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Dear Diary #8 - Lab Practical

Dear Pharmacy School Diary -

It's been well over a month, but last semester's lab practical tested two prescriptions. One prescription was compounded (capsule-punching prescription), and the other was paper only (solution).

Prescription #1:

An 81 year-old lactose intolerant patient presented the following prescription:

Inscription: Prednisone 0.007, Diphenhydramine 0.025
Subscription: DTD #2
Sig: Take T qam x 2 days
Refills: 0
Physician address: Pulmonary Clinic

I'm in a self-deprecating mood, so instead of detailing the compounding process, I'll list everything I lost points for and be done with it. The lab final was a bloodbath, but I got an A for the semester, so it's all good in the end. I made a lot of dumb errors, to be expected in a high-stakes, timed final exam.

Prescription Documentation:

  • -1: no RX# sticker on prescription
  • -1: no RX# written on prescription
  • -1: amount compounded, dispensed, wasted not on prescription

Compounding Calculations and Methods:

  • -1: "Product's Therapeutic Intent" on compounding form did not mention treatment of a pulmonary condition (prescription was from pulmonary clinic)
  • -1: amount used, dispensed, discards not recorded in compounding calculations (that's right - one error can be penalized multiple times!)
  • -1: "Product's Compounded Label Name" missing quantity (#2)
  • -1: "Compounding Method" did not specify to re-zero prescription balance before weighing each ingredient
  • -1: did not include "mix thoroughly" in directions for combining diphenhydramine and starch (I stated "triturate geometrically" without specifying trituration should be done thoroughly)
  • -1: did not specify to "use gloves" when filling capsules

Patient Instructions / Counseling:

  • -1: did not ask patient about other medical conditions when questioning about other prescription and OTC medication use
  • -1: did not educate patient that prednisone reduces inflammation and diphenhydramine is an antihistamine
  • -1: did not tell patient to avoid alcohol
  • -1: did not tell patient to avoid OTC antihistamines
  • -1: incorrect expiration date (30 days, not 1 year - this was a really dumb error)
  • -1: instructed patient to watch for capsule changes/discoloration, but not what to do about it (don't take and call the pharmacy)

Product and Label:

  • -2: wrong expiration/discard after date (again, a really dumb error on my part... and being double-penalized for it drives the point home!)
  • -4: missing auxiliary label - "Store away from direct sunlight. Keep in a cool, dry place"
  • -4: missing auxiliary label - "May cause drowsiness. Alcohol may intensify this effect. Use care when operating a car or dangerous machinery."

This prescription was worth 70 points. You can calculate my grade using the deductions above. It's not pretty! :-)

Prescription #2:

A 19 year-old female transferred from a long-term care facility presented the following prescription:

Inscription: Chlorhexidine Gluconate 1:200
Subscription: Dispense 1 liter
Sig: apply to acne pustules on back BID
Refills: 6

Prescription Documentation:

  • -0.1: qs amount (not sure what this meant)

Compounding Calculations and Methods:

  • -1: "Product's Therapeutic Intent" should have been "decrease bacteria count"; mine was "Topical antiseptic for acne." That's splitting hairs if I've ever seen it... but I got an A, so why complain?
  • -6: This was a 0.5% chlorhexidine solution that should have been prepared in water; I prepared an alcohol solution because Remington's (reference book) said 0.5% solutions in water were erratically antiseptic, but ethyl alcohol solutions were more reliable. The red ink stated: "Use water. Do not want to use any pharmaceutically active ingredients that were not in Rx. Ethyl alcohol on inflammed skin would increase infection and pain."

Prescription Label:

  • -1: missing "solution" in patient instructions (Apply solution to acne pustules on back 2 times a day.)
  • -1: missing federal caution (Federal law prohibits dispensing without a prescription.)

This prescription was worth 30 points. Again, feel free to calculate my grade if you're interested!

:: Bryan Travis :: 01/25/2005 @ 19:03 :: [link] ::
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Dieting Wolf Spiders in My Sleep

I am an arachnophobe. Spiders wig me out. My fear of spiders is superceded only by the fear of suffering some sort of severe bodily trauma resulting from something like a car wreck, surgery gone horribly wrong, errant chain saw, or getting a piece of clothing caught in a PTO. Emerging from the sense of daze caused by the accident, I would look at my injured arm, hand, or foot and see a hideous, ulcer-like open wound exposing tendons, bones, eroded muscle, and other sinewy structures of my anatomy. It would be a cross between this and that (via Malady of the Month). It would look more like this (via crisispictures.org).

Lying in bed half asleep one morning, Morning Edition blaring on the alarm clock radio, came a quasi-testament to hypnotic suggestion. I foggily remember this soundbite making me dream about spiders... immediately after "29 minutes past the hour" (skip to 2:38).

:: Bryan Travis :: 01/21/2005 @ 17:34 :: [link] ::
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Six Digit Pittance

NASA administrator Sean O'Keefe's resignation letter explains his $158,000 annual salary was insufficient to support his family. That requires a $500,000 salary and a free residence so he can send his three kids through college.

Oh, yeah, I totally understand where he's coming from. A salary exceeding 95+% of the U.S. population's total household income (salary plus other sources) is insufficient. He might have to drive a Mercedes E Class instead of that Mercedes CL65 he's had his eye on. Abominable! Demanding a three-fold raise with perks, like free use of a home, is completely understandable. To quote a popular cliché in often seen in recent advertising: You Deserve It!

Some perspective from the Middle Class:

My wife and I are on the verge of being "career students." She has 10 years of post-secondary education. I will also have 10 years after graduating from pharmacy school.

Total price of her education: $180,000
Total price of my education: $90,000

We have 20 years of education between us, enough time for 5 people to earn bachelor's degrees. How do we finance this? Loans, scholarships, and employer reimbursement, but mostly loans (~75%). With one spouse working and the other in school, I can assure you our household income is well under $158,000, but we're doing just fine.

Some perspective from the Working Class:

A lot of folks can't even afford to go to school. Some states simply don't allow undergraduate students sufficient loans to finance higher education. Hell, a lot of people can't even afford utilities!

Oh, and I forgot to mention domestic spending will be cut in the 2006 budget as the U.S. continues to go it alone playing cowboys and indians in Iraq.

:: Bryan Travis :: 01/20/2005 @ 17:05 :: [link] ::
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Behavior Modification Project

The easiest class this semester is Health and Nutrition. A quarter of the course grade is a behavior modification project to develop an appreciation of what our future patients will be experiencing when making significant lifestyle changes to improve their health, such as exercising, losing weight, or improved diet. Understanding what it's like for someone else helps empathy come more easily.

The goal of my behavior modification project is to increase my cardiovascular fitness by reducing the time it takes me to jog/walk a mile over a 12 week period. My goal is a 10 minute mile, with an 8 minute stretch goal. I will jog as long as possible, then walk when I need to rest. I will jog/walk at least one mile at least three times a week.

A ten minute mile may seem overly easy, but since my baseline run on Wednesday was 12 minutes and 19 seconds (yikes!), 10 minutes seems more reasonable. In my own defense, I could blame the exercise-induced asthma exacerbation I had because I didn't take my daily puff of Advair before running, but honestly, the pain in my legs and overall lack of endurance slowed me down more than the inability to breathe.

On Thursday, the asthma was under control, but the shin splints from Wednesday's run left me cursing my project choice. I also should have straightened my boxers before running, because one side bunched up against my inner thigh, and the chaffing during the second mile became quite worrisome. It stung horribly when it got wet in the shower. Excuses aside, Thursday's mile was 12m 17s, two seconds shorter than the first.

I walked about a mile from the UK Medical Center to my car in the Commonwealth Stadium parking lot after class on Friday instead of taking the shuttle, but refrained from jogging so the inflammed connective tissues causing my shin splints would have some time to heal and strengthen.

:: Bryan Travis :: 01/15/2005 @ 10:08 :: [link] ::
...