Your Virtual Pharmacist Guest Post: Coronary Artery Disease

[youtube http://www.youtube.com/watch?v=xd8LgihLouM] You are in a hospital room and overhear the physician say the word (or you think it's a word) "STEMI." What exactly does this mean? Coronary artery disease and it's consequences do not have to be a foreign language.

First of all coronary artery disease is just a fancy term for heart disease. Basically, when the choloesterol is high, plaque is able to be formed and gathers in the heart arteries (or coronary arteries). When this plaque is growing, it can form a clot due to attracting platelets that are gathering to try to heal or fix the plaque. This platelet rich clot grows to the point of stressing the heart whether completely or incompletely.

There are currently three different types of CAD (coronary artery disease) types. The least invasive is UA or unstable angina. Basically angina means heart pain. The second is called NSTEMI or non S-T wave elevation myocardial infarction. The third is called STEMI or S-T wave elevation myocardial infarction.

UA and NSTEMI present the same. Both with chest pain. The difference between the two is that NSTEMI has coronary markers or troponin involved. UA does not. NSTEMI is a clot that is not complete. STEMI, on the other hand, is a complete clot and more of an emergency because cell death is happening in the heart muscle. With no blood flow down a coronary artery, the heart muscle is dying. When the heart muscle cells begin to die due to lack of oxygen and blood, the heart cannot function properly and will go into erratic rhythms. Most of the time, this is what causes death.

The difference between NSTEMI and STEMI is the S-T elevation in the heart waves. S-T elevation signifies cardiac cell death and is a more serious event.

The reason why your doctor will always give you aspirin is due to aspirin's anti-platelet effects. Aspirin is a wonderful drug in that it targets that platelet rich clot that is forming in your coronary arteries and helps to prevent a heart attack. It is also the FIRST thing that you should take if you feel the symptoms of a heart attack coming on... aspirin 81 mg. Well, that and if you have a nitroglycerin sublingual tablet and get to the emergency room fast!

The goal is to prevent these events from happening in the first place. The statins are a class of drugs that help to reduce cholesterol, specifically LDL in the bloodstream to prevent these clots from forming (Lipitor, Pravachol, Zocor, etc... ). Diet and exercise are the best to try first.

I hoped this helped to clear up some of the more complex terms of coronary artery disease.

BCPS - some flashcards from quizlet

So as promised, I'm sitting here studying (not really) for the BCPS and wanted to share with you some flashcards that I have found online.  I did personally purchase the ACCP study materials in print and I bought last year's audio lectures.  I really don't think I have enough time to devote entirely the amount of time that I need; however, I'm going to just go for it.  If I fail, I will retake in 2013.  Goals.  You need goals in your personal and professional life, ok? Enjoy.  I would like to personally thank the pharmacists that created these.  I've made a few sets, but once I stumbled upon these I realized it is all about studying smarter, correct? So today's set:  GI

Choose a Study ModeScatterLearnFlashcards

This should get you going.  Better yet go to http://www.quizlet.com and search "BCPS."  I promise you'll find a lot of study materials that will help.

There's a study guide online.  Of course we are almost two months out.  (UNREAL):
Jul 23 Amb Care
Outpt Cards
M/W Health
Jul 30 GI
Nephrology
Oncology
Aug 06 Biostats
Policy/Practice
Economics
Aug 13 Pediatrics
Geriatrics
Kinetics
Aug 20 Neurology
Psychiatry
Fluids/Elytes
Aug 27 Ac Care Cards
Crit Care
Sep 03 ID
HIV/ID
Endocrine
Sep 10 Amb Care
Outpt Cards
M/W Health
Sep 17 GI
Nephrology
Oncology
Sep 24 Free Study
Oct 01 Free Study
Oct 06, 2012 BCPS Exam

I am also subscribed to http://www.highyieldmedreviews.com.  We'll see if it helps after October 6th, right?

 

 

 

 

The BCPS and Tackling the Beast

I decided to take the BCPS this October. First of all, I have to admit the first time I even heard of this test, I thought it was a joke. I just figured it was something that wouldn't be recognizable as anything important. Fast forward thirteen years, and I believe this certification should be something most pharmacists should want to attempt. It is pricey though. I have a little over two months and have a ton of information to go through while trying to become a biostats expert. Wish me luck. I figured I could post some posts about recent guidelines in the next few months... Sort of a way to blog and study simultaneously. Genius?

What advice I would give students graduating from pharmacy school

Seems others are doing the same, so I'll put in my 2 cents. 1.  Don't assume that all of pharmacy is retail.  Yes, you will make the most bucks in retail and if you have gone the way of borrowing your way into a huge hole, then it may be your only way to make it out and then find something else.  Perhaps retail is your goal, and you love it, but personally, I found 3 years of retail to be enough pharmacy prostituting that I could do.  The bucks WERE nice, but the abuse to my body from standing 14 hours a day, lack of bathroom breaks, treatment from STORE managers who have barely any sort of education, abuse from patients, and abuse from non-caring technicians, I look back now and say RUN -- no I SCREAM RUN!  There are some great jobs out there that don't involve retail at all.

2.  If you DO choose retail know that the longer you stay IN retail, the less likely you'll ever get out.  It's like getting hooked on a drug.  You keep doing it saying you'll quit, but by the time you are ready to leave, it's almost too late, unless you are lucky and some poor sweet manager in a different realm of pharmacy sees the pain you have experienced and wants to throw you a lifeline.  I had one of those - a female pharmacist that I am forever indebted to.... thanks J!

3.  Make pharmacy a hobby somehow.  Read and read and read.  The only difference between you and the girl (since girls are taking over ;)) standing next to you is that you somehow have made yourself marketable... you are reading publications and keeping up.  You are giving a rats ass about pharmacy and all the crap going on...  You know how to find anything FAST...  you can think on your toes.  Who care what you made in Biochem.  No one cares.  But do you know the difference between using Primaxin/Fortaz vs. Tygacil in different situations?  Can you think critically?

My top advice... DO NOT GO INTO RETAIL!!!!!!!!!!!!!!!!!!!!!!!!!!!

NAPLEX is Suspended

Prof. accused of sharing licensure exam questionsQuality of University not in doubt KRISTEN COULTER

Issue date: 8/30/07 Section: News

Shirley Zhang, a graduate student from China studying biochemical sciences, walks past the Pharmacy Building located on South Campus.

A University pharmacy professor is a defendant in a federal court case, in which he is accused of collecting and disseminating pharmacy test questions to students, according to court documents obtained by The Red & Black.

The National Association of Boards of Pharmacy filed the case Aug. 3 against the Board of Regents and Flynn Warren Jr., citing copyright infringement, misappropriation of trade secrets and breach of contract, according to the documents.

NABP has investigated Warren twice for these allegations.

The North American Pharmacist Licensure Examination and Georgia Multistate Pharmacy Jurisprudence Examination are tests required to obtain a license to practice pharmacy. The NAPLEX is used by all 50 states’ boards of pharmacy, and the MPJE “combines federal and state specific law items to serve as the state law examination in 46 participating jurisdictions,” according to a NABP news release.

At an Aug. 23 meeting, the executive committee of NABP decided to suspend all administrations of the NAPLEX and the Georgia MPJE beginning Aug. 25 and will not administer the test nationwide.

NABF said in the news release it has not decided when to reinstate the test.

“I cannot comment on this, given the current investigation,” said University Provost Arnett Mace Wednesday afternoon.

Warren, who was reached at his home Wednesday evening, also refused to comment.

The College of Pharmacy referred calls to Tom Jackson, the associate vice president for public affairs. Jackson wrote Wednesday in an e-mail, “parties have been ordered by the court not to comment on the matter while it is in litigation.”

While he would not comment on the investigation, George Francisco, associate dean of the College of Pharmacy, said Warren has taught the board review course at the University “for several years.” Francisco said the class lasts three days and is available to both University pharmacy students and students at other institutions.

Warren is accused of copyright infringement because NABP owns the copyrights on the exam questions. Court papers say he asked students to memorize NAPLEX test questions and share them with him. He collected the tests’ contents and created a review packet.

Warren is faced with these accusations because he was never “granted a license … to copy, sell, distribute, prepare derivative works from, or otherwise offered to transfer the ownership of the copyrights of the NABP Examination Questions, to which NABP has exclusive rights,” the court papers read.

Warren is accused of misappropriation of trade secrets because: “the NABP Examination Questions are original lists of questions containing technical information used for evaluating the competency of a candidate in the field of pharmacy,” and the questions “derive economic and evaluative value from not being generally known and not being readily ascertainable by proper means,” according to the documents.

The breach of contract charge stems from a 1995 settlement agreement, in which Warren and the University said they will “cease and desist for profit or otherwise from all past, present and future copying, transcribing or other infringing use of NABP copyrighted materials, including but not limited to patient profiles, sample questions, or other copyrighted information.”

Francisco said he was unaware of the 1995 settlement, and the pharmacy school was not monitoring Warren’s classes.

Last year, the BOR offered to pay $40 million for an addition to the College of Pharmacy.

Professors at other schools exposed exam study guide

According to a biography on the University’s Web site, Warren has been a pharmacy faculty member since 1985. Before his July 1 retirement, he was a clinical professor and the college’s assistant dean for student affairs.

Though he retired last month, Warren still is teaching elective classes for the pharmacy school, Francisco said.

This case arose after Warren offered an annual exam review course at Samford University.

Alan Ray Spies, an assistant pharmacy professor at Samford, said in an affidavit that he learned Warren was giving NAPLEX questions to students. Spies said he first found out this information in May 2007.

“Specifically, I learned that Mr. Warren’s course materials include, among others, a series of questions, some 2,700 in number, that appear to be very similar, if not verbatim, to questions asked on the NAPLEX,” Spies said in the affidavit.

Spies said he talked with some of his students about Warren’s course in the affidavit.

“It soon became apparent to me that individuals who had just taken the exam were sending Mr. Warren questions which he in turn was forwarding to students who had not yet taken the NAPLEX.”

Spies said he sent the information he found in an e-mail to Steven Pray, a pharmacy professor at Southwestern Oklahoma State University.

In his affidavit, Pray discussed his view of the importance of exam security for the NAPLEX.

“The knowledge base required to become a competent pharmacist is vast, taught via hundreds of hours of lectures, laboratories, and practical experiences,” Pray said.

In the affidavit, Pray also discussed his thoughts about the extensive consequences for the exam if the questions have been compromised.

“A loss of hundreds or thousands of items, as it appears, has occurred through the activities of Mr. Warren, will force NABP to endure a loss of millions of dollars and will necessitate a radical overhauling of the examination pool,” he said. “If this is required, the nation’s pharmacy graduates cannot be licensed until a new, uncompromised NAPLEX can be created.”

As he further researched the issue, Pray said in the affidavit that he found an online forum where students discussed Warren’s course.

“This Web site also discussed an individual named ‘Flynn,’ who offered a review course and notes on passing the NAPLEX,” Pray said in the document. “One correspondent on the Web site suggested that prospective examinees review the comments sent to ‘Flynn’ by other students, and another provided his address at the University of Georgia.”

Pray declined Wednesday to speak for attribution about the case with The Red & Black.

Professionals feared news would ‘impair confidence’

According to court documents, Pray sent the information to Carmen Catizone, executive director of NBAP.

In his affidavit, Catizone said Kerri Hochgesang, a lawyer for NABP, bought Warren’s course materials on July 31. In her affidavit, she stated, “a true and correct copy of my payment receipt from the ‘UGA Pharmacy Cont ED, Pharmacy Building’ for the course materials” was given to her for $100.

According to Catizone, the materials contained at least three PDF files. On the NAPLEX REVIEW 2007 disc included in the materials, the files were labeled “NAPLEX MATERIAL PART 2, 2006 INFO FOR NAPLEX, and NAPLEX SAMPLE TEST W ANSWERS.”

Catizone reported his analysis of this material “revealed at least 633 ’sample’ questions contained in Warren’s ‘review course’ and/or were made available by Mr. Warren to candidates who gave him their e-mail addresses.”

He also discussed his concerns about the value of the test if the allegations against Warren are true.

“The extent of the forgoing breach in the confidentiality of NAPLEX exam questions calls into serious question the integrity of the exam,” Catizone said in the affidavit.

Efforts to reach Catizone Wednesday were unsuccessful.

According to an Aug. 6 NABP news release, “United States’ Marshals seized materials and computers from the University of Georgia College of Pharmacy and the offices and home of Flynn Warren, Jr.”

“NABP is disappointed and appalled that the

public trust and health were victimized, the security of the NAPLEX and MPJE breached, and the integrity of the licensure process compromised,” Catizone said in the news release.

On Aug. 3, NABP motioned to file the case under seal, citing potential public panic as a result of the case.

“If the facts of this case are covered in the media or are otherwise publicly available, there is a significant chance that the confidence of the general public in pharmacists and the dispensation of pharmaceuticals will be impaired,” NABP stated in the document.

“This case involved copyright infringement and misappropriation of trade secrets in highly confidential testing materials used in the licensure of pharmacists in many jurisdictions, and reproduction of the testing materials is required in order for Plaintiff to prove its case. Making this information publicly available will further compromise the licensure of pharmacists.”

Warren filed a motion to stay Aug. 21, citing a lack of subject matter jurisdiction.

On Aug. 27, the court “provided the parties with a limited opportunity to conduct discovery related solely to the jurisdiction issue,” according to court documents.

The court also stated, “there have been no final factual determinations by the court and no findings of liability on behalf of any defendant. Furthermore, the court has made no findings that would question the quality of education provided by the University of Georgia College of Pharmacy.”

- Alexis Garrobo, Juanita Cousins and Brian Hughes contributed to this report.