Medication adherence has long been an issue that is negatively impacting the health of our patients. With the evolution of technology, it is only appropriate that a "smart" product be at the frontlines helping improve medication non-adherence rates amongst our population. Under the American Heart Association and American Stroke Association, a study was completed to show the impact medication non-adherence can have on the health of many patients and costs for the hospitals. A correlation was established to demonstrate that medication adherence helped improve patient outcomes, resulting in less frequent hospitalizations; thus leading to reduced health care spending. Non-adherence is not as simple as taking a pill, there are many factors that can contribute such as adverse effects, costs, lack of belief, forgetful, busy lifestyle, health literacy, language barriers, etc. At the same time, the development of the "Smart bottle" to help improve medication adherence rates has paved the way to potentially benefit all parties involved [Patient, Pharmacy, Manufacturer]. With the embedded technology, patients will be able to better manage their health and the pharmacy will have increased profits with consistent usage from the patients. To add, if it is a new drug with limited data on efficacy and use, the pharmacy dispensing the medication with the "smart bottle" will be able to provide the collected information per patient usage. Moving forward, the Smart bottle feature is a product that is looking to make its way into all patients' homes and help improve medication use across the boards.
Proton pump inhibitors (PPI) are among some of the most commonly prescribed medications. Additionally, they are also available for purchase over the counter (Nexium, Prilosec, Prevacid), which makes them easily accessible to the public. Many also assume that this medication is seemingly harmless, but like all medications, PPIs have some major adverse effects and interactions that everyone should be aware of.
One of the main adverse effects of PPI is the decreased absorption of vitamins and minerals. PPIs can prevent absorption of vitamin B12 and vitamin C leading to deficiencies. More importantly, long-term use can also decrease absorption of calcium and magnesium leading to increase fracture risk and hypomagnesaemia. Additionally, different drugs can also have an interaction and not be absorbed, which can lead to treatment failure. It is important for pharmacists to inform the patient about the drugs, vitamins, and minerals that can interact with PPIs.
PPIs can also affect metabolism of medications, therefore pharmacists should be observant if the patient is on any drugs with a narrow therapeutic window. Medications such as warfarin, diazepam, phenytoin, and clopidogrel are all medications that can be affected by PPIs. Ultimately, it is the pharmacists’ role to educate patients’ about these potential interactions so that they can be avoided.
Congratulations to the 2018 Post-Docs for the completion of their residency or fellowship (Program Director):
Dr. Elizabeth Akhparyan (Dr. Janice Hoffman)
Dr. Nancy Dao (Dr. Micah Hata)
Dr. Sun Lee (Dr. Anandi Law)
Dr. Yang Qiu (Dr. Mark Nguyen)
Dr. Kayla Uh (Dr. Emmanuelle Schwartzman)
Congratulations to the new Post-Docs starting July 1, 2018:
Dr. Neehoufar Fakoufar from UCSD (Dr. Emmanuelle Schwartzman)
Dr. Kelli Shiroma from WesternU (Dr. Mark Nguyen)
Dr. Arutyun Sarkissian from CSU Northridge (Dr. Janice Hoffman)
Dr. An Chau from Chapman (Dr. Micah Hata)
Dr. Aya Fukuma Ozaki from WesternU (Dr Cynthia Jackevicius)
Dr. Dimitri Delecry from University of Florida (Dr. JaeJin An & Dr. Quang Le)
Dr. David Essie from State University of New York, Buffalo (Dr. Anandi Law)
Penelope Nwaukwa is WesternU's first Health Career Connection (HCC) summer intern. HCC is a program that encourages undergraduate and recent graduate students to successfully choose and pursue the health career that is best suited for them. This is done by carefully paring students with organizations that best fit the student's interests, talents, and future career aspirations. These organizations will then provide the HCC interns with mentors, exposure, and real world experience. Penelope was paired with Western U because of her interest in pharmacy, public health, and community outreach. Penelope is a recent graduate from the University of California, Riverside where she received her B.S. in Neuroscience. As an undergrad she was a pharmacy volunteer for Riverside Free Clinic, a student-run health clinic that provided health care services and medication to the underserved population of Riverside. During her internship she hopes to continue to expand her knowledge about pharmacy and help improve the health of underserved communities all across Southern California.
The WesternU College of Pharmacy welcomed their new intern Penelope Nwaukwa with a breakfast reception on June 25, 2018. She will be here until August 31, 2018. During her internship she will be participating in health fairs, clinical job shadowing, public speaking, research activities, informational interviews and community outreach events.
Posted by Penelope Nwaukwa and Sam Shimomura, PharmD
Heartburn is defined as the acidic contents of the stomach coming back into the esophagus causing an uncomfortable feeling of burning and warmth near the chest region. Per the National Institute of Diabetes and Digestive and Kidney Diseases, roughly 20% of the United States population is affected. Heartburn is also known as acid reflux, acid indigestion, acid regurgitation. An individual has a higher likelihood to developing heartburn if they present with the following risk factors: overweight/obese, pregnant, smoker, stress, etc. It is important to recognize the symptoms of heartburn early on and treat it appropriately. If left untreated it can cause serious complications over time and become difficult to treat in the near future.
The following is a case example of heartburn:
A mom stopped by the pharmacy to ask for a recommendation for her healthy 15 years old daughter who experiences burning sensation in the stomach with regurgitation started 3 days ago. Her final exams are coming up so she has been drinking coffee daily. She noticed that the symptoms got worse every time she had coffee. Mom got her Tums (calcium carbonate) but the symptoms relief didn’t last long. She doesn’t have any food or drug allergies. She’s not taking any prescription or supplements. She has put on some weight because she loves eating fast foods.
Headaches are a commonly treated condition in Urgent Care and Emergency rooms. In a study done in 2003, it is estimated that anywhere between $650 million to $1.94 billion is spent annually on ER bills for headaches. Pharmacists can help cut costs by recommending over the counter self-care products when applicable. By recognizing the signs of tension, migraine, and sinus headaches, pharmacists can recommend an appropriate over the counter abortive regimen and reduce health care costs.
Tension headaches generally affect the forehead area. The pain is bilateral and like a band squeezing the head. Patients who experience onset of tension headache without prior history meet the criteria for self-care and can be treated effectively with acetaminophen or NSAIDS.
Migraines differ from tension headaches as the pain can be unilateral or bilateral. Patients often experience an aura prior to migraine attack where visual changes are reported. Additionally, migraines can cause nausea. When evaluating migraines for self-care pharmacists should consider frequency (less than 2x a week) as criteria for self-care. Also note whether the patient has attempted any prior therapy. Patients who have failed OTC regimens or who have frequent migraines are candidates for referral.
Sinus headaches are caused by congestion and are accompanied by pressure near the forehead or cheekbones. Pressure makes these areas tender to palpation. Patients with sinus headaches are candidates for self-care if they do not present with any pressing signs of infection. Patients who have fever, malaise, extended
duration of the symptoms should be referred. If patient is a candidate for self-care, recommend acetaminophen or NSAIDS for abortive therapy as well as pseudoephedrine as a decongestant.
Acetaminophen or NSAIDS (Ibuprofen & Naproxen Sodium) should be the first OTC abortive analgesics recommended. Doses of 1000mg acetaminophen every 8 hours, ibuprofen 200mg every 6 hours, and 220mg naproxen sodium every 12 hours have similar analgesic relief. While aspirin can also be used as an analgesic for headaches, the dose needed is associated with toxic effects and therefore not recommended for headache.
When choosing between acetaminophen and NSAIDS, consider their respective black box warnings. Acetaminophen is hepatotoxic at high doses exceeding 4 grams and should be avoided in cirrhotic patients. NSAIDS have 2 black box warnings of increased risk of cardiac events and risk of damage to the GI mucosa. Treatment with NSAIDs should be avoided in patients with CVD (high cardiac event risk) and patients with increased risk of stomach bleed. Aside from the high risk patients mentioned above, acetaminophen or NSAIDs can be used with equal efficacy in treating headache.
The Commencement Ceremony for the WesternU Colleges of Dental Medicine and Pharmacy on May 23, 2018 started 3 days of Commencement Ceremonies for WesternU graduates. Once the faculty and graduates had entered the auditorium, the national anthem was beautifully sung by vocalist Tricia Tahara-Stoller, PharmD Candidate 2020. An honorary degree was conferred on Stanley M. Bergman, Chairman and CEO of Henry Schein, Inc., the largest provider of health care products and services to dental, animal health, pharmacy and medical practitioners. He then gave a very inspiring commencement address and quoted Robert F. Kennedy "Some people see things the way they are ask why. I dream of things that never were and ask, why not."
The alumni association welcome was given by Dennis Anchetta, PharmD 2013 and the the Oath of the a Pharmacist was administered by Emmanuelle Schwartzman, PharmD, BCACP, CDE, Associate Professor of Pharmacy Practice and Administration. As always, the highlight of the afternoon was the presentation of the diplomas and the family hooding.
The WesternU College of Pharmacy Class of 2018 celebrated at their Commencement Dinner on May 22, 2018 at the Pasadena Conference Center. The highlight of the evening was the class speaker, Kevin Mai who gave an excellent speak which included a poem/rap. In addition, there was a toast to the class of 2018 by Dean Robinson, presentations of awards and dancing. The Class of 2018 also wanted to thank the parents, spouses and significant others and children of the the Class of 2018 for their support, dedication and sacrifice. The evening was supported in part by the California Pharmacists Association and McKesson.
Dr. Ben Malcolm gave an excellent introduction to Psychiatric Pharmacy practice to the Noon Elective Seminar class. Dr. Malcolm is an Assistant Professor of Pharmacy Practice at the WesternU College of Pharmacy. A couple of reflections by students in the class are posted below:
Reflection: Justin Nam, PharmD Candidate
On May 16th, Dr. Malcolm came to talk to us about psychiatric pharmacy and explained how mental illness can be a chronic disease, and explained what psychiatric pharmacy is all about. He went on to explain the many different kinds of pros and cons of the field. Especially the fact that the patients are underserved and stigmatized due to their conditions. He explained his own struggles he has gone through, and explained that these struggles are opportunities to grow. He went into more detail about the stigmas that those who suffer from mental illness have. He explained how the cause of this could be because of lack of understanding from both parties involved, and the difficulty of getting help. He also told us where psychiatric pharmacists can practice, and some that I was interested in were academia, prison, and long term care. Then he explained what they do during practice, which was a lot of monitoring, and educating patients. He also explained how to become a psychiatric pharmacist, and stressed to do it because you are interested in it, not because of money or because others tell you to do it.
Reflection#2: Larissa Navarro, PharmD Candidate
This seminar has brought to light the more needed attention psychiatry
medications should have. Chronic diseases like hypertension and high cholesterol
are very highlighted and focused on in the drug world. But medications for mental
health should be highlighted just as much because psychiatric diseases are chronic
and very common as well. The seminar has also reinforced the stigma surrounding
mental health. Again, this seminar has shown me more options on what a pharmacists can specialize in. Psychiatric pharmacists work anywhere from chemical dependencies
and hospitals to long-term cares facilities. Their duties may include optimizing drug therapy, educating others, monitoring efficacy, etc. I can get more information about
being a psych pharmacist by joining CPNP and taking a psych elective. Now I am
interested in taking the Essential Oils and Therapeutic Uses of Illicit Substances
elective courses. Overall this seminar has gotten me interested in seeking a specialty
in psychiatry as a pharmacist.
The College of Pharmacy held its 19th Annual Poster Day on May 10, 2018. Graduating seniors are given the opportunity to display their Advanced Elective research projects or business plan projects (Independent Ownership track). This year 108 posters were on display. Each poster was graded and judged by faculty and resident reviewers.