The Pharmacist Answers Podcast

How to Become a Pharmacist

 in Blog  tagged anatomy / board exam / chemistry / license / math / pharmacist / pharmacy school by

How did you become a pharmacist?  How many years did you have to go to school?  Was it hard?  Do you have to be good at math? I get asked all the time, whether at the pharmacy counter, on Facebook, or just out and about in town.

What does it take to be a Pharmacist?

  1. Decide you want to be a pharmacist.
  2. Go to college and make Pre-Pharmacy your area of focus.
  3. Take lots of chemistry, biology, anatomy, and physics. Take a little history, literature, and speech communications, and probably some PE…
  4. Research and apply to Pharmacy Schools.
  5. Take the PCAT (only after taking Organic Chemistry).
  6. Get invited for an interview.  Dress nice, comb your hair, practice good eye contact, and not saying “um, like” so much.
  7. Get accepted! *You don’t have to graduate with a degree before starting Pharmacy School*
  8. Start Pharmacy school. Move across town or across the country, if necessary.
  9. Study your brains out.
  10. Gain experience in different pharmacy settings through practical rotations and getting a job in a pharmacy.
  11. Pass all your classes (even if just barely).
  12. Graduate and get called Doctor.
  13. Study your brains out some more.
  14. Take a 3-hour test called the NAPLEX (North American Pharmacy Licensure Examination).
  15. Take a slightly shorter test called the MPJE (Multistate Pharmacy Jurisprudence Exam) – aka Pharmacy Law.
  16. Pass your board exams and become a licensed Pharmacist.
  17. Start work.  *Somewhere between your last year of school and passing your exams you should have applied for and accepted a job*

This is not the only path to becoming a pharmacist.  It is just one option, the straightest option.  You can take many other paths to become a pharmacist, and any path you choose is going to give you personalized experiences and a unique story.

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Feed You Bones [Show Notes]

 in Podcasts  tagged bones / calcium / diet / food / osteoporosis / recommendations / supplements / vitamin D by

Basics

Calcium is a natural element (yep, one of those periodic table guys).  Our teeth and our bones are made strong by it.

For most healthy adults, daily recommended amount is 1000 mg.  For females approaching 50 years old, recommendation increases to 1200 mg to 15oo mg per day.

The trick to supplementation is knowing that your body can only absorb 500 mg of elemental calcium at a time.  So you gotta split it up.  When you get it from your diet, then this is NBD because it will naturally be spread out between your meals and snacks.

These supplements always go with Vitamin D.  Vitamin D is responsible for helping with calcium absorption.  If you’re low on D (and more people are than might realize b/c very few jobs have you working out in the sun – and Vitamin D is synthesized and activated by UV exposure), calcium can’t be absorbed and used like it should.

2 types of OTC supplements

  1. Calcium carbonate (Caltrate) – a base (also what makes up OTC antacid tablets [i.e. Tums] so a bonus if you have heartburn); requires the acid in your stomach to break out of the tablet for your body to use.
  2. Calcium citrate (Citracal) – an acid; doesn’t require extra stomach acid to be absorbed. A good supplement for those who had gastric bypass, because the stomach has been shrunk and there are less acid pumps to break down medications that require acid to work.  Bad for people with reflux or ulcers.

The labels can be tricky.  It will say “600 mg Calcium Carbonate”, but you have to look for the hint of how much elemental calcium that is equal to.  This is because your recommended daily dose is in milligrams of elemental calcium.  So, doctors don’t always tell you that when they recommend it.  Your calcium-rich foods are going to provide you with 250-300 mg of elemental calcium per serving (about 25% of your daily requirement).

Random dietary sources (between 6-20% of your daily requirement)

  1. White Beans
  2. Black-eyed Peas
  3. Sardines (cuz you eat their bones?!)
  4. Dried Figs
  5. Bok Choy
  6. Molasses
  7. Kale
  8. Turnip Greens
  9. Almonds
  10. Oranges
  11. Sesame Seeds

Calcium-fortified foods

  1. Instant Oatmeal
  2. Mainstream orange juices
  3. Soy products (because you’re using them instead of dairy and animal products)
  4. Cheerios

Vitamin D helps your stomach absorb the calcium into the blood.  And then in the blood, keeps the calcium from binding with other things, so it’s free when the body needs it in other places.

Unfortunately, pounding supplements is not going to reverse osteoporosis.

Recommended dose for kids

  • 1 to 3 years old — 700 milligrams daily
  • 4 to 8 years old — 1,000 milligrams daily
  • 9 to 18 years old — 1,300 milligrams daily

Usually not hard for kids to get the right amount with their diet plus a vitamin.  Babies don’t need supplementation since their main source of nutrition is milk (breast milk or formula).

Seasonal Affective Disorder – is partly due to a Vit D deficiency, because Vit D also helps with mood.  The sun exposure is the best way to supply your body with Vit D.  A bonus is that sunlight stimulates serotonin production in your brain which is also responsible for good mood.

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Medication Disposal [Show Notes]

 in Podcasts  tagged EPA / FDA / medication disposal / National Prescription Drug Take-Back Day / needles / privacy protection / sharps by

The Regulation

The FDA and EPA agree that certain medications are okay to flush.  The comparison being, the medication, though diluted, are still being present in tap water after filtration and purification, or a kid or petor junkie eating it out of your trash and getting really hurt or dying.

This is usually the advice for extended release pain medications (tablets, liquids, or patches), narcotics, and other controlled substances.

Homemade Disposal

The goal of disposing medications at home is to make it unappetizing to anyone who may find it and try to eat it.

Ingredients:  Unwanted medications, Water,  Sand, Cat litter, or coffee grounds

Crush the tablets or capsules in a ziplock bag.  Add water to dissolve.  Add sand/cat litter/coffee grounds to absorb water.  Throw in trash.

Available for purchase

If you don’t want to DIY at home, Medaway bags are available at a pharmacy.  They have an activated charcoal compound in it.  Add pills, add warm water, and shake.  Adsorption = when one compound adheres to another compound and they can’t be separated.

Privacy Recommendations

It is advised to throw away the medications separate from the prescription bottle.  Best option is to remove labels and shred with other personal information.  At the very least, black out all of your personal information and the drug information before putting in the trash.  Even if your bottle is empty, if someone finds a bottle that previously held pain pills, that person may think you have more and it puts you at higher risk for crime.

Syringes

For syringe disposal, you can buy Sharps containers at a pharmacy.  All the instructions for using, and packing and shipping, including a prepaid return label, are included in the box.  If you don’t use an official Sharps container, it’s best to use an opaque jug or carton that 1) you can’t see through to see the needles easily, and 2) that has a small opening so it’s difficult for the needles to come back out (either by someone reaching in for them or by spillage).  Once it’s full, just seal it and put it in the trash (do not try to recycle that jug!).

National Prescription Drug Take-Back Day – local law enforcement agencies are set up to take back unused or unwanted medications from the public and will dispose of them properly.  Only certain locations will take controlled substances (check the website for your zip).

Holla

“Stoned raccoons aren’t funny!” – @kendh

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Measuring [Show Notes]

 in Podcasts  tagged errors / liquid medications / measuring / milliliters / tablespoon / teaspoon by

Measuring Liquids

Medication for kids are usually in liquid form and require some kind of device to accurately measure the dose.

1 teaspoon = 5 ml

1 tablespoon = 3 teaspoons = 15 ml

1 fl oz = 30 ml

Milliliters = ml = cc = cubic centimeters –> all the same

Kitchen spoons and cooking teaspoons are not accurately calibrated to measure medication.

My Home Experiment

100 mg/5 ml = 20 mg/ml

Incorrect spoon #1:  4 ml < 5 ml (80 mg < 100 mg)

Incorrect spoon #2: 3.5 ml < 5 ml (75 mg < 100 mg)

Incorrect spoon #3: 6 ml > 5 ml (120 mg > 100 mg)

The cups that come with liquid OTC medications are calibrated accurately to measure medication.

Restaurant spoons are HUGE sometimes.

The Results

Maximum error when testing kitchen spoons is a 40% error (meaning it could be 40% below or 40% above the standard of 5 ml in a teaspoon).  For a 500 mg/5 ml medication – a 40% error is equal to 200 mg too much or 200 mg too few.  That could mean the difference in not being treated adequately and leading to complications (i.e. infection resistance) or being over-treated and experiencing side effects.

It’s a different story if you’re taking an adult dose (i.e tablet, capsule – which is already pre-measured) and putting it into something more palatable.

History of pharmacy: the only way pharmacists got medicine to people was by mixing it up and making the pills themselves.  The process of taking bulk ingredients and making specialized forms of medications is called compounding.

Brand to generic conversion: generics are only allowed to have a 5% variation from the brand name, and some companies are even more strict on themselves and follow a 3% error standard.

3% << 40%!!

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Medication Intolerances 3 [Show Notes]

 in Podcasts  tagged ADD / ADHD / allergies / blood pressure / headache / intolerance / medication by

Tidbits about Headaches

A headache is an ambiguous side effect because there are so many different things that can cause headaches.  Hormones are a big culprit of this.  Blood pressure medications can too.

For someone with chronic high blood pressure, the higher pressure becomes the body’s new “normal”.  Once medication starts to bring it down, even though the pressures are within a normal range, the body will experience symptoms of low blood pressure.

2 lies people tell about allergies

  1. No allergies – so then they take something they are allergic to and have an emergency
  2. Allergic to “everything” – because they experienced mild or moderate side effects.  Or in the case of pain pill seekers, they’re “allergic” to the weak pain meds to get the doctor to prescribe stronger ones.

Stimulants

Irritability, nervousness, jitteriness, or moodiness can be a side effect of amphetamines (used for ADD) or cold medicines (i.e. pseudoephedrine).

A factoid about ADD/ADHD:  the focus and attention area of the brain are underactive, so a stimulant helps it be more active so improve focus.

The biggest complaint people have from any stimulant is the inability to sleep at night.  Just need to make sure it’s taken early enough in the day so it wears off in time for bed.

Bones and Joints

In this case, we rarely want you to keep taking the medication if these side effects happen.  For example, cholesterol medications (i.e. statins, and fibrates) and quinolone antibiotics (Levaquin, Cipro, Avelox).  The quinolones have a rare but serious side effect of tendon rupture; it is painful and permanent.

Tendons: the connective tissue that anchors muscles to the bones.

Osteoporosis medications can lead to bone pain – since their job is to cause changes in the way the bones are built and rebuilt, it’s not uncommon to feel something.  But usually temporary.

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Medication Intolerances 2 [Show Notes]

 in Podcasts  tagged allergies / dryness / flushing / intolerance / itching / medications / rash / skin by

3 drug intolerances that involve the skin

  1. Itching and rash – even though they are a big sign of allergies, they also can be typical side effects of medications
    • Narcotics – in hospitals, they give diphenhydramine (Benadryl) to calm an itching side effect
    • Sulfa antibiotics and tetracyclines – sun hypersensitivity.  Not a sunburn, though.  May require pain reliever to get comfortable.
  2. Flushing – redness and hotness of the skin
    • Niacin – used for cholesterol reduction.  Flushing is reduced by taking 81 mg of aspirin 30 minutes before taking niacin
    • Hormones – natural or in medication (birth control or hormone replacement).  Can be reduced or eased by taking before bed or taking with food
    • IV contrast – as the medication spreads through the body.
  3. Dryness – especially of skin surfaces that require moisture (i.e. mucous membranes)
    • Antihistamines and cold medications – dry eyes, dry nose
    • Overactive bladder medications – dry eyes, dry mouth, constipation
    • IBS meds that control diarrhea – constipation

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Medication Intolerances 1 [Show Notes]

 in Podcasts  tagged allergy / diarrhea / intolerance / nausea / side effects by

Allergy vs Intolerance

Medication allergies, especially the dangerous, life-threatening kind, affect your entire body, multiple organ systems, and put you at serious risk of death.  They also require immediate medical attention.

Symptoms include:

  • Serious swelling
  • Not being able to breathe or swallow
  • Significant speeding or slowing of your heart rate or breathing
  • Blood leaking out of blood vessels into other regions of your body

Intolerances are usually related to regular side effects of the medications, but are so bad that you can’t tolerate it.  At no time should you be asked to keep taking something that makes you feel worse than death.  And in most cases, avoid it at all costs.  Other times, the discomfort can be short-lived or fixed by altering how the medication is used.

My main point is: intolerances to medication side effects are not true allergies (even though a lot of people will group them together when giving a medical history to a doctor or pharmacy).

Nausea

Nausea is a side effect of almost everything that you swallow.  It’s too vague and nondescript to be an allergy.  It is usually due to the increase in acid production by the stomach when it is trying to break down and dissolve the medication.

Nausea can be caused by:

  • Pain medications (narcotics)
  • Antibiotics
  • Any large, powdery elephant-sized tablet
  • Multivitamins

Nausea is a potential side effect of almost everything that you swallow.  It’s too vague and nondescript to be an allergy.  It is usually due to the increase in acid production by the stomach when it is trying to break down and dissolve the medication.

The main way to avoid nausea is to take the medication with food – and in some cases, a decent amount of food.

Some widespread advice is to take medications with milk because milk is a base to counteract the stomach acid.  Unfortunately, the calcium in milk and cause certain antibiotics to not work.  Also, some medications require acid to be activated, so making the stomach less acidic, reduces their effectiveness.

A Positive Side of Nausea?

Certain injectable medications for Type 2 Diabetes have a main side effect of nausea or indigestion.  With these medications, the patients are encouraged to keep taking them.  The logic behind this is that in most cases, someone with Type 2 Diabetes will be overweight.  And they may have been resistant to the lifestyle changes (i.e. diet and exercise) that would help improve their weight, thus also improving the diabetes outcomes.  So, if they take a medication that causes nausea thus reducing their appetite, it helps them limit their food intake, and the final results will most likely be weight loss.  This is really what the manufacturers think!

Diarrhea

Diarrhea can be caused by:

  • Antibiotics: They kill the bad bacteria that are making you sick, but also your good bacteria.
    • Take probiotics or eat live culture yogurt (the more diverse the better)
  • Certain cholesterol medications: Particularly, the ones that help trap up the fat in your intestines so it’s not absorbed and add it to your waste that is about to exit.  Fat is an oil.  Oil is slippery.  Poo that is slippery…you get the idea.
    • The less fat you eat, the less slippery things will be.
  • Metformin: It causes diarrhea in the beginning while the body is adjusting to it.  Diarrhea lasting a month sounds like forever, but is really not compared to the amount of time (aka the rest of your life) that someone may have to take this medication for Type 2 Diabetes.
    • The best way to control this is to start this medication low and slow.

The best way to counteract long-term diarrhea issues from medications is to use bulking fiber.  They help absorb extra water and add solid substance to stool so it’s firmer.

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Sleep Aids [Show Notes]

 in Podcasts / Sleep  tagged cycle / daylight / melatonin / SAD / serotonin / Sleep / Sleep aids by

Who needs help falling asleep?  *raises hand*

WARNING: Do not mix any sleep aids with alcohol – compounded drowsiness, depressed breathing or depressed heart rate

Sleep Aids

  1.  Melatonin – the chemical your brain makes when it’s dark.  Electronic light can interfere with your natural production of melatonin after the sun goes down.
  2. Valerian Root – claims to promote calming and relaxation
  3. 1st Generation Antihistamines – Diphenhydramine (Benadryl) or Doxylamine (Unisom; also in NyQuil).  They have natural drowsy side effect, so using for the purpose of that side effect is a common practice.
  4. Rozerem – stimulates melatonin production in your brain
  5. Hypnotics – Ambien (zolpidem), Lunesta (eszopiclone). They seduce your brain to sleep in an unnatural way, thus they have high risk side effects (vivid dreams, sleep driving/walking/eating) and a high risk of dependence.  The side effects are due to the fact that the medications may get you to a deeper level of sleep before the rest of your body is prepared.  Your body has a natural paralysis process to ensure you don’t act out dreams in the REM cycle, but if your brain reaches REM before your body is paralyzed, you may do crazy things!
  6. Benzodiazepines – generic names end in -lam or -pam.  Also have a risk of dependence and side effects (mainly “hangover” effect).
  7. Tricyclic Antidepressants – a symptom of depression is sleeping too much, but insomnia can be a symptom of depression.  Also, insomnia can make you feel depressed – it’s a vicious cycle.  In small doses, they work to help rebalance the brain chemicals and reset the sleep-wake cycle.

Where to Start

Use as natural a solution as possible that is effective.  Physiological and neurological issues can lead to chronic insomnia that is not corrected by the most natural solutions, thus pharmaceuticals are needed – and that’s nothing to be ashamed of!

Sunlight stimulates your eyes and tells your brain to make serotonin.  When the light is gone, and that stimulation stops, serotonin stops and melatonin replaces it.  This is how we functioned and planned our days back in the “old days”.

Summertime brings on long days and lots of sunlight.  Thus we may not sleep as long because the long daylight hours keep us awake.  But this can also be the issue in the winter and for people who experience SAD (Seasonal Affective Disorder) – the shorter daylight doesn’t allow sufficient serotonin to be produced and we actually feel sad.

Analyzing your sleep patterns and knowing your options will allow you to have a productive conversation with your doctor – different medications are used depending on if you have trouble falling asleep or waking up halfway through sleep or both.

Audience Question

*Melatonin in nursing:  your natural melatonin gets in breast milk and is thought to help baby’s sleep cycle (especially early on when baby’s sleep-wake cycle may be backwards because that’s how they rolled in the womb).  Thus, if your natural melatonin gets into breast milk, then supplemented melatonin will get there too.  The rationale is that if you’re not sleeping (despite the exhaustion of having a new baby), then you may not be making enough natural melatonin.  If you’re going to take melatonin while breastfeeding, LOW dose is key to ensure the excess isn’t deposited in the breast milk to pass on to baby – 3 mg seems to be the highest recommended, and I agree.  PLEASE do your own research and discuss it with a medical professional you trust rather than just taking my word for it!*

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Sleep Hygiene

 in Podcasts / Sleep  tagged bed / emotions / environment / food / habits / hygiene / mindset / risk / Sleep by

A Definition

Sleep Hygiene: how conducive your night time and bedtime habits are for restful sleep on a regular basis

Your body performs important processes while you sleep.

Risk of disease is increased when you don’t get enough sleep.  Heart disease, diabetes, and stroke, just to name a few.

4 Areas of Sleep Hygiene

  1. Environment
    • dark (all of our light-emitting toys are bad for our sleep) – your body makes serotonin stimulated by light, and then melatonin when the light is gone.
    • temperature – your body sleeps well when it’s cool, kind of like hibernation. Gotta get past REM sleep because REM sleep is not restful sleep
  2. Habits
    • no naps – recovery processes can be inefficient
    • exercise (vigorous exercise during the day; slow & calming exercise late at night)
    • getting adequate natural light – so your brain isn’t confused about which chemical it needs to make
    • consistent routine – your brain likes predictable patterns
  3. Consumption
    • stimulants – caffeine, nicotine
    • alcohol – initially makes you sleepy, but can disrupt sleep when the liver finishes processing it into sugar
    • large meals – can cause indigestion which can disrupt sleep
    • drastic dietary changes – fluctuating amounts of sugar in the blood stream or digestive discomfort
  4. Mindset
    • bed is for sleep – not a place for work or studying or eating
    • avoid emotional stress – positive (i.e. excitement) or negative (i.e. anger)

Tidbits

CPAP machine – helps in sleep apnea, which is wear the body doesn’t get enough oxygen during sleep.  Oxygen is needed for all sorts of processes.  If the body can’t get the oxygen, then it probably isn’t using the nutrients and energy sources available, and it can lead to feeling awful, even after a night of sleep.

Nothing good comes from a lack of sleep.

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Thrive with sleep [Show Notes]

 in Podcasts / Sleep  tagged disease / emotions / health / productivity / risk / Sleep / stress / wellness by

3 Areas Thrive When You Sleep

1. Productivity 

  • Memory
  • Attention span
  • Creativity

2. Health

  • Decreased risk for cardiac disease
  • Inflammatory chemicals are cleansed out
  • Weight management – certain metabolism processes only happen while you’re sleeping
  • Tissues heal and rebuild
  • Reaction time improves

3. Emotions

  • Stress hormones are removed from your system
  • Gives your serotonin production a break, so you get a fresh supply in the morning (Serotonin is your happy chemical)

The Bottom Line

The cells in your brain (neurons) run on electricity (aka the flow of positive and negative charges).  Sleep allows the electricity to reset, so it’s really to flow quickly and efficiently the next morning.  You live longer when you get enough sleep.

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