US News 100 Best Jobs of 2013 | Pharmacist is #3

I am a little baffled at Pharmacist being listed as #3 on this year's US News 100 Best Jobs because it seems to me that many of the pharmacists I read about on the internet are not very happy.  Personally pharmacy has been good to me.  I definitely would rather be a pharmacist than a dentist or an RN. #1 - Dentist Overall Score: 8.4 | Median Salary $142,740 Ever heard the phrase "Your face is your fortune"? For dentists, our smile is their fortune. They earn their living diagnosing and treating teeth and gums, performing oral surgery, and counseling and educating us on maintaining proper oral health. The profession should grow 21.1 percent by 2020.

#2 - Registered Nurse Overall Score: 8.2 | Median Salary $65,690 The nursing profession will almost always have great hiring opportunity because of its expanse (from pediatric care to geriatric care, and everything in between). And as a substantial chunk of our population ages, the necessity for qualified RNs intensifies.

#3 - Pharmacist Overall Score: 8.2 | Median Salary $113,390 With excellent job prospects and a solid average salary, the pharmacist profession nabs the No. 3 spot on our list. Possessors of a Pharm.D can anticipate nearly 70,000 available jobs this decade—the brunt in physician offices, outpatient care centers, and nursing homes.

#4 - Computer Systems Analyst Overall Score: 8.2 | Median Salary $78,770 Think of a computer systems analyst as a tech project manager. He or she is often a liaison between the IT department and a client, and has influence over both the budgetary and technical considerations of a project.

#5 - Physician Overall Score: 8.2 | Median Salary $183,170 At the top of the medical food chain, physicians diagnose and treat patients, plus they instruct on proper diet, hygiene, and disease prevention. And like other jobs in the healthcare industry, physicians will see abundant job growth to 2020.

And because I love this link mostly because I am included on the page, I will repost.  You will notice though who #1 is:

The Angry Pharmacist: For opinionated posts about drugs, patients, and pharmacy in general, read through this blog and see how this blogger earned his name.

He's angry.  I bet he wouldn't say his procession should be listed #3.

Read more about the top pharmacy blogs out there.

BCPS 2013: Pediatrics

I feel I have a bit of insight into the test and can attest to what is needed to know in each section.  Keep in mind the guidelines could change between 2012 and 2013 along with the test questions, but for the most part I found the test to be incredibly fair though stressing areas more than others that I would have not expected. I want you to pass!  First attempt!

So what do you need to do to pass?  Start now.  I especially am talking to those with families and/or children and very little time to spare for sitting down and studying the traditional way.  Again, I did fail this past year, so I will disclose that immediately, but I do believe I have insight into the test and very much plan to pass it this fall.  It's a goal at this point for my own personal development.

So, ahead I will have some material presented that does come from the ACCP study material though reworded and simplified in more study form and perhaps some hints as to what was important on the test in each particular section.  I am hoping to not get in any sort of trouble by doing this as far as with the BPS, so if this is not appropriate, would someone from there contact me?  I do not plan on giving test questions per se' and I couldn't if I tried as there were far too many to memorize.

After two children I am convinced parts of my brain were delivered with the children as it is.

First up!  PEDIATRICS!

This was always the topic that would terrify me prior to having children, but at this point besides missing one of the most common concepts of children and the very small amount of data on the test regarding pediatrics (at least in my opinion), pediatrics just doesn't seem so daunting.

Know the common pathogens of children in sepsis and meningitis.

0–1 month  

• Group B streptococcus
• Escherichia coli
• Listeria monocytogenes
• Viral (e.g., herpes simplex virus)
• Coagulase-negative staphylococcus—nosocomial
• Gram (−) bacteria (e.g., Pseudomonas spp., Enterobacter spp.)
• nosocomial

1–3 months

• Neonatal pathogens (see above)
• Haemophilus influenzae type B
• Neisseria meningitidis
• Streptococcus pneumoniae

3 months–12 years

• H. influenzae type Ba
• N. meningitidis
• S. pneumoniae

> 12 years

• N. meningitidis
• S. pneumonia

Not to hard to figure out correct?  Keep in mind that H. flu is less and less due to immunizations.  I suppose if you live in an area where vaccination is the devil, you may find more of this organism.

Potential Antibiotic Regimens

Age                                                                         Regimen

0–1 month                                                            Ampicillin + gentamicin OR ampicillin + cefotaxime

1–3 months                                                          Ampicillin + cefotaxime/ceftriaxone

3 months–12 years                                             Ceftriaxone ± vancomycina

> 12 years                                                             Ceftriaxone ± vancomycina

**Addition of vancomycin should be based on the regional incidence of resistant S. pneumoniae.

Regimens for Chemoprophylaxis  (I will have to reformat this later)

Drug                      Neisseria meningitidis                                                                       Haemophilus influenzae

Rifampin            < 1 month old: 5 mg/kg/dose PO every 12 hours × 2 days                       20 mg/kg/dose (maximum 600 mg)

> 1 month old: 10 mg/kg/dose PO every 12 hours × 2 days                   daily x 4 days

Adults: 600 mg PO every 12 hours × 2 days

Ceftriaxone             < 15 years old: 125 mg IM × 1 dose                                                               Not indicated

> 15 years old: 250 mg IM × 1 dose

**Ciprofloxacin and azithromycin are possible alternatives although not routinely recommended.

RSV - Identify the drugs available for preventing and treating respiratory syncytial virus.

Prophylaxis

1. Nonpharmacologic: Avoid crowds during RSV season and conscientiously use good hand-washing practice.
2. RSV IVIG (RespiGam): No longer marketed in the United States (didn't see on the test ;))
3. Palivizumab (Synagis)

• a. Dosing: 15 mg/kg/dose intramuscularly; given monthly during RSV season
• b. Effects on outcomes

i. A 55% reduction in hospitalizations for RSV

ii. Safe in patients with cyanotic congenital heart disease

iii. No reduction in overall mortality

iv. Does not interfere with the response to vaccines

v. Not recommended for the prevention of nosocomial transmission of RSV

Know this:  Supportive care.  Treatment is supportive care only.

American Academy of Pediatrics Palivizumab approval:  (you WILL see this)

i. Premature infants born before 32 weeks’ gestation (i.e., 31 weeks, 6 days or earlier) who are 6 months old or younger at the beginning of RSV season

(a) Infants born at less than 28 weeks’ gestation may benefit up to 12 months of age.

(b) Eligible for a maximum of five doses of palivizumab during RSV season

ii. Infants with chronic lung disease who are 2 years or younger and who required medical management of their chronic lung disease in the previous 6 months – Eligible for a maximum of five doses of palivizumab during RSV season

iii. 32 and 35 weeks’ gestation (i.e., 32 weeks, 0 days through 34 weeks, 6 days) who are 3 months or younger at the beginning of RSV season

(a) With at least one of the following risk factors may benefit: infant attends childcare or sibling younger than 5 yo in same household

(b) Eligible for a maximum of three doses of palivizumab during RSV season

iv. Infants 24 months and younger with hemodynamically significant congenital heart disease

(a) Eligible for a maximum of five doses of palivizumab during RSV season

(b) There is a 58% decrease in palivizumab serum concentration after cardiopulmonary bypass; therefore, a postoperative dose of palivizumab is recommended as soon as the patient is medically stable.

v. Infants 12 months and younger with congenital abnormalities of the airway or neuromuscular disease that compromises the handling of respiratory tract secretions – Eligible for a maximum of five doses of palivizumab during RSV

Tomorrow will continue with otitis media...

When People Fail

I am personally struggling with two pieces of information today.  The first is that Lance Armstrong has come clean with Oprah about his doping scandal.  I had hoped that it was all fabricated by those who were jealous, but alas he is guilty.  I cannot even understand why the leagues (baseball, biking etc...) don't realize that the cost of winning is at ALL costs.  Why not just make these substances all legal and do away with that aspect of what we are capable of doing on our own.  This is 2013.  I would say at this point most sports has seen their very best without enhancement.  What is left?  Enhancement. I know that seems bizarre for a pharmacist to say publicly that doping for sports should be made legal, but that is what I am saying.  As long as it stays illegal, the coaches and trainers and others involved in making the best of the best will go at all lengths to find substances that are not yet known or tested and continue to dope.  It is inevitable.

The other piece of information that I am struggling with today is that a former classmate in pharmacy school (who I will call Ed for his own privacy) has made a deal in pleading guilty in a case that I have had a hard time understanding.

You see, Ed was the type of student in our class who was a man of character.  He was one of the good guys.  I believe he was already married and was in the pharmacy fraternity that was more studious and less partying.  You can imagine that I was in the partying one and you would imagine right.  Ed has a large family now; he has small children and a wife that need him.

Ed has had some legal trouble in which there was some sort of federal charge brought against him for distributing controlled substance (Oxycontin) from his pharmacy.  I don't know how this whole thing began, but apparently it began fairly innocent enough with perhaps one bad decision or perhaps another part of the story that I do not know.  Maybe it was driven by needing money.  Perhaps it was driven by a bad decision further snowballing into extortion by some drug addicted criminals.

Either way, Ed is going to likely go to prison for around five years or so, and my heart breaks for him.

I know that it is easy for many to condemn a man like Lance Armstrong for doping but the bigger offense being the lies he told over the years and nastiness that ensued.  He threatened, sued and was a bully for the most part.  He "beat" cancer of the brain metastasized from testicular cancer, and he founded Livestrong.  There was good to the fame and notoriety even if he came by it by cheating.  Does the means justify the end?  Sometimes?

Fifteen years ago I would have looked at both men making bad decisions and would have spewed my opinion, and it would have been quite judgmental.  I tend to not do that as much because the situation is much more complicated the older I get.  You see, people fail.  People are human - even the most trusted professional, the pharmacist.  The moment that I believe that I am infallible of filling will be the moment where I am the most vulnerable.  We must always strive to do our best.  Do not compromise even for a moment the integrity and good name you have.  It is all you have in the way of public opinion, and in the case of Ed, I was a little saddened to read that he has struck a deal with the government about pleading guilty to one count and going to prison.  He will be sentenced right before this summer, and I dread it for him and his sweet wife and children.

I do hope for a silver lining for Lance Armstrong somehow.  I hope that he is able to look back at his life and see his own shortcomings and how they shaped him into something even better.  Yes, he made a mistake and turned that mistake into a snowball of lies and more denials that took years for him to admit, but there are good things that he has done.

My friend made a mistake and is going to pay the consequence for it by missing five years of his children's lives.  Both of them still are men I can admire for good things in the past and I hope even better things in the future.  Somehow.

How to Be a Better Pharmacist

Don't you remember graduating pharmacy school with all the hope in the world? Pseudomonas treatment options were on the tip of your tongue, and all those "older" pharmacists, let's face it, are SO behind the times. You knew it all, or so you thought at least. Confidence? Maybe so, or maybe an over inflated ego. If you attended a clinical type pharmacy school as I did, the idea of working retail was frowned upon. You were considered to be selling out. (I sold out... At first).

1. You absolutely must keep up year to year. Your education does not end the day you graduate. There's the boards, passing the state exam, and keeping up with continuing education. That window of time between what's printed and accepted by all to the newest guidelines should be studied. Know where to search. Be a google pro.

2. Consider challenging yourself with becoming board certified. If you fail the first time, take it again.

3. Be a team player. If you are clinical, work hard to treat dispensing pharmacists the way you would want to be treated and vice versa. The best model would be for most pharmacists in a department to be clinically trained.

4. Be tech savvy. Most health calculators are online or you can buy apps to help. I still can't believe the company I work for isn't 100% paperless. It's coming, and I can't wait.

Keep up... Because it won't be long, and you will see new graduates flooding the market, and you will recognize them eyeing you as one of the older pharmacists!

Morality and Ethics in the Pharmacy

Should a pharmacist be allowed to exercise their own beliefs and ethics while at work?  This question is part of a big debate in our country in regards to abortion vs. a woman’s right to choose and how it could pertain to a pharmacists’ right to not dispense a medication, specifically the morning after pill.

It is ironic that the same liberal and feminist groups have defended other people in their choice to exercise their own beliefs.  A soldier has been backed by these same groups when they have not wanted to go to war.  The man or woman smoking marijuana to ease pain, although illegal in most states, has been backed by the same.  However, exercising your own beliefs or morals about abortion and the debate of when life begins ends when it comes to the morning after pill.  These groups want to make it mandatory that all pharmacists must dispense Plan B when requested regardless.

On the other hand, a female wanting to exercise her right to choose could be met with resistance from a pharmacist whose morals including viewing life beginning at conception.  There is no clear winner on either side.

By law, a pharmacist can refuse to fill a prescription for any reason they see fit.  Should that reason include their own morals?  Why do you believe yes or no in this debate?

You Lucky Pharmacist You

How are you doing out there fellow pharmacists in an economy that is slowing down? Are your jobs secure? Do you have any fear of being laid-off or losing your job? Do you feel content where you are? On the plus side, it's easy to see how pharmacists and other medical personnel will more than likely be in demand. People continue to age and grow sick. People still need us. Perhaps they'll need us more? However, I am reading from fellow classmates that retail pharmacy is taking a bit of a hit as far as hours the stores are open. I hear that even Walgreens is shortening their hours and therefore not offering as much hours to their current staff. I'm not for sure if this is true, but things are slowing and slowing.

How slow will the grow and how much will it affect us? I'm not so sure that we couldn't find something else if we HAD to versus my husband who could not. That in itself is a good reason to sit and consider how lucky we are to be pharmacists right now. People need us. Even in bad times.

Update:  Three Years Later

I have always wanted to do this and spend the time to tell you how the pharmacy market has changed over time.  Yes, we were right.  Now there are so many pharmacy schools and pharmacy students graduating that the jobs have all but dried up.  You can't find a job.

How sad is that?

How to Make the Transition from Retail to ANYTHING Else

You've finally reached the end of the line in retail.  You've had enough of the rude public, the non-pharmacist managers, and the corporate cuts.  You are ready to have an hour lunch (maybe) and normal bathroom breaks.  You are ready to feel a little more professional.  Sorry, retail pharmacists, you know it's true.  Yes, you probably make more money than me, but at least I'm not worried about my health.  (I was working retail in a terrible part of town.  All of the good areas were full with waiting lists of pharmacists ready to transfer out just like me.  I just chose a quicker path). The first thing that is entering your mind as I'm noticing on a couple of comments here is that you think a special amount of training is required.  Let's first think about hospital pharmacy.  You can transfer from retail to hospital pharmacy fairly easily.  Hospitals can train you.  There is a lot to learn, yes, but I was up-to-speed in two months.  I worked five years in retail, if that helps at all.

You will have to learn about the hospital's formulary, allergy list, and perhaps coumadin and pharmacokinetic dosing again.  You will certainly have a lot of pharmacists willing to help.  There will be no more jerks in line waiting on you to hand them their papersack with drugs; you will merely have a function to be a part of the team that helps to heal the acutely and chronically ill.  You will revisit sterile technique to mix IVs, chemo, and TPN. (I hope, though it seems the hospitals I worked in didn't observe this at all!)

And most importantly... you will have a life back.  No more driving home from work in retail and a customer follow you home.  No more jerks waiting until 3 minutes before close to get 10 prescriptions filled... all new.

I don't regret leaving retail at all.  I do regret losing the knowledge of some of the new drugs since graduation, but it's worth it for peace of mind and life.

I hope that helps.

Two Pharmacists Convicted

My question is this:  How did they get away with it for so long???

By Nick Madigan

Sun reporter

August 1, 2008

After a seven-week trial, two pharmacists accused of selling almost 10 million addictive painkillers illegally over the Internet were convicted yesterday in federal court in Baltimore of that offense and several others.

Steven Abiodun Sodipo, 51, of Forest Hill and Callixtus Onigbo Nwaehiri, 49, of Jarrettsville were found guilty of selling 9,936,075 units of hydrocodone online using phony prescriptions; conspiracy to launder money; engaging in transactions involving the proceeds of drug sales; and filing false tax returns.

Sodipo and Nwaehiri, who face maximum sentences of 70 years in prison, owned and operated Newcare Pharmacy in the 400 block of Sinclair Lane in Baltimore, a business they founded in 1993 that initially specialized in delivering medications and medical supplies to nursing homes and other assisted-living facilities. There was no walk-in service as in traditional, drugstore-based pharmacies.

Prosecutors said that beginning in 2004, the defendants joined a "nationwide conspiracy" to illegally sell hydrocodone over the Internet to anyone with a valid credit card. They engaged in agreements with Web site operators to fill prescriptions e-mailed to them that were signed by a small group of doctors. The doctors, who never saw or spoke to customers, routinely authorized the prescriptions, which were then wired to Newcare for filling and shipment, prosecutors said. In return, Newcare was paid $20 for each prescription it filled and shipped.

"Prescription drug abuse is a growing crisis in Maryland and throughout the nation, and it is one of our most important drug enforcement challenges," Maryland U.S. Attorney Rod J. Rosenstein said after the verdicts. "Many people wrongly assume that prescription drugs are safe. The truth is that using any drugs without proper medical supervision can result in addiction, injury or death."

Carl J. Kotowski, an assistant special agent in charge of the Drug Enforcement Administration's Baltimore office, said the investigation of Newcare "sends an instant message to cybercriminals that the Internet is not their safe house."

Evidence presented at trial showed that Sodipo and Nwaehiri continued to sell large quantities of hydrocodone even while aware that some of their customers were addicts.

The government is seeking the forfeiture of $20 million, the gross proceeds of the sales of hydrocodone from January 2005 to October 2006, when DEA agents raided Newcare's 55,000-square-foot facility and arrested its owners. More than 50 employees of the pharmacy lost their jobs. The government also intends to seize the Newcare facility and its contents, and the homes, bank accounts and motor vehicles of the defendants.

Chief U.S. District Judge Benson E. Legg set sentencing of the two men for Oct. 21.

A co-defendant, Ahmed Alhaji Abdulrazaaq, 49, of Forest Hill was charged with conspiracy to defraud the IRS and is scheduled to go to trial Sept. 2.

nick.madigan@baltsun.com

Copyright © 2008, The Baltimore Sun

Are You Kidding Me?

My mouth just dropped open.  It's obvious to me that physicians do NOT read medication reconciliation forms for home meds at all.  The ones that do, kudos, but the ones that don't make my job more interesting and at times really get to me. Case-in-point:  50-something presenting to the hospital with lower GI bleed.

The doctor signed off to CONTINUE HER HOME MED OF PHENTERMINE FOR WEIGHT LOSS.  Are you kidding me?

I guess the nurse could have written "Purina Dog Chow - take one cup by mouth daily" and the physician would have signed off on it.

Way to go Joint Commission on putting in a requirement with no means of adhering to any sort of THINKING for anyone involved.

Except for the pharmacist of course to wade through the BS and find what is really needed.

I really like the one where the physician wanted to continue the patient's viagra while in the hospital.  THAT should keep the nurses on the floor on their toes running from a man who is looking for some fun.  Not good.

Medication reconciliation forms.  The bane of my existence.

Paternity Testing Available More Discreetly

Friday , February 29, 2008

By Marrecca Fiore

Who needs Maury Povich when paternity tests are now available at Rite Aid, Meijer and other pharmacies for just $29.99?

The Identigene DNA Paternity Test Collection Kit was first rolled out in Washington State, Oregon and California in November last year, according to Rite Aid spokeswoman Ashley Flower. The company continues to evaluate whether it should expand the kits to other states, she said.

According to the Identigene's Web site, the tests compare genetic information obtained from cheek swabs collected from both the child and the father. The swabs are then sent to the company's laboratory along with a $119 lab fee. The results are mailed within five business days.

While the tests are believed to be accurate (the company's Web site says they're 99 percent accurate), there are some reasons why women and couples may want to consult a professional laboratory for paternity tests, said Brad Imler, president of the American Pregnancy Association.

"There's no risk of harm from a medical standpoint," he said. "Although they're not admissible in court. And, from an emotional standpoint, it's a good idea to see a professional. It doesn't have to be a doctor, but someone who is prepared to discuss the result with you if it comes back in a way you were not expecting."

Imler said some people, especially married couples, may find the results of paternity tests traumatic.

"Whatever the circumstances are that bring someone to the point of needing a paternity test, that's irrelevant," he said. "The professionals associated with the laboratories are trained to present the results in a way that doesn't cause panic or in a way that reduces panic."

Both Rite Aid and Identigene representatives say the tests have brought no more controversy than at-home home pregnancy, blood pressure, cholesterol and drug tests did when they were first introduced.

"There was a lot of concern when the home pregnancy test first came out," said Douglas Fogg, chief operating officer for Identigene. "Would people use it correctly? Would people be able to handle the results?

"We have been providing home DNA testing since 1993 and on the rare occasion we'll have a client that has a hard time dealing with the results," he continued. "Most of our clientele are aware of what the results will be. They don't want to involve lawyers or physicians. They just want confirmation in a quick, easy and confidential way."

Fogg said the company’s Web site provides consumers with counseling information

"Some people are devastated by the result of a paternity test," he said. "A paternity test can have a life-changing result. For those that need professional help in dealing with their situation, our Web site offers references to family counseling services that can provide people with the help they need."

Fogg said 60 percent of Identigene's clients are females. Some users are looking to confirm their own paternity. Almost 30 percent of purchasers buy the test for someone other than themselves, according to the company's own surveys.

The tests are sold in 1,000 pharmacies nationwide, Fogg said. He said all pharmacies have reported sales and the company is pleased with the interest. The tests are also marketed online and through resellers.