Pharmacy student quality going down?

[pharmschooler]

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Anyways, what is your answer to the number one problem? Students are dumber/lazier than they were 15 years ago, despite the fact that admissions standards have skyrocketed over the past decade (excluding the past couple years) ?

Older pharmacists have insinuated that while it was much easier to enter pharmacy school in the past, it was much harder to graduate, so that cut down on the number of graduates and ensured only the "best" (or most prepared...however you'd like to see it) made it.

 

[Old Timer]

still waiting for the real answer Z. I'm honestly curious...

First it wasn't Z who said that. Second you confuse intelligence with smarts. They are not the same thing. Plenty of people are book smart, but lack the skills necessary to function in the real world. I think that with the increasing number of applicants to pharmacy school, grades have become more important to getting into school.

In the real world, less so....

 

[BrightLight]

While to us practicing pharmacists there are drugs that seem no-brainers since we dispense them much often than others, to those students whose real-world exposure from drugs mostly come from internship it may not be so.

In pharmacy school, those instructors always tell students that they have to know EVERYTHING about drugs. This is not helpful at all. There is information that is much more practical than other. With so much information to take in during those two to three pre-clinical years, students need to prioritize their learning. While a preceptor may expect his students to know the dosing of Lovenox if not those of the other less commonly dispensed agents in the same class, students could have spent equally amount of time trying to memorize all the details of Lovenox, Fragmin, and Innohep that in the end they fail to master the most practical information.

If knowing everything is the answer to what to get out of pharmacy school, what is the purpose of having instructors? Students might as well stay in their apartments and memorizing the entire pharmacothery textbooks. IMO, schools need to be a better job helping student prioritize their learning in order to better help them prepare for rotations and become a useful member of the healthcare team.

 

[p-rog]

Older pharmacists have insinuated that while it was much easier to enter pharmacy school in the past, it was much harder to graduate, so that cut down on the number of graduates and ensured only the "best" (or most prepared...however you'd like to see it) made it.

people used to fail out of pharmacy school? Really?

 

[pharmschooler]

people used to fail out of pharmacy school? Really?

That's what I heard...or they took much longer than the regular 5 years to get their bachelor's in pharm. This is all hearsay, but I think it was this was with lots of bachelor's programs (not just pharmacy) back in the day.

 

[p-rog]

First it wasn't Z who said that. Second you confuse intelligence with smarts. They are not the same thing. Plenty of people are book smart, but lack the skills necessary to function in the real world. I think that with the increasing number of applicants to pharmacy school, grades have become more important to getting into school.

In the real world, less so....

I'll agree with that. All they cared about when I got into pharmacy school was GPA and PCAT score. That said, you guys are upset over pharmacy students not knowing the stuff they were supposed to be taught in school..which should correlate with book smarts. It's not like you guys are upset that they don't know how to talk to patients or physicians or anything more "real world".

 

[p-rog]

First it wasn't Z who said that.

gotdrugs =/= Z? He sure sounds like him to me...

 

[rxlea]

I am a big fan of the socratic method. Also, what happened to initiative and curiosity/desire for learning? A student shouldn't expect to have their hand held during a 4th year rotation should they? I mean, even in IPPE, it doesn't take a genius to figure out what needs to be done.

 

[gotdrugs]

gotdrugs =/= Z? He sure sounds like him to me...

Nope.

But from things he said in the past, we entered the profession around the same era, and have done many different things so we have seen how the profession changes over the years, how pharmacy students and pharmacists have changed (and their attitudes), and have perspectives that many don't have.

It's multi-factorial, but the decision to go with the "all pharmd" route had a huge impact IMO.

It really was a game-changer in a lot of ways, not all of them for the positive.

 

[p-rog]

Nope.

But from things he said in the past, we entered the profession around the same era, and have done many different things so we have seen how the profession changes over the years, how pharmacy students and pharmacists have changed (and their attitudes), and have perspectives that many don't have.

It's multi-factorial, but the decision to go with the "all pharmd" route had a huge impact IMO.

It really was a game-changer in a lot of ways, not all of them for the positive.

My understanding is that it used to take 5 years to get a BS pharm degree. and then if you wanted the pharmD, you needed another 2-3 years of class/rotations. Definitely a lot more work than a 2 year pre-pharm and 4 year pharmD.

So is PGY-2 the new PharmD now?

 

[Allure]

I had one rotation that I absolutely hated. The preceptor was a d-bag. I was surprised when I received an A at the end cause he gave me a C for mid-point. He told me that the reason why I got an A was cause the physician he was kissing ass to liked my presentation. I can't believe he based my grade on just that.

If I am ever a preceptor, I would want to know what the student wants to learn and how much the student wants to learn and what can be done to achieve that goal. I don't like busy work, the student is there to learn, not to do tech work. I had rotations where I would go with technicians for a week or two just to deliver drugs. I would want it to be a stress-free environment. I don't want the student to feel stressed out just coming to a place where he/she is supposed to learn. I'm not a hard grader and I don't like preceptors that are out there to get you, to give you a B because "there is always room for improvement". That is BS. I would let the student know that I don't give the grade, they earn the grade.

Every student is different. I don't think the grade should be based on how much they know at the beginning of the rotation, but rather how much they want to learn. They are going to graduate and they are going to be pharmacists whether you like it or not, so instead of trashing the students or the schools, just do your best in helping them become the best they can.

 

[gotdrugs]

My understanding is that it used to take 5 years to get a BS pharm degree. and then if you wanted the pharmD, you needed another 2-3 years of class/rotations. Definitely a lot more work than a 2 year pre-pharm and 4 year pharmD.

So is PGY-2 the new PharmD now?

Not always true. Many schools - including my own, was 5+1

But......I had to take many more credit hours for my degree that what is required now.

Other things that changed, due to the all-PharmD:

1) The schools could charge graduate tuition rates once you started your first year of pharmacy school, in the past they charged undergrad rates for your BS of Pharm, then graduate rates for your PharmD year(s). With the current tuition structure, it gives Universities/Colleges a lot more incentive to open school of pharmacies..............

2) The all-PharmD move also helped contribute to the artificial "shortage" due to one year having no graduating class during the transition phase from BS to PharmD

3) The all-PharmD move also led to dilution of the quality of faculty

There are other reasons that IMO, the all-PharmD transition was a bad one.

 

[Old Timer]

I'll agree with that. All they cared about when I got into pharmacy school was GPA and PCAT score. That said, you guys are upset over pharmacy students not knowing the stuff they were supposed to be taught in school..which should correlate with book smarts. It's not like you guys are upset that they don't know how to talk to patients or physicians or anything more "real world".

There is a certain minimum knowledge base. I don't agree with the OP at all. He had one bad student and the follows up with a generalization that all students suck. Clearly anecdotal evidence.

I find that many students are older and more mature. I think they don't understand that Mr. Myagi was right

[YOUTUBE]QsPoBXemFmg[/YOUTUBE]

You must have proper balance. All school, no play and no work, you will never be a pharmacist.

 

[taken2]

I had one rotation that I absolutely hated. The preceptor was a d-bag. I was surprised when I received an A at the end cause he gave me a C for mid-point. He told me that the reason why I got an A was cause the physician he was kissing ass to liked my presentation. I can't believe he based my grade on just that.

If I am ever a preceptor, I would want to know what the student wants to learn and how much the student wants to learn and what can be done to achieve that goal. I don't like busy work, the student is there to learn, not to do tech work. I had rotations where I would go with technicians for a week or two just to deliver drugs. I would want it to be a stress-free environment. I don't want the student to feel stressed out just coming to a place where he/she is supposed to learn. I'm not a hard grader and I don't like preceptors that are out there to get you, to give you a B because "there is always room for improvement". That is BS. I would let the student know that I don't give the grade, they earn the grade.

Every student is different. I don't think the grade should be based on how much they know at the beginning of the rotation, but rather how much they want to learn. They are going to graduate and they are going to be pharmacists whether you like it or not, so instead of trashing the students or the schools, just do your best in helping them become the best they can.

This is exactly how I feel about rotations. Students are there to learn so your concern should be how much they learned at the end of the rotation.

 

[Sparda29]

This is exactly how I feel about rotations. Students are there to learn so your concern should be how much they learned at the end of the rotation.

What about when there is not much to learn? This was the case at my retail rotation. I was basically making doctor calls and counseling on Rx and OTC items all day. Only new things my preceptor taught me was stuff like DEA222 forms, ordering, management, etc.

 

[njac]

Yes, I expect to round with MDs when I have a hospital rotation. I prefer that and staying around reading charts, seeing patients on the floor than ever setting foot inside the hospital pharmacy other than compounding IVs. I have zero interest in order entry, filling/labeling orders, delivering, refilling Pyxis machines, etc.

.

What if you're rotating at a community hospital where the physicians don't really round, and certainly not in the manner they do at an academic institution? The only way you can assess patients is via chart review. You shouldn't be doing distributive duties on a clinical rotation other than helping obtain stat meds as needed.

 

[psychoandy]

i agree with your thoughts, but my impression is selection bias. i picked the hardest rotations at [insert university hospital here], where all of the questions you asked would be considered baseline P4 knowledge. but a lot of people i know who are not as academically inclined so to speak usually went to community hospitals back home or picked weaker rotations, where they would probably get a pat on the back for knowing ppx dose of LMWH.

the saddest part is that there are a lot of things i don't know, i barely remember adj phenytoin...but i know where to look for these things. if your student doesn't know AND doesn't know where to look, you should probably fail them. not knowing is one thing...not wanting to know is much worse.

What about when there is not much to learn? This was the case at my retail rotation. I was basically making doctor calls and counseling on Rx and OTC items all day. Only new things my preceptor taught me was stuff like DEA222 forms, ordering, management, etc.

retail rotation = free labor for the pharmacy. not only do they not have to pay you, but you even do more work than the techs (MD calls, counseling, etc). i probably would have learned more if they benched me the whole time...at least then i could read package inserts or something.

 

[iluvtennis]

While to us practicing pharmacists there are drugs that seem no-brainers since we dispense them much often than others, to those students whose real-world exposure from drugs mostly come from internship it may not be so.

In pharmacy school, those instructors always tell students that they have to know EVERYTHING about drugs. This is not helpful at all. There is information that is much more practical than other. With so much information to take in during those two to three pre-clinical years, students need to prioritize their learning. While a preceptor may expect his students to know the dosing of Lovenox if not those of the other less commonly dispensed agents in the same class, students could have spent equally amount of time trying to memorize all the details of Lovenox, Fragmin, and Innohep that in the end they fail to master the most practical information.

If knowing everything is the answer to what to get out of pharmacy school, what is the purpose of having instructors? Students might as well stay in their apartments and memorizing the entire pharmacothery textbooks. IMO, schools need to be a better job helping student prioritize their learning in order to better help them prepare for rotations and become a useful member of the healthcare team.

Agree.

My thoughts:

1. Students are nervous. Most schools emphasize pharmacotherapy education with exams and in large lecture halls (at least thats how my school worked). Being one on one with the person grading them is intimidating, it will take him or her some time to adjust. I was nervous at the beginning of every single rotation, regardless if it was my first or my last.

2. How much do you remember about medications that are not widely used in your immediate practice area? Meaning, maybe you feel like these are things all students should know because you use them everyday. Students often memorize everything, because to be honest everything was fair game when it came to the exam. When I was in school not every professor prioritized their test questions so the most commonly dispensed or the most commonly used medications were what was being tested. It is your role as the preceptor to teach them the real life applications of what they have learned. That why pharmacy schools have a full year of rotations, as opposed to unleashing the students into the world after completion of 3rd year. This won't happen over the course of one rotation, but over the entire year.

A lazy student in my opinion should not be tolerated. Discuss this with the grading preceptor, perhaps the student feels that since you aren't grading him that he can take it easy.

 

[Sparda29]

What if you're rotating at a community hospital where the physicians don't really round, and certainly not in the manner they do at an academic institution? The only way you can assess patients is via chart review. You shouldn't be doing distributive duties on a clinical rotation other than helping obtain stat meds as needed.

I was in with the attending and residents when they were demonstrating physical exams and whatnot on actual patients. Discharge counseling, patient interviews about medication reconciliation, etc.

retail rotation = free labor for the pharmacy. not only do they not have to pay you, but you even do more work than the techs (MD calls, counseling, etc). i probably would have learned more if they benched me the whole time...at least then i could read package inserts or something.

Actually, I had a decent retail rotation. They never had me doing any of the tech work. Just doctor calls and counseling.

 

[KARM12]

I'm sorry, but saying "I don't remember because I work retail" is not a valid reason for no knowing something on rotation. Go look it up and learn something! As a practicing clinical pharmacist there are plenty of questions that I don't know or don't remember. I look it up.

Being nervous is also not an excuse...what are you going to when a physician or patient asks you a question? Rotations are the time to practice these skills, so use every opportunity possible.

I don't expect my students to know everything, but I expect them to be proactive about their learning.

 

[bp2313]

I will be 1st year pharm student this fall so I can't say I know about learning drugs. However, about 1-2 weeks ago around Memorial weekend, a patient called and asked our pharmacist how long after finishing Flagyl she could drink. The pharmacist on duty that day (one of the most brilliant person I know) said 72 hours. About 2 days later, the same patient called back and said she was having rash and vomitting. Then that pharmacist asked 2 other pharmacists and they both said 2 weeks.
My point is you learn new things everyday and to the OP, aren't you proud that you're teaching other people things you've learned?

 

[BrightLight]

I'm sorry, but saying "I don't remember because I work retail" is not a valid reason for no knowing something on rotation. Go look it up and learn something! As a practicing clinical pharmacist there are plenty of questions that I don't know or don't remember. I look it up.

Being nervous is also not an excuse...what are you going to when a physician or patient asks you a question? Rotations are the time to practice these skills, so use every opportunity possible.

I don't expect my students to know everything, but I expect them to be proactive about their learning.

Yes, I agree with you that clinical pharmacists are the most proactive species in learning. Anyone else who doesn't know how to answer a question is just lazy and a disgrace to our profession.

 

[gotdrugs]

Yes, I agree with you that clinical pharmacists are the most proactive species in learning. Anyone else who doesn't know how to answer a question is just lazy and a disgrace to our profession.

Awesome strawman argument you are trying to set up there. 🙄

 

[KARM12]

Yes, I agree with you that clinical pharmacists are the most proactive species in learning. Anyone else who doesn't know how to answer a question is just lazy and a disgrace to our profession.

I don't care what setting you working, being able to find information to help patients and physicians is part of the job. You're not going to be able to remember every side effect or drug interaction, but you should know where to find the answer when asked.

Students are there to learn and they better be looking up things they don't know.

 

[pharmschooler]

Other things that changed, due to the all-PharmD:

1) The schools could charge graduate tuition rates once you started your first year of pharmacy school, in the past they charged undergrad rates for your BS of Pharm, then graduate rates for your PharmD year(s). With the current tuition structure, it gives Universities/Colleges a lot more incentive to open school of pharmacies..............

2) The all-PharmD move also helped contribute to the artificial "shortage" due to one year having no graduating class during the transition phase from BS to PharmD

3) The all-PharmD move also led to dilution of the quality of faculty

There are other reasons that IMO, the all-PharmD transition was a bad one.

Interesting points. It would be interesting to look at other programs that now have recently made the transition to doctoral programs at the entry-level (like physical therapy) to see if these same issues have been noted.

I often wonder about the credentials arms race; I'd like to know if there are any real advantages, or are the advantages solely to those in academia?

 

[Its Z]

still waiting for the real answer Z. I'm honestly curious...

Every generation
Blames the one before
And all of their frustrations
Come beating on your door

You say you just don't see it
He says it's perfect sense
You just can't get agreement
In this present tense
We all talk a different language
Talking in defence

Just a little lyric from Mike & The Mechanics.

Our generation likes to say the next generation kids are dumb and lazy and the generation before us said we're thankless and don't know what real work means.

Circle of life man...


Every pharmacy school and every class has that 4.0 never miss a day studious and introverted type. And every class has *******es and lazy mofos. And every class has go getters.

This will never change.

The student singled out by the OP does not represent the new generation nor does he represent the drop off in the education level of a PharmD program. He's just one of those stupid mofo who floats through pharmacy school and gets by.. every class has those. Every class.

It means nothing...other than that particular student really couldn't care less other than finding that job that'll pay him $120,000 year wiping someone's ass.

Entry level PharmD was more good for our profession than bad. Some good came of it and some bad came of it... that artificial shortage..was that a bad thing? I think not. It helped us increase our salary. Did doctorate PharmD degree cause some sense of entitlement to some young PharmDs? Perhaps.

But who cares. It's what it is.

I didn't read the entire thread... no need to as I'm not really sure what you're arguing about.

 

[psychoandy]

Did doctorate PharmD degree cause some sense of entitlement to some young PharmDs? Perhaps.

I'm pretty sure at least half of my class are still basking in calling themselves "doctor" (and are completely serious about it). it's quite precious.

 

[Thoughtfulsinner]

I'm pretty sure at least half of my class are still basking in calling themselves "doctor" (and are completely serious about it). it's quite precious.

 

[confettiflyer]

I'm pretty sure at least half of my class are still basking in calling themselves "doctor" (and are completely serious about it). it's quite precious.

yeah i hate that, i see it on FB too for all the crazy doctorate degrees coming up.

even had a law friend say he was technically a juris doctor...who the hell says that?

 

[ChasingMyDreams]

I think this is student specific...

Is this a student that is only interested in retail and just trying to skate through rotations so he can start working at XYZ chain where he has already signed a contract?

For me, school is what you get out of it. Grades do not matter. I know 4.0 rho chi students who don't know a thing and some who know everything. The same with the 2.5 students.

Work experience has a lot to do with it. By the time I hit rotations I will have 3 yrs of 30-40 hr/wk hospital experience. I should be light-years ahead of someone who worked retail or not at all....

It comes down to interest and will to learn in my opinion. The information is there (hell, I could learn everything we learned in therapeutics from lexicomp and uptodate and maybe dipiro), it just depends on the drive of the student. You cant blame the school.

Just my 2 cents...

 

[30Percent]

yeah i hate that, i see it on FB too for all the crazy doctorate degrees coming up.

even had a law friend say he was technically a juris doctor...who the hell says that?

I've noticed the same thing. My friend made a status "I'm going to be a doctor!" when he found out he got into pharmacy school. His later update was about him adding "Dr." to his credit card after he graduates.

 

[pfaction]

I'm a fifth year. I'm pushing myself to review so I don't become like the student in the first post. However:

• The student doesn't know how to calculate Adjusted Calcium Level, Adjusted Dilantin level, and even Creatine Clearace.
• The student doesn't know what class and mechanism of action of Lovenox (a 4tH YEAR student?)
• He has no idea what dopamine is used for.
• He has no idea what antibiotics cover Pseudomona.

1) I don't know how to do Adjusted Ca level. I learned it December last year - I have no excuses. I DO know that it depends on albumin, something like 0.8 * albumin. I know it goes down with low albumin...I think.

As for dilantin, I remember level /10 = free level, and you want 10-20. Adjusted dilantin = observed / (0.2*albumin +0.1), where 0.2->0.1 in renal dysfunction.

I can do CrCl off back of my hand like crazy since we were told to tattoo it on us. The only problem I have is with IBW, AdjBW, ActBW. I always ask which one to use because it's also diff for Vd.
2) I forgot the EXACT mechanism of Lovenox, but I know it is a LMWH and probably has to do with anti-thrombin III. Not DTI. I learned this also in December/February, and I again have no excuses.
3) I don't know what dopamine is used for. I think it is shock or renal perfusion. This isn't a clear question IMO, because at high concentrations it's a vpressor but low it is renal dilator (I THINK)...I learned this in Feb, but I would need clarification. Unless I'm totally wrong.
4) If I didn't review Infectious recently I would simply say Zosyn, Aminoglycosides, Polymyxins, Fortaz and Aztreonam. Not ertapenem.

Cipro skipped my mind until I read those comments. I forgot it's the DOC Quinolone for Pseudo.


As for some of the other comments - at Walgreens, I have dispensed Fragmin (is that the one with units instead of mg?) and Lovenox. It's there, and it's used frequently. I have also SEEN, but not dispensed Arixtra (Factor X, no II...or something)



So rate me so far as a 5th year, about to walk into a hospital. I have a feeling I failed a lot of expectations.

I will be 1st year pharm student this fall so I can't say I know about learning drugs. However, about 1-2 weeks ago around Memorial weekend, a patient called and asked our pharmacist how long after finishing Flagyl she could drink. The pharmacist on duty that day (one of the most brilliant person I know) said 72 hours. About 2 days later, the same patient called back and said she was having rash and vomitting. Then that pharmacist asked 2 other pharmacists and they both said 2 weeks.

It may just be me...but it usually is 72 hours. My notes even say 48 hours.

 

[rph3664]

I take back my Lovenox comment. No way he ever saw that dispensed at Wags, and he could easily have forgot it from when he actually learned it.

Actually, he may very well have seen it there. Lots of people are going home on it, and one of my Facebook friends was on it while she was pregnant because she has a rare blood clotting anomaly (she didn't say exactly what it was, and I didn't ask).

We once had a test where the professor put questions on it that weren't covered in that section, and enough people filed complaints, everyone got their scores altered accordingly. I happened to get it right because I remembered that information from a previous section, or maybe even class (keep in mind that this was 20-odd years ago) and several people said to me, "You remember stuff you were already tested on?" Why wouldn't I? I am going to need to know that, KWIM? This isn't, say, a geography class!

 

[pfaction]

This is a message to all the preceptors here. What do you expect the student to remember from their therapeutics walking into your site?

 

[PumpkinSmasher]

This is a message to all the preceptors here. What do you expect the student to remember from their therapeutics walking into your site?

🙄 Silly students...got to love them.

 

[rxlea]

Surely the preceptors expect you to remember basic stuff (at the very least) like vanco and AG monitoring/dosing; differences between the quinolones and their dosing; which abx require reduction in renal impairment; cross sensitivity issues; CrCl; common lab values and their normal parameters; tx for CHF, COPD, DMI + II, and a-fib; INR goals/heparin bridge therapy/lovenox tx vs prophylaxis/reversal agents; common immune disorders and their treatements; counseling points for common meds; electrolytes;etc. These are just the things off the top of my head that we went over in first year. I hope I don't forget it all 🙁 but, since I am seeing it all the time at IPPE and work, I think it might just stick. Is it true you guys forget this stuff come 4th year?

 

[owlegrad]

Actually, he may very well have seen it there. Lots of people are going home on it, and one of my Facebook friends was on it while she was pregnant because she has a rare blood clotting anomaly (she didn't say exactly what it was, and I didn't ask).

Enough people have said this that it must be true. I haven't seen it outpatient myself and we don't even stock it.

 

[rxlea]

We dispense lovenox a lot at my IPPE site but that's because the pharmacy is associated with the hospital...

 

[Sparda29]

I used to hate dispensing Lovenox and Vitamin B12 injections in retail because for some reason we always stored those all the way on the back and top of the shelves and it would be a pain to retrieve them. That and I hated dispensing things in ziploc bags.

 

[Carboxide]

Enough people have said this that it must be true. I haven't seen it outpatient myself and we don't even stock it.

We frequently dispense it for surgery patients.

 

[deleted129840]

so hopefully after your rotation he/she will be better.
we have some complete idiots in my class, that i believe if they graduate, they will eventually harm the public.
so if your students are still incompetent by the end of ur rotation, please fail them for patient's sake.

I agree with fiorio -- this is just one of those real-life experiences (employee with super-bad attitude) that everyone in any kind of supervisory capacity has to learn to deal with.

 

[pfaction]

🙄 Silly students...got to love them.

...

Surely the preceptors expect you to remember basic stuff (at the very least) like vanco and AG monitoring/dosing; differences between the quinolones and their dosing; which abx require reduction in renal impairment; cross sensitivity issues; CrCl; common lab values and their normal parameters; tx for CHF, COPD, DMI + II, and a-fib; INR goals/heparin bridge therapy/lovenox tx vs prophylaxis/reversal agents; common immune disorders and their treatements; counseling points for common meds; electrolytes;etc. These are just the things off the top of my head that we went over in first year. I hope I don't forget it all 🙁 but, since I am seeing it all the time at IPPE and work, I think it might just stick. Is it true you guys forget this stuff come 4th year?

1) I'm taking that course right now. I don't expect to remember how to perfectly do those.
2) Diff btwn quinolones and dosing - I know some differences but haven't learned dosing yet. I don't think we do.
3) I think I know this, or can ballpark. I forget if some are <50, <30 (nitro and cipro)
4) aztreonam, not sure if this is what you meant.
5) CrCl I think every student should know how to do, but that weight part (IBW, ABW, AdjBW) is questionable to me. Obese patient...
6) i myself know lab values to an extent, but each hosp is diff.
7) I have forgotten most therapeutics but can ballpark everything you just said. Loop, ACE, low dose BB. SABA, LABA/ACh, incr dose. I haven't taken the course for diabetes, but I'm assuming therapeutic lifestyle, metformin, but past that I hear it's crapshot - TZD? DPP-4? a-fib...not sure either. I know warfarin for clots. 2-3, heparin bridge, not sure what time to start. I think week bridge. protamine, vit k, I think is what you mean? As for electrolyte, that's a nightmare and I deserve an F if asked about it. I can't calculate water deficiency or osmolarity or sodium infusate. That is REALLY hard for me. And as for your last question, we forget it 5th year (we learn it during 4th year). So overall, I'd give myself a C when it came to your questions, you may even score me lower.


We've dispensed B12, heparin, Lovenox and Fragmin in my outpatient pharmacy.

 

[deleted205891]

Is it true you guys forget this stuff come 4th year?

Yes, at least I forgot a lot of it, especially since I couldn't get a hospital job over the past 3+ years due to too many pharmacy schools in Philly. And with my first rotation being promotional regulatory affairs in industry, I might forget even more. I guess I will be able to assess how much I still remember in my next rotation, which is hospital.

 

[PharMed2016]

I will be 1st year pharm student this fall so I can't say I know about learning drugs. However, about 1-2 weeks ago around Memorial weekend, a patient called and asked our pharmacist how long after finishing Flagyl she could drink. The pharmacist on duty that day (one of the most brilliant person I know) said 72 hours. About 2 days later, the same patient called back and said she was having rash and vomitting. Then that pharmacist asked 2 other pharmacists and they both said 2 weeks.
My point is you learn new things everyday and to the OP, aren't you proud that you're teaching other people things you've learned?

This is where personal experience may trump what you learn on what to tell the patient. 72 hours is what they recommend on the PI but technically they didn't wait 72 hours if it was only 2 days time. Hell, (pardon me) they are probably still on Flagyl if it only been two days time. It should have been 72 hours after last dose.

 

[Tinkerbell22]

This is where personal experience may trump what you learn on what to tell the patient. 72 hours is what they recommend on the PI but technically they didn't wait 72 hours if it was only 2 days time. Hell, (pardon me) they are probably still on Flagyl if it only been two days time. It should have been 72 hours after last dose.

i was thinking the same thing... i've never heard 2 weeks... just 3 days. i guess the extra day matters (assuming it was 2 days after completion and not 2 days after pick-up)?

 

[297point1]

Just a little lyric from Mike & The Mechanics.

Our generation likes to say the next generation kids are dumb and lazy and the generation before us said we're thankless and don't know what real work means.

Circle of life man...

Quoting lyrics from "The Living Years"? Man, that's deep. That's one of the greatest songs of the last 25 years, something even this alt-rock / grunge / speed metal fan appreciates.

Sometimes I think students on this forum would benefit from the last line before the concluding chorus:
"If you don't give up, and don't give in, you may just be okay."

 

[CUpharmD2013]

Quoting lyrics from "The Living Years"? Man, that's deep. That's one of the greatest songs of the last 25 years, something even this alt-rock / grunge / speed metal fan appreciates.

Sometimes I think students on this forum would benefit from the last line before the concluding chorus:
"If you don't give up, and don't give in, you may just be okay."

Say it loud, say it loud.....

 

[PharMed2016]

i was thinking the same thing... i've never heard 2 weeks... just 3 days. i guess the extra day matters (assuming it was 2 days after completion and not 2 days after pick-up)?

Just looked up the half-life of Flagyl = 6-12 hours with an average of 8 hours. Based on that information (t1/2=12hrs upper limit) - 6 t1/2s would've passed by 3 days time or over 97.5% is gone or only 2.5% of the medication is remaining if you are using 12 hours.

If your using 8 hours or the average, then over 99.5% should've be eliminated based on 9t1/2s.

 

[pfaction]

This is where personal experience may trump what you learn on what to tell the patient. 72 hours is what they recommend on the PI but technically they didn't wait 72 hours if it was only 2 days time. Hell, (pardon me) they are probably still on Flagyl if it only been two days time. It should have been 72 hours after last dose.

But that's right..the pharmacist was answering how long until AFTER they were done taking it. SO the pharmacist was right. This patient prob had a long half life or something. IIRC metro is both renal and hepatic dysfunction prolonged or hypersensitive / low alcodehydro.

Exactly what you said later!

 

[deleted205891]

Also patients tend to round. What they said was 2 days may have been about 36 hours.