COLLEGE OF PHARMACY AND ALLIED HEAL TH PROFESSIONS

ST. JOHN'S UNIVERSITY DECEMBER 1980

T'was the Eve of the Organic Final, And all through the night,

YES, All the students were studying; They \\ere psyched out from fright. Their books all laid out, Models assembled with care; No fingernails were left, And they pulled out their hair. Last year's tests were all torn and tattered; From banging on walls, th~r heads bruised and battered. Reactions and synthesis Were coming out of their ears. Not since their first dates Had they known such fears . At 4 A.M. they took to their beds With visions of cyclohexanes Dancing in their heads. They woke up in time To see the sunrise, And little did they know But they were in for a surprise. They rubbed their eyes and yawned alot. Suddenly they realized--Every scrap--all forgot !!~ No compounds could they name, Not even simple alkanes! No structures could they draw, They all looked the same! Many hysterics later, They arrived at the test' And tried so hard to do their best. (Which wasn't much.) Then they drank themselves blind And slept a whole night! !I Hoping the teacher Would pity their plight(SURE)

In all their Stockings On that merry Christmas Day SURPRISE!!!!! They each found an A!!!

(Which all goes to prove­Yes, Virginia, there is a Santa Claude)

GOOD LUCK EVERYONE FROM FRANCIS VALLIE!!!

By Laura Gucciardi. Reprinted with permission - Common Good 1179

VIRGINIA ...

Vo I. XIX No. 2

EDITOR-IN-CHIEF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ALEX KARDOS MANAGING EDITOR ............................ JOSEPH B. LAUDANO COPY EDITORS ................................. FEE YUEN SHERRY CHIN

MAURICE F. DEPALO PHOTOGRAPHY EDITOR ............................. . SECRET ARY ........ . ...... . .. . ................ .. ...... SUSAN BOLECEK TREASURER .......... . ..................... ... .......... JOHN STIMMEL FACULTY ADVISOR ........ .... ........... .. .... ... .. DR. ROBERT SAUSE

VICTOR CALDERARO

MICHAEL CHUDYK

RAFFAELLA DEL VECCHIO

KAREN IKONOM/DIS

STAFF

TABLE OF CONTENTS

DONNA LISI

LOUIS LOIODICE

KA TH LEEN MA THEWS

LUCIA SANTORO

Page

EDITORIAL ....... . ............. ... . ..... ... . . .. . ....... .......... ............ 2 OUTLOOK ON ORGANIZATIONS-Alex Kardos .................................... 4 PHARMACY EDUCATION IN SOME FOREIGN COUNTRIES-Mike Chudyk ... . . ..... 6 IPSF-Alex Kardos .............................................................. 8 CAUTION-Alex Kardos ......................................................... 8 OBSERVATIONS ON DRUG INTERACTIONS-Joseph Laudano ............ .. .. . . .. 9 CAN YOU READ THIS? ............. . .......................... ............... 11 THE OSTOMY PATIENT-Maurice DePalo .... . ... .. ..... .. .. . .. ....... ........... 12 EASTERN EUROPEAN PHARMACY-Mike Chudyk ................ ............ .... 13 MED TECH BRIEFS-Kris Alaiz MED TECH BRIEFS-Kris Ala iz .............................................. .... 14 QUINIDINE-DIGOXIN?-Raffaella DelVecchio ............................ .. ... .. .. 15 THE REAL TRUTH ABOUT P.A. MAJORS-Annette Calabrese . . .... ........ . .. ..... 16 THE DRUG PUZZLE-Mike Chudyk ........ .. .................. ........ .......... 18 ASK ALBERT,R.Ph.-Mike Chudyk ......... ...... .. ................ ........ .. . ... 19 THE PHARMACY JUMBLE-Mike Chudyk ........................................ 20 FACULTY FUNNIES ... . ..... ... . . . ..... . . ........ . . . .......... .. . ......... .... 20

From the Editor's

Desk

It is now December, final exams are, for some, frightfu lly present. First-year students have already grown quite familiar with the "fear of Organic Chemistry blues." Second-year stu­dents, lost in hydroxylation reactions , are seriously wondering if they chose the right profes­sion (see Twa s the Eve of the Organic Final ... ). Students in the third year have become overly concerned with chronic writer' s cramp syndrome. Fourth-year students, as usual, have "mellowed-out" into chronic complainers of the 1.U.P.A.C. nomenclature system (Aw come onl It's not that hard!). Students in the fifth-year are forever dreaming into the future and are continually awakening as undergraduate students. Fortunately, the irritations produced are usually soothed when we view them as difficuities universal to all pharmacy students.

For many students, this will be their last semester at St. John's (hopefully I'm only referring to the January graduates). To these people I, on behalf of the staff of REC I PE and the students of the College of Pharmacy, congratulate you and wish you all the success, health , and happiness. For myself, this is also my last semester (don 't worry , I'm graduating) and therefore my last ed itorial (don't be so happy, it's not done yet). In my "past five years" I've seen many things and many th ings change.

The program that you are enrolled in is a very difficult one (no kidding ). It seems that we as pharmacy students (myself no exception) find great difficulty in acknowledging our fears of failure and strong feelings of loneliness. The loneliness describes those weekend parties missed, those terrible hours at night that we wich others could comprehend , that feeling that overtakes us as September approaches. Unfortunately these feelings are not eradicated as we leave the St. John's campus five minutes after the close of our last class of the day.

Through my experience as a student, I have been unable to find a cure for either loneliness or fears of failure . There are supportive treatments. In my experience (there he goes again!), involvement in extra-curricu lar activities within the school of pharmacy will relieve many painful symptoms (I knew he would get to that!) . Face your problems head-on! Your life at school is boring! Do something about it! Attend a pharmacy convention, write an article for RECIPE (this is a plug), aid in organizing a drug fair, pharmacy mixer, or a diabetes monitoring program. Take a chance, get involved. Risk running into your profession outside of the classroom. Live with in the profession, not withing your textbooks only. Complain about my editorial (my office is Rm. 1 50-E, or whatever). Don't wait until your fifth year and then try to apply the excuse, "Well , it's too late now."

If you don't remember with all the studying, December 25 is Christmas (oh yes!) . Just to keep this short, please remember what the true meaning of Christmas is. The holiday has many meanings stemming out of one. Sometimes we do not see these. If I may use a quote, I think I can explain my point.

"Every chi ld comes with the message that God is not yet discouraged of man ... " Rabindranath Tugora

WEARE

G N

I w

0 Join us

R

G

STOP BY RM. 15,0E, ST. ALBERT'S HALL FOR FURTHER INFORMATION

OutlGGk on Student Organizations by Alex Kardos

LAMBDA KAPPA SIGMA is an international, pro­gressive and professional Pharmacy fraternity exclu­sively for women . It has the distinction of being the oldest and largest pharmaceutical fraternity for women in the world. Fraternity chapter operation provides training for young women in the cultural, social, intellectual and professional aspects of modern day living.

Advantages of belonging to a fraternity, and Lambda Kappa Sigma in particular, include: (a) a focus for social exchange and fellowship, (b) a more personal approach to the complex adjustments to the campus and to the pharmacy school, (c} the encouragement for superior academic achievement, (d) recognition to women as part of an identifiable group, (e) the inculation of high ideals and social graces, (f) the promotion of a sense of group loyalty to college and country, (h) a haven from the pressures of class work, (i) the rapport that a group achieves in working together, and (j) the identification of a professional group of women committed to the advancement of women in pharmacy.

4 RECIPE

Ethel J. Heath of Massachusetts College of Pharmacy in Boston created a center of friendship and culture among the women studying pharmacy. With her enthusiasm and initiative Alpha Chapter of Lambda Kappa Sigma was established in 1913. In 1918 the women at the Albany College of Pharmacy in Albany, New York, realized the value of belonging to such a group and Beta chapter was installed. Lambda Kappa Sigma has continued to grow and how has 37 active collegiate and 16 active alumnae chapters. The collegiate chapters are located in the leading ac­credited schools and colleges of pharmacy in the US and Canada. A lumnae chapters are located in the major cities. More than 8500 women have been initiated into Lambda Kappa Sigma since 1913.

A collegiate woman studying pharmacy, regardless of race, religion or national origin , 'may be elected to membersh ip on the basis of her character , scholarship and her ability to cooperate with her associates. Each chapter establishes its own scholastic standard for election to membership.

The St . John's chapter of Lambda Kappa Sigma is known as the Alpha Pi chapter Lambda involves itself with many actLVities around the St. John's commu­nity, such as the recent pre-marathon M.D. drive. Their activity is also evident in their involvement in other organizations around campus for example: student government, SAPhA, Recipe, I FC just to mention a few.

Anyone wishing more information about Lambda should speak to the chapter President, or any member that can be found at their table in St. Al's Cafe.

® The

Student American Pharmaceutical

Association The Student American Pharmaceutical Association (SAPhA) is the national professional society of pharmacy students in the United States and an official subdivision of the American Pharmaceutical Association (APhA). The American Pharmaceutical Association, the national professional society of pharmacists, was founded in 1852. Since 1931, when pharmacy students were organized as the APhA Student Section, student membership in APhA has been available to all pharmacy students. In 1969, the former APhA Student Section was reorganized and became the Student American Pharmaceutical Association and an official sub­division of the American Pharmaceutical Associa­tion.

The Student American Pharmaceutical Association was organized to aid and support the objectives of the Association, to promote the interests of the student members of the Association, to aid the SAPhA chapters in their operations, to provide a mechanism whereby student members may be informed of the affairs of the Association and the profession, to provide a forum for the expression of student opinion on pertinent Association activi­ties and policies, and to strengthen the program whereby student members upon graduation would become active members of the Association and continue to participate in its programs for the advancement of the profession of pharmacy.

There are 72 SAPhA chapters at colleges of pharmacy in the United States and Puerto Rico. These chapters are local SAPhA organizational units serving and involving the individual student member. SAPhA chapters provide many profes­sional, educational and social activities for mem­bers. The 72 SAPhA chapters are geographically divided into eight regions, which were established primarily for electing SAPhA delegates and alter­nate delegates to represent the student member­ship in the American Pharmaceutical Association House of Delegates. SAPhA has nine voting dele­gates in the APhA House of Delegates-the Dele­gate-at-Large and one delegate elected in each region .

SAPhA presents a Midyear Meeting for each of its eight regions during the fall. The purpose of the SAPhA Midyear Meetings for the Regions is to bring together members of SAPhA chapters and provide a forum for discussions of common inter­est, to encourage interest and participation in APhA and SAPhA programs, and to inform stu­dents of the affairs and activities of APhA and the profession.

RECIPE 5

PHARMACY EDUCATION IN SOME

FOREIGN COUNTRIES by Michael Chudyk

As of 1973, there were approximately 140,000 actively practicing licensed pharmacists in the United States. This number is constantly increasing as is the proportion of female to male pharmacists. Of the practicing pharmacists in the U.S. toda . the distribution between their areas of practice fall roughly as follows: 77 per cent in a community setting, 15-per cent in an institutional (hospital or long-term care facility) setting, 5 per cent in industry, and the remainder in other specialty areas.

The educational process is undergoing some changes although most states still maintain a five-year program of study leading to the B.S. degree in Pharmacy. In a few states, a six-year program leading to the Pharm.D. degree has been instituted.

If we were to compare the practice of pharmacy and the preparation for such a career in foreign countries. a few interesting differences can be noted. An exploration of non-Western pharmacy training and practice follows.

Denmark: As of 1975, Denmark had 333 pharmacies. There is only one school of pharmacy in the country, the Royal Danish School of Pharmacy, and the education is free of charge. The curriculum involves five years of study including fifteen months of practice in a community or hospital pharmacy. About 100 candidates graduate each year. The academic title for pharmacist is "Cand. Pharm." and that is the license given upon graduation. Currently, the employment situation is very severe in Denmark; the majority of new pharmacy graduates find themselves unemployed after graduation.

In Denmark, the operation of a pharmacy is the Apoteker's (Chief Pharmacist's) private business and it is his economic responsibility, but the government has established many regulations and limitations on pharmacy practice concerning duties and equipment. Therefore, one does not just buy or open a pharmacy. The number of pharmacies and their locations are decided by the government. A special school has been established for the education of pharmacy technicians as well.

6 RECIPE

Pharmacy is unique in this country in that 40 per cent of the drug products on the market are manufactured by pharmacies (community and hospital). For instance approximately half of the hospital pharmacists ar~ occupied by the manufacture of drug products, while the other portion are occupied with distribution, drug information, administration, and other functions . Because of its challenging prospects, many pharmacy graduates look for jobs in the sector of hospital pharmacy.

Finland: In this country, Pharmacy is taught at three universities. The students (about 15% male, the rest female) are accepted into one of the two Pharmacy programs: 1 . tarmasentti equivalent to a B.S. degree after two and a half years of study plus an additional six months of• training in a community pharmacy, the first three. months in a community pharmacy and the other three in, a hospital or pharmaceutical factory; and 2. provisori< equivalent to a M.S. degree after five years of study. No clinical pharmacy or strictly hospital-pharmacy related courses have been included in the curriculum thus far.

The highest academic degree offered in the Farmesian tohtori (Doctor of Pharmacy) which involves extensive research. There are only professional pharmacies which are privately owned but controlled by the National Me_dical Board (equivalent to the United States' FDA). which determines the number and location of pharmacies. If a pharmacist dies, the vacancy if filled by the Board with the best qualified applicant for the position. Because of the limited number of pharmacies, a pharmacist usually assumes ownership between the ages of forty and fifty.

There are very few hospital pharmacies in the country at this time; drugs in hospitals are for use only by inpatients and the hospital staff, with no outpatient dispensing. Duties include IV admixture services, unit-dose, and the distribution of medications to the wards.

Hungary: The training of pharmacists, as well as dentists and physicians, takes place in four medical universities.

Pharmacy training lasts four and a half years. The first two years provide the fundamentals, while the third and fourth years offer specialized pharmaceutical training. Every year. about 180 to 200 qualified ptiarmacists are graduated. There are about 4,000 active pharmacists in ~un~a~ - 90 per cent of them are women. The regional d1str1but1on of pharmacists is uneven. A pharmaceutical as~istant program also exists. All pharmacists are obliged to take part, at least once every five years, in a state-funded refresher course. Hungary exports pharmaceutical products to about ninety countries world-wide and it ranks second in the world in size of

drug export volume. Extensive research has been a very important facet of the industry in Hungary, which accounts for some five to ten new drug products appearing on the market every year. Inspectors monitor pharmacies and individual pharmacists several times a year.

In contrast with most United States pharmacies, the Hungarian pharmacy stocks only medications. bandages, medicinal foods for children, and certain therapeutic aids; drug-compounding is very common in pharmacies. In spite of these facts. Hungary is still plagued with a shortage of pharmacists.

France: Pharmacy students in this country complete a five-year course of study. The first two years cover the basic sciences, the next two years are pharmacy-oriented, and the last year is a specialty year. In this final year, three options are offered: 1. dispensing, 2. clinically­oriented biological analysis, or 3. the so-called "industry option."

The industry option is particularly interesting in that students working in pairs are assigned a project which both poses a challenge and gives them a chance to exercise real initiative in determining a solution to a problem. All students attend weekly meetings at which they describe work performed, planned outcome of events, and the reasoning upon which their conclusions are based. At the final meeting, student pairs each present their final products: ampules, tubes of ointments, effervescent tablets. etc.

Rhodesia: Emphasis is placed on clinical training for the pharmacists since he can be utilized readily to supplement nurses or other trained personnel in clinics where physicians are not available. Pharmacy education is three years with a fourth year of internship

I

before licensing. The third-year curriculum allows for the students to have maximum clinical exposure as part of their practical experience. This is a honors course; therefore, in the final year, the student is required to do a research project in addition to his/her studies.

This type of curriculum is possible by shortening the holiday after the second year and starting a concentrated session of six weeks before the regular term begins. During this time the student spends five hours daily, for five days a week, attending classes.

A maximum of twenty-four students are accepted each year. Before entry to the university, students are required to have taken two years of advanced-level education after the ordinary-level examination at the end of high school. Advanced-level includes chemistry, biology, physics, and mathematics.

Israel: Many students elect pharmacy as an alternative to medicine. which was preferred but could not be attained due to very austere selection procedures.

The School of Pharmacy of the Hebrew University of Jerusalem offers the Bachelor of Pharmacy degree and the curriculum consists of four and a half years of schooling including internship. The program is somewhat modeled after programs for the B.S. in Pharmacy offered by schools of pharmacy in the United States. There is a wide preference for industry and research as opposed to community or hospital pharmacy even though community pharmacies offer higher salaries. Students are motivated to seek careers in i~dustry or research. It is in these fields that they attribute the highest prestige in pharmacy to, primarily because the physician's authority is only diffusely apparent in the pharmacist's role here. Nor is overeducation and underutilization a problem in industry.

Australia: As :>f 1975, there were approximately 14,000 licensed pharmacists in Australia. The average age of male and female pharmacists is, respectively, forty-two and thirty-eight years. Australia is served by six schoolds of pharmacy. Education is of three years' duration followed by at least one year of traineeship in practice under the guidance of a pharmacist before registration by the appropriate pharmacy board. The course of study is bui!t around basic and applied sci,mces, particularly chemistry. Post-graduate studies leading to the degrees Master of Science, Master of Pharmacy, and Doctor of Pharmacy are also offered.

RECIPE 7

IPSF

Since we have discussed international pharmacy in articles in this issue, we find it proper to.inform you of an organization for students that will deal with this . This orqanization goes by the name of the International Phar­maceutical Students' Federation (IPSF). In this article we would like to introduce this organization to you.

The main objective of the IPSF since its formation in 1949 has been to be a professional , non-political organ­ization which studies and promotes the interests of pharmacy students and encourages international co­operation among them. Starting with 10 full members, IPSF now has members in over 30 countries and con­tacts in many others.

The activities of IPSF include the student exchange programs, projects in the field of pharmaceutical edu­cation , organization of the Development Fund and the Gift in Kind Program. At the annual congress, the Gen­eral Assembly of the Federation and symposia are held. Contact is maintained with other pharmaceutical and allied organizations and an IPSF News Bulletin is pub­lished as the offical organ of the Federation.

To develop well , a profession must be directed by its members. Thepharmacy students and young graduates of today are the future members of the profession and hence their ideas are important, for it is they who will promote the future changes in pharmacy. It is important that these ideas are developed within an international framework, for the comparison of the practice of phar­macy in ones own country with that of other countries opens up an enormous field of knowledge from which can be gained a new appreciation of ones own situation and the stimulus and ideas to contribute to the advance­ment of the profession in ones own country.

For the future, it is therefore important that one should look beyond ones national boundaries for fresh ideas. The activities of I PSF offer this opportunity for, via them, pharmacy students can meet, work and compare ideas with colleages from all over the world.

8 RECIPE

CAUTION

by Alex Kardos

With final exams coming upon us, we feel pressure of our course load on us. Some of us will get brave and try to take a simpler way of "studying" for a final. Some will attempt to micronize their notes and reference them during the examination. Oth­ers will just simply transfer data from any available neighbors document. This seems all fine and well , but if we view the benefits vs risks , some may think there -are more benefits than risks. Nothing could be further from the truth. If an instructor catches one in the act and if you are extremely lucky he will just fail you in the course or exam.

Cheating (or what ever you would like to call it) is not take.n so lightly by the faculty and administra­tion of the College of Pharmacy and Allied Healh Professions. You may be thinking that the punish­ment mentioned previously was harsh, WAIT! This behavior is punishable in many ways. The following is some of them: failure in the course with suspension for a semester, suspension from the program, expulsion from the university.

Doesn't seem as inviting as it use to be huh! If you've done it before and got away with it, you were probably lucky, but don't try it in pharmacy because that is carefully guarded against. And if you haven'thought about something else yet, If you don't study the material, you not studying YOUR PROFESSION! Good luck on all your final examinations.

Observations on Drug Interactions

In Our Diet by Joseph Laudano

Did you know that delicious cheddar cheese in combination with certain drugs can cause a terrible headache and vomiting7 Unsuspecting licorice lovers should also be aware that its ingestion whi le taking drugs that affect the heart or blood pressure cou ld be fatal. The fact is, any time more than one kind of prescription or OTC drug is mixed with alcoho l or with certa in foods, one could be setting himself up for an unexpected response. This response can range from nullifying the effects of the drug to producing mild il lness or to even caus ing death.

In general, the toxicity of drugs may be increased by diets that conta in (1) high concentrat ions of certain carbohydrates, (2) rancid fats and oi ls, (3) very high concentrations or inadequate amounts of proteins, (4) high concentrations of sa lt, (5) unsuitable amounts of water, and (6) inadequate amounts of certain vitamins. Many essential components of the normal diet such as carbohydrates, proteins, l ipids, minerals, oxygen, vitamins, and water may affect drug efficacy and saftey when an excess or a deficiency exists. Through animal research, it has been found that diets with a high sugar content lower the body's resistance to toxic doses of drugs. At a recent meeting of the Federation of American Societies for Experimental Biology on food-drug metabolism research, it was concluded that a diet adequate in prote ins, unsaturated fats, vitamins, and minerals is the best way to maintain microsoma l enzymes in prime condition to detoxify any medications or environmentally-imposed chemicals. The impact of diet on the drug-metabolizing enzymes holds more practical health imp lications for people than does the influence of genes in drug-drug interact ion. Diet is something that each of us can contro l. Therefore, it is important that biochemists and toxicologists continue in their research on the inter.actions of nutrients and drug metabolism, not

only to help people eat the most advantageous diets possible, but also to warn the public what not to eat , when certain drugs have been prescribed.

After having a few cocktails a young mother caused a sensation when she passed out at a party. When she was revived, she insisted she wasn't drunk. It was found that the OTC medication she was taking for her allergies had potentiated the effects of the alcohol to cause extreme drowsiness and sedation. Alcohol is an ingredient in many ordinary medicines and foods of which any can react with medications such as Flagyl® (metronidazole) to cause nausea or antihistamines to cause sedation.

Knowledge about drug interactions is by no means complete and any type of reaction that a patient may have should be reported to hi s doctor or pharmacist. It is important that pharmacists not assume a false

sophist ication and knowledge on ·the part of their patients as far as medication is concerned. They shou ld assume that every patient knows nothing and they should be very expli cit in the ir instructions and warnings about medicines.

Alcohol-Drug Interaction Chart

Drug

Aspirin

Ant1coagulnnts

Ant icorwulsanis

Ant1d£?pressJnts

Oral Hyµo~lycernics and Insul in

Antih1starn1nes

Guanethidine (Antihypertensive)

Possible Effect of Combination

lnc1l1C1·s uastro,intest1nal bleedinq.

lnl.'.n~ases or rleueascs antic..oaqulant cffctt.

Di111in1shcs or enhances drur1 cflm.t.

Causes deep sedation and severe drop in body temperature. ... Can be fatal.

Produces mild :o seven! symptoms of hypoglyccrrna. Causes drowsiness. severe nausea, and vorn itin!J.

Causes drowsiness, rcspira1ory depression. and in sc>vcre cases loss of consciousness.

Causes diuiness and fainting spells.

Codeine Causes respiratory depression, diuiness, and drowsiness.

Darvon Causes diuiness. drowsiness. and an excessive amount may be lethal. (Propoxyphenel

Sedatives, Minor Produces severe effects on the Central Nervous System, which in Tranquilizers (Valium, excessive amounts may lead to death. Librium. and Meprobamatel. and Barbiturates

RECIPE 9

-

Food-Drug Interaction Chart Food

Almonds, Dairy Products, Custard, Pudding, Antacids, Vegetables (green), and Yogurt

Drug Incompatibilities

Tetracycline antibiotics (Achromycin, Mysteclin-F and Rondomycin)

Possible Effect When Combined

Reduces therapeutic effect. Increased gastro-i ntesti na I disturbance. (diarrhea or constipation)

Green leafy vegetables Anticoagulants (Coumadin, Dicumarol)

Cancels anticoagulant effect.

Vitamin B rich foods (wheat germ, l.iver, pork,

Levodopa ( Larodopa) druQ for Parkinson ism

Blocks drug effect.

or beef) (Vit. B6 in particular)

Pickled herring, ripened or aged cheese, Chianti wine, chicken liver, or excessive chocolate

Monoamine oxidase inhibitors (Nardi!, Marplan, Parnate, Eutony!, or Eutron)

Cause rapid rise in blood pressure, terrible headache, vomiting, even death.

Monosodium glutamate (often found in Chinese cooking)

Diuretics ( Loop and tniazide types)

Causes increased sodium elimination from the body leading to hypdnatremia.

Fruit juices, soda, and other acidic drinks

Penicillin G, Benzathine, cloxacillin, erythromycin

Drugs' acidic-decomposition decreases therapeutic effect.

Excessive licorice Cardiac and Anti hypertensive Drugs

May cause headache, hypertension, and even heart failure; also can cause excessive potassium loss resulting in fatigue.

Foods containing sugar Hypoglycemics

Fifty years ago, the small-town druggist knew each customer who came into his store. He knew about his life, his family, medical history, etc. Today, a consumer may go to various pharmacies in order to get their prescriptions at the lowest price possible. When the customers move about from one pharmacy to another, contact between the patient and pharmacist is lost. Although both the physiciar: and the pharmacist should be responsible for inforrning the patient about the possibility of adverse drug reactions, drug dosages, and so on, a great responsibility lies with the patient himself. Many patients c:re admitted to hospitals because they fail to comply with the physician's intended drug therapy. At Mercy Hospital, Rockville Center, New York, a staff of thirty pharmacists interview patients on admission, take drug histories, note allergies, and problems and then instruct and caution patients on prescriptions. Together with nurses and dieticians

Blocks drug action.

they instruct diabetic, low sodium, and coronary patients.

In conclusion, it is important that the pharmacist be aware of any drugs the patient is currently taking and check whether the new drug is incompatible with any other drugs, alcohol, or food. The patient should be encouraged to ask the doctor or pharmacist how the drug should be taken; (before, after, or at meals and with milk, water, etc.). Drugs (prescription and OTC), should be bought at one pharmacy. In this way the pharmacist can keep a record of his customer's prescriptions and note if there is a chance of an interaction.

During the last two years a list of foods that do not mix with medicatfons has been known to the public. The incompatability and possible effects of combin­ing these foods is listed. (See Food-Drug Interaction Chart & Alcohol-Drug lnteractiorr Chart) ·

ll

CAN YOU READ THIS?!?

Remember! Always check with prescriber

when there is any doubt.

.... -Z­PAW

If you have a hard-to-read Rx, drop it in to us in Room 150-E, St. Albert's Hall.

ANSWER

uJd 0\0 dsi l --zo t, -dnJAS 1!Jewa1

NEED HELP!

* Try your friendly neighborhood Student Government Pharmacy Representatives. They can be found in either Room 150-E or anywhere about St. Al's.

Fifth Year ............. Maurice DePalo Alex Kardos

Fourth Year ................ Lisa Anzisi Jeri Schmidt

Third Year ............. Corey Nahman

Second Year ............. Maureen Fox Dominic Scorsiello

Presented as a public service by RECIPE.

RECIPE 11

HOW TO EDUCATE, MONITOR AND TREAT THE OSTOMY PATIENT

by Maurice DePalo

A pharmacist can make a significant contribution in educating, monitoring, and treating the ostomy patient. Since the pharmacist does not receive extensive training in this area while he is in sohool , he should research this subject in his spare time.

Ostomy refers to the surgical procedure whereby an opening is made between the colon, rectum or bladder and the abdominal wall in order that the feces or urine may be excreted. The major causes of ostomy surgery are: (1 )provide optimum drainage;(2}protect the skin;(3)afford security and confidence;(4)control odors and (5)be reasonably priced. The decision of whether to use a disposable or permanent appliance must also be weighed.

A pharmacist should be aware of the various problems that an ostomy patient may face. There is a chance of skin irritation. This may be due to a poorly fitted appliance, an allergic reaction to the materials the appliance is made of, or to a bacterial or yeast infection. For such conditions karaya is an effective and popular skin remedy, which is available in powder.paste and solid ring form. If a skin infection develops on the skin around the stoma (the opening), nystatin powder is the drug of choice. A chronic situation may result from a poorly fitted appliance. If this occurs, the pharmacist should refer the patient to an enterostomal therapist(E.T.) , a person extensively trained to handle these problems.

To counteract odor, there ! are liquid and tablet deodorants, which are placed inside the appliance. For internal odors, oral products such as bismuth subgallate and chlorophyll are available.

A patient who has undergone an ileostomy, the surgical removal of the colon, should be advised to increase his fluid intake because of an increased susceptibility to dehydration. Severe dehydration may lead to electrolyte imbalance or kidney stone formation. Therefore, if diarrhea persists for more than a few hours, the patient's physician should be notified.

12 RECIPE

The pharmacist should also familiarize himself with the drugs, dosage forms, kinetics and drug interactions that an ostomy patient's treatment may involve. An example of where the pharmacist's knowledge of dosage forms can be applied is in the treatment of the ileostomy patient, for whom chewable or liquid dosage forms are best. Enteric coated, time released, hard gelatin capsules and tablets should be avoided.

Other complications are as follows :

(1 )Ostomates (those who have had a surgically formed artificial tubelike passage made connecting the bowel or intestine to the outside, usually through the abdominal wall. An artificial anus exists at the ostomy site) with hypertension might be faced with electrolyte imbalance if a diuretic is prescribed.

(2)Urostomates(those who have undergone a surgical incision of the urinary bladder) should avoid sulfa drugs since these drugs may precipitate in the kidney.

(3)Antibiotics should be used with caution in both those who have had an ileostomy(incision of the ileum.the lower part of the small intestine) and colostomy(incision of the colon between the bowel and the abdominal wall) because destruction of the normal flora may result in severe diarrhea.

(4)Calcium-containing antacids ~re to be avoided in urostomates due to the increased chance of kidney stone formation .

(5)Magnesium containing antacids should not be taken by ileostomates since they may induce diarrhea.

A pharmacist, before recommending care for the ostomy patient must have a full background of the nature of the condition. He should be knowledgeable about dietetic regulations.therapy and should always be watchful for potential problems that may arise. The most positive results are achieved when the pharmacist is thoroughly educated and when he keeps himself abreast of the patient's condition by monitoring his profile.

EASTERN EUROPEAN SOCIALIST PHARMACY

PRACTICE

by Michael Chudyk

The pharmacies examined in this article are situated in different Eastern European Socialist nations. The drug/pharmacy sectors in each function as a component of a state-owned and operated, centrally regulated, nationally planned health care delivery system.

The education of pharmacy practitioners is nearly identical in all these countries. Students spend an average of 4-5 years in study following their secondary education. Pre-enrollment requirements include successful completion of entrance examinations in chemistry, biology, the countries' language, and a satisfactory medical certificate. No tuition is charged however, most are expected to work for the State for a total of 1-3 years after graduation. Pharmacies in these countries are open, on the average, for 12 hours a day and staffed by two shifts.

The number and distribution of pharmacies are controlled by the Health Authority of each country;both according to the population served.by the pharmacy and distance between stores. Pharmacy licenses are issued free by the state. Women are comprising an

increasingly big proportion of the pharmacy labor force in Eastern Europe.In Czechoslovakia, for instance wnmP.n r.omorise 70% of the oracticinq pharmacists whereas in Hungary, this figure reaches 80%. Finally,

80% of the pharmacists working in Soviet industries are women.

Laws forbid window displays advertisinq medicines to the public or the distribution of samples. Physicians' only sources of information are reports obtained through state issued journals. Windows are used for educational purposes on themes such as preventing infection or alcohol addiction.

While there are in excess of 200,000 pharmaceutical products on the U.S. market, countries like Poland or Hungary stock less than 1,000 of such products. Moreover.from 1 0-25% of the prescriptions in Europe are compounded extemporaneously whereas only 1 % of all prescriptions prepared in the U.S. are done in this manner. It is noteworthy to examine the procedures employed in

dispensing a prescription. A patient bringing in a

RECIPE 13

prescription order turns it over to the cashier who tells the patient the price of the drug and whether it is in stock.The patient is then given a slip of paper indicating the number and time when the medication will be ready.Medications are disper.ised through a separate window where the original prescription, stamped on the back, is returned to the patient. This process entails anywhere from 15 minutes to several hours, depending on how busy the pharmacy is. Some countries, like Romania, require that the diagnosis also be written on the prescription and that the patient must first be examined before any prescription is issued. No refills are allowed although a patient may receive up to a 6-month supply of a drug for a chronic disease.In general very few O.T.C. products are offered for sale; those offered include: bandages, medicinal food for children, and certain therapeutic aids. In Romania, such items as narcotics and cancer . drugs are available oniy at selected stores and patients are required to present a special 1.0. card to obtain such drugs. No direct payments for drugs from the patients are required , as most services are provided through contracts between

the health facilities and insurance funds. The Soviet Union merits special mention. There are presently 165,000 registered pharmacists in the U.S.S.R., with 5,000 pharmacy graduates entering the work force every year. Many of the drugs stocked by Soviet pharmacies include herbs,powders,and plants.

In fact, citizens are encouraged to collect local plants for sale to pharmac1es.~oviet pharmacies must estimate their drug requirements for a year in advance and submit these to the regional board after which they travel through a myriad of bureacratic levels before

being worked into th_e drug production plans. Due to the c?m_ple~1ty of their centralized approach to drug d1stnbut1on, drugs are supplied in an unreliable manner such that even when orders are placed which accurately reflect the demand, there is no guarantee that thev will be filled.

14 RECIPE

MED TECH BRIEFS

The Medical Technology Club is one of many profes­sional clubs on campus. The club has various goals which iclude informing the public about the field of Medical Technology, helping its members to gain insight and first hand knowledge of the field of Medical Technology through meetings, lectures, trips, literature and demonstrations; to provide a place for fun ; to act as a source of support and encouragement; and to provide long lasting friendship between its members.

Some events which are planned for the future include: design and printing of Med Tech T Shirts and bumper stickers; guest speakers; demonstrations including urine analysis and blood typing; tours of Nassua County Medical Examiner's office, Technicon in Tarrytown , New York and Medpath in Teterboro, New Jersey.

The Club meets every activity hour and is open to all interested students.

The Medical Technology Club is one of many profes­sionalalalalalalalalalalalalalalalalalalalalalalalal

The Medical Technology Club is one of many profes­sio_nal _clubs on campus. The club has various goals which include informing the public about the field of Medical Technology, helping its members to gain insight and first hand knowledge of the field of Medical Technology through meetings, lectures, trips , literature and demonstrations; to provide a place for fun ; to act as a source of support and encouragement; and to provide long lasting friendship between its members.

Some events which are planned for the future include: design and printing of Med Tech T Shirts and bumper stickers; guest speakers; demonstrations including urine analysis and blood typing; tours of Nassua County Medical Examiner's office, Technicon in Tarrytown, New York and Medpath in Teterboro, New Jersey.

The Club meets every activity hour and is open to all interested students.

Drug Interactions: Do you know about Quinidine-Digoxin?

by Raffaella Del Vecchio

Digitalis is ranked first by many in the list of drugs causing adverse reactions but few have alluded to the possibil iW that the toxicity is due to a drug inter­act ion rather than hypothyroidism, hypox ia, renal impairment or altered electrodyte concentration.

The quinidine-digoxin interaction was brought to light by Ralph E. Small, Pharm.D. and James H. Marshall, Doctor of Pharmacy Cand idate, in a case report describing the course of a hospitalizat ion for congest ive heart failure and a tria l fibrillation in an elder ly b lack female. She was stabi li zed on digoxin for the treatment of left ventricular fa il ure and given quin idine treatment of atrial fibri llation. After two days of quinidine therapy the patient was experienc­ing anorexia, nausea, and diarrhea whi ch was thought to be induced by the quinidine. Ouinid ine was discontinued and disopyramide therapy was initiated and a digoxin serum assay at this time reveale.d a digox in serum level of 2.55 ng/ml (thErapeutic range: 0.8-2. 0 ng/m l) . Because of th is elevated level, digoxin was implicated as the factor causing the patient's adverse effects; to re lieve her gastrointestinal symptoms, the d igoxin dosage was adjusted.

It can be seen from this case report that quin idine added to the therapy of an individual stabi li zed on digoxin will cause approximately a two-fold increase in the serum digoxin concentration, resulting in gastrointestinal (nausea-vomiting-anorex ia) or ca rdiac toxic symptoms in many patients. Recent literature has indicated that digoxin and quinidine may interact and may result in a rise in the serum digoxin concentration. There are severa l reasons why the

discovery of this interaction is so important. The use of digoxin and quinidine concommitant ly has been increased over the past years due to the fact that congest ive heart fai lure (CHF) being present in approx imately 2% of the population is treated with digoxin; in most cases, with quinidine showing effect iveness in the treatment of atria l arhythmias . Therefore, the chances for concommitant use of digoxin and quinidine are increased . It seems likely that the gastrointestinal d isturbances noted in our patient were due to digoxin tox icity and therefore an alteration of the digoxin dosage after symptoms appeared may have allowed the continued use of quinidine rather than necessitating a change to disopyramide therapy.

What is the mechan ism of this interaction? It is currently thought that quinidine may cause displace­ment of digoxin from tissue - binding sites (binding sites are found in myocard ial tissue as well as non-cardiac tissue) which would lead to the toxicity. Digoxin mean rat io of myocardial tissue concentra­tion to serum concentration is 67: 1, which means if digoxin is displaced from its myocarqial tissue bind­ing site this wou ld lead to an increase in digox in serum cc.,ncentration and might cause gastrointestinal symptoms and, possibly , a decrease in cardiac effect leadi ng to card iac symptoms.

The cl inical pharmacist, in her/his daily review of the patient charts, shou ld screen for patients receiving both digoxi n and quinidine; such patients should be carefu lly observed, and serum digoxin concentrations and ECG readings should be carried out so that appropriate alterat ions in therapy can be initiated if adverse effects are detected. Those patients experi­encing poss ible digitalis toxicity and a rise in serum digox in concentration should have their dose of digoxin reduced, or an alternative antiarrhythmic agent prescribed .

RECIPE 15

The Real Truth About P.A. Majors

by Annette Calabrese

"You're a P.A. major, huh. Well, that's nice. We could alwa~ use another Public Accountant."

I can't begin to count the number of tirfles I've been in the midst of such a conversation . At the beginning, way back in by freshman year (or, at least it seems to have been, eons ago) I would have been very polite to the person who had just uttered such a remark. Very simply and patiently I would have explained that P.A. stood for Physician's Assistant. Then I would cringe and bite my lip to prevent a scream from leaving my mouth in anticipation of that next inevitable question,"Oh is that like a nurse?" or "Oh is that like a medical secretary?", then with even more patience I'd explain just what a P.A . is and does.

But now I'm a junior in my last semester at St. John's, and I guess the wear and tear of endless exams and lab reports have gotten to me because I no longer possess the patience to handle such questions. P.A. majors are just not given the credit, respect and recognition they deserve.

The P.A. program consists of 5 years leading to a B,S. degree. For the first three years, we follow almost the same course as the pharmacy majors do, replacing the strict pharmacy courses, such as Physical Pharmacy. The next 2 years are spent at the U.S. Public Health Service Hospital in Staten Island. Before we can enter this phase of the program, we must fill out an extensive application and undergo an intense interview. There is no guarantee of being accepted. Therefore, the first 3 years of hard work may have been futile. We can also be dismissed for unsatisfactory performance during the latter phase of the program. This point is unknown by many people. It is because of this uncertainty that we feel the P.A. program is Iha most intent, extensive and carefully screened program at St. John's. At the hospital, we are taught by M.D.'s and

16 RECIPE

technicians such courses as Surgery, Radiology and Dermatology, which are on the medical school level. The fifth year is the ultimate learning experience. It is during this year that we are assigned clinical rotations on the various hospital services such as Surgery, Internal Medicine and Orthopedics. After 24 months, we return to St . Johh's for graduation. Of course, like the pharmacy majors, a diploma is useless until we pass the Boards and become certified to work.

Employment in New York State enables us to perform all diagnostic and medical procedures delegated by the supervising physician, and to prescribe medications. The role of the P.A. in the American health care system is to offset the imbalance that has been caused by lack of primary care or family G.P.'s. The P.A.'s function is twofold: the physician tm more time for major medical problems and the patient receives can and diagnoois from a highly trained and qualified a55istant.

The number of P.A. students on campus is small. During my freshman year, there were approximately 25 students in the freshmen class. By the second semester of sophomore year, the number had been reduced to 7 and in the third year the total came to 13 due to several transfer students. The program is relatively new, but the need for such a small group to unite and support one another was recognized. The result of this spirit of cooperatfon was the formation of the P.A. Club, which became official in September 1979. The purpose of the club is to establish a better understanding and appreciation of the importance and scope of a P.A. in the modern medical field. We are a cheerful group, concerned for each other and for the well being of the patients we will one day serve. We are proud to be part of a profession that is beginning to play such a vital role as a health care team. We meet during activities hour, room 244, in the library. Stop by and visit. We're more than willing to meet you and for you to meet us.

Oam a pharmacist

I am a speclallst In medications

I supply medicines and pharmaceuticals to those who need li1em. I prepare and compound special dosage forms. I control the storage and preservation of all medication in my care.

I am a custodian of medical lnfonnatlon

My library is a ready source of drug knowledge. My files contain thousands of specific drug names and tens_of thousands of facts about them. My record includes the medication and health history of entire families. My journals and meetings report advances in pharmacy from around the world.

I am a companion of the physician

1 am a partner in the case of every patient who takes any kind of medication. 1 am a consultant on the merits of different therapeutic agents. 1 am the connecting link between physician and patient and the final check on the safety of

medicines.

I am a counselor to the patient

I help the patient understand the proper use of prescription medicat_ion. . . I assist in the patient's choice of nonprescription drugs or in the dec1s1on to consult a phys1c1an. 1 advise the patient on matters of prescription storage and potency. I

I am a guardian of the public health

My pharmacy is a center for health-care information. I encourage and promote sound personal health practices. My services are available to all at all times.

This Is my calling • This Is my pride

- Author Unknown

T IHI E []RUCi ~ ZZLE

by Mike Chudyk

1 a) Pavabid 1 d) Pyridium 2) Serax 3) Talwin 4) Tofranil 5) lndocin 6) Aldactone

NAME

THE GENERIC

7) Antivert 8) Valmid 9) Vibramycin 10) Furacin 11 a) Keflex 11 d) Magnamycin 12) Aldomet

Ask Albert, R.Ph.

by Mike Chudyk

1. Which of the following is an abrasive soap?

a)Fostril b)Acnomel c)Clearasil d)Oxycel e)Brasivol

2.Patients should restrict their dietarv intake of foods tha\ contain tyramine if they are given a prescription for

a)Eutonyl b)Proloid c)Benemid d)Ascriptin e)Declomycin

3.Cimetidine is used primarily a)to treat nutritional deficiencies b )to treat colitis c)to treat duodenal ulcers d)as a laxative e)as an antinauseant

4.Which of the following is the drug of choice for the treatment of acute gonococcal endocarditis? a)Sulfisoxazole b)Cloxacillin c)Methicillin d)Remicillin G e)Chloramphenicol

5.Enhanced absorption of griseofulvin can occur if the

patient takes the drug a)with antacide containing Calcium b)with 8-complex vitamins c)with large amounts of water d)within 2 hours of a meal

.., e)concurrently with foods rich in fats

6.A primary symptom of an incontinent patient is a)intermitted claudication b)an impacted bowel

' c)frequent urination d)partial impotency e)severe mental depression

7.Coalscence is the opposite of a)dissolution b)drying c)emulsification d)extraction e )sterilization

8.Which of the following drugs must be protected from light? a)Cholestyramine (Questran)

" b)Chlorpromazine (Thorazine) c)Chymotrypsin (Chymoral) d)Chlorpropamide (Diabinese) e)Chlorothiazide (Diuril)

9.Which of the following drugs is administered solely by inhalation? a)Beclomethasone dipropionate b)Epinephrine hydrochloride c)Dexamethasone d)ldoxuridine e)Metaproterenol sulfate

1 O.Keto-Diastix is used to test urine for the presence of a)occult blood b)albumin and ketones c)protein and glucose

' d)glucose and ketones e)bilirubin and urobilinogen

The Pharmacy ~~u "1~ l ~,,

by Michael Chudyk

1) E X I R V C 0 0

2) A T ..

B L E T 0 0

3) L L H A 0 D

0 0 --

4) L A R C s E

0

5) R M T I A u 0 0 -

A substance that manifests its capacities by lightening the burdens of the bowels

......_. ....... ---------

ANSWl!R KEY

81H:fv'H.l 'v'8-V-Jnltl.l 'v' ''v'tl318S lOOl'v'H '.l318'v' .l 'Xl/\tl38

QUIZ ANSWERS

HASK ALBERT" ANSWERS

1) E 6) C

2) A 7) C

3) C 8) B

4) D 9)A

5) E 10) D

The Drug Puzzle Answers

1 a) Papaverine 7) Meclizine

1 d) Phenazopyridine 8) Ethinamate

2) Oxazepam 9) Doxycyc line

3) Pentazocine 10) Nitrofurazone

4) lmip·ramine 11 a) Cephalexin

5) lndomethacin 11 d) Carbomycin

6) Spironolactone 12) Methyldopa

"FACULTY FUNNIES"

"Just for kicks, let's come up with something that has a good side effect."

What do you do In case of a medlcal emergency? Call an ambulance ..... But in the meantime, would you know what to do?

First aid and cardiopulmonary resuscitation courses are being offered by the:

Jamaica Estates Volunteer Ambulance Corps 212-04 Union Turnpike

(21 2) 464-0592 Call after 6 PM weeknights-all day weekends

Volunteers gladly accepted.

The Brothers of Phi Delta Chi wish the students of the College of Pharmacy a very Merry Christmas and a Happy and

Healthy New Year.

MERRY CHRISTMAS

and .HAPPY NEW YEAR

From the staff of RECIPE