PQ Plus 2 March 2018

PQ Plus 2

ISSUE

5 S p o n s o r e d by P h a r m ac a r e & S c ot i a ban k |

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MArCH 2018

February Issue -Table of Contents 02

Table of Contents A word from your editors

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Vampire Cup A competition to get your blood running

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Pharmacy Awareness Month Calendar A Calendar for PAM

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PAM Lunch and Learns PAM Lunch and learn dates and information

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Industry Trade Show Information and details about the this year’s upcoming Industry Trade Show!

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Therapeutic Tent Talk This issue’s Therapeutic Tent Talk discusses treatment options for a broken heart … heartburn Present meets Future Interview with the current APSA President Sean Hanson and President-Elect Jessica Buhler The Opioid Crisis The opioid crisis and the role of the pharmacist

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You’ve got to try this Next Stop: The Chopped Leaf

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Crepe paper roses A Valentine’s day special—craft the perfect gift for your loved one

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Interview with an oncology pharmacist Humirah Sultani, University of Alberta pharmacy alumna class of 2016, shares her experiences and journey into becoming an oncology pharmacist

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You’ve got to try this mobile game Need a study break? Try Fire Emblem Heroes—a free-to-play tactical mobile game

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Fresh start to a new, energized you!

Booster your energy with these healthy snacks!

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What can we learn from naturopathy?

Why we need to look at a holistic approach in medicine

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Horoscopes What the alignment of astrological objects in the Universe tell us about our lives David Poon —I hope everyone is having a fantastic semester so far! As you all are aware, March is Pharmacy Awareness Month (PAM) and I think this is the perfect opportunity for us to promote ourselves and the services we offer to our patients and Albertans. With the recent changes to the pan-Canadian Pharmaceutical Alliance Pricing Agreement and Pharmacy Funding Framework, it’s important to show Albertans our value as pharmacists. What we do daily greatly impacts the health of our patients. What we do is important and frankly, it’s time we let our voices be heard.

Ethos Ho - Hey guys I hope the semester has been treating you well. I know seems can be stressful as we are approaching project deadlines and midterms, and the news regarding reduced funding to our profession is the cherry on top for an already stressful time. It is important for all of us to work together and stand up towards a common goal. It is time for us to rise up as professionals and show the public why we are important as pharmacists and what we contribute to our healthcare system. Stand with your colleagues on March 22 at legislature and be a voice for our profession! Cheers!

The Vampire Cup was first organized by the National Australian Pharmaceutical Students’ Association (NAPSA) in 2006-07 as a blood donation competition between local associations. Pharmacy students donated their blood at the Australian Red Cross Blood Service blood bank or at a donation bus provided by the Red Cross on the university campus.

At the end of the event, the total blood donation of each local association was reported to the NAPSA National Council, with the winner announced during their national congress.

IPSF saw great potential in this event and with the approval of NAPSA, Vampire Cup was launched globally. The idea is that each country launches the Vampire Cup just like in Australia. Now the Vampire Cup is an international blood donation competition among all the IPSF associations, being the only official campaign for Humanitarian and Human Rights. – Darryl Mah (IPSF Director) | 3 |

Pharmacy Awareness Month During the month of March we celebrate the contributions pharmacists make to better the health of our patients. To find out what you can do to get involved, or what you can tell your patients, please visit: https://www.pharmacists.ca/news-events/events/pharmacist-awareness-month-pam/

Lunch and Learns Antimicrobial Stewardship Lunch & Learn -- Friday, March 9 MSA and APSA jointly present this Lunch & Learn on Antimicrobial Stewardship. A physician and a pharmacist working with Covenant Health will speak about: the antimicrobial stewardship program at the U of A, local data on efficacy and changes in resistance patterns, role of different healthcare professionals in the program, case studies and resources for students for preventing antibiotic resistance.

Cannabinoid Guidelines Lunch & Learn -- Monday, March 12 Wondering what to expect when guidelines surrounding cannabis change on July 1? Joey Ton will be walking you through what you need to know as a pharmacist.

Diabetes Interprofessional Lunch & Learn -- Wednesday, March 14 The PAM Interprofessional Lunch & Learn is intended to promote discussion concerning collaboration in actual practice. Come join the panel of health care professionals that will be working through a patient case, each discussing their role in the care of Type 2 Diabetes.

Indigenous Lunch & Learn -- Wednesday, March 21 The Indigenous Health Program is a health service provided by Alberta Health Services in partnership with Indigenous peoples and communities to provide accessible and culturally appropriate health service for the First Nations, Metis and Inuit people of Alberta. Mr. Douglas Longmore is an Indigenous Cultural Helper Lead that will be presenting more on what the program is about and how the approach to Indigenous health care can differ from traditional health care.

HIV Lunch & Learn -- Monday, March 26 This event will feature Dr. Hughes and a panel of professionals working in the area of HIV. They will discuss current trends and research within the field, and the role of pharmacists as front line clinicians providing care for those at risk or living with this condition. As part of the panel, a patient will also share their lived experience with HIV. Financial Lunch & Learn: Graduated, now what? -- Wednesday, March 28 This event will be presented by Afshan Butt from Investors Group. Last semester, she focused on the basics of financial planning. This time she will be focusing on what to do when you graduate. She’ll go over investment planning, retirement planning and even how to read a pharmacist’s pay stub. It’s a great opportunity to get some financial knowledge before you graduate and have to figure it out on your own! | 5 |

Industry Trade Show

Imagine that you are working at a pharmacy and a patient comes up to the counter. He has a brand new prescription for Janumet®. As you put the prescription through, he asks you, “What is this medication, anyway? And why did I get switched to it from metformin?”

Or, say that a woman approaches the pick-up counter and is wondering if you can help her pick out a multivitamin. Where do you start?

These instances are where the Industry Trade Show comes in. The Industry Trade Show seeks to be a conduit between what we learn in class and what tangible products we will see in practice.

Last year was the first annual Industry Trade Show, organized under the direction of Mike Song. It hosted 10 pharmaceutical companies, whose representatives gave presentations on new medications on the market. Some vendors even had hands-on demos for students, such as learning how to use a glucose meter with some “plasma” samples.

This year’s Industry Trade Show has a mix of returning and new vendors. It will be a fantastic opportunity to gain an extra edge on new medications; or, you can learn how to use devices commonly seen in the pharmacy, such as valve holding chambers for asthma. We also have the pleasure of hosting the Alberta Pharmacists’ Association (RxA), who will chat about GoPharmacist. Not sure what that is? Come to the Trade Show to find out!

Here is how the day will work: When you register for the event, you will be placed into a group of students from different years of pharmacy. Students will cycle in their groups through a series of workrooms, where there will be 20-minute presentations from each vendor. But don’t fret—we’ll have snacks and lunch to keep you energized throughout the day.

The Industry Trade Show will be on Saturday March 24, 2018 on the first floor of Edmonton Clinic Health Academy (ECHA) from 10 AM to 3 PM. Sign up for the event and come out for a day of learning, food, and a perfectly valid reason to dress business casual.

— Vanessa Hill, Students Advocating for the Future of Pharmacy (SAF-Pharm) Director | 7 |

Therapeutic Tent Talk Featuring David Poon & Jonathon Thomson

Valentine’s Day has come and gone. For some, Valentine’s Day can be a tough day. Some fools hike deep into the wilderness to take photos of awkward yoga poses in front of a tent. Normal people take their significant other out for a romantic dinner, meanwhile others indulge their sorrows away. Depending on what (or how much) you ate, heartburn may occur. This issue of Therapeutic Tent Talk, we will address how to fix a broken heart heartburn.

DISCALIMER! Although topics discussed will be targeted to pharmacy students of all years, practice to your competence level. This article is not intended to be a replacement for a therapeutics course. The purpose of this article is to supplement knowledge and provide basic background information to the selected therapeutic topic.

Heartburn is a burning or sub-sternal pain

that is felt to travel from the esophagus to the pharynx. Heartburn is a typical symptom of Gastroesophageal Reflux Disease (GERD), or the passage of stomach acid back into the esophagus1. Other symptoms of GERD include epigastric pain, nausea, dysphagia (difficulty swallowing) and odynophagia (pain with swallowing). Many of these symptoms overlap with dyspepsia (indigestion), which can make it difficult to differentiate between the two.

Goals of Therapy Reduce frequency and duration of symptoms or eliminate symptoms, induce healing of any damaged mucosa, educate patients to recognize worsening symptoms of GERD, and prevent complications such as Barrett's esophagus or esophageal adenocarcinoma

C—Pain may range from mild 1-3/10 or severe (7-10/10) vs. heart attack may be characterised as a 10+/10. Impairment in daily activity can range from no impairment to severe impairment and middle of the night awakening.

H—Has it happened in the past? If so, how frequent (can dictate the severity and treatment options. Mild - < 3 occurrences a week.

Severe - daily attacks).

O—Associated with a recent meal or certain foods, rule out recent changes in medication (s) L—Burning or pain can be anywhere between the neck down to the stomach.

A—Foods with high fat content, chocolate (should have thought twice about that Valentine’s Day gift…), peppermint, alcohol, spices/spicy food, onions, citrus juice, coffee, lying down after eating, smoking, obesity, pregnancy, excessive eating R—avoid: triggers/modify diet, laying down after meals, smoking, alcohol, tight clothing, eating 3 hours prior to bedtime; elevating head (extra pillow), weight loss

Red flags require further investigation and a referral to a physician.

Chest (cardiac) pain, choking (acid reflux cause shortness of breath, coughing or hoarseness), dysphagia (difficulty swallowing), GI bleed (blood in vomit/black tarry Pharmacological Treatments stools), odynophagia, unintentional weight Please refer to RxTx or Lexicomp for drug inloss (can signal a GI malignancy), vomiting. teractions, as antacids commonly interact with certain medications.

S.C.H.O.L.A.R. S—Nausea, bloating, early satiety, excessive belching, epigastric pain, epigastric burning sensation | 9 |

1. Mild Antacids are commonly used for acute exacerbations of heartburn. Patients using high dose or long term use of antacids may require additional drug therapy, but should be thoroughly assessed.

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3. Severe A trial using proton pump inhibitors (PPI) should last approximately 2 weeks. If no response, a referral to a physician would be warranted.

• Omeprazole • 20 mg once daily 30 mins before Tums® (carbonate acid) food • Adults: 500–1500 mg per day in di• S/E: headache, nausea, rash and divided doses arrhea • S/E: constipation, belching, flatu• Other PPIs are Schedule I lence

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Milk of Magnesia® (magnesium salts) • Adults and children >12 years old: 650-1300 mg per day, in 4 divided doses PRN • S/E: diarrhea

Non-pharmacological Treatments Avoid: triggers/modify diet, laying down after meals, smoking, alcohol, tight clothing, eating 3 hours prior to bedtime; elevating head (extra pillow), weight loss.

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Gaviscon® (alginic acid/antacid combination) • Adults: 10-20 mL PC and HS PRN, followed by a glass of water • S/E: constipation

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Dioval® (aluminium hydroxide/ magnesium hydroxide) • Adults: 30 mL 1h PC and HS PRN • S/E: diarrhea

Special populations Pregnancy - The increase in intra-abdominal pressure caused by the growing fetus can increase the risk of GERD and its associated symptoms. Lifestyle/nonpharmacologic treatments are first line, but antacids (not sodium bicarbonate), alginic acid are safe options.

For more resistant cases, H2RAs and PPIs are viable options, but there is less evidence regarding PPI safety.

2. Moderate Histamine 2-receptor antagonists (H2RA) rapid onset of action is desirable even for mild cases and they can be taken at bedtime to prevent nocturnal reflux (adjunct to PPI therapy). They have an excellent safety profiles with headache, nausea, vomiting, and diarrhea being reported as most frequent side effects.

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Zantac® (ranitidine) • Adults and children >16 years old: 75-150 mg po BID PRN (max 300 mg per day) • S/E: headache, nausea, vomiting and diarrhea Famotidine • Adults and children >12 years old: 10-20 mg po BIDPRN (max 40 mg per day) • S/E: headache and dizziness

Elderly - In older adults, doses of the medications may need to be adjusted based on their renal function as well as assessing the risk of drug interactions. However, being on PPIs long term have consequences that are important considerations in the elderly such as, increased risk of fractures, C. difficile infections, community acquired pneumonia, hypomagnesemia, and low vitamin B12 levels. Consequently, PPIs are often targeted for deprescribing.

References 1. Dyspepsia and GERD CTMA from RxTx 2. Gastroesophageal Reflux Disease CTC from RxTx

Present Meets Future Sandy Xu

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Q1. How has your role as President of APSA helped you grow as a professional?

Without a doubt, my roles with APSA have been the single greatest contributor to my professional development throughout my time as a pharmacy student. This position forces you to learn how to manage both time and people, two very important aspects of being a healthcare professional. It's taught me to become more organized (something that was lacking in my life prior to this) and to trust my instincts as a leader. The amount that you learn about yourself in a position like this is crazy, I'm constantly achieving things that I never thought I could, and also coming to terms with my weaknesses as well. Overall, I think I have developed a ton as a leader, advocate for the profession, and as a professional and have my role in APSA to thank for it.

Q2.What were some things you didnâ&#x20AC;&#x2122;t expect coming into this position?

I think the impact of my role with RxA surprised me. Before I entered this position I knew that the President was involved with RxA, but my impression was it was more reporting on what APSA is up to. Boy oh boy was I ever wrong. RxA provides the APSA President with an opportunity to sit on its Board of Directors and help make decisions that will shape the future of the profession. I have been involved in some very heavy discussions over the past few months, including negotiations of our new pharmacy framework. This is an opportunity that has allowed me to develop a ton as a professional, and one that I wish more of my student colleagues could have.

Q3.Whatâ&#x20AC;&#x2122;s the hardest part about your role in APSA? I wish I could say that this position is easy, but it's really not. There are a lot of headaches and hard conversations that I've had and will continue to have. Not always seeing eye to eye with other parties in meetings is incredibly frustrating, and not being

able to come to a compromise that is acceptable to the students I represent, for the lack of a better word, really sucks. It can be mentally and emotionally draining and it seems to come in waves, but at the end of the day I know that I'm working toward something larger than myself and it is all worth it. I've been fortunate to have a few fewer headaches in my role than Aliaks did last year, and I hope I can help APSA get to a place where Jes and future presidents have to deal with fewer and fewer tough conversations.

pharmacy faculties across Canada and share ideas with them, and it was very exciting to share our successes with each other and hear about how the profession and pharmacy education is growing nationwide.

Q5. What do you want your legacy to be?

This is a question I get a lot, and one I try not to put much thought into.

Everyone always says you need to "leave a legacy" and that's not really what I'm trying to focus on. I just want to do what's best for the students and implement programs and initiatives that will benefit everyone. I want to help my councillors to fulfill their positions to the best of their abilities and to inspire students to advocate for themselves and for the profession. I want to be good, honest, and responsible leader, the type of leader that APSA Members deserve. If I can do that, then I would like that to be my legacy. Also looks like I'm going to get last in the pharm hockey pool so maybe that can be a part of it.

Q6. If APSA had a 1 million dollar budget, what would you spend it on?

The first answer that jumps into my head is an ice cream fountain. After that, maybe some more scholarships and rural placement awards, more things to save students money would be great.

Q4. Best memory since becoming president?

I would have to say PDW 2018 (thanks once again to the wonderful planning committee)! It was such an honour to be the President of the host school and to see all the fantastic work that UAlberta Students did in planning that conference. Aside from that, it was one of my best memories in pharmacy school period, the conference was absolutely fantastic and I couldn't ask for better friends and colleagues to share it with.

Additionally, I had the opportunity to meet with other Presidents from

Q7. What would the perfect APSA lounge look like?

Way way bigger would be nice. I know the old APSA Lounge in the Dent Pharm building used to hold all of the TGIFs which would be pretty cool. Also students used to steal ethanol from the compounding lab for punch at TGIFs. So yeah, something that could hold an event like this would be great.

Q8. If you were a drug, what drug would you be?

Ketamine. I induce strong cravings, people seem to lose track of time around me, and I might even treat your depression (more data needed).

Q1. What are some things we can look forward to seeing or hearing from you as the incoming APSA President?

Probably a few terrible jokes, in -class announcements and a lot of emails! And hopefully convincing the faculty to put cup holders in the MedSci classrooms.

and the doctors are anticipating that he should be able to skate and play hockey again.

Watching his journey—his tenacity and determination to make the most of his situation has been the most rewarding part of the process.

Q2. What’s the hardest part about running for APSA president?

Running against other peers, especially those whom you really admire and respect, is extremely difficult; you want to win but on the other hand, you also do not want anyone to lose. The Presidential Forum was also very difficult!

Coming up with immediate answers to questions and trying to articulate your answer under a minute was one of the hardest things I have had to do.

Q3. You are very involved both on and off campus, what would you say is the most rewarding thing you’ve done?

In November, I shaved my head as fundraiser and part of the money raised was donated to my friend, Ben, who had lost his leg to cancer. He has been keeping me updated on his progress with his new prosthetic, which was what the money was used toward, and he has already begun to walk again

out there and anyone who chooses to do that should receive as much support as possible from fellow peers!

Q5. What do you want your legacy to be?

I want to be remembered as being approachable, relatable and humorous (my life goal is to try and be as funny as Megan Elliot).

Q6.If APSA had a 1 million dollar budget, what would you spend it on?

“You get your student debt paid off, and you get your student debt paid off and EVERYONE gets their student debt paid off!”

Q7. What would the perfect APSA lounge look like?

Oh gosh. For me, there would be a designated napping area with those sleep pods. They’re only about $8000 a piece so I am sure APSA can find room in the budget for a couple of them…

Q4. What’s one event hosted by APSA that you think to deserve more recognition?

The election forums! This is the best way to hear all of the candidate’s platforms and why they are running. It takes a lot of courage to stand up in front of your peers and put yourself | 13 |

Q8. If you were a drug, what drug would you be?

Warfarin because I looooove interacting with people.

The Opioid Crisis & What you can do What is the opioid crisis?

Why is it important?

Opioids are medications used to treat pain. If used correctly, they can be very effective, however, if used in excess, acquired from an unknown source, or used with other substances, harm and death can occur. All over Canada and the United States, more and more individuals are misusing opioids that can cause individuals to stop breathing.

The opioid crisis has been occurring over the last few years and has since progressively resulted in more deaths.

The appearance of carfentanil has complicated the crisis, as it approximately 100 times as potent as fentanyl or 10,000 times as potent as morphine1. This means that only a small amount of fentanyl, and even a smaller amount of carfentanil is needed to cause respiratory distress and death.

Role of the Pharmacist The pharmacist can ensure that other analgesic medications (NSAIDs, acetaminophen, physiotherapy, etc.) have been utilised before a medication with an opioid is trialed. If opioid medications are necessary, pharmacists can identify those at risk of experiencing respiratory depression (high doses, history or known use of illicit drugs, those coming off a period of abstinence) and provide a naloxone kit. Pharmacists can also promote the dispensing of naloxone kits to anyone. Naloxone kits do not require a prescription, are free of charge, and do not require ID to obtain one.

Figure 2*: Number of apparent accidental fentanyl toxicity deaths, by Zone (based on place of death) and quarter. Jan. 1, 2016 to Sept. 30, 2017. *Figure from AHS

What is naloxone and how can it help?

Naloxone is a drug that temporarily reverses an opioid overdose. Opioids are drugs, such as heroin, opium, fentanyl, morphine, codeine, oxycodone and hydromorphone. It is important to call 911 even though someone may become responsive after intramuscular injection of naloxone. Naloxone is a relatively safe drug. If you administer naloxone into someone that does not have an opioid overdose, it will not harm them.

Signs of an opioid overdose 1. Breathing is slow or not breathing at all 2. Nails and/or lips are blue 3. Choking or throwing up 4. Making gurgling sounds 5. Skin is cold and clammy 6. Canâ&#x20AC;&#x2122;t wake them up Naloxone Administration Tutorial Under 2 Minutes (YouTube): https://tinyurl.com/ya5ne2an

References 1. https://www.albertahealthservices.ca/info/page12491.aspx 2. http://www.ottawapublichealth.ca/en/public-health-topics/fentanyl-andcarfentanil.aspx | 15 |

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For this issue of PQ+2, Jonathon and I will be doing an interview with a recent pharmacy alumna whose passion for the profession has led her into the area of oncology practice. Humirah Sultani recently graduated in 2016, where after she pursued a residency specializing in oncology and is now a staff-pharmacist at the Tom Baker Cancer Centre in Calgary. During her time in pharmacy school, she was actively involved in many extracurricular activities that promoted the profession, and served as the APSA president during her third year. Humirah continues to be a passionate advocate for pharmacy and is currently the President Elect for the Alberta Pharmacists’ Association!

She was so passionate about her program – it was absolutely infectious!

My older sister thought it was the perfect blend of science and patient care, and she told me to just apply. I applied rather spontaneously and thankfully, I was accepted into the program. Truly, I had no inkling of the profession back then and I could not even differentiate between Tylenol® and Advil®! One of the main reasons that I was so interested was the potential for pharmacists to work in hospital, which was why I wanted to pursue a residency.

Q3: Where could undergraduate pharmacy students learn more about oncology, or about the oncology residency program?

Q1 Thank you Humirah for agreeing to do this interview for PQ+2. For the first question, could you briefly share with us your education history and why you decided to choose the pharmacy profession?

Hi Jonathon & Ethos, thanks for your interest and choosing to interview me. In high school, I completed the full International Baccalaureate program and because I had an interest in everything, I had no idea what I wanted to pursue in university. I just knew that I my future career had to focus on helping patients, but I didn’t know how to get there. When I started University, I studied a multidisciplinary program called Science 100. It was a one year introductory curriculum that allowed me to sample all of the sciences ranging from biology to computing sciences, organic chemistry to earth and atmospheric sciences, and it had a dash of calculus. I realized that I had an interest in biochemistry, so I pursued it in my second year. I was very interested in completing cancer-based research, but I found that a scientific degree alone would not sufficiently nurture my love for teaching and empowering people around me. My interest in pharmacy actually came from two individuals: my good friend and my older sister. I volunteered at the Canadian Blood Services since my last year of high school, and my friend Emily Yu had just gotten into pharmacy.

such an impact on me that I decided that working with cancer patients would be my greatest contribution to society. In my first year of pharmacy, I collaborated with Vincent Ha on designing intramural t -shirts. I remember this was during my first exam season, and I showed him my design in the Medical Sciences Building library. He mentioned that he was planning to apply for a hospital residency in oncology. At that point in time, my mind connected the dots to build a pathway from my undergraduate degree to an oncology pharmacy practice. I did everything I could in order to be sure that oncology was the right practice for me.

Q2: Were you always passionate about oncology during your undergraduate pharmacy years? What made you eventually decide to choose oncology practice as your specialization?

My interest in oncology stemmed from my five years of volunteering with the Canadian Blood Services. I learned that hematology cancer patients required weekly blood transfusions and it motivated me to try to get people to donate blood. During one of our Youth Committee meetings, a leukemia patient came to share her story with us. It had

During my undergraduate years, I attended every networking event that I could in order to meet an oncology pharmacist. I was able to meet with Melanie Danilak, who answered my questions and helped cultivate my interests. I decided that I wanted to complete my institutional rotations at oncology sites around Alberta. During my second year, I spent 2 weeks at the Cross Cancer Institute where I worked with my preceptor, oncologists and nurses in a more intensive oncology unit.

I saw her again during her breast cancer presentation in third year during the oncology module, and it was nice to reconnect and reflect. That year, I also watched a presentation by Sabina Choi who completed her specialty rotation there. She delivered a presentation on febrile neutropenia and I realized that pharmacists had a critical role to play in managing patients’ supportive therapies.

At the end of the presentation, I e-mailed Marlene Gukert straight away to express in my interest in completing an specialty rotation in my fourth year in oncology. I had the excellent fortune of being able to work with Melanie in her outpatient breast cancer clinic where her and a nurse practitioner managed antihormonal therapy in women with hormone-sensitive breast cancer.

Early on, I also shadowed Marcel Romanick at the Stollery Children’s hospital and when he became my CSHP mentor, I was able to ask him how he became a pediatric oncology pharmacist and Clinical Practice Leader (CPL).

recommendation using clinical experience and therapeutic resources, including primary literature. I truly feel that I am practising to the fullest scope To be honest, everyone struggles for of pharmacy practice in Alberta, just shy their first year out of university in order to establish their own pharmacy practice. of prescribing (which I am currently working towards).

It was during my residency when I found Everything I learned in school provided me with the foundation to identify drug out how I could learn more about Q5: What are some of the most oncology. First off, for any student that is related programs and selected therapies rewarding aspects of your job? for their management, but a residency interested, register yourself with the The most rewarding aspect of my job is built on this. Some people say that a Canadian Association of Pharmacy in being able to make life easier for my residency is only one year of practice but Oncology (CAPhO) and attend Oncology patients. I love to interact with patients it gives you the experience of five years Fundamentals, an online one day and I find the day to be rather dull if I in hospital.

I realized this was true and conference to learn the basics of haven’t been able to do at least a few more, because even if you work in oncology. It’s primarily geared towards patient education sessions. I answer hospital after your graduate, it would community pharmacists, and it is an their questions on the phone, and I take a number of years to get into a excellent resource! When I prepared for triage oral and IV oncology orders. Every clinical area and many years after that to my first oncology rotation, I actually day I am learning about new diagnoses, learn about leadership and studied a document called Oncology therapies and regimens. I’ve always had management.

Basics, which has since been updated this foresight to help identify when things and can be accessed through the CAPhO could go wrong, so I always think website. CAPhO also hosts an annual critically and plan ahead so that my team conference, and my pharmacy student can work efficiently and so that therapies whom I precepted last year also can work effectively in my patients. attended. He thought it was an excellent introduction to the oncology world and When I’m not at work, I am still working! he was also able to meet oncology My interest in oncology has manifest into pharmacists from across Canada. I an interest in oncology research. After would also recommend registering with my pediatric oncology rotation, I’ve the International Society of Oncology continued to work with one of my Pharmacy Practitioners (ISOPP). preceptors on a project to design a Registration with these groups are free mobile application to support pediatric for students, so take advantage of it oncology patients in managing their even if you don’t plan to pursue cancer symptoms and medication oncology! adverse effects. This has really been the Some other resources to check out: Alberta Health Services Cancer Guidelines, National Comprehensive Cancer Network (NCCN), British Columbia Cancer Agency Cancer Drug Manual, Journal of Clinical Oncology (ASCO) and the Canadian Cancer Society (CCS). I also recommend these resources for pharmacy students and pharmacists that are working with a cancer patient and would like to do some further reading. Lastly, I don’t have access to uAlberta library services anymore, but there was a textbook by DeVita that was also super helpful (but terribly high level)!

Q4: How has the oncology pharmacy residency program prepared you to be the pharmacist that you are today?

I was able to gain experience in general medicine, hematology, bone marrow transplants, acute care oncology, cancer pain and symptom management and my personal favourite, pediatric oncology. I was also able to improve my skills in drug information, research, scholarly writing, critical appraisal, and leadership and management. I found that when I started as a staff pharmacist at the Tom Baker Cancer Centre, I learned quickly, drew from my clinical experiences and gained confidence faster than pharmacists that were not residencytrained. Today, if you give me a clinical problem, I am able to at least work out all the steps in order to get to my | 19 |

cherry on top of a challenging year because everything I learned during my residency has helped me become a useful member on our research team.

We even have a pharmacy student working with us! That’s another way for a student to learn more about oncology – get connected with Alberta Health Services over the summers to work in hospital units or with CPLs. Any experience is good experience!

Q6: What tips would you provide for prospective students that want to pursue a career in oncology practice?

tools to teach myself and learn how to practice. In fact, I’ve always tried to challenge myself by throwing myself into different areas. People said cancer was scary, so I pursued it.

One: learn more about oncology and really define your interest People said pediatrics was challenging, so I tried that, too. In in it. Everyone has a baseline interest, or rather a fear of fact, my dream job would be to practice as a pharmacist in cancer, but it helps to know more about an area that you want pediatric oncology. I’ll have to let you know what happens to pursue. This can be found in textbooks, through networking after my interview tomorrow. and shadowing, during rotations and by talking to me! It is my priority as a pharmacist to nurture all of the pharmacy students that will be entering into practice, especially oncology. I encourage prospective oncology pharmacists to connect with me by e-mail (humirah@ualberta.ca) and I’d be more than happy to answer questions. Past oncology residents and current oncology pharmacists are also a valuable resource.

Two: gain some experience in hospital or oncology practice.

This can really be dictated by your selection of oncology focused rotations and summer employment positions. Be sure to also try to pursue oncology research positions. You really need to be creative and think critically about how to get yourself where you want to be, and sometimes the answers are not clear cut nor obvious. Often times, opportunities present themselves and you must be ready and willing to seize them. I’ve always found that expressing my interests honestly with my peers, preceptors and mentors has helped me reach for opportunities that I did not even know existed.

Three: become a leader. No matter how big or how small, gaining leadership experience is always an asset. If you want to become a resident, this will help your application immensely. Even within the work place, getting involved, taking initiative and paving the way for pharmacy can only help strengthen your personal pharmacy practice. Our greatest contribution to our patients is our ability to strengthen our profession and to uplift the standard of pharmacy care.

Recognize the role you play in advocating for your profession and most importantly, for your greatest stakeholders, your patients.

Q7: From our (Jonathon and I’s) experiences with the thirdyear oncology course, there are numerous drugs in oncology that are not seen in community or other areas of practice (Ex. infectious diseases). Did you find it difficult or overwhelming to adapt to this new area of practice?

To be honest, no matter which clinical area you find yourself in, you will always be challenged to learn about new drugs that you can’t even pronounce. It’s the same for cancer, but my interest in oncology has helped me learned quickly. The residency program was an immersive year that helped me learn how to learn. That’s right, to learn.

As if studying in university didn’t teach me this, but it’s true that it hasn’t. My learning style has changed so much since I graduated high school and during residency, I learned that I could be thrown into any clinical area. Even then, I had the

By: Casey Kwong Are you looking for something to do when taking a study break thatâ&#x20AC;&#x2122;s more interactive than Facebook or Netflix? Or are you just looking for something to do to pass the time during the long commute to school? If so, Fire Emblem Heroes is an option for you. It is a fun, low-commitment game that is simple to learn but difficult to master.

Fire Emblem Heroes is a free-to-play mobile game based on the Fire Emblem Series, which are tactical, turn-based strategy games. Players take on the role of a â&#x20AC;&#x153;summonerâ&#x20AC;?, who travels to different Fire Emblem worlds to fight different characters controlled by an evil empire. Players control a team of up to four characters against enemy teams on a gridded map. While new players can feel intimidated because of the different maps and diverse cast of characters, Fire Emblem Heroes offers difficulty levels friendly to newcomers that allow them to learn the ropes. Over time, with enough experience and accumulating different character types, maps of higher difficulty will become easier to clear. In addition, there also offers special maps and arena-based gameplay to give seasoned players a challenge. One of the highlights of Fire Emblem Heroes is that overall gameplay has remained faithful to the original series while being optimized on a mobile platform.

game currency known as orbs. When orbs are redeemed, a character can be summoned through a gacha system. In other words, when characters are summoned, they appear at a random rate with rarest type (5 stars) appearing at the lowest rate.

For many, the most fulfilling part of the game is the rush that comes with summoning a new and rare 5 star character (which usually appears at a low 3% rate).

While some of the playable characters are original to Fire Emblem Heroes, most of them are from the Fire Emblem Series. Fans who have played games from the series such as Conquest or Fates or even people who have played Smash have to opportunity to summon some familiar faces!

Fire Emblem Heroes is a fun game that is accessible enough to allow for on-the-go play for when you only have minutes to spare. It offers simplified, low-commitment version of the Fire Emblem Series that makes it appealing to newcomers while also offering challenging maps that is engaging to veteran players. Overall, Fire Emblem Heroes is an entertaining mobile game as it offers maps and gameplay options that appeal to a variety of players and a diverse cast of playable characters.

Characters have different movement abilities, skill sets, weapon types, stat spreads, and rarities. In the beginning, it can be difficult to determine which characters and abilities are the most powerful or versatile. Over time, with experience, it becomes clear what stats and abilities are optimal in either killing or tanking enemies. In addition, as the variety of characters players obtain increases, it also becomes easier to build the optimal teams to take down more difficult maps or play in the arena.

Despite there being a variety of different game modes, one of the most enticing incentives to play Fire Emblem Heroes is collecting new characters.

Most characters can be acquired by redeeming in| 21 |

By: Sandy Xu

For a caffeine degenerate like me, I always wished there was a natural substitute for caffeine. Although there isn’t any perfect substitute, over the years I’ve found some ways to help me beat the afternoon slump without resorting to Starbucks. As a busy pharmacy student, my philosophy is that caffeine should be a last resort than the first choice, and should utilized effectively to meet those harsh deadlines or lastminute exam cramming. So for those of you who are addicts, degenerates or dependents, the new year is a time for self-reflection and a time to potentially adding some positive tweaks to you daily routine.

Rather than upheave your entire dieting routine, as many new year resolutions involve, try taking baby steps that are realistic and achievable. If one of your goals is to stay to energized naturally then we’ve compiled the perfect list for substituting that espresso with some quality snacking.

Dark chocolate Flavonoids found in dark chocolate are a potent antiinflammatory agent, helping boost your immune system and improve cardiovascular health. Could it help your energy level as well? Studies show that absorbed flavonoids accumulate in brain regions responsible for learning and memory (Berk, 2017).

Specifically, it enhances sensory awareness that could be the secret to staying awake longer in those sluggish afternoons. Choose low-sugar dark chocolate for optimal results.

Peppermint tea Without the threat of upcoming deadlines, I can safely sip on my peppermint tea and feel awakened with the cool, minty sensation. Peppermint tea has been proven to improve alertness, long term memory and speed of memory (Moss, 2016). Of course, the best peppermint tea involve using fresh, crushed peppermint leaves, you can always substitute with dried store bought tea.

Raw veggie and hummus Staying hydrated plays a large role in your natural ability to fight sleepiness, and raw veggies not only offers hydration but also sustainable, beneficial carbohydrates that will last you until dinner. Hummus offers an excellent dose of protein without being excessive. One of the most important tips I’ve learned is asking yourself if you’re truly hungry or simply bored. Many times, it could be the latter and controlling the sizes of your snacks could be difficult.

Whole grain crackers Complex carbohydrates help sustain your blood sugar level without allowing it to spike. In the afternoon following a large meal your natural energy level plummets, especially after a carbohydrate-heavy meal, which makes the afternoon extra difficult to survive.

For me, a ten minutes nap typically turns into a three hour snooze. To help combat the energy drop, try adding some whole grain snacks into your afternoon and help keep your facial muscles moving.

Trail mix

I love mixing my own trail mixes since I can gauge the nutrients without feeling guilty about excess sugar content. Raw walnuts are my personal favorite since it offers the much needed omega-3 oils for a well-oiled engine that is your brain. Before you consider chocolate chips or simple carbohydrates, try adding coconut shreds or craisins that add a touch of sweetness without spiking your blood sugar.

By: Ziqi Wang As a pharmacy student, have you ever been asked about over the counter supplements, herbals or any other “natural” ways to treat health ailments?

Questions about naturopathic remedies have weaved their way into community pharmacies thanks to Dr. Oz, Gwenyth Paltrow and many other media personalities who promote health trends on TV, social media and other forums.

primary care providers are able to spend with a single patient

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Photo credit: https://www.goop.com Although what appears in the media is not always reflective of what naturopaths recommend in practice, it does appear from the media that there is about something “natural” that can be used for almost any health concern. I have been exposed to arguments for and against naturopathy and also have personal experience with naturopathy. Before I outline what I believe are the potential reasons to see or to not see a naturopath, I will introduce naturopathic medicine looks like in Alberta.

Both Pharmacy and Naturopathic Medicine are four -year accredited professional programs in Canada.

In July 2012, Naturopathic Doctor and Naturopath became protected titles under the Health Professions Act and naturopaths were granted the authority of self-governance by the Government of Alberta. The College of Naturopathic Doctors of Alberta (CNDA) is the governing body of naturopaths and is similar to the Alberta College of Pharmacy in establishing and enforcing the profession’s Standards of Practice and Code of Ethics. According to Dr. Alissa Gaul, the founding president of the CNDA, “[naturopaths] offer Albertans a distinct system of primary health care that is an art, a science, a philosophy and a practice of diagnosis and assessment, treatment and prevention of illness.” Naturopaths are not exempt from safety measures that prevent harm to patients, such as reporting diseases that cannot be treated within their scope of practice to the appropriate healthcare provider. Therefore, naturopaths do abide by the non-maleficence or “do no harm” principle that other allied professionals adhere to. Key exclusions from the naturopaths’ scope of practice include prescribing medications, ordering x-rays or ultrasounds, and administering IV nutrition.

Potential reasons to see a naturopath

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Naturopaths are focused on the “bigger picture” of wellness including mental, physical and spiritual wellness. Behavioral and lifestyle factors that may not be deemed medically relevant to primary care providers are also assessed more thoroughly by naturopaths

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The typical appointment time for each patient is 30-60 minutes, which is longer than most

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Naturopaths may provide a second opinion for patients who have medical conditions or diseases that have not been effectively addressed within the traditional healthcare system Naturopaths have a high level of expertise in the area of alternative medicine and are primarily focused on the use of supplements, herbals and non-pharmacological measures to promote wellness and to prevent and treat disease; they are more likely to recommend legitimate and safe products than non-experts and are likely able to help patients navigate through health trends All licensed naturopaths are trained to assess and diagnose patients; with additional training, some naturopaths are able to perform alternative medicine procedures such as IV ozone therapy and minor surgeries such as mole removal and suturing

Potential reasons to not see a naturopath

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Considering how medically necessary healthcare services are covered by Alberta Health insurance plans and naturopathic services are not, the cost of naturopathy may present a barrier for patients

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Since naturopaths cannot order certain lab tests that are often essential for diagnosis and are not able to prescribe medications, there will be gaps in care that cannot be filled unless the patient visits a primary care provider

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Textbox: Facts about Ozone Therapy (3)

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Ozone is naturally occurring compound that can be made through ultraviolet conversion of oxygen into an unstable, activated form

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Ozone is thought to modulate antioxidant enzymes and nitric oxide pathways. Animal studies suggests that ozone reduces oxidative damage, preserves beta-cell function, and improves glycemic control

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Ozone has a potential role in disinfecting dental caries and stopping their progression.

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The therapeutic claims for ozone therapy range from prevention to treatment of diseases such as cancer and HIV

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Administered IV, ozone therapy has been evaluated to be “likely unsafe”

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Overall, there is insufficient evidence about the safety and effectiveness of ozone therapy

Although there are many potential reasons for seeking a naturopath, I believe many of the individuals who do decide to stray away from traditional Western medicine have been influenced by negative experiences in the care settings such as health clinics, hospitals or pharmacies. Since naturopaths have longer appointment times and place a greater emphasis on the overall wellness of patients, it is likely that patients feel more heard and understood by naturopaths than with a primary care providers who are more limited in time and place a greater emphasis on physical health than overall wellness.

The ideal of patient-centered care may not always been possible in fast-paced environments such as a busy community pharmacy, but should be upheld Some naturopathic remedies such as IV whenever possible. To provide patient-centered ozone therapy are lacking in evidence for care for patients is to prioritize the overall wellness safety and efficacy (see textbox) of patients, to provide education for patients without adding our personal biases and to avoid Some naturopathic remedies may involve a judging patients who do not agree with our lot of effort, time or money for patients, but may not actually treat the patient’s underlying recommendations. Since natural health products are becoming more commonplace in pharmacies health issues. and on patient’s medication lists, pharmacists should always keep the door open for patients to Lastly, primary care providers may disagree ask questions and to ensure that patients are have with naturopaths and vice versa on how to access to essential health resources. As much as diagnose and treat patients. In Alberta, interwe may agree or disagree with the principles of professional collaboration between alternative medicine or the recommendations of naturopaths and allied health professionals is naturopaths, we have to understand that patients very rare, which leaves patients who see are entitled to make decisions about their own health professionals from both sides with the health and that inter-professional collaboration and burden of figuring out how to reconcile mutual understanding most often provides the recommendations. most beneficial outcomes for patients.

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Horoscopes By: Jonathon Thomson

The long line of people dropping off prescriptions could have you wanting to run Someone who is a believer in natural health away and hide, Leo. Don't fight the urge. This products may come to visit you and share some may be just what you need in order to clear your ideas today. You tend to be critical in matters mind from your most recent exam and heal your concerning health, but today you might want to wounded psyche. You might also receive some learn not only about herbs and nutrition, but also spiritual healing. This is a good time to train rather disconcerting revelations about yourself and be asked about drugs that you’ve long since your own healing abilities, Aries, as your forgotten. Don't fight these feelings. Simply sensitivity is high and you’re more able than release your potential. usual to tune in to the healing energies.

A friend, perhaps a patient, could well be upset or even angry with you today, Taurus. Money or how long it takes to dispense a prescription might be involved in some way. There may be nothing you can do to reassure them at this time, so it's best to give what reassurances you can and then back off. Whatever has gone wrong, they are probably overreacting, and eventually they will see that. In the meantime, you do what you can to work off your own anxieties. Hang in there!

Too much exposure to the CTC, Pharmacy Times, and the prescription intake computer(s) today could produce eyestrain headaches, Gemini, so try to exercise a little caution when working with small print or computer text. Stay hydrated and keep your own supply of NSAIDs close by today. You may be tempted to spend most of your time on the phone. We all have days like this, so don't fight it. Just make sure you're feeling great when the evening rolls around!

Your extremely overpowering empathy is apt to scare people off today, Cancer, especially when it comes to matters involving pharmacotherapy.

Unless your desired result is to convince everyone around you that you’re completely insane, it may be best for you to back off or at least tone it down.

You’re usually a very clumsy compounder, but today you may be more inclined than usual toward pharmaceutics. Emulsions seem extremely appealing, and you could find yourself gravitating toward the USP or seeking discussions with people who are well versed in such matters. Invest in a new white coat, Virgo.

We all make spills from time to time!

Your pharmacy could be a very busy place today, Sagittarius. Patients could come and go throughout the day, probably annoying you at times. You might also find yourself having to soothe angry outbursts on the part of a member of your pharmacy team. Take care, however, that this person's problem doesn't get you so inflamed that you go into a fit of anger, too. Try to stay calm and focused and you'll get through the day.

Some wonderful news concerning money and career matters could come your way today, Capricorn. Your natural kindness and empathy has led you to make some good friends who are also long-time patients. This is definitely paying off. Your aesthetic sense is at an all-time high, so this is a great day to start any creative ways that you have in mind to complete care plans. Success is definitely coming your way!

Your patients could be upset today, Aquarius.

Their cigarettes are something they think they Group activities involving compounding, absolutely have to have right now. You might communications, integrated cases, or INT D are find yourself having to assess their willingness to probably very appealing to you right now, Libra. quit and reassuring them that "not now" doesn't This is the perfect time to start to pay attention necessarily mean "never." If they don't respond, in class and actually attend a lecture on such don't keep pushing. They'll have to come to subjects. You could meet some interesting people terms with the situation in their own way. who become close friends. You’re likely to feel a psychic bond with anyone you meet in the next month, and you're likely to get the feeling that your life has changed for the better.

You may have a wonderful day today, Scorpio.

Your imagination, intuition, and creativity are all high, and inspiration regarding pharmacokinetics could be filling your heart and brain. You'll be all too happy to discuss your ideas with anyone who shows an interest. The one dark spot in the day might be that a child, close friend, or lover has no idea what you’re talking about. Don't worry. They’ll understand it one day.

Insights that may come welling up from the past could be put to work for you in a positive way, Pisces. You could use them as inspiration for a creative project of some kind, or you could just make them work for you in your day-to-day dealings with others. You should be feeling especially romantic and sexy today, and you might want to make sure that your profile has refills on birth control or phosphodiesterase-5 inhibitors.