June 15th

Rohypnol (aka Flunitrazepam/roofies/date rape drug) is available by Rx. It is a controlled substance and isn't commonly prescribed. But we did dispense it today...I really feel like there are other things they could be prescribing instead of the Rohypnol but I guess that's up to the doctor. But apparently the tablet has been reformulated so that if it is dissolved it will color the drink purple so that people will be able to tell if their drink has been spiked...which I guess is better than nothing but probably not so helpful if you have a purple colored mixed drink.

June 14th

Today I visited the pharmacy school at the "Royal College of Surgeons in Ireland." Classes were done for the summer so none of the students were at the school. I was given a tour of the facility--seeing the science labs, patient practicum labs, and lecture halls. Some of the lecture halls are absolutely beautiful--with old woodwork. I got the chance to browse their online "courseweb" equivalent. And I was given the opportunity to take some of their online quizzes for "fun." That didn't go so well considering my brain is on vacation, they use other units (ie mmol/L), and they have other drugs and other drug names.

Below is some of what I learned:

-The program here is 4 years + 1 year of internship = 5 years total

-It's not a doctorate degree like in the USA

-Each class only has ~50 students

-There's only 3 pharmacy schools in Ireland (2 in Dublin, 1 in Cork)

-There's no undergrad schooling--you go straight from college. You get accepted via points from your coursework. The administrator said that only about ~60% of the top students get placed in their top pick for area of study.

-Their final year includes an internship, online modules, and assignments

June 11, 2011

Today I went on a 1-day bus tour to Northern Ireland. We departed at 6:40 am (ugh really early) from Dublin city centre. We drove to Belfast and picked up more people there. The bus was completely full, so I sat next to a Western Australian guy that took the year off to travel. I was quite jealous of his travels and wish that I could just take a year off.

We made our first official stop at Carrick-a-rede were we had the chance to cross a rope bridge. The area was really beautiful and we really lucked out with the weather. Then we made our way to the Giant's Causeway. It was quite remarkable to think that the rock formation occurred naturally from volcanic lava...but it was fun to hear about the legend. The legend goes as follows (per the bus driver's version):

Finn McCool was a Irish warrior and one day he got into a big argument with a giant in Scotland. The distance was too great to swim, so he decided to build a causeway to get to Scotland to fight the giant. When he got there he realized that the giant was 2-3x his size so he ran back home to Ireland. He was scared of the other giant so he asked his wife what he should do. His wife dressed him up as a baby and left him on the bed. When Finn McCool didn't show up to fight the Scottish giant, the giant decided to come after Finn McCool at his home. The wife answered and invited the giant in for tea while he waited for Finn McCool to come home from work. While they were chatting the giant noticed the huge baby and inquired about him. The wife explained that it was Finn's baby. The giant immediately got scarred and ran for Scotland because he figured if that's the size of Finn McCool's baby, Finn McCool must be HUGE. So he ran across the causeway and destroyed it so that Finn McCool couldn't come after him.

After the Giant's Causeway, we made our way to Derry, also known as Londonderry, depending on what side you're on. Part's of the city are still loyal to England, which is evident by the British flags. We had a walking tour of the city along the city walls...which was interesting to hear about the conflict that occurred not that long ago.

Today I spent another day at UPMC Beacon Hospital. I came in at 8am (before the pharmacy actually opens) to observe a technician prepare chemo drugs. We had to dress in proper aseptic technique so I had to change into scrubs and remove all jewelry/makeup. Then we went into the clean room where the technician disinfected everything. There are 3 kinds of sprays they can use...1 for general cleaning, 1 for weekly cleaning that kills more bacteria, and 1 for monthly cleaning that also kills fungus. I've never inhaled so much cleaning product particles in my life... It took >1 hour for her to clean everything. Then she was finally ready to prepare 2 IV chemo bags. They use isolated chambers with negative pressure for the chemo, but they also have positive pressure chambers for other preparations. They do a lot of monoclonal antibody preparations but have also recently started to make some chemo drugs to keep costs down.

I spent a lot of the day with a pharmacist that deals with all the chemo and RA drugs. She spends a lot of time ordering medications for the patients. She also looks at patients' medication regimens and makes any comments/recommendations. She talked a lot about working in England--which she says was a lot more advanced in technology than in Ireland. And she said pharmacists had more of a proactive role in the hospitals there. The only real think the pharmacists can do clinically is switch PPIs (ie switching from pantoprazole to omeprazole to cut costs). One thing that struck me is that because the prescriptions aren't entered in electronically, the pharmacists often times do not check the prescriptions before the patient gets it...they just check it when they see it in the medication list and then can question it.

Ireland is definitely behind in innovating the hospital practice...Beacon is considered advanced so I'd be kind of interested to see things at one of the public hospitals

June 8th

Today I went to UPMC Beacon Hospital for the day. I spent the morning watching the technician fill the Pyxus machine. The Beacon Hospital is either the only or one of the only pharmacies in Ireland with one of these machines. For anyone that doesn't know what the machine is: they are computer controlled medication cabinets that are placed on different hospital wards. It keeps inventory counts after each dispensing/refill. It also allows for the tracking of who is opening/taking stock from the cabinets. That way it tracks inventory better and deters potential stealing.

I also helped count out some medications--for the few that come in bulk bottles instead of blister packaging. It was weird though because they don't have a counting tray like in the USA. Instead it is a metal triangle that you pour out the tablets on and then based on how many rows it forms you can see how many tablets are there. The only bad thing is that it really only works for round tablets and definitely not capsules.

In the afternoon, I observed one of the pharmacists on one of the wards. She takes their medication record and checks doses and writes down comments for the regimens. But after that, the rest of the afternoon was very slow...i put a couple of things away...stamped a bunch of invoices...and sat for a long time.

And the pharmacy isn't open on the weekends! Only Monday-Friday...I found this incredibly weird but I guess they have the pyxis machines on the wards...

The countryside is absolutely beautiful!

So this weekend I went on a 3-day bus tour of Southern Ireland. And it was AMAZING. The countryside was absolutely beautiful. I expected to see a lot of nice green fields but I was surprised with much more than that. The tour included a tour of Connemara, stops at Kylemore Abbey, Galway, Cliffs of Moher, Blarney Castle and Kilarney National Park, Burren, Rock of Dunamase. It was really beautiful and definitely worth the money.

June 2nd: Heat Wave hits!

So today the heat-wave that everyone has been talking about has hit. Everyone kept commenting on how hot it was...they even turned on the AC. So I decided to check the temperature online--it was 67'F. I asked my preceptor if this was "hot" and he said yeah that was quite hot. I laughed... especially when I told them how warm it's been in Pittsburgh. But the weather was really nice in comparison to the previous weeks. It was sunny with a nice breeze instead of intense wind :) I went for a run to St. Stephen's Green and there were so many people out on benches, on the lawn, and walking around. Everyone seemed so happy. Reminds me of Schenley Plaza in the summer.

Pharmacy stuff:

I've noticed some frustration between the pharmacist and doctors. From what I've observed, the doctor often writes for something that's not available or doesn't even take the patient's opinion into consideration. For example, the doctor initially wanted the pharmacist to crush up Augmentin 500/125 tablets and put it into a suspension of amoxicillin 250/5ml because he wanted a specific dosage of the amoxicillin. Finally he ended up changing it to an available Augmentin suspension...but not without causing frustration first. Another doctor wrote for 2 different suppositories to be used at the same time...which the patient preferred the tablet formulation of the one but the doctor didn't even want to consider it because he liked the suppositories better...but he's not the one that has to get up 4x/day to go insert it.

June 1st

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Non-Rx:

Family of Ducklings at the local shopping centre :)

Pharmacy Stuff:

-Promethazine syrup is OTC

-Pantoprazole is OTC, but omeprazole is RxOnly

May 31st

So the last several days have been pretty uneventful...

Saturday I went into town for a bit and did a little bit of shopping. In the afternoon I watched a rugby final between 2 rival Irish teams & the Champions League final between Manchester United and Barcelona. I've got to say rugby is a lot more interesting to watch on TV than American football is because it's faster paced.

Sunday I went for a run into the city...which allowed me to explore more of the surrounding neighborhoods. Elaine invited some friends over in the evening for dinner so I chatted with them about random things.

This week I'm at the Beacon Pharmacy, another of the Farmer's Pharmacies. It's located in Sandyford right next to the UPMC Beacon Hospital. It's located in a "mall" which really isn't a mall at all. The building itself is all glass and it's built in a very convoluted manner...since people can never seem to figure out where they are going. Many of the people that stop in the pharmacy are there to ask for directions. Since the recession hit, most of the offices are empty...so it's pretty deserted and uninviting.

The pharmacy doesn't do all that many prescriptions because it really depends on the amount of people coming to the clinics located in the "mall." Most of the prescriptions filled at the pharmacy are for IVF (in vitro fertilization) medications since there is a consultants office nearby. Apparently there isn't an actual clinic that does the IVF in Ireland. Patients have to go to London, Prague, Copenhagen, etc to go for the consultation/procedure and then just see a consultant in Dublin to get prescription refills for the meds.

I was talking with the pharmacist about insurance/medical visits. Gov't funded patients can see the doctor for free, but everyone else has to pay. To see a doctor for an appointment in Dublin, you'd have to generally pay ~60-70 Euros, but if it's a private place (like UPMC Beacon) it can be ~120 Euro. Citizens can apply for the Drug Payment Scheme (DPS) to get some prescription coverage. After the patient/family pays 120 Euro out-of-pocket every month, the scheme will pick up the rest. So generally the IVF patients have the DPS since the meds are really expensive.

Friday May 27th

Pharmacy Facts:

Plain diphenhydramine is not available here! The pharmacist couldn't remember why it was taken off the Irish market, but that it hasn't been available for years. But it can be found in some combination cold/flu products...So for allergies, they only have cetirizine, loratadine, and chlorpheniramine OTC. Fexofenadine is RxOnly and is not commonly used. I asked what they recommend as a sleep aid, and the pharmacist said they only have herbals like valerian root.

Also, today I saw some prescriptions from the dentist that I've never seen before... Metronidazole for gingivitis and diclofenac for dental pain.

May 25th: National Fish & Chips Day!

Today was National Fish and Chips Day so naturally I had my first fish & chips experience. The meal consisted of a large piece of fresh cod battered and fried with a side of fries. The meal was delicious, but quite greasy and quite filling. I definitely wouldn't be able to eat it everyday haha

I spent the day in a Dun Laoghaire methadone clinic. The building itself looks very ordinary and it's just called a "health clinic" so if I hadn't been told exactly where it was, I'd have no clue drug addicts were going there. The clinic is only open Monday-Friday since residents didn't want them open on the weekends...so most patients get a weekend supply of methadone. The clinic is open 8:45-12:45 for patients to get a dose of methadone and sometimes some other medications (antidepressants, sleep aids, multivitamins, etc). Some patients get a "take away" dose so that they only have to come in 3 times/week instead of everyday. The clinic deals with only a max of 100 patients at one time...so sometimes there can be a wait list.

When a patient comes in, they are asked by the pharmacist how they are doing, they can get a urine test to test for other opiods/BZDs/etc, and if they have a history of alcohol abuse they get a breathalyzer test. If they are under 0.08, they get their regular full dose. If it's above 0.08 and less than ~0.12 or 0.14 (can't remember), they get half the dose. If it's higher than that, they don't get any dose. If the patient doesn't come in for 3 consecutive days, they automatically get a lower dose. And if they want to get a higher dose, they need to see the doctor at the clinic. If they don't come in the proper days per week, they will be refused a weekend take-away dose.

In the afternoon, there is a shorter clinic that isn't open for general methadone services. It is reserved for those patients that are there to see the doctor or if they had special circumstances that they couldn't come in the morning. If a patient comes in the afternoon without an excused reason, they get a lower dose of methadone that their regular dose... For this reason, patients often try to make up excuses...but they don't allow for exceptions without documentation.

Because they dispense so much methadone, they order large bulk bottles of methadone (like the size of an antifreeze bottle). They also have pumps that can more accurately and quickly dispense out doses of methadone. I was curious if it had any specific taste, and one of the patients said it had a little bit of an odd taste but he couldn't link it to the taste of anything else. But it is a bit thick, so it can be hard to take down especially in higher doses.

A large proportion of the methadone patients at this clinic have alcohol abuse issues, so I got to see lots of breathalyzer tests and a lot of reduced doses. For the most part, the patients were calm and friendly. Many looked like they'd be addicts, but some looked so surprisingly normal...which was even more of a shock to me. It was also interesting to see the large range of dosing...some people were fine on 40 ml, while others were taking 120+ml. There were a couple of patients that caused a stir...which the pharmacists just deal with them frankly and go on with the day. I got to experience a few of those lovely patients.

According to the pharmacists, heroin use has definitely come down in Ireland...but it continues to be a problem since it's easy to come by. They also mentioned the there's another problem becoming popular (similar to the USA)--"HeadShop bath salts." People are using these in large doses and they are noticing that these people are becoming psychotic...often times being committed in the hospital for a while. For those with underlying psychotic diseases, it can aggravate it or trigger the development of their psychosis...Like in the States, they keep banning the substances, but manufacturers of the drugs just chemically alter it slightly so that it isn't illegal.

Overall, a very interesting day in the pharmacy.

Obama Arrives:Is féidir linn. Yes we can

Today I went to a different Farmer's Pharmacy--this one in Leopardstown Valley. The patient basis is different from the one in Dundrum in that it has a lot of kids and younger adults. Unfortunately it's a bit farther away so I got soaked in the blowing rain...and then the pharmacy was freezing because the door can't stay completely shut so the wind blows in...so that was an uncomfortable morning.

Obama arrived this morning...with a bit of an amusing incident. They were trying to leave the US Embassy to make their way to Moneygall in an armored car dubbed "The Beast." They didn't get passed the driveway when they got stuck when they drove over a metal spike...they couldn't get it off so they actually had to switch cars haha.

I was allowed to leave early in the hopes to get to College Green (located in the City Centre near Trinity College) to see Obama. Unfortunately, by the time I got there (~3:45) the line was ridiculously long (thousands and thousands, literally). I got in it anyways....and waited forever. After 1.5 hours of moving less than 100 yards, I kept hearing people on phones saying that they had reached max capacity (20,000+). We still continued to wait in the hopes of a miracle...that didn't happen. Instead they brought a few "BigTVs" for people in the streets...but I decided to go watch it in a restaurant. Didn't get the see it live but it was still really interesting to see people so excited to see Obama. Irish people were going crazy--wearing American sports logos, flags, painted faces, wearing and waving flags, etc. After watching the recap on the news, I realized I had no hope of getting in since people started lining up at ~4am.

100th RedBull Flugtag

May 22nd: RedBull Flugtag

Last night I spent some time chatting with Elaine and her friend about traveling and stuff. It amazes me how many places they've visited and it really makes me want to travel even more now. Elaine has been to so many places--Australia, Antarctica, Sri Lanka, New Zealand, Italy, Spain, etc. I really want to be able to do that after I graduate...

Last week I said Dun Laoghaire was REALLY windy. After today, I'd have to say that it's BEYOND windy. On the Dun Laoghaire Harbor, Red Bull was hosting the 100th Flugtag...So I thought it'd be cool to go and see the event. They let people in at 11:45am and the event was supposed to start at 1pm...During that wait time, it was so windy. Literally the strongest winds I've felt so far....the gusts were so strong that at times it was hard for me to breathe--a bit of the same feeling when I went skydiving. The wind made it feel way colder than it actually was, so everyone was freezing...and then in normal Dublin fashion it started to rain which made everything feel worse than ever. Then they decided to delay the event for another 45 minutes, so we had to wait even longer in the cold...so everyone was miserable. I wore decently warm clothes for the air temperature, but the wind just went through it...so I literally shivered for ~2 hours. And because the wind was so strong, I had to brace myself the entire time...so after 2 hours of waiting, I was sore/exhausted haha.Finally after the first 3 acts the weather cleared up a bit and the wind died down for a bit.

Leprechaun Museum

May 21st-Day of the Rapture

So obviously, knowing that today is the day of the Rapture, I started the morning by shopping for groceries to stock up for the coming week. Last week I decided to wait until Sunday evening...which was an awful mistake. Shelves were empty, the store was packed, and the lines were even longer...Thus, this morning was a much more relaxing shop.

After lunch I decided to explore more of the centre...which I keep discovering new streets and areas, so I will have more to explore in the coming weeks. There are so many stores and so many shoppers...the thing that kind of annoys me though is how similar things are to the USA--large shopping centers, full of many of the same stores. They even have a Forever 21. And when I went to H&M, they had many of the same displays as I saw in Pittsburgh. So that kind of disappoints me a bit. But oh well.

I also went to the National Leprechaun Museum! During the tour they talk about some of the Irish folklore--leprechauns, giants, and fairies. It was an interesting little tour. My favorite was the "Giants room" where there was extremely oversized furniture that you could climb up on. And it was interesting to hear about superstitions about fairies. Like there was a superstition that fairies would come to take baby boys and replace them with "changlings." If you suspected that your child was switched, you were supposed to throw the "changling" down a well and your baby was supposed to be returned back from where he was taken. Apparently they've found quite a few skeletal remains of babies from the past...

As I mentioned yesterday, my foot has been hurting more...which kind of sucks because I'm accustomed to my fast walking pace. Now walking with a slight limp is adding to my travel time...haha. I decided to buy an Ace bandage to see if wrapping it up will help give it support, so we'll see if that helps any.

Friday May 20th

Pharm Stuff:

I'm improving on filling prescriptions on the computer. I can now do many without asking for help... And I'm also becoming more comfortable using the register. One thing that is kind of tricky though is I can't always understand people when they speak even though it's English! I had an awkward moment with my preceptor when he asked me to get him a medication of the shelf. I thought he asked if we had it in the States. So I responded "Um No." He and another girl immediately looked up in shock (they thought I was refusing to get the med off the shelf). I immediately realized that I must of misheard him so got the medication. Um yeah... definitely would not say No to my preceptor haha.

Facts:

1) Naproxen is RxOnly in Ireland

2) They say GORD (instead of GERD) and Diarrhoea (instead of Diarrhea)

Non-Pharm:

Today I went into town again to see about bus tours. I booked one for the weekend of the 4th because I get a 3-day weekend since the 6th is a "Bank-holiday" so the pharmacy is closed. I'm really looking forward to that one since I'll be going to the South of Ireland...and will get a quick look at a lot of nice places. While in town I decided to get a more traditional meal--Gaelic Chicken--instead of fast/cheaper food. The meat and the pint of Guinness were delicious...not so much the tasteless boiled vegetables. But nonetheless, it was worth the extra money.

But...doing all of this walking over the past 2 weeks has taken a bit of a toll on my legs haha. I guess I'm getting old because now my knees and feet hurt...but no worries, I have plenty of NSAIDs.

May 18th

Today was the 2nd day of the Queen's visit. And I must say I cannot wait for her to leave already. All I hear about on the radio at the pharmacy is where she went, what she wore, who was there, etc...when really I could care less. The only kind of funny thing out of that was that someone held onto the Queen's hand a little too long after shaking it...so long that one of the security people had to tap his hand to let it go. haha that's embarrassing.

Tonight the Europa Cup Final between 2 Portuguese teams is being held in Aviva Stadium in Dublin. After the pharmacy, I went into town to walk around/explore some more. The centre was very crowded with Portuguese fans, many of which were clearly intoxicated haha. I considered watching the game in a pub, but they were all so packed that I gave up after 3 stops. Instead I'm enjoying the game from the comfort of my couch.

Pharmacy Stuff:

1) The pharmacy dispenses medical supplies like ostomy bags, catheters, even IUD's like Mirena which they then take to the doctor.

2) Ibuprofen gel is an available product. Diclofenac gel can be bought OTC. And diclofenac tablets are prescribed quite a bit more than ibuprofen and naproxen.

3) Herbal products are a lot bigger than in the States. Many of the products I've never even heard of...ie. Arnica for bruising...

Historic Day for Ireland: May 17th

The Queen of England arrived in Dublin today, the first time an English monarch has officially visited since Queen Victoria did a long time ago... This apparently has huge meaning because of the history of English occupation. The Queen will be staying in Ireland for 4 days...which is causing a disruption in Dublin (not so much for me since I'm a little removed from where she's staying) because they are shutting down numerous roads and highways. It was quoted that the security operation will cost ~30 million Euro! Over the last couple of weeks they've been doing sweeps of the city and monitoring activity of people that have been 'listed' in the past or have ties with groups like the IRA. They also searched all "man-holes" along the routes that the Queen was going to take. Police men from all over the country were being brought into Dublin for security. I think the amount of money they are spending is insane, but apparently the Queen is still a huge target for the IRA. And because this is such a historic gesture, it would be awful if something happens to her. I am curious though how they are paying for all of this since the country is pretty much bankrupt...

Next week Obama is coming to Dublin too!

Pharm Stuff:

1) Flonase is sold OTC (they call it Flixonase)...but only in 60 metered doses (the 120 dose=Rx Only).

2) They have limits on both acetaminophen and ibuprofen over the counter. You can only buy 24 tablets of acetaminophen and 48 tablets of ibuprofen. I guess this helps keep business up since you have to keep buying it.

May 16th

Pharm Fun:

1) At the pharmacy they prepare 7-day pill packs for some of their psychiatric or older patients because they can't manage their medications a month at a time. It's interesting to see them fill it out. It's designed like a little booklet with slots for morning, lunch, evening, and night. The pills go into clear plastic slots and then a cardboard-like booklet is stuck to it. The part covering the pills is foil, so the patient just punches it out for that dose.

2) Safety caps are recommended but not required. This isn't that big of an issue since most of the meds are in blister packs, but the vials they do have are all random--some safety, some not.

3) Instead of writing "take a half teaspoonful," they write "take a half 5ml spoonful."

Non-Pharm:

Today I learned about Travelers/Tinkers. These are terms to describe Irish gypsies... Apparently they date back to the Famine where people would be kicked off their land so they would just wander around homeless in their wagon (now a car). These people are known to steal things and there is really no prosecution for the theft. All a shop owner could do is yell and tell them to leave. The Travelers then take the stolen goods and go door to door selling things at reduced prices. They don't pay taxes, don't pay for things, but yet they still get aid from the government...

=

Week 1 complete: Sunday May 15th

Today marks me being in Dublin for a week. Another 5 weeks left to explore Ireland :)

I spent much of the morning reevaluating my money/spending situation as things are kind of expensive. I knew that things were going to cost more....but I guess I didn't think I'd lose quite so much in the money exchange. For $500, I only get about 340 Euro...which is a bit sad. After a week of not packing a lunch, I've realized that I can't afford it so I will be packing most days...at least thats the goal.

In the afternoon, Elaine (woman I live with) and I went to Dun Laoghaire (pronounced Dun Leary) which is located along the cost of Dublin. We walked along the pier which was quite beautiful but REALLY windy. I haven't experienced such a strong wind in a really long time. There were quite a few yachts on the harbor which Elaine says wasn't the case before the time of the "celtic tiger." That term is used to describe the economic period from the mid-90's to 2000s that saw a huge economic boom. According to Elaine, during this time banks were giving out loans to basically anybody for pretty much anything. So people borrowed money to pay for houses, cars, yachts, everything. Then things collapsed and people are finding themselves buried in huge debt without any way to pay it back.

Elaine's friend stopped by after dinner and we chatted a bit. It was interesting to hear about the Irish way of life and family issues. They also started the conversations about hospitals in Dublin which was a new topic for me. Because many of the hospitals are public hospitals there is an extremely long wait for procedures...which makes many people opt for the private hospitals like UPMC Beacon. We drove past the Beacon Hospital and I have to say it looks amazing from the outside. I've never seen a hospital that looked so nice. But anyways, another big problem in the hospitals is infection (ie. MRSA)...so some people look at infection scores to pick which hospital they want to go to. And patients often opt to leave the hospital earlier because it's safer to be at home than in the hospital...which I thought was a bit scary.

Out and About in Dublin: May 14th

(I'm not sure why this first half is hyperlinked...but don't know how to fix it and am too lazy to retype it all). I got up early today to take the Luas (light rail) into the main city centre. The Luas is so easy to use and so clean...compared to the lovely Pittsburgh buses. But I'll have to ride the Dublin bus to see how the buses are here

The centre is full of shops, restaurants, coffee shops, etc... It's a really cute area and it's nice to be able to enjoy nice weather while doing some shopping (not so nice when it rains though). I went on a "Hop-on-Hop-off" bus tour where you pay for the ticket and you get a audio-guided tour of the city. If you want to get off at one of the stops to see the location you can just catch the next bus when you're done. Unfortunately this morning was quite chilly and windy...so it was quite a cold ride sitting on the 2nd level of the double-decker convertible bus.

The only stop I got off at was the Guinness Storehouse. I got a tour of the place and a pint of Guiness. The brewing process is quite interesting--they went step-by-step explaining how they make their beer. They also had their marketing posters on display which I thought were quite cool. At the end you are taken to the top of the building where you have a great view of the city and you can enjoy your complementary pint. I've had Guinness in the States before and didn't really like it. But the beer today was great! I'll try it again when I'm back in Pittsburgh, but I'm sure it will never taste as good as from the storehouse.

Afterwards I hopped back onto the bus and continued the tour and learned some interesting facts like that the original MGM lion was born at the Dublin Zoo. After the tour ended I decided to walk around..get a little lost..and then finally asked for directions. I managed to wander off the boundary of my map...so there was no way knowing where I was haha. But it all worked out because I saw more of the city so no complaints about getting lost.

I stopped in a TkMaxx (note: not TJ Maxx)...but the same nonetheless. It was insanely crowded. Women were all over the racks and I barely got a chance to look around. It was really overwhelming so I left haha. I guess they don't see good deals very often.

In the evening I went to the Dundrum Cinema again with 2 girls, Marie and Claire, both of which work for Farmer's Pharmacy. It was nice to finally go somewhere with people my age :)

Everything is so green! Luckily that's my favorite color

Friday the 13th

Yesterday I got dinner at Yo Sushi! which was an interesting set up because you can pick food off of a conveyor belt and get as many things as you want. Each plate is a different color and each color corresponds to a price. It was definitely entertaining to watch the food go around...kind of like the luggage at baggage claim.

Today I went to McDonald's to compare it to that in the USA. I got the BigMac meal which was maybe better than I remember it...but smaller than I remember. The downside was that it cost 6.50 Euro= $9.75 which I think is just ridiculous. The one I went to was quite packed, so I guess it's quite popular here.

Apparently I live next to a mental hospital...and one that houses the criminally insane. That makes me feel great and safe haha. Luckily there's a giant wall surrounding the premises and the security is apparently really tough.

In Ireland, the 21st birthday is an important milestone. But when I asked a girl why, she couldn't give me a definite reason. She said it was tradition or maybe that's when you're really seen as an adult. I found this interesting because I can understand that in the USA it's when you can legally drink...but here I didn't think it'd be a big deal.

Pharm Stuff:

-I've noticed that there's a bunch of drugs that I've never heard of before...which makes me wonder if anyone ever tried to introduce them to the USA or if the FDA rejected for them for some reason.

-Controlled medications can be ordered with the regular drug order and you can even order it online and for a mid-day shipment.

-The emergency contraceptive pill was recently approved for OTC use in Ireland which has caused some controversy. But in order to get it, they need to be counseled on it and are given a information sheet...which is way more than we do in the USA.

Landmark Irish Trial Regarding Drinking

The verdict of a landmark trial came out today. A bartender and bar owner were being charged with manslaughter after they served a guy a pint of shots...the young guy was found dead the next morning. Apparently the guy was celebrating his 26th birthday at a hotel bar. He had already been drinking for hours when he was challenged to drink a pint of shots faster than his friends could drink their pints of beer. The bartender and owner agreed to serve the guy the pint of liquor and the guy proceeded to chug the pint. Later he was passing out and his friends carried him to a conference room and left him on his side while they got food. The next morning someone found him dead. The question of the case was whether bartenders should have any liability. According the to the judge, the men were acquitted because the victim had responsibility for his own actions. I'm not sure if I think the men should have been found guilty of manslaughter...but I do feel that they had the duty to say no to the guy when he requested a pint of liquor. After drinking for hours anything can seem like a good idea...the bartenders should have recognized that that was a ridiculous request which would have saved his life.

May 11th

Today was pretty uneventful...the pharmacy was dreadfully slow.

Things to mention:

There is a new diet craze called Lipotrim. It's all shakes based and you basically replace all meals with shakes for a while and then you have a "re-feed" period. You can get it at the pharmacy but you have to have weekly follow-ups with the staff. It's pretty awful in my opinion because they are basically starving themselves which is definitely unhealthy. The shakes look awful and the people doing it seem miserable.

Another thing is that they were amazed when I mentioned that we have bubble-gum flavored antibiotic suspensions. And when I told them we had other flavorings that we could add they were astonished. Here they only have berry flavor and banana...I would really be unhappy if I were stuck with the banana.

Non-Pharm:

Tonight I went to the movies to see "Something Borrowed." The seats were so much more comfortable than in the States and you had assigned seating. But it was a failure since it was so dark that I couldn't find my actual seat so I just sat wherever haha.

May 10th: Day 2

So today I realized that not all adapters are compatible with my computer cord...my adapter has 2 prongs while the computer cord has 3...which led to an unsuccessful hunt for a new adapter so that I could charge my dying computer. Fortunately, Elaine has a Mac and has the extension cord that can connect to my cord so I don't have to spend money buying a new adapter!

Things about Dundrum:

1) People really love using the phrases: your man (general term for the random person they are talking about), glorious or lovely (ie. dinner was glorious), & thanks a million. It's funny because even though they speak English, there are times I don't understand a thing people are talking about.

2) Irish people LOVE their tea. Staff at the pharmacy drink tea 2-3 times while I'm there.

3) It rains a lot...but generally it's light, random, and only for short periods.

4) They have a huge, beautiful mall that has escalator ramps so people can take carts/strollers up and down different floors.

Things from the pharmacy:

1) Regular prescriptions are only valid for 6 months after they are written & controls are only valid for 14 days.

2) Diabetic medication and testing supplies are free for patients...which is likely to become a problem for the government since Type II Diabetes is on the rise.

3) They develop passport photos at the pharmacy! They actually take the picture, format it, and print it up for the people. I cannot imagine that being part of my job at Giant Eagle.

4) Things aren't quite as electronic as in the USA. They have to submit all the paperwork/claims... which then they get a printout of the paid claims after the month is complete and they have to match it up to the submitted claims to look for any that were not paid for. This is a very tedious job. From what I saw though, they can fit all or most of their claims in one medium-sized paper bag...which is definitely not possible at Giant Eagle.

5) Even though there are 4 Farmer's Pharmacy locations, the pharmacy computers are NOT linked, so they cannot pull up patient profiles from the other pharmacies.

Day 1 of Rotation @ Farmer's Pharmacy

Farmer's Pharmacy is a family owned community pharmacy started in the 1940's. The pharmacy has 4 locations, 2 near my house and 2 that are further away.

It's about a 25 minute walk from my house to the pharmacy so that's pretty convenient. The pharmacy is not large and half of it's size is taken up by the store section that has OTC and personal hygiene products. Because Liam (my preceptor) owns the pharmacies, he often spends a lot of time floating between the various pharmacies. At this pharmacy there is 1 pharmacist, Tony, on staff and 2-3 other workers--one of which is a pharmacy intern. Here it's a bit different than in the USA. Here a pharmacy student doesn't work during school. Instead they do one full year working after school, after which they can take the exams necessary to become a pharmacist.

Compared to the pharmacy where I work, Farmer's Pharmacy is quite "slow." But for their standards they are pretty busy, at least compared to other pharmacies. Some things that I found interesting:

1) Tylenol + Coedine is sold over-the-counter. However, because people started to get addicted, they are no longer to keep it on display. If you want to buy it you have to ask for it specifically. But surprisingly, pseuoephedrine products are not regulated since meth is not a problem for them.

2) Almost all drugs come prepackaged in blister packs of 28, 30, 100. So there is very little counting. In fact they don't have a counting tray. Instead they have a scale that they use to count the tablets. It works by measuring the weight of 5 tablets and calibrating it so that it counts the weight of each tablet as one unit.

3) They can dispense methadone for addiction treatment. And they don't have tablets available, only liquid. (For those non-pharmacy people reading this, in the USA retail pharmacies can only dispense it for pain--it has to be specified for pain on the prescription). Addiction patients have to register with one doctor and one pharmacy and have an ID card made up. There's also special methadone prescription pads. The doctor can specify to dispense a bottle of it or can require the patient to get a supervised dose in the pharmacy everyday...which there is one patient that has that requirement because the doctor doesn't trust him to go home with it.

4) Apparently not many patients get opiods in general. When I asked about it the pharmacist said that generally most people only get it if they are on their deathbed...which I found interesting because I feel like in the USA we give it out like candy.

5) Most of the drug names are different from the USA...which makes it a game to see if I can guess what it is by the name of the medication. There's the general brand name that is the same as the USA (ie Augmentin=Augmentin) but there's also generic brand names (Valium=diazepam=Anxicalm).

May 8, 2011: Arrival to Dublin was quite interesting to say the least...

When I arrived in London for my connection to Dublin I had to go through UK immigration. When opening my passport the guy said so what brings you to Dublin. I didn't think much of the question so said "Visiting and a pharmacy rotation." A second later I realized that was a huge mistake. The man didn't understand what a rotation was and when I tried to explain it he assumed it was a general internship for which I needed a work visa. He asked for paperwork...which I had none. He finally gave me a 24 hour visa and said I would have to sort it out in Dublin. So for the next 6 hours of my layover all I could think of was how I was going to get out of this mess. I finally got to Dublin and I got to the Irish immigration place and the man immediately started to ask me what I was doing in Dublin, who I'm staying with (Elaine), how I know her (via email), how I know my preceptor (Liam) (via email/school). He didn't believe me when I said I wouldn't be "working" in the traditional sense. He asked me how I would support myself while in Dublin. Thank God my mom forced me to take cash instead of use my bank card because the guy was definitely taken aback by the wad I had in my wallet haha. He then insisted on calling Elaine and questioning her on what I would be doing there. He basically told her on the phone not to hold her breath for me to come into the country. He then was going to call Liam my preceptor but then asked me if I was getting any compensation while I was here. Clearly upset I responded "Absolutely Not! Not from Liam and nothing at all from Ireland!" He finally reluctantly stamped my passport and let me in. From there nothing interesting happend. Just took a bus from the airport to a hotel, where Elaine was there to drive me to her home.

Moral of the story for all the other students going to Dublin/abroad: You are there just to visit and absolutely nothing else.

The plane right before landing