Pertussis and New Recommendation

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It is a well know fact that I support vaccinations. I become irritated when I think about the cases of pertussis that takes the life of an infant because herd immunity is losing its protection. These gaps allow these vaccine preventable diseases to find their way back into the general population. Just the other day on my Facebook wall, there was a comment from someone who is against vaccines. They were told their insurance would no longer cover well visits because she doesn't vaccinate her children. I believe this is the directions insurance companies will go. Vaccinate or no coverage. I do not agree with taking away choice. But truly, if we didn't need insurance and paid for our own healthcare (who does that?) we could make our own decisions.

The CDC now recommends that pregnant women get a dose of the Tdap every time they are pregnant rather than the one time booster if they had not previously received the vaccine. Dr. William Schaffner, who is the chair of the department of preventative medicine at Vanderbilt School of Medicine, suspects that a proportion of babies who die of Sudden Infant Death Syndrome are caused by pertussis.

Just Take Care of Yourself

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Sitting in the waiting room of a pain clinic is more uncomfortable to me than seeing a cop's blue lights in my rear view mirror. Not only is it fairly evident that people in my area do not take care of themselves, I wonder why in the heck do I have to visit this place every six months or so? I have a very shoddy lower lumbar. The rest of my back is great, but for some reason God saw it fit for me to have some crappy genetics coupled with a severe love of running. I use the word severe because it is no secret that eventually most runners will have joint problems, and a severe love so great that it is worth the pain is nuts. There, I said it. I like to run. Even when it hurts. So I use radio frequency lesioning (RFL) to burn the nerves (they grow back) so I don't feel the pain in my lower back.

I watched a woman roll into the waiting room this morning still dressed in pajamas. She looked to be around 400 lbs, and I wonder, how have we allowed ourselves to get to the point where a donut or ten is worth being on a ton of medicine? How can we look in the mirror every day and know we are slowly poisoning ourselves? I'm preaching to the choir here because my diet is crap. Another patient limped in. He hadn't taken care of himself. I sort of stuck out like a sore thumb. This is a good thing.

These pain clinic docs would be out of a job if people took care of themselves!

A good friend of mine sent me this link: Why You Should Not Go to Medical School. Basically it really settled some things that my subconscious mind already knew. Although my dad wanted me to be a doctor, he had no idea what kind of life that would entail. It would mean telling someone to lose that weight so you could get off all the pain and hypertension meds. It would mean knowing that most wouldn't give a rats' ass and keep on stuffing their face with processed sugary foods contributing to diabetes and the like. I'm glad I didn't go to medical school. I'm not so sure I'm glad I chose pharmacy, but I seem to be pretty good at it.

The Perfect Medical Model

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I have been doing a lot of thinking lately in regards to my career.  I am still in waiting mode about the BCPS exam, but in the meantime have spent some time making lists of how pharmacists are utilized and even on a smaller level within pharmacy departments.  You see, it is tough being on this side of a career.  I guess you could say I'm in the middle in regards to time and experience.  I have been a pharmacist now for thirteen years. I have watched, usually with protest unfortunately, as pharmacists are labeled and grouped depending on different criteria.  Back in 1999, it was about having a residency in order to be a "clinical" pharmacist.  That is still the case today except in the smaller hospital where residency trained pharmacists aren't in supply.  Other criteria is used at that point.

In a perfect medical model, especially in the small hospital, I think it would be beneficial if the physician handled diagnoses, testing, and collaborated with the clinical pharmacist for treatment.  It is fairly obvious when you study the medical school curriculum that the focus is on diagnosis.  Yes, it is important to know what we are treating, but it does no good if you throwing ertapenem at pseudomonas or if you are dosing vancomycin at 1 gm every 12 hours in a young obese man for MRSA.

Hospitals really should consider encouraging all their pharmacists, especially PharmDs to learn the material that the BCPS requires.  It has seriously helped me in the past several months personally.  It is worth the investment of money and time and makes a FABULOUS resume' builder.

And in the end, it's about the patient receiving the best care possible.  Wouldn't a collaboration encourage that?

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Fungal Meningitis and the End of Lackadaisical FDA Involvement in Compound Pharmacies

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New England Compounding Center (NECC) is at the center of this quite horrific tragedy that has affected the lives of many with fourteen already dead. I cannot personally fathom such a loss over something so seemingly accidental. As a pharmacist my thoughts immediately go to sterile technique and the FDA's regulation of our industry. You see, the states oversee the pharmacies compounding and normally that should be enough. However, something went terribly wrong here. But what is coming out lately is the role of compounding pharmacies and how in this case, there was a grey area they were working in. Basically compound pharmacies can make patient specific medications, what is not allowed is these compounding pharmacies acting as manufacturing and bulk shipping repackaged medications without FDA oversight.

It's all about the dollar, but in this case many priceless lives have been lost.

There are two fungi involved: aspergillus and Exserohilum rostratum.

In the past, these pharmacies have been the heroes making things like bioidentical hormones and other specialty concoctions.

Under the FDA's definition, compounding pharmacies are supposed to mix drugs to order only on a specific patient in response to a prescription from a doctor. Under this definition NECC was not operating as a compounding pharmacy but as a large-scale production of a drug. The FDa should have stepped in before these lives were lost.

BCPS 2012 | a small review of my thoughts of the test

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The BCPS is the abbreviation for Board Certified Pharmacotherapy Specialist.  Basically according to the BPS website:

Pharmacotherapy is that area of pharmacy practice that is responsible for ensuring the safe, appropriate, and economical use of drugs in patient care. The pharmacotherapy specialist has responsibility for direct patient care, often functions as a member of a multidisciplinary team and is frequently the primary source of drug information for other healthcare professionals. Those who are granted certification in this specialty may use the designation Board Certified Pharmacotherapy Specialist and the initials BCPS, as long as certification is valid.

So, this is what I have been doing with every (or most) every free moment since April.  It is over now, and this is the first day I have had to sit and reflect.  I did not have the opportunity to finish the review of the test itself, and I was seated last (my own choice) for the second part so did not receive the handwritten review of the test.  I really spent all my time on the test itself, and my feedback wasn't given.

I wish it had been in hindsight.

I signed this paragraph at the beginning of the test but I don't remember what it said.  Something about not trying to memorize the test itself or copying the questions in any way.  So with that in mind, my review will not be specific but broad.

I am a hospital pharmacist who graduated in 1999 from the University of TN School of Pharmacy.  At the time we were rated number 7 in the United States, and I have never had any issues with being clinical minded in the jobs that required that role in the past 13 years.  Times have changed.  Schools have multiplied, and the residency which was a "side thought" in 1999 is a must today.  BCPS certification is also important if one did not do a residency or the cherry on the top if you did.

So, I decided at the ripe old age of 39 to study like a fiend and pay all sort of money to this organization to have study materials including written, web, and audio.  I spent most days listening to the likes of pharmacy lecturers discuss things from stats to ID to cardiology to oncology to nephrology.  It kind of made me realize I haven't really been using my brain at work, and to all the patients out there I have treated, I am sorry I haven't been a more thorough and clinically-minded pharmacist.

You see, an order entry pharmacist enters orders and most of the time relies on the computer system itself to flag for interactions and other things, but you know what?  Just yesterday I found something pretty profound.  The computer fails.  I found a place in our current process where I made a difference.  Just one of the many that are to come.

The test:  200 questions.  2 sections of 100 questions each.  I found the first part harder; but many I heard said the reverse.  I have always been the one marching at the beat of a different drummer.  Topics:  tons of stats, pharmacy regulations was everywhere.  I wasn't prepared for regs.  Psoriasis.  Acne.  Both of those disappointing as I haven't had an acute admission to the hospital yet for either.  And I have not found acne guidelines with the American  Dermatological Society yet.  I know I missed the psoriasis question.  Tons of COPD, albuterol, and not so much STEMI.  Angina more stressed.  Maybe due to the new Chest Guidelines that came out.  One chemo question I remember.  Tons of stats.  Did I already say that?

There were a couple kinetics questions.  Guess what?  I bought a $5 cheapie calculator from Walgreens that died.  YEP.  I had THAT luck.

Temperature was given in C rather than F.  I was bummed about that.  Guess it's time to join the rest of the world on that one!

There was one INR question I remember.  Pretty specific.  I got it right ;).

And the usual question that appears every year was there.  I don't think I can say what it is on here, but if you talk to anyone that has taken the test, they can tell you what it is ;).

Psychiatry a couple of times.  All side effects of drugs.  CYP3A4.  All CYP really.  Pharmacoeconomics more than I would have liked.

Guideline driven.  Mostly accp.com material so would recommend studying that.  Keep in mind if there's something not in that material though, you may want to find a review book to read on the side.

If I failed, which is possible (last year passed 70% of test takers with cut-off being 111/200 or so) I will retake it again next October.  I really liked the challenge, liked the things I have learned, and like the possibility of continuing my education in this field to grow in my career.

What did I study?

1.  ACCP materials.  I purchased the slides, handouts, and audio to listen in the car on my iPhone.

2.  http://quizlet.com/  There were tons of BCPS flashcards made by some pretty smart pharmacists.  Just search BCPS on Quizlet.

3.  High Yield Med Reviews  We will see how this goes.  It's a subscription service with test questions.  I think it helped me.  I will probably resubscribe around July if I failed for next year.

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Another One Bites the Dust...

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  Sorry I have no sympathy or anything for Dr. Vikul Patel of Nephrology Associates in Chattanooga, TN.  See, he was busted with an online chat with an informant and then was promptly arrested when he was en route to have what he thought was "sex with a minor."  Seriously?  Wow.  I have no words really except I hope they put you away for a long long time.  Dr. Patel will probably be in a  lot of trouble when he hits prison.  I'm just sayin'.

IMPORTANT MESSAGE FROM NEPHROLOGY ASSOCIATES

Effective Wednesday, Sept. 5, Dr. Vikul Patel is no longer employed with Nephrology Associates. The unanimous decision was made by the board of directors. Letters to reassign patients of Dr. Vikul Patel to other physicians within the Group will be sent within the coming days. Please note that this in no way involves Dr. Nilesh Patel. Dr. Nilesh Patel is a valued member of our team. The care and needs of our patients are very important to us, and we will continue to keep you updated.

A link...  can't wait to see this one go to court.

 

Ambien and _______ Do Not Mix

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Have you ever had the rare opportunity to have ambien (zolpidem) prescribed to you and experienced how quickly this medication takes effect? According to pharmacokinetic properties of this medication, zolpidem is rapidly absorbed after oral administration. Peak medication effects of the immediate-release tablet occur within 90 minutes of a single oral dosage. In single-dose studies in subjects administered 5 mg and 10 mg zolpidem, the mean peak concentrations (Cmax) were 59 (range: 29—113) and 121 (range: 58—272) ng/ml, respectively, occurring at a mean time (Tmax) of 1.6 hours for both strengths. The presence of food reduces the amount of absorption and increases the time taken to achieve maximum concentration, delaying sleep onset. Therefore all formulations of zolpidem should be taken on an empty stomach versus after a meal... unless of course you are out driving then by all means eat first, or do the right thing and don't take ambien and drive!

This medication has now been implicated in a car crash two weeks ago, when Kerry Kennedy, the daughter of Robert F. Kennedy, swerved into a tractor-trailer on New York's Route 684 and kept driving. Witnesses said she had been weaving in and out of lanes for miles before the accident.

Toxicology reports showed 14 nanograms per milliliter of zolpidem in Kennedy's blood, according to the Associated Press. Both her blood and urine samples were negative for alcohol or other drugs.

Police found Kennedy slumped in her white Lexus on the morning of July 13, according to Reuters. She was unsteady on her feet and slurring her words. Initially she told police she may have accidentally taken the sleeping aid earlier that day, mistaking it for her thyroid medication.

At a court appearance July 17, she pleaded not guilty to a charge of drunk driving and said the hospital where she was treated found no trace of drugs and doctors had suspected a brain seizure. She is due back in court Aug. 14.

In 2006, her cousin Patrick Kennedy, the former congressman from Rhode Island and the son of the late Sen. Edward Kennedy, was sent to alcohol and drug rehab, after crashing his car while on Ambien in Washington, D.C.

Ambien is a sedative-hypnotic that works by slowing activity in the brain, according to the National Institutes of Health. It is prescribed for those who have difficulty falling or staying asleep. It's meant to be taken immediately before bedtime and its effects last about seven to eight hours.

Sometimes patients can experience memory problems on awakening. Some have reportedly taken Ambien, left their bed and driven cars, prepared and eaten food, had sex or made phone calls while under the influence of the drug and not fully awake, according to the Food and Drug Administration.

The drug has a risk for anterior-grade amnesia, as well, according to Doering. "Memory never burns from RAM to ROM."

"The things that happen to a driver can be very scary," he said. "You are in a state where you are dreaming, but you are not quite sure whether you are awake or dreaming."

Drugmonkey Was Dooced by Rite-Aid

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Follow my blog with Bloglovin I've often had fears in the past about blogging.  I know I have personally taken great care to not blog about where I work, personal information regarding work (HIPAA violations), negative posts about current management, or anything that would seem inappropriate from the standpoint of the corporation I draw my living.  To be honest, I don't work for a retail big pharma organization as this blogger did.  I USED to work for Eckerd before it was bought (I think?) by Rite Aid, and I do remember the day-to-day struggles.  It was the reason I begged for a home health infusion job with a $20,000 pay cut per year just to leave retail forever back in 2002.  Back then though... retail jobs were a dime a dozen.  I don't know how it is where Drugmonkey lives today (CA, I think?) but here... crickets.

David Stanley (Drugmonkey).  Seemingly someone I would want on my team, perhaps.  Seemingly someone who tells it like it is and also writes for Drug Topics.  Well, he was fired by Rite-Aid.  And though he and I are different in many ways (political, for one), I kind of like to imagine had I stayed in retail ten years ago this is what I would have become.  I do believe that this is his chance to change and that something so out-of-ordinary as firing for a blog post (which has happened before... thus the term Dooced) can turn into something better.  He deserves better than Rite-Aid!

Did you know he can write really well?  No I'm not saying he can write well.  He can write really REALLY well.

Rite-Aid was probably scared of that and waiting for the perfect post to bring down the guillotine to his career with Rite-Aid.  What they didn't expect though is the result of this firing and what this is going to do to their company.

I'm expecting to see this story go viral, only if enough people get a hold of it and pass it on.

Rite-Aid fires pharmacist for a blog post.

Pass it on...

From Drug Topics by David Stanley, RPh just a few days ago:
Members of seven Southern California locals of the United Food and Commercial Workers (UFCW) have voted to reject a contract offer from drug retailer Rite Aid and to authorize union leaders to call a strike if an agreement can’t be reached.

Although specific numbers weren’t immediately released, the union called the vote, which took place from July 26 through July 30, “overwhelming” and said in a statement, “The members’ emphatic rejection of Rite Aid’s demands and their vote for strike authorization will push management toward negotiating an agreement the workers can ratify.”

According to the same statement, the UFCW says that Rite Aid is seeking 34 concessions from workers, including:

• Effective elimination of healthcare for workers' spouses and children

• An increase in out-of-pocket costs for healthcare benefits of up to $10,000 a year

• Virtual elimination of all accumulated sick leave pay

• Reduction of the number of hours workers are allowed to work

• Elimination of the 40-hour work week and 24-hour guarantee for part-time employees

In a statement of its own, Rite Aid announced, “The specifics of our proposal are matters we will be discussing at the bargaining table with the Union as we continue to work hard to reach a fair agreement for all involved.

“We’re disappointed that the Union has called for a strike authorization vote and think such a vote is premature, especially since the Union hasn’t even given us a counter proposal to our first proposal.”

The proposal would affect all store employees except store managers, including pharmacists, at Rite Aid locations from Kern County south to the Mexican border. The soonest a strike could begin would be August 8, 72 hours after the current contract extension is set to expire.

The union is also currently in negotiations with CVS/Caremark.

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Donating a Kidney to a Complete Stranger

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I sat at dinner with some friends a few years back, actually friends of my husband that I met through him, and the husband told his tale of needing a kidney transplant.  He had had a family member donate a kidney only for the transplant to be botched during the transplant.  What a waste, not only for my friend, but also for the living donor who didn't get to see her selfless donation be wasted.  He later did get another successful transplant and is doing well. I remember sitting there at dinner thinking about how I wish I could get to the place in life to donate a kidney to someone, to totally revolutionize their life.  It is a huge undertaking, one that I cannot quite get to.  Wonder if I need both?  Wonder if one of my children or husband need a kidney in the future?  (Though I'm the only one in my family of four with my bloodtype...).

U.S. woman's altruism starts chain of five kidney swaps, extending lives

"I'm not losing nothing," Honica Brittman said this week, sitting in a blue and white hospital gown before surgery in which she would give, for free, the initial kidney in a chain of five kidney transplants at the New York-Presbyterian Hospital/Columbia University Medical Center.

"To actually help somebody live a little bit, a lot longer, that's an awesome thing," she said.

The series of operation on Wednesday and Thursday, which required 10 separate surgical teams and weeks of coordination, was made up of a series of swaps within a group of men and women between the ages of 23 and 68 and with compatible blood types, all motivated by a mix of compassion and commitment to their loved ones.

The chain started with Brittman, who donated a kidney to a 39-year-old television producer whose fiancée and partner of more than 10 years donated to a businessman from upstate New York.

In turn, the businessman's son, a college-age student who felt that for being healthy and the youngest of four sons, he should step up on behalf of his father and donate one of his kidneys to another young man, a 23-year-old originally from Haiti.

His father then donated to a retired teacher from New Jersey.

Can you imagine the lives that would be changed setting off a chain like this?  I have thought about it.  I wonder if there is a special place on the transplant list if something were to happen with your remaining kidney that would make it worth your while?

Who is David Matthew Kwiatkowski?

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Exeter, NH – Exeter Hospital worker David Matthew Kwiatkowski, who officials say had hepatitis C and spread the disease to 30 unsuspecting patients by stealing drugs, has been arrested, the U.S. Attorney's office in New Hampshire announced Thursday. Kwiatkowsi, 32, of Exeter, was arrested this morning at a hospital in Massachusetts, where he's receiving treatment for hepatitis C. He's charged with fraud and tampering.

He faces up to 24 years in prison and a $250,000 fine.

That is it?  A life sentence would be more appropriate.  Let us delve into the world which is Hepatitis C.  What future will these patients and any others that he so selfishly infected face?

Thomas Wharton, MD, FACC, medical director of the Cardiac Catheterization Unit at Exeter Hospital, now views Kwiatkowski as “the ultimate con artist and an extremely good cardiac technologist who pulled the wool over everyone's eyes.”

Of the isolated incidents that fellow Cardiac Catheterization Unit employees began reporting in the spring, Dr. Wharton said, “David had stories for everything that pulled at your heart-strings and we had no reason to disbelieve him. David claimed to have several important medical conditions, and we had no reason to challenge this. The day he reportedly arrived to work with red eyes he told us his aunt had died the night before and he had been up all night crying.”

And the kicker really is his response to investigators about the people he spread the virus to:

"You know, I'm more concerned about myself, my own well being," he told investigators. "That's all I'm really concerned about and I've learned here to just worry about myself and that's all I really care about now."

From http://www.epidemic.org:

Although few prospective long-term survival and health care cost studies are available for hepatitis C, it has been possible to estimate the life-long economic impact of the disease for both the individual patient and for the U.S. population with chronic hepatitis B. Lifetime health care costs for a patient with chronic hepatitis B has been estimated at $65,000 in the absence of liver transplantation. For the 150,000 HBV carriers with significant liver damage, the lifetime health care costs in the U.S. have been estimated to be $9 billion. Assuming an estimated survival of 25 years, the annual health care costs for the affected U.S. population with chronic hepatitis B is $360 million. Based on the same economic analysis, treatment of chronic hepatitis B with interferon is projected to increase life expectancy by about three years and cut the total health care costs.

Hepatitis C can only represent a far greater economic cost. While it infects about 3 and a half more times as many people in the United States than does hepatitis B, more than 80% of hepatitis C patients will develop chronic liver disease, as compared to only 20% of hepatitis B patients. Limited data suggest that 15-20% of those with chronic hepatitis C will develop cirrhosis within a five-year period, and as many as 25% may have cirrhosis by 10-20 years. The risk of developing liver cancer is uncertain, but may approach or exceed 1% during the first 20 years of infection and increase afterwards. Hepatitis C is responsible for about one-third of all liver transplants in the United States.

Approximately 1,000 patients are transplanted each year for liver disease due to hepatitis C. With the cost per liver transplantation in the range of $280,000 for one year, liver transplantation for hepatitis C alone reaches a cost of nearly $300 million per year.

Moreover, the average lifetime cost for hepatitis C, in the absence of liver transplant, has been estimated to be about $100,000 for individual patients. Assuming that 80% of the 4.5 million Americans believed to be infected develop chronic liver disease, the total lifetime cost for this group (3.6 million) will be a staggering $360 billion in today's dollars. Assuming an estimated survival of 40 years, the annual health care costs for the affected U.S. population with chronic hepatitis C may be as high as $9 billion.

It would be prudent to consider that every single person that he has infected would at the VERY least receive $100,000 up front PLUS the cost of transplant and the cost of the emotional toll.  He should never be able to walk in society again and spend the rest of his time working to pay this debt.

I also believe that the hospital should cover the rest of the cost considering the signs were there for him being under the influence.  All it would have taken would be ONE person, ONE coworker, ONE physician to take the chance and get this guy tested.  Also, pharmacists should have a bigger role in a cath lab like this to prevent nurses and staff from having such access to be able to hide something like this.  I'm just appalled at this man's evil behavior coupled with the lack of safe policy at the hospital(s) in question.

This is just my opinion.

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