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