Meded101 - Guest Post

I really wanted to use Beth’s 2014 resolution post to put some pressure on all of the pharmacists that follow this blog.  I really think as pharmacists we need to focus on changing our mindset to help convince others in the healthcare field realize how valuable we are.  I’ve been doing quite of bit of reading and investigating of various healthcare providers blogs and I see many of them talk about the importance of interprofessional teamwork.  I think this is incredibly important as well and try to gear my educational pieces (found at www.meded101.com ) toward all healthcare professionals.  However, when I read these stories, blogs, articles etc. from other HCP’s, I can’t help but notice that many of them don’t even mention pharmacists, and if they do, it’s at the very end of their statement.  Do we want to have a greater role in the selection of medication therapy?  I believe we need to focus on placing ourselves at the forefront of the hearts and minds of nurses and doctors.  We need to earn the trust of our fellow healthcare providers.  What does this mean for us as pharmacists and how do we get there?  We need to be available.  We need to take on the challenging questions and provide solutions to those questions.  You know those cases that no one wants to deal with and how easy it is for us to say, “not my problem, I’m not the doctor”.  I’ll give you a brief example of what I’m talking about.  I’ve seen pharmacists make the recommendation not to use metformin due to an elevated creatinine – very legitimate.  However, I’ve seen numerous times where no solution is made on how to control their diabetes.  Here’s a great example where we can step out and say “this medication is not appropriate, and here’s an alternative solution to fix it.”  Put yourself in the shoes of the prescriber that receives that recommendation – here’s a pharmacist telling me what I can’t do.  They want to be the medication experts and don’t even give me an idea to solve the problem that they brought to my attention?  This type of recommendation also puts them in a position where I can easily understand their frustration with pharmacists.  I’m making a plea to you all that if we want to be taken seriously and as part of team that solves medication related problems, we have to provide value.  One of my favorite quotes is from Einstein – “Try not to become a man of success, but rather try to become a man of value.”  The easiest way we can do that is to offer quality answers when prescribers and nurses have questions.  To be able to offer quality answers, we need to pursue education, knowledge, and understanding.

Eric Christianson, PharmD, CGP, BCPS

www.meded101.com

Twitter:  @Mededucation101

Facebook – www.facebook.com/meded101

World Report on Cancer

The past few months I have seen too many reports of friends being affected by cancer.  Cases roll in daily at the hospital, and though I can handle the workload, there are days when I see a folder and a name and wonder what they are dealing with personally.  I have a friend that is on the brink of discovering what is going on with a possible diagnosis and another in Australia who is fighting for her life.  My husband lost both of his parents and grandparents to cancer.  I have another acquaintance back home dealing with cancer and younger than me, and then at church the other night heard about yet another case.  Even my own mother has been diagnosed in the past.  I am in tears, folks.  I do not understand how it seems there are more cases in my life whether it is that I am growing older or that the article mentions cancer is on the rise.  I have to agree. The International Agency for Research on Cancer, the specialized agency of WHO for cancer, has launched "World cancer report 2014". The report reveals prevention is key and that cases of cancer are growing at an alarming rate.

From the WHO website:

Key facts

• Cancers figure among the leading causes of death worldwide, accounting for 8.2 million deaths in 2012 (1).
• Lung, liver, stomach, colorectal and breast cancers cause the most cancer deaths each year.
• The most frequent types of cancer differ between men and women.
• About 30% of cancer deaths are due to the five leading behavioral and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, alcohol use.
• Tobacco use is the most important risk factor for cancer causing over 20% of global cancer deaths and about 70% of global lung cancer deaths.
• Cancer causing viral infections such as HBV/HCV and HPV are responsible for up to 20% of cancer deaths in low- and middle-income countries (2).
• More than 60% of world’s total new annual cases occur in Africa, Asia and Central and South America. These regions account for 70% of the world’s cancer deaths (1).
• It is expected that annual cancer cases will rise from 14 million in 2012 to 22 within the next two decades (1).

---

 The main types of cancer are:

• lung (1.59 million deaths)
• liver (745 000 deaths)
• stomach (723 000 deaths)
• colorectal (694 000 deaths)
• breast (521 000 deaths)
• oesophageal cancer (400 000 deaths) (1).

What causes cancer?

Cancer arises from one single cell. The transformation from a normal cell into a tumour cell is a multistage process, typically a progression from a pre-cancerous lesion to malignant tumours. These changes are the result of the interaction between a person's genetic factors and three categories of external agents, including:

• physical carcinogens, such as ultraviolet and ionizing radiation;
• chemical carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a food contaminant) and arsenic (a drinking water contaminant); and
• biological carcinogens, such as infections from certain viruses, bacteria or parasites.

WHO, through its cancer research agency, International Agency for Research on Cancer (IARC), maintains a classification of cancer causing agents.

Ageing is another fundamental factor for the development of cancer. The incidence of cancer rises dramatically with age, most likely due to a build up of risks for specific cancers that increase with age. The overall risk accumulation is combined with the tendency for cellular repair mechanisms to be less effective as a person grows older.

Risk factors for cancers

Tobacco use, alcohol use, unhealthy diet and physical inactivity are the main cancer risk factors worldwide. Chronic infections from hepatitis B (HBV), hepatitis C virus (HCV) and some types of Human Papilloma Virus (HPV) are leading risk factors for cancer in low- and middle-income countries. Cervical cancer, which is caused by HPV, is a leading cause of cancer death among women in low-income countries.

How can the burden of cancer be reduced?

Knowledge about the causes of cancer, and interventions to prevent and manage the disease is extensive. Cancer can be reduced and controlled by implementing evidence-based strategies for cancer prevention, early detection of cancer and management of patients with cancer. Many cancers have a high chance of cure if detected early and treated adequately.

Modifying and avoiding risk factors

More than 30% of cancer deaths could be prevented by modifying or avoiding key risk factors, including:

• tobacco use
• being overweight or obese
• unhealthy diet with low fruit and vegetable intake
• lack of physical activity
• alcohol use
• sexually transmitted HPV-infection
• urban air pollution
• indoor smoke from household use of solid fuels.

Tobacco use is the single most important risk factor for cancer causing about 22% of global cancer deaths and about 71% of global lung cancer deaths. In many low-income countries, up to 20% of cancer deaths are due to infection by HBV and HPV.

Prevention strategies

• Increase avoidance of the risk factors listed above.
• Vaccinate against human papilloma virus (HPV) and hepatitis B virus (HBV).
• Control occupational hazards.
• Reduce exposure to sunlight.

Early detection

Cancer mortality can be reduced if cases are detected and treated early. There are two components of early detection efforts:

Early diagnosis

The awareness of early signs and symptoms (for cancer types such as cervical, breast colorectal and oral) in order to get them diagnosed and treated early before the disease becomes advanced. Early diagnosis programmes are particularly relevant in low-resource settings where the majority of patients are diagnosed in very late stages and where there is no screening.

Screening

Screening is defined as the systematic application of a test in an asymptomatic population. It aims to identify individuals with abnormalities suggestive of a specific cancer or pre-cancer and refer them promptly for diagnosis and treatment. Screening programmes are especially effective for frequent cancer types for which a cost-effective, affordable, acceptable and accessible screening test is available to the majority of the population at risk.

Examples of screening methods are:

• visual inspection with acetic acid (VIA) for cervical cancer in low-resource settings;
• PAP test for cervical cancer in middle- and high-income settings;
• mammography screening for breast cancer in high-income settings.

Treatment

Cancer treatment requires a careful selection of one or more intervention, such as surgery, radiotherapy, and chemotherapy. The goal is to cure the disease or considerably prolong life while improving the patient's quality of life. Cancer diagnosis and treatment is complemented by psychological support.

Treatment of early detectable cancers

Some of the most common cancer types, such as breast cancer, cervical cancer, oral cancer and colorectal cancer have higher cure rates when detected early and treated according to best practices.

Treatment of other cancers with potential for cure

Some cancer types, even though disseminated, such as leukemias and lymphomas in children, and testicular seminoma, have high cure rates if appropriate treatment is provided.

References

1. Globocan 2012, IARC

2. de Martel C, Ferlay J, Franceschi S, et al. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. The Lancet Oncology 2012;13: 607-615.

I suppose it is time that instead of thinking it is caused by genetics and cigarettes alone, but sugar, high fat diets, low fruit and vegetable intake among the other risks listed above.  I think it is time to change my diet.

10 Rules of Email Etiquette at Work

One of the most frustrating things about pharmacy jobs today, for me at least, is the lack of email etiquette at work.  I know it sounds crazy to even bring this up, but I have been pondering this post for years.  You see, I have been guilty of not being the best at email, but over the years it is becoming crystal clear the errors people make every single day that not only make the sender look badly, but can actually fracture a team.  Without further ado, the email changes I would like to see in the pharmacy and hospital world with a disclaimer that since I have been practicing for almost 15 years, these examples go way back in time. 1.  REFRAIN FROM REACTIVE EMOTIONAL EMAILS.  If you find yourself getting worked up over what you are reading, do your best to avoid pressing reply and firing off a response.  Avoid sending emails when you’re feeling any type of negative emotion. These types of emails will ALWAYS make you look unprofessional and maybe even unstable.  Before you send off that email rant or reply to an email that angers you, try cooling off overnight.  Or, write an uncensored draft that you never actually send. Remember that all emails are forwardable.  If you don't want your whole department to read it, do not send it.

2.  RESIST THE REPLY ALL BUTTON.  This is the one that literally will make my entire head explode at work.  I have seen coworker after coworker make this mistake and it is not pretty.  This can make you look totally clueless all the way up the chain.  Coworkers don't let coworkers reply all.  In fact, I would love to see the day when reply all is no longer an option in Outlook, Gmail, or any other email client.  Why?  Because it creates mindless replies when all of the discussion could be tabled and then ONE single email sent out to a team.  Time after time in all of my jobs have seen emails go out - an official type declaration of what we are going to be doing - and someone else will reply all and jump in with something else essentially calling out critically all the things wrong with the initial.  Take the time to call the person that sent the email and give them the professional courtesy to make any corrections.  Don't shoot the messenger!

3.  UNDERSTAND WHAT CC AND BCC MEAN.  The recipients listed in the To field are the direct addressees of your email. These are the people to whom you are writing directly.  CC, which stands for “carbon copy” or even “courtesy copy,” is for anyone you want to keep in the loop but are not addressing directly in the email. The person(s) in the CC field is being sent a copy of your email as an FYI. Commonly, people CC their supervisors to let them know an email has been sent/an action has been taken or to provide a record of communications. The general rule of thumb is that recipients in the To field are expected to reply or follow up to the email, while those in the CC field do not.  So many times I see the ones in the CC field adding in their two-cents and then the whole thing becomes a reply-all festival.

4. IF YOU ADD SOMEONE IN THE CC OR TO FIELD, LET THE OTHERS KNOW.  Guess what?  There are times when people are added willy-nilly for no good reason and you look back and notice it a couple of emails later.  Let people know.  Professional courtesy and politeness go a long way.

5.  BCC IS GOOD FOR ONE THING ONLY.  Let's say that only half in your department contributed to the annual walk fund.  Rather than sending out an email to all those that contribute in the TO field where each of them can see who did contribute and who did not, put your own name in the TO and the rest in the BCC.  That way, gossip about who gives and doesn't is stopped before it can even begin.  Don't use the BCC field to add someone random to eavesdrop on the email.

6.  PICK UP THE PHONE.  If you notice that you are going back and forth on an email and getting nowhere, the phone still works.  Guess what?  Voices can convey so much more than words and rarely are misinterpreted as much as typed words.  I remember an email I saw that was sent for the third time.  The second time it was heavily highlighted with quotes from the manager's email weeks before.  The third send apologized for resending the email yet again but someone was not doing it correctly.  Because of the sender's frustration, more time was wasted from the entire department reading about some small piece in the whole operation, and worse, half of the department had nothing to do with the infraction.

7.  DON'T PUT A QUOTE IN YOUR SIGNATURE.  There is no reason for it.  From The Wordsmith:

******Avoid quotes, witty sayings and colors in the signature.

8.  DON'T ASSUME EVERYONE READS THEIR EMAIL IMMEDIATELY.  If something is important and needs to be communicated quickly, pick up the phone.

9.  DO NOT FORWARD AN EMAIL UNTIL YOU ASK PERMISSION.  This is just plain common professional sense.

10.  DO NOT USE UNPROFESSIONAL FONTS OR BACKGROUND PAPERS.  They only distract.  This means NO comic sans.

Hope that helps.  And, by the way, I do mess up on some of these myself.

Ativan Drips and Precipitation

If you happen to run short of the lorazepam 2 mg/mL vials to compound your ativan drips, be mindful of the possibility of precipitation when using the lorazepam 4 mg/mL vials.  AHFS Drug Info states:

Precipitation-- The choice of commercial lorazepam concentration to use in the preparation of dilutions is a critical factor in the physical stability of the dilutions. Both the 2- and 4-mg/mL concentrations utilize the same concentrations of solubilizing solvents. On admixture, the solvents that keep the aqueous insoluble lorazepam in solution are diluted twice as much using the 4-mg/mL concentration than if the 2- mg/mL were used, resulting in different precipitation potentials for the same concentration of lorazepam. Care should be taken to ensure that the compounding procedure that is to be used for lorazepam admixtures has been demonstrated to result in solutions in which the lorazepam remains soluble.

Lorazepam concentrations up to 0.08 mg/mL have been reported to be physically stable, while occasional precipitate formation in admixtures of lorazepam 0.1 to 0.2 mg/mL has been reported. The precipitate has been observed in both containers and in administration set tubing.

In one case, a visible precipitate formed in a lorazepam 0.5-mg/mL admixture in sodium chloride 0.9% in a glass bottle.  However, a 0.5-mg/mL concentration may remain in solution longer if prepared from the 2-mg/mL concentration, yielding a higher concentration of organic solvents in the final admixture.

Concentrations of 1 and 2 mg/mL have been reported to be physically stable for up to 24 hours as well as concentrations below 0.08 mg/mL.

Concentrations in the middle range of 0.8 to 1 mg/mL may be problematic.  In one report, use of lorazepam 2 mg/mL to prepare lorazepam 1-mg/mL admixtures in dextrose 5% or sodium chloride 0.9% was acceptable but use of the lorazepam 4-mg/mL concentration to prepare the same solutions resulted in almost immediate precipitation.

Lorazepam solubility in common infusion solutions has been reported. Its solubility in sodium chloride 0.9% is approximately half that found in the other tested solutions. This result was attributed to the pH of the sodium chloride 0.9% (pH 6.3) being essentially the same as the isoelectric point of lorazepam (pH 6.4), where aqueous solubility would be the lowest. Dextrose 5% was the best diluent for lorazepam.

If you are a hospital or facility that mixes the middle range of 0.8mg to 1 mg/mL you have to be more mindful of other factors.  This is the reason I had no idea of this problem since other facilities where I have worked we mixed a much less concentrated solution.  I found out the validity of this information and wasn't too pleased.

The bottom line is that it would be nearly impossible for a pharmacist to know every single intricacies of different hospitals and compounding practices.  If knowledge like this is indeed something we should all 100%  know, then someone somewhere dropped the ball on training and/or education.  I am mostly wondering, how does your facility compound ativan drips?  What scenarios caused precipitation?

For more about this issue read here.

New Year's Resolutions for the Pharmacist

Most of the time, the New Year ushers in thoughts of dropping 15-20 lbs and signing up for a few road races.  No, not to race, but just to finish.  This year, I have been much more introspective thinking about life and career and all the above.  Maybe some of these pharmacy related resolutions will be similar to yours.

1. Begin studying for another certification.  I am heavily learning toward the BCNSP.  I am in no hurry because quite honestly, there is no reason professionally to obtain.  I would just accomplish something that has interested me in the past.  I used to work for a home infusion company and there was a pharmacist (JB) who was quite fabulous.  I am sure he still is today, but I noticed he has this designation and is probably running circles around most in the area when it comes to nutrition.  It is quite an in-depth topic from enteral to parenteral nutrition, and I am predicting another 1-2 year study.  I have purchased the material and have started though not nearly as much gusto as the BCPS so far.  If you are not certified, consider it.  IT MATTERS.
2. Stop worrying about what other pharmacists think about you.  You cannot live your professional life trying to beat out or outsmart the guy/gal next to you.  Yes, you may be in fact more qualified and more experienced, but you cannot control how a company decides to utilize your experience or knowledge.  Perhaps a position in a different area will open up and any type of learning on the side you have pursued will open doors!?  Sometimes it is just timing and sometimes just sheer luck.  In the meantime, focus on being a better pharmacist.  Focus on remaining competitive and the go-to person for all things current.  If you keep up with the current practice and move forward, the people who win are your patients.
3. Look to the future.  Prepare for the future so that when it happens, you will be ready to step right into the role without any problems.

Those are my resolutions for pharmacy this year.  I hope 2014 holds many wonderful things for you in your career whether it is pursuing a board certification or attending an update to begin the process to do more for your patients than last year.

Cheers!

The Study Schedule I Used in 2013

I have received many requests about how I studied for the exam, and I wanted to share what I did.  I utilized the same sort of format that Ted Williams' website mentions.  His website, though dated material, still has the outline I'd focus on (with ACCP) and High Yield Med Reviews perhaps if you need more in-depth material to understand the topics better (depending on your level of expertise and day-to-day work).

• Domain 1: Patient-specific Pharmacotherapy (60% of the examination) • Domain 2: Retrieval, generation, interpretation and dissemination of knowledge in pharmacotherapy (25% of the examination) • Domain 3: Systems and Population-based Pharmacotherapy (15% of the examination)

• Week 1:  Statistics - know statistics VERY well.  I spent a lot of time on statistics outside of this first week, but every year I'd start again WITH statistics and end with statistics.  In the beginning, I hated statistics.  Today, I love it.  I guess repeated exposure grows on you.
• Week 2:  Pediatrics
• Week 3:  Geriatrics
• Week 4:  Kinetics
• Week 5: Neurology
• Week 6: Psychiatry
• Week 7:  Fluids, Electrolytes, and Nutrition
• Week 8: Acute and Critical Care
• Week 9:  Regs, Policy/Practice, Pharmacoeconomics
• Week 10:  Endocrine
• Week 11:  ID
• Week 12:  HIV/ID
• Week 13:  Men/Women's Health
• Week 14 and 15:  Outpatient Cardiology
• Week 16:  Ambulatory Care
• Week 17:  GI
• Week 18:  Nephrology
• Week 19:  Oncology
• Week 20:  Biostats Refresh, Clinical Trial Design, Pharmacoeconomics, Policy/Practice, Economic/Humanistic Outcomes
• Week 21:  Peds, Geriatrics, Kinetics
• Week 22:  Neurology, Psych, Fluids, Elytes/Nutrition
• Week 23:  Acute Care/Critical Care
• Week 24:  ID, HIV, Endocrine
• Week 25:

  Amb Care, Outpt Cards, M/W Health

• Week 26:  G

  I, Nephrology, Oncology

• Week 27:

  Biostats Refresh/Applications, Clinical Trial Design, Policy/Practice,

  Economic/Humanistic Outcomes

• Week 28:  Peds, Geriatrics, Kinetics
• Week 29:

  Neurology, Psychiatry, Fluids, Elytes & Nutrition

• Week 30:

  Acute Care Cards 1 and 2, Critical Care 1 and 2

• Week 31:

  ID, HIV/ID, Endocrine

• Week 32:

  Amb Care, Outpt Cards, M/W Health

• Week 33:  GI, Neph, Oncology
• Week 34:  Review all
• Week 35:  Review all

This is basically how I tackled it each time.  Pace yourself to cover the material and try to make 3 loops, even 4 if possible through all of the material.

This book is good for statistics.

High Yield Med Review is good for in-depth lectures and study material.  Cheaper than ACCP too, I believe.

ACCP - hands down, the best bang for your buck as far as study materials -- succinct and up-to-date.  This link is for 2013.  Sometimes people sell theirs.  Student Doctor Forum has those selling.

ASHP has great material as well.  In fact I used them for the Pharmacoeconomic section and in hindsight wish I had researched them a bit more for test prep.

Hope this helps someone.

By the way, we had our educational walk-through with a representative of JCAHO, and he mentioned three times about how important board certification was.  Our facility only has two practicing pharmacists that are board certified (including me).  There are two in management who have it.  Other than that, I hope more will attempt.

My Alma Mater: University of Tennessee Health Science Center (Pharmacy School)

Back when I attended UT Memphis Pharmacy School, it ranked in the top 10 of pharmacy colleges in the country.  Today, US News and World Reports ranks it as #17.  

Why Should You Become Board Certified?

I enjoy brainstorming with other pharmacists and asking them their opinions on becoming board certified.  I remember back in 1998-1999, the assistant dean of my alma mater, University of Tennessee at Memphis stressed how important it was for us to consider residency and board certification.  At the time, I was a 25-26 year old making decisions that would impact me for life.  You see, I decided back then to decline that path.  I only saw the dollars that were before me and the student loan debt piling up.  I quipped, "Why would I want to work for half-pay or less for a whole year?" Why?  Hindsight is 20/20.  Fast forward to a 40 year-old in the profession for over 14 years experiencing all sorts of different experiences, and after trying most, I have a couple of regrets as far as my tenure in pharmacy school.  I regret not doing a rotation overseas.  I regret not doing an residency.  I regret that I dismissed more learning inferior to money.

I know not everyone feels like me, and that is understandable.  Perhaps I am just a different sort who becomes stir-crazy when bored.  Whatever the reason, I decided to pursue BCPS last year.  I missed it barely the first time and immediately jumped back up and started studying again.  I work in a small community setting in a smaller city and though it is nothing like Memphis was in terms of clinical opportunities, these opportunities can be found with a little thought.  Passing the test was probably up there with other accomplishments in life - like the time I finished my first marathon (26.2 mile run) in 2002.  Victory!

Why should you become board certified?

1. BPS website quotes:  "From patient to provider, the value of the BPS-certified practitioner registers throughout the health care continuum. For pharmacy professionals, documentation of specialized experience and skills yields the additional benefits of personal satisfaction, financial rewards and career advancement."  I definitely agree with most of this though most I have talked with did not receive a raise unless they changed jobs.  In the past where BCPS maybe helped with landing a clinical job, today it may be the thing to separate you from a PharmD without BCPS.
2. If you have been out of school for over four to five years, you can be sure you have already forgotten some of what you have learned and have not learned new material being presented to new graduates.  You can depend on your local hospitals' computer system to remind you of every little thing (trusting those that program such systems) OR you can take charge of what you know and remain committed to being the best you can be.  Think of it like this, if you work in a hospital and you are commanding larger salaries than new graduates with fresher knowledge, there comes a point where you are replaceable.  Be your best to remain competitive in your field.  This means utilizing continuing education to really learn something and not last-minute cramming to renew your state license.  (Guilty, by the way).
3. A paper wrote in 2006 (seven years ago) states that "Future Clinical Pharmacy Practitioners Should Be Board-Certified Specialists."  In the past clinical pharmacists have not made board certification a priority, but this is changing rapidly with not only clinical positions but in staff positions.  Clinical faculty and preceptors MUST be board certified, I believe.  As pharmacists move toward the direction of becoming reimbursed professionals for optimizing medications, there will be a trend toward licensing agencies requiring board certification in certain scenarios.  Sure, it is not TODAY, but if you would have asked me in 2000 if I thought the market would be in the shape it is with oversaturation, I would have done things VERY differently in 1999-2002.  Direct patient care IS coming.
4. The PharmD curriculum is not enough to be able to interact in sync with other healthcare professionals.  Experience in dealing with physicians and their assistance along with board certification will take you to the next level in recommending appropriate treatment.  Placing a new graduate in a clinical position without experience and expecting them to build relationships with clinicians is not the best case scenario for the patient.  Requiring a board certification ensures a higher level of expertise and should be a requirement of all hospitals (in my opinion).  I know, I know.  Not something anyone wants to enforce, but wow!  The benefits in just preparing and studying for the test are immense.
5. Last, but not least, you should become board certified to give your patients the best care possible.  This was my number one reason.  I remember the day I sat at my desk years ago and realized I had no idea about new guidelines (and even some not-so-new) and that centralized order entry had essentially turned me into a robot at a computer verifying at will, I realized it was time to make some personal changes that would cost me both dollar and more importantly time but result in amazing benefits for my patients.  BCPS.

I hope that you will consider these reasons.  For the most part most people are reluctant because no one wants to fail, much less fail twice.  Yes, it is humbling to fail once, but it is euphoric to pass (even the second time).  Especially for someone like me, I prove you can teach an old dog new tricks.  I hope to inspire more of you to seek to be your best in our profession, stop worrying about your coworkers and if you fail, and realize that any amount of learning that happens will significantly change how you practice pharmacy.

In the future, I am thinking about tackling another certification.  I hope you will, too!

I Passed BCPS!

The weight was lifted off my shoulders when I saw the results last Friday. I am thrilled this one is in the past and thinking about taking another one.

CV Risk Calculator - American Heart Association and American College of Cardiology's Changes

Guidelines change, and recently new material was released concerning cardiovascular risk.   The spreadsheet enables health care providers and patients to estimate 10-year and lifetime risks for atherosclerotic cardiovascular disease (ASCVD), defined as coronary death or nonfatal myocardial infarction, or fatal or nonfatal stroke, based on the Pooled Cohort Equations and the work of Lloyd-Jones, et al., respectively. The information required to estimate ASCVD risk includes age, sex, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure lowering medication use, diabetes status, and smoking status. However, the more I play with different patients' numbers, even my own mother's, the more it is very obvious the calculator overestimates risk fairly significantly.  We can expect, I guess, statin snack machines to pop up everywhere since most will now be candidates to be on a statin.

Read more about this in a fabulous NY Times article that really goes in-depth concerning the embarrassment and application in the future.

The controversy set off turmoil at the annual meeting of the American Heart Association, which started this weekend in Dallas. After an emergency session on Saturday night, the two organizations that published the guidelines — the American Heart Association and the American College of Cardiology — said that while the calculator was not perfect, it was a major step forward, and that the guidelines already say patients and doctors should discuss treatment options rather than blindly follow a calculator.