Category Archives: Pharmacy Topics

What you can do after getting a PharmD

So you finally earned your Doctor of Pharmacy degree after sitting through 3-4 years of mind-numbing lectures on cytochrome p450 enzymes, vancomycin dosing nomograms, and reading through hundreds of adverse effects, contraindications, dosage/administration, and mechanism of action information about drugs.  You also secured a hefty loan from a lender where now the interest on the loan will start adding to the principle.  First of all, congratulations on finishing pharmacy school and getting your degree.  It is no small feat, and the patience, discipline, hard work, and fortitude required to achieve a PharmD will have prepared you to become a professional working contributor to society, which will help facilitate and advance your career.

So now what?  If you haven’t already begun (perhaps six months prior to graduation in seeking a job or a post-graduate position (residency, fellowship, etc) then you should probably begin searching for a job.  Apply to jobs within a state in which you plan living in, and obtain the necessary requirements by referring to the State Board of Pharmacy for each state, which will guide you on what you need to start practicing as a pharmacist.  Usually, this will require a state exam (MPJE for most), and the national pharmacy licensure exam (NAPLEX).  Apply to as many jobs as you are able to, and begin studying for your tests so that you’ll be eligible to start working if you are fortunate enough to be accepted for a position.  Many employers would want to know that you have the required eligibility and license to practice as a pharmacist before they would even consider granting an interview.  Post-graduate programs such as residencies and fellowships may not require this since interviews with those programs may begin long before graduation.

Ok, so now you have earned your state pharmacy license(s) to practice, and you have hopefully found a job.  You’ve made it!  You can now start to apply for health insurance benefits, contribute to your retirement plan, pay off those high interest college loans, help out your family,  and maybe consider replacing that broken-down car of yours.  You may finally get to go out with your friends and eat something nice for once rather than looking for the cheapest item on the menu, or sticking with the cup-o-noodles and peanut butter sandwiches that you feasted on through college.  Hopefully, your bank account statements will look nicer each month as long as you save some of your income, and if you don’t spend more than you earn.  Now what? You’ll notice after a couple years of working as a pharmacist that it’s pretty much the same old same old everyday whether you work in the retail or hospital setting.  As a retail pharmacist, you’ll come to work with dozens of refills to process, and insurance companies to call when the claims are rejected.  You’ll constantly talk to angry customers waiting to pick up prescriptions that are not ready for them, or even misfiled.  You’ll have pharmacy technicians not report to work on time, or call-in sick which will almost certainly lead to a very stressful morning.  You’ll deal with slippery situations when you feel a prescription is forged, or if customers are being prescribed too much narcotics for their pain, but yet are  yelling at you because they want their pain medications immediately while you ponder what to do.  As for hospital pharmacists, you’ll deal constantly with nurses on the phone calling you for missing medications which was supposed to be sent hours ago, and which you may have already sent twice but somehow kept getting lost.  You’ll deal with your coworkers calling in sick requiring you to do another double shift.  These are some examples of situations that await you after pharmacy school.  Generally, the pay appears to be very good at first.  However, you’ll notice the salaries plateauing and not increasing as they may do for other occupations.  Even after many years, you may not earn much more than when you first started your position after graduation.  As your life progresses and you get older, you’ll probably be getting married at some point, have kids, and buy a new home.  You’ll wonder if you’re able to earn more income, and if there other ways to better your position, of if doing the same old same old stagnant job every day is it for you until you retire.  Of course, this applies to pharmacists who are unsatisfied and want more out of their careers.  There are many pharmacists who are okay with the same old same old status quo until they retire, and may not care to do anything else.

There are some options you have that may put you in a better position to excel or move up the ladder.  Opportunities for leadership positions such as a manager or director of the pharmacy, or a different type of industry altogether such as pursuing a career in consulting ,or an atypical pharmacist position are some options for you.  Applying for these positions may require either experience or degrees and certifications, or both.  If moving up the ladder to management positions, a masters in business administration (MBA) or a masters in public health (MPH) may be a good start, or something to put on your resume.  There are many pharmacy schools that offer a dual degree program combined with a PharmD, but since you’ve already graduated, perhaps you could check your benefits department to see if they would subsidize part of your tuition if you decide to obtain another degree.  If you’re interested in pursuing the clinical route, asking your management whether board of pharmacy specialty certifications will earn them more income, or whether the exams and certification fees can be reimbursed by the employer may be appropriate considering the costs required to obtain the certification.  Networking with other similar health professionals by joining an organization, attending or participating in meetings and events (continuing education) is another great way to learn about other opportunities that you would otherwise not know of when using only the internet or job sites.  Networking can be the most formidable tool you have if you are able to establish relationships easily.   Attending classes or joining clubs which focus on helping you network may be beneficial for you such as courses that educate people how to perform presentations (e.g. toastmasters).

These are only some of the options that are available for those that feel stagnant in their careers.  Keep in mind that pursuing another graduate degree, or a board specialty certification could be costly, and may take your time away from your family or social life.  Work/life balance is something that has to be assessed by each pharmacist depending on their life situation and age.

Famous Pharmacists in History

Famous Pharmacists in History

If you’re considering a career in the field of pharmacy, you may be interested to know that the job does not always involve counting pills and printing labels for customers. As many people who have chosen this career path would confirm1, this important vocation offers countless opportunities to positively impact the lives of others. In fact, a pharmacist acts as a crucial link between patients and their health care providers. 

In addition to being an intensely gratifying line of work, the pharmacy profession has also produced a wealth of fascinating individuals. These famous pharmacists have accomplished some truly notable deeds. In some cases, their achievements were related to their original vocation of choice – while in other instances, they were not. The following are a few examples of famous pharmacists in history.

Hubert H. Humphrey

Hubert H. Humphrey’s accomplishments have been well-documented – and for good reason. The American Pharmacists Association even extends an award2 in the man’s name. This former pharmacist who went on to enjoy a highly successful career in politics – first, as a U.S Senator for the State of Minnesota, and then, as Vice President of the United States under Lyndon B. Johnson from 1965 to 1969. Humphrey followed his father into the pharmacy profession, and he worked as a pharmacist in the drugstore that his father owned in South Dakota. Some of the most notable accomplishments of his political career included chairing the advisory council for the Peace Corps, chairing the Civil Rights Council, organizing an antipoverty program, and working with Congress to enact Medicare and the Voting Rights Act3 .

Charles Alderton

After attending college in England, Brooklyn-born Charles Alderton obtained his training in medicine at the University of Texas. He then worked as a pharmacist in a drug store in Waco, Texas4. The drug store in which he worked also had a soda fountain, which was the place that Alderton observed customers growing bored with the traditional soda flavors of the time period (the late 1800s). That observation inspired the pharmacist to create a carbonated drink with a flavor that smelled similar to all of the various fruit syrups used in the store to make sodas. The result was a beverage that remains highly popular to this day – which is known as Dr Pepper (the original period after the “Dr.” in the drink’s name was eventually omitted)5.

Agatha Christie

When you consider her history as an apothecary’s assistant, it is no small wonder that Agatha Christie experienced great success as an author whose crime novels sometimes included poison as a means of murder. To say that Christie was successful is actually an understatement; after her work as a volunteer nurse during the First World War and then in the pharmacy field6, she became known as one of the top-selling authors in the world7.  

 

Benjamin Green

After he served as an airman in the Second World War, pharmacist Benjamin Green began experimenting with various substances in order to create an effective sunscreen. He initially applied a type of veterinary petroleum to his skin to protect himself from harmful UV rays during wartime. Later, he added other substances to develop what would ultimately become the basis for the suntan product manufactured by Coppertone8.

Luke Howard

Londoner Luke Howard was a pharmacist who became famous for his meteorological work in the 1800s. After establishing a pharmacy of his own in Fleet Street, he partnered with scientist William Allen to start a pharmaceutical firm. Howard later became known for creating some of the cloud names9 that are still in use to this day. Howard has since been referred to as the “Father of Meteorology”10.

A career in the pharmacy field may be one of the most personally gratifying career choices you could make. Helping consumers to get the medications they need is an invaluable service. If you follow the lead of some of the most famous pharmacists in history, you may even find yourself using your knowledge to benefit the world in ways that you never imagined.    

Henri Nestle

Most people are familiar with the chocolate brand, Nestle.  What they might not know is it began with Henri Nestle, a pharmacists’ assistant, before becoming the world recognized brand that people love and admire.

Footnotes:

1. Pharmacy Times, “Why I Love Being a Pharmacist: Honorable Mentions” <https://www.pharmacytimes.com/news/why-i-love-being-a-pharmacist-honorable-mentions> (accessed August 15, 2016)

2. American Pharmacists Association, “Hubert H. Humphrey Award” <https://www.pharmacist.com/hubert-h-humphrey-award> (accessed August 15, 2016)

3. Encyclopædia Britannica, The Editors of Encyclopædia Britannica, “Hubert Humphrey, Vice president of United States” < https://www.britannica.com/biography/Hubert-Humphrey> (accessed August 15, 2016)

4. NNDB, “Charles Alderton”, <https://www.nndb.com/people/635/000207014/> (accessed August 15, 2016)

5. Dr Pepper Museum, “History of Dr Pepper” <https://www.drpeppermuseum.com/About-Us/History-Of-Dr–Pepper.aspx> (accessed August 15, 2016)

6. Science Friday, Kathryn Harkup, “Agatha Christie: From Pharmacist’s Apprentice to Poison Expert, An excerpt from “A Is for Arsenic: The Poisons of Agatha Christie.” <https://www.sciencefriday.com/articles/agatha-christie-from-pharmacists-apprentice-to-poison-expert/> (accessed August 15, 2016)

7. Bio, “Agatha Christie Biography”, <https://www.biography.com/people/agatha-christie-9247405> (accessed August 15, 2016)

8. The New York Times, “Sunscreen: A History” <https://www.nytimes.com/2010/06/24/fashion/24skinside.html?_r=0> (accessed August 15, 2016)

9. Royal Meteorological Society, “Luke Howard and Cloud Names” <https://www.rmets.org/weather-and-climate/observing/luke-howard-and-cloud-names> (accessed August 15, 2016)

10. Royal Meteorological Society, “The Invention of Clouds: Luke Howard, The Father of Meteorology”<https://www.rmets.org/events/invention-clouds-luke-howard-father-meteorology> (accessed August 15, 2016)

Pharmacist Skills

Many people ask what it takes to be a good pharmacist.  Pharmacists who love their profession, and are passionate about serving customers/patients whether it is within the community setting or a hospital, and have the drive to keep evolving their skill set and learn new things may have the “right stuff.”  Similar to many other jobs, if one dislikes/detests their job and dreads going to work every day, then the person might not be the most motivated to excel in their specialty, and less likely to be a good representative of their chosen occupation for other future career seekers.  Passion, enjoyment, and motivation are few of the key ingredients needed for a long  and successful career as a pharmacist regardless of the type of pharmacy setting.

Pharmacists also need to proficient in certain academic subjects that are part of their everyday usage at the workplace.  Subjects such as mathematics, chemistry, biology, and physiology heavily influence the study of pharmacy and its applications.  Mathematics is highly emphasized in pharmacy school, and is essential for patient safety as pharmacists will need to be accurate with duties such as pharmaceutical recipe calculations, measuring medication dosages, mixing the correct amount of ingredients, and dispensing the correct quantity of medications.  Chemistry, biology, and physiology enables a pharmacist to understand the medication effects on the human body and vice versa.  The complexities that involve taking multiple medications and its interactions with each other and the human body are courses that are usually part of the pharmacy school curriculum.

Good pharmacists should be able to communicate with people well as pharmacists are usually the first point of contact or support for questions relating to medications for patients, doctors, and nurses.  Being able to educate the public and answer questions are an essential responsibility and opportunity for pharmacists to represent their field as the drug information specialists.  Pharmacists educate patients on the correct way to take the medications, side effects to expect, cost, and encouraging them to always take the medication as prescribed (compliance).  Pharmacists are also present to answer drug information questions for doctors and nurses regarding proper dosages, preparation instructions, drug availability, and alternative options if the drugs prescribed are not available.

Good attitude is recommended in the workplace.  The job of a pharmacist could get stressful with hoards of orders, issues with incorrectly written orders, insurance claim issues, telephone calls, talking to customers, etc.  Having the right composure, patience, and attitude will go far in this field.  No one likes approaching grumpy pharmacists and doing business with them, especially when there are other pharmacies around the corner to transfer prescriptions to.  Good customer service with a smile will be remembered by customers, however irascible some may be.

Pharmacists who are always on the “cutting edge” will always be a step ahead of their peers.  In order to stay ahead of the pack, pharmacists should join or register as members with their local or national pharmacy organizations where they will have opportunities to attend interesting continuing education seminars, network with other practicing pharmacists, and be eligible for other educational opportunities not available to the public.  Also, subscribing to pharmacist publications and periodicals will provide the pharmacist with consistently new educational material delivered to the home or workplace.

There are many solutions and steps to becoming a solid pharmacist.  Strong proficiencies in the basic sciences and mathematics will provide a sound foundation for the future pharmacist.  The passion to serve the public, and the love of the profession will enable most pharmacists to motivate themselves to improve their skills and knowledge each day for the betterment of serving the community.

Hospital Pharmacy Operations

With the introduction of new technologies in software, server management, database systems, and hardware innovations in the past decade, hospital pharmacy operations have been improved from vendors who build such products geared towards streamlining many of the time-consuming workflow processes of medication dispensing. In the not too distant past, many pharmacies held patient medication records on paper or paper cards for storage in file cabinets and bins; this kind of record keeping seems unheard of with the growing prevalence of smartphones, tablets, and laptops. You could imagine the burden of sifting through hundreds to thousands of files within file cabinets to retrieve a patient’s medication record given the volume of the patients that routinely come in and out of a hospital each day. Hospital pharmacy operations are significantly different from retail pharmacy operations, especially when it comes to the steps required to process a medication between preparation steps and delivery to the patient.

Understanding the role of the pharmacy technician in a hospital requires a fundamental knowledge of basic hospital pharmacy operations. In short, pharmacies store medications that will be ordered by prescribers, and deliver them to nurses for proper administration to patients. The process isn’t as simple as written here because of the existence of different measures involved that are dependent on the due date of a medication, the stability (shelf-life) of the medication, and policies of the medication in question for the hospital. Unlike retail pharmacies (or outpatient pharmacies), hospital pharmacies do not dispense a thirty day supply, sixty day supply of medications, or what have you for the patient to pick up and go home. Usually pharmacies dispense as much as needed for a 24 hour day due to the fact that the patient’s medication may change, the medication may expire (eg. injectable medications), or if the patient is expected to be discharged (sent home) soon. There isn’t much sense in preparing a month’s supply of medication for a patient that could be discharged the next day or within the week, or if the medication has a short shelf-life.

Also unlike retail pharmacies, hospital pharmacists carry many different formulations of medications that include injectables, oral liquids, tablets, capsules, creams, lotions, ointments, emulsions, gels, eye/ear/nose drops, inhalers, nasal sprays, sublinguals, buccals, intravenous solutions, patches, and many more. Injectable medications could further be divided into different categories based on the site of administration such as intravenous, intramuscular, subcutaneous, intra-articular, intra-dermal, etc. Many injectables have to be further diluted in a larger volume of fluid for proper administration to a patient.

There are numerous classes of medications such as antihypertensives, antipsychotics, proton-pump inhibitors, narcotics, chemotherapeutics, investigational, and many more. Each medication has their own clinical information and usage guidelines from the manufacturer for proper dosages, adverse effects, drug interactions with other drugs/food/labs/allergies, contraindications, stability, compatibility with solutions, etc. Some even have regulatory oversight on proper usage such as narcotics and hazardous medications. Even more, the hospital may also determine how certain medications are to be processed and ordered, and could hold restrictions on which prescribers are permitted to order these medications.

As you could see, the amount of information and work required to operate a hospital pharmacy could seem overwhelming. Today’s hospital pharmacies require pharmacists AND pharmacy technicians to be versed in the proper dispensing of medications within the limits of regulatory and hospital policies in order to operate an efficient pharmacy operation.

Pharmacy Robots

Hospital pharmacies are increasing efficiency and patient safety with the implementation of new technology such as sterile IV preparation robots.  These robots are able to prepare admixtures within a clean air-controlled environment while remaining compliant with USP 797 requirements.

Although intravenous robot designs vary, each robot comes equipped with HEPA filters, a compounding area, barcode scanners, a scale, and an attached computer system.  The interior of the machine is initially sterilized by the pharmacy technician in charge of operations prior to the addition of tubing and ingredients. The scale is calibrated as needed to ensure quality control. As each ingredient is added, an image of the product is captured which include the lot numbers and expiration dates; these are stored in an easily accessed database for future reference.  Powdered vials are reconstituted automatically by the machine, and weighed for accuracy before production.  After the the robot is programmed to begin, specifications of the operation are checked by a pharmacist for accuracy; this is also done again upon completion.

IV robots have the ability to compound patient specific medication orders or batch thousands of IV doses per day.  Many are able to fill syringes or intravenous bags.  The frequency by which doses are weighed for quality control is based on type. Every patient specific dose and usually every third to fifth batched item is weighed and validated against a certain range of error. There is a defined standard deviation that the doses have to meet in order to pass quality checks.  When there is a discrepancy in weight (i.e. it falls outside the acceptable standard deviation), the robot rejects the item and subsequently sends it to a rejection drawer/ bin.  Every order compounded is labeled with patient specific information (when available), medication information, and a barcode for scanning.

Some IV robots have the ability to send a text message to a pager carried by the operating pharmacy technician. This allows the technician to migrate to other areas within the IV room where help is needed increasing efficiency. Other benefits that come with IV robots are high productivity, reduction in employee injury from repetitive tasks, and better patient safety.

Robot designs have evolved allowing an opportunity for IV robots to be decentralized from pharmacy. Pharmacists are able to keep overall control of the preparation process while increasing efficiency and availability of admixtures on nursing units. Overnight sterility is accomplished in these machines through the use of UV-C lamps.

Hazardous IV preparation robots are also available. They are able to support chemotherapy, monoclonal antibody therapy, and gene therapy preparations. With every compounded item produced by these machines there is a decrease in operator risk of exposure, needle-stick injuries, and repetitive strain.

Some other new additions for hospital pharmacy robots may include built-in controlled substance support such as tamper evident caps and single slot access.