Friday, July 31, 2009

Studying for the PCAT

I have had some inquires as to how I studied for the PCAT considering the sizable change in my scores the second time around. I shall describe my method, but first I must offer a disclaimer.

I'm a science geek. When I learn something interesting in class, it sticks with me. Thus can tell you to use a Lindlar catalyst to go from an alkyne to an alkene and to use H2 and a palladium catalyst to go from an alkyne to an alkane. I remember vividly viral replication and the fact it can follow a lytic or lysogenic path. I remember how and what the kidney filters and replaces at its various stages.

Again, I am a nerd. All I need is a very brief refresher and it all comes pouring back out of my brain. I know not everyone is like this, thus why I am offering this disclaimer.

I used mainly the Kaplan 2008-2009 PCAT prep book. The book is quite good, but it does have some faults. For one, there are some incorrect answers in the back off the book which will drive you nuts at times. It only glances over O Chem and I felt it under prepared me for the quant portion of the test.

That being said it is a great reference for all the other sections of the test. If you're comfortable with what you know, you may only need this book. Personally I like to cover every single base and then some before I go into a test like this.

Therefore I went to Barnes and Noble and picked up a couple of Spark Notes book. First I picked up a book on biology found here. It covers virtually everything you'd cover in general biology and A&P. I never really had a class on plants, due to falling into a crack in our bio dept, so I used this heavily to prep for that. It's not detailed by any means, but it covers a good deal of information.

Next I picked up these two books, one on Pre-calc and the other on stats. In reality I probably did not need these (although I needed to brush up on trig) but it provided good practice for the test. Part of the challenge of the Quant portion is being able to quickly do calculations and being able to distinguish which answers are illogical. You should be able to do trig, division and basic stats problems very very quickly. In reality you do not have much time to spend on a particular problem.

I brought those three books with me virtually everywhere I went for two weeks reading through them and quizzing myself. At night, I would come home and hit up the Kaplan book to cap off the night.

Generally I would go section by section in the Kaplan book being slow and methodical. If there was a concept I vaguely remember or didn't understand when I remember it initially, I made note of it and after the section researched it further. I have kept virtually all of my pre-pharmacy course books which greatly helped with this part.

I know some of you are going, he started studying with two weeks to go? He's nuts! Hear me out.

I have studied for every single test in college in this manner. And I cannot sit and study for hours and hours on end. You know those kids who go to the library when it opens and leaves when it closes? That's not me.

I have learned to study in spurts. Hit the books really hard for 45 min to an hour and then leave them. Go screw around on the internet, go to the store, but do not touch the books. I try not to even think about it. Usually this break lasts for a half or so and then I go back to studying. I repeat this method again and again until I'm comfortable with the material.

And since I usually remember about 3/4ths of the material from the first time around, I don't study until it gets closer to the test date. I will get test anxiety and wind up burnt out if I start studying sooner. I simply cannot study for a test in that manner.

Finally purchase at least one of the practice tests from Pearson. Next to the Kaplan book, they are the best thing you can use to study. They generally reflect the type of questions of the test and will give you a really good ballpark for how prepared you.

As for the test make sure you're well-rested, eat breakfast and at the break time (this was my undoing the first time) and above all remain calm. I am lucky in that I am a fast test taker. Usually I am the first one done at a test and, in this instance, it allowed me to go over the whole section twice to check for errors. In taking it the second time I learned how to properly pace myself and I was able to whip out answers more quickly due to, I think, being more relaxed.

I know I probably study in an atypical manner, but I figure this should help answer some questions. If anyone has anymore either shoot me an email or leave a reply in the comments field and I will do my best to answer it.

Thursday, July 30, 2009

But It's Sooooo HARD

I love the mid afternoon lull. The lunch rush is over with and the after work rush is still about 45 minutes away. Granted you're still busy, but it's not nearly as chaotic as it can be.

Sipping on my Mtn Dew I grab a Rx off the fax, read it and immediately chuckle.

Patient Name : Morbidly Obese
Drug : Freestyle Lite Test Strips
10 MISC Vials (30 day supply)
Date: 7/30/09
Refills: One
Dispense as Written
Instructions: Use As Directed
Provider: Julie Dipshit, RN, CDE
Who can pick out the problems with this particular prescription?

First I have no idea what 10 MISC Vials (30 Day Supply) means. I assume that's a quantity of 100, but I'm really not too sure.

Second, a DAW? Seriously? What the hell have you been smoking?

Third, Use as directed? Now this may be okay for some of you, but in our area the insurances have begun cracking down hardcore on sigs that state this. To be honest, I actually understand this one to a point. People who are getting 200 strips a month but only test twice a day is a bit ludicrous. Plus it's very simple to fix.

Finally, the RN signed off on it. There was no doc listed anywhere on the Rx and I know CDEs aren't granted the power to write prescriptions.

So I grab a chair, my trusty old phone, make sure I have enough Dew to last me and dial the Diabetes Office this came from.

I had the pleasure of talking to another nurse that I shall call Hilda. I kindly explain the situation to her and state what I need done before I can fill this.

Her response? "So you want me to get the doctor to sign off on every single thing that comes out of the Diabetes Center"

Myself: "Well generally prescriptions have to have a providers name on it, so yes that is needed"

Hilda: "And you want to know how often she tests? Why can't you just use what we put on there"

I then explain to her the situation with insurances in the area.

Hilda: "I've been doing this for years and you're the second person I've had ask for this in that time. Do you realize how this is going to complicate the relationship between the CDEs and patients? It's going to take days to get these signed off on"

Myself: "It won't take days, especially since I'm sure the doc is already aware that this needs to be done."

Hilda: "But it just doesn't make sense." *SIGH* "I guess I can go get this done for you. Is there anything else you want done?"

Myself: "Yes, what's your supervisors name?"

Have I mentioned again how much I love nurses? I left out the fact she referred to herself as a CDE about twenty times during our conversation.

At least it gave me something to giggle after lunch.

Wednesday, July 29, 2009

PCAT Scores Are Back... Part 2

Before anyone asks, I will make a post or two about my wedding. As is the case with many adventures in my life it was hilarious, frustrating and a damn lot of fun all at the same time.

When I picked up the mail yesterday upon returning home, I found my PCAT scores awaiting my arrival. They actually had arrived in less than five weeks which is fairly impressive.

I have had a couple people ask about these so I will post them much like I did for my first PCAT.

The format goes as follows:

Scaled Score (Change from 1st PCAT) - Percentile (Change from 1st PCAT)

Multiple Choice Scores

Verbal Ability - 431 (+9) - 89th (+7)
Biology - 455 (+37) - 98th (+22)
Reading Comp - 410 (-13) - 62nd (-18)
Quantitative Ability - 433 (+39) - 88th (+57)
Chemistry - 439 (+23) - 91st (14)

Composite - 434 (+18) - 94th (+20)
Writing Scores

Conventions of Language - My Score - 3.0, Avg Score - 2.84
Problem Solving - My Score - 3.0, Avg Score - 2.87

The main reason for retaking the test was my Quant scores which were due to the migraine I developed after the second essay. That is why eating in between tests is a damn good idea.

I thought I had done well when I finished, but not quite this well. I knew the reading comp would go down because I had grown bored by the last two readings.

As such I am quite happy with the results. Now I just need to finish up those damned essays...

Thursday, July 23, 2009

I'm Hot

Caught this before I left town.

Go to Google, search for "good looking pharmacists", see what pops up first.

Giggity giggity

Wednesday, July 22, 2009

It's Time to get Hitched

I write this today as, what could still be considered, a single man. Come 1pm on Saturday however, that portion of my life shall be over and I will be a married man.

I have mentioned in passing a couple times my fiancee during my various stories. This past summer, in addition to working full time, going to school, studying for the PCAT, volunteering and filling out pharmacy school apps, I have been planning a wedding with my future missus.

No, I will not dole out advice on weddings. I may answer questions regarding pharmacy and getting into pharmacy school, but I am not one to talk to about planning a wedding.

My advice? Go to Vegas and make it quick and simple.

As such I shall be gone for at least a week or so. No honeymoon at this moment as that shall come later, but more a relaxation from work and studying.

I will probably be twittering the day of for a few people who cannot make it to the actual wedding, so feel free to enjoy that on Saturday.

Until then, this is my final posting as an un-married boy. You'll next hear from me as a married man.


Tuesday, July 21, 2009

We Should Legalize Meth

The story I'm about to share with you here is 100% true. I have not embellished any part in anyway.

Earlier today the pharmacist, a new tech and I were discussing the idea of creating a new schedule (Schedule VI) to cover things like Plan B, Sudafed, etc. Kind of gray area things if that makes any sense.

Our new tech piped up and made a statement which literally floored me. A statement I never would have expected to hear come out of a cognizant human's mouth.

...that Sudafed law is stupid anyways, it hasn't helped anything. All it did was move the creation of it offshore, it hasn't helped any problems. We should just legalize it like cigarettes so then we could make some money off of it at least.
Say what?

I have a large multitude of experience with meth labs. I grew up in an area that was quite literally flourishing with them. I have watched friends succumb to meth addiction. I have been robbed by meth heads. I have witnessed them tweek out on an unsuspecting person. I have been around when they have randomly torched homes. I have seen the crater which remains from a meth lab explosion.

Needless to say, I have had a lot of experiences with meth and the problems it produces.

And yet this guy thinks we should legalize it. Treat it like its as simple as buying a pack of smokes. Oh it gets better.

All meth is is Sudafed without an oxygen on it. It's just the same stuff. The only reason it's bad is because it's impure and the government could make sure it's pure so it's safer. I've read lots of CEs on it, it's not that bad

Not that bad? Not that fucking bad? I have seen people who have literally ripped their skin of because of the 'meth bugs' they had trapped under their skin.

He kept insisting that since he had taken CEs that his knowledge was sufficient.

If we make meth legal, less people will want to do it because it won't be so hard to get.
Huh? Where the fuck do you get that logic from?

I have never met anyone so obtuse towards what is perhaps the most dangerous illicit drug in the world. I have never been so disturbed by statements from someone in a very very very long time.

And this guy wants to go to pharmacy school too.

Jesus, I don't think I'll be able to sleep tonight...

Monday, July 20, 2009

A Drunken Oops

You ever get worked up over something while your drinking? And then, due to the advent of technology, decide to put those thoughts into words. And then decide, Hey I should post this shit!

Well you see I did that a few weeks back. I had never intended to post it because, once I reread it, I realized what a shitty post it was. For some reason, Blogger decided to post this particular draft.

So those of you who did read that, just wipe it from your memory. And if that doesn't work, I'll send y'all a couple of Valium. And some Jack Daniels.

Good times my friends, good times.

Saturday, July 18, 2009

A Simple Thank You

I have had a helluva time writing my essays for pharmacy school apps the last few days. They are rather ambiguous questions to which I have a difficult time formulating a response.

Funny thing is, I can write pretty damn well in my opinion. I have my baby right here (although I have a habit of not proofreading before I post, one of my sins I suppose) and I have had a couple of sports articles published on major sports websites. Actually I foresee some kind of future in writing in whatever career I end up having.

The question I have been grappling most with is why I chose this profession. Sure I could answer it with the same recycled response that 90% of the other applicants will use. That doesn't relay my actual desire for this profession though and thus I have been scratching my head for the last few days.

Until last night that is.

One of the things I have emphasized over the past two years of writing this blog is the ability, and need, to become friendly with your patients. Sometimes, this progresses into a type of friendship that you don't find in your personal life. Namely because this friendship is completely open. You know their problems and in time you may share yours.

We, and by we I mean us Pharmacy Folk, are good and kind people. Often we come across as callous egotistical assholes, but that is mainly the result of the stress we deal with on a regular basis.

Which all leads to what happened last night.

One of our long time customers at one of our stores died recently. It was unexpected, one of those passing in your sleep type deaths. At least once a week she and her husband would be in our store to pick up a prescription.

After five years of this regular interaction, you get to know them fairly well. They were almost always in a good mood (and by that I mean they always found the humor in life, something I appreciate greatly) even when things were quite sour.

Since her death, her now widow has been understandably quiet when coming into the store. In fact, I think a month had past without him saying virtually a word to anyone in the store.

Until last night.

As he was walking past the pharmacy to the exit he turned to me and said "Thank You."

Thinking this was merely a response to today's activity I replied how I normally would in this situation.

To which he responded, "No thank you for everything. One of the highlights of my wife's week was coming here and talking to you guys. She always said you specifically were funnier than hell and would make one damn good pharmacist some day. So thank you."

He then walked out the door.

That is precisely why I am in this field. Not to make money, not to shuffle people in and out of the store, but to make a difference in someone's life.

I think I finally know what to write about now...

Friday, July 17, 2009

The Great Wall of Pharmacy

In the 5th Century B.C. the people of China began constructing what would later be called The Great Wall of China. It was constructed as a defensive measure to keep the warring northern tribes out of China proper. Since it's completion in the 16th century it has stood as a example of the ingenuity and perseverance of the Chinese peoples.

Today, ladies and gentleman, I present to you the beginnings of the Great Wall of Pharmacy.

Construction began on July 16th, 2009 and is expected to be completed some time near the end of the 42nd century.

It is constructed out of Barr brand Trazodone 150mg tablets and is already a staggering five inches in height. It is hoped that this will shall help keep addicts, invalids and screaming children far away from the pharmacy counter.

It truly is a glorious sight to behold with one's own eyes.

I shall keep you updated on the continued construction of pharmacy's first true defensive measure.

Monday, July 13, 2009

I Hate My Life

Been a while since I tossed some tunes up here, so I figure what the hell. Picked up Theory of a Deadman's new CD about a week ago (well it's not so new, but I'm just really fucking slow). A particular song on here made me laugh my ass off the first time I heard it, especially because on rough days on the Pharm I can relate to it.

Plus I read why the leader singer wrote it and found it rather fitting:

"I wrote this song because one day I got out of bed and was like 'Today feels like it's going to be a bad day. I can feel it.' I realized that there are people out there that have it worse than most people who bitch and complain, and decided to write it so maybe it could make someone's day a little better."

So I present to you, Theory of a Deadman - I Hate My Life

edit: found out afterwards that this is edited. takes most of the fun out of it if you ask me

Song Lyrics

Friday, July 10, 2009

The Rain Man Nursing School

I swear to God, without nurses I would have nothing to write about lately.

One of our more... intellectually challenged nurses whom is in charge of the meds at a local group home called us today. I affectionately call her Rain Man because I imagine that she is only one step away from mumbling "Blue light special" on a regular basis.

She states she will be sending over some new prescriptions for a patient and asks to keep an eye out for them. Nothing really out of the ordinary.

Until I actually receive the fax. Turns out she faxed them herself as they were handwritten scripts she had received from the patient's dentist. Naturally, in big bold letters were the words VOID and NULO (I get a kick out of the addition of NULO in the last year) across the faxed copies.

And of course one of them has to be a Schedule III.

I call her back and tell her that she cannot just fax prescriptions like this and she will have to have someone bring them down. I then have to to explain the various safety features that have been implemented on pad prescriptions for the last three years.

She responded with a doozy of a question that quite literally left me with a stupefied facial expression.

"Well if you don't take fax prescriptions, how else do you fill them for patients who come in?"

**Crickets chirping**

See even after I explained to her that you can call in some prescriptions from the doctors office. Sometimes, and this may sound shocking, but people actually bring us the prescription to fill.

Honestly she seemed a little taken aback by these notions. Alas I was taken aback by the fact that she is lacking even a squeaky wheel in her nurse's brain of hers.

And some of you ask why I bitch so much about nurses...

Wednesday, July 8, 2009

Pharmacy Redemption

Here is another little benefit that no one ever mentions to newcomers to the pharmacy world. That is the joy of pharmacy redemption.

You see while working in a pharmacy you are blessed with medical knowledge. This knowledge is then applied to the people, i.e. the patients, who come into the pharmacy. Without every explicitly asking, you can generally tell what medication they have by what medications they pick up. Pretty simple really.

But there is an added joy to this knowledge. You can infer medical conditions of people you know who come in. And if that particular person has ever made their life hell and you find out they're suffering from... oh say genital herpes... why that just makes your fucking day.

For example when I was a wee lad starting out in the pharmacy world, a mere 15 years old, my first interest in drugs came in the form of anything that made you pee, shit or had something to do with STDs. I figure that's pretty typical of 15 year old boys or at least that's how I shall justify my depravity.

Now in school I had a guidance counselor who was a real bitch. I mean she would degrade Jesus until there was nothing left but his robe. One of those teachers who you know that, when they die, you can look down at the ground smiling because you know they are roasting in hell for all eternity.

Six months into my pharmacy career she walked through the front door of our store. Now she had recently gotten divorced from her husband, because of something she did, for 'unknown' reasons. She was smiling until she walked up to the counter and saw me standing there.

Little did I know what sweet vengeance this would be.

What was she picking up? A Rx for Valtrex. No, not with the directions for cold sores Valtrex. The I 'have Mount Vesuvius in various parts of my fun zone' Valtrex. I also noticed it was a fairly recent prescription for her as well.

Oh sweet Jesus was it a beautiful moment. She, of course, hurriedly exited the store and I finally let my repressed grin surface. Never again would she come back to the store. And, no, I did not joyfully tell anyone else about my experience. But that was my first taste of pharmacy redemption.

And damn it was good.

Thanks to a reader for sparking this glorious story from my memory

Tuesday, July 7, 2009

A Question for the Pharmacists Out There

Are you too good for 'tech work'?

The pharmacist I worked with today bitched and moaned all day about tech work. Actually at one point he snapped at me, started yelling and mocking me, when I was offering a quick solution to a problem he was having.

See he, and a few others I work with, believe that entering prescriptions is 'tech work' and that they are above that. They believe they should be able to sit on their stool and merely check all day long.

Now I do not understand this. If I were a pharmacist, and it were not terribly busy like today, I would want to run as many prescriptions as I could in order to catch interactions, notice compliance issues and to make note of the health of my patients. Plus the way our checking system is setup, if the pharmacist does not run the script and look at the past history, he has no idea what it is as he checks it on the counter.

Instead this breed of pharmacist believes it is the technicians duty to do all of the above. Granted, I have no problem with this, but many of my co-techs are not very well versed in interactions. Hell I can't remember the last time anyone besides myself made note of an antibiotic/birth control interaction.

So I ask the other pharmacists that read this blog, what do you think? Are you above this 'tech work' even if that involves a lack of knowledge on the history of your patient? Or am I perhaps just a bit overly ambitious?

Monday, July 6, 2009

This Is How You Find Me?

Was going through the blogs stats the other day and I've noticed some of the things people have searched for and found this blog. Some of them I really don't get:

what is a fupa
- I'm actually pretty proud of that one.

i want to see a women get rape and have a baby in the ass
- What?

"jack meoff"
- Ohhhhhh yeah...

midget transvestite porn
- Seriously, this one pops up almost once a day

sticking in a suppository
- Glad I could help someone there

weird jesus sightings
- Maybe I should become a church...

testicle massage u tube
- Huh?

asshole pharmacist
- Man, TAP beats me by two sites...

To all you who were searching for some kind of porn or jesus or testicle information, Welcome! I am glad to have you here at this blog!

Saturday, July 4, 2009

Losing Yet Another Idol

I'm not one to generally get wrapped up in the happenings of celebrities. Thus it did not really phase me when Michael Jackson or Farrah Fawcett died. I paid more attention to Billy May's death simply because I found him entertaining and I had studied him in two different classes this past semester. He really was one helluva guy.

Today is slightly different. See I am a rather huge Tennessee Titans fan. Actually I am probably the only Titans fan in this area because I do not live in Tennessee.

I'll never forget witnessing the Music City Miracle after being jabbed by my friends on how they just lost.

I can still visualize Kevin Dyson come to rest just a yard away from the endzone in Super Bowl XXXIV. At that point in my life I'd never been so devastated by a sporting event.

Naturally when I had ESPN on earlier and they broke programming to announce Steve McNair had been murdered I was more than a little shocked.

This was a guy I idolized, someone whom I thought was literally indestructible. Ironically he is the second person whom I have thought was indestructible who has died tragically.

Just kinda bums me out ya know? During his 2003 MVP season the guy played an entire season without practicing during the week because he hurt so damned bad. He was of the mantra that when you focused on something you block out all other difficulties in order to accomplish that goal. And that is something I greatly appreciate in life.

So yet another life is cut tragically short. Seems to be the theme the past few weeks. I thought deaths were supposed to come in threes?

Rest In Peace Steve McNair. You kicked some major ass while you were with us.

Wednesday, July 1, 2009

Medco, You Can Go Fuck Off

Was minding my business today. Really I was, I was in a chipper mood, bought our clerk a Mtn Dew to perk her up some. Someone asked where a specific section of cards were, I gladly got out of the pharmacy and walked her to them. Ya know, just one of those nice days.

Until about 3pm.

You see I got a refill auth on some pen needles for one of our elderly diabetics. Brought up the previous fill and noted the last fill date (patient was on Day 22 of 25. Remember that). Started processing through his insurance... and then hit a rejection.

No big deal, flip to the screen and low and behold I see this.

Refill too soon.. Next refill date 7.14.09... days left 13... last filled 6/9/09


I'm doing the math again and 25 days after 6/9/09 is 7/4/09 correct?

Puzzled I call Medco to see if this was a glitch on their end. I started talking to a chipper, but obviously dense, young lady.

She starts rattling off that the patient should have another 10 day supplies and yada yada yada. I ask her how she would know how many he should left.

She then goes, well he had it filled five days early two fills ago, two days early one fill ago and three days early today.

I then ask her, in much more polite language, just how the fuck that has to do with anything.

She replied, and wait for it

We only pay on exactly the day it is to be filled, not sooner

Literally I have to fill this on Day 25 of 25.

I ask her what we are supposed to do if the patient misplaces a tablet or two or we happen to not be open that day. The woman says she's sorry, but it cannot be filled any earlier than that day.

And they will not do an override.

AND this applies to ALL classes of prescriptions, not just pen needles.

So Medco has decided that every single one of their insurees must now pick up their meds on exactly the day they are due to be refilled. No filling early by any means for any reason.

How fucking illogical is that? Of all the penny-pinching unethical things to fucking do. I informed my manager who decided we need to go do some ass kicking at Medco.

Just who the fuck do they think they are dictating something like this?

The scary thing is, this policy had been in place for over two months. No one had decided to notify the patients or the pharmacies. I just happened to stumble upon it today by a stroke of luck. And some fucking stroke that was...

Thus Medco, you can go fuck off.

And for all you other pharmacy minions out there, hopefully I have enlightened you with a tidbit of knowledge you weren't familiar with. At least you may not be caught as off guard as I was.

Yet Another Scary Nurse Story

Ya know, the media likes to pick on pharmacies for making one small mistake, over the course of thousands and thousands of scripts, but situations like these go unnoticed.

Little back info for y'all, this patient is 71 years and old and legally blind. She is, however, smart as a whip and has developed a system based on feel in order to take her meds. Each med is in a specific container that she recognizes in order to take the proper medication. She has used this system for twenty years and it has worked flawlessly. The only drawback is she requires her home nurse to put them in the respective containers.

Now gather around the fire kiddies and let's begin our story...

***Ring ring ring*** goes the phone

Myself: "Good afternoon, shittiest pharmacy in the world, how may I help you?"

Dr: "This is Dr. Peeved Off calling from 'Non-profit' Hospital. I have a patient of mine here with her meds and I'm having a little trouble identifying it"

Myself: "Ok, what's it look like"

Dr: "Well first its in her Omeprazole bottle, but I take Omeprazole and I've never seen a capsule look like this before. It's yellow, kinda Docusate like with markings of 25mg and an hourglass"

I dig through our database looking for something that matches it. Obviously it's an oddball one, judging by the docusate-like description, and after 10 minutes I stumble upon it.

Myself: "It looks like it's Cyclosporine 25mg... which is what she gets filled on a regular basis."

Dr: "What?" - Doctor than consults with the patient for a minute, "She mentioned that she had had a little trouble this week opening the unit dose packaging and the nurse said she'd put it in a separate bottle for her. She must have put it in her Omeprazole bottle."

Myself: "Well that's cute."

Dr: "Yes it is, you don't happen to have the name of her nurse do you?"

Myself: "I don't off hand but I can give you the number of the company she works for."

Dr: "Good."

Now this is a big big fuck up in my opinion. This woman had a system that worked well for her and the nurse, being lazy and not thinking, effectively abused her system. Luckily this had only happened three days ago and the directions were the same, but irregardless this should NEVER have happened.

And sometimes you guys wonder why we bitch about nurses. If we did that, we'd lose our fucking license, but she'll most likely get a slap on the wrist.