Tuesday, June 27, 2017

Natural Does Not Equal Safe

What is the number one reason some people choose a natural health product (NHP) over a pharmaceutical one? Safety!

It’s a common misconception that a natural product is safer than a “chemical/synthetic” one. There are several natural substances that are toxic and even deadly, like arsenic, lead and venom, just to name a few. Many people fall into this trap and end up choosing a product that is less effective for one they think is safer but it may not be as safe as they think.
 Recently an article was published in the Canadian Medical Association Journal criticizing Health Canada for its leniency when it comes to approving natural health products. The editor of the journal, Dr. Matthew Stanbrook, was quoted as saying "They simply have to show that someone, somewhere once used this as therapy for something". He went on to claim that manufacturers of NHPs have to stop advertizing  that their products are remedies because they have very little evidence for their actual efficacy.  Furthermore, the director of general of natural and nonprescription health products for Health Canada stated that “Health Canada has the power to recall a bag of chips, but does not have the power to recall an unsafe natural health product”.

There is clearly a big safety and efficacy gap that needs to be filled at Health Canada regarding NHPs. I used to think that even though NHP efficacy was questionable their safety was not, but now I’m not so sure.  Thankfully, Health Canada is currently reviewing the regulations that govern the sale of self-care products, which includes NHPs. All products, whether they are termed “natural” or pharmaceutical should follow the same strict and rigorous testing to ensure our safety.  Just because something is chemical doesn’t mean it isn’t natural and just because something is natural doesn’t mean it’s safe.


Chemistry begins in the stars. The stars are the source of the chemical elements, which are the building blocks of matter and the core of our subject.”
Peter Atkins

Tuesday, June 20, 2017

Want a Glowing Tan? Head to the Lab!

Everyone wants to look tanned for the summer but we’re all afraid of harmful UV rays. Skin cancer is one of the most prevalent cancers in North America so we do our best to prevent it by lathering on the sunscreen and staying out of the sun but this leaves us pale and pasty during shorts and T-shirt season! What are we to do?? Yes, there are spray tans and moisturizers that gradually tan your skin but most of these products make your skin look more orange than a nice bronze color and they can stain your sheets and clothes.

What if you could have a bronze glow without the damaging effects of UV rays or dyeing your skin? Well thanks to Dr. David E. Fisher and his team of scientists, you may be able to in the near future! They found that inhibiting enzymes called SIKs (salt-inducible kinases) activated the pigmentation pathway in the same way as UV radiation would but without the DNA-damaging effects. They went on to develop a superior version of this inhibitor so that it can be better absorbed by human skin. It takes 1-2 days for the skin to “tan” and it lasts a few days.

In the future, the team will be conducting toxicity studies, and then they hope to move onto clinical trials. Ultimately, they strive to develop a compound that can be added to sunscreenJ
and be used regularly; tanning and skin protection all in one! If it turns out to be safe I’m definitely going to try it


-        Mena

References:

Friday, June 16, 2017

RxBriefCase: the Pharmacy Student’s Perfect Study Buddy

Happy Friday everyone!

I’ve almost completed my first week at mdBriefCase and it’s been great! Looking forward to the next 4 weeks! J

A couple of days ago I was chatting with some of my friends about their pharmacy placements and all of them said the same thing, “I need to go over my notes because I forgot a bunch of stuff that we learned in class”. For example, a customer asked one of my friends about allergy medications and which one she should take but since we covered that topic almost 2 years ago it’s kind of hard to remember. But luckily for us there’s rxBriefCase! All we have to do is log on and click on the topic we need a refresher on and voila! We are saved from the embarrassment of not being able to answer a question and our patients are the better for it. 

Unfortunately there is one issue…. Most of my pharmacy class doesn’t know about rxBriefCase! Before I started my APPE rotation here I didn’t know about it either. Having this resource would have helped a lot for our medication management classes as well as our pharmacy summer placements. But now I’m spreading the word! I posted a link to rxBriefCase to my pharmacy classes’ facebook page so that we can all take advantage of this knowledge source.

rxBriefCase is a valuable resource to have; it’ll help us get through our APPE rotations and continue being a great resource throughout our careers. Register now and gain access to a wealth of clinical knowledge for free! You also get continuing education credits for each program you complete.

“The goal of education is the advancement of knowledge and the dissemination of truth” - John F. Kennedy

Take care everyone!


Mena

Monday, June 12, 2017

10 Things About Me

Hi There!

My name is Mena, I’m a fourth year pharmacy student from the University of Toronto and mdBriefCase is my second APPE placement. I’m so excited to get started and try something new! J

Since I’m new I thought I would introduce myself with 10 random facts about me:
  1. For most of my life I wanted to be an astronaut. Unfortunately, at the age of 21 I went to an amusement park for the first time and realized I had bad motion sickness …. So I realized the astronaut thing wasn’t going to happen!
  2. I speak 3 languages; English, French and Arabic
  3. Shopping is both my happiness and downfall
  4. Sci-Fi and fantasy are my favorite genres of movies/shows/books
  5. I got married last summer! 
  6. I used to be a Sagittarius but recently I found out that I’m actually an Ophiuchus, which is the 13th astrological sign that most people don’t know about. If you were born between November 29th and December 17th then you are actually not a Sagittarius but an Ophiuchus… weird!
  7. I love learning about molecular pathways especially when related to the mechanism of action of medications
  8. I believe the Universe is infinite
  9. Red wine is my favorite drink (preferably from California)
  10. I love to cook but I love to eat even more!

Until next time!


-        Mena

Thursday, May 4, 2017

And that’s a wrap!


I’ll start off with a very generic line of “it seems like it was only yesterday that I started my rotation..” But in all honestly, it truly feels as if 5 weeks flew by in a blink of an eye.

With just 2 days left into finishing my final rotation, I wanted to express my biggest gratitude for the amazing team at mdBriefCase. It’s been a pleasure working with everyone in developing the contents for the eNewsletter, MSFY and my final presentation. Special thanks to Cassandra and Mike!

I came into this rotation with minimal understanding of what continuing education is and what role it plays for a practicing healthcare professional. However, the past 5 weeks has taught me not only what CME is but also the process of how a CME program is developed and accredited. It’s been an eye-opening experience to be able to learn all the various aspects of continuing education.
As mentioned in my previous blog post, the main initiatives I took part on at mdBriefCase included the following:
  • eNewsletter “Resistant Head Lice: A Real Head Scratcher”
  • MSFY “Heartburn: A Burning Sensation”

Although these contents are not yet live, be sure to be on the lookout in the next couple weeks rxPASSPORT and MedSchool For You: Pharmacy Corner!

Thank you again for the amazing opportunity. J


Boo

Friday, April 28, 2017

Hidden Dangers of Drug-Food Interaction

Whether you’re picking up a new antibiotic from the pharmacy or renewing your cholesterol medication, you often get counseled by the pharmacist regarding certain drug-food interactions. Many people are aware that these interactions exist – but just how real and serious is this issue?
The main mechanism behind drug-food interaction is dependent on how the body breaks down the medication. Enzymes known as the cytochrome P450 enzymes allow the body to metabolize and gradually degrade the medications after administration. Certain foods are able to inhibit or potentiate the action of these enzymes. This in turn can lead to too much drug in the body (i.e. increased side effect or toxicity) or too little drug in the body (sub-therapeutic effect). Other interactions between medications and certain foods can take place by hindering with the absorption of the medication or by amplifying the existing side effects of the medication.
Many different food groups interact with medications. While I am unable to give a comprehensive list of all the interactions, I’ll mention few that are worthwhile to know about.
  1. Grapefruit juice: Grapefruit juice is one of the most notorious offenders for causing drug-food interactions. Grapefruit juice inhibits a major subtype of P450 enzyme that metabolizes cholesterol medications such as atorvastatin, lovastatin, and simvastatin. Blood pressure medication such as amlodipine is also affected by this interaction. By inhibiting the enzyme, grapefruit juice allows the medication to stay in the body for a longer duration and increases the possibility of experiencing side effects. Drugs that interact with grapefruit juice should not be taken together within the same 24 hour period since the inhibition of P450 enzyme by grapefruit juice leaves a long-lasting effect.
  2. Alcohol: The interaction between alcohol and medications doesn’t necessarily involve the CYP P450 enzymes but mostly on the effect of the medication. For instance, any medications that can cause drowsiness or sedation can be worsened if taken alongside alcohol. These medications include antihistamines, muscle relaxants and even some painkillers. Although this interaction may not diminish the efficacy of the medications, it is best to separate t
    heir administration to avoid serious side effects.
  3. Dairy products: This category extends beyond just dairy products but also encompasses calcium or iron supplements. The major concern regarding dairy products is with thyroid medication (i.e. levothyroxine) and certain antibiotics known as the fluoroquinolones. Dairy products and mineral supplements hinder the absorption of these medications and lower their efficacy. These medications should be spaced out by minimum 1 hour before or 2 hours after dairy products are consumed. 

If you’re unsure about your medications and whether it interacts with certain groups, check out a great online resource from FDA and be sure to ask your pharmacist on your next visit!


Boo

Friday, April 21, 2017

Half way done!

Three weeks went by in a blink of an eye. After receiving few ‘urgent’ reminders from my faculty to complete the midpoint evaluations, I thought this would be the perfect time to recap everyone about what I’ve been up to so far.

Overall, my tasks during the 5 week rotation at mdBriefCase can be broken down to 2 main categories: 

  1. Critical appraisal of one of the CCCEP-accredited eCME program on http://www.rxbriefcase.com
  2. Content development for practicing pharmacists and patients.

For my critical appraisal, I chose the eCME on Considerations in the Selection of Pharmacotherapy for ADHD. I am in the midst of analyzing the various aspects of the program as well as the national participation report to find key strengths and weaknesses. I’ll be presenting on my findings towards the end of my rotation.

In terms of content development, I’ve been knee-deep in writing an eNewsletter, which will be sent out nation-wide to practicing pharmacists across Canada. Although my draft is not yet finished and available for viewing, past eNewsletters can be found at rxPassport. I’m also working on a mini Q&A on the patient education portal, MedSchool For You: Pharmacy Corner.

Last but not least, I’ve been given the lovely opportunity to complete the Certificate-level training of my choice on Advancing Practice. I chose to go over the diabetes education program since this will be a handy-dandy review before I start practicing as a pharmacist.

No complaints so far! Looking forward to spending 2 more exciting weeks at mdBriefCase!

- Boo


Thursday, April 13, 2017

Is my EpiPen safe to use?

On April 1st, 2017, Pfizer Canada issued a voluntary recall of one lot of both EpiPen auto-injector and EpiPen Jr. auto-injector.  The recall decision was made after two confirmed international reports of the devices failing to activate. The company stated that more than 100,000 products which may be affected by this recall were distributed across Canada.

EpiPen auto-injectors are indicated for emergency treatment of severe allergic reactions (anaphylaxis) for patients with high risk. After the administration of EpiPen, patients are advised to seek immediate medical attention or proceed to the nearest ER.

This event was of particular significance since Epipen has been the lone defender against anaphylactic reactions with the nation-wide recall of Allerject back in 2015. Although the incidence of the defect is extremely rare, it may pose a serious impact on patients who rely heavily on the efficacy of EpiPen.  

Image result for epi penDespite the recall, Pfizer recommends patients to keep the existing product until they can secure the replacement EpiPen. Product Replacement Instructions can be found here.

Before using your Epipen, follow these 3 simple steps to ensure safe/effective EpiPen use:
  1. Always check the expiration date (generally 1-2 years from time of purchase)!
  2. Examine the window of the EpiPen to make sure the solution is clear and free of any discoloration.
  3. Remember the instructions:  “blue to the sky, orange to the thigh”

References:

CBC news. “Canadian Patients wait longest to see family doctor.”  January 20, 2014.
Retrieved from http://www.cbc.ca/news/health/us-epipen-recall-1.4051059 on April 13, 2017.
Epipen. “Frequently asked questions.” 2015. Retrieved from http://www.epipen.ca/en/about-epipen/frequently-asked-questions on April 13, 2017.
Government of Canada. “Pfizer Canada recalls two lots of EpiPen/EpiPen Jr auto-injectors (0.3mg and 0.15mg epinephrine) due to possible device failure.” April 01, 2017. Retrieved from http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2017/62872a-eng.php on April 13, 2017.
Pfizer. “How do I exchange my recalled EpiPen auto-injector?” April 01, 2017. Retrieved from http://www.pfizer.ca/node/7656 on April 13, 2017.

Tuesday, April 4, 2017

Hello...it's me

Greetings from the newest addition to the mdBriefcase team. 

My name is Hyeyoon and I’m a fourth year pharmacy student currently here on APPE placement for the next 5 weeks. I wanted to introduce myself to the team and to the blog as I will be contributing new posts from time to time in the upcoming weeks.

I'm extremely excited for my time here at mdBriefcase as it's my very last block before graduating and moving out into the real ‘adult’ world. This is a special time for me as not only am I finally graduating after years and years of school but it's also the transitional time prior to obtaining my license. I'm currently preparing for my licensing exam which takes place in a month’s time.
Some interesting facts about me:
  • I have 50 succulents and cactii all growing in my home.
  • I am an avid lover of coffee and an even bigger addict for sleep/hibernation.
  • My last name is BOO!
  • I’m currently in the midst of growing my very own mushroom farm (in a box).
The majority of my previous experiences are from community pharmacy environments (Shopper's Drug Mart, Loblaw Pharmacy; You name it -- I’ve been there).  Practicing in community pharmacies holds a special place in my heart as I love interacting with patients on a daily basis.


I'll be sharing my insights about the practice and interesting topics in pharmacy very soon. Stay tuned for new updates!

Friday, March 31, 2017

Farewell!

It’s my last day here at mdBriefCase already. During my 5 weeks, I’ve worked on various projects that helped me develop my writing and presentation skills.

I wanted to share my experience about these projects to provide some insight and suggestions for future students.

Project
My responsibilities
Suggestions for future students
eCME critical appraisal
·         Critically appraise “Pharmacists Improving Treatment Adherence & Patient Outcomes in AD”
·         Present and discuss finding to team members through 20 minute PowerPoint presentation
·         Be critical. Don’t be afraid to point out things you dislike
·         Become an expert on the topic yourself

eNewsletter
·         Write an eNewsletter that would be distributed to many pharmacists across Canada
·         See “4 Simple Steps to Deprescribe Benzodiazepines
·         This is not an essay!
·         Tell a story that pharmacists can relate to in order to make an impact
MedSchoolForYou Q&A
·         Develop answers to frequently asked questions on a medical topic of choice
·         Customize information to patients
·         See “When Every Breath Counts – Asthma in Children

·         Keep the language simple
·         Think about what the patients are interested in (Probably not pharmacokinetics of drugs)

Blogs
·         Contribute to the pharmacy student blog
·         Write about my experiences and insights on pharmacy practice and healthcare
·         Be creative, funny, quirky
·         Share YOUR thoughts


Although my rotation with rxBriefcase has come to an end, I know that rxBriefcase will continue to be a valuable asset through my journey of life-long learning. 

I would like to thank everyone at mdBriefcase for all the opportunities I’ve been given. The writing support and freedom of expression I received here was phenomenal. I’m sure future students would thoroughly enjoy this rotation as much as I did.

Kevin


Wednesday, March 22, 2017

“Excuse me, where is the orange juice?”


Last summer, I had the opportunity to work in a supermarket-pharmacy. Originally, I was concerned that there might be a “Supermarket-first-Pharmacy-second” mindset that would undervalue a pharmacist’s role. I thought that a dedicated pharmacy would be a more appropriate environment to practice in. However, I quickly learned that supermarket-pharmacies can be a mutually beneficial business model that allows pharmacists more opportunities to promote health and wellness.



One advantage of supermarket pharmacies is the increased foot traffic. The average adult may go grocery shopping 1-2 times a week whereas visits to a pharmacy are likely less frequent. Thus, supermarket pharmacies allow pharmacists to interact with their patients more frequently. This would facilitate easier follow-ups and long term relationship with patients.

Supermarket-pharmacies are also unique positioned for collaboration. Some supermarkets employ registered dieticians to help consumers make healthy food choices. Consequently, pharmacists who identify patients with dietary restrictions (ie: Diabetes, hypertension) may benefit from referrals to on-site dieticians. This partnership between pharmacists and dieticians can greatly improve patient outcome.

Patients are also tolerate wait times more because they can do grocery shopping while their medication is prepared. 

The only disadvantage is that there may be some role confusion. If you wander around the supermarket with a name tag, consumers may ask you where certain food items are!
Overall, supermarket pharmacies can be an interesting environment to work in. By embracing the setting, pharmacists can actually improve the pharmaceutical services they provide to the public.

Kevin

Friday, March 10, 2017

Thx Doc! TTYL!


Maple, Canada’s first 24/7 online service that allows virtual doctor’s visit, was launched in Ontario January 2017. Maple is a service that permits online consultation with registered Canadian doctors via instant messaging or video chat. This is not an entirely novel service. Akira, which also operates in Ontario, utilizes a similar model (though not 24/7). This type of service is coined “Telemedicine.” It intends to use telecommunication to provide care to patients from a distance. In countries such as U.K. and United States, massive adoption of these services has already taken place.


An encounter with Maple doctors consists of the following: describing your symptoms, talking with a doctor via instant messaging or video chat, and a wrap up. Doctors are able to write prescriptions (except for narcotics and control substances), write sick notes, and diagnose.

Maple certainly addresses some significant downfalls with our current healthcare system. A report noted “Only 31-46% of Canadians could get an appointment the same day or the next day, not including emergency department visits.” Maple claims that patients would be able to see physicians online “within minutes.” In terms of convenience, Maple may be appealing due to being accessible from anywhere:  home, vacation, or office. The advantages mentioned may be further magnified for patients living in rural/remote areas as there is a deficit of doctors areas available in these areas.

There are also several elements that prevent Maple from being widely used. Due to the nature of the interactions, a physical examination would not be possible. This can be concerning because accurate diagnosis of many medical conditions may rely on physical examinations. However, Maple has cited that up to 70% of non-emergency issues can be resolved without ever needing a hands-on physical exam. Another disadvantage is that patients are unable to pick their own doctors using Maple. This makes it difficult to establish long term relationships and to follow up on any issues. In addition, the services have to be paid for because OHIP does not currently cover these services. Lastly, there are limitations to the physician’s scope of practice. They are unable to prescribe narcotics and controlled substances, authorize a specialist referral or order lab tests, and finally consultations are not intended for emergency situations.

Maple and telemedicine are unique services. Given the technology driven age we live in, it would be exciting to see if this service will grow. Currently, the lack of public coverage significantly limits its use. Despite this, there are select groups of patients with limited access to doctors that could benefit greatly from this service.

It would be interesting to hear from patients who have firsthand experience with these types of services.

Kevin

References

CBC news. “Canadian Patients wait longest to see family doctors”. January 20, 2014.
Retrieved from
http://www.cbc.ca/news/health/canadian-patients-wait-longest-to-see-family-doctors-1.2501468  on March 9, 2017


CNW. “First 24/7 virtual doctor’s ‘office’ arrives in Canada: New services launches to connect doctors and patients in minutes.” January 30, 2017
Retrieved from
http://www.newswire.ca/news-releases/first-247-virtual-doctors-office-arrives-in-canada-new-service-launches-to-connect-doctors-and-patients-in-minutes-612141113.html on March 9, 2017


Maple. “Maple – Frequently asked questions.” 2016.
Retrieved from
https://www.getmaple.ca/faq on March 9, 2017


OTN. “What is Telemedicine.” 2017.
Retrieved from
https://otn.ca/what-is-telemedicine/ on March 9, 2017