When you start school, most of us only think about how far the end is to attain that degree, but as cliche as this might sound, the future is closer than we feel it is. For some of us, we might know what we want to do with the degree that we are trying to achieve. Then there are others who hope that education will steer them toward a career path during school. Either way, it is good to start thinking about how to make the transition from school to a full-time job. At the end of the day, even though some of us might be ahead of others by knowing what our end goal is, we are all going to heavily rely on our transferable skills to make that transition smoother.

What are transferable skills?

Transferable skills help you adjust to a new position or setting in your career. These are the general core skills that you have gained throughout all of your life experiences that you can apply to that new step in your life.

These are some examples of transferable skills, but depending on the environment of your previous experiences, jobs, education, etc., you’ll attain different transferable skills.

One of the first questions that might come up when thinking about transitions in life is, “How do I know what skills I will need so I can prepare myself to be successful,” or “How do I know what I want to do with my degree?”

Prepare yourself ahead of time. Extracurriculars are one way that can help you attain skills while doing things outside of your coursework that exposes you to possible job prospects. It is important to take advantage of all the opportunities you can because once you graduate, it is not the same as when you are a student. Being a student, you have a special advantage that some forget to utilize to learn things from others. Remember that everything you did when you were a student has shaped you become a full-time employee. Make sure to strategically approach those years, so you can get the most out of them.

Often, we hear that connections are very important. Well, this is one example where your connections might help you. If you’re going into an entry-level job, residency, or fellowship, people before you had to go through the change from being a student to a full-time employee. Don’t forget to reach out to your connections to hear how they handled their transitions. Even though your post-graduate plans may be unique or your road in life is different from others, don’t disregard others’ experiences and opinions. Connecting with others makes you more educated about life. At the end of the day, what you do will be what’s best for you.  

Overall, transferable skills and preparing yourself ahead of time for that transition will help you in the long run. In the future, others may reach out to you to understand how you handled your career transition. You will be able to share your story at that time, and in sharing those experiences, you will be able to set the stage for other people’s success in their journey of finding their ideal career.

Dagmara Zajac

RxPharmacist Team

References:

The continued drug development expands the drugs available on the market for patients. How do we determine if patients are on the best drugs available? How do we determine if the drugs on the formulary for a given healthcare system are appropriate based on the market or trends seen within a healthcare system? The answer to these questions is in the importance of medication use evaluation (MUE). This type of evaluation does not provide answers to all the questions surrounding medication use but helps us get to a place of understanding, which can facilitate changes that are beneficial for patients in the long-term sense.

When discussing MUE, there are other processes needed to be addressed. Those processes are the drug utilization review (DUR) and the drug use evaluation (DUE). DUE and DUR are regarded as being synonymous with each other as these are ongoing drug therapy reviews. DUR is a quality assurance measure. For example, DUR encompasses three categories: prospective, concurrent, and retrospective. There are different categories for these drug therapy reviews depending on if we are addressing the drug review before dispensing, evaluating medication use during ongoing treatment, or reviewing therapy after treatment completion. Overall, DURs are put in place to ensure safety and efficacy of medication use.

DURs and DUEs are precursors to the MUE, which provides a more detailed performance tool for healthcare professionals. The difference that stands out about MUE from other processes is that it focuses on outcomes and quality of life. Well, the next question someone may ask is, “how do you know if an MUE needs to be initiated?” From the various MUE objectives, one can realize that the MUE process can begin for a variety of reasons. For example, it can be because of increased medication errors seen within a healthcare system, or the withdrawal of approved products. Depending on the objective to start an MUE, a therapeutic or process outcome is usually determined at the end. There are different types of MUE objectives, such as:

• Patient safety improvement
• Drug therapy optimization
• Cost minimization
• Innovative practices assessment

According to the American Society of Health System Pharmacists (ASHP), the framework one can utilize to begin the MUE process is FOCUS-PDCA:

• Find
• Organize
• Clarify
• Understand
• Select
• Plan
• Do
• Check
• Act

Depending on the site utilizing this framework, the approach will differ. On the other hand, MUEs can have its limitations due to the lack of scope, poor documentation, or poor communication. Pharmacists are a very important component of these evaluations because of their expertise. Medication therapy management (MTM) is a big part of many pharmacists’ everyday jobs, and in the long run, MTM results in better patient outcomes. ASHP has a great guidelines documents for those interested in MUE and learning about its in-depth practices.

It is important to be aware of the various processes within systems that determine how patients are treated so they can ultimately receive the best outcomes. The MUE is a long process, but the findings from an MUE can help healthcare systems in various areas. As with any process, there are limitations, and for this reason it is important to have the right healthcare professionals assess these medication evaluations. 

Dagmara Zajac

RxPharmacist Team

References:

1. ASHP guidelines on medication-use evaluation. https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/medication-use-evaluation-current.ashx?la=en&hash=4927E9E8F085C17B19CA40AC0BAACBA229F47B07. Accessed December 23, 2022.
2. Faley B, Fanikos J. Best Practices for Medication Utilization Evaluations in Postsurgical Pain Management. Curr Emerg Hosp Med Rep. 2017;5(1):33-40. doi:10.1007/s40138-016-0121-2
3. Fanikos J, Jenkins KL, Piazza G, Connors J, Goldhaber SZ. Medication use evaluation: pharmacist rubric for performance improvement. Pharmacotherapy. 2014;34 Suppl 1:5S-13S. doi:10.1002/phar.1506
4. Drug utilization review. AMCP.org. https://www.amcp.org/about/managed-care-pharmacy-101/concepts-managed-care-pharmacy/drug-utilization-review. Accessed December 23, 2022.

Direct oral anticoagulants (DOACs) are used to prevent thrombosis and are used for several different indications. This class of medication has stood out for several reasons, but the main reason was that this class of medication does not require regular laboratory monitoring compared to other anticoagulation drug classes. In many ways, anticoagulation guidelines and practices have changed with the addition of this therapeutic drug class. In 2010, the first DOAC dabigatran was approved by the Food and Drug Administration (FDA); since then, many more have been approved.

Dabigatran is categorized as the direct thrombin inhibitor DOAC compared to rivaroxaban and apixaban, which are categorized as the oral direct factor Xa inhibitor DOACs. By 2013, there were more prescriptions for DOACs compared to warfarin (vitamin K antagonist), which in previous years, was the commonly used form of anticoagulation by patients. The common FDA-approved indications for DOACs are the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), stroke prevention in nonvalvular atrial fibrillation (NVAF), prevention of recurrent DVT and PE, and many other indications. In addition, there are multiple off-label indications seen with this drug class as well.

There are considerations that need to be addressed when prescribing this class of medications. In terms of pharmacokinetics, there are comorbidities that may affect the efficacy of DOACs. For example, renal impairment, hepatic impairment, and body weight are all things to consider in patients initiating DOAC therapy. As mentioned previously, this drug class monitoring is different compared to previous methods of anticoagulation monitoring. Currently, there is no approved FDA-specific DOAC monitoring method; however, there are monitoring parameters that need to be performed in patients taking DOACs.

Patient education is critical when patients are beginning any anticoagulation medication. Anticoagulation medications are one of the therapeutic areas where a reversal agent for a class of medication is very beneficial due to the associated risk factors. When the first DOAC was approved, there was no reversal agent approved on the market. In 2015, FDA approved the first reversal agent for the first approved DOAC dabigatran. After that, in 2018, the next reversal agent was approved for apixaban and rivaroxaban.

For newer classes of medications, it is beneficial to be able to look at statistics to understand how receptive the healthcare systems and doctors are to adapting to new methods of treatment. The use of warfarin for atrial fibrillation between 2011 and 2020 decreased from 52.4% to 17.7%. In contrast, DOAC use for atrial fibrillation between 2011 to 2020 increased from 4.7% to 47.9%. It is apparent that these trends in oral anticoagulant use among patients with atrial fibrillation in community practice show an increased use of DOACs over warfarin.

In terms of anticoagulation methods for patients, DOACs have changed the standards of practice. Since the first DOAC was approved, there have been many advancements seen within this class of medications. This overview follows the current anticoagulant standards for patients. Perhaps in the near future, this drug class will continually expand and newer therapies will be introduced and implemented.

Dagmara Zajac

RxPharmacist Team

References:

1. Chen A, Stecker E, A Warden B. Direct Oral Anticoagulant Use: A Practical Guide to Common Clinical Challenges. J Am Heart Assoc. 2020;9(13):e017559. doi:10.1161/JAHA.120.017559
2. Navar AM, Kolkailah AA, Overton R, et al. Trends in Oral Anticoagulant Use Among 436 864 Patients With Atrial Fibrillation in Community Practice, 2011 to 2020. J Am Heart Assoc. 2022;11(22):e026723. doi:10.1161/JAHA.122.026723
3. SavaysaÔ [package insert]. Basking Ridge, NJ: Daiichi Sankyo, Inc., 2021.
4. Direct oral anticoagulants (doacs). Blood Clots. https://www.stoptheclot.org/about-clots/blood-clot-treatment/direct-oral-anticoagulants/. Published October 4, 2018. Accessed December 20, 2022.

A pharmacy degree is a monumental stepping stone to opening your doors to a variety of jobs. There are three big job areas that pharmacists usually utilize their degree in, and that is a hospital, retail, or the pharmaceutical industry setting. The economic standpoint has influenced many to think outside the box and pursue areas that take more than just attaining a pharmacy degree. There are so many brilliant pharmacists that chose to take a different path, and many refer to that as the “nontraditional path.” These individuals have consequently changed the world job market and more importantly, changed the lives of patients because of their creativity, grit, and braveness.

There are individuals who chose to start their own pharmacies. Pharmacy is a growing field and individuals will require prescriptions, but it is not easy to compete against large chain pharmacies. Yet, individuals choose to go into that market because they see the good outcomesdespite the hurdles that they will most likely face along the way. From an economic standpoint, pharmacies are not usually affected by a recession, which makes it an appealing business market option. Other benefits of starting a business mean you can be your own boss, and there’s a work-life balance component seen in this field compared to others. There is a whole business factor to starting a pharmacy, but that has not discouraged people. They find ways to either educate themselves about it or partner with individuals to see their dream come to life.

An example of entrepreneurs that created something innovative and transformed the pharmacy business is TJ Parker and Elliott Cohen. Parker, after attending pharmacy school, worked for his father’s drug prepackaging business, and then met Cohen while working on an MIT contest. These individuals started PillPack, which prepackages patients’ medications by dosages and delivers it directly to them. PillPack was acquired by Amazon; they reportedly bought it for one billion dollars in cash. Overall, these individuals created something that, in the end, has helped many patients.

Looking at the future, we need to realize that pharmacy, like other healthcare fields, is being revolutionized because of entrepreneurs. Another entrepreneur took his degree and used it in another way to revolutionize the world with a healthy option for individuals. That individual is  Kun Yang, who graduated from pharmacy school and wanted something more than the regular 9 to 5 job in the long-term sense. Yang, along with a group of individuals, started and founded Pricklee. It is a drink that’s made from a cactus and is filled with antioxidants and electrolytes. This group, like others, identified an area that was missing something and created a beneficial product for many individuals.

There are so many things that have been discovered because of entrepreneurs who have the right innovative visions. With the ever-changing economic climate, for some, entrepreneurship is an appealing market to go into. Entrepreneurs must take all their skills and experiences and bring them forward to start something new. There are many ways to define pharmacy entrepreneurs, but in the overall sense, the common factor that drives these individuals to pursue entrepreneurship is their devoted passion to help others.

Dagmara Zajac

RxPharmacist Team

References:

1. Desk N. Why opening a pharmacy is a good business choice. Advisory Excellence. https://www.advisoryexcellence.com/why-opening-a-pharmacy-is-a-good-business-choice/. Published June 30, 2022. Accessed December 16, 2022.
2. Tindera M. 32-year-old founder sells his pharmacy startup to Amazon. Forbes. https://www.forbes.com/sites/michelatindera/2018/06/28/32-year-old-founder-sells-his-pharmacy-startup-to-amazon/amp/. Published June 28, 2018. Accessed December 16, 2022.
3. Your medication, sorted and delivered. PillPack. https://www.pillpack.com/. Accessed December 16, 2022.
4. Landi H. Making pharmacy more ‘amazon-like’: PillPack founder details Tech Giant’s push into drug delivery. Fierce Healthcare. https://www.fiercehealthcare.com/tech/making-pharmacy-more-amazon-like-pillpack-founder-details-tech-giant-s-push-into-drug-delivery. Published May 13, 2021. Accessed December 16, 2022.
5. Paul S. Entrepreneurship and pharmacy: Is it possible? LinkedIn. https://www.linkedin.com/pulse/entrepreneurship-pharmacy-possible-sue-paul. Published February 20, 2021. Accessed December 16, 2022.
6. Kun Yang: Superfruit and celebrating the small wins. YouTube. https://www.youtube.com/watch?app=desktop&v=2unvWHiDT8E. Published November 30, 2019. Accessed December 16, 2022.

For DNA replication and cellular division to occur, topoisomerase I is required. It is an enzyme that creates and helps repair strands of DNA. In cancer cells, it has been shown that there is an increased activity of topoisomerases. This is why topoisomerase inhibitor medications have been used in many cancer therapies. Mainly topoisomerase I is responsible for relaxing supercoiled double strands of DNA, which then allows for replication to occur. The most common topoisomerase I inhibitor medications are irinotecan and topotecan.

In 1996, irinotecan and topotecan were approved for use in the United States. Camptothecin is another topoisomerase I inhibitor, and irinotecan and topotecan were originally derived from it. Camptothecin was isolated from the Camptotheca acuminata, which is a Chinese tree. Since its discovery and use, there have been fewer toxic analogues made.

Depending on the drug, indications can vary. Commonly, they are used in advanced colorectal, ovarian, and small-cell lung cancer. There are multiple regimens, and dose administration is dependent on the specific regimen cycle it is being used for. Irinotecan has been used with other therapies, such as 5-fluorouracil (5-FU) and leucovorin (LV). Hepatic adjustments may be seen with irinotecan because it is metabolized by the liver. Compared to topotecan, it is renally eliminated, which may result in possible renal adjustments in patients. Moreover, dosage and administration can sometimes vary based on the regimen, body weight, and other patient-specific factors.

What are the differences and similarities between liposomal irinotecan and irinotecan?

• Liposomal form of irinotecan has a lipid bilayer
• SN-38 is an active metabolite of both medications
• The lipid bilayer prolongs irinotecan half-life, and it prevents it from converting to its active metabolite quicker
• The liposomal form is used for treatment in patients with metastatic adenocarcinoma of the pancreas
• These are not interchangeable medications

There are many chemotherapeutic medications that have extensive side effect profiles or adverse reactions associated with them. It is important to distinguish that there are acute and delayed adverse reactions. To overcome these acute and delayed adverse reactions, patients are pre-medicated. For example, the most notable toxicity seen with irinotecan is diarrhea, which is usually delayed. To overcome this, some patients will receive loperamide. Another example associated with irinotecan is its acute cholinergic syndrome, which can be treated with atropine. Overall, not all patients will be pre-medicated with the same regimens because there are patient-specific factors to account for prior to selecting treatments that mitigate and prevent adverse effects seen with these chemotherapeutic medications. The noticeable toxicities in topoisomerase I inhibitors are typically hematologic and gastrointestinal.

Irinotecan and topotecan have been used for a long time. It is important to notice that even though these medications are in the same drug class, they are not interchangeable. These medications are utilized for many different cancer types, such as advanced colorectal, ovarian, and small-cell lung cancer. Overall, staying up to date with new findings and the most current literature is important to ensure that patients receive the best-individualized therapy.

Dagmara Zajac

RxPharmacist Team

References:

1. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Topoisomerase Inhibitors. [Updated 2020 Sep 12]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548372/
2. Topoisomerase inhibitor. Topoisomerase Inhibitor – an overview | ScienceDirect Topics. https://www.sciencedirect.com/topics/neuroscience/topoisomerase-inhibitor#:~:text=Topoisomerase%20I%20inhibitors%20include%20irinotecan,etoposide%2C%20doxorubicin%2C%20and%20epirubicin. Accessed December 13, 2022.
3. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Irinotecan. [Updated 2018 Apr 27]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548037/
4. CAMPTOSAR®Dosage and Administration (irinotecan hcl). CAMPTOSAR® Dosage and Administration (irinotecan HCl) | Pfizer Medical Information – US. https://www.pfizermedicalinformation.com/en-us/camptosar/dosage-admin. Accessed December 13, 2022.
5. Baker DE, Levien TL. Irinotecan Liposome Injection. Hosp Pharm. 2017;52(2):144-150. doi:10.1310/hpj5202-144
6. HYCAMTIN® (topotecan) for injection, for intravenous use. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020671s023lbl.pdf. Accessed December 13, 2022.