Saturday, March 10, 2007

This is baddd

Too tired to post yesterday after deciding to stay the whole stretch of the NSU open house on Saturday. I went for every open house since year 2 - hoping to open the eyes of my future juniors.

More often than not, prospective students will put their choices as such - Medicine, Dentistry, Pharmacy - nursing not counted in yet as it is in its infancy and I personally feel that the course should be exploited more by the Nurs Dip. students.

(Just to add on, I do not know if the centre head for nursing knows that the striping on the missy uniforms [orange one blue on white] machiam looks like it had been cut from the pharmacology department's lab coats)

Many students who wanted to come into pharmacy thinking it was a branch of life science (harrrooozzzz we a lot older dept than life science) and there are bridging courses available. The sad thing is not - we need BOTH bio and chem A-levels (H2) as you'll be thrown into the higher levels of biology and organic chem from day 1. No slacking allowed. We are not a branch of life science or a mere biological discipline - we are a profession degree course catered to improve the lives of patients' through proper use of drugs.

I would like to appeal to the healthcare professionals in Singapore - PLEASE HAVE A SCHOOL / FACULTY OF HEALTH SCIENCES - Pharmacy, dentistry, nursing, medicine and other auxcillary health science instead of one faculty of medicine, one under science and another dentistry (punny cohort) - very confusing leh.

Some students want to apply for the course but they are very uncertain about the profession. Perhaps having being moulded by family, friends or black sheep, they come to believe that pharmacists are mere storekeepers of drugs and medicine packers. I had a hard time explaining to 2 potential students who have the misconception of pharmacists standing behind picking and packing - for that we have the help of PTs - Pharmacy Technicians.

I always remember the words of my idol - "Whenever you do something in the pharmacy, trying to think whether this is what you should be doing. If your pharmacy is very busy and there is a backload of scripts to pack, just help out -but remember to ask yourself if you should be just packing medicines. Your place is in front of the pharmacy helping patients and providing them pharmaceutical care."

Pharmaceutical care is something very foreign concept to the local healthcare professionals - a lot of them (may include some of my own kind) do not know how to place pharmacists. Bulk of the patient's bill often comes from taking medication and some patients are resistant to taking something foreign into their body - this places us in possible bad light. The amount of money a pharmacy handles can be a crazy sum, but we are not money guzzlers - we are there to help the patient get well in the best possible manner.

Let's look at the definition of Pharmaceutical care:

"Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life . \

These outcomes are:
(i) cure of a disease
(ii) elimination or reduction of a patient's symptomatology
(iii) arresting or slowing of a disease process or
(iv) preventing a disease or symptomatology.

Pharmaceutical care involves the process through which a pharmacist cooperates with a patient and other professionals in designing, implementing, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient.

This in turn involves three major functions:
(i) identifying potential and actual drug-related problems
(ii) resolving actual drug-related problems
(iii) preventing drug-related problems.

Pharmaceutical care is a necessary element of health care and should be integrated with other elements. Pharmaceutical care is, however, provided for the direct benefit of the patient, and the pharmacist is responsible directly to the patient for the quality of that care. The fundamental relationship in pharmaceutical care is a mutually beneficial exchange in which the patient grants authority to the provider, and the provider gives competence and commitment (accept responsibility) to the patient.The fundamental goals, processes, and relationships of pharmaceutical care exist regardless of practice setting."
-Helper, D.D. & Strand, L.M., Opportunities and Responsibilities in Pharmaceutical Care, Am.J. Pharm.Educ., 53, 7S-15S(1989).

PS, those going for discretionary interviews - please know the profession - it will also help you on in a better path in life. The profession may not be what you want to be in. Alternatives are out there as well. We are looking for people who can bring the profession forward, not a step back.

You get mixed reactions when you hand out procedures - some "eee"s, some "no thanks. Oh pharmacy ar?! i wan", then there are some (especially the Caucasians) who go, "Oh! Pharmacy." May be it could be because of my monstrous face that should be buried in the depths of the ground never to be seen ever or something. For some reason, I was only one giving out fliers at the front end while most of the people are clustered in the booth squeezed right at the corner. Hmmm, can we like get some pretty ladies or handsome guys out to give fliers out. May be because of out triple serving of tests this week that made everyone stay at home? Tests fly by all the time - just take it in stride.

I supposed some already had made their decision to join the healthcare sector and decided not to come for the open house. But then they would follow the usual ranking, wipe out all those with not so good grades by placing pharmacy as their 3rd choice and decide to fume when they got their 3rd choice. I think there is a need to come out with an algorithm to make selfish people suffer !!! I'm one of the few people who placed pharmacy as my first choice and medicine at the bottom just to fill out the blanks >.<. How about the others who feel strongly about the profession by don't make the cut because the straight As-ers put pharmacy as 3rd? Unfair hor? In the end they cause the shrinkage of the co-hort by flying off overseas or appealing to get into medicine =.= Really chian bian.

What differentiates us from Life Science, Medicine, Nursing grads? Let's take a drug like liposomal doxorubicin:

Doctors - Know on who to use, when to use, roughly how much to use
Nurses - Know how to administer
Life scientists - research, manufacture, molecular make-up
Pharmacist - should have the knowledge of all the above (albeit the hands-on bit), accurate dosing, manufacture, storage, stability, interaction and accurate dosing in certain age groups and co-morbidities - we are usually the ones carrying calculators and PK is something unique to us that we should embrace.

Even as a pharmaceutical rep, compared to sales reps who hold other degrees, they are able to use jargon and be on par with doctors and fellow pharmacists. They would also be able to explain better on use, interaction, storage and even medicinal chemistry of the product they are selling.

So, incoming juniors, choose your poison carefully.

Friday, March 09, 2007

Little Britain Abroad

In Thailand, just north of Shetland (Tie land just north of shirt land)



Dawn French is sooo good

YYY Why public TV in SG dun have such good BBC comedies X_x

Unflasking Cattleya walkeriana Part I - the break up.

A method for skyrise people with LOS (lack of space).

Bought this flask from Ching Hua Orchids (Taiwan) during the Singapore Orchid Show in conjunction with the Singapore Garden Festival 2006. Gao peh peh helped me reserve this flask which I made pre-orders ^^.

Here is one of the methods I use for unflasking these babies

Lay newspaper around to capture any glass shards or splinters that result. Also to keep any falling potting / mounting media from spilling around.

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Wrap flask in newspaper and use a striking tool - some people use hammers, I prefer a pair of convenient and versatile pliers:

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Remember to lift the flask when you strike at about 2 cm above the base - if you press the flask down onto the surface of the table top, you may cause the top of the flask to collapse onto the seedlings. There will be cause increased mortality. To decrease the chances of this happening, lift the flask up before striking. Hold the flask wrapped in newspaper firmly around the rim of the flask and give a quick hard strike. The base of the flask should drop down.

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The rest is the base coming off and acting as a plate for to hold the seedlings.

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Tip out the seedlings into a basin of water - you may wish to add pesticide or fungcide or an antiseptic if required or if you wish to. This is to wash off any of the fine glass splinters. The pesticides is for prophylatic treatment against pests that are interested in the tender shoots. The fungicide and antiseptics can be use for prophlaxis or to treat the seedlings whenever there is contamination in the flask.



After rinising and soaking, sort the seedlings accordance to size - make your own judgement. You may want to grow the smaller ones in a community setting and the bigger ones individually.

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For me, the bigger seedlings are those with visible pseudobulbs - the young ones usually consist of just a bunch of leaves.

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NUS OPEN HOUSE

COME COME COME

Click here for more

Saturday and Sunday 10th March - 11th march 2007.

Pharmacy specialities

Pharmacy Specialties

BPS has recognized five specialty practice areas: nuclear pharmacy (1978), nutrition support pharmacy (1988), pharmacotherapy (1988), psychiatric pharmacy (1992), and oncology pharmacy (1996). The table accompanying this package illustrates the growth in numbers of BPS-certified specialists in each specialty.

Nuclear Pharmacy seeks to improve and promote public health through the safe and effective use of radioactive drugs for diagnosis and therapy. A nuclear pharmacist, as a member of the nuclear medicine team, specializes in procurement, compounding, quality assurance, dispensing, distribution, and development of radiopharmaceuticals. In addition, the nuclear pharmacist monitors patient outcomes and provides information and consultation regarding health and safety issues.

Nutrition Support Pharmacy addresses the care of patients who receive specialized parenteral or enteral nutrition. The nutrition support pharmacist has responsibility for promoting maintenance and/or restoration of optimal nutritional status, designing and modifying treatment according to the needs of the patient. These specialists have responsibility for direct patient care and often function as members of a multidisciplinary nutrition support team.

Oncology Pharmacy addresses the pharmaceutical care of patients with cancer. The oncology pharmacist specialist promotes optimal care of patients with various malignant diseases and their complications. These specialists are closely involved in: recognition, management, and prevention of unique morbidities associated with cancer and cancer treatment; recognition of the balance between improved survival and quality of life as primary outcome indicators; and provision of safeguards against drug misadventures in a treatment area where novel and experimental drug therapies are frequently employed.

Pharmacotherapy is that area of pharmacy responsible for ensuring the safe, appropriate and economical use of drugs in patient care. The pharmacotherapy specialist has responsibility for direct patient care, often functions as a member of a multidisciplinary treatment team, may conduct clinical research, and is frequently a primary source of drug information for other health care professionals.

Psychiatric Pharmacy addresses the pharmaceutical care of patients with psychiatric disorders. As a member of a multidisciplinary treatment team, the psychiatric pharmacist specialist is often responsible for optimizing drug treatment and patient care by conducting patient assessments, recommending appropriate treatment plans, monitoring patient response, and recognizing drug-induced problems.

Read more

I wonder when they will have PK specialist for those who are renally and hepatically impaired as well as those from extreme age groups.

Wednesday, March 07, 2007

Sophronitis cernua

All the palm-sized beauties:

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The small one is var. minerva. Very sianz - all my Brazilian imports still hibernating. Zzzz

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Bud Bud - like peas in a half opened pod hor?

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Reminder to self

"We are not out there just to tell patients ji zgi sa bai, sa liap ji bai, as pharmacists we supposed to do more" - wise words of the only local male BCPP (Board Certified Pyschiatric Pharmacist) in Singapore.

Today was counselling session - pharmacist do not just blapper the name and instructions for meds to patients - if like that, our training can just pour down the drain. Given the opportunity we should do more. Opportunity begets opportunities - more you value-add to the patients' drug therapy, more would they want to seek help and advice from you. Got to let the doctor rest hor =p.

Other reminders - Anti-coag can take with Anti-platelet (according to guidelines) since there are 2 different mechanisms of action. But then antiplatelet's order (safety considerations and patient's profile withstanding) should be aspirin, clopidogrel then ticlopidine.
The following format is advisable for medical hamper scripts:

1. Explain every drug in detail
2. Ask if there are any questions
3. Summarise and simplify dosage and regime

Classic signs and symptoms of metabolic syndrome:
1. Obese
2. high LDL and TG
3. Low HDL
4. Poor glucose control
5. HTN

H2 blockers also given to prevent GI bleeding during anticoag therapy

Q1W dosing of alendronate 70mg produces less GI effects than QD dosing alendronate 10mg
It is advisable to bring the patient down to the shop floor to explain supplements (e.g. calcium supplements) in detail so that the patient understands better when needed.
Vit D supplement needed for those people who are housebound, do not see much of the sun - since cannot auto synthesis.
Alendronate to be taken 2 hours after last intake of med or food. Best method is as follows:
Take alendronate first thing when you wake up with a full glass of water (nothing else- the rest will interfere with alendronate absorption). Stay upright for 30min before you take anything else - in the mean time can go walk walk, etc.


Remember to write in full as possible e.g. supp = supplement or suppository - calcium suppository anyone?

Digoxin increases ejection fraction not ejeculation fraction.

Chemotherapy induced nausea and vomitting (CINV) comes in 3 types - anticipatory, acute and delayed.
Acute use a sedative, e.g. lorazepam. Loarazepam can also cause amnesia which may help forget the previous noxious effects leading to vomitting.
Acute CINV is usually given prophylaxis or just before the chemo itself.
Delayed CINV is treated for 5-7 days post chemotherapy
Aprepitant is only approved for cisplatin -containing regimes. (120mg, 80mg, 80 mg)

My wishlist list ^^

Pharmacy Books:

Aulton's Pharmaceutics: The Design and Manufacture of Medicines (Paperback)
by Michael E. Aulton (Author)


Theory and Practice of Contemporary Pharmaceutics (Hardcover) by Tapash K. Ghosh (Editor), Bhaskara R. Jasti (Editor)

Modern Pharmaceutics (Drugs & the Pharmaceutical Sciences, 121) (Hardcover) by Gilbert S. Banker (Editor), Christopher Rhodes (Editor)

Compounding Sterile Preparations (Paperback) by Phillip S. Schneider (Author)

Pharmaceutical Compounding And Dispensing (Includes video clips CD-ROM) (Paperback) by John F. Marriott (Author), Keith A. Wilson (Author), Christopher A. Langley (Author), Dawn Belcher (Author)

Orchid Books

BIRK, Lance Paphiopedilum Grower's Manual 2nd ed

BEAMAN, Teofila E.; WOOD, Jeffrey J.; BEAMAN, Reed S. and BEAMAN, John .H. Orchids of Sarawak

BRAEM, Dr. Guido and CHIRON, Guy Paphiopedilum

CHEEK, M. and JEBB, M. Flora Malesiana - Nepenthaceae

CRIBB, Phillip The Genus Paphiopedilum (2nd edition)

DIXON, Kingsley; KELL,Shelagh; BARRETT,Russel; CRIBB,Phillip (Eds) Orchid Conservation

HÁGSATER, Eric; SOTO, Miguel; SALAZAR, Gerardo; JIMÉNEZ, Rolando; LÓPEZ, Marco and DRESSLER, Robert L. Orchids of Mexico

KYTE, Lydiane & KLEYN, John Plants from Test Tubes

Orquídeas Planalto Central Brasileiro / Orchids of the Brazilian Central Plateau

STEWART, Joyce; HERMANS, Johan and CAMPBELL, Bob Angraecoid Orchids - Species form the African Region

Masdevallias : Gems of the Orchid World by GERRITSEN, Mary E. and PARSONS, Ron

Tuesday, March 06, 2007

Some SSs

He think priestess can settle everything ar?!

Puppy found his friend friend

The GMs seriously need spell check. Imagine kids in school say, "it's spelt ' dyas' because GM say one." *pengz*

ZZZ she/he seriously rich to mega every waking hour (ps. 1 mega = $2.10) or she/he cash hack? Dunno.
The piece la resistancé >.<

DOC 1

While driving her son to school, Martha realised she missed out something she wanted to tell her husband. At the traffic light junction when the red light was on, she fumbled through the front compartment and managed to pull out a sticky pad and she further ruffled through her pocket to draw out a pen. In red ink, she scribbled something on the pad against time before the green light comes on and she plastered the message on her child's shirt.

"Mark, when Daddy fetches you later, remember to pass this to him. I only want whatever I wrote there from the supermarket and nothing else. I'll be in the O T later in another one of those marathons and my handphone will be off later. Also, I'll be late, so don't wait up."

"'k Mom," the little boy replied while folding the yellow paper and pushing it into his pants pocket.

When they reached the school, the little boy opened the door and leaped off to the ground to join the horde of primary school children making a dash for the assembly ground before the ringing of the bell.

"Bye Mom," he said and closed the door behind.

As Martha made a dash for the hospital, Mark stood in the midst of the children and reached for the paper. He gradually unfolded to paper to see what was written. A lady accidentally bumped into him while he was doing so and dropped the paper onto the ground. The lady then bent down to retrieve the paper.

"Sorry Mark," she said as she tried to return the note and realised that it stucked to her finger,"oh. Never knew talismans come in this shape and it has a sticky end."

"No Miss Gwee, it's one of those last minute messages my mom leaves for my dad," he replied as he peeled it off her finger.

"A note? It looks like those Chinese talisman with red ink on yellow paper. Looks very illegible," she said with a puzzled look on her face.

"Let's say my parents are complementary healthcare professionals," sniggered the precocious child before he made his way to join the other children.

Congratz Cecilia

Welcome to the outside world Angus!!!

PS Cecilia, better leak out secret hor - how in the world did you managed to have 3 consecutive boys?!

Monday, March 05, 2007

Tamtam and marathonrunner see see here

Marathonrunner bought one plant recently and was (mis)indentified as Ansellia africana. It is a case where the once common form of the plant gradually becomes uncommon. What he bought was actually a tiger orchid Grammatophyllum scriptum but if he ask why not green green one? Simple - the green one is the albino form and it had been very vigourously cloned and reproduced as it was "rare" then. Now the normal form is rarer =.=

Tamtam got one interesting plant which I had before - Acriopsis javanica. Interesting pseudobulbs. This plant is rather variable in size. The one I have is about 3 x the normal size:

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One taxonomist thought it was a new species X_X. This plant attracts a lot of ants and it is related to Grammatophyllum and Cymbidium - anyone tried crossing yet?

Thecostele alata and Thecopus secunda are one of the most commonly mislabelled or misIDed plants. I hope the people in that plant forum where the mistake recent occurred knows what to do =p.

Morning drive on the NS highway

For those sleepyheads who did not get to see the sunrise everyday.

PS this was taken when I went up north to 拜拜年 and visit my grandmother.

6am from Singapore:

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The lowland areas were all misted up due to the recent flooding. Curious thing was that the roadside plants too the brunt of the herbicides poured onto the palm trees. You can see the palm trees happy and alive while all the teak trees all kena brown out. Dad pointed out one house that was complete submerge but couldn't take pic on time =.=

Here comes the sun:

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The trip home (also 6am):

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Sunday, March 04, 2007

Camera-less for a fortnight

Very sianz. Today want to take picture of the 4 Laelia purpurata var. carnea BBs given by Peggy but then press to take that time, camera LCD says cannot read SD card. Tried to change SD card, camera tell me there's system error.

Now it's in the hands of the Nikon people - thank goodness for the 2 years extended warrant from Harvey Norman's

Get well soon trusty camera
Shaky hands misses you.

In process of budding:

Mini form of Dendrobium canaliculiatum
Paphiopedilum godefroyae (various first flowering seedlings)

Laelia rubescens - of all colour forms, I've only the oddballs =.=

Lucy had not seen one before and Woon Cheng said he imported a batch that had not sprouted yet. So here's a pic of how Laelia rubescens var. aurea looks like:

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Verli chio right *slaps own horse's butt*

I was hoping for a pink or purple though (sorry, not interested in an exchange as yet) Hmmm. should I invest in more with my ang bao $$$? But then this plant does not flower frequently until it reached the humongous (may be sic) size that my see fook has for his var. alba form:

I bought 2 divisions which I paid in instalments (i.e. not cheap hor)

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Haven't opened full though =.=. Some sellers will label their var. semi-alba as var. alba thinking that the purple throat is integral of the flower which is not true.

My plants are pathetic because they are small. Most of the mature plants can retain their spikes for the next flowering but mine already browned off =,=. TMDKKJ bleh.

Interesting to know that most long spiked Laeliae sold in their native lands as cut flowers usually comes with a bit of psuedobulb make the flowers last long. EYOF also uses that technique to make their Oncidiinae hybrids last longer.