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All right, we're winding down now to the end of the semester! I had six classes, and finished three finals (two essays and a practical) so all that's left is three exams next week! Multiple choice exams, which still weird me out because most of what I took in undergrad were biochem, physics, math, stuff that you need to show your work on so they were all short answer questions, not this scantron thing. I have terrible luck guessing, I hate scantron ):
But that won't matter so long as I know the material, so let's go!! First exam is for my Professional Discovery course.
The topic for this post is an overview of different divisions of research offered in the college, as the next two semesters will include some sort of self-study research course. They're all really cool projects, but some divisions are more exciting than others and unfortunately excitement doesn't translate very well sometimes...
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MEDICINAL AND NATURAL PRODUCTS CHEMISTRY
So medicinal chemistry is exactly as it says: the chemistry of medicine, or more specifically, the relationship between the structure of drugs and their function. Here is an example given in class:
As you can see from the left hand side, you can take three completely different molecules, attach the same pharmacophore (meaning phamaco/drug-phore/carrier) to each of them and BAM!! The same piece of structure gives rise to same function, altering this array of different activities into a single one.
So that's basically how some drugs are designed, taking an identified pharmacophore and attaching it to drugs that are structurally similar to endogenous molecules and seeing if the effect carries over. Or the other way around! You can take an endogenous molecule, remove or alter the pharmacophore, and stop its activity. A lot of inhibitors are used this way, because most of the structure is intact and the same as other substrates, but once it binds and becomes part of the pathway, a key part of the structure is missing for the next step so it halts right there.
Drug design is so slow though, it takes years and I wouldn't have the patience to work in this field ): To get a single drug candidate, you have to identify "leads," which come from millions of "hits," which come from all sorts of places:
1. Know nothing --> random screening of synthetic organic compounds: hopefully this isn't where you're starting from... You bring up a library of thousands of compounds that may or may not be similar to what you're looking for, and just high throughput screen them all. Godspeed.
2. Know source --> natural product: the oldest way to discover drugs is from plants or other microorganisms, where people used to eat whatever plants/roots/berries/whatever they got their hands on and learn is makes them sleepy or nauseous or dead. Uncovering what *exactly* is the molecule to blame is a pain since there's just so many compounds in a plant extract and you've got to screen each one for activity.
3. Know target --> rational drug design: now we're getting somewhere more specific. If you know the target receptor/enzyme/etc that you want the drug to effect, all you need to do is look at the orthosteric or allosteric site and work backwards to figure out what structure can fit in there and design a compound that will likely interact.
4. Know pathway --> metabolism study: if you don't know the exact target but you know you want to affect a certain pathway, you can design a drug that's structurally similar to one of the compounds involved in the pathway but missing some key part, like described above where I mentioned pharmacophores.
5. Know effect --> observed side effects: there could be drugs already existing that have side effects you're interested in instead of the activity. Have another diagram to explain better than I can with words alone:
From the starting compound, we play around with the structure a bit and on the top right end up with diphenhydramine, a potent antihistamine that's also very sedating (great for when you want to breathe at night, but it's a struggle during the day so people start with the nonsedating first). Keeping the sedating pharmacophore in mind, keep tweaking that structure, and in the middle right you end up with a sedating antihistamine that now has dissociative properties. Maybe this is the effect you're interested in, so you work at identifying that pharmacophore, and at the end you've created an antipsychotic! Using an antihistmine as the framework! Amazing!! \o/
Whichever pathway you take, you finally get your lead. What now? The next step is lead refinement, because look at all the trial and error that's led up to your drug design, it's probably so complex and messy that all the extra bits are restricting its activity, not to mention any side effects that might arise from those extra functional groups, etc. It's also cheaper and easier to produce, which is a BIG DEAL because you're sinking millions of dollars into this thing, gotta make a profit.
So here, this is cool! Once you optimize the lead, you learn all sorts of cool stuff with how the activity changes with just a little modification of the structure. An example given in class is morphine. See the R-group on the left side of the molecule? With different functional groups you can go from increased to decreased to no activity at all, with just some extra carbons!!
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PHAMACEUTICS AND TRANSLATIONAL THERAPEUTICS
PTT is super dry... I can't make it as interesting and exciting as MNPC ): The main point of this topic is to encourage more PharmD students to go into research as opposed to choosing between PharmD and PhD as if you've got to choose one over the other. Having clinical knowledge *and* background in research is something of an asset, because you know first hand what areas of your practice you wish there were more information on, and what better way to get that information than with your own hands?
In designing your own research project, you can define your testable hypothesis using the FINER criteria: Is your question
Feasible? First of all, money. But also things like time, equipment, subjects. Focus on if you're able to do it, then worry about the how.
Interesting? You're sinking months to years into this project; pursue what you're really excited to learn, and ride that motivation. If it's not interesting to you, it may not be interesting to anyone else either, so you're unlikely to be published and read if nobody cares.
Novel? It's all about the new and shiny. There's really no point of reinventing the wheel, so if you do a little digging in other literature and find that the question's already been answered, change it a little and find something that adds on to it. Just a little different is still different.
Ethical? IRB approval for human studies, IACUC for animals. Ethics is huge in research, you'll get closed up fast if your study's found out to be unethical.
Relevant? It's got to have an impact on some patient population somewhere, or no one's going to fund you and no one's going to care about the results. The whole point of research is to study something relevant to your patients anyways, so make it count!
Once you get going, the actual projects that come out of the PTT field (which is HUGE and extremely varied because there's so many applications) is super cool. We had professors come in and talk about their projects; they're not part of the exam, but I think they're worth mentioning because they're so cool. Everything from drug crystallization to thermoreversible gels to microneedles-- look at this stuff:
itty bitty needles that comes like a patch you stick on your skin and it gets the drug in you, so small it doesn't hurt at all and you can get drugs that wouldn't normally be absorbed through the skin.
I don't want to work on the actual lit search and study design, but once a PI has a project defined, then maybe I'll jump on board then :P
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APPLIED CLINICAL SCIENCE
The difference between PTT and ACS is the "what" versus the "who." While PTT involves cool things to apply to patients, ACS focuses on the patients they're going to be applied to: certain disease states (e.g. oncology, acute care), subsets of population (e.g. pediatrics, geriatrics), pharmacy specialties (e.g. ambulatory, community), practice specialties (e.g. dental pharmacy, drug information center), etc.
There's... not really a lot. idk what they do specifically; the lecture slides are 7 slides long and I probably fell asleep during the lecture /o\ One of the slides is titled "How ACS can help you" and the three bullet points are "We will provide an idea," "We'll help answer questions," and "We'll help you revise the report."
???? idk. sorry.
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COMMUNITY PHARMACY
/lies down. At this point in the semester I'm really not feeling the whole research thing and my attention's wandering. Which is funny/sad? because a few days later after this lecture I interviewed for a research position with the professor giving the lecture and now I'm working on the stuff he talked about this summer /o\ But, I mean, this isn't really a division of research, it's just a talk on how research can be applied to community pharmacies, which a lot of people are going into and don't think research is directly applicable because they're *dispensing* drugs, not *designing* them. But there's more than just drugs that need research, there's drug related problems, other services for patients, and even finance. Nothing new to talk about since the process is basically the same as PTT (follow the FINER criteria for designing, then follow through accordingly) so I'll just... move on.
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SCHOLARSHIP OF TEACHING AND LEARNING
Drugs are important, technology's important, people are important. It's great for all these big shot pharmacists who have knowledge in their field, but us lowly student pharmacists are important too! SOTL focuses on education, producing papers on educational standards, practice based experiences, use of technology in the classrooms, stuff like that to influence how pharmacy schools can teach students more effectively. There's entire journals that publish these sort of papers, like Currents in Pharmacy Teaching and Learning, American Journal of Pharmaceutical Education, and even general pharmacy journals like the Journal of the American Pharmacists Association. Hey, students are the professionals of tomorrow, so it's important stuff. But I'm just a lowly student, I can't do much so I'm not really interested in this either /: I know I'm going to integrate research into my practice in the future, but right now I'm looking for cool stuff I can do at my current level of education, not years into practice.
Every lecturer gets to write 3 exam questions, but there's not enough material to ask 3 questions?? idk what's going on, no one knows what's going on. It's not hard stuff, it just seems so arbitrary, so it's confusing /:
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INSTITUTIONAL REVIEW BOARD
We got a lecture from someone from the IRB, which is the committee who reviews human subject research proposals to see if they're ethical. "Human subject" here is defined as data from a living individual through intervention or interaction and includes identifiable private information. Basically if you can trace a data point to a specific person, it's human subjects research and you've got to go through the IRB gatekeeper before you can proceed. The person has to be living, so dead people info is fine. It must be private info, so you can use info that's publicly available.
Ethics is really strict in human studies because you're involving lives and there's potential for harm. Even something like an online survey counts, because there may be some distressing question or something and that's harm too, not just physical harm like experimental drugs. To be ethical, subjects must receive information about the study, understand what it involves, and be free to volunteer and leave at any time they wish. The study itself must be designed to minimize risks, and these risks must be reasonable compared to the benefits (so, for example, you can't study a blood pressure lowering drug which has a very common side effect of heart attacks because that's just... why).
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MANUSCRIPT
We've gone through a lot of research ideas and applications, but the end result's going to be the paper for publication. We had a lecturer come in to talk about writing tips, but a lot of it is straightforward, so this'll be short too.
Unlike a normal essay, a research paper has a strict format to follow so you're just sort of filling in the blanks instead of arranging sections on whim. PRISMA is a good resource for a checklist of what sections are required and what needs to go into each section to make sure your paper is thorough and you're not leaving anything important out that'll cause it to be sent back for revision.
With an outline in place, the introduction is a good place to start so you focus on what you need to write about without deviating. How this is usually structured is to begin with a summary of the topic and background information so people have a reference to where your research takes place. Then you narrow it down to the specific areas where there's gaps in knowledge you're going to fill in with your research. After that, you can go on to the rest of the paper, explaining what you did, the results of what happened, what you learned from doing the research, other papers you referenced, and possibly an appendix for extra information that's relevant but unessential.
Then a bunch of miscellaneous writing tips, like using short sentences instead of rambling, defining abbreviations, avoiding personal pronouns (instead of "I showed that," it's "the data showed that," even though the data... didn't really. "We" is better than "I" but in general you just sort of pretend things happened without drawing attention to yourself and making things personal). Then send it off to a reviewer and have then correct things for you!!
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PALLIATIVE MEDICINE AND HOSPICE
Back to applications! Things sort of jump around because each lecture is taught by a different person and they come whenever they can take time off their practice.
Palliative care and hospice focuses on managing symptoms instead of curing diseases, so things like anxiety, depression, nausea, and pain, and depending on how the patient is able to take medication, the drugs can be given via the skin, mouth, nose, rectum, or even the spine.
For example, topical drugs are creams and ointments and stuff you spread on your skin and it does its thing right there. Compare this to a transdermal drug, which goes through the skin and into the bloodstream, where it's carried all around the body. E.g. a transdermal analgesic affects the entire body, which is good if you hurt everywhere, but you're also going to get side effects everywhere (no nausea if it's sitting on your skin not touching your gut) and you need a lot more of the drug since it's travelling throughout your body. Topical drugs don't usually have side effects unless you're allergic to it or something, but on the flipside it's harder to get the drug past the skin and into you because the skin's job is all about keeping stuff out of the body.
HERE'S THE KICKER THOUGH!!
There's topical drugs out there that don't get into the body at all, they're being marketed and used and they work exactly like a placebo and I'm just ???? The placebo effect's strong with these, especially topical pain medications, and there's studies done where almost none of the drug actually gets into the body but patients report pain relief, which researchers link to maybe pressure points on the wrist where the medication's rubbed into, or simply being touched and cared for by a nurse since a lot of these patients aren't getting a lot of interaction otherwise. I was so mad when I heard this, because these people are in pain, they're here to relieve pain, the medication does squat for relieving pain, so ????????? ):
Another formulation is tablets you stick under the tongue or on your cheek, great for patients who can't swallow or you can't get to their veins. WHAT'S NOT SO GREAT THOUGH!! is that some medications are given under the tongue when it doesn't actually get absorbed very well that way???? I'm really mad here, what are they doing. One example they gave was morphine, which doesn't cross the mucosa in the mouth, and yet it's given as a sublingual all the time because it "works." <-- note the quotes. It """works""" because patients are swallowing the drug instead of leaving it under their tongue. It goes through their GI and filtered by the liver and does its stuff then, nothing to do with being given sublingually.
I'm just /o\ the entire time. We only got through 20 out of the 70 slides during class, so even though there's a lot of other routes to go through, this is where I stop. But basically this whole thing is a huge mess and someone should come in and set things straight /o\
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CLINICAL RESEARCH
Aaaand we're back to research in general. A lot of review in this lecture, mostly because it'd make more sense to have this one at the beginning of the semester instead of towards the end, but I guess this was the only time the lecturer could make it.
The lecturer briefly described the process of Translational Phases (T1 = early stage clinical trials for safety, T2 = late stage clinical trials for efficacy, T3 = implementation to real-world practice setting, T4 = evaluation in public health and social determinants). Griped a bit about funding (want funding? develop a drug in a popular disease state. good luck to all those orphan diseases). Encouraged us to do research. Then spent 15 minutes talking about himself and his path to becoming a researcher-- we have 2-3 speakers each lecture period, he only has 50 minutes to talk, I really don't care about your life story.......
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HEALTH SYSTEM PHARMACY
Uhh. This class is difficult to stay awake in unless they're talking about innovative projects, and this lecture isn't one of them :x The first few slides are about the hospital we're neighbors to, a few preview pics of the new children's ward, nothing super interesting. The actual meat of the lecture is about how pharmacists should expand their practice beyond just filling medications (most can't offer extra services because it involves so much time and they don't paid for it, so they risk the pharmacies closing due to bankruptcy. so at the moment, we're fighting for reimbursement for these services, so we can focus on helping patients use their medications correctly and making sure nothing dangerous is going on, which will reduce hospital admission due to drug problems, and reduce medical costs in general. that's the plan, anyways). Health systems then, is a computerized documentation and measurement system that's used to integrate patient care and drug dispensing, and lead to better patient safety. Then the lecturer ends with 40 examples of projects going on at the hospital and just?? no???? don't do that to us??????
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DENTAL PHARMACY
HANDS IN THE AIR: THE LAST LECTURE AND AN ACTUAL INTERESTING LECTURE, THANK YOU
I didn't even know dental pharmacy was a thing, but apparently it is. Like, they made it up specifically for our school or something. idk if that's enough for it to officially be a thing.
We start off with some cringe-worthy statistics:
- Americans make up ~5% of the world population.
- They consume 80% of the world's opiate supply.
- And over 99% of the world's hydrocodone.
Who's hurting you, America??
A lot of this opiate use is actually drug abuse though, and the first drug many addicts start with? PRESCRIPTION hydrocodone. When the prescription runs out, they switch to oxycontin, but it's very expensive. That's when they turn to the streets and to heroin. This prescription hydrocodone though, why do so many people have that to begin with?
The idea is wisdom teeth extraction. Everyone gets it, and they get it early in their lives usually before the age of 25 because it's supposed to hurt less and not crowd out their teeth. Most people don't even need their wisdom teeth extracted, but everybody does it because it's just something everyone does?? So you get painkillers and antibiotics and everything-- 20 to 25 tablets to take as needed for pain. That's up to 8 days worth, when the pain only lasts an average of 2 to 3 days. I don't remember getting prescription painkillers at all, I just took two ibuprofen before bed the first day and woke up and I was fine. Other people actually need strong painkillers, but for most people, that's way too many. I mean. You're in your early 20's. The brain doesn't fully mature until around 25, you've got questionable impulse control and your hands on all this addictive substance and ????
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what is this class
But that won't matter so long as I know the material, so let's go!! First exam is for my Professional Discovery course.
The topic for this post is an overview of different divisions of research offered in the college, as the next two semesters will include some sort of self-study research course. They're all really cool projects, but some divisions are more exciting than others and unfortunately excitement doesn't translate very well sometimes...
-------------------------------------------------------------------------------------
So medicinal chemistry is exactly as it says: the chemistry of medicine, or more specifically, the relationship between the structure of drugs and their function. Here is an example given in class:
As you can see from the left hand side, you can take three completely different molecules, attach the same pharmacophore (meaning phamaco/drug-phore/carrier) to each of them and BAM!! The same piece of structure gives rise to same function, altering this array of different activities into a single one.
So that's basically how some drugs are designed, taking an identified pharmacophore and attaching it to drugs that are structurally similar to endogenous molecules and seeing if the effect carries over. Or the other way around! You can take an endogenous molecule, remove or alter the pharmacophore, and stop its activity. A lot of inhibitors are used this way, because most of the structure is intact and the same as other substrates, but once it binds and becomes part of the pathway, a key part of the structure is missing for the next step so it halts right there.
Drug design is so slow though, it takes years and I wouldn't have the patience to work in this field ): To get a single drug candidate, you have to identify "leads," which come from millions of "hits," which come from all sorts of places:
1. Know nothing --> random screening of synthetic organic compounds: hopefully this isn't where you're starting from... You bring up a library of thousands of compounds that may or may not be similar to what you're looking for, and just high throughput screen them all. Godspeed.
2. Know source --> natural product: the oldest way to discover drugs is from plants or other microorganisms, where people used to eat whatever plants/roots/berries/whatever they got their hands on and learn is makes them sleepy or nauseous or dead. Uncovering what *exactly* is the molecule to blame is a pain since there's just so many compounds in a plant extract and you've got to screen each one for activity.
3. Know target --> rational drug design: now we're getting somewhere more specific. If you know the target receptor/enzyme/etc that you want the drug to effect, all you need to do is look at the orthosteric or allosteric site and work backwards to figure out what structure can fit in there and design a compound that will likely interact.
4. Know pathway --> metabolism study: if you don't know the exact target but you know you want to affect a certain pathway, you can design a drug that's structurally similar to one of the compounds involved in the pathway but missing some key part, like described above where I mentioned pharmacophores.
5. Know effect --> observed side effects: there could be drugs already existing that have side effects you're interested in instead of the activity. Have another diagram to explain better than I can with words alone:
From the starting compound, we play around with the structure a bit and on the top right end up with diphenhydramine, a potent antihistamine that's also very sedating (great for when you want to breathe at night, but it's a struggle during the day so people start with the nonsedating first). Keeping the sedating pharmacophore in mind, keep tweaking that structure, and in the middle right you end up with a sedating antihistamine that now has dissociative properties. Maybe this is the effect you're interested in, so you work at identifying that pharmacophore, and at the end you've created an antipsychotic! Using an antihistmine as the framework! Amazing!! \o/
Whichever pathway you take, you finally get your lead. What now? The next step is lead refinement, because look at all the trial and error that's led up to your drug design, it's probably so complex and messy that all the extra bits are restricting its activity, not to mention any side effects that might arise from those extra functional groups, etc. It's also cheaper and easier to produce, which is a BIG DEAL because you're sinking millions of dollars into this thing, gotta make a profit.
So here, this is cool! Once you optimize the lead, you learn all sorts of cool stuff with how the activity changes with just a little modification of the structure. An example given in class is morphine. See the R-group on the left side of the molecule? With different functional groups you can go from increased to decreased to no activity at all, with just some extra carbons!!
-------------------------------------------------------------------------------------
PTT is super dry... I can't make it as interesting and exciting as MNPC ): The main point of this topic is to encourage more PharmD students to go into research as opposed to choosing between PharmD and PhD as if you've got to choose one over the other. Having clinical knowledge *and* background in research is something of an asset, because you know first hand what areas of your practice you wish there were more information on, and what better way to get that information than with your own hands?
In designing your own research project, you can define your testable hypothesis using the FINER criteria: Is your question
Feasible? First of all, money. But also things like time, equipment, subjects. Focus on if you're able to do it, then worry about the how.
Interesting? You're sinking months to years into this project; pursue what you're really excited to learn, and ride that motivation. If it's not interesting to you, it may not be interesting to anyone else either, so you're unlikely to be published and read if nobody cares.
Novel? It's all about the new and shiny. There's really no point of reinventing the wheel, so if you do a little digging in other literature and find that the question's already been answered, change it a little and find something that adds on to it. Just a little different is still different.
Ethical? IRB approval for human studies, IACUC for animals. Ethics is huge in research, you'll get closed up fast if your study's found out to be unethical.
Relevant? It's got to have an impact on some patient population somewhere, or no one's going to fund you and no one's going to care about the results. The whole point of research is to study something relevant to your patients anyways, so make it count!
Once you get going, the actual projects that come out of the PTT field (which is HUGE and extremely varied because there's so many applications) is super cool. We had professors come in and talk about their projects; they're not part of the exam, but I think they're worth mentioning because they're so cool. Everything from drug crystallization to thermoreversible gels to microneedles-- look at this stuff:
itty bitty needles that comes like a patch you stick on your skin and it gets the drug in you, so small it doesn't hurt at all and you can get drugs that wouldn't normally be absorbed through the skin.
I don't want to work on the actual lit search and study design, but once a PI has a project defined, then maybe I'll jump on board then :P
-------------------------------------------------------------------------------------
The difference between PTT and ACS is the "what" versus the "who." While PTT involves cool things to apply to patients, ACS focuses on the patients they're going to be applied to: certain disease states (e.g. oncology, acute care), subsets of population (e.g. pediatrics, geriatrics), pharmacy specialties (e.g. ambulatory, community), practice specialties (e.g. dental pharmacy, drug information center), etc.
There's... not really a lot. idk what they do specifically; the lecture slides are 7 slides long and I probably fell asleep during the lecture /o\ One of the slides is titled "How ACS can help you" and the three bullet points are "We will provide an idea," "We'll help answer questions," and "We'll help you revise the report."
???? idk. sorry.
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/lies down. At this point in the semester I'm really not feeling the whole research thing and my attention's wandering. Which is funny/sad? because a few days later after this lecture I interviewed for a research position with the professor giving the lecture and now I'm working on the stuff he talked about this summer /o\ But, I mean, this isn't really a division of research, it's just a talk on how research can be applied to community pharmacies, which a lot of people are going into and don't think research is directly applicable because they're *dispensing* drugs, not *designing* them. But there's more than just drugs that need research, there's drug related problems, other services for patients, and even finance. Nothing new to talk about since the process is basically the same as PTT (follow the FINER criteria for designing, then follow through accordingly) so I'll just... move on.
-------------------------------------------------------------------------------------
Drugs are important, technology's important, people are important. It's great for all these big shot pharmacists who have knowledge in their field, but us lowly student pharmacists are important too! SOTL focuses on education, producing papers on educational standards, practice based experiences, use of technology in the classrooms, stuff like that to influence how pharmacy schools can teach students more effectively. There's entire journals that publish these sort of papers, like Currents in Pharmacy Teaching and Learning, American Journal of Pharmaceutical Education, and even general pharmacy journals like the Journal of the American Pharmacists Association. Hey, students are the professionals of tomorrow, so it's important stuff. But I'm just a lowly student, I can't do much so I'm not really interested in this either /: I know I'm going to integrate research into my practice in the future, but right now I'm looking for cool stuff I can do at my current level of education, not years into practice.
Every lecturer gets to write 3 exam questions, but there's not enough material to ask 3 questions?? idk what's going on, no one knows what's going on. It's not hard stuff, it just seems so arbitrary, so it's confusing /:
-------------------------------------------------------------------------------------
We got a lecture from someone from the IRB, which is the committee who reviews human subject research proposals to see if they're ethical. "Human subject" here is defined as data from a living individual through intervention or interaction and includes identifiable private information. Basically if you can trace a data point to a specific person, it's human subjects research and you've got to go through the IRB gatekeeper before you can proceed. The person has to be living, so dead people info is fine. It must be private info, so you can use info that's publicly available.
Ethics is really strict in human studies because you're involving lives and there's potential for harm. Even something like an online survey counts, because there may be some distressing question or something and that's harm too, not just physical harm like experimental drugs. To be ethical, subjects must receive information about the study, understand what it involves, and be free to volunteer and leave at any time they wish. The study itself must be designed to minimize risks, and these risks must be reasonable compared to the benefits (so, for example, you can't study a blood pressure lowering drug which has a very common side effect of heart attacks because that's just... why).
-------------------------------------------------------------------------------------
We've gone through a lot of research ideas and applications, but the end result's going to be the paper for publication. We had a lecturer come in to talk about writing tips, but a lot of it is straightforward, so this'll be short too.
Unlike a normal essay, a research paper has a strict format to follow so you're just sort of filling in the blanks instead of arranging sections on whim. PRISMA is a good resource for a checklist of what sections are required and what needs to go into each section to make sure your paper is thorough and you're not leaving anything important out that'll cause it to be sent back for revision.
With an outline in place, the introduction is a good place to start so you focus on what you need to write about without deviating. How this is usually structured is to begin with a summary of the topic and background information so people have a reference to where your research takes place. Then you narrow it down to the specific areas where there's gaps in knowledge you're going to fill in with your research. After that, you can go on to the rest of the paper, explaining what you did, the results of what happened, what you learned from doing the research, other papers you referenced, and possibly an appendix for extra information that's relevant but unessential.
Then a bunch of miscellaneous writing tips, like using short sentences instead of rambling, defining abbreviations, avoiding personal pronouns (instead of "I showed that," it's "the data showed that," even though the data... didn't really. "We" is better than "I" but in general you just sort of pretend things happened without drawing attention to yourself and making things personal). Then send it off to a reviewer and have then correct things for you!!
-------------------------------------------------------------------------------------
Back to applications! Things sort of jump around because each lecture is taught by a different person and they come whenever they can take time off their practice.
Palliative care and hospice focuses on managing symptoms instead of curing diseases, so things like anxiety, depression, nausea, and pain, and depending on how the patient is able to take medication, the drugs can be given via the skin, mouth, nose, rectum, or even the spine.
For example, topical drugs are creams and ointments and stuff you spread on your skin and it does its thing right there. Compare this to a transdermal drug, which goes through the skin and into the bloodstream, where it's carried all around the body. E.g. a transdermal analgesic affects the entire body, which is good if you hurt everywhere, but you're also going to get side effects everywhere (no nausea if it's sitting on your skin not touching your gut) and you need a lot more of the drug since it's travelling throughout your body. Topical drugs don't usually have side effects unless you're allergic to it or something, but on the flipside it's harder to get the drug past the skin and into you because the skin's job is all about keeping stuff out of the body.
HERE'S THE KICKER THOUGH!!
There's topical drugs out there that don't get into the body at all, they're being marketed and used and they work exactly like a placebo and I'm just ???? The placebo effect's strong with these, especially topical pain medications, and there's studies done where almost none of the drug actually gets into the body but patients report pain relief, which researchers link to maybe pressure points on the wrist where the medication's rubbed into, or simply being touched and cared for by a nurse since a lot of these patients aren't getting a lot of interaction otherwise. I was so mad when I heard this, because these people are in pain, they're here to relieve pain, the medication does squat for relieving pain, so ????????? ):
Another formulation is tablets you stick under the tongue or on your cheek, great for patients who can't swallow or you can't get to their veins. WHAT'S NOT SO GREAT THOUGH!! is that some medications are given under the tongue when it doesn't actually get absorbed very well that way???? I'm really mad here, what are they doing. One example they gave was morphine, which doesn't cross the mucosa in the mouth, and yet it's given as a sublingual all the time because it "works." <-- note the quotes. It """works""" because patients are swallowing the drug instead of leaving it under their tongue. It goes through their GI and filtered by the liver and does its stuff then, nothing to do with being given sublingually.
I'm just /o\ the entire time. We only got through 20 out of the 70 slides during class, so even though there's a lot of other routes to go through, this is where I stop. But basically this whole thing is a huge mess and someone should come in and set things straight /o\
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Aaaand we're back to research in general. A lot of review in this lecture, mostly because it'd make more sense to have this one at the beginning of the semester instead of towards the end, but I guess this was the only time the lecturer could make it.
The lecturer briefly described the process of Translational Phases (T1 = early stage clinical trials for safety, T2 = late stage clinical trials for efficacy, T3 = implementation to real-world practice setting, T4 = evaluation in public health and social determinants). Griped a bit about funding (want funding? develop a drug in a popular disease state. good luck to all those orphan diseases). Encouraged us to do research. Then spent 15 minutes talking about himself and his path to becoming a researcher-- we have 2-3 speakers each lecture period, he only has 50 minutes to talk, I really don't care about your life story.......
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Uhh. This class is difficult to stay awake in unless they're talking about innovative projects, and this lecture isn't one of them :x The first few slides are about the hospital we're neighbors to, a few preview pics of the new children's ward, nothing super interesting. The actual meat of the lecture is about how pharmacists should expand their practice beyond just filling medications (most can't offer extra services because it involves so much time and they don't paid for it, so they risk the pharmacies closing due to bankruptcy. so at the moment, we're fighting for reimbursement for these services, so we can focus on helping patients use their medications correctly and making sure nothing dangerous is going on, which will reduce hospital admission due to drug problems, and reduce medical costs in general. that's the plan, anyways). Health systems then, is a computerized documentation and measurement system that's used to integrate patient care and drug dispensing, and lead to better patient safety. Then the lecturer ends with 40 examples of projects going on at the hospital and just?? no???? don't do that to us??????
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HANDS IN THE AIR: THE LAST LECTURE AND AN ACTUAL INTERESTING LECTURE, THANK YOU
I didn't even know dental pharmacy was a thing, but apparently it is. Like, they made it up specifically for our school or something. idk if that's enough for it to officially be a thing.
We start off with some cringe-worthy statistics:
- Americans make up ~5% of the world population.
- They consume 80% of the world's opiate supply.
- And over 99% of the world's hydrocodone.
Who's hurting you, America??
A lot of this opiate use is actually drug abuse though, and the first drug many addicts start with? PRESCRIPTION hydrocodone. When the prescription runs out, they switch to oxycontin, but it's very expensive. That's when they turn to the streets and to heroin. This prescription hydrocodone though, why do so many people have that to begin with?
The idea is wisdom teeth extraction. Everyone gets it, and they get it early in their lives usually before the age of 25 because it's supposed to hurt less and not crowd out their teeth. Most people don't even need their wisdom teeth extracted, but everybody does it because it's just something everyone does?? So you get painkillers and antibiotics and everything-- 20 to 25 tablets to take as needed for pain. That's up to 8 days worth, when the pain only lasts an average of 2 to 3 days. I don't remember getting prescription painkillers at all, I just took two ibuprofen before bed the first day and woke up and I was fine. Other people actually need strong painkillers, but for most people, that's way too many. I mean. You're in your early 20's. The brain doesn't fully mature until around 25, you've got questionable impulse control and your hands on all this addictive substance and ????
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what is this class