RxPharmacist

Menu
LOGIN

Education

Pharmacy Deserts: Navigating the Dry Lands of Medication Access

Leave a Comment / Blog /
Reference image: Unsplash

Imagine needing critical medication but having to travel miles to the nearest pharmacy. Or worse… finding none in your community. This scenario is a reality for 15.8 million Americans living in “pharmacy deserts.” Pharmacy deserts, modeled after the term “food desert,” describe areas where residents face significant barriers and have to travel considerable distances in order to access a pharmacy. It is a term coined in 2014 by Dr. Dima Qato, an associate professor at the University of Southern California studying pharmacy access and health equity. The distances defining this term varies depending on geographical location, as described below: 

  • Rural → Area within ten-mile radius from the nearest pharmacy
  • Suburban → Area within two-mile radius from the nearest pharmacy, or half a mile for those without cars
  • Urban → Area within one-mile radius from the nearest pharmacy, or half a mile for those without cars

Pharmacists play a critical role in providing healthcare services and are often considered as the most accessible healthcare professionals. Aside from dispensing essential medications, pharmacists also assist in immunization administration and diagnostic testing. The consequences of not having a pharmacy within adequate traveling distance can affect many lives, particularly in marginalized communities, where they are most prevalent. Dr. Qato’s studies show that predominantly white neighborhoods, despite making up 28.9% of all neighborhoods, only account for 4.3% of pharmacy deserts. This highlights the uneven distribution of pharmacy resources, the need for improved pharmacy access in underserved areas, and the importance of providing medical care for those  who need it the most.

Image created with Canva

Factors Contributing to Pharmacy Deserts and Impact

Grasping the underlying causes of pharmacy deserts is key to finding effective solutions. Various challenges contribute to the lack of pharmacy access in many communities.

Pharmacy Closures

In the past couple of years, there has been an increase in community pharmacy closures across the United States, contributing significantly to the formation of pharmacy deserts. Major chains like Rite Aid, CVS, and Walgreens have collectively closed over 1,500 stores, often in predominantly Black, Latino, and low-income neighborhoods. These closures are partly driven by business competition between independent pharmacies and chains, desire to cut costs by closing underperforming stores, and financial strains from settlements related to the opioid epidemic.

Pharmacy Benefit Managers (PBMs)

PBMs play a large role in the healthcare system by negotiating drug prices and creating pharmacy networks for insurers. However, they often exclude independent pharmacies from these networks, directing patients to specific chain pharmacies instead. This exclusion hits independent pharmacies hard, especially those serving Medicaid and Medicare patients, as they receive lower reimbursement rates compared to private insurers. Furthermore, the lack of price transparency in PBM practices makes it financially difficult for pharmacies, especially in low-income areas, to profit and keep up with operational costs.

Economic and Demographic Challenges

Pharmacy deserts are more common in areas with higher poverty levels, more renters, an ethnic population, and limited transportation options. These areas may also face higher crime rates and lack healthcare professionals, further limiting access to pharmacy services.

Pharmacy deserts disproportionately affect marginalized communities, leading to poorer health outcomes. Residents in these areas face barriers such as longer travel times and medication shortages, resulting in lower adherence to prescribed treatments and this impacts their overall well-being. This situation not only increases healthcare costs, but also worsens health disparities.

Climate Change

The impact of pharmacy deserts is worsened by the increasing frequency of extreme weather due to climate change. These events can disrupt pharmacies and even supply chains, further complicating medication access issues. Additionally, pharmacies often aren’t fully prepared with a protocol to continue operations and deliver care promptly during extreme events. For instance, after a wildfire, patients often need to find alternative pharmacies or providers, adding stress during an already challenging time. As a result, extreme weather conditions only put further strain on a community with limited access to medication services.

Solutions and Takeaway

Several solutions have been proposed and put into action to tackle pharmacy deserts. For instance, mail-order and delivery options have been offered and encouraged to minimize the need for long trips to the pharmacy. There are also mobile pharmacies that bring essential medications, health screenings, and vaccinations directly to underserved communities. With the closure of major chain pharmacies, this also increases the opportunity for independent pharmacies to step in, especially in rural areas, and provide personalized services that cater to the need of the community. However, there is still much that needs to be done, and public advocacy for health equity is needed to properly address this issue. A collaborative effort among local healthcare providers, non-profit organizations, government agencies, and pharmacy associations is crucial to expanding pharmacy services and reducing disparities, especially in marginalized communities. Pharmacy schools should also incorporate education on social determinants of health to prepare future pharmacists for these challenges.

Overall, pharmacy deserts highlight significant healthcare inequities that largely negatively impact the health outcomes of marginalized communities. The complexity of this issue coupled with deeply rooted systemic inequalities makes this a challenging problem to address. It is imperative that we as healthcare professionals stay informed and advocate for change to pave the way for a future where pharmacy services are accessible for everyone.

Winnie Chu

RxPharmacist Team

Resources
  1. Pharmacy deserts put the health of underserved communities at risk. Available at: https://spotlightonpoverty.org/spotlight-exclusives/pharmacy-deserts-put-the-health-of-undeserved-communities-at-risk/. Accessed August 2, 2024.
  2. Locations and characteristics of pharmacy deserts in the United States: a geospatial study. Health Affairs Scholar. Available at: https://academic.oup.com/healthaffairsscholar/article/2/4/qxae035/7630415. Accessed August 2, 2024.
  3. Pharmacy deserts: More than where pharmacies are. PubMed. Available at: https://pubmed.ncbi.nlm.nih.gov/35953379/. Accessed August 2, 2024.
  4. Access to pharmacies and pharmacy services in New York City, Los Angeles, Chicago, and Houston, 2015-2020. PubMed. Available at: https://pubmed.ncbi.nlm.nih.gov/34366287/. Accessed August 2, 2024.
  5. Pharmacy deserts and pharmacies’ roles post-extreme weather and climate events in the United States: a scoping review. PubMed. Available at https://pubmed.ncbi.nlm.nih.gov/37431885/#. Accessed August 7, 2024.

Pharmacy Deserts: Navigating the Dry Lands of Medication Access Read More »

GLP-1 Receptor Agonists: Ensuring Appropriate Use Amidst High Demand

Leave a Comment / Blog /
Reference image: Pexels

GLP-1 receptor agonists (GLP-1s) have become a hot topic in recent years. Celebrities, online influencers, and even multi-billionaires like Elon Musk use them, touting them as a quick fix weight loss solution. With about 70% of American adults being overweight or obese, and many dealing with related health complications, it’s no surprise that people seeking a slimmer figure are turning to GLP-1s for help. After all, the ability to lose upwards of 10-25 pounds just by taking a weekly injection sounds ideal and convenient.

However, GLP-1s are more than just a trend. It is a class of drugs used as a second-line add-on medication in type 2 diabetes management and as a first-line treatment in obesity management. This growing popularity, especially among those with obesity, has contributed to a nationwide drug shortage and raises concerns about ensuring that patients with diabetes still have access to these vital treatments. Therefore, understanding the appropriate use of GLP-1s for individuals is crucial.

How do GLP-1s work?

GLP-1s work by stimulating insulin secretion and suppressing glucagon secretion in hyperglycemic states. This delays gastric emptying and decreases appetite.

Image created with Canva

What are GLP-1s used for?

  1. Diabetes Mellitus

GLP-1s are primarily used as a second-line treatment for type 2 diabetes. They are especially beneficial when used alongside metformin or combination therapy in the following situations:

  • Atherosclerotic cardiovascular disease (ASCVD)
  • Chronic kidney disease (if SGLT2 inhibitors are not tolerable or if additional glucose control is needed)
  • Existing combination therapy with need for additional weight loss or glycemic management
  1. Weight Loss

GLP-1s are also a first-line therapy for managing obesity in patients who have not achieved at least 5% total body weight loss in three to six months through lifestyle interventions. They are recommended for:

  • Individuals with a BMI >30 kg/m²
  • Individuals with a BMI of 27-29.9 kg/m² who have weight-related comorbidities such as hypertension, dyslipidemia, type 2 diabetes mellitus, obstructive sleep apnea, or cardiovascular disease

See below for additional information regarding available GLP-1 medications:

What are some adverse reactions and warnings to be aware of?

When starting GLP-1 receptor agonists, patients typically undergo a titration period to help mitigate gastrointestinal side effects. It is recommended to prescribe a low dose initially and gradually increase it to minimize adverse effects like nausea and vomiting.

  • Gastrointestinal (nausea, vomiting, diarrhea)
  • Injection site reactions (redness, itching, swelling)
  • Acute kidney injury
  • Cholelithiasis (gallstones)

Black Box Warning

GLP-1s are not recommended in patients with or at risk of Thyroid C-Cell tumors. These drugs are also not recommended for pregnant patients and those with severe gastrointestinal diseases (ulcerative colitis, Crohn’s disease, irritable bowel syndrome, inflammatory bowel disease).

Challenges

Despite their effectiveness, GLP-1s face challenges regarding cost and availability. A one-month supply of these medications can cost over $1,000 without insurance, creating a financial barrier for many people. The demand for these drugs has also exceeded supply, causing major manufacturers to announce shortages. The Food and Drug Administration (FDA) manages a website that allows healthcare providers and patients to view drugs on shortage. To further assist patients, a telehealth company, Ro, has also developed a public tracker to provide real-time availability information submitted by consumers themselves. Another issue to note is the disparity in medication access, with the largest users being disproportionately non-Hispanic white females. Difficulty finding insurance coverage further exacerbates these inequities. Lastly, counterfeit versions of GLP-1s have also emerged in the market, posing risks to patient safety. Addressing these issues requires collaborative effort between insurers, healthcare professionals, and government entities to improve access, lower costs, and to ensure the authenticity and safety of medications.

Takeaway

GLP-1s offer significant benefits for diabetes and obesity management, but challenges such as high costs and shortages limit access to patients who need the drugs. People who are seeking these medications should always see a licensed medical professional to determine if the use of GLP-1s is the most appropriate option for them. Healthcare providers and pharmacists alike have a responsibility to stay informed about these medications, their availability, and cost to ensure they can offer the best guidance for patients.

Winnie Chu

RxPharmacist Team

Resources
  1. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. The New England Journal of Medicine. 2021;385(6):503-515. doi:10.1056/NEJMoa2107519. Available at: https://www.nejm.org/doi/full/10.1056/NEJMoa2107519. Accessed August 3, 2024.
  2. FDA Approves New Medication for Chronic Weight Management. U.S. Food and Drug Administration. Available at: https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management. Accessed August 3, 2024.
  3. Glucagon-like peptide-1 receptor agonists. Available at: https://www.ncbi.nlm.nih.gov/books/NBK551568/. Accessed August 3, 2024.
  4. Shifting Trends in the Indication of Glucagon-like Peptide-1 Receptor Agonist Prescriptions: A Nationwide Analysis. Available at: https://www.acpjournals.org/doi/10.7326/M24-0019. Accessed August 3, 2024.
  5. Are You Sure Your Ozempic Is Real? Fakes Are on the Rise. The New York Times. July 12, 2024. Available at: https://www.nytimes.com/2024/07/12/well/ozempic-fake-counterfeit-drugs.html. Accessed August 3, 2024.
  6. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2024. American Diabetes Association. 2024;26(4):501-510. doi:10.1111/dom.14535. Available at: https://pubmed.ncbi.nlm.nih.gov/38078590/. Accessed August 3, 2024.

GLP-1 Receptor Agonists: Ensuring Appropriate Use Amidst High Demand Read More »

AI & Pharmacists: What Does The Future Hold For The Pharmacy Profession?

Leave a Comment / Blog /
Reference image: Unsplash

Remember when artificial intelligence (AI) felt like something from a sci-fi movie? These days, AI exists in many parts of our lives – from virtual assistants like Siri to self-driving cars. Even tools like ChatGPT are now helping with everyday tasks like drafting emails and answering questions. As AI continues to evolve and make its way into different work sectors, what does this mean for the future of the pharmacy profession as a whole?

Believe it or not, AI’s presence in healthcare is growing rapidly, offering new opportunities to enhance medication management, patient care, and pharmacy operations. Here’s how AI is currently making a difference in the pharmacy field:

Medication Management

Machine learning is being used to analyze patient information, including medical records, laboratory results, and medication lists. This can help assess the safety and efficacy of drugs, discover possible possible drug-drug interactions, and  provide recommendations best suited for unique patient needs. AI models can even predict drug levels within the body and help optimize improve medication dosages. This is especially true for medications that need frequent close monitoring, like vancomycin. 

Automating Pharmacy Operations

In community chain pharmacies, robotic dispensing systems exist to help fill prescribed medicines. This reduces error and improves efficiency by allowing staff and pharmacists to focus on personalized patient interactions. There are also chatbots or automated voicemails that help assist patients by resolving common, simple customer queries or rerouting complex questions to human staff. AI also helps with inventory management, predicting future patient needs, optimizing stock levels, and using software to send reminders to patients about their medication requirements. Additionally, AI monitors patient medication adherence by analyzing usage and refill history, allowing early identification of nonadherence risks and enabling timely interventions. One example is AiCure, a mobile app designed to ensure patients adhere to their medication regimen during clinical trials. AiCure tracks when patients miss doses and alerts clinical teams to response promptly.

Image created with Canva

Benefits and Challenges

AI has come a long way in helping pharmacists with many tasks, but there’s growing concern about whether it might replace human pharmacists entirely someday.  After all, it seems like it can complete human tasks more accurately and at a faster pace. Let’s weigh the advantages and disadvantages of AI.

Despite the impressive capabilities and cost-saving benefits AI seems to offer, it still requires human oversight to ensure accuracy and provide the personal interaction that patients value. As a result, while AI can automate many tasks and improve operational efficiency, it is unlikely to replace human pharmacists entirely.

Future Outlook

AI is expected to be increasingly integrated with electronic health records and clinical decision support systems, providing personalized treatment plans and improving patient outcomes. Major pharmaceutical companies such as Pfizer and Johnson & Johnson, have already collaborated with or acquired AI technologies. In fact, Pfizer took advantage of AI models to research and accelerate the development Paxlovid® for COVID-19 treatment.  According to the McKinsey Global Institute, AI and machine learning in the pharmaceutical industry can generate nearly $110 billion annually across the US healthcare system. As this estimate suggests, AI holds a strong potential to transform the pharmacy and healthcare field in the upcoming years and enhance both efficiency and patient outcomes. The Food and Drug Administration (FDA) also recognizes the impact AI holds for the future and has established support in ensuring AI medical products are safe and effective. As of March 2024, the FDA is building on Good Machine Learning Practice principles to refine guidelines and promote a quality assurance framework for future AI medical products that will enter the market.

Overall, while AI can assist with managing data and streamlining processes, the human connection provided by pharmacists remains invaluable. It cannot replace the clinical judgment, expertise, and patient counseling that pharmacists provide. As a result, AI will most likely be utilized as a tool to complement the work of pharmacists in the future, allowing them to better personalize medication management and improve patient care.

Winnie Chu

RxPharmacist Team

Resources
  1. Artificial intelligence in the field of pharmacy practice: A literature review. Available at:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10598710/. Accessed August 1, 2024.
  2. Artificial Intelligence (AI) in Pharmacy: An Overview of Innovations. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836757/. Accessed August 1, 2024.
  3. Generative AI in the pharmaceutical industry: moving from hype to reality. McKinsey & Company. Available at: https://www.mckinsey.com/industries/life-sciences/our-insights/generative-ai-in-the-pharmaceutical-industry-moving-from-hype-to-reality. Accessed August 1, 2024.
  4. AI in healthcare: uses, examples and benefits. Available at: https://builtin.com/artificial-intelligence/artificial-intelligence-healthcare. Accessed August 7, 2024.
  5. Pfizer is using AI to discover breakthrough medicines. Available at: https://insights.pfizer.com/pfizer-is-using-ai-to-discover-breakthrough-medicines/. Accessed August 7, 2024.
  6. Artificial intelligence and medical products: how CBER, CDER, CDRH, and OCP are working together. Available at: https://www.fda.gov/media/177030/download?attachment. Accessed August 7, 2024.

AI & Pharmacists: What Does The Future Hold For The Pharmacy Profession? Read More »

Polycystic Ovary Syndrome: An Unseen Struggle for Many Women

Leave a Comment / Blog /
Reference Image: Freepik

Despite affecting 1 in 10 women of childbearing age, polycystic ovary syndrome (PCOS) remains a common endocrine condition with many unanswered questions. While the disorder can significantly impact a woman’s health and fertility, it’s often under-recognized and misdiagnosed. A 2017 study highlights that over 50% of women with PCOS faced frustrating delays in diagnosis, sometimes over two years and involving more than three healthcare professionals. This leaves many undiagnosed women with ongoing concerns about managing symptoms like weight gain, irregular menstrual cycles, and infertility. Therefore, Increasing awareness and education among healthcare providers and improving patient support are crucial for enhancing outcomes and quality of life for those affected.

Image created with Canva
Image created with Canva

In addition to a myriad of symptoms, PCOS is linked to many other serious health risks that can further complicate a woman’s well-being. These include:

  • Type 2 Diabetes
  • Hypertension
  • Lipid abnormalities
  • Cardiovascular disease
  • Obesity
  • Sleep Apnea
  • Depression
  • Anxiety
  • Endometrial Cancer

Diagnosis

Most women find out they have PCOS in their 20s and 30s when they have concerns with fertility and visit their healthcare provider. However, PCOS can present at any age after puberty. To properly diagnose PCOS, a woman must have two of the following symptoms:

  • Irregular periods
  • Elevated androgen levels
  • Multiple cysts on one or both ovaries

Diagnosis typically involves several evaluations:

  • Physical exam → includes measuring blood pressure, body mass index (BMI), and checking for symptoms such as excessive hair growth or hair loss
  • Pelvic ultrasound (sonogram) → examines ovaries for cysts and the endometrial lining of the uterus
  • Blood test → check androgen hormone levels, lipids, thyroid function to rule out other causative factors, and A1c and blood glucose levels
  • Family history → the risk of PCOS is typically higher if an immediate family member, such as a sister, mom, aunt, also has a diagnosis

Cause

The exact cause of PCOS is not known, although several factors are thought to contribute. These include:

  1. Elevated levels of androgens

Elevated androgen levels can disrupt the ovarian cycle, leading to issues like anovulation (the absence of egg release), excessive hair growth, and acne

  1. Insulin resistance

Many women with PCOS do not respond properly to insulin and as a result, blood glucose is not absorbed efficiently within the body. This can increase glucose levels and over time increase the risk of type 2 diabetes.

Treatment

There is currently no cure nor any FDA-approved medications to treat PCOS. Symptoms are often managed through lifestyle interventions such as weight management, exercise, diet changes, or medications. See below for a comprehensive list of PCOS symptoms along with common first line off-label medication options.

Research and the Need for Action

Despite affecting 5 million women, PCOS remains severely underfunded and under-researched. Women with PCOS need treatments that address the condition’s root causes, not just its symptoms. Currently, only $10 million is allocated for PCOS research in 2024, and it is not included in recent major health funding initiatives. Consequently, this limited investment hinders the development of effective treatments.

There is hope, though. Spruce Biosciences is conducting the P.O.W.E.R study to assess if an investigational drug, tildacerfont, can effectively decrease androgen hormone production and improve PCOS symptoms. If successful, such breakthroughs could not only advance treatment options but also stimulate further research by demonstrating the condition’s relevance and significant impact on women’s health. With increased funding, these advances could significantly improve management and quality of life for those affected.

To conclude, PCOS remains a complex condition that is not completely understood. With its prevalence in women of childbearing age, it is only logical to push for more research in order to deepen our understanding and improve treatment options. Therefore, healthcare providers bear a responsibility to advocate for their patients to drive forward progress. By amplifying the voices of PCOS patients, we can drive meaningful change and improve outcomes for millions of women.

Winnie Chu

RxPharmacist Team

Resources

  1. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertility and Sterility. Available at: https://www.fertstert.org/article/S0015-0282(23)00719-7/fulltext. Accessed August 3, 2024.
  2. Polycystic Ovary Syndrome (PCOS). U.S. Department of Health and Human Services. Available at: https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome. Accessed August 3, 2024.
  3. Diabetes and Polycystic Ovary Syndrome (PCOS). Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/diabetes/risk-factors/pcos-polycystic-ovary-syndrome.html. Accessed August 3, 2024.
  4. Delayed Diagnosis and a Lack of Information Associated With Dissatisfaction in Women With Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology & Metabolism. 2017;102(2):604-612. Available at: https://academic.oup.com/jcem/article/102/2/604/2972079. Accessed August 3, 2024.
  5. Polycystic Ovary Syndrome (PCOS) Research Program. Icahn School of Medicine at Mount Sinai. Available at: https://icahn.mssm.edu/research/pcos. Accessed August 3, 2024.
  6. P.O.W.E.R. Study. Spruce Biosciences. Available at: https://sprucebio.com/power/. Accessed August 3, 2024.

Polycystic Ovary Syndrome: An Unseen Struggle for Many Women Read More »

How to Pass Your MPJE Exam the First Time

Leave a Comment / Blog, Education, General /
Reference image: Unsplash

Remember the one or two pharmacy law classes you took in school? They may feel like a distant memory, but knowledge of the federal and state laws is crucial in passing the Multistate Pharmacy Jurisprudence Examination® (MPJE®).

Exam Information and Breakdown

You might be wondering, “Do I HAVE to take the MPJE?” It varies by state or jurisdiction, but as of 2024, the following boards of pharmacy do not require a jurisprudence exam:

  • Alaska
  • Idaho
  • Michigan
  • Puerto Rico
  • Vermont
  • Virgin Islands

If you are not seeking licensure in the states or jurisdictions mentioned above, you are required to pass the MPJE® to practice as a pharmacist. Another thing to note is that Arkansas and California have their own jurisprudence exam. Each state’s unique laws and regulations make this exam necessary, ensuring pharmacists are well-versed in the laws and compliant in practice.

Recent statistics show a downward trend in MPJE® first-time pass rates, reflecting the growing difficulty of the exam. For instance, the mean first time pass rate was 77.6% in 2021, 73.8% in 2022, and decreased even more to 72% in 2023. While the specifics of the MPJE® can be challenging, understanding its format and preparing effectively will set you up for success.

    Image created with Canva

To tackle the MPJE® with confidence, it helps to know what to expect on exam day. The MPJE® is a 2.5-hour test featuring 120 questions designed to adapt to your responses. Out of these, 100 questions will impact your score, while the remaining 20 are pretest questions meant for future exams. You won’t know which questions are pretest questions, so it is in your best interest to answer all questions. Similar to the NAPLEX ®, you’ll answer questions in the sequence they appear and there is no option to skip or revisit questions once you have moved on. The MPJE® test results are reported simply as “Pass” or “Fail”, with no numerical score. Understanding this format can guide your study strategy and time management.

What will you be tested on? As of October 2023, the MPJE® will test you on the following key competencies:

Exam Study Tips and Helpful Suggestions

Now that you’re familiar with the exam layout, let’s dive into some effective study tips and strategies to help you prepare and ace the MPJE®.

  1. When in Doubt, Stick with the Stricter Law

Navigating the MPJE® can be tricky, especially since laws vary between federal and state levels. When you’re unsure, go with the stricter law in order to make sure you are answering the questions correctly. Always refer to your state’s board of pharmacy website for the most accurate and up-to-date information. These sites offer details on state laws, regulations, and policies, and frequently asked questions that clarify common questions and ambiguities.

  1. Read Slowly

Legal terminology can feel like a whole new language for pharmacists. After all, you weren’t trained to be well versed in knowing lots of legal jargon. To navigate this unfamiliar territory, take your time with the material. Reading slowly helps you process and understand complex legal concepts better. As you continue studying, these terms will become more familiar, making it easier to grasp the law.

  1. Know Your Controlled Substances

Make time to understand the different schedules for controlled substances, as these can vary by state. The DEA Manual for Pharmacists is a great resource to read up on regarding the regulations surrounding controlled substances. The exam often includes scenario-based questions where you’ll need to know the specific schedule of a drug and how it affects prescribing and dispensing practices. For these reasons, it is important to make sure you’re familiar with how different substances are categorized and any state-specific nuances that might apply. 

  1. Know Your Numbers

Memorize key numbers related to pharmacy law. Some examples include:

  • DEA form numbers
  • Prescription expiration dates
  • Record retention periods
  • Technician-to-pharmacist ratios
  • Refill limits
  • Time limits to notify the state board of pharmacy for closures and address changes
  1. Practice, Practice, Practice

The MPJE® may include scenario-based questions that may seem unfamiliar. When in doubt, approach these questions by eliminating incorrect options and doing your best with arriving to the most logical answer on the exam. For targeted practice, RxPharmacist offers state-specific study guides  designed by recent graduates. These concise guides feature two full practice exams covering both federal and state laws, helping you feel confident and well-prepared to pass your MPJE® on the first try. 

While the MPJE® might seem like a daunting exam, thorough preparation will set you up for success. Follow these study tips and stay focused and confident—you are capable and have the skills to succeed. Good luck!

Winnie Chu

RxPharmacist Team

References:

  1. National Association of Boards of Pharmacy. Which States Require the MPJE? Available at: https://nabp.pharmacy/help/which-states-require-the-mpje/. Accessed July 23, 2024.
  2. National Association of Boards of Pharmacy. What is the MPJE? NABP Bulletin. Available at: https://read.nxtbook.com/nabp/bulletin/naplex_mpje_bulletin/what_is_the_mpje.html. Accessed July 23, 2024.
  3. National Association of Boards of Pharmacy. MPJE Pass Rates 2023. Available from: https://nabp.pharmacy/wp-content/uploads/NAPLEX-Pass-Rates-2023.pdf. Accessed July 28, 2024.
  4. National Association of Boards of Pharmacy. MPJE Competency Statements. Available at: https://nabp.pharmacy/programs/examinations/mpje/competency-statements/. Accessed July 23, 2024.
  5. U.S. Department of Justice Drug Enforcement Administration. Pharmacist’s Manual. Available at: https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-046R1)(EO-DEA154R1)_Pharmacist%27s_Manual_DEA.pdf. Accessed July 23, 2024.

How to Pass Your MPJE Exam the First Time Read More »

How to pass your NAPLEX the first time

Leave a Comment / Blog /
Reference image: Unsplash

You’ve just finished pharmacy school. You’ve conquered countless exams and challenges, but one final hurdle remains – the North American Pharmacist Licensure Examination® (NAPLEX®). This daunting 6-hour exam is the culmination of your four years of hard work. Passing the NAPLEX® is a crucial step in your career, opening doors to licensure and allowing you to practice as a pharmacist.

The challenge of the NAPLEX® exam is reflected in recent statistics. According to the National Association of Boards of Pharmacy (NABP), the mean first-time pass rates were 81.3% for the Class of 2021, 77.1% for the Class of 2022, and 77.5% for the Class of 2023. Data shows a slight decline in pass rates over the last three years, underscoring the importance of thorough preparation. Understanding the structure of the NAPLEX®, effective study strategies, and tips for exam day will help you approach this challenge with confidence and pass.

Exam Breakdown and Competencies

As you prepare for the NAPLEX®, it’s helpful to know exactly what to expect and how the exam is set up. The NAPLEX® is a 6-hour, computer-based exam with 225 questions. Out of all these questions, 200 will count towards your score and 25 are pretest questions that will be used to evaluate their potential for future exams. You won’t be able to distinguish which are pretest questions, so treat them as if every question is graded on the exam. The majority of the questions will be scenario-based, and you need to answer questions in the order they appear as you will not have the ability to go back after you moved on from a question. For these reasons, make sure you are answering each question carefully!

What will you be tested on? The NAPLEX® will test you on the following key competencies:

A more detailed breakdown can be viewed here and is great to reference when studying.

NAPLEX® results are reported as “Pass” or “Fail” with no numerical score. To pass, you must meet the minimum competency required to practice as a pharmacist. For the latest details on registration, costs, and other important information, visit the NAPLEX® Registration Bulletin for the most up-to-date information.

Exam Study Tips and Helpful Suggestions

Now that you have an idea of how the exam is broken down, let’s go over some tips to help you study effectively.

  1. Set a study schedule and stick to it.

Start by creating a study schedule that fits your routine. Break your study material into chunks and set achievable goals for each session. Having a plan helps to hold yourself accountable and stay organized, making the whole process feel less overwhelming.

  1. Perform practice questions regularly.

It’s important to do practice questions regularly and even stimulate exam conditions during the later stages of your studying journey. This will ensure that you will be familiar with the types of questions that may appear on your exam and be able to answer them in a timely fashion. With 225 questions over 6 hours, you’ll have about 1 minute and 30 seconds to spend per question, so make sure you focus on answering quickly and accurately to stay on track during the exam. For comprehensive practice, consider checking out RxPharmacist’s 2024-2025 NAPLEX® Practice Questions course, which offers over 700 questions with up-to-date explanations to help you gain confidence and pass on your first attempt.

  1. Review your calculations.

Don’t overlook the calculations section! Regular practice can make this section feel like a breeze and save you time on the NAPLEX®. It helps to memorize some basic conversions and standard formulas as well (e.g., creatinine clearance, body mass index, pharmacokinetics). These questions are open responses, meaning you must manually type in your answer, so please be extra mindful about decimal places and rounding .

  1. Know your brand and generic names.

You’ve probably had class exams where they used brand and generic names interchangeably. Expect the same on the NAPLEX®. You don’t want to miss any points to a question just because you forgot the brand name of a drug. Flashcards and mnemonics are great tools to help you remember medications. Additionally, group study sessions, quizzing with your friends, and associating the names to the drugs’ packaging are great ways to reinforce your memory.

  1. Understand patient exceptions.

While it is important to know the therapeutic indications for drugs, it’s also crucial to be prepared for specific patient scenarios. For example:

  • What if a patient has a drug allergy?
  • What if the patient is pregnant?
  • What if they have chronic conditions like heart failure or chronic kidney disease?
  • What if the patient has failed a first-line treatment in the past?

Having alternative recommendations ready for these situations will help you tackle any tricky questions that may come up.

  1. Take breaks.

Give yourself regular short breaks to recharge – whether it’s a quick walk, a snack, or a power nap. This keeps your mind fresh and focused, making your study sessions more effective. A popular method is the Pomodoro Technique: study for 25 minutes, then take a 5-minute break. On exam day, you’ll have two optional ten-minute breaks. Use these to your advantage to maintain mental clarity and momentum throughout the exam.

Remember, the NAPLEX® is a challenging exam, but with the right preparation, you can succeed. Stay focused, keep a positive mindset, and trust in your preparation. Good luck studying!

Winnie Chu

RxPharmacist Team

References:

  1. National Association of Boards of Pharmacy. NAPLEX & MPJE Bulletin. Available from: https://read.nxtbook.com/nabp/bulletin/naplex_mpje_bulletin/cover.html. Accessed July 22, 2024.
  2. National Association of Boards of Pharmacy. NAPLEX Competency Statements. Available from: https://nabp.pharmacy/programs/examinations/naplex/competency-statements/. Accessed July 22, 2024.
  3. National Association of Boards of Pharmacy. NAPLEX. Available from: https://nabp.pharmacy/programs/examinations/naplex/. Accessed July 22, 2024.
  4. National Association of Boards of Pharmacy. NAPLEX Pass Rates 2023. Available from: https://nabp.pharmacy/wp-content/uploads/NAPLEX-Pass-Rates-2023.pdf. Accessed July 22, 2024.

How to pass your NAPLEX the first time Read More »

NAPLEX or MPJE… Which one first?

Leave a Comment / Blog /

One of the most substantial fears that PharmD graduates face upon completion of pharmacy school surrounds the next step in their professional development: becoming a licensed pharmacist. With the exception of some states that require an additional practical exam, such as Georgia and New York, the main two exams that are required from state to state to become licensed to practice are the North American Pharmacist Licensure Examination (NAPLEX) and the Multistate Pharmacy Jurisprudence Examination (MPJE). The NAPLEX and MPJE are both pass or fail examinations. While the MPJE exam results do not provide a performance report, the NAPLEX does provide a performance report to reflect on the areas you did well and the areas you might need to review once more. This is an example of the NAPLEX performance report:

Source: NABP Website

While some have no preference in the order of when to take their exams, others may be challenged with a relatively common dilemma – do I take the NAPLEX or MPJE first? This article will not necessarily state why you should pick one option over the other, but instead uncover things to consider when scheduling your exams.

Reason to take the NAPLEX first:Coming out of school, you may feel like a lot of what you have learned in class and during rotations is still relatively fresh in your mind. Before you switch gears to a completely different area of focus, you may want to tackle something you are more familiar with first. Also, depending on the school you have graduated from, you may have been required to register for RxPrep and take on assignments throughout your fourth-year rotations, ultimately keeping your mind engaged on all clinical modules. Another reason is perhaps you have covered your law course during your third year instead of your fourth year of pharmacy school. Lastly, if your school does not provide any law prep course or support before you graduate. 
Reason to take the MPJE first:Based on the plethora of disheartening comments surrounding the exam, many previous exam takers can agree that the MPJE is a more difficult exam. Individuals who take the NAPLEX first may often feel burnt out after extensive preparation, thus leaving those who still have to take the MPJE mentally exhausted and devoid of motivation. Remember, pharmacy law is naturally perceived as a drier topic to begin with. Another reason is if your pharmacy school had you take a law course during your fourth year instead of your third year, making the content fresher in your mind. Lastly, if your pharmacy school does provide a law prep course or support before you graduate. 

Our advice?

Ultimately, what you decide is based on where you stand with respect to how comfortable you are with the content of each exam and even the urgency of addressing your financial situation. Also, depending on the institution, you may be a part of a residency or fellowship program that grants you an additional couple of months of flexibility to become licensed. While it is fine to space out both exams to ensure adequate preparation, you should still be conscious of not distancing your exams too far apart. Remember, the goal is to promptly eliminate the last barrier that stands in the way of you becoming a licensed pharmacist and begin the take down of those horrifying student loans. This was why RxPharmacist was created in supporting pharmacy graduates and pharmacists to overcome the barrier of their licensure exams. Even more so, we also provide state-specific MPJE guides which is a unique offering among other known test-prep companies such as RxPrep which only offers NAPLEX and very minimal (and general) federal MPJE reviews. For more in-depth analysis and advice on each exam, please be sure to check out our previous blogs that provide excellent tips, things to consider, and resources to use to help you overcome your upcoming board exams:

Good luck!

Dagmara Zajac

RxPharmacist Team

References:

  1. NAPLEX Prep Opportunities & Study Guide: NAPLEX exam. National Association of Boards of Pharmacy. https://nabp.pharmacy/programs/examinations/naplex/. Published November 11, 2022. Accessed November 10, 2022.
  2. Multistate Pharmacy Jurisprudence Examination (MPJE): NABP. National Association of Boards of Pharmacy. https://nabp.pharmacy/programs/examinations/mpje/. Published October 6, 2022. Accessed November 10, 2022.

NAPLEX or MPJE… Which one first? Read More »

How Pharmacists Can Work Toward Reducing Polypharmacy

Leave a Comment / Blog, General /
Reference image: Unsplash

Do you know someone who is overwhelmed with managing multiple medications? Maybe you know a close relative or have even seen this happening in practice settings. These experiences may be due to polypharmacy, and it’s a growing concern, especially among older adults. Polypharmacy refers to the use of several medications, typically five or more, daily. It is common in individuals with multiple chronic conditions, such as arthritis, asthma, diabetes, or hypertension. According to the Centers for Disease Control and Prevention (CDC), 7 in 10 adults aged 40-79 in the United States used at least one prescription drug in the past 30 days, and around 1 in 5 took five or more prescription drugs. While polypharmacy can help manage complex health issues, it also raises safety concerns, making pharmacists essential in ensuring safe medication use.

Image created with Canva

As you can imagine, taking so many medications daily can pose health risks for the patient. Here’s why polypharmacy can be a significant concern:

  • Complex Medical System

Older adults frequently manage several chronic conditions, which leads to polypharmacy. This often involves various medications prescribed by multiple doctors, sometimes filled at different pharmacies. This makes it difficult to track what they are taking at one time.

  • Tracking and Management

Keeping up with multiple medications can be difficult with all the pills, varying dosages, and times of administration. This often leads to trouble with medication adherence and can result in missed doses or improper medication use, further complicating health management.

  • Increased Risk of Adverse Reactions

The use of excessive or unnecessary medications can increase the risk of experiencing adverse drug reactions and drug interactions. This risk is particularly significant in the aging population, as changes in body composition and metabolism can affect how medications are absorbed, distributed, and eliminated. As a result, older adults are more susceptible to side effects and unintended consequences from their medications.

  • Increased Health Costs

Polypharmacy can lead to adverse effects that may require hospitalization. If not managed properly, this can trigger a prescribing cascade, where a side effect of one medication is misdiagnosed as a new condition and treated with additional medications. This cycle can have serious health consequences, increasing both the patient’s care costs and the likelihood of repeated hospitalizations. The added burden of managing these issues also increases expenses for the healthcare system.

Often, these issues are preventable. Healthcare professionals, particularly pharmacists, play a crucial role in managing medications and preventing such complications. The World Health Organization (WHO) outlines the following key steps for ensuring medication safety:

Reference image: World Health Organization (WHO)

As the figure describes, medications should be reviewed for appropriate prescribing. A helpful resource that assists with evaluating medication risks in elderly patients is the American Geriatrics Society Beers Criteria®. The AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults is updated every three years and provides a list of medications to be used cautiously or avoided in older adults. This includes drugs generally inappropriate, those to avoid in specific conditions, those to use cautiously, drug-drug interactions, and dose adjustments based on kidney function.

Other ways pharmacists can be involved in a patient’s medication management include encouraging patients to maintain an up-to-date list of all their medications, including prescriptions, over-the-counter drugs, and supplements. This list should be shared with healthcare providers to identify potential side effects and interactions. Patients and caregivers should be counseled on common side effects to watch for. These commonly include:

  • Headaches and confusion
  • Dizziness and falls
  • Weight changes
  • Memory or cognitive issues

Encouraging regular checkups and having all prescriptions filled at one pharmacy can help pharmacists monitor for potential drug interactions and manage medications more effectively. If necessary, they can coordinate with physicians to review medications and explore safer alternatives for the patient. Furthermore, the patient may consult a pharmacist before purchasing any over-the-counter product or supplement to ensure safety with current medications or health conditions. Medication reconciliation during transition of care settings further supports safe medication use by addressing any inconsistencies and errors in medication lists as the patient moves between different care settings.

All in all, while taking multiple medications has its risks, it can also happen out of necessity, such as in patients with diabetes who may require multiple medications. As a result, it is crucial to manage and monitor it carefully. Regular check-ups and clear communication about medications can help mitigate the risks associated with taking multiple drugs. Deprescribing also needs to be approached carefully, as stopping certain medications can lead to withdrawal effects or exacerbate existing conditions. The objective is to minimize inappropriate polypharmacy where too many medications are prescribed inappropriately, while ensuring that the use of multiple medications is truly beneficial for the patient’s health. By focusing on effective management and informed patient care, we can make reduce polypharmacy and improve health outcomes.

Winnie Chu

RxPharmacist Team

Resources

How Pharmacists Can Work Toward Reducing Polypharmacy Read More »

Are Supplements Worth the Hype? What You Need to Know 

Leave a Comment / Blog /

Are those supplements on your shelf truly boosting your health, or just empty promises? According to the Centers for Disease Control and Prevention (CDC), 57.6% of U.S. adults over the age of 20 used a dietary supplement in the past 30 days between 2017 to 2018. This is an approximate 10% increase among all adults from 2007 to 2008. With the rising trend of supplement use, it is worthwhile to explore whether you are taking these supplements safely and really reaping the health benefits marketed to you.   

Image created with Canva
Supplements vs. Prescription Drugs

There are many types of supplements, including vitamins, minerals, herbal medications, enzymes, and amino acids. The purpose is to support the body by providing the additional nutrients needed to meet daily intake requirements. Supplements can come in a variety of forms including tablets, capsules, gummies, powders, and more.

Unlike prescription drugs, dietary supplements are not closely regulated by the U.S. Food and Drug Administration (FDA). That is, the FDA is not heavily involved in the pre-market approval process but rather more focused on post-market surveillance. Instead, the manufacturer and distributors are responsible for ensuring the supplement’s safety before entering the market. They are required to submit data regarding the supplement’s safety, but not effectiveness. As a result, supplements cannot claim to treat, prevent, or cure diseases. Yet, manufacturers are allowed to skate by, stating the supplement “supports” or “enhances” a body organ or function. Furthermore, the labeling may not always reflect the actual contents. In fact, a 2013 study found that compounded vitamin D3 supplements varied greatly in potency, with only one-third of the study pills meeting US Pharmacopeial (USP) Convention standards and containing the appropriate amount of active ingredient.

The Risks of Overuse and Interactions

Supplements are widely available over the counter and online, leading some individuals to use them even when they might not need additional nutrients. While generally safe in moderation, it’s important to remember that too much of a good thing can be problematic. This is especially true for individuals with multiple chronic conditions or those taking various medications. Some dietary supplements may interact with other medications, potentially reducing the effectiveness of prescribed drugs or leading to adverse effects.

Below is a table with some common supplements with common side effects, drug-drug, and drug-food interactions to look out for. This is not a comprehensive list but demonstrates how taking many supplements can pose more risks than benefits if not taken appropriately.

Managing Supplements Safely

With loose pre-marketing regulations and a potential risk for drug interactions and side effects, how can supplements be taken safely? It is highly encouraged that patients take caution and consult with their healthcare provider or pharmacist before starting any new supplements. Healthcare professionals, especially pharmacists, can help assess potential risks and interactions with current medications. It is also helpful to bring a list of all medications, including dosages and frequency, to all healthcare consultations. Patient education is especially crucial when it comes to understanding and making decisions about supplement use. Here are some available resources and tools to learn more about supplements:

Takeaway

With many supplements claiming various health benefits nowadays, it helps to consult with healthcare providers and pharmacists to ensure safety and effectiveness. Their expertise can help navigate potential risks and interactions, making informed decisions easier. By seeking professional guidance from healthcare providers and staying informed, you can make better choices that truly support your health.

Winnie Chu

RxPharmacist Team

Resources
  1. Centers for Disease Control and Prevention. (2023). Use of Prescription Medications Among U.S. Adults Aged 20 and Over. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db399.htm
  2. American Pharmacists Association. Dietary Supplements: What You Need to Know. Available at: https://aphanet.pharmacist.com/sites/default/files/files/APhA-DietarySupplements-Brochure-14×8%205-A7.pdf. Accessed July 25, 2024.
  3. LeBlanc ES, Perrin N, Johnson JD, Ballatore A, Hillier T. Over the Counter and Compounded Vitamin D: Is Potency What We Expect? JAMA Intern Med. 2013;173(7):585-586. doi:10.1001/jamainternmed.2013.3818. Available from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1570096.
  4. U.S. Food and Drug Administration. Questions and Answers on Dietary Supplements. Available at: https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements. Accessed July 25, 2024.
  5. National Center for Complementary and Integrative Health. Yohimbe. Available at: https://www.nccih.nih.gov/health/yohimbe#:~:text=Yohimbe%20is%20an%20evergreen%20tree,and%20to%20enhance%20sexual%20performance. Accessed July 25, 2024.
  6. National Center for Complementary and Integrative Health. Kava. Available at: https://www.nccih.nih.gov/health/kava. Accessed July 25, 2024.
  7. National Center for Complementary and Integrative Health. Red Yeast Rice. Available at: https://www.nccih.nih.gov/health/red-yeast-rice. Accessed July 25, 2024.

Are Supplements Worth the Hype? What You Need to Know  Read More »

If at first you don’t succeed, try again!

Leave a Comment / Blog /

My path to success began with unfathomable pressure and consequently, failure. Remember – if at first you do not succeed, try, try again.

After failing my NAPLEX twice I reached out to one of my former professors from pharmacy school for advice. I needed new study material and support to try again. Having recently being introduced to RxPharmacist, she recommended I email them to see if they could help. I reached out as suggested and after one phone call with the founder of RxPharmacist I had been offered the opportunity to write a study guide for my upcoming AL MPJE and receive study help for my next attempt at passing the NAPLEX.

I was given access to professional medical writers that could guide me through writing the Alabama Pharmacy Law Review and a practice exam to go with it. My preceptor/editor helped me learn the ins and outs of medical writing and editing. I felt the steep learning curve, but I worked hard and got the job done. My editor and the founder supported me throughout the writing process, and I learned the best way to write a guide and the questions necessary for the practice exam. After completing the guide and the practice exam, I got to build the online course. With my love for informatics, building the online course was my favorite part of this experience.

As part of this opportunity, I have also been part of the RxPharmacist “How to Get a Job” series where the founder teaches how to network effectively, craft your resume, compose your cover letter, prepare for an interview, and negotiate salary once you receive the job offer. This information has been invaluable to me, and I cannot thank RxPharmacist enough for allowing me to be a part of this educational series.

I have been given access to law and NAPLEX study materials, instructed in the intricacies of medical writing and editing, and the nuances of getting a job. With support of RxPharmacist behind me and the confidence to do what needs to be done I can get my license and my dream job.

The path to success has many turns and speed bumps, but with the right support and self-confidence you will reach your destination.

-Spring 2024 Intern, Lipscomb University

If at first you don’t succeed, try again! Read More »

error: Content is protected !!