Dumb Pharmacy Questions

[dumbguy]

i have some pretty dumb pharmacy questions if anyone can answer it.
i was afraid of asking the pharmacist i worked with, for fear of being called dumb.
1.) does XL and SR mean the same thing?
2.) pharmacy calls caloptima and workers comp directly for prior auth
doctors need to call other insurances( insurances other than caloptima and workers comp) directly to get prior auth.
3.) what's the difference bietween ointment and cream?
4.) what are all the C2 drugs? I know some such as adderall, oxycontin, ms contin, percocet, methadone, concerta, fentanyl patches. Any more?
5.) what does shizm mean? I think that's how it's spell. I always hear the pharmacists say I have to schizm so and so. How do you spell it and what does it exactly mean?

Thanks.

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[PolarBear21]

Hey dumb guy! These aren't dumb questions! When you don't know you don't know

Sorry I can't help though... I don't know.

 

[sdn1977]

i have some pretty dumb pharmacy questions if anyone can answer it.
i was afraid of asking the pharmacist i worked with, for fear of being called dumb.
1.) does XL and SR mean the same thing?
2.) pharmacy calls caloptima and workers comp directly for prior auth
doctors need to call other insurances( insurances other than caloptima and workers comp) directly to get prior auth.
3.) what's the difference bietween ointment and cream?
4.) what are all the C2 drugs? I know some such as adderall, oxycontin, ms contin, percocet, methadone, concerta, fentanyl patches. Any more?
5.) what does shizm mean? I think that's how it's spell. I always hear the pharmacists say I have to schizm so and so. How do you spell it and what does it exactly mean?

Thanks.

I'll try to help:

1. XL & SR are patented abbreviations & can mean different thing depending on the drug. Take for example - Wellbutrin is available in XL & SR - the XL is once a day dosing, the SR is twice daily dosing. However..that is not always the case. There is also ER, XR, etc.....Don't rely on these abbreviations to mean the same thing between different drugs.

2. I don't know what caloptima is - I think it must be a state specific program. With workers comp in my state (CA) I make the call - they ok a 14 day supply then initiate the interaction with the prescriber. Depending on the worker's comp policy, the pt must see an approved worker's comp prescriber &/or they get in contact with the specific prescriber to get mor info - radiology exams, etc...

3. The difference between ointments & creams has a lot to do with "shear" - or how smoothly they spread on any surface - in pharmacy it can be the skin, the vaginal mucosa, the mucosa of the eye or mouth...

Generally, ointments are "thicker" & more occlusive - which means there is less fluid loss from the skin to the air.

So....ointments are "slicker" (think Vaseline) than creams (think Pamolive cold cream). The cream will "dry" & leave less of a slick feel - the ointment will stay slicker. Either one will work depending on what is being treated. In CA we can therapeutically change dosage forms.

4. C2 - or called Schedule II drugs are those which require the most stringent monitoring for a number of reasons - to follow usage, possible abuse, diversion,etc. They can Be 2N or just 2 - the 2N's are the narcotics - morphine, methadone, Avinza, fentayl and the other 2's are the non-narcotics - Adderall, Concerta, dextroamphetamine, etc....there are lots more, but you can look them up individually. They fall within different pharmacological groups, but are classified as II's because of their abuse & diversion potential primarily.

5. I really don't know what shizm means - can you use it in the context of a sentence?? Could it be schism - or a "break"????

Good luck - hope that helps!!!

 

[MissPharmD]

First of all, don't think that these questions dumb at all.

(*) I believe the main difference between XL and SR is the time it takes for your body to digest and process the drug. SR stands for "sustained release" and the XL stands for "extended release". If I am not wrong, they both have same/similar ingredients; it's just the matter of how it's being released into the body.

(*) Ointments are mostly used for sore cuts. They are very oily compared to creams. On the other hand, creams absorb some of the water from the wound area and try to make the cut(s) dry faster. They are more acceptable than the ointments. They are not as greesy.

(*) C II (schedule II) drugs have higher potential for abuse and dependency. Abuse of the drug or other substance may lead to severe psychological or physical dependence. Only a pharmacist can fill a C II Rx; however, technicians can enter them into the system. They are always locked in a cabinet and only RPh can have access to them. Mostly they are used for ADD or severe pain.


I am not sure what you are trying to ask for the last question.

Hope this helps.....

 

[sdn1977]

First of all, don't think that these questions dumb at all.

(*) I believe the main difference between XL and SR is the time it takes for your body to digest and process the drug. SR stands for "sustained release" and the XL stands for "extended release". If I am not wrong, they both have same/similar ingredients; it's just the matter of how it's being released into the body.

(*) Ointments are mostly used for sore cuts. They are very oily compared to creams. On the other hand, creams absorb some of the water from the wound area and try to make the cut(s) dry faster. They are more acceptable than the ointments. They are not as greesy.

(*) C II (schedule II) drugs have higher potential for abuse and dependency. Abuse of the drug or other substance may lead to severe psychological or physical dependence. Only a pharmacist can fill a C II Rx; however, technicians can enter them into the system. They are always locked in a cabinet and only RPh can have access to them. Mostly they are used for ADD or severe pain.


I am not sure what you are trying to ask for the last question.

Hope this helps....

I hope you're not giving out this information!

Creams (both USP & NF) are either oil-in-water or water-in-oil emulisions. They do not absorb water (which is not water at all - it is plasma!) from a wound!

Perhaps you are thinking of the pharmaceutical preparation called a "paste" which is more absorptive than ointments due to a higher percentage of what is added - such as starch, zinc oxide, calcium carbonate or talc.

Some of your other info is wrong as well.....but - just ask your pharmacist! He/she will tell you when they have or get time!

 

[dumbguy]

First of all, don't think that these questions dumb at all.

(*) I believe the main difference between XL and SR is the time it takes for your body to digest and process the drug. SR stands for "sustained release" and the XL stands for "extended release". If I am not wrong, they both have same/similar ingredients; it's just the matter of how it's being released into the body.

(*) Ointments are mostly used for sore cuts. They are very oily compared to creams. On the other hand, creams absorb some of the water from the wound area and try to make the cut(s) dry faster. They are more acceptable than the ointments. They are not as greesy.

(*) C II (schedule II) drugs have higher potential for abuse and dependency. Abuse of the drug or other substance may lead to severe psychological or physical dependence. Only a pharmacist can fill a C II Rx; however, technicians can enter them into the system. They are always locked in a cabinet and only RPh can have access to them. Mostly they are used for ADD or severe pain.


I am not sure what you are trying to ask for the last question.

Hope this helps....

yeah, i sometimes hear my pharmacy manager say that she has to shizm the district manager and then she emails him using the pharmacy computer. Is it pharmacy jargon or did she invent that word?

 

[npage148]

shizm=sysm (sp) (si-zem phonetically) is Rite Aid's Intracompany email. You sysm your district manager or send him an email.

As an intern, I fill CII all the time and they are not locked in a cabinet. They are distributed on the shelves.

an ointment is occulsive and a cream is not

 

[dumbguy]

shizm=sysm (sp) (si-zem phonetically) is Rite Aid's Intracompany email. You sysm your district manager or send him an email.

As an intern, I fill CII all the time and they are not locked in a cabinet. They are distributed on the shelves.

an ointment is occulsive and a cream is not

wow, thanks. I learn something new everyday!

 

[MissPharmD]

that is what we were told by our professors about the creams...so, that's NOT wrong. Unless, teachers don't know what they r talking about, and I don't believe that. And sorry, by "water" I meant "fluid" around the wound and not water literally.

I hate to argue, so that's where i'll leave it. I am not trying to give out wrong information on purpose to anyone, I said what I knew about it. No need to be rude about it. If u really wanted to correct me, u could have done it in nicer way.

But, WHATEVER....

 

[Sosumi]

shizm=sysm (sp) (si-zem phonetically) is Rite Aid's Intracompany email. You sysm your district manager or send him an email.

As an intern, I fill CII all the time and they are not locked in a cabinet. They are distributed on the shelves.

an ointment is occulsive and a cream is not

CII's are often varied from store to store. Some managers do not let their technicians fill CII's for liability reasons.

Creams are occlusive, just generally less occlusive than ointments.

 

[All4MyDaughter]

Someone should look the creams, ointments, thing up in Remington's. I'd do it but that book is just SO heavy! I've already done my hard exercise for the day.

 

[gaba101]

that is what we were told by our professors about the creams...so, that's NOT wrong. Unless, teachers don't know what they r talking about, and I don't believe that. And sorry, by "water" I meant "fluid" around the wound and not water literally.

I hate to argue, so that's where i'll leave it. I am not trying to give out wrong information on purpose to anyone, I said what I knew about it. No need to be rude about it. If u really wanted to correct me, u could have done it in nicer way.

But, WHATEVER

Don't ASSuME. SDN was not trying to be rude. If anything, SDN is a very kind-hearted individual and pharmacist (of 30 yrs!). The internet is very black and white with lots of room for interpretation (as was your case). And it is very possible to have your professors give you wrong information because they, too, like anyone else, can get stage fright, choke, and say the wrong thing.

 

[longstech]

2.) pharmacy calls caloptima and workers comp directly for prior auth
doctors need to call other insurances( insurances other than caloptima and workers comp) directly to get prior auth.



In our store we need to fill out a CPAS for CALoptima with pt info, Dr. info, medication, sig, NDC, etc, and then fax it to the MD to fill out for diagnosis and justification. He/She then faxes it to CALoptima and CALoptima will fax them back with a denial, approval or deferrment of the medication.

We usually call work comp for PA's and they will usually call the adjuster to get it approved. Once approved, they will call us back to fill it.

Usually MD's need to call other insurances for PA's, but on rare occasion, if it is a renewal PA, sometimes you can call the insurance yourself and get the PA approved for another year yourself and the MD does not have to do it (we have a few pt's like this).

 

[dgroulx]

that is what we were told by our professors about the creams...so, that's NOT wrong. Unless, teachers don't know what they r talking about, and I don't believe that. And sorry, by "water" I meant "fluid" around the wound and not water literally.

I hate to argue, so that's where i'll leave it. I am not trying to give out wrong information on purpose to anyone, I said what I knew about it. No need to be rude about it. If u really wanted to correct me, u could have done it in nicer way.

But, WHATEVER....

You did give out some incorrect information. I didn't think that SDN's comments were rude. You need to get used to constructive criticism.

 

[sdn1977]

that is what we were told by our professors about the creams...so, that's NOT wrong. Unless, teachers don't know what they r talking about, and I don't believe that. And sorry, by "water" I meant "fluid" around the wound and not water literally.

I hate to argue, so that's where i'll leave it. I am not trying to give out wrong information on purpose to anyone, I said what I knew about it. No need to be rude about it. If u really wanted to correct me, u could have done it in nicer way.

But, WHATEVER....

Miss PharmD - I apologize for you receiving my comments as rude. However, with all due respect, since you referred to what your professor's said, I'm going to make the assumption that you're either in tech school or pharmacy school. Either way....I cannot believe a professor would say the things you reported, but I can believe you might have misunderstood it or perhaps you were not told the complete information. (If your professor did indeed say that - he/she was absolutely & completely wrong!).

If you had been my student (since I've precepted both techs & pharmacy students) - I would have corrected you exactly the way I did. Most instructors don't care if you like us or not - we just care you get the info right. Because - the most dangererous person is the one who doesn't know what he/she doesn't know, yet speaks with some authority.

Had you given this information to someone who is trying to decide whether to purchase hydrocortisone ointment or cream for a poison oak rash - hmmm - probably no difference. But...had you given this information to a diabetic who had a foot ulcer - that could be tremendously compromising to the pt &/or his ability to retain his foot.

For the person who actually asked about what Remington's says......."....the reheological properties of ointments and creams....can be interpreted fully only by inspection of the consistency curve of each system which is obtained by the plotting of rheological data. Since these preparations are non-Newtonians, their rheological properties will be influenced by the rate of shear....." The text goes on into thixotropic preparations & the differences between Hydrophilic Ointment USP & petrolatum - both of which are ointments, but have very different yield values & plastic viscosity of their bases.

Now...I really didn't think the OP wanted that kind of detail since it didn't appear the OP was that far along in his professional training. But...to me, which is as valid an assessment as yours was, the OP wanted some clearer understanding of what the actual physical difference is. (And...for those of you students who don't think labs have any function or purpose - this is exactly what the function is - to understand the pharmaceutics behind the preparations so you don't make unfounded statements).

Our function as pharmacists is to get the correct information out there. It's important to understand that abbreviations such as XL, XR, SR are not pharmaceutical terms like an elixir or a solution or a suspension. They are patented names - like Kapseal or Infatab.

When it comes down to the one thing of value pharmacists have to offer - it is our ability to be accurate with our knowledge of drugs. Again...I apologize for hurting your feelings - but you were not accurate.

 

[beccala33]

that is what we were told by our professors about the creams...so, that's NOT wrong. Unless, teachers don't know what they r talking about, and I don't believe that. And sorry, by "water" I meant "fluid" around the wound and not water literally.

I hate to argue, so that's where i'll leave it. I am not trying to give out wrong information on purpose to anyone, I said what I knew about it. No need to be rude about it. If u really wanted to correct me, u could have done it in nicer way.

But, WHATEVER....

Plasma IS 98% water...

 

[JerryPharmD]

I've had classes where the students knew more than the professors/instructors...

 

[OSUpharmy]

Yeah, the method of correction came off as rude to me too. Don't start acting like people in a different profession. (if you know what I mean)

 

[pharmhan]

I believe you're talking about "sysm", pronounced "sizz-um" which is Rite Aid's internal email system. That's how Rite Aid pharmacists and store managers communicate with one another.

 

[bananaface]

maybe by schizm they mean split, leave, go evsewhere?

 

[Shadowstar]

In my opinion if someone gives out info that is wrong it wouldn't hurt to correct them in a polite way. You don't want to be the type of person who said something or did something to someone and make them have a bad day because of it...we are all educated people and I would hope somewhere along that educational path we were taught courtesy and respect for others. This is a pharmacist forum, not an internet porno website lets act like mature individuals here.

 

[Farmercyst]

In my opinion if someone gives out info that is wrong it wouldn't hurt to correct them in a polite way.

You don't want to be the type of person who said something or did something to someone and make them have a bad day because of it....

There are varying ways to respond to incorrect information. Not all instructors are as tactful and/or polite as we'd like them to be. The more important part here is that correct information get to where it will do the most good.

I will agree the presentation of the information, while accurate, was not the most friendly method, but it was better to have it than not.

In terms of making/breaking someone's day. Being told you're wrong generally won't make your day, but ultimately you can decide to get over it or not. If you can't get over it, there are other issues to deal with. It's really a little late at this point to ask whether or not you should have to.

 

[Shadowstar]

In terms of making/breaking someone's day. Being told you're wrong generally won't make your day, but ultimately you can decide to get over it or not. If you can't get over it, there are other issues to deal with. It's really a little late at this point to ask whether or not you should have to.

Oh I believe the people on these forums can get over it just fine, they are not the ones with the problems. The ones with the problems are the people being rude about correcting others...ultimately its those people who are going to have to deal with the fact that their attitude will cause others to dislike them sooner or later in their lives and it is they who are the ones who will have to suffer from that in the end. God does exist and yes he's watching.

 

[OSUpharmy]

Oh great, now I have to start being nice.

 

[Shadowstar]

You should be nice to people who deserve it and be helpful to strangers but to jerks you should be a jerk back.

 

[KellyBean]

I just thought SDN's posts were very informative and not rude at all.

 

[sdn1977]

You should be nice to people who deserve it and be helpful to strangers but to jerks you should be a jerk back.

I'm just a bit unclear. Are you referring to me as a "jerk" and comparing my posts to those which might be found on pornographic internet websites?

Then, threatening me with the potential of God's wrath??

Thank goodness I've endured 30 years of a productive, well-respected and fulfilling career as a pharmacist since without your sage advice I might not have gotten this far !

Oh - I thought name calling was not allowed???

 

[Shadowstar]

I'm just a bit unclear. Are you referring to me as a "jerk" and comparing my posts to those which might be found on pornographic internet websites?

Then, threatening me with the potential of God's wrath??

Thank goodness I've endured 30 years of a productive, well-respected and fulfilling career as a pharmacist since without your sage advice I might not have gotten this far !

Oh - I thought name calling was not allowed???

No I'm not calling you a jerk when I said Jerk I meant jerks you meet in everyday life not you specifically. And that pornographic internet comment was not directed at you either I was merely stating that WE as a pharmacist COMMUNITY should treat each other with respect and we shouldn't criticize one another. To tell the truth I didn't even think your post was offensive at all, I was merely responding with my own opinion on the subject of criticism and how to deal with it. Notice not once did I mention any names...but I do think you are a little paranoid though to be honest.

 

[sdn1977]

No I'm not calling you a jerk when I said Jerk I meant jerks you meet in everyday life not you specifically. And that pornographic internet comment was not directed at you either I was merely stating that WE as a pharmacist COMMUNITY should treat each other with respect and we shouldn't criticize one another. To tell the truth I didn't even think your post was offensive at all, I was merely responding with my own opinion on the subject of criticism and how to deal with it. Notice not once did I mention any names...but I do think you are a little paranoid though to be honest.

AAAhhh - so clear now! But...I didn't realize this thread was about jerks within our everyday lives - I must have misread it somewhere.....

And....I am respectfully appreciative of your psych consult - which I take as the constructive criticizism it was meant to be - altho you don't think we should do that.

But - good try at a save though!

 

[dumbguy]

hey, what's going on here? I posted this thread to answer my dumb questions not to create animosity among ourselves.

 

[OSUpharmy]

What a tangled web we weave when first we practice to deceive. Oops, I mean when we create new threads.

 

[sdn1977]

hey, what's going on here? I posted this thread to answer my dumb questions not to create animosity among ourselves.

Don't worry!!!

Your questions were good ones & they encouraged spirited conversation.

Disagreement does not equal animosity. I disagreed with Zpak plenty, but he's one (or was one) of the best dop's I've ever had the pleasure of knowing.

Keep up with the questions - the more you keep questioning yourself, the better pharmacist you'll become.

 

[dgroulx]

Let's keep it on topic. If you want to talk about how to deal with people, please start a new thread.

Thanks.

 

[acetyl]

So, I don't think I know what occlusive means pertaining to the cream and ointment stuff?

Also, why does Embrel cost so much-like $1500 per 3.92 mL's?

Go Tar Heels!!

 

[crimson1566]

wouldn't ointemnts be more oclusive and thus better for dry skin whereas creams and lotions would be better for weeping wounds/rashes?

 

[golf299]

^^^^^

Not really. If you have a weeping wound, you should dry it. You may have heard the phrase "if it's wet, dry it; if it's dry, wet it". Depending on the wound type it may be more appropriate to put an astringent or even a gel on a weeping wound since gels generally contain alcohol and will help dry the wound.

 

[LowGPAHighPCAT]

i have some pretty dumb pharmacy questions if anyone can answer it.
i was afraid of asking the pharmacist i worked with, for fear of being called dumb.
1.) does XL and SR mean the same thing?
2.) pharmacy calls caloptima and workers comp directly for prior auth
doctors need to call other insurances( insurances other than caloptima and workers comp) directly to get prior auth.
3.) what's the difference bietween ointment and cream?
4.) what are all the C2 drugs? I know some such as adderall, oxycontin, ms contin, percocet, methadone, concerta, fentanyl patches. Any more?
5.) what does shizm mean? I think that's how it's spell. I always hear the pharmacists say I have to schizm so and so. How do you spell it and what does it exactly mean?

Thanks.

Some points that may or may not have been left off....
3.) Ointments are typically petroleum based and therefore have typically a longer time of absorption. In addition ointments tend to work better when applied in very thin layers.

4.) There are a lot of CII's. Anything with oxycodone, morphine, meperidine or amphetamine salts will be considered a CII. In addition there are some older diet drugs that still carry CII status, though they are rarely used any more. Seconal is an older sleep aid that has CII status. Also, just in case you are wondering, there is a CI class of drugs. These are drugs that have abuse potential but are deemed of little or know medicinal value and are generally considered illicit.

5.) A "schism" is a division between parties or factions. I don't know how that would apply to pharmacy. Is the pharmacist named "Snoop Dogg"?

 

[LowGPAHighPCAT]

There are varying ways to respond to incorrect information. Not all instructors are as tactful and/or polite as we'd like them to be. The more important part here is that correct information get to where it will do the most good.

I will agree the presentation of the information, while accurate, was not the most friendly method, but it was better to have it than not.

In terms of making/breaking someone's day. Being told you're wrong generally won't make your day, but ultimately you can decide to get over it or not. If you can't get over it, there are other issues to deal with. It's really a little late at this point to ask whether or not you should have to.

I think that some people might be overreacting to this correction thing. I didn't really read any rudeness - just firm correction (justified and correct in my opinion). Giving out advice in pharmacy is likely telling somebody how to dismantle a bomb. You better know what you are doing or the whole thing can blow up in your face.

 

[Caverject]

that is what we were told by our professors about the creams...so, that's NOT wrong. Unless, teachers don't know what they r talking about, and I don't believe that. And sorry, by "water" I meant "fluid" around the wound and not water literally.

I hate to argue, so that's where i'll leave it. I am not trying to give out wrong information on purpose to anyone, I said what I knew about it. No need to be rude about it. If u really wanted to correct me, u could have done it in nicer way.

But, WHATEVER....

where do you go to school? Texas Southern or Incarnate Word? Obviously, you don't know much and you are not in any position as a P1 to be counseling anybody about medications or how they work. If you can't get over it, then you don't need to be in pharmacy. SDN1977 was nice to you. The real "clinical" people will eat you alive and spit you out like House MD does with his residents on TV if you ever give info like that and then back it up with "my teacher taught me that"

 

[Caverject]

Also, why does Embrel cost so much-like $1500 per 3.92 mL's?

Go Tar Heels!!

Enbrel is a bio-pharmaceutic which means its very expensive to research, develop and actually make. It also means there will never ever be a generic unless current drug laws change thus Amgen is well within their right to charge so much for their liquid gold.

 

[Lurkerkat]

Also, why does Embrel cost so much-like $1500 per 3.92 mL's?

I'm guessing you're talking about Enbrel. The high cost is probably related to the cost of producing the anti-TNF proteins I believe or at least that's what I heard. All of the other biologics like Remicade and Humira have the same high price likewise. Also the companies know they can get away with charging anything they want. Speaking from personal experience, Remicade is darn effective of controlling my arthritis, without it I couldn't function, much less even consider going pharmacy school.

 

[Bunny2010]

where do you go to school? Texas Southern or Incarnate Word? Obviously, you don't know much and you are not in any position as a P1 to be counseling anybody about medications or how they work. If you can't get over it, then you don't need to be in pharmacy. SDN1977 was nice to you. The real "clinical" people will eat you alive and spit you out like House MD does with his residents on TV if you ever give info like that and then back it up with "my teacher taught me that"

OK. So, I have been surfing on this forum for a while. But when I saw your comments, I had to say something about what you just wrote. Why would you assume that MissPharmD is a student at either TSU or Incarnate word? I am sorry, but that was totally inappropriate. So, are you saying that all the pharmacists from TSU are not competent enough or they didn't learn anything?

I have been a pharmacist for many years. The other pharmacist that I work with graduated from TSU and is a darn good pharmacist. And as far as incarnate word goes, one of my technicians is currently going there and he is a very bright student. It is a new school, you don't even know the NAPLEX passing rate, then how would you know that the students at that school were not taught the right stuff.

Your comments were totally bogus, irrelevant and again disrespectful to people who went to TSU or Incarnate word.

If you don't mind, what school did you go to or are currently attending? What makes you think that those 2 schools are not good enough? Obviously, you are the one who is in no position to make these types of assumptions.

 

[sweetpea982]

where do you go to school? Texas Southern or Incarnate Word? Obviously, you don't know much and you are not in any position as a P1 to be counseling anybody about medications or how they work. If you can't get over it, then you don't need to be in pharmacy. SDN1977 was nice to you. The real "clinical" people will eat you alive and spit you out like House MD does with his residents on TV if you ever give info like that and then back it up with "my teacher taught me that"

Although I graduated from the University of Texas, I must comment that what you said about TSU and Incarnate Word was uncalled for. I am currently doing a residency with a TSU graduate and I actually look up to him as a pharmacist. I really hope that you do not walk around thinking since you graduated from a certain pharmacy school you're a better pharmacist. Second I would like to mention, please do not refer to the real "clinical" people and then reference House MD as you example. Remember we are all pharmacist (or future) here there is no need to be commenting in that manner. Thank you.

 

[twester]

^^^^^

Not really. If you have a weeping wound, you should dry it. You may have heard the phrase "if it's wet, dry it; if it's dry, wet it". Depending on the wound type it may be more appropriate to put an astringent or even a gel on a weeping wound since gels generally contain alcohol and will help dry the wound.

Dr. Paulsen is that you?

 

[golf299]

Not Dr. Paulsen, only a stressed CPC student