Wednesday, November 14, 2007

I haven't written in a while

I admit, I've been lazy with keeping up this blog. I really haven't had much to write about. No new developments in my life. The pharmacy hasn't changed much. I don't really have any interesting stories or complaints.

I suppose I have made one pretty big realization about myself as a pharmacist in the last couple weeks. I never thought it would happen to me because I was an exceptional student, and I have an inquisitive mind. However, within the last month or so, I've realized that I've completely lost all interest in the clinical aspects of pharmacy. I'm starting to forget a lot of the things I've learned in school, and quite honestly, I couldn't care less. They're pretty much useless to me besides from showing other pharmacists how smart I am. I don't make any effort to learn the little details about new drugs coming to market. My mind is now on the business of pharmacy, which is something I never imagined.

Now, I want you all to know that I still care about my customers. I still care about their health, and I still go out of my way to help everyone, no matter how reprehensible they might be. I've just lost my interest in the science of pharmacy. Think about it, what new, original, and most importantly useful drugs have come out in the past couple years or are coming out in the near futuer? Nothing I can think of. Every drug that was supposed to rewrite drug therapy guidelines got canned. Ximelagatran was supposed to make warfarin therapy obselete... until it was shown to cause liver failure. Pfizer's torecetrapib (HDL raiser) was supposed to revolutionize the hyperlipidemia guidelines. The drug never made it to market.

I haven't really paid much attention to cancer or HIV drugs because I don't really see too many of them in my realm of practice. Perhaps great things are happening there. I have no idea. However, there haven't really been any major advancements in the treatment of your usual longterm illnesses (diabetes, hyperlipidemia, hypertension, etc.) in quite a long time. What came out recently? Januvia? I'm sure that's useful to some people who need an additional 0.6% lowering of their A1c, but it's not mindblowing in any way. Tekturna? It may be the first direct renin inhibitor, but as of right now, there's no reason whatsoever to use it instead of an ACE Inhibitor or an ARB.

Then, there's the "me too" drugs like Xyzal (levocetirizine). It's just the active isomer of Zyrtec (ceterizine). On a related note: Don't you love that cetirizine chain? First there was Atarax (hydroxyzine). The most actice metabolite of hydroxyzine is ceterizine (aka Zyrtec). Zyrtec is a racemic mixture, but the active isomer is levocetirizine (aka Xyzal). Can they specialize it anymore???

Let's not forget Vyvanse (lisdexamfetamine). Yes folks, it's another ADHD drug. Its developer, Shire Pharmaceuticals, is trying to say there's some evidence in a small trial that shows it may have less abuse potential than the other ADHD drugs, but it's still a CII.

It just seems like drug development for the prevelant longterm illnesses has stagnated, so I've lost all interest in learning about the new crap that's coming out. I've become much more interested in figuring out ways to run the pharmacy more efficiently. I've taken an interest in the financial issues of retail pharmacy because, let's face it, expanding the knowledgebase of your average retail pharmacist isn't going to ensure the survival of the profession. We have to figure out how to survive in an era of lower and lower reimbursements.

The more drug info that I forget, the better I get at my job. In a perfect world, would it be great if I could call up every physician that puts their elderly patients on amitriptyline and remind them that highly anticholinergic drugs in the elderly is a bad idea? Of course. In the real world, that'll get you nowhere fast. I've learned to just make sure that the amitriptyline we use is from the generic manufacturer that gives us the best deal.

Alright... I wrote a little more than I planned, but that's not a bad thing. I'll try to come up with new things to write about.


pharmacy girl said...

I know what you mean...I graduated pharmacy school in 2005 and I feel like there is so much I have forgotten. The other day I was explaining to my technician about creatinine clearance and was trying to remember the formula (140 - age???). There was a day when I could do it in my head. It would be nice if in pharmacy school they gave students a more realistic expectation of what their jobs will be like. It's not that clinical pharmacy isn't interesting to me anymore, there just isn't as much place for it in retail as I would like.

Pharmacy Mike said...

I think it's


I could be wrong though.

Daniel said...

Hey, I'm a 2nd year pharmacy student and we just went over creatinine clearance. You're referring to Cockroft and Gault's equation (most commonly used according to our therapeutic drug management prof.) It is

[(140-age) * Actual Body Weight] / 72 *SCr and that total is multiplied by .85 for a female.

The professor said that the distinction between ideal body weight and actual being used in this formula is debated as to clinical accuracy, so we just use actual body weight for simplicity unless some definitive study is performed.

Pharmacy Mike said...

That illustrates my point exactly. I couldn't remember the formula correctly, yet that in no way makes me any worse at my job than someone who could remember it.