on The downhill portion

Ok. I can do this.

Thursday has passed…slipped by, really. Wednesday was the first day that I felt like I could stand on my own two feet, not looking wildly around and wondering, “What the heck am I supposed to be doing? Am I doing this right? Am I in the right place? What is everyone else doing? Holy goodness I have no idea what I’m doing… Quick! Look like I know what I’m doing!”

You know, normal stuff.

Saranne has been a godsend…she’s so sweet and calm and willing to help with EVERYTHING. A quality lady if I ever knew one!

Today was the first patient assessment lab…we role-played with each other for three different patients, filled out medical history charts, and absorbed functional drug knowledge from our professors. I have a feeling that this acronym will be drilled into my head:

OLDCART

Onset: When the symptoms started

Location: Where is the problem located in/on the body?

Duration: When during the day are the symptoms present?

Characteristics: Please describe the symptoms

Aggravators: Does anything make it worse?

Relieving factors: Does anything make it better?

Treatment: Have you tried any OTC or home remedies?

Our three patients were a woman with dry, itchy red eyes, a man with severe constipation, and another man with a very runny nose/eyes.

The woman had been taking an OTC sleep aid for some time, 1 a day, and we found that prolonged ingestion of the sleep aid (Nytrol) could produce her very symptoms: dry and itchy eyes.

The first man had only had one bowel movement in the last 7 days, and though he had eaten more fiber (bran flakes) at the suggestion of his wife, he was still a bit ‘backed up’…(trying not to laugh). Upon examination of his medications (Celebrex, Norvasc, and docusate sodium), we found a possible problem. Celebrex is a calcium channel blocker. Smooth muscle is stimulated by calcium channel activation. Our GI tracts are lined and controlled by smooth muscle….so its possible that the Celebrex was causing decreased GI motility. The suggested remedy was a round of glycerin suppositories, drinking lots of fluids, and a salt-based laxative like Miralax.

The third patient was a college student with a runny nose and eyes who was already taking Zyrtec to no avail. His symptoms appeared around the time he moved back to Pullman and began working on the yard; the symptoms consistently improved when he left the house ( you know, when he goes to Rico’s, as Tasha put it) or was indoors. He also had a history of mold allergies. First of all, the patient was taking his medication at night before bed…er…well, it would probably be smart to take it during the day, since Zyrtec doesn’t cause drowsiness and he probably needs allergy medication to work when he is awake. We also suggested that he use an OTC allergy eye-drop to stop the watery eyes and give the Zyrtec a chance to work; sometimes drainage from the eyes can inhibit drug action in the olfactory area. If the symptoms continued, we suggested he try Claritin, an antihistamine that works differently in the system than Zyrtec.

Whew! I can’t believe I remembered all that!

After a morning of Pharmaceutics (drug design and dosage….SO interesting), where we learned WHY some things can’t be injected into the blood stream and why some things need to be inhaled and why some things have to be taken sublingually, I had lunch at the Co-Op (salad bar is astoundingly good on a hot day) with the lovely Tiffany. Give me a plate of greens, cheese, BBQ tofu, and kale slaw…plus a dear friend, and you’ve got one happy girl on your hands!

A couple hours of laundry and studying made me antsy, so I busted out a late evening run. Now, it’s time to devote one more chunk of time to pharmacy before I hunker down with the latest Lie to Me episode before bed. Oh the joy of going to sleep at 9:30. I’m a grandma, I know. Respect the bedtime.

on Making wise Decisions

Sometimes, time management gets the best of me. Some days though, I come home from classes and am extremely judicious and productive, like today.

I walked in the door, dropped my backpack, and

took a nap.

(pause)

It felt SO good. exactly what I needed after a morning of forgetting my wallet, misreading my lab schedule, and running around campus, then back home, then back to campus…you get the picture. Note to self: next time, remember everything you need to, and then we won’t have these problems any more.

I just wrote out notecards for the first Top 200 Drugs quiz, and tomorrow I need to buy a patient assesment text, prep for lab, and print off a bunch of lecture notes.

Our first class today was pharmaceutics, which is the study of drug dosage, design, and delivery. It amazes me what drugs have to pass through and overcome to get to their target; acidic environments, basic environments, lipid barriers, blood solubility, enzymes, efflux transporters, and many many more entities.
Next up was a writing assessment for the college; my question was concerning “Etiquette Based Practice”…more on that later.
Last in the queue today was pharmacy practice foundations, which is a class on the basics of law, ethics, and procedures within the pharmacy. Our extremely informative guest speaker was the executive director of the Idaho Board of Pharmacy; he gave us the run-down of all Idaho’s basic pharmacy laws and their systems. I think I’ll be getting an Idaho extern application so that I can do IPPEs in Idaho – their application is so short compared to Washington’s!

Last night I baked a loaf of whole-wheat amaranth bread…it filled the entire house with a lovely autumn smell. My roommates were thoroughly enraged that I didn’t make two loaves…once I nail down the recipe I’ll post it here.

It’s 9:30 and my adenosine receptors are getting quite full…it’s time to call it a night.

on Day 1

The white coats have been neatly hung and stored in our closets…now the work begins.

Yesterday was a whirlwind of new professors, subject matter and jittery thoughts of, ‘ohmygoodness can I really do this? Can I keep up and time manage and understand things?”

Why yes, I do believe I can.

The first class on the books was Top 200, which is a wonderfully pedantic name for a class – it’s a title that’s a bit crunchy and just ominous enough to give me a pause. We’ll be learning several attributes of the current top 200 meds in the U.S.: generic names, brand names, treatment category (analgesics, pain therapy, etc.) , and a few other tidbits. 8 quizzes, four tests, and a final exam that we must score a 90% on to go on in the program. Needless to say, I’ll  soon be very attached to that little booklet of names and descriptions.

Next up was Integrated Pharmacology, which is a melting pot full of organic chemistry, physiology, biotransformation(how drugs change in the body), and biochemistry. It’s like the last two years of college all condensed into one class; I quite enjoyed seeing everything from all those components of my undergrad career jammed into one screen…it was oddly reassuring. Somehow it made me feel as if all those sleepless nights of study and memorizing and notecard writing weren’t in vain.

After a long break, during which I noshed on my lunch and chatted with the lovely Anastasia about life, we re-convened on the pharmacy building around 2pm for Pharmacy Calculations. Ratios, direct proportions, simple math, and a workbook that contains word problems about pharmacy…usually I have a sore spot with math, but when it’s applied to patient care, it’s oddly exciting. We’ll have homework, tests, and quizzes – and there is no partial credit on the tests. As our petite professor stated, ” We don’t give any credit for patient suffering.” Oh dear. I’ll be checking and double checking my work!

Lastly, there was Pharmacy Communications, where I realized many things are still to be done. It requires, Blood Borne Pathogen training (check), HIPPA training (written into curriculum of another class), CPR/first aid training (signed up for a class on Oct. 2nd), and all our immunizations (eh…kind of checked). My last Hep B shot isn’t until November, so I’ll have to turn that in later. The class also has a lab component, where we’ll get to ‘counsel patients’ and work on our ‘pharmacy language’…I’m a bit nervous about this class – it will take some serious preparation to do well. Since it is a self-evaluation class, “…what you put into it is what you’ll get out of it.” Alright, then I’d better put in everything  I’ve got! We also have to log 8 hours of Introductory Pharmacy Practice Experience (IPPE) this semester.

First day, done. The jitters are gone, the butterflies have quieted, and I’m ready to tackle Tuesday.

on Wearing a White Coat…with 93 other people

We all converged on the CUB auditorium Friday afternoon, whispering, laughing, accompanied by family and friends. Every face was shiny with happiness, satisfaction, and anticipation of the coming event. Every arm was draped with a white button down coat, each emblazoned with the college’s logo. We filed into the front of the auditorium after a long, nervous wait in the hall ( high heels and all…oh the pain!), then calmly (on the outside at least!) took our seats. We absorbed advice and admonition from wise, seasoned people who want the best for us: Dean Pollock, Dr. Brandt, Marian, Cathy Elstad, and others. Then, praying to God that we wouldn’t fall flat on our faces in front of everyone, we marched across the stage to be enrobed in that symbol of the healthcare professional: the white coat. It’s a simple thing, really – just a bright white button down jacket with a stiff collar and a bit of embroidery. But once it is slipped over the shoulders, the wearer takes on a suddenly polished, professional air that reassures and inspires confidence.

We are not simply students anymore; we are student pharmacists. Not “pharmacy students”…that phrase implies that we have yet to assume the role of patient care. No, we are “student pharmacists”, or pharmacists in training, if you will. We have pledged, ” I will” and have lodged the good of the patient at the top of our priority list. We are no longer studying simply for our own sakes, for our grades or our GPA – we are studying to the benefit of our future patients.

Once the white coat is put onto our shoulders by faculty members, we exit stage left (again, thank God, not tripping on our heels) and take the pledge of professionalism. The ceremony echoes the one that will take place in four more years, at which we will recite the Oath of a Pharmacist. For now, we have merely pledged to be professional and ascribe to the absolute highest moral standards. That’s all – no big deal.

The most outstanding thing to me about the ceremony was how much the word family was emphasized. It’s quite wonderful to see the attitude of “We’re a family and we want to help you succeed.” And they do – from the staff & faculty all the way down to my classmates, we’re all rooting for each other.

There is a somber, serious note to all this though: all of the above comes with higher expectations and standards than normal. We are now professionals, a term that envelops high ideals, hard work, and growing up very very quickly.

Tomorrow, we’ll walk into our first class at 8:00 AM, bright eyed and bushy-tailed (hopefully)…if we don’t stay up late thinking about classes and studying and lab and professors and and and and…

on Being Oriented

Well, dear friends, we are officially oriented…or at least we should be.
SO much information has been packed into the last two days – curriculum, endless acronyms (PPSO, PSAC, etc. etc.)expectations, student organizations, blood borne pathogen training, practice experience locations, safety, and meeting new people! Oh it’s so exciting…

on Excitement and Anticipation

Is this going to be one of those things that’s very exciting in theory but disappoints in reality?

I hope not.

I don’t think it will be.

Orientation (!) starts on Thursday morning, August 19th, at 8:30 AM sharp. We’ll be gathering in the pharmacy building, of course, each of us new and fresh. I’m eager to meet new faces, learn the stories behind them, and absorb all that we’ll be doing for the next few months/four years.

I got a text from a fellow class-of-2014-er today…”I’m starting to get excited!”

Me too…but is it this close already? Wow.

I just got back from a few days of sun, family, and rest at the Lake. A bit of a last vacation before the autumn pace of things – it’s good to be starting though. I’m ready to work hard after this season of respite.

Lake Pend Oreille

The Short List and a tall stack

501 (PharP) Applied Patient Care I: Patient Assessment 1 (0-3) Prereq admission to PharD program. Laboratory course teaching hands-on physical assessment techniques from a pharmacy perspective, to provide patient-specific care. S, F grading.

502 (PharS 551) Integrated Pharmacology I 3 Prereq admission to PharD program. Medicinal chemistry, drug metabolism, signal transduction, drug development and autonomic pharmacology.

503 (PharS 500) Pathophysiology with Medical Terminology 4 Prereq admission to PharD program. Review of human physiology along with an overview of human pathophysiology, including medical terminology.

504 (PharS 510) Pharmacy Calculations 1 (0-3) Prereq admission to PharD program. Familiarizes students with the drugs most frequently prescribed in the US, as a basis for pharmacy practice. S, F grading.

505 (PharP 500) Pharmacy Practice Foundations 2 Prereq admission to PharD program. Perspectives into the profession of pharmacy; pharmacy law, ethics, and careers.

507 (PharP 510) Introduction to Therapeutic Agents: Top 200 Drugs 1 (0-3) Prereq admission to PharD program. Drugs most frequently prescribed in the US as a basis for pharmacy practice.

508 (PharS 521) Pharmaceutics I 3 Prereq admission to PharD program. Principles of dosage form design and drug delivery, with an emphasis on physiochemical principles.

509 (PharP 521) Professional Communications Lab 1 (0-3) Prereq admission to PharD program. Professional communication skills as an essential foundation for career development.

That, my friends, is the short list. Fall 2010: a concise, deceivingly short compilation of what we’ll be tossed into. And what a glorious short list it is! Perspectives into the profession of pharmacy! Top 200 Drugs!  Dosage forms and drug delivery! So specific! No more adjectives like ‘general’ or ‘overview’ or ‘entire’; we get to focus on physiology and anatomy and microbiology from a single viewpoint: pharmaceutics. I can’t hardly wait. And I don’t have to…I’m the proud new owner of a very very thick medical dictionary, a tome entitled “Clinical Pharmacology”, and a beasty bound book called “Pharmacotherapy”, all courtesy of my wise mentor-pharmacist.

When they’re stacked all together, they’re about 15 inches tall. I think I’ll use them for dead lifts and shoulder-presses during study breaks. Why not, right?

Will I crack open their overly-informing pages before school? Perhaps. Or maybe I’ll stick to my iced tea, my back porch, and books that are less than 2 inches thick.