.

I'd like to support him and stop gnashing my teeth, but I know as soon as he nominates an ultra-conservative to the Supreme Court, or increases the deficit with another taxcut the treasury cannot afford, or enacts a policy that further burdens the working poor, or rolls back environmental protections in the name of economic growth, I'm going to lose it and revert to my old ways.

But in the meantime, I won't smirk when an oil company tries to portray itself as pro-environment (but at least they acknowledge global warming while Mr. Prez says the jury's still out). And maybe, just maybe, when BP claims the total world proved oil reserves is actually increasing despite increasing oil consumption, I'll believe that there really is a proven 40 year supply of oil in the ground.

:: Bryan Travis :: 11/06/2004 @ 19:50 :: [link] ::
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Pharmacy School Interview Resource

The Student Doctor Network allows applicants to read and post their pharmacy school interview experiences. Includes comments, interview format, the applicant's overall impression, interview questions, positive/negative impressions, and things the applicants wish they had known ahead of time.

:: Bryan Travis :: 11/06/2004 @ 18:24 :: [link] ::
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