Propranolol Mixture CF APF20, prepared by me…

PHAR1821 Social Pharmacy

Teaching first year students is always interesting and challenges you to go back to the fundamentals and explain concepts from first principles. Social Pharmacy is primarily a health psychology unit of study, focusing on the psychosocial processes that underlie health behaviour. The unit of study also included the Teamwork in Health module as part of the Interprofessional Learning (IPL) initiative of the Faculties of Health.

This year the Unit of Study Coordinator, Dr Lorraine Smith, chose to run PHAR1821 tutorials as larger classes with two tutors. One of the main advantages of this format was that most classes had at least one tutor who was a practising pharmacist, which brought a real-world perspective to the frequently abstract field. In practice, I thought this was quite an effective approach – my co-tutor (an actor by training) and I complemented each other through bringing our diversely different knowledge and experiences to the fold.

The Teamwork in Health module, run in conjunction with the Faculty of Health Sciences, focused on teamwork in the context of health and involved mixed groups of pharmacy and health sciences students working together on a project through the semester whilst reflecting on their teamwork and learning processes. The module is still in its infancy, however, and I was able to voice some of my suggestions for improving the structure and relevance of the module during the staff feedback session.

PHAR3602 Dispensing

Having taught PHAR4620 Integrated Dispensing for a month during semester one, I jumped at the opportunity to teach PHAR3602 Dispensing during semester two. This unit of study teaches students the skills necessary for extemporaneously preparing various pharmaceutical products from raw materials (i.e. pharmaceutical compounding) and gives students an appreciation of the historical context of pharmacy practice. Whilst greater than 90% of products dispensed in pharmacies today are ready-prepared products, pharmaceutical compounding is still an important discipline to master as it is part of the unique professional skill set of pharmacists and patients do still occasionally present for extemporaneous products.

I really enjoy teaching Dispensing. Being a demonstrator for around 10 students in the dispensing practice laboratory allows a high level of interaction with individual students (and other demonstrators) in a relatively relaxed learning environment. It was great getting to know many of the students and also to hear their perspectives on their future careers, the pharmacy profession, etc. Many of them work part-time in community pharmacy and it was interesting to observe how some of them had already started picking up habits from the community pharmacists they work with.

At some stage during the semester it occurred to me that we as demonstrators were bearing a great responsibility to the public. For many of the skills that our students were practising, this would be the only occasion during which they would be taught and assessed prior to becoming pharmacists – specific skills in pharmaceutical compounding are not formally assessed in registration examinations by the Pharmacy Board of New South Wales. Fortunately, the good citizens of New South Wales are in safe hands thanks to the team of pharmacist colleagues I taught with every week: Ian Dean, Sofia M, Mohamed Elashwah, and Bill Larkins; along with the Unit of Study Coordinator, Dr Romano Fois, and the many other tutors/demonstrators/volunteers involved in PHAR3602.

Rain-soaked Stage 2 USydMP students at the Stage 2 Barrier Assessment 2008
(follow hyperlink for full resolution photo)

As it was one of the last occasions we’d be on main campus together, we decided to organise a year photo. It was a pity that the weather conspired against us, although I was pleasantly surprised that my non-weather sealed camera and lens (Canon EOS 30D, EF-S 17–55mm f/2.8 IS USM) managed to survive several minutes of light rain. Thanks go out to Heather Gleba for organising, George Pappas for the use of his tripod, and my Med 2 colleagues who braved the rain.

Next stop: Block 9 Oncology…

Enoxaparin 100 mg/1 mL (10 pack) from Australia and the United States

When we received the interim stock at work, the first thing I noticed was the size of the pack. For the same quantity of the same strength, the Lovenox pack was more than twice the size of the Clexane pack. Now whilst Lovenox pre-filled syringes are slightly larger, due to the built-in sharps safety mechanism, this alone could not justify a doubling in package volume.

I guess it’s like they say… everything’s bigger in America!

I had the privilege of compiling/editing this issue and providing the cover photo. This issue also marks the return of a volume number (corroborated from the Fisher Library and NLA catalogues, as well as The centenary book of the Sydney University Medical Society) to reflect the long history of Innominate, which has been in near-continuous publication since 1946.

Highlights from the current issue include:

• Mama Meri: women & health in rural PNG – Bronwen Morrison
• Oh my god! You’re a medical student? – Jodi Allen
• Do U C what I C at GHC? – Susanna Lam
• AMSA Convention report/photos – Amanda Wijeratne
• Reel Doctors – Elizabeth Cochran
• PBL mechanism for House – Matt Silsby
• Medical education in communist China – from Innominate 1958;13(2)
• …and the (in)famous regular section Quotable Quotes!

Our contributors have again continued the traditions of quality writing and USyd medical student wit. Even if you’re not a medical student or involved in the health field, you may still find these articles interesting/entertaining and I’d encourage you to download it and have a read.

I had a letter published in the July 2008 issue of Australian Pharmacist, which was written with the aim of adding a few points to an earlier continuing professional development (CPD) article published in the journal.

In reference to Natalie Soulsby’s recent CPD article on arterial blood gases (ABGs) (Australian Pharmacist May 2008, page 404), indeed ABG interpretation is an area in which many pharmacists have limited experience, even in the clinical hospital pharmacy setting. Furthermore the results may be challenging to interpret, particularly without a comprehensive knowledge of respiratory physiology. There are a few points I’d like to add to those mentioned in the article.

Firstly, supplementary oxygen therapy (particularly in an intubated patient) can often actually cause a very high PaO2 reading. This is an expected consequence of the high alveolar partial oxygen pressure (PAO2), but can potentially be mistaken for a sampling/technical error by inexperienced personnel.

It may also be useful for pharmacists to be aware that one of the major indications for ABGs, besides determination of acidosis/alkalosis, is the characterisation of respiratory failure. Type 1 respiratory failure is hypoxaemia without hypercapnia (low PaO2, low or normal PaCO2) and implies a ventilation/perfusion (V/Q) mismatch – pneumonia, pulmonary oedema, pulmonary embolism, asthma, emphysema, etc.[1] Type 2 respiratory failure is hypercapnia (low PaO2, high PaCO2) and implies alveolar hypoventilation – obstructive/restrictive airways disease, reduced respiratory drive, neuromusculoskeletal disease, etc.[1]

Finally, it should be noted that the major limitation of pulse oximetry (in comparison with ABGs) is that it only measures the percentage oxygen saturation of haemoglobin. An anaemic patient, for example, may have normal oxygen saturation on oximetry but still be hypoxaemic.

Reference:
1. Longmore M, et al. Oxford handbook of clinical medicine. 7th ed. Oxford: Oxford University Press; 2007.

Citation: Po K. Arterial blood gases and their use in respiratory disease. Australian Pharmacist 2008;27(7):516.

Effects of 6-methyl-2’-methoxyflavone on wildtype and mutant GABAC receptors

I also discovered that I’d been credited as second author on a conference poster presented at the recent 3D at the Cove – Drug Design & Development conference, which was organised by the Royal Australian Chemical Institute. My contribution to this research was in helping to lay some of the groundwork, having synthesised 2′-methoxy-6-methylflavone and assessed its activity at α1β2γ2L GABAA receptors during my undergraduate honours project with the research group at the University of Sydney.

Citation: Premoli I, Po K, An SP, Johnston GAR, Chebib M, Hanrahan JR. Effects of 6-methyl-2’-methoxyflavone on wildtype and mutant GABAC receptors. 3D at the Cove – Drug Discovery & Development Conference; 2008 July 13–17; South Stradbroke QLD, Australia.

Some of my friends were particularly amazed by the song “Four Chords”, which proposes that most contemporary pop songs are based on the same four chords, demonstrating the point using a 35-song medley:

James Blunt – You’re Beautiful / Richard Marx – Right Here Waiting / Alicia Keys – No One / Mika – Happy Ending / Amiel – Lovesong / Black Eyed Peas – Where Is The Love / Alex Lloyd – Amazing / The Calling – Wherever You Will Go / Bush – Glycerine / Thirsty Merc – 20 Good Reasons / Lighthouse Family – High / Red Hot Chili Peppers – Soul To Squeeze / Bic Runga – Stay / Ben Lee – Cigarettes Will Kill You / Maroon 5 – She Will Be Loved / U2 – With Or Without You / Crowded House – Fall At Your Feet / Kasey Chambers – Not Pretty Enough / The Beatles – Let It Be / Red Hot Chili Peppers – Under The Bridge / Michael Jackson – Man In The Mirror / Elton John – Can You Feel The Love Tonight / Men At Work – Down Under / Waltzing Matilda / Kasey Chambers – Not Pretty Enough [repeat] / A-Ha – Take On Me / Eagle Eye Cherry – Save Tonight / Toto – Africa / The Offspring – Self-Esteem / Blink-182 – Dammit / OneRepublic – Apologize / Tim Minchin – Canvas Bags / Natalie Imbruglia – Torn / Axis of Awesome – Bird Plane / Missy Higgins – Scar

Indeed, four-chord progressions are commonly used in music writing and “Four Chords” seems to demonstrate a I–V–vi–IV progression (E–B/D#–C#m7–A/C#) by transposing the medley songs to E. I suspect that the successful harmonics of chord progressions can be explained by thinking of them as a series of cadences, e.g. the strong I–V imperfect cadence and IV–I plagal cadence in this particular progression.

Overall, regardless of your appreciation of music theory, Axis of Awesome have produced a well-executed and entertaining piece.

Apple Store Sydney, viewed from George St (more photos)

My only previous exposure to the Apple Retail Store experience was Apple Store Ginza in Tokyo, Japan (東京銀座のアップルストア). While the Ginza store is already quite impressive, the Sydney store is much larger and has a more distinctive design. With the opening of this store, and at least two more planned, Apple has greatly increased its Australian presence and users will reap the benefits particularly through the Genius Bar and various programs/events. Things are looking good for Apple users in Australia!

Campos Superior Blend and The Obama Blend at Campos Coffee

It’s described as:

Great depth of character, strong, and eloquent. This very appealing blend unites coffees from Africa and the Americas to produce a cup which has gotten us excited. Formidable middle palate flavours, syrupy with an uplifting finish. Excellent choice for going forward and ideal for those looking for change.

Now are they describing Barack Obama or the coffee blend? =)

Amongst the highlights:

• Being mistaken for a fellow first-year pharmacy student
• The meningococcal disease song
• “Hey Kieren, can you help me? That other lady scares me!”
• The awesome History of Pharmacy presentations… Arnie!!
• Random coincidences: teaching my friend’s sister, and teaching a friend of a friend I’d met in Japan
• Discovering that one of my students got into graduate medicine, but turned it down to study undergraduate pharmacy!

One more thing: I noticed the poster below hanging in the display cabinet opposite our tute room N352… If you ignore the faux-leetspeak kitsch for a moment, the messages it conveys are for the most part true – like any profession there are challenges, but on the whole pharmacy is a great profession to be in.

So, to my (former) students: as the name of the unit of study suggests, you’ve now taken your first steps towards your future profession and will be building on strong foundations. I’d like to wish you all the best for the rest of your BPharm course and with your future careers as pharmacists. Thanks for the memories!

Firstly, our SCORPIO sessions for the last two weeks have included patients with:

• Cushing’s syndrome
• Hypopituitarism post-hypophysectomy for pituitary macroprolactinoma
• Type 1 diabetes mellitus
• Type 2 diabetes mellitus

It was during one of the SCORPIOs that we spoke to a fellow medical student with type 1 diabetes mellitus (T1DM). Although it was a little unusual at first to have the “patient” teach us how to take a medical history from him, it was great to hear his experiences and perspectives from the other side of the patient-doctor relationship. We later spoke to a high school student also with T1DM, who gave us his perspective on being a teenager living with diabetes. Both had a great insight into their condition (demonstrating the adage that patients often know more about their chronic illnesses than their doctors do) and were very proactive in self-management of their diabetes. These were normal people trying to live normal lives as best they could under the circumstances. Indeed the high school student was trying to get his learner driving licence and, as I was practising assessing his visual acuity and visual fields (prior to our tutor conducting the formal medical assessment), I related my experiences at the RTA motor registry when I’d gotten my Gold Licence the previous week.

The other young patients we saw were an entirely different experience altogether. Our tutor had brought in two young children (and their mother) from his private practice – an 18 month old girl with asthma and her 3 year old sister – to help us practise paediatric history-taking. As was usual practice for our communications tutorials, we were each assigned a task (history taker, “phone-a-friend” buddy, information reporter, etc) and I was assigned the task of… keeping the girls entertained! Not waiting for my doubtful look to disappear, he proceeded to give me some props with which to play with the children: an Aurorix clown puppet and a Seretide soft toy dragon – we later reflected on the irony of drug companies marketing the antidepressant moclobemide (Aurorix) and the asthma medication fluticasone+salmeterol (Seretide) to young children. Anyway, now I will readily admit that I’m probably not the best with children and lack paeds experience. Despite my initial self-doubt, however, I took on the task and quickly warmed to it – by the end of the session, I was even crawling around with the kids!

So yet again I found myself enjoying a refreshing change from the endemic frustration of endocrinology block. Thank goodness for Concord!