The Medicine Guy

Money wise how's life as a pharmacist? D you have a big house or other luxuries?

Mon, 14 May 2012 18:19:02 -0400

Before I answer this question, let me first state that this should not be the primary reason that anyone would want to be a pharmacist. It is a very important job, and for the sake of the patients and the pharmacist it would be best if they are actually passionate about medicine and want to be a pharmacists regardless of the money.

Now, in terms of money it is all relative. What is a lot of money to some people isn’t much money to others. Most pharmacists, depending on the job type and region, make between $90K-130K per year or so. I have a modest home and live a conservative lifestyle, but do not have to worry about money. I’m not balling like Floyd Mayweather, but I am financially secure.

I am a financially savvy person myself. I can attest that you will find many pharmacists that do live in big homes and drive expensive cars. That is their choice however, and barring any substantial additional income will likely prevent them from accumulating substantial wealth and retiring at a reasonable age.

What would be the physiological reason for a PPI to stop working? I was on Aciphex for three years wtih great success and symptom relief, then weaned myself off fairly successfully, was off for two years, and began to take it again recently (at double the dose as per my gastroenterologist's advice about two weeks ago after I experienced a severe flareup of symptoms). Taking the Aciphex at twice the dose has been like taking nothing. Can't seem to find an answer for this anywhere. Thank you.

Thu, 26 Apr 2012 19:17:01 -0400

Hmm, not really sure about the answer to your specific question on this one. I imagine the most likely explanation is a worsening of your disease process (assuming you are taking it for GERD). Sometimes GERD doesn’t respond adequately to PPI treatment. Are symptoms constant, or only worse at times? Did the PPI help at all? Sometimes patients have worse symptoms at night, and a possible solution to that would be to add an H-2 blocker such as Zantac at bedtime, although no strong evidence supports that. Another possible attempt at a solution would be to get changed to a different PPI. No evidence supports any PPI as being more effective than the others, but some people seem to respond better to one PPI than other. If this is the case with you, I wouldn’t really have an explanation for why AcipHex worked before but not now.

My boyfriend recently suffered a concussion, which also resulted in a ruptured ear drum. He is in a lot of pain but the doctor only prescribed him ibuprofen (mainly for the swelling). He has some Vicodin. Is it safe for him to take the Vicodin considering his concussion?

Sat, 31 Mar 2012 16:06:14 -0400

Hello,

The big concern would be that he will be at a heightened risk of sedation, confusion, and other neurologic effects due to additive effects of the concussive symptoms and drug side effects. While these do not pose any long term harms, he could be at an increased risk of falls and accidents. It would be wise for him to avoid any situations in which he could hurt himself or others while taking it (such as driving or operating machinery).

I am taking warfarin for the 3rd week now. 3 days ago my INR reading was 7.8 in which i was experiencing hematuria. my question is, does this elevation had a effect to my current ankle problem. i thought the pain i was feeling due to my ankle problem ( not the bone but the tissue around my ankle) was improving but since the elevation of my INR the pain is unbelievable. I can't move my foot without feeling the pain. I was off warfarin for the last 2 days and had resume it. will the pain improve?

Sat, 31 Mar 2012 16:02:55 -0400

I honestly doubt the two were related.

What are your thoughts on Drug Information as a career? Pros? Moreso the cons? What is the future of this specialty? Any other insights including perhaps why you didn't go down this path are appreciated as well.

Sat, 31 Mar 2012 16:01:21 -0400

Sorry for the delayed response.

Technically, most pharmacists will spend some of their professional lives dealing with drug information. Whether you work in the retail, clinic or institutional setting, you are going to have to obtain information and evaluate that information according to the situation.

I will assume that you are talking about a career in which your job description is to obtain and evaluate drug information. The pros would be learning new stuff everyday, and not dealing with all of the cons of working in one of the aforementioned settings. The cons would be a lack of direct patient care, relationship building with other healthcare professionals, and I would imagine a limited opportunity to advance your career. I say this in ignorance though, as I have literally no experience in this setting. I had a 4 week “drug information” experiential experience during my clinical rotations, but it wasn’t a true drug information setting.

Drug information centers a few and far between, so getting in one would be very difficult. I never really thought about it as a career, and I don’t think it would suit me as I am one that is always looking to move around and try new things.

Aaron

Metformin (by TheMedicineGuy)

Sun, 18 Mar 2012 17:46:56 -0400

Metformin (by TheMedicineGuy)

Sleep Medications and Risk of Death (by TheMedicineGuy)

Thu, 01 Mar 2012 19:50:43 -0500

Sleep Medications and Risk of Death (by TheMedicineGuy)

Counterfeit Medications (by TheMedicineGuy)

Wed, 22 Feb 2012 17:24:32 -0500

Counterfeit Medications (by TheMedicineGuy)

What are your thoughts on Procrit vs. Aranesp? For example, someone taking a Procrit injection every two weeks if hemoglobin is < 12 g/dL, etc. Is it worthwhile to switch to Aranesp monthly? Thanks.

Sun, 19 Feb 2012 16:54:09 -0500

It would be worthwhile if the less frequent injections are a big advantage for you…depending on the cost of course. It may be more expensive to switch to Aranesp, so that would be a factor as well.

There is a good bit more clinical data and experience with Procrit, but no evidence to suggest that one is “better” or safer than the other. So to me, the only two factors are going to be convenience and cost.

Lastly, depending on the reason you need Procrit, you may want to talk with your healthcare provider about modifying your target hemoglobin. Last year, the FDA issued an advisory recommending more conservative hemoglobin targets for kidney disease patients in light of the risks of Procrit or Aranesp treatment. As a general rule, you probably shouldn’t start on it until your hemoglobin is falling below 10, and your goal for treatment should not exceed 10-11.

http://themedicineguy.com/post/6936015666/fda-warning-anemia-drugs

Hope this helps!

-Aaron Emmel, Pharm.D., BCNSP, BCPS

Warfarin Monitoring Every 12 Weeks (by TheMedicineGuy)

Sat, 18 Feb 2012 17:15:41 -0500

Warfarin Monitoring Every 12 Weeks (by TheMedicineGuy)

My latest Medcast: a discussion of the association between...

Sat, 11 Feb 2012 12:29:27 -0500

My latest Medcast: a discussion of the association between Proton Pump Inhibitors and infectious diarrhea.

Nice informational video about statin medications.

Thu, 09 Feb 2012 20:21:15 -0500

Nice informational video about statin medications.

I was on adderral (instant release) for a long time but I stopped when summer came and I didn't have classes because I don't like the effects of being more boring. What other drugs might I try for my ADD? I only heard of one non-stimulant, strattera, and the side effects list for that was terrible.

Sun, 05 Feb 2012 13:09:38 -0500

Hello,

Please note my terms of use prior to interpreting the information below.

Stimulants (like Adderall) are the most effective treatment for ADD/ADHD. If you tolerated it ok, and did not experience any significant side effects, that is still probably the best way to go.

Alternative non-stimulant drugs include Strattera as you mentioned, as well as guanfacine. Neither are as effective as stimulants, but they do have the advantage of not carrying as much abuse potential or sleep disturbance. Guanfacine can be quite sedating though, which may be a drawback. Another option is the antidepressant drug bupropion, although it has problems of its own (such as a risk of seizures) and it doesn’t have much data for effectiveness in adults.

Let me know if you would like further clarification.

-Aaron Emmel, Pharm.D., BCNSP, BCPS

RxEconsult interviews Dr. Emmel

Tue, 31 Jan 2012 13:24:34 -0500

RxEconsult interviews Dr. Emmel:

RxEconsult interviews Dr. Aaron Emmel about his medication therapy management business, SmarterMeds.

Good morning medicine guy. Quick question. Doc gives me 50 mg of painkillers per day for injuries sustained in military. I am tryig to quit smoking but do not know the safety limits of taking pain pills and the nicotine patch. I cannot find a reliable answer to this question, any thoughts?

Fri, 27 Jan 2012 15:52:35 -0500

Good afternoon to you.

The terms of this blog apply to this post.

Well, I am not sure what kind of pain medications you are referring to. Regardless though, it really doesn’t matter as there shouldn’t be any drug interaction between nicotine and either narcotic pain medications, acetaminophen, or NSAIDs. The only concern I can think of would be with certain migraine medications (the “triptans” and Migranal), as nicotine may enhance their cardiovascular toxicity.

So the fact that you are on a nicotine patch really wouldn’t effect the safety of the pain pills otherwise.

Good luck!

-Aaron

I know this is not really what your used to answering , but I was wondering.. Can starting out getting my Pharmacy Technician Certification help my chances of getting into Pharmacy schools? And if so, can you recommend a good school to attend? (I like your videos!) Thanks - Tkc

Wed, 25 Jan 2012 17:53:01 -0500

Thank you!

I have never been involved in the admissions process, so I couldn’t give you a concrete answer. But I imagine, that all other things being equal, the person with the certification will look better since the college knows that person has a true interest in pharmacy. If it doesn’t interfere with your schoolwork or delay your application, you may want to consider it.

US News did a ranking of pharmacy colleges several years ago, based on survey data from those in the academic field.

http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-health-schools/pharmacy-rankings

I would apply to as many as possible, in whichever locations you’d be willing to go to. Pharmacy school has become very competitive, so you’ll have a better chance of getting in the more you apply.

The school that you go to doesn’t make as much of a difference in your education as your own personal attitude towards the process. Just remember that the more you learn and the more proficient you become, the better off your patients will be.

Good luck!

-Aaron

Hey, I was wondering what your opinion was on cleansing? i.e. the substitution of all food for just vegetables fruits and fruit juice. Is it healthy? Should it be avoided?

Mon, 23 Jan 2012 20:59:14 -0500

Perhaps outside the scope of my pharmacist blog, but I will tackle this question since I maintain board certification in nutrition support:

Honestly, I am not familiar with this strategy. I did a quick search on “cleansing” diets, and I have to say they appear to be nothing short of ridiculous. Also, a pubmed search of the terms “colon cleanse”, “cleansing diets”, “detox diet”, etc. turns up only information pertaining to evacuating the colon prior to colonoscopy. None of the websites I browsed that promote the diets cite any reliable scientific evidence of safety or benefit.

It would not be healthy at all if sustained for any significant period. The body needs protein to avoid catabolism, and sufficient protein intake is unlikely to occur from a diet restricted to fruits and vegetables. Additionally, the body needs certain fatty acids to sustain life. Once again, unless a significant quantity of avacados were consumed, this is not likely to occur from that type of diet.

A healthy diet will contain a various foods choices from all of the food groups. Studies have suggested that diets plentiful in fruits and vegetables may reduce the risk for certain cancers and cardiovascular disease, so they are an extremely important component of a healthy diet. But eliminating all other food groups is not a good idea.

I think it is safe to state that there is no evidence to support any health benefit or sustained weight loss from the use of a cleansing diet. Looks to me like another case of some clowns trying to make money utilizing a “snake oil” approach to promoting health.

Hope this helps!

Aaron Emmel, Pharm.D., BCNSP, BCPS

I know I’m a little late on this one…sorry! I...

Thu, 19 Jan 2012 20:18:20 -0500

I know I’m a little late on this one…sorry! I didn’t really address the issue with iron, but I will say that most are probably best getting one w/out unless you have either been diagnosed with an iron deficiency or are a premenopausal woman. That is, if you are going to take a multivitamin at all (watch the video!).

I'm just starting undergrad. Could you talk a little about how retail pharmacies pay their pharmacists? Numbers like $120K per year are thrown around? Are pharmacists paid salary? Or do they go by an hourly rate (i.e. $60/hr)? Are they limited at the one job to only around 40 hrs per week? Does an RPh working 50 hours per week end up making closer to $150K per year or are they somehow prevented from working this much? Thanks.

Mon, 16 Jan 2012 20:20:22 -0500

First, let me preface that it has been years since I have worked in retail pharmacy. The initial figure you threw out is probably fairly close. Most structure their pharmacists as salaried employees, with additional shifts categorized as overtime (with or without an added premium). Given how tight the current job market is, however, I doubt there is much overtime available at all. Some chain retail pharmacies in some areas are only offering sub 40 hour/week contracts to new grads.

I also believe that we are not going to continue to see the same types of salary increases we have been seeing for years. The market has been flooded with pharmacists, so the demand isn’t as high as it has historically been. Also, payment to health care providers is changing in general towards a pay-for-performance model. This has the opportunity to benefit us in the long run, so long as enough pharmacists are willing to step up to the plate to prove our value as providers of clinically and economically valuable services. Otherwise, I would not be surprised to see our average salaries plateau or even decline (as it did with physical therapists).

A bit of advice:

Do not focus on the salary! You will earn a decent living as a pharmacist no matter what environment you work in. Find what you like to do, and do it. When you are talking about around 6 figures in yearly salary, $10,000 to $20,000 does not make a big difference as far as lifestyle goes. However, once you have established a certain financial lifestyle (through commitments to housing and vehicles, etc.), that $10,000 to $20,000 becomes a big deal and makes it very tough to change directions in the future. Job satisfaction will lend much more towards personal happiness than a 10% difference in salary. Trust me.

I committed myself to a chain drugstore, took scholarship assistance, bought a house, etc. When I faced the grim reality of hating my job, and having an opportunity to do something that would make me much happier (and pay me a good bit less), it was an extremely difficult move to make. Fortunately, I made the right decision…but I can’t imagine many in a similar situation would have to stomach to do it.

This is not a knock on any particular field of pharmacy practice, but a general issue that I see pharmacy students make time and time again. Given my personal experience with the same, I always try to pass on what I have learned.

Anyway, best of luck and thanks for checking out the blog.

-Aaron

i am on minocycline for acne and one of the common side effects is having vagina itching. what would you recommended I do to make it stop itching?

Thu, 12 Jan 2012 20:44:19 -0500

Talk to your doctor. While that is a reported side effect of minocycline, it is important to be evaluate for a potential bacterial or fungal infection (which you are at increased risk for while taking an antibiotic such as minocycline).

Regardless, this sounds like reason enough to talk to your doctor about changing to a different treatment for your acne. There are a plethora of options, so I won’t go into specifics (since it really depends on the particular patient). Unfortunately, this is something that can persist from weeks to months after stopping minocycline.