Rho Chi Post Vol 1, Issue 5

VOLUME I, ISSUE 5RHO CHI POST  FEBRUARY 1 ST 2012A s t u d e n t -o p e r a t e d n e w s l e t t e r b y t h e S t . Jo h n ’ s U n i v e r s i t y B e ta D e l ta c h a p te r RHOCHISTJ.ORGSINGLE-LINE STORIES Revamped and ready to go—the Rho Chi Post editorial team restructures for the future Members of the 2011 Rho Chi executive board, Shannon and Mohamed, join the editorial team Community Pharmacy security now a major topic of discussion in New York Various science-related organizations to collaborate on ―My Vascular Valentine‖ event on February 14 The countdown begins—PharmD-only Doctoral Hooding Ceremony to be held on May 10 A MESSAGE FROM THE NEW RHO CHI PRESIDENT BY: YINING SHAO INSIDE THIS ISSUE Greetings fellow Rho Chi members and fellow Pharmacy candidates! In think- Residencies in Pharmacy 2ing about my presidency, the following comes to mind: ―Leadership and learningare indispensable to each other.‖ This quote, first stated by John F. Kennedy, re- Novartis Recalls 4mains true today. To be a good leader is not to simply dictate, but rather to be Rho Chi GBM Flyer 5malleable, adaptable, and humble enough to take dictation. Similarly, as fellow Brilinta® vs. Plavix® 6learners, we must be aware that learning is not about sitting in a classroom and Express Scripts and Medco 7hearing about a subject, but it is also taking what we have heard and putting it intoplay. As we move into the new year, I encourage everyone to keep this in mind. Medco and Express Scripts 8 I remember the day when I checked my email and viewed my acceptance into Dr. Lam & Residencies 9the Rho Chi Society. The application for a position on the executive board was Dr. See & Residencies 10also enclosed. Immediately, I thought, ―why not? Get involved.‖ Dr. Ginzburg & Residencies 11 Currently, as new ideas for our Rho Chi chapter are discussed in executiveboard meetings, I feel the excitement and energy, further encouraging my passion Dr. Hughes & Residencies 13for Pharmacy. As I become more involved with my peers and patients, I expand Bydureon® 15my understanding of our profession. Personally, going from ―never being on an APhA-ASP GBM Flyer 16executive board‖ to becoming ―the person everyone goes to for answers‖ is a Pharmacists as HCP 17huge transition. I feel that it is necessary to approach this transition with theheart of a learner. PPIs and Osteoporosis 18 I have learned more during these past two weeks than I have ever in my years Puzzle: Crossword 20here at St John‘s University College of Pharmacy and Allied Health Professions. I PPIs, Smoking, & Fractures 21would like to thank our past president, Mohammed Dungersi, for making this tran- Plan B and Age Restrictions 22sition as smooth as possible. After handing me a truckload of papers, he explainedto me, in detail, everything that I was required to do. I would also like to express NYCSHP Event Flyer 23my gratitude for the current members of the executive board for all of their dedi- EPIC and Seniors‘ Troubles 24cation, help, and experience. My Vascular Valentine Flyer 25 Recently, I had the privilege of attending the I-LEAD STJ workshop. Of the Adapting to Changing Roles 26many things discussed at this workshop, the most memorable idea was the follow-ing: sit in the front seat of your life. Crossword (Solution) 27 I have great expectations for this year. We are planning to continue tradition- Student Star of the Month 28al events, such as the Coffeehouse Chats, as well as provide new and exciting Puzzle: Word Search 30events that further the mission of Rho Chi and the Pharmacy profession. I en- Editorial Team Bios 31courage everyone to sit in the front seat, rather than the one in the corner, in Upcoming Events 32order to learn and lead, and also to have a great academic year. Thank you. About Us 32

RHO CHI POST (RHOCHISTJ.ORG)PHARMACY PRACTICE RESIDENCY TRAINING PROGRAMS BY DR. TINA KANMAZ Dr. Kanmaz is the Assistant Dean programs are searchable by the institution‘s for Experiential Pharmacy Educa- name, geographical location, and the residency tion and Associate Clinical Profes- type. The residency listing for a specific program sor at St. Johns University College may also have a link to that program‘s webpage. of Pharmacy and Allied Health The residency program webpage will provide de- Professions. tailed information including a description of the program, the goals of the program, the number of Pharmacy practice residency training is a one- available positions, the estimated stipend, addi-year program that serves as a bridge for the re- tional application information, the program direc-cent Doctor of Pharmacy graduate (with little to tor‘s contact information, and more.no independent work experience as a pharmacist)toward functioning as a competent, independent Postgraduate Year One (PGY-1) Pharmacypractitioner. The American Society of Health- ResidenciesSystem Pharmacists (ASHP) defines a pharmacy PGY-1 residency programs are the first steppractice residency as an ―organized, directed, for recent graduates from an entry-level PharmDpostgraduate training program in a defined area of program. PGY-1 residencies provide residentspharmacy practice.‖ During residency training, with opportunities to enhance their growth andyou have multiple opportunities to build upon the skill levels (beyond the entry-level PharmD pro-foundation of knowledge obtained during the gram) in patient-centered care and daily opera-PharmD program and refine your skills as a practi- tions of pharmacy practice. Most PGY-1 residen-tioner under the mentorship of a preceptor. cies have required and elective rotations. UnderASHP-Accredited Residency Programs the guidance of practicing pharmacists, during res- If you are wondering about where to begin idency training, residents build upon the clinicallearning more about Pharmacy practice residen- judgment skills they acquired during the Ad-cies, an invaluable resource is the ASHP website. vanced Pharmacy Practice Experiences (APPEs).Log on to www.ashp.org, click on ―Information Your experiences will encompass direct patientFor…,‖ and then click on ―Residents.‖ On this care activities, staffing, serving in leadership roles,site, you will hear from residency directors, as and much more. If the residency program has anwell as former pharmacy practice residents, in the affiliation with a school of pharmacy, the residentfollowing videos: may also serve as an educator to PharmD stu-1) Why should I do a residency? dents in a direct patient care setting, the didactic2) What is a residency? setting, or both.3) The benefits of doing a residency4) When should you start thinking of doing a residency? The resident should be able to demonstrate5) The final steps (learning to master the residency inter- competence beyond the entry-level PharmD pro- view process) gram in managing and improving the medication- use process, providing evidence-based and patient Frequently Asked Questions (FAQs) about -centered medication therapy management withresidency programs will also answer your ques- interdisciplinary teams, exercising leadership andtions about what a pharmacy residency is, what practice management, demonstrating projectthe U.S. citizenship requirements are for that par- management skills, providing medication andticular program, and whether you will earn a sala- practice-related education and training, and utiliz-ry. A link to the online directory of ASHP- ing medical informatics.accredited residency programs provides access toall ASHP-accredited residency programs. These

V O LU M E I , I S S U E 5Postgraduate Year Two (PGY-2) Pharmacy ning to apply to a residency program, you willResidencies want to plan to be off during rotation in period PGY-2 residency programs offer specializa- 12 to attend the ASHP Midyear Clinical Meetingtions in ambulatory care, cardiology, critical care, in December. You should continue adding yourdrug information, emergency medicine, geriatrics, accomplishments to your RxPortfolio as you pro-infectious diseases, informatics, internal medicine, gress through the program. You can automatical-managed care pharmacy systems, medication safe- ly generate a Curriculum Vitae (CV) from yourty, nuclear, nutrition support, oncology, pediatrics, RxPortfolio, which is required as part of your res-pharmacotherapy, health-system pharmacy admin- idency application. You will also need to provideistration, psychiatry, and solid organ transplant. three letters of recommendation. I have found itMost PGY-2 residency programs are looking for to be very helpful to ask your preceptors whilecandidates who have completed a PGY-1 residen- you are still on rotation, perhaps during the lastcy. PGY-2 programs build upon the strong foun- week of the rotation, if they will write a recom-dation achieved in a PGY-1 residency, developing mendation letter for you in preparation for yourthe resident as a competent practitioner in a application.more specialized area of pharmacy practice. A Unfortunately, there are currently manyresident who successfully completes an accredited more interested applicants than there are resi-PGY-2 residency should have the competencies dency slots. In order to make yourself stand outneeded to achieve board certification in the prac- and be competitive, I recommend that you speaktice area (where applicable). to your preceptors and faculty members to gain advice and professional experiences. Gaining ex-WH A T A RE THE R EQU IR E MEN TS F O R perience publishing an article and/or collaboratingA DMIS S ION T O A RES IDE NC Y ? on a research project are some suggestions to You must be a graduate of an ACPE- express to your preceptors. These professional accredited college of pharmacy or otherwise experiences will continue to develop you as a be eligible for licensure. competent practitioner and enhance your applica- You will need to demonstrate your interest in tion to a pharmacy practice residency. and aptitude for advanced training in pharma- During the fall semester, you can attend an cy. Some residencies require licensure to practice informational session on campus to help you pre- before you enter the program. Others will pare for the ASHP Midyear Clinical Meeting. accept you while you pursue state board licen- During the Midyear meeting, you will have the opportunity to meet with current residents and sure. For residencies combined with a graduate de- residency directors from across the country. The gree program, you must satisfy the require- Midyear meeting is the first step to possibly se- ments of the college of pharmacy or graduate curing an on-site interview with the program in school for admission to the advanced degree January, February, or early March. We also host program. In addition, you will need to satisfy an on-campus Residency/Fellowship Showcase. Representatives from residencies and fellowships the residency requirements. Residents in ASHP-accredited programs are will be on campus for the day to answer your questions about their programs. I highly encour- encouraged to become members of ASHP. age you to attend both of these events to learnPractical Advice more about individual programs, network, and Depending on what year you are in the Doc- learn more about the National Matching Program.tor of Pharmacy program, my advice to you will I wish the best of luck to all of you!vary. If you are on your APPE rotations and plan-

RHO CHI POST (RHOCHISTJ.ORG)THE LATEST NOVARTIS RECALLS BY: ALEENA CHACKO, LONG ISLAND UNIVERSITY PHARM.D. CANDIDATE C/O 2013 Established in 1996, No- shape, and size. It issued a warning for the following vartis International AG is a Controlled Substance Schedule II (C-II) prescription multinational pharmaceutical products: company based in Switzer- land. On January 8, 2012,  Opana ER (oxymorphone hydrochloride) ER tablets Novartis issued a recall on  Opana (oxymorphone hydrochloride) tablets some popular over the  Oxymorphone hydrochloride tablets counter (OTC) medications  Percocet (oxycodone hydrochloride and acetaminophen)in the United States (U.S.) over concerns about bro- tabletsken or incorrect tablets ending up in these medication  Percodan (oxycodone hydrochloride and aspirin) tabletsbottles. The drugs in question were Excedrin® and  Endocet (oxycodone hydrochloride and acetaminophen)Bufferin®. However, Novartis Consumer Health stat- tabletsed that the recall, a precautionary measure, also ap-  Endodan (oxycodone hydrochloride and aspirin) tabletsplies to bottled versions of Gas-X® and NoDoz®.  Morphine sulfate ER tabletsWith this, Novartis decided to suspend production at  Zydone (hydrocodone bitartrate/acetaminophen tablets)its plant in Lincoln, Nebraska for ―maintenance andother improvement activities.‖ However, the recall did not end there. On Janu- ary 13, 2012, Novartis AG expanded its Excedrin® Some bottles of headache medicine (Excedrin®) recall to the Canadian health authorities. Health Can-and caffeine caplets (NoDoz®) with expiration dates of ada said the Swiss company is recalling all lots of Ex-December 20, 2014 or earlier are subject to the recall. cedrin® Extra Strength Caplets and Excedrin® TensionAdditionally, some packages of pain medicine Headache caplets with expiration dates of December(Bufferin®) and stomach medicine (Gas-X®) with expi- 20, 2014 or earlier. The medication is being recalledration dates of December 20, 2013 or earlier are also for the same reason as above. Health Canada willaffected. Novartis stated that the mixing of different advise Canadian citizens if other details emerge.products in the same bottle could result in patientstaking an incorrect product (stray medication), receiv- As previously mentioned, Novartis has voluntarilying a higher / lower strength than intended, or perhaps suspended operations and shipments from its Lincoln,receiving an unintended ingredient that could result in Nebraska, facility to rectify the problems at the site.overdose or an allergic reaction. This Swiss pharmaceutical company states that the recalls and factory repairs will cost around $120 mil- Novartis became aware of this potential problem lion. On January 16, shares of Novartis fell 95 cents toduring an internal review and complaints that identified $55.78, and may continue to decrease in value withinissues such as broken gelcaps, chipped tablets, and in- the next couple of days.consistent bottle packaging line clearance practices(where a potential for a tablet mix up was not ruled- SOURCES:out). The Swiss pharmaceutical company is working 1. Drug Topics. Novartis recalls OTC products; FDAwith the Food and Drug Administration (FDA) during issues warning about company‘s opiate products. Avail- ablethe voluntary recall that affects U.S. retailers to make drugtopics/Top+News/Novartis-recalls-OTC-products-sure that patients did not take any medications that FDA-issues-warning-a/ArticleStandard/Article/they might be allergic to or that might be dangerous detail/755520?contextCategoryId=47443when mixed with other medications. However, No- 2. MarketWatch. Novartis Recall of Excedrin Productsvartis also stated that there have not been any com- Extends to Canada. Available online: http://plaints or consumer-reported adverse events. www.marketwatch.com/story/novartis-recall-of- excedrin-products-extends-to-canada-2012-01-13 On the other hand, the FDA is advising healthcare 3. Thomson Reuters Foundation. Novartis issues recall onprofessionals and patients to examine the opiate prod- Excedrin, Bufferin. Available online: http://ucts that Novartis makes for Endo Pharmaceuticals to www.trust.org/alertnet/news/novartis-issues-recall-on-make sure that all the tablets are the same color, excedrin-bufferin/

V O LU M E I , I S S U E 5

RHO CHI POST (RHOCHISTJ.ORG)BRILINTA VS. PLAVIX IN PATIENTS WITH ACUTE CORONARY SYNDROMES BY: RONIK SAHA, PHARM.D. CANDIDATE C/O 2013 ® ® Clopidogrel (Plavix®) is a thienopyridine antiplate- P<0.001).1let agent, which exerts its antiplatelet effects via in vivoconversion to an active thiol metabolite that irreversi- PLATO did indeed demonstrate that in patientsbly blocks the P2-12 component of platelet ADP re- with ACS, treatment with ticagrelor (compared toceptors. This prevents activation of the GP2B/3A clopidogrel) significantly reduced the rate of deathcomplex, thereby preventing platelet aggregation. from vascular causes, myocardial infarction, or stroke.Along with aspirin, clopidogrel reduces the rate of ath- It achieved this without a significant increase in theerothrombotic events (e.g. myocardial infarction and rate of major bleeding. However, several key factorsstroke) in patients with acute coronary syndrome will limit ticagrelor‘s use in clinical practice. First,(ACS) with or without ST-segment elevation. Ticagre- dyspnea is a serious adverse effect that can be verylor (Brilinta®) is a reversible antagonist of the P2-12 troublesome for patients, and PLATO showed that itcomponent of platelet ADP receptors that prevents occurred more frequently in patients on ticagrelor.activation of the GP2B/3A complex. Ticagrelor also Second, the package insert for Brilinta® states,reduces the rate of atherothrombotic events in pa- ―maintenance doses of aspirin above 100mg reducetients with ACS with or without ST-segment elevation the effectiveness of Brilinta® and should be avoided.‖2in conjunction with aspirin.1 Other antiplatelet drugs, such as Plavix®, do not have this warning. This black box warning contraindicates The Platelet Inhibition and Patient Outcomes the use of ticagrelor in patients who might require(PLATO) study sought to determine whether ticagre- higher doses of aspirin to show a therapeutic effect inlor was superior to clopidogrel for the prevention of anticoagulation therapy. Third, the high cost of Brilin-thromboembolic events and death in patients with ta® will most likely limit its use in patients; Plavix® willACS. The primary outcome measured in this study be available from generic manufacturers in May.3was death of study participants from cardiovascular or Most insurance companies will probably be reluctantcerebrovascular causes. The primary endpoint oc- to place Brilinta® on their formularies, as well. Ascurred significantly less often in the ticagrelor group alluded above, Plavix® is a frequently prescribed medi-than in the clopidogrel group (in 9.8% of patients vs. cation and will soon be available as a generic.11.7% at 12 months; hazard ratio, 0.84; 95% confi-dence interval [CI], 0.77 to 0.92; P<0.001). Further- Although ticagrelor does show an advantage overmore, the hierarchical testing of secondary end points clopidogrel in terms of therapeutic efficacy,showed significant reductions in the ticagrelor group clopidogrel will most likely remain the drug of choiceas compared to the clopidogrel group, with respect to in preventing thromboembolic events in patients withthe rates of the composite end point of death from ACS for years to come because of the cost and limita-any cause, myocardial infarction, or stroke (10.2% vs. tions to the use of ticagrelor.12.3%, P<0.001).1 SOURCES: The PLATO trial also examined the incidences of 1. Wallentin, Lars et al. ―Ticagrelor versusadverse reactions. First, the ticagrelor and clopidogrel Clopidogrel in Patients with Acute Coronary Syn-groups did not differ significantly with regard to the dromes‖. N Engl J Med 2009; 361:1045-1057.rates of major bleeding, as defined in the trial (11.6% Epub 2009 Sept 10.and 11.2%, respectively; P=0.43). The study showed 2. Brilinta (Package Insert). AstraZeneca, Wilming-that greater platelet inhibition with ticagrelor was not ton, DE; July 2011associated with an increase in the rate of any major 3. Moisse, Katie. ―10 Top-Selling Drugs Coming Offbleeding. However, dyspnea was more common in the Patent‖. ABC News Website Online. July 25, 2011. <ticagrelor group than in the clopidogrel group (in http://abcnews.go.com/Health/Drugs/prescription-13.8% of patients vs. 7.8%). It is also important to drug-prices-plummet/story?id=14152014#.Tx-note that discontinuation of the study drug due to ad- GFPmwW1w> Accessed January 24, 2012.verse events occurred more frequently with ticagrelorthan with clopidogrel (in 7.4% of patients vs. 6.0%,

V O LU M E I , I S S U E 5EXPRESS SCRIPTS AND MEDCO MERGER BY: MAHDIEH DANESH YAZDI Express Scripts Inc., one of the nation‘s top happens. They also claim that prices would notpharmacy benefit managers (PBMs), has an- increase from their current levels (as they expectnounced a $29 billion deal to take over one of its drug prices to drop), and the merger would leadtop competitors, Medco Health Solutions Inc. to greater efficiency in the dispensing chain. TheMedco shareholders re-approved the merger on companies also dispute the claim that consumersDecember 21. For finalization, it needs the ap- would no longer be able to use their neighbor-proval of Express Scripts‘ shareholders and the hood community pharmacies; they point out that,federal government. The deal had raised concern for Medco alone, 85% percent of consumers relyin some corners, which saw it as stifling competi- on community pharmacies for their medications.tion and potentially leading to higher prescription The Federal Trade Commission (FTC) is alsodrug prices for consumers. In fact, it raised legal reviewing the case to determine whether it is inissues as some thought it might even be in viola- violation of any antitrust legislation. Thus far, ittion of antitrust legislation, as the combined force has asked both companies to provide more infor-of both PBMs may lead to 41% control of the PBM mation about the deal. The Department of Jus-market. On Tuesday, December 6, 2011, the tice has recently been more adamant in perusingUnited States Senate held a hearing in the anti- such mergers that it perceives might interferetrust subcommittee of the judiciary committee to with competition in the free market, with theaddress the issue. It asked experts who oppose prime example being AT&T‘s failed bid to pro-and support the measure to offer their sides of cure T-Mobile. Therefore, depending on furtherthe story. clarification by Express Scripts and Medco, it is The opponents of the bill, which include sever- unknown if this merger will be approved or not.al consumer groups and Pharmacy organizations, Upon approval by the Express Scripts sharehold-say that the merger would result in a super- ers and the FTC, the deal will be completed bypowered conglomerate that would dictate prices early 2012.and the types of medications that patients couldreceive (while leaving little room for other alter- SOURCES:natives). They point to the fact that, besides Med- 1. Abelson, Reed and Natasha Singer. "Express Scripts- Medco Merger Raises Antitrust Concerns." 5 Dec 2011.co and Express Scripts, the only PBM with a major The New York Times. 25 Dec 2011 <http://customer base is CVS Caremark. They argue that www.nytimes.com/2011/12/06/business/tough-questions-it would also further limit patients‘ choices, as for-express-scripts-medco-merger.html?pagewanted=all>. 2. Matthews, Anna Wilde and Thomas Catan. "FTC PressesPBMs would force many of their members to use Express Scripts on Merger with Medco." 2 Sep 2011. Themail-order pharmacies (as opposed to traditional Wall Street Journal. 25 Dec 2011 <http://online.wsj.com/community pharmacies), in order to avoid addi- article/tional fees and increased costs. This will give the- SB10001424053111904583204576546991138106086.html >.se PBMs a greater advantage in negotiating con- 3. PR Newswire. "NCPA Warns of Dangers of Expresstracts with community pharmacies that might not Scripts-Medco Merger at US Senate Hearing." 6 Dec 2011.be able to survive further cuts in their reimburse- PR Newswire: United Business Media. 25 Dec 2011ment rates. This would particularly hurt inde- <http://www.prnewswire.com/news-releases/ncpa-warns- of-dangers-of-express-scripts-medco-merger-at-us-senate-pendent pharmacies, which do not have the same hearing-135112988.html>.financial resources as their chain Pharmacy coun- 4. Weigley, Samuel. "Medco Shareholders Approve Mergerterparts. with Express Scripts." 21 Dec 2011. International Business Times. 25 Dec 2011 <http://www.ibtimes.com/ The proponents of the deal argue that there articles/270954/20111221/medco-express-scripts-merger-would be no lack of competition once the merger shareholders-pharmacy-benefit.htm>.

RHO CHI POST (RHOCHISTJ.ORG)MEDCO & EXPRESS SCRIPTS MERGER BY: ALISHA KUMAR, PHARM.D. CANDIDATE C/O 2012 Express Scripts George Paz, CEO of Express Scripts, claimed in a proposed a $29 billion recent testimony, that the merger would be ac- acquisition of Medco ceptable because drug prices are expected to Health back in July drop due to heightened competition in the phar- 2011, and Medco‘s maceutical industry (from both, brand and generic shareholders almost drugs). According to the two companies, this unanimously accepted merger will allow for significant reductions in thethe offer. According to Medco‘s press release, nation‘s healthcare costs and allow drugs to bethe plan was approved by a margin of 99% to 1%, delivered in a safer and more efficient manner.with approximately 72% of its shareholders voting. Now, with both companies‘ shareholders in The two companies manage prescription drug acceptance with the merger, the plan is for Ex-benefits for more than 115 million people and press Scripts to pay $29 billion in cash and stockhandle one third of all prescriptions filled in the for Franklin Lakes, New Jersey-based Medco.United States (U.S.). Their collective revenues Meanwhile, each side waits to receive regulatoryare greater than $110 billion per year, which approvals by the federal government and expectsmeans the merger would allow them to become to close the deal in the first half of 2012.the primary player in the domestic markets for SOURCES:providing mail-order drugs to patients with chron- 1. Weigley, Samuel. Medco Shareholders Approveic conditions (as well as expensive specialty drugs Merger with Express Scripts. International Busi-for conditions such as HIV, hemophilia, and rheu- ness Times. December 21, 2011. http://matoid arthritis). www.ibtimes.com/articles/270954/20111221/ The merger is interesting because it would medco-express-scripts-merger-shareholders-reduce the number of major competitors from pharmacy-benefit.htmthree to only two, which would leave customers 2. Barr, Diana. Express Scripts, Medco Sharehold-(particularly large employers) too few choices and ers OK Merger. St. Louis Business Journal. De-limited bargaining power. According to a recent cember 21, 2011. http://www.bizjournals.com/analysis by Morgan Stanley Research, the 50 larg- stlouis/news/2011/12/21/express-scripts-medco- shareholders-ok.htmlest companies in the U.S. rely heavily on services 3. Abelson, Reed. Concerns over Pharmacy Mer-of Medco, Express Scripts, and the third major ger. The New York Times. December 5, 2011.pharmacy benefits manager (PBM), CVS Care- http://www.nytimes.com/2011/12/06/business/mark. tough-questions-for-express-scripts-medco- Keeping this in mind, it is not a surprise that merger.html?pagewanted=allthere are antitrust concerns. Lawmakers feel thata merger will harm competition. However, Do you have something to say? Write to our editors at rhochis@gmail.com and we will feature your response in our next edition!

V O LU M E I , I S S U E 5MY RESIDENCY, MY EXPERIENCE, A FOUNDATION FOR MY CAREER BY: SUM LAM, PHARMD, CGP, BCPS, FASCP Sum Lam, Pharm.D., CGP, with patients to optimize drug therapy outcomes. I BCPS, FASCP is an Associate witnessed the receptive and welcoming attitudes of Clinical Professor in the Depart- the physicians to pharmacy recommendations that ment of Clinical Pharmacy Prac- aimed at identifying, preventing, and resolving drug tice at St. John’s University Col- related problems. Pharmacists were valued members lege of Pharmacy and Allied of the interdisciplinary team, and had the privilege of Health Professions. In conjunc- documenting Pharmacy care plan notes in patient tion with her full time appoint- charts. One of the most treasured experiences was ment at St. John’s University, she to serve as a clinical instructor for pharmacy students is a clinical faculty at Geriatric at the University of North Carolina and a guest lectur-Medicine Division, Winthrop University Hospital in Mineola. er for medical/physician assistant students at DukeShe is a preceptor for pharmacy students on their Inpatient University. I was responsible for didactic lectures andand Geriatrics rotations. a laboratory session for pharmacy students for one A pharmacy residency is an organized, directed, entire semester.postgraduate training program in a defined area of Each rotation gave me a memorable and uniquepharmacy practice. There are two types of residen- experience. Running an outpatient pharmacy cliniccies: Postgraduate Year One (PGY-1, general pharma- and a PHARMAssist program (a clinic for indigent pa-cy practice) and PGY-2 (specialized pharmacy prac- tients) opened my eyes on the diverse types of non-tice). Example areas of specialization for PGY-2 resi- traditional remedies that local people used to treatdencies and other useful information about pharmacy daily aliments. For examples, BC powder for pain,residencies are available at the American Society of Windex glass cleaner for bug bites, vinegar immersionHealth-System Pharmacists (ASHP) website: http:// for warts on the hands, and many others. Workingwww.ashp.org/menu/Residents/GeneralInfo.aspx. with these patients allowed me to develop cultural After graduating from the University of Connecti- sensitivity and respect for patients‘ individuality. Incut and completing a PGY-1 residency at Montefiore the extended care and rehabilitation center, I per-Medical Center in the Bronx, I eagerly relocated to formed monthly medication regimen reviews forDurham, North Carolina for a PGY-2 specialized resi- about 20 long-term care residents throughout thedency in geriatric pharmacy practice. By then, I had year. Following these patients longitudinally alloweddeveloped a deep interest in optimizing drug therapy me to develop personal connections with these veter-for older adults, who are more likely to have multiple ans.disease states requiring complicated drug therapy. My favorite rotation was home-based primaryOften, the elderly are needy and disadvantaged finan- care, which incorporated telemedicine practice (a fed-cially, physically, and/or functionally. I felt that my erally funded research project to reduce the hospitali-knowledge and skills as a pharmacist could truly bene- zation rate among frail elderly who reside at least 50fit and serve these patients. It was a big decision for miles away from the medical center). Pharmacistsme to leave New York for further pharmacy training, traveled across towns, with a nurse practitioner and abut I am so glad that I did. clinical social worker, to visit patients in their homes. My PGY-2 residency was a special collaboration We performed assessments and counseled on medicalamong three institutions: Geriatric Research, Educa- issues, medication use, home safety, and benefit eligi-tion & Clinical Center (GRECC) at Durham Veterans bility. Most patients were thrilled to meet us and toAffairs Medical Center, Duke University Center for receive telemonitors (computers that allowed them tothe Study of Aging and Human Development, and the perform health monitoring and to gain access toSchool of Pharmacy at the University of North Caroli- healthcare professionals, including pharmacists, at thena. The training not only prepared me to be a more medical center at all times). This rotation also al-seasoned clinician, but also enhanced my ability to be lowed me to learn about life through the experiencean educator. Throughout the year, I worked directly of others. I will never forget the elderly man who showed me his purple heart and told me the heroic

RHO CHI POST (RHOCHISTJ.ORG)story behind it. In addition, this rotation gave me the few recommendations for pharmacy students who areunexpected opportunity to visit charming small rural interested in postgraduate training. First, learn abouttowns in North Carolina. residencies from ASHP websites, colleagues, and facul- I was most fond of the training on research and ty. Second, prepare early; attend residency showcasespublication during the residencies. Thanks to the dedi- and resume/CV / interview workshops offered by ourcated guidance of mentors, I completed and published college. Third, explore your interest in pharmacy spe-two residency projects (during the PGY-1 and PGY-2) cialties during your year of rotations. Fourth, be men-in a peer-reviewed, Medline-indexed pharmacy journal tored; Clinical Pharmacy Practice faculty members are(AJHP). I presented both research projects at regional ideal for providing advice on residencies. Finally, ifresidency conferences and national ASHP clinical possible, do not limit your residency search geograph-meetings. These were great rewards for the endless ically. It is worthwhile to relocate for one or twohours that I spent on protocols, data collection, poster years for excellent residencies. Personally, I wouldpreparation, and manuscript revisions during my resi- never regret leaving Connecticut to go to New Yorkdency years! (and then moving to North Carolina) for residencies that prepared me to become a better teacher and My pharmacy residency years were filled with hard clinician. Now, I am back in New York: a place I callwork, yet they were fulfilling and rewarding. I have a home. Every good and perfect gift is from above.RESIDENCY EXPERIENCES: DIRECT IMPACT ON PROFESSIONAL DEVELOPMENT BY DR. SHARON SEE, PHARMD, FCCP, BCPS Sharon See, Pharm.D., FCCP, BCPS is gressive and very clinical. I wanted direct patient care an Associate Clinical Professor in the and to collaborate with physicians at the point of care. Clinical Pharmacy Practice Department It turned out to be the perfect setting for me. at St. John’s University College of Phar- I was part of the Deaconess Hospital Family Medi- macy and Allied Health Professions. In cine Residency Program where my preceptor, Jack conjunction with her full time appoint- Burke, was the Pharm.D. attending for the residency ment at St. John’s University, she is a program. He was on faculty, along with the other at- clinical faculty member in the Beth tending physicians, and was in charge of the inpatient Israel Residency in Urban Family pharmacotherapy curriculum. We took care of all the Health in New York City where she is patients on the inpatient service. This residency pro-the coordinator of the inpatient pharmacotherapy curricu- gram did not have any staffing component. My day-to-lum. day work consisted of a sit-down meeting with the I have been asked to reflect on my residency expe- team at morning rounds, where we discussed patientsrience and offer advice to prospective residency candi- admitted the night before. We would then go ondates. I completed a specialty residency in Inpatient walk rounds with the attending to see all the patientsFamily Medicine with Deaconess Family Medicine and on our service. I followed all of the patients on thethe St. Louis College of Pharmacy (STLCOP) in St. service, which usually consisted of about 20 to 30 pa-Louis, MO. At that time, there were pharmacy prac- tients. I helped to identify drug-related problems,tice residencies (now referred to as PGY-1 residen- made recommendations for adding or discontinuingcies) and specialty residencies (now referred to as therapy, answered drug information questions, andPGY-2 residencies). I graduated from the five-year BS provided patient education. I rounded with the teamprogram at Rutgers, and stayed on for a two-year post on the weekends to provide continuity of care. It wasbaccalaureate Pharm.D. I was fortunate to have been a wonderful training environment. Oftentimes, theaccepted into a specialty residency without first com- residents would wait to hear what I had to say about apleting a pharmacy practice residency. Although I had patient‘s regimen before they wrote the orders.interviewed at several Pharmacy Practice residencies, One of the attractive things about STLCOP wasSTLCOP and Deaconess offered me opportunities that the teaching component of the residency. In additionfit my career goals. I wanted to go somewhere pro-

V O LU M E I , I S S U E 5to my clinical duties, I had opportunities to precept I compiled a few tips for you to consider as youpharmacy students on rotations, teach in a physician learn more about pharmacy residencies.assistant (PA) pharmacology course, give various lec-tures to family medicine residents, and facilitate work- TIP #1 – Apply to out of state residencies. If youshops at the pharmacy school. There were nine phar- are not geographically restricted, I highly recommendmacy residents affiliated with STLCOP; we attended training in another state. This is a great way to gainweekly resident teaching seminars where we learned experience in another part of the country and form athe foundations of effective teaching and explored the new network of friends and colleagues. You can al-use of abilities-based education in pharmacy. We ways come back home to implement what you havewere each assigned topics in the infectious diseases learned elsewhere. It is only one year!(ID) elective, and the weekly seminars helped us shape TIP #2 – Clarify your intent. Why you are inter-our lectures. ested in pursuing a residency? This is a crucial ques- My year in St. Louis was also the beginning of tion because a residency is not for everyone. What isbuilding my professional network. The faculty mem- the position that you are hoping to get in the future?bers at STLCOP were very active in the American Does it require a residency? It is not enough to wantCollege of Clinical Pharmacy (ACCP). In fact, my for- to do a residency because it is the thing to do or youmer chair at STLCOP is now the executive director at cannot decide what you want to do with the rest ofACCP. Their mentoring spurred me to join ACCP. your life. The economic climate makes residencyMy affiliation with ACCP has been invaluable in con- training attractive; however, is this compatible withtributing to my professional development as a clinician your career goals?and a teacher. It has also helped me gain leadership TIP #3 – Obtain letters of recommendation. Ifexperience and learn from colleagues from across the you are thinking about applying for a residency, youcountry. should really start the process when you start rota- Today, in concert with my faculty position at St. tions. ASHP midyear occurs in December; so, if youJohn‘s University, I am a faculty member with the Beth are asking faculty or preceptors to write you lettersIsrael Residency in Urban Family Health where I am in of recommendation, please do so PRIOR to midyear,charge of the inpatient pharmacotherapy curriculum. I ideally in November or as soon as you are thinkinghelp to train family medicine residents who wish to about it. Your faculty and preceptors need time tobecome family physicians. I designed my clinical prac- write these letters. Keep in mind that they may betice and inpatient rotation based on my residency ex- writing letters for five to seven students (each whoperience in St. Louis. We see patients with the team may be applying to five or more programs). Thisand optimize their drug therapy. takes time. Ultimately, my residency training directly affected TIP #4 – Focus. What are you looking for in a resi-my career path and led me to where I am now. Good dency? Do you want more managerial or teachingluck with your journey, and feel free to contact me if experiences? Look for programs that fit your inter-you have further questions. Thank you for providing ests or career goals.an opportunity to share my residency experiences.THE IMPORTANCE OF RESEARCHING RESIDENCY SITES BY: DR. REGINA GINZBURG Dr. Regina Ginzburg is an Associate ily Health. She and Dr. See oversee the pharmacothera- Clinical Professor of St. John’s University py curriculum for the family medicine residents. She and College of Pharmacy and Allied Health her pharmacy students also provide education to pa- Professions. Her clinical site is at the tients in the family medicine clinic. Additionally, she is Institute for Family Health (IFH) where the co-chair of the IFH Pharmacy & Therapeutics com- she is an appointed faculty member for mittee which oversees medication-related policies for 22 the Beth Israel Residency in Urban Fam- clinics throughout New York.

RHO CHI POST (RHOCHISTJ.ORG) The profession of pharmacy practice continues hooked. In fact, I was so hooked that I only put Al-to expand, as does the recognition of the vital role bert Einstein as my choice on the match (by theof a pharmacist being part of the healthcare team. way, I do not recommend doing this nowadays).More than ever, the demand from hospitals, clinics, However, I feel I should say that I did have an alter-and community pharmacies to undergo postgraduate native plan should I not get into residency (but it isclinical training (aka residency) after obtaining a too long and tangential to mention in this article).Doctor of Pharmacy degree is abundant. Nevertheless, thankfully, I matched! As a student (years back), I went in to the resi-dency application and interview process somewhat Because I was so naïve to this process, I wasblindly. My preceptors informed me about how im- not aware that the program I matched into was aportant a residency is. Watching how respected my relatively new program that only started threepreceptors were by the physicians and nurses sur- years prior to my being there.rounding them, I wanted to be a clinical pharmacist ASHP provides somewhat of a guideline on theand/or teacher just like them (and by teacher I do fundamentals of a residency program and type ofnot just mean teaching students, I did not realize I rotations that should be included (e.g. core, elec-wanted to do that until later. I wanted to teach pa- tive, longitudinal, extended, etc.). This is part of thetients and healthcare professionals). requirement to be accredited. However, each resi- Therefore, I went to the American Society of dency is still unique in the type of rotation and theHealth-System Pharmacist (ASHP) Midyear Clinical preceptors‘ guidance. For example, residency AMeeting to explore the residency showcase. I was and B are both PGY-I hospital-affiliated programs.told that it was best to do a residency outside of However, residency A may offer electives in trans-NY, so I could experience the ―real‖ contribution plant, while residency B tends to specialize more inthat a pharmacist could make (as pharmacists had pain medicine (or endocrine, critical care, infectiousmore limitations in NY 10 years back). However, disease, etcetera).coming from a family that did not want to consider Some residencies are very stringent in theirme leaving home before I got married, I felt that I schedules for the year, whereas others are moreshould probably limit myself to a feasible drive dis- lax and have the resident seek out electives of theirtance away (CT, NJ, or PA). choice. It is important for the applicant to know I did not know ambulatory care was my calling which type of residency would suit them best. Theyet, and was not familiar with the Veterans Affairs stringent program works best for those who thrive(VA) system or the role of the pharmacist in the VA on structure, organization, and guidance. The laxsetting. Therefore, when I went to Midyear, I wan- program would suit someone who is ambitious anddered aimlessly from booth to booth, casually con- can get things done despite the lack of organizationversing with some of the residents and/or program surrounding them. Perhaps this person may workdirectors. I spoke with the residents of the Albert better in this setting because they can tweak theEinstein Medical Center (in Philadelphia, PA), who program to suit their interests without much oppo-appeared to be very enthusiastic when speaking sition from administrators – I matched into thisabout their residency program. I felt compelled to type of residency program.apply there and really only to a few other places I have to admit that, as a student, I was not thatthat piqued my interest. At my interview there, I ambitious. Therefore, when I started the residencywas impressed by the number of clinical pharmacists program and saw how laid back it could be, I wasemployed by the hospital (not really heard of in disheartened. I planned to make a commitment forNYC at the time, unless you worked for a college of the year where I would work extremely hard withpharmacy), as well as the responsibilities and experi- the payoff of substantial knowledge and experienceences the pharmacy residents endured. I was enhancement. In the first couple of months, as my

V O LU M E I , I S S U E 5co-residents and I were wandering around aimlessly, ilar suit where she had to contact numerous attend-it seemed evident that we did not know what we ing physicians whom she never met and establishshould be doing or what our priorities were. My electives in various critical care units throughoutprogram director had the best of intentions, but, the hospital. The other resident just did not havesadly, did not follow through on meeting with us or the drive. She just fulfilled her core rotations andtracking our progression (mainly because he was so spent her elective months dabbling in differentbusy). I thankfully met a clinical pharmacist at the floors of the hospital, but never felt that she ac-hospital who started her own Coumadin® (warfarin) quired anything out of her residency experience.clinic. After shadowing her for some time, I sawhow beneficial a pharmacist could be in the ambula- I cannot speak on behalf of my residency pro-tory care setting. With her coaching, I introduced gram or inform you about how it currently oper-myself to the endocrinologists at the diabetes clinic ates. My program director left the hospital a fewand developed an elective there. I continued to set years after I graduated and all of the pharmacists Iup more elective rotations in other clinics, as well worked with back then are currently employed(pain, HIV, etc.). Hence, I was able to make the best elsewhere. It may very well be a much more struc-of my situation and feel proficient in ambulatory tured program or it may still have same the sponta-care. neity as it did then. However, many other programs may be similar in nature. It is very important Looking back, I am very grateful for everything for the pharmacy student / applicant to research thethat I have learned in my residency program and for programs that they are interested in and make athe people who guided me and showed me how val- decision about the type of programs that woulduable a pharmacist can be. best suit them. This situation, however, could have gone down A PGY-1 residency is a year of dedicationa different road. There were two other pharmacy equivalent to three years of experience. It is crucialresidents in my year, and they were as similarly dis- to make the best of it because you only get to ex-heartened as I was. One of the residents had a pas- perience a PGY-1 residency once.sion for critical care. Therefore, she followed a sim-EXPRESS, BE INVOLVED, AND GROW BY: DR. GREGORY J. HUGHES Gregory J. Hughes, PharmD, Upon completion of the Doctor of Pharmacy BCPS, CGP is an Assistant curriculum, new graduates are prepared to begin Clinical Professor in the Clini- their careers as new practitioners. While some cal Pharmacy Practice de- new graduates will chose to begin practice in partment at St. John’s Uni- community or hospital pharmacy settings, others versity College of Pharmacy will strive to hone and build on their skills, and Allied Health Profes- knowledge, and abilities by completing a pharma-sions. He completed his pharmacy practice residency cy practice residency. This one-to-two-year,at the St. Louis VA Medical Center and the St. Louis highly competitive venture is an important deci-College of Pharmacy with an emphasis on geriatric sion for a fledgling pharmacist.pharmacotherapy. Dr. Hughes’ clinical practice site is When deciding to complete a residency, eachNorth Shore University Hospital in the Department of resident will create his or her own unique experi-Internal Medicine. His areas of interest are geriatrics, ence, within the constraints of a program‘s struc-anticoagulation, arrhythmias, heart failure, infectious ture. No two residencies are identical. As perdisease, and teaching methodologies. the accrediting organization, all ASHP-accredited first year residencies must have some core com-

RHO CHI POST (RHOCHISTJ.ORG)ponents. The program must build a structured One of the editors from this newsletterapproach for the resident to manage and improve asked me to write briefly about my experiencesthe medication-use process, provide evidence- and my feelings about them. Upon graduatingbased patient-centered care with interdisciplinary from St. John‘s University, I chose to complete ateams, exercise leadership and management skills, residency at a joint program of the St. Louis Vet-provide education and training, and utilize medical erans Affairs Medical Center and the St. Louisinformatics. Residencies will generally have a College of Pharmacy. My residency focused onnumber of required rotations and may have elec- the geriatric population; its current and futuretive rotations varying with each resident‘s goals. needs in our society cannot be overstated. Dur-Residencies require a project or research plan ing my residency experience, I cared for patientsthat may take the entire year, or longer, to ac- in a pharmacist-run geriatric clinic, a rehabilitationcomplish. unit, an anticoagulation clinic, internal medicine, The daily routine of each resident will vary and several other practice settings. I performeddepending on which program he or she chooses. chart reviews for nursing homes, admission re-The best way to find out specifically what a typical views in a Program for All-Inclusive Care for theday will encompass is to ask the current or past Elderly, was a preceptor for IPPE and APPE stu-residents, or the residency director. The best dents, taught in Therapeutics and Advanced Phar-time for these questions is within the months pre- macotherapy courses, and spoke at a regionalceding the application deadline to the program. geriatric conference. These activities were notApplications are typically due at the beginning of prescriptive, but merely examples of what a phar-the calendar year. In the fall, many residency pro- macy practice residency can offer. During thegrams will take part in local, regional, or national residency, I developed (previously underutilized)residency showcases. The largest of these is the strengths, as well as relationships that I wouldASHP Midyear Clinical Meeting, where a large never forget. If I could go back and make the de-number of programs gather to seek out potential cision to do a residency again, I would do soresidency candidates. The ASHP website is a without hesitation.good resource for general information and many The following are some words of advice toprograms will have information available on their those considering a pharmacy practice residency.own website throughout the year. My recommendations are to express your inter- In completing a pharmacy practice residency, ests early and to get involved with pharmacy or-the resident will transform both professionally and ganizations that share your interests. Most phar-personally. Enhanced clinical aptitude is only one macy organizations offer memberships and re-aspect that will be cultivated. Residents will find sources to students at a discounted rate or forthemselves in a position to deliver education and free. Many events take place locally where youdemonstrate their abilities to fellow pharmacists may be able to network with pharmacists. I alsoin addition to other disciplines. Residents will recommend traveling to national meetings priorforge lifelong relationships with co-residents and to the last professional year to those who canpreceptors. Opportunities will develop for collab- within their means. These national meetingsoration on research and publishing that otherwise open up the profession to a different level andwould not have existed. In addition to profession- may help you realize you really want to commital growth, maintaining a balance with a healthy to a residency or find it is not for you. Lastly,social life is an important, incorporated goal in a you can always turn to your faculty at St. John‘sresidency. This is important, since, unfortunately, University, who can provide you with individual-socializing may go by the wayside in intense aca- ized advice and guidance.demic programs.

V O LU M E I , I S S U E 5BYDUREON®: A WEEKLY INJECTION FOR TYPE 2 DIABETES MELLITUS BY: MOHAMED DUNGERSI On January 27, the FDA approved Bydureon® ufacturer to conduct a randomized, double blind,(exenatide extended-release) for use in Type 2 placebo-controlled trial evaluating the drug‘s ef-Diabetes Mellitus (T2DM), as an adjunct to diet fect on the incidence of major cardiovascularand exercise. Bydureon®, a product of Amylin events among patients with T2DM. The trialPharmaceuticals, is a modified formulation of the must also assess the risk other adverse events,twice-daily injection, Byetta® (exenatide). It is the such as pancreatic cancer, renal disorders, andfirst once-a-week medication for T2DM in the serious hypoglycemia, as well as the long-termmarket. effects on potential biomarkers of medullary thy- The twice-daily injection formulation, Byetta®, roid carcinoma (MTC). In addition, the companyis also a recent addition to medications that used must conduct a number of studies with mice —to control T2DM. The active ingredient, ex- and one that also includes mouse, rat, and humanenatide, was the first incretin mimetic used to thyroid C cells — that focus on MTC.treat T2DM. It is a GLP-1 (glucagon-like peptide- Bydureon® has a black box warning for MTC due1) receptor agonist suggested to have multiple to the incidence of thyroid C-cell tumors at clini-actions, such as the potentiation of glucose- cally relevant exposures in rats. There is no es-mediated insulin secretion, suppression of post- tablished data on the incidence of such tumors orprandial glucagon release (via unknown mecha- MTC in humans. Hence, patients with a personalnisms), slowed gastric emptying, and a central loss or family history of MTC or patients with Multi-of appetite. All these actions, in combination, lead ple Endocrine Neoplasia syndrome type 2 (MENto decreased blood glucose levels and the control 2) should not use Bydureon®.of T2DM. The effect of increased satiety, through SOURCES:delayed gastric emptying and a central loss of ap- 1. Lowes R. Once-Weekly Exenatide Okayed bypetite, produces anorexia and weight loss. These FDA for T2DM after Long Look. Medscapeare key components in treating the typical T2DM Pharmacists News Website. http://patient with exenatide. www.medscape.com/viewarticle/757664? Since most of the anti-diabetic agents cause src=ptalk. Accessed February 1, 2012.weight gain as an undesirable consequence (as 2. Katzung BG, ed. Basic and clinical pharmacol-with pioglitazone), the use of incretins has been ogy. 11th Ed. New York (NY): Lange Medicalquickly gaining popularity. Victoza® (liraglutide), a Books/McGraw-Hill; 2007.once a day injection, is another incretin mimetic 3. Bydureon [package insert]. Sand Diego, CA:that was approved in January of 2010 for similar Amylin Pharmaceuticals; 2012uses. 4. Byetta [package insert]. Sand Diego, CA: Am- Bydureon® provides all the advantages of the ylin Pharmaceuticals; 2005incretin mimetics, but offers a much more con- 5. FDA News Release. FDA Approves Newvenient once-a-week dosing regimen. Although Treatment for Type 2 Diabetes. http://the FDA approved its use, there are still some www.fda.gov/newsevents/newsroom/safety concerns. The FDA is requesting the man- pressannouncements/ucm198638.htm. Ac- cessed February 1, 2012. What is your clinical input? Write to our editors at rhochis@gmail.com and we will feature your response in our next edition!

RHO CHI POST (RHOCHISTJ.ORG)

V O LU M E I , I S S U E 5PHARMACISTS ARE HEALTHCARE PROVIDERS! BY: SANDRA LEAL, PHARM.D., CDE Sandra Leal, PharmD, CDE tient care setting where I could practice to my full is the Director of Clinical potential. My current position was funded Pharmacy at El Rio Health through a grant from the Office of Pharmacy Af- Center in Tucson, Arizona. fairs. The purpose was to integrate clinical phar- Dr. Leal is the first pharma- macy services into a treatment team to improve cist in Arizona to receive the use of medications in a patient care setting. prescriptive authority under Initially, the position was only funded for two collaborative practice. She is years but after being able to show improved currently the Co-Chair of health outcomes for the patients I was workingHRSA’s Patient Safety and Clinical Pharmacy Services with, I was able to retain my position. The chal-Collaborative, a national effort to improve health out- lenge is this…lack of provider status makes it dif-comes and patient safety through clinical pharmacy ficult to add other clinical pharmacists to our pro-services. gram because there is not a direct source of re- Dr. Sandra Leal is also responsible for the petition imbursement from payers even though the evi-on change.org to recognize pharmacists as healthcare dence shows improve outcomes!providers under federal law. It was our pleasure toinvite Dr. Leal to contribute to the Rho Chi Post re- This might not seem like a big deal but thegarding her inspiration for creating this petition and reality is that we are educated to be medicationspeak to us about why she considers this an important use experts. After working in different environ-matter for our profession. We highly recommend that ments, I realized that I could make the biggestfellow students, professionals, faculty members, phar- impact working directly with patients and provid-macists and readers read about the petition and sign ers to optimize the medication regimen before,it by clicking the link here. On behalf of the entire Rho during and after the prescription was written.Chi Post editorial team and St. John’s University Col- Some pharmacists might worry about the extralege of Pharmacy, we would like to thank Dr. Leal for work or liability, but the reality is that you arecontributing to our newsletter. liable no matter what. The real impact that you can make to reduce liability is by getting involvedTopic Question: When you started pharma- and being proactive as oppose to being reactive.cy school did you think you were going tobe a health care provider? Please explain Because of this, I started a petition onyour answer and the reasoning behind your Change.org to recognize pharmacists as healthpetition on change.org care providers to create awareness about this issue. With over 16,500 signatures, it has resulted I did, and I was shocked to find out that this in an energizing dialogue that is gaining momen-was not the case. In fact, I had not even realized tum. The pharmacy profession is changing…youthe gravity of this lack of provider status recogni- might not realize this now, but reflect back ontion until I started working at my current position. this petition just one or two years after you grad- I had worked in a hospital, a retail setting, a uate and you too will understand the gravity ofcompounding pharmacy and even in a lab doing this issue.research. My passion was really working in a pa- What are your thoughts on the topic?Write to our editors at rhochis@gmail.com and we will feature your response in our next edition!

RHO CHI POST (RHOCHISTJ.ORG)PROTON PUMP INHIBITORS AND THE TREATMENT OF OSTEOPOROSIS BY: NEAL SHAH Osteoporosis is a disease of the bone charac- thus decreasing bone resorption. Patients receiveterized by decreased bone mineral density (BMD), a 60 mg subcutaneous injection of denusomab forwhich reduces the ability of bone to provide ade- osteoporosis every six months.7quate structural support. The main cause of this A recent economic study of postmenopausaldecreased BMD is inadequate calcium intake or osteoporotic women in Belgium compared theabsorption. The decreased BMD can cause diffuse cost effectiveness of three years of treatmentlesions throughout the skeletal system and can with denosumab versus risedronate or alendro-eventually lead to fractures.1 nate. The study found that denosumab was a The most common places for fractures to oc- cost-effective strategy compared to the twocur are the wrist, hip, and spine, and femur.2,3 Du- bisphosphonates, and it has the potential to be-al-energy X-ray absorptiometry (DXA) scans de- come a first line therapy due to the relative easetermine the BMD of a patient by measuring and of (and duration between) administration.8comparing the results of these body locations to a Bisphosphonates are the most commonlynormal, matched population. The measurement used drugs in osteoporosis therapy because ofof BMD, a T-score, represents standard deviations easy, once-weekly or once-monthly oral admin-from the mean. Osteoporosis is defined as a T- istration and low cost, whereas the other thera-score of < -2.5, whereas a milder form of osteo- pies may be parenteral and are associated withporosis (known as osteomalacia) is defined as a T- increased costs.9 Patients usually take bisphos-score between -2.5 to -1.0.2,4 Universally, women phonates in the morning, before any other foodabove the age of 65 and men above age 70 should or liquids, with a full glass of water, remaining up-receive screening for osteoporosis.2-4 right for at least half an hour (as seen with alen- Once a diagnosis of osteoporosis is estab- dronate). The 30-minute waiting period preventslished, the patient should increase physical activity any reflux from causing esophagitis.11and start a daily regimen of calcium and vitamin D, Patients who may have pre-existing gas-and the clinician should initiate prescription medi- troesophageal reflux disease (GERD) may also becation therapy. on proton pump inhibitors (PPIs). A recent re- Pharmacologic treatments of osteoporosis port stated that PPIs decreased the efficacy ofinclude bisphosphonates, teriparatide, denusomab, alendronate in preventing hip fractures.11 Inraloxifene, and calcitonin.3,5 Some drugs worth 2010, the FDA issued a statement, warning thatmentioning are raloxifene, bazedoxifene, and high dose and long-term PPI therapy may increasedenusomab. Raloxifene is a selective estrogen the risk of developing osteoporosis. These resultsreceptor modulator (SERM) used in the preven- were not very clear: two studies cited in theirtion of vertebral fractures and treatment of oste- statement used high dose PPIs in their trial, an-oporosis in postmenopausal patients, when there other two studies cited used long term PPI use inis an increased risk of breast cancer.2 Another their trial, and three other studies have shownSERM, bazedoxifene, exhibits favorable effects on that there is no consistent association betweenlipid and bone profiles—both vertebral and non- osteoporosis and PPI use.12 The cause behind thevertebral, and provides protection against frac- purported decrease in efficacy is due to the phar-tures for up to five years. This drug is not cur- macologic effects of PPIs.rently available in the United States market.6 Calcium is traditionally absorbed in an acidicDenusomab is a monoclonal antibody that increas- environment. PPIs decrease acidity; so, one canes prevents RANKL from activating its receptor, logically assume that decreased calcium absorp-

V O LU M E I , I S S U E 5tion in at-risk patients may accelerate bone re- SOURCES:sorption. In one observational study, concurrent 1. Raphael, R., Strayer, D., Rubin, E. et al. Rubin‘s Pathology: Clinicopathologic Foundations of Medicine, 5th ed. Lippincottbisphosphonate (alendronate) and PPI use in el- Williams & Wilkins. Baltimore, Maryland.derly patients was associated with a dose- 2. Institute for Clinical Systems Improvement (ICSI). Diagnosisdependent loss of protection against hip fractures. and treatment of osteoporosis. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Sep.This study did not show any association between 3. Tutorials - Pathology Subjects. Osteoporosis. Available onlinehistamine-2 receptor antagonists (H2RA) and de- at: http://library.med.utah.edu/WebPath/TUTORIAL/OSTEO/creased protection against hip fractures.13 OSTEOPOR.html. Last accessed on December 17, 2011. 4. Molfetta L, Caldo D. Clinical and forensic medicine issues in Another study at the Massachusetts General osteoporosis fractures. Aging Clin Exp Res. 2011 Apr;23(2 Suppl):17-9.Hospital observed that PPI use was associated 5. Ragucci KR, Shrader SP. Osteoporosis treatment: an evi-with an increased risk of non-spine fracture in dence-based approach. J Gerontol Nurs. 2011 Jul;37(7):17-22.men not taking calcium supplements, but H2RA doi: 10.3928/00989134-20110602-02. Epub 2011 Jun 15. 6. Duggan ST, McKeage K. Bazedoxifene: a review of its use inuse was not associated with non-spine fractures.14 the treatment of postmenopausal osteoporosis. Drugs. 2011A retrospective 10-year analysis by a research Nov 12;71(16):2193-212. doi: 10.2165/11207420-000000000-group in California found that both, PPIs and 00000. 7. Prolia package insert. Amgen.H2RAs, posed an increased risk of hip fracture. 8. Hiligsmann M, Reginster JY. Cost effectiveness of denosumabHowever, this association was only found in those compared with oral bisphosphonates in the treatment of postwith at least one other risk factor for hip frac- -menopausal osteoporotic women in Belgium. Pharmacoeco- nomics. 2011 Oct;29(10):895-911. doi: 10.2165/11539980-tures.15 Another study analyzed the results from 000000000-00000.the Women‘s Health Initiative (WHI), in terms of 9. Selis S. New osteoporosis drug may not be worth its highPPI and fracture risks, and concluded that the use price, study finds. Available online at: http:// h e a l t h p o l i c y . s t an f o r d . e d u / n e w s /of PPIs was not associated with hip fractures, but new_osteoporosis_drug_may_not_be_worth_its_high_pricewas modestly associated with clinical spine, fore- _study_finds_20060610/. Last accessed on December 17,arm or wrist, and total fractures.16 2011. 10. U.S. National Library of Medicine: PubMed Health. Alendro- One limit unaddressed in any study was the nate. http://w ww.ncbi.nlm.nih.g ov/pubmedhealth/type of calcium supplementation. There are two PMH0000018/#a601011-how. Last accessed on December 17, 2011.common, orally administered calcium products: 11. Abrahamsen B, Eiken P, Eastell R. Proton pump inhibitor usecalcium carbonate and calcium citrate. Calcium and the antifracture efficacy of alendronate. Arch Intern Med.carbonate requires an acidic environment, where- 2011 Jun 13;171(11):998-1004. Epub 2011 Feb 14. 12. Lowes R. Proton Pump Inhibitors May Increase Fracture Risk,as calcium citrate does not.17 The daily allowance FDA Warns. Available online at: http://www.medscape.com/of calcium in males and females above the age of viewarticle/722442. Last accessed on December 17, 2011.50 is 1000-1200 mg per day. Combinations of 13. Abrahamsen B, Eiken P, Eastell R. Proton pump inhibitor use and the antifracture efficacy of alendronate. Arch Intern Med.calcium and vitamin D increase the absorption of 2011 Jun 13;171(11):998-1004. Epub 2011 Feb 14.calcium. Since the maximal absorption of calcium 14. Yu EW, Blackwell T, Ensrud KE et al. Acid-suppressive medi-is roughly 500-600 mg, patients should separate cations and risk of bone loss and fracture in older adults. Calcif Tissue Int. 2008 Oct;83(4):251-9. Epub 2008 Sep 24.their calcium intake to twice daily. Hence, none 15. Corley DA, Kubo A, Zhao W et al. Proton pump inhibitorsof the studies addressed whether calcium supple- and histamine-2 receptor antagonists are associated with hipmentation was with calcium carbonate or calcium fractures among at-risk patients. Gastroenterology. 2010 Jul;139(1):93-101. Epub 2010 Mar 27.citrate. 16. Gray SL, LaCroix AZ, Larson J et al. Proton pump inhibitor use, hip fracture, and change in bone mineral density in post- Patients on concomitant bisphosphonates and menopausal women: results from the Womens Health Initia-PPIs should continue to take calcium citrate and tive. Arch Intern Med. 2010 May 10;170(9):765-71.vitamin D to reach their daily allowance of calci- 17. National Institutes of Health: Office of Dietary Supplements. Dietary Supplement Fact Sheet: Calcium. Available online at:um. http://ods.od.nih.gov/factsheets/calcium. Last accessed De- cember 17, 2011.

RHO CHI POST (RHOCHISTJ.ORG)PUZZLE: CROSSWORD BY: MAHDIEH DANESH YAZDI Across Down 4. Alternative to Flomax 1. A type of surgery used in patients with an en- 7. Hytrin larged prostate 10. Alpha blocker with greatest potential for car- 2. Transdermal testosterone patch diovascular side effects 3. Testosterone gel 11. =Flomax+Avodart 5. 5 alpha reductase inhibitor also indicated for alo- 13. Synthetic Prostaglandin E1 pecia 15. Only selective alpha 1a receptor blocker 6. PDE 5 inhibitor more commonly associated with available generically QT prolongation 17. Newer 5 alpha reductase inhibitor 8. PDE 5 inhibitor more commonly associated with 18. System of intra-urethral suppositories/pellets hearing loss of alprostadil 9. Uroxatral 19. PDE 5 inhibitor without an active metabolite 10. Removal of the prostate 12. Herbal alkaloid derived from Pausinystalia yo- himbe 14. Alternate brand name to Levitra 16. Alpha blocker that comes in an extended release formulation as well

V O LU M E I , I S S U E 5LINK REVEALED: PPI USAGE, SMOKING, AND BONE FRACTURES BY: EBEY P. SOMAN Proton pump inhibitors (PPIs) are medications Dr. John Stevenson, who sits on the medicalcommonly prescribed to treat heartburn, acid re- advisory council of the British Menopause Socie-flux disease, and ulcers. Almost a vast majority of ty, stated that the study shows an association be-patients in the United States seem to be taking a tween PPI use and hip fractures, but is not signifi-PPI, either as a prescription or from over-the- cant enough to warrant a warning against use incounter (OTC). Researchers recently discovered patients needing such medications. However, it isassociations between the long-term use of PPIs a clear indicator of the need to educate patientsand bone fractures. Now, a new study published on appropriate ways to take PPIs and smokingin the British Medical Journal (BMJ) revealed more cessation.condemning links to bone fractures in a prospec- Mr. Dan Greer, the Royal Pharmaceutical So-tive cohort study titled ―Use of proton pump in- ciety spokesperson on gastroenterology medi-hibitors and risk of hip fracture in relation to die- cines, stated, ―this study strengthens the currenttary and lifestyle factors.‖ recommendations for PPI use, in that for the ma- The study used 79,899 women (aged between jority of patients with symptoms of indigestion,30 and 55) enrolled in the Nurses‘ Health Study. PPIs should only be used for short courses (oneThe women provided six-month‘s worth of data to two months), with repeat courses offered aton their use of PPIs and other risk factors. The the lowest dose that controls symptoms.‖main monitoring outcome was the incidence of Community pharmacists play a vital role inhip fractures in women taking PPIs compared to society as the bridge between the patient and thewomen who did not take PPIs, as well as women medical community. Thus, this is an importantwho smoked while taking PPIs. The study showed opportunity for pharmacists to make headwaythat the risk of hip fractures in women taking long into counseling patients on proper usage of cer-term PPIs was 2.02 events per 1000 person years, tain OTC medications, such as PPIs. It also raisescompared with 1.51 events per 1000 person years the necessity to push smoking cessation programsamong women not taking any PPIs. Women who and to offer information about making healthyused PPIs regularly for two years had a 35% in- choices to prevent future complications.creased risk of fractures, with longer usage con-tinuing to increase that risk. SOURCES: 1. BBC News. Ulcer drugs ‗link to fractures.‘ The results in women who smoked or had a Available online: http://www.bbc.co.uk/news/history of smoking were even more interesting. health-16808621 Last accessed 1 Feb 2012.The use of PPIs in this population resulted in a 2. Khalili H, Huang ES, Jacobson BC, et. al. Use50% increased risk of hip fracture compared with of proton pump inhibitors and risk of hip frac-women who did not take the medication. The ture in relation to dietary and lifestyle factors:study concluded, ―Chronic use of PPIs is associat- a prospective cohort study. BMJ. 2012 Janed with increased risk of hip fracture, particularly 30;344:e372. doi: 10.1136/bmj.e372.among women with a history of smoking.‖ What is your clinical input? Write to our editors at rhochis@gmail.com and we will feature your response in our next edition!

RHO CHI POST (RHOCHISTJ.ORG)SHOULD PLAN B HAVE AN AGE RESTRICTION? BY: MARIE HUANG Back in December, the FDA was overruled by affects the mother, but it contributes to far-the presidential administration to make Plan B reaching societal and national problems for our(levonorgestrel 1.5 mg) an over-the-counter economy and healthcare systems. The current(OTC) medication.1 We became interested in the model is encouraging; potential users of Plan Bmatter, and asked our fellow students if Plan B need to educate themselves on taking other pre-should be available to people of all ages directly cautions before having to rely on medication aoff of drugstore / supermarket shelves without a convenient resort. Holding Plan B ‗behind theprescription. We found that an overwhelming counter‘ and as a prescription for those undermajority of students preferred the current model age 17 will channel patients through the physician– patients should present identification that states and pharmacist outlets, where the much-neededthat they are > 17 years of age. guidance, reinforcement, and healthcare services We were able to get in touch with two stu- can be provided.‖dents from opposing sides of the debate. Amy Findakly, also a 5th Alexandra Alleva, a 5th year year PharmD candidate, pro- PharmD candidate, provided vided us the following: ―I be- us with the following insight: lieve Plan B should be acces- ―The decision to maintain sible to girls who find them- Plan B as inaccessible without selves in these kinds of diffi- a prescription to minors is, in cult situations, including my professional opinion, the those under 17. Young girls most appropriate action at deal with the challenge of this time. From the pharma- teen pregnancies, and shows like ‗Teen Mom‘ andcist‘s perspective, there is the issue of offering the ‗16 and Pregnant‘ document it. Although this isproper medication counseling, for which our field definitely a very controversial subject, Plan B canis well qualified. Allowing adolescents the access remedy accidents, such as contraception failure,to Plan B (without age restrictions) would not on- and can keep these girls on the same track theyly deprive them of this vital person-to-person were on prior to the incident. It should ultimate-component, but it also increases the risk of medi- ly be the girl‘s decision, of course; as we havecation misuse that this demographic is already learned, Plan B is a safe method of emergencyprone to experiencing. Plan B is not devoid of contraception. I feel that it should be accessibleside effects, and when considering the young age to those who seek it.‖of this group, it is imperative that they know the SOURCES:correct dosing and instructions for effective con- 1. New York Times. Plan to Widen Availabilitytraception. Another issue I find with ‗restriction- of Morning-After Pill Is Rejected. Availablefree‘ / OTC Plan B is from the perspective of the online at: http://purchaser, who could translate the convenience www.nytimes.com/2011/12/08/health/policy/into lesser ramifications. This type of contracep- sebelius-overrules-fda-on-freer-sale-of-tion is a last resort and not like other OTC prod- emergency-contraceptives.html. Last Ac-ucts. With the fragility of this subject matter, cer- cessed on 1 Feb 2012.tain restrictions can help them evaluate their deci-sions more gravely and less haphazardly, and allowthem time to weigh their choices accordingly.Unintentional childbearing at that age not only

RHO CHI POST (RHOCHISTJ.ORG)EPIC SPELLS TROUBLE FOR MANY SENIORS BY: EBEY P. SOMAN (up to $320) and exceed the Part D limit of $2,930 to fall into the coverage gap. Some patients had EPIC listed as their primary insurance, and pharmacies billed EPIC as a primary plan. This has also changed, as these members are now required to obtain Medicare Part D insurance. Senior citizens who do not enroll in a Part D plan by the end of February (63 days after December 21, 2011) will receive a penalty in the form of an increased monthly premium. On aver- age, the monthly premium can increase by >1% for each month that the patient does not enroll in New York State‘s Elderly Pharmaceutical In- a Medicare Part D plan. Additionally, patients willsurance Coverage Program (EPIC) is a secondary need to pay the increased premium rate afterprescription insurance program for over 280,000 they obtain Part D coverage.income-eligible seniors aged 65 and older. Theprogram supplements members‘ out-of-pocket EPIC members have a Special Enrollment Pe-Medicare Part D drug plan costs. riod (SEP) to sign up for Medicare Part D. To avoid any penalties, they may contact EPIC and To be eligible for EPIC, the senior must be a receive assistance in selecting the most appropri-state resident with an annual income of less than ate plan. EPIC members who wish to switch$50,000 (if married) or less than $35,000 (if sin- their Part D plans may do so only once during thegle). Up until December 31, 2011, these patients 2012 year, with the exception of Medicare Ad-receive subsidized low-cost medication. The co- vantage members (who must contact their plan topayments ranged from $3.00 to $20, depending exercise this option).on the cost of the medication and the income cat-egory. Patients can obtain more details about this opportunity and other EPIC changes by calling the On January 1, 2012, many seniors who were toll-free EPIC service number 1-800-332-3742accustomed to the traditional EPIC coverage re- (TTY 1-800-290-9138) or the Spanish languageceived an unexpected new year‘s ―gift.‖ Many pa- service line by calling 1-800-332-3742.tients found that the cost of their medications hadincreased. This was primarily due to the huge SOURCES:budget cuts and program changes that went into 1. New York State Department of Health. Elder-effect the beginning of this year. ly Pharmaceutical Insurance Coverage (EPIC) EPIC currently covers medication copayments Program. Available online at: http://when the member is in the ―donut hole‖ or the www.health.ny.gov/health_care/epic/. Last ac-Medicare coverage gap. The program also pays cessed 1 Feb 2012.for medications excluded from Medicare Part D IMAGE SOURCE:coverage, such as benzodiazepines and barbitu- http://wskgnews.files.wordpress.com/2012/01/pill-rates. During this coverage gap period, the sen- bottle-by-madcowiv.jpgiors will see their familiar $3, $7, $15, or $20 co-payment amounts for their medications. To ob-tain EPIC‘s benefits, patients must pay a deductible

RHO CHI POST (RHOCHISTJ.ORG)ADAPTING TO THE CHANGING ROLES IN PHARMACY BY: KATE CROEGAERT, PHARM.D. CANDIDATE C/O 2013 Kate Croegaert is a PharmD Candi- changing; there are constantly new drug therapies date (Class of 2013) and the cur- and discoveries. Only a small portion of the rent President of the Rho Chi Delta knowledge that we obtain comes from our phar- Chapter at the University of Iowa macy education. The majority of our pharmaceu- College of Pharmacy. She believes tical knowledge comes from on-the-job training in the importance of advancing the and educational experiences, such as residencyprofession of pharmacy and promoting innovative programs and mentorship opportunities. As fu-practices within the profession. We would like to ture and current healthcare practitioners, wethank Associate Dean, Dr. Bernard Sorofman, for con- have the responsibility to remain up-to-date withnecting us to Mrs. Croegaert. the most current clinical guidelines and innova- The role of the pharmacist is undergoing sig- tions.nificant changes; the focus of pharmacy practice is So, how can a student pharmacist be success-shifting from dispensing medication to providing ful in these future roles and show commitment topatient-centered care. In the past, the volume of life-long learning? Well, assimilating into theseprescriptions filled has driven profits in pharmacy. new duties requires pharmacists to prove thatThis focus will evolve into a quality driven system, they are medication therapy experts. One canwith incentives for both doctors and pharmacists build a strong knowledge base and develop his ordetermined by the caliber of care that they pro- herself professionally by continuing education op-vide to patients. As the role of the pharmacist portunities, involvement in professional organiza-evolves, it is imperative for future practitioners to tions, residency experiences, and mentorship.embrace these new aspects of the profession and These types of professional development and life-to promote their progression. long learning display commitment to the profes- Along with a more value-based ideology, sion; they can help build trusting relationshipspharmacists will increase their integration with with other practitioners.the healthcare team. Past methods of practice An optimal opportunity for pharmacy stu-have segregated pharmacists from other dents to prepare themselves for future practice ishealthcare practitioners. This future care model to complete a residency program. Completion ofemphasizes multidisciplinary teamwork, where a pharmacy practice residency provides invaluablepharmacists will work with others to help provide learning opportunities. Residency programs allowthe best possible patient care. This type of part- the PharmD graduate to expand on clinicalnership will not only improve patient outcomes, knowledge and learn to pharmacy practice in abut will also help to prevent medication errors clinical setting. A general postgraduate year oneand medication side effects, as well as cut down (PGY-1) residency provides the opportunity toon healthcare costs. Pharmacists will play vital experience multiple types of pharmacy practice.roles in these synergistic relationships because of This helps the pharmacy resident develop passionthe profound therapeutic knowledge they can of- for specific areas of pharmacy. Not only does afer to promote patient care and safety. New in- residency program permit students to sharpensurance models will also help to foster the devel- pharmaceutical care skills, but it also opens op-opment of a collaborative environment. portunities in advanced practice settings. Com- Pharmacists must be devoted to continuous pletion of a PGY-1 residency can lead to the op-learning in order to excel in these current and portunity to complete a PGY-2 specialty residen-future roles. The pharmaceutical field is ever cy. Specialty residencies in areas such as oncology, pediatrics, or pharmacy management (among

V O LU M E I , I S S U E 5many others) allow pharmacists to focus on pre- pert requires a thorough understanding of differ-ferred areas. The detailed skills acquired in these ent topics, which challenges pharmacists to beresidencies prepare pharmacists to provide better ―on top of their game.‖ This type of mentorshipcare to patients and more effectively collaborate also provides new outlooks on topics or patientwith other medical professionals within the field. care strategies that were unrealized when work- Involvement in professional or state pharmacy ing alone.organizations is another way to be on the fore- There is no doubt the pharmacy profession isfront of professional changes. Being a member of evolving into a more patient-centered practice.these pharmacy organizations provides network- There will be greater focus on the value and qual-ing opportunities with colleagues and offers phar- ity of care, and partnerships with othermacists a voice in matters that affect their profes- healthcare practitioners will be vital. Acknowl-sion. In addition to providing pharmacists with edging these changes and adjusting to new rolesprofessional opportunities, these organizations will allow for greater professional success andallow pharmacists to utilize their knowledge and better patient care. Pharmacists have the excitingexperiences to advance their profession. opportunity to prepare for these changing roles Mentorship and continuing education oppor- through completion of a residency program, in-tunities prepare pharmacists for future career volvement in professional organizations, and col-roles. Teamwork with other healthcare practi- laboration and mentorship with other healthcaretioners not only promotes better patient care, but providers. These professional development op-also allows providers to learn from one another. portunities come with the responsibility to im-Working with another pharmacy or medical ex- prove one‘s skills through life-long learning.PUZZLE: CROSSWORD (SOLUTION) BY: MAHDIEH DANESH YAZDI

RHO CHI POST (RHOCHISTJ.ORG)STUDENT PHARMACIST STAR OF THE MONTH: YINING SHAO BY: MARIE HUANG Each month, Rho Chi Post has the wonderful ence organizations brought up the idea of ―Myopportunity to sit down with an inspiring leader Vascular Valentine.‖ I also learned that they holdamong the student pharmacists here at St. John‘s an annual Jeopardy game with various scienceUniversity College of Pharmacy and Allied Health topics. I am trying to have pharmacy organiza-Professions – someone who is not afraid to stand tions included in that event.apart from the crowd and can be the change heor she wants to see in the world. Q: Events targeted towards the general th This February, Yining Shao, a 4 year PharmD populace is a great way to bring the com-candidate and, as you know, the organization‘s munity together. However, one cannotPresident, speaks with us about the community run an event without any supporters. Howinvolvement, his inspiration, and studying abroad. would you instill motivation and encourage involvement in a student body that is com-Q: It is an honor to be here today with Rho posed of stressed peers and students onChis newly elected president. Tell us, how APPE rotations?do you see yourself changing the organiza- A: Well, since I am one of those stressed stu-tion for the better, and through what ways dents, I know how it feels. We are planning ourwill you reach out to the community of stu- events around all of our examination dates anddent pharmacists? preferably right after major exams. We believeA: I plan to expand the organization events to inthat students can use our events as tools to relaxvolve not only Rho Chi members but also all of and unwind after a Drugs & Diseases exam. Wethe other students on campus. In order to pro- also encourage students of other years, who arevide improved events, I am working with the Biol- less busy and stressed, to lend us some of theirogy Students Organization (BSO), the Roger Ba- energy and enthusiasm. In addition, our eventscon Scientific Honor Society, and other science- will be very interesting because they will involverelated organizations on campus. Currently we students in the fields that they are learning.are inviting children from the local community tocome to our campus and participate in an event Q: What has been the most rewarding mo-called ―My Vascular Valentine.‖ During this event, ment or project of your college career?we will teach the children about being ―heart A: While studying abroad, I experienced the mosthealthy.‖ rewarding moment of my college career; I had For more community involvement, I am also the opportunity to volunteer in a soup kitchen inplanning an event with Marie, the current presi- Rome. Speaking with the locals taught me ―alldent of Rho Chi at Long Island University (LIU). people are generally the same.‖ What I mean is that persons from any place, at any age, and ofQ: Are there any confirmed dates for these any race, all have their own struggles, beliefs, andevents? In addition, from working with the- dreams. When I keep this idea in mind, it helpsse science organizations, what new ideas me treat strangers, especially in my case, my pa-can you bring to Rho Chi? tients at the community pharmacy, with dignity and equality. I think that this is an especially im-A: We have the ―Coffeehouse Chats‖ event date portant lesson for persons in a healthcare profes-set for March 29, and on February 14, we will col- sion.laborate on ―My Vascular Valentine.‖ There areno official dates yet for the other events. The sci- Q: Who is the one person, besides your

V O LU M E I , I S S U E 5parents or family members, who has always Diseases courses into two, one-hour classes perserved as an inspiration to you? Moreover, day (rather than one, two-hour class). The earli-why? er class would be one focused on medicinalA: C. S. Lewis always inspires me. Growing up in chemistry and pharmacology, while the later onea Christian home, I have always had the Christian would be about physiology and therapeutics.values, but Lewis makes everything real for me. Professors would receive a template so that stu-When I read some of my favorite books by Lewis, dents would not have to adapt to each profes-things become clearer and more relevant to my sors questioning style. To help students practicelife: the state of heaven, good versus evil and hu- and understand the important elements, past ex-man suffering. These are just some of the im- ams would also be available to students.portant things that I often think about, and Lewishas some grasp in explaining such things in a way Q: Sounds like you have some great ideasthat I understand and can apply to my own life. brewing! Perhaps the administration can consider your D&D model in the future. IfQ: If you had not selected pharmacy or an- you could only have one meal to eat everyother health-related study, what profession day for the rest of your life, what would itwould you have chosen? be?A: I have always had a passion for music. I think I A: 梅干菜烧肉 - Mei gan cai shao rou. My grand-would want to be a symphony conductor. There parents always make it for me when I see them inis something about creating beautiful music and China.stirring emotions in a captive audience. I wouldstart conducting some classics and then, perhaps Q: Thanks for sitting down with us! It hasone day when I am famous, compose my own been a pleasure. Do you have any lastpiece. words for our readers? A: Remember what Confucius said: ―Choose aQ: Just for fun: if you, Yining Shao, suddenly job you love, and you will never have to work abecame the head of the department, what day in your life.‖are some of the changes that you would im-plement to the D&D courses for the class- If you have any additional questions for Mr.men who will be taking the modules start- Shao, you may contact him ating next semester? yining.shao08@stjohns.eduA: Hypothetically, I would separate the Drugs & Do you know an influential colleague with extraordinary accomplishments? Tell us at rhochis@gmail.com!

RHO CHI POST (RHOCHISTJ.ORG)PUZZLE: WORD SEARCH BY: MARIE HUANG H N N E O L P A A R I A P E E A A E P T E R I L A S E S N N I R I P S A R H C A N H R O A A H L I P L P N I O P E I E T A N O W I E N I R H P E N I P E N D E N O X A P A R I N R I A E P R R L D A D E L R N E D A I A G F O T D P P M L I N S N R G A I I P I N O O E E A R I N E M L A D I F L W E D I L T I A Z E M E S L H R I O I P L R P O FIND THE FOLLOWING WORDS: ASPIRIN HEPARIN CLOPIDOGREL EPINEPHRINE ATROPINE DILTIAZEM WARFARIN AMIODARONE ENOXAPARIN ALTEPLASE NOTICE A THEME?

V O LU M E I , I S S U E 5 THE RHO CHI POST EDITORIAL TEAM My name is Mohammad A. Rattu, My name is Mahdieh Danesh Yazdi, and I am a 6th year PharmD candi- and I am a 5th year PharmD candidate. I have had profound experi- date. I like to stay current with all ences with media-related positions the changes in our profession, both in pharmacy organizations at our legal and clinical. I hope to keep you university, and continue to support informed with all that I learn. Please the utilization of technology to fur- enjoy Rho Chi Post, and provide us ther our profession. As the current detailed feedback so that we mayEditor-in-Chief of Rho Chi Post, I hope to instill motiva- improve our newsletter. If you have any questions ortion and leadership in our student body. Feel free to get concerns, you can reach me at:in touch with me at: mohammad.rattu06@stjohns.edu mahdieh.daneshyazdi07@stjohns.edu My name is Marie Huang, and I am My name is Ebey P. Soman, and I a 5th year PharmD candidate. I am in am a 5th year PharmD candidate. I a continuous process of self- enjoy writing very opinionated arti- definition, and constantly testing the cles, and am excited to be an editor boundaries of this world. I enjoy of Rho Chi Post. I encourage all channeling my inspiration through readers of our newsletter (students, words and photographs. As a stu- faculty, professionals) to respond dent editor and a witness to an with their own literary pieces. Ievolving profession, I look forward to keeping you up- look forward to hearing from you, and welcome yourdated! Who knows where we will be tomorrow? You comments and constructive criticisms:can reach me at: mary.huang07@stjohns.edu ebey.soman07@stjohns.edu My name is Neal Shah, and I am a My name is Shannon Tellier and Im 5th year PharmD candidate. I fre- a 5th year PharmD candidate. I be- quently assist several professors on lieve it is extremely important for campus with their research. My goal pharmacy students and everyone is to provide my fellow students else in the profession to stay in- with research-based information that formed about current pharmacy correlates with clinical pharma- events. The Rho Chi Post is a great cotherapy. If you have any topics of way to stay informed and to contin-interest or comments on currently-published articles, ue learning about pharmacy information that is pertinentplease do not hesitate to email me at: to our campus and the nation. Feel free to contact meneal.shah07@stjohns.edu at: shannon.tellier07@stjohns.edu My name is Mohamed Dungersi, ? and I am a 5th year PharmD candidate. I am excited to continue the hard work put into this newsletter, Attention! We are looking for creative and especially since its inception during motivated students in the 4th and 5th my term as president last year. I am years of pharmacy school. If you are enthusiastic about promoting the interested in becoming a full-time pharmacy profession; what better student editor or would like more information about theway to do this than by being a part of the Rho Chi Post? responsibilities that the position entails, please contactShould you have any comments or concerns, feel free to us via email: rhochis@gmail.comcontact me at: mohamedjameel.dungersi07@stjohns.edu

RHO CHI CURRENT EXECUTIVE BOARD The Rho Chi Society encourages and rec-ognizes excellence in intellectual achievementand advocates critical inquiry in all aspects ofPharmacy. The Society further encourages highstandards of conduct and character and fos-ters fellowship among its members. Bethsy, Albana, Yining, Elizabeth, and Aleena at the 2012 Induction Ceremony The Society seeks universal recognition of President: Yining Shaoits members as lifelong intellectual leaders in Vice President: Albana AliliPharmacy, and as a community of scholars, to Secretary: Elizabeth Moinstill the desire to pursue intellectual excel- Treasurer: Aleena Cherian Historian: Bethsy Jacoblence and critical inquiry to advance the pro- Media Relations Coordinator: Mohammad A. Rattufession. Faculty Advisor: S. William Zito, PhD THE RHO CHI POST UPCOMING EVENTSMISSION Feb. 1st: PCOA Examination (MAR AUD, 5pm)The Rho Chi Post aims to promote the Pharmacy pro-fession through creativity and effective communication. Feb. 2nd: APhA-ASP GBM (SUL B-14, Common Hour)Our publication is a profound platform for integratingideas, opinions, and innovations from students, faculty, Feb. 6th: APhA-ASP Annual Meeting Q&A (SUL B-14, 2pm)and administrators. Feb. 7th: Local Pharmacist Security SummitVISIONThe Rho Chi Post is the most exciting and creative Feb. 13th: SGI Organization Congress (DAC 416, 3pm-5pm)student-operated newsletter within the St. Johns Uni-versity College of Pharmacy and Allied Health Profes- Feb. 14th: My Vascular Valentine (Bent 277B, 11am-1pm)sions. Our newsletter is known for its relatable anduseful content. Our editorial team members are rec- Feb. 27th - Mar. 3rd: Spring Breakognized for their excellence and professionalism. TheRho Chi Post sets the stage for the future of student- Mar. 8th: NYCSHP Pharmacy Student Roundtable Sessionrun publications in Pharmacy. (NYU, 6pm-8:30pm)VALUESOpportunity, Teamwork, Respect, ExcellenceGOALS Promote your event1. To provide the highest quality student-operated newsletter with accurate information through us!2. To maintain a healthy, respectful, challenging, and rewarding environment for student editors3. To cultivate sound relationships with other organi- Submit the name, location, and time zations and individuals who are like minded and of your venue to our editors at: involved in like pursuits rhochis@gmail.com4. To have a strong, positive impact on fellow students, faculty, and administrators5. To contribute ideas and innovations to the Phar- We welcome all pharmacy-related macy profession advertisements.

Rho Chi Post Vol 1, Issue 5

by Ebey Soman on Mar 19, 2012

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