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:: Wednesday, December 22, 2004 ::
Wow, I had completely forgotten about bubble gum cigarettes. Anyone much younger than me probably wouldn't believe such things even existed. I remember being 5 or 6 and begging my parents to buy them. Opening a pack and blowing on a cigarette to produce a puff of powdered sugar "smoke" brought undescribable joy.Bryan Travis :: 12/22/2004 @ 21:38 :: [link] ::
:: Tuesday, December 21, 2004 ::
The Quick Kill mousetraps have made their first kill, bringing the total to three:
I discovered the third mouse kill while preparing to winterize the lawn mower. I haven't been in that corner of the garage for a while, so there's no telling how long it had been in the trap. Mostly likely, the mouse was a recent immigrant fleeing the recent cold snap. The corpse was plump and pliable, not shriveled or stiff, and it didn't stink. However, the garage had been a virtual refrigerator since the temperature had barely crept above freezing in the days before discovery.
This kill was a surprise, because the traps have been neglected for months. If the mousetrap hadn't killed the mouse, then surely the powerful liver carcinogen aflataxin B1, produced by a fungus that grows on peanut butter, would have. Just a tip: Beware of moldy peanut butter. Ah, yes... the things you learn about in biochemistry class.
The cats were added to the scoreboard because they love hanging out in the garage, ostensibly because they can smell the mice. They're usually in there once a day, sometimes more if we notice them standing at the door. Therefore, the cats have ample opportunity to catch mice. Back in his youthful heyday, Mr. Mist was a prolific mouser. So far, however, neither cat has proven their skills. The only mouse Maya can catch is the inanimate toy mouse she likes to fling from her mouth and then pounce.
An unexpected benefit of the Quick Kill trap is the hidden mouse head. The beady, glazed-over eyes of a dead mouse are disturbing to some. Also note how the forearm extends toward the hind-quarters, as if the mouse were completely at ease with its own demise. For some reason, I found this intriguing. I couldn't stop staring at it.
The game continues!:: Bryan Travis :: 12/21/2004 @ 15:04 :: [link] ::
:: Monday, December 20, 2004 ::
I was never so glad to finish something as I was after the 3rd block exams, but that feeling of relief was trumped today by the relief of finishing the semester finals. Not because they were unreasonably difficult, but because:
Having solid A's in all courses except for one weak A before finals is a mixed blessing. On the one hand, you know you're in good shape, because scoring in the low 70's to preserve an A is very attainable; even if you bomb the final, you slide by with a B. On the other hand, complacency combined with end-of-semester burnout has a deleterious effect on studying.
Somewhere in all those "one hand" and "other hands" is a feeling of guilt when you think of your future patients who won't benefit from that extra 5 hours of studying for the antibiotics final, because you forgot to tell them that Metronidazole has a severe antabuse-like reaction when taken with alcohol, and they went partying Friday night and spent the weekend with their head in the toilet. What's even more sobering (no pun intended) is the statistic our pharmacy law professor shared one day: a pharmacist kills one patient every 4-5 years.
In pharmacy, attention to detail is critical, because that's where the devil is.:: Bryan Travis :: 12/20/2004 @ 13:15 :: [link] ::
:: Friday, December 17, 2004 ::
Wrong, plain wrong. Whoever did this is very sick:Bryan Travis :: 12/17/2004 @ 16:01 :: [link] ::
Dear Pharmacy School Diary -
We walked into the lab and were handed a prescription and blank compounding notes in our seventh compounding lab. This was the mock practical to give us a flavor for the final lab practical worth 100 points.
A doctor calls for assistance dosing chlorpheniramine maleate antihistamine in a 6 year-old patient sensitive to the anticholinergic effects of some antihistamines. She wanted to give a dose slightly less than the average pediatric dose (2mg). Given are the patient's height (2' 8") and weight (57 lbs).
The original prescription:
Inscription: Chlorpheniramine maleate 4mg/5ml
The plan: determine the patient's body surface area (BSA = 0.7 sq m) and recalculate dose accordingly. The adult dose is 4mg q4-6h and the average adult BSA is 1.73 sq m. (0.7 sq m)/(1.73 sq m) * 4mg = 1.62mg, so reduce the patient's dose from 2mg to 1.6 mg.
Next, change the sig from "ss tsp" (2.5 ml) to "2 ml" to yield a 1.6mg dose and note to include a dosing spoon and counsel its proper use to the parent.
(150 ml) * (4mg/5ml) = 120mg chlorpheniramine maleate needed in prescription. Fortunately, this is the minimum weighable quantity on a Class IIIa prescription balance.
Available sources of chlorpheniramine maleate are pure powder and tablets. The pure powder is freely soluble in water (1g per 4ml), so this prescription will be compounded as a solution. Triturate in a glass mortar and dissolve the pure drug powder in 2ml purified water. Add a portion of syrup to the mortar solution and triturate. Pour into an amber bottle pre-calibrated to 150ml and shake. Rinse the mortar with several portions of syrup, shaking the bottle after each rinsing. QS with syrup to the 150ml mark. Shake. Check for clarity. Label and dispense.
Finally, write the patient counseling instructions.:: Bryan Travis :: 12/17/2004 @ 15:25 :: [link] ::
:: Wednesday, December 15, 2004 ::
Dear Pharmacy School Diary,
Our sixth pharmacy school lab was another hand punching capsule exercise. A 52 year old woman presented a prescription for four 0.5 mg estradiol capsules to treat her osteoporosis. She also asked for OTC Lactaid, a hint that we should use starch as a diluent instead of the standard lactose. Her doctor gave her 19 capsules from his office and the below prescription for the balance of her monthly supply.
Inscription: Estradiol caps 0.0005
The MD's DEA number was invalid, one of those "attention to detail" points we're supposed to catch. Sum the 1st, 3rd, and 5th digits. Sum the 2nd, 4th, and 6th digits, then multiply by two. Add the two results, and the "ones" digit should match the last digit of the DEA number. In this case, 3+3+7 = 13; 2(9+6+4) = 38. The total is 51, but the last DEA number digit is 5, so the DEA number is invalid. DEA#'s are only required for controlled substances, but even if there's an invalid number on a non-CS prescription, you'd better call the prescriber for the correct number, or the board of pharmacy inspector can fine you a minimum of $100 per offense. And in all probability, a BOP inspector in the state of Kentucky will do just that.
Apparently, many drug dealers and addicts will go to the trouble of stealing a pantone green controlled substance prescription pad or counterfeit their own, but can't be bothered with mastering simple arithmetic.
I remarked a couple of labs ago that eventually I expected us to prepare all the compounding notes and calculations on our own for labs. It finally happened. Although we wrote the prelab notes at home, this lab was done entirely on our own.
Estradiol is a steroid hormone; thus, it absorbs through skin and mucous membranes. I didn't want to grow breasts and sing soprano, so I wore gloves and a surgical mask. Actually, estradiol is expensive, so we were actually using an inert powder in its place, but we wore gloves and masks, anyway, to appease the instructor.
I used #3 capsules for this prescription. Eacj #3 capsule will contain 270mg starch. We needed to dispense 4 capsules, plus 2 for compounding waste, so that meant I needed to compound for 6 capsules (6 caps * 270mg each) = 1620 mg powder and (6 caps * 0.5mg estradiol each) = 3mg estradiol. Problem is, the minimum weighable quantity on a Class IIIa prescription balance is 120mg, so we had to use an aliquot to prepare the estradiol. I prefer to setup my aliquots as ratios:
(3mg estradiol needed)/(120mg aliquot) = (120mg estradiol powder)/(4800mg total powder)
To obtain the 4800mg powder needed, I geometrically triturated 120mg estradiol powder and 4680mg starch. I took a 120mg aliquot of this powder containing 3mg estradiol and mixed it with 1500mg starch to obtain the 1620mg of capsule powder needed for 6 capsules.
We gained a valuable nugget of knowledge about hand-punching capsules with starch: it's damn-near impossible. Unlike lactose, starch is a dry, free-flowing powder. Instead of packing inside the capsule after hand-punching, it falls back out. And when it does stick, you can't pack enough in there to be within the acceptable weight range.
Solution: pack the capsules horizontally with a spatula so the powder won't fall out. Don't let the lab instructor see you, because while this method yields a packed capsule of acceptable weight, it's considered bad practice and usually results in point deductions. Whatever. Either method yields safe and equivalent products. If it works, it works. I'd give the school a point deduction for not even allowing us to use primitive hand-operated capsule-filling machines, if I could.
Hand-punching capsules in pharmacy school is analagous to fire-making in army and marine survival training: every soldier's and marine's survival kit has a fire-making implement, but they have to build a fire by rubbing two sticks together to pass the survival training course, "just in case." Every pharmacy has capsule filling equipment lying around somewhere, even the ones that don't compound prescriptions. It's called "doing your time.":: Bryan Travis :: 12/15/2004 @ 20:25 :: [link] ::
:: Saturday, December 11, 2004 ::
The original Prius' tires spun their last at 36,668 miles. The tires slid on wet pavement as I was turning at this intersection. We can't have that with winter approaching. The tires were rated for 30,000, but two were replaced very early because of road hazards.
I bought BF Goodrich Pro Touring or something from Sam's Club. The originals were low rolling resistance tires. This improves fuel economy slightly, but they're twice as expensive and have half the tread life (30k miles) of most tires. In other words, 4 times the cost and twice as much environmental impact for an additional 3 mpg is simply not worth it.
The receipt said "Have Your Lug Nuts Retorqued After The First 50 Miles." After some research, I find out ALL aluminum wheel lug nuts are supposed to be retorqued whenever the lug nuts are removed. This means I should have been retorquing after every tire rotation!
The lug nuts were never retorqued on the Saturn, and the Prius' were never retorqued until today. I probably had better odds for winning the lottery than losing a wheel while driving. Seriously, how many people with alloy wheels retorque their lug nuts? In 7 years of driving cars with alloy wheels and faithful 5,000-7,500 mile tire rotations, I had never heard of retorquing until that faithful day at Sam's.
But now I knew, and I had to do something about it, because knowledge is power, and that power would make the lug nuts fly off the wheels at 75mph on the interstate. I just knew it would! Clenching the steering wheel, knuckles white with straining, my fellow motorists would be irrascible as I idled down the street at 10mph so I could maintain control of the vehicle and not scratch up the underbody too much in case a wheel came off.
What seemed an easy task became complicated when I read about applying too much torque and stripping the studs off the wheel. I know, millions have tightened their lugs using nothing more than an impact wrench. But I had never done this before, and again, the knowledge that it could happen would make it so. I didn't know what 76 ft-lbs of torque felt like, so I could just as easily have applied 50 ft-lbs or 100 ft-lbs without knowing the difference. One meant losing a wheel at 75mph on the interstate, the other mean stripping the lugs.
So I went to AutoZone and bought a torque wrench. Now I knew what 76 ft-lbs of torque felt like. I loosened the lugs to retorque them, some loosened easily while others required at least twice as much force, enough to make the Prius lunge forward on the driveway. The loose ones weren't loose because they needed retorquing; no, they were properly torqued. It was the tight ones that needed loosening. Those pneumatic drills in tire shops are notoriously inaccurate.
Today I drive on the streets at the speed limit, confident the wheels are securely fastened to the car. Until, that is, I realized I wasn't supposed to loosen the lug nuts before retorquing them. For the next 50 miles, images of the Prius spinning out of control at 75mph on the interstate will haunt me. I'll have to carry the torque wrench in the trunk, just in case I'm miles from home when the odometer says it's been 50 miles. Maybe then I'll get it right.:: Bryan Travis :: 12/11/2004 @ 13:04 :: [link] ::
:: Wednesday, December 08, 2004 ::
The interim Iraqi president Ghazi Al-Yawar was on Meet the Press Sunday. Tim Russert kept asking how Iraq could hold elections in January given that even the road from the Baghdad airport to downtown Baghdad couldn't be secured, the insurgency was spreading, the U.S. was increasing troop levels beyond invasion levels.
Al-Yawar must have gone to the George W. Bush school of problem solving, because he kept overlooking the obvious. He denied the January elections were at risk, saying there were two months left to quell the insurgency. My jaw's dropping on the floor as I'm thinking, "Dude, if you've been losing ground on a problem over the last 20 months, what reasonable person thinks a worsening problem can be solved in the next 2 months?" Al-Yawar went on to say he thought American troops needed to maintain a presence for 6, 8, or 12 months; it was a matter of months, not years.
And that's when it hit me, George W. Bush is his mentor. Go figure.
Then Russert showed Al-Yawar his own quote from mid-October. He said January 31 was a "sacred date" for the elections. Al-Yawar, thinking Russert had given him an out, was suddenly like, oh, yeah, that's right - sure, if people can't safely vote, then we might push it back.
He must have spoken with Donald Rumsfeld, as well.
No, Al-Yawar shouldn't throw up his arms and admit defeat, but I am saying he should ask Bush about his drug and alcohol recovery programs. This may help him realize the first step to solving a problem is admitting you have a problem.:: Bryan Travis :: 12/08/2004 @ 18:42 :: [link] ::
:: Saturday, December 04, 2004 ::
Oh, how I wish I could write Flash and compose music, then I would melodically animate my bad poetry in Flash movies. If I had that sort of talent, then I might spend more time making my bad poetry rather good.
This is the first of what I hope will be a thriving series of bad poetry pieces. Surprisingly, though, writing bad poetry isn't as easy as it looks.
:: Bryan Travis :: 12/04/2004 @ 14:25 :: [link] ::
:: Friday, December 03, 2004 ::
In our country founded on free speech, two notable non-free speech events this week:
Tell me, exactly how free do you think our society is?:: Bryan Travis :: 12/03/2004 @ 15:19 :: [link] ::