Mike Corvino, PharmD, BCPS, BCACP, CDCES; Yara Salem, PharmD Candidate 2020, and Aaron Young, PharmD Candidate 2020

This case is based on the work of Dr. David Osser and colleagues.

A 34-year-old overweight AA female presents to clinic for mental health follow up. The patient lost her insurance due to losing her job and was not on any medications for 2–3 months, however she is now enrolled in a patient assistance program. Before losing her insurance, she was on sertraline 50mg daily for anxiety and depression for 3 months. At her next appointment, she states that she’s still having crying spells, panic attacks, and difficulty getting out of bed. Her sertraline was increased to 100mg. One month later, she comes to the clinic complaining of sexual dysfunction due to the sertraline. She has a history of substance use disorder 10 years prior and wants to avoid taking benzodiazepines if possible. …

Background

Estimated 3.5 million persons in the living with Hep C in the US (CDC estimation). Big increase in new acute cases from 2005 to 2015 (possibly due to opioid epidemic). It is estimated that 75% of the patients with HCV were born between 1945 and 1965 and 50% of patients are unaware.

The most common risk factor for HCV is injection drug use. Can be transmitted sexually but higher risk with MSM (especially those with HIV). Experts projecting that HCV deaths will peak around the year 2030 to 2035 with rates as high as 36,000 per year. …

Growing up, I didn’t want to be a nurse. I was going to be an elementary school teacher. Then, 8th grade hit and my life changed forever. First, was an unexpected surgery and subsequent recovery. A few months later, I dislocated my knee and was in physical therapy for months. After that, I got mono and was sick for several months. One health problem after another and hours upon hours in doctors offices and hospital rooms. These months gave me a greater understanding and appreciation for the medical community, nurses in particular. The nurses were always there, taking care of me as a person. They made me as comfortable as possible, and I would even label the experience as pleasant. They embodied compassion and knowledge blended together, and I wanted to join their ranks. I applied to a four-year Bachelor of Nursing program. However, when I began nursing classes and clinicals, I faced a realization: I was not in love with nursing. Why? All of my classmates seemed to be happy and content. But for me, nothing was clicking. I appreciated it from a scientific perspective but I still didn’t feel passion for the profession. I shadowed a friend of mine who was an ER nurse, I shadowed in the oncology center at Johns Hopkins. My senior year, I spent a day with a school nurse, and for the first time I had found a setting in which I could see myself being a nurse. At the same time, I began to have a greater interest in overseas medical work and various ministry opportunities. I realized how much nursing could be used in various avenues and what a valuable tool it was. …

By Vincent Wartenweiler, PharmD Candidate

When I meet someone new and I tell them that I’m in pharmacy school, I usually get one of two responses. The most common is usually something along the lines of, “Wow! You must be really smart!” The second, somewhat irritating, response sounds like “Oh, so you’re going to work at *insert major chain retail pharmacy here* for the rest of your life?” What often follows the second response is a genuine conversation regarding the diverse career options available to current pharmacy graduates. Today’s pharmacists have many responsibilities beyond simply dispensing medication. Other critical roles pharmacists play include patient education, medication therapy management, and treatment adherence. …

By Mary Tremaine

When guest lecturers attend Purdue University College of Pharmacy, I enjoy the inclusion that each lecturer makes to state their name followed by a brief story of how they got to where they are today. Each person shows a distinct journey that increases relatability to those who may connect to certain aspects of their journey or relatability in the acknowledgement that they sat in our exact seats as a student. No, I won’t be presenting any sort of lecture, but I am here to present my journey to pharmacy and where I hope that this will lead me in my future. …

This is an article that I wrote for Dr. Adam Martin’s Fit Pharmacist blog back in 2017. My career has e-volved significantly since I wrote this, but the overall thesis remains. Enjoy…..

What is the recipe for success as a pharmacist? Start with having perfect attendance in school, add good grades, mix-in memberships to a few professional organizations, and sprinkle a residency on top. Then, all this hard work will hopefully culminate in landing an excellent job. Many universities and professors regularly pontificate on this foolproof path to success. However, there are always students that do not fit the generic mold or simply enjoy going against the flow. Are these students destined for less successful careers or even career failure? I think it completely depends on the individual. …

Time is money. Everyone has 24 hours in a day. Feel free to insert a different cliché statement to proclaim how busy you are. You may roll your eyes when you hear those types of statements, but that doesn’t change the fact that everyone enjoys saving time. As healthcare professionals, a lack of time is the number one excuse we give (according to a survey that I fabrocated) as to why we can’t keep up with current medical literature. Regardless for what subject you are learning, there is no better time saver than a podcast. Podcasts allow listeners the freedom to listen to their favorite show where they want and when it’s convenient. …

What is the difference between tenofovir disoproxil fumarate (TDF) and the new formulation tenofovir alafenamide fumarate (TAF)? Both of these medications are typically used in combination with other antiretrovirals to make up a patient’s HAART regimen for the treatment of HIV. TDF was the original form and has been used for years. While it is very effective at suppressing viral load, it can potentially cause some adverse effects over time. The two biggest issues with TDF are nephrotoxicity and a reduction in bone mineral density. TDF, a prodrug, is transported from the gut, to the plasma, and then to the target cell that contains the virus. After absorption from the gut, it is converted to the active drug tenofovir (tenofovir has poor bioavailability in its active form). After entering the plasma, the prodrug TDF has a half-life of around 20 to 30 seconds before it is metabolized into its active form. This means that a high percentage of the drug stays in the extracellular plasma where it is renally eliminated (cause of nephrotoxicity). TAF is the new prodrug formulation of tenofovir. After entering the plasma, it has a half-life of around 90 minutes. More of the prodrug has time to enter the target cell. This leads to much higher intracellular concentrations of active tenofovir and greatly reduces extracellular concentrations. TAF has shown in clinical trials (so far anyway) to not cause nephrotoxicity or bone mineral density loss like its predecessor. Several of the combination products are being re-released with TAF instead of TDF. Genvoya is the TAF version of Stribild, Odefsey is the TAF version of Complera, and Descovy is the TAF version of Truvada. TAF is also available by itself as Vemlidy (taking the place of Viread) but is only approved for Hep B treatment. I hope this helps clear up any confusion between TDF and TAF. .
I want to give a huge thanks to Dylan LeBlanc, PharmD for collaborating with me on this post. Dylan is currently a PGY-1 resident at Mercy Hospital in Joplin, Missouri. Dylan has a passion for educating. …