PAM 2017
SPECIALTY PHARMACIES
PHARMACARE
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APSA Elections Information Important information for getting through elections season.
Poster Slam 2017 The Publications Committee takes on this year’s posters!
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PAM 2017
Everyone learns something during Pharmacist Awareness Month.
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Gregory House, PharmD
A look at the famous House, MD series from a pharmacist’s perspective.
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Horoscopes!
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Contest!
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Blue and Gold
The annual event saw the first new winning class in over 4 years.
Editors’ Notes So make sure to keep up to date with all the exciting events to promote our profession and participate in the elections whether it be campaigning or voting! :) - Jasmine Han
Happy Pharmacy Awareness Month (PAM), everybody! This month is a busy month for everyone with PAM events and APSA elections coming up.
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First, let me congratulate the Class of 2017 for their win at Blue and Gold. In related news, March is a tough period. It’s a month of midterms and finals and a month where Reading Week is just a faint memory. And there is no respite - St. Patrick’s Day is in fact only an official holiday in Newfoundland and Labrador. G’wan, will ya!? And with these conditions coming up, it will come as no surprise that some of us will feel as if we’ve spread ourselves too
thin. Regardless, keep your eye on the prize and go easy on yourself. And keep reading PQ! - Yusuf Nasihi
Disclaimer: Any opinions or viewpoints published are directly from the contributing authors and do not represent the philosophy or viewpoints of the Faculty of Pharmacy or the University of Alberta.
X . . . APSA Elections 2017
Election
From my first year of pharmacy to now, I can truly say that I’ve experienced all sides of the APSA Elections. I’ve been the nervous candidate standing in front of a class pouring my heart out, hoping I don’t choke. I’ve been the annoyed student bombarded overnight with hundreds of invites to candidates’ Facebook pages. And this year, as APSA’s Chief Returning Officer (fancy title for elections dictator), my duty is to enforce the rules for a fair and fun election!
could spend a few minutes reading candidates’ platforms in between Facebook stalking and laughing out loud at memes. Candidate Forums: Wednesday, March 15 (1212:50 pm, MS628) Monday, March 20 (12-12:50 pm, MS227)
- Mehnaz Anwar, APSA CRO Campaign Period: March 14th – March 21st CRO: Morning of March 14…73 notifications on Facebook. WTF? Oh ya, I mandated that candidates add me as an admin to their Campaign Facebook page. Candidate: I’ve never ran for anything…what if I have to run against someone?...What if the other candidate is taller, smarter, more popular? I hope these elections are like Survivor, I’ve watched all 33 seasons of the show…I can outwit, outplay, and outlast! Man, I’m so cool. I’m in Med Sci at 7:00 AM on March 14 to find the best spot for my posters. I hope this tape sticks and my posters don’t fall. I have classes to attend, exams to write, assignments to complete….why did I run for a position? This is nothing like the show Survivor… Pharmacy Student: Morning of March 14….26 notifications on Facebook. WTF? Oh ya, the campaign period has started and all the candidates invited me to check out their platforms. I really should make an informed vote…I
CRO: I hope students are interested in the election and show up to the forums to learn more about their candidates. I’d hate for none of the above to win. Candidate: Wow, only 60 seconds for my speech, it takes me longer than that to count 50 Tylenol #3s. After I finish my speech, I should ask “what questions do you have for me”. If the other candidate asks a hard question and I don’t know what to say…I’ll just say cash me outside howbow dah
Voting Days (Online): Wednesday, March 22 & Thursday, March 23 Annual General Meeting (election results announced): Monday, March 27, 5:00 PM
Pharmacy Student: Nice, I got a 60 second summary of each candidate’s platform.
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×APSA×POSITIONS× By Winnie Lo You’ve seen the posters, read the biographies, and heard a dozen speeches by now, but you’re still not really sure what each candidate will be doing for you next year. Well here’s a breakdown of what each position is supposed to be doing – and what they really do behind the scenes. APSA President Candidates: Sean Hanson Organize and assist APSA council, sit on multiple meetings to advocate for pharmacy students, work with professional pharmacy associations What they actually do: take great pleasure in smashing the gavel with call to order and adjournment and then introduce yourself as THE APSA President
VP Student Services Candidates: Cassandra Cooper, Jes Buhler, Jonathon Thomson Coordinate textbook/locker sales, maintain PBLs and APSA lounge, promote stress relief and work with the SPACE committee What they actually do: decide what your craving of the month will be and then invest APSA funding into making your dreams come true.
VP Administration Candidates: Alisha Shivji Take meeting minutes at council meetings, organize council communications, organize office hours and electronic sign up forms What they actually do: learn to type as if you hand demonic powers in your fingertips and juggle the schedule for the entirety of APSA council. Good luck
VP Academic Candidates: Frank Huang, Abanoub Graiss Create association policy on academic issues, address students’ academic concerns, act as pharmacy liaison on several committees What they actually do: have everyone submit long applications for awards and then pick the winner with a dart (alternatively, be bribed by adequate amounts of Tim Hortons during RUTR).
VP Social Candidates: Megan Elliot, Alec Huard Organize Welcome Reception, Blue and Gold, and other pharmacy social events What they actually do: decide how much alcohol and pizza is necessary for the next event and carefully ration a quarter of it for themselves. VP Finance Candidates: Jerry Zhang Compile finance reports, manage cash flow, manage APSA’s financial commitments What they actually do: sign off cheques for other people while bemoaning the fact that it’s probably enough money to pay off half their student loan.
VP External Candidates: Preston Eshanko Work with external bodies and organizations, chair the Mr. Pharmacy committee, co-chair PAM What they actually do: dream up ways to embarrass Mr. Pharmacy candidates while they are onstage in the name of fundraising for mustache-appreciation month. CAPSI Sr Candidates: Hannah Kaliel Act as a liaison between APSA and CAPSI, promote CAPSI to pharmacy students, organize educational seminars, organize CAPSI competitions
What they actually do: attend cool conferences and travel around Canada while casually ordering your underli– ahem, CAPSI Jr to assist you in life. CAPSI Jr Candidates: Mark Contreras Act as a liaison between APSA and CAPSI, promote CAPSI to pharmacy students, organize educational seminars, organize CAPSI competitions What they actually do: attend cool conferences and travel around Canada while casually avoiding things you were supposed to do as per above.
What they actually do: promote the world the UofA Pharmacy and promote UofA pharmacy to the world. IT Director Candidates: Uncontested Maintain the APSA website, assist in coordinating email list server and locker rentals, coordinate Paypal service What they actually do: spend copious amounts of time updating the website by ensuring that photos are correctly aligned down to the millimetre – don’t worry, this only takes a few hours.
Publications Director Candidates: Uncontested Work with the publications committee on the PQ, coordinate yearbook fundraising, and oversee APSA photographers and grad photos What they actually do: laze around on social media in the name of “APSA work” and follow it up by pretending they know how to use a camera at official APSA events.
Community Education Director Candidates: Lynnea Schultz, Kevin Huang Recruit student volunteers to give pharmacy-related presentations, work with WISEST to organize pharmacy labs, and oversee inter-professional activities What they actually do: mingle with cute kids in school (and encourage your fellow pharmacy students to do so) and then try your best to convince them that “not all your bugs need drugs!”
Fundraising Director Candidates: Michael Tiet, Jyoti Palak Coordinate the associations’ funding with outside sources, support the grad committee, assist with event silent auction preparation What they actually do: Schmooze with potential sponsors in order to secure funding for more food at the next APSA event
Recruitment Director Candidates: Miray Aizouki Collaborate with CAPS to run the Pharmacy Career Fair, accept and process job postings, organize annual Career Night What they actually do: first pick of jobs and the important duty of deciding on how much pizza is necessary for lunch and learns.
Interprofessional Director Candidates: Emma Bedard Promote and create interprofessional opportunities, work with the SHINE rep, promote pharmacy awareness to other faculties What they actually do: do their best to make all of the healthcare professionals one big, cuddly family while inwardly rejoicing over each pharmacy ‘victory’.
SAF-Pharm Director Candidates: Uncontested Organize speakers and workshops, chair SAF-Pharm meetings What they actually do: top secret undercover work that is kept very hush-hush; the lives of SAF-Pharm directors are one of the greatest secrets at APSA…
IPSF Rep Candidates: Darryl Mah Act as UofA IPSF liaision, search for SEP host sites, promote exchange opportunities and World Congress
CSHP Rep Candidates: Peter Van Herk, Shaja Chaudhry Coordinate CSHP memberships, mentorship program, assist in promotion of Banff Seminar and CSHP awards What they actually do: can’t wait to get into hospital? Well first, you must promote how amazing it is to other people and then curse the competition for AHS applications…
Disclaimer: the tasks that each APSA council member accomplishes are by no means the entire portfolio of the position. Also, APSA council is really, publications. Please remember to vote – you can find more information really, great and we love them lots, even when we make fun of them in our on these positions at: www.myapsa.ca under the constitution.
POSTER SLAM 2017 Let’s face it - there must be a poster that has earned your disdain among the endless wallpaper currently decorating our hallway. Or maybe the poster blocks your nice view of all the grad portraits from the PBL room and you feel like you’re trapped in the study room. Or maybe you’re just a grumpy person and the posters are a good a target as any to spread your negativity. Well those of us in the Publications Committee have stepped out of our PBLs hiding holes to air all of our opinions on said posters. And we have A LOT of those. J: That gaze. I think he was going for the looks ‘cause all his platforms blend in with the poster. I can’t read any of them. What a whole new level of transparency. A: It’s like he’s staring right into my soul. N: He can see what we want, what our heart desires…. W: Why bother when you’re the only one running? To spread your good looks to the faculty? Except… you’ve already been half naked on stage. N: This is literally the second time a Mr. Pharmacy candidate has become president #thatshowtheydoit #buyingvotesbytakingoffclothes #stillnotoverlosing I: Trying to compensate for that Mr. Pharmacy loss by winning this? Well, it worked for Aliaks. DK: The “I’m the only one running but pls don’t vote none of the above” poster. YN: Sleeves are folded up and above the elbows: this man is ready to get to work. A president in 2017 should have a much longer tie, though. (See below).
06 PHARMACY QUARTERLY Left: AP/Evan Vucci. Right: Twitter/@ColbertAtHome
W: Wow this is such a cold, cold joke… J: OMG. My OCD is kicking in. Why… Fix that D please A: FIX. THE. D. N: Smile: Ace! Font: Dece. Photo quality: Questionable. I: This low-key feels like a family planning poster. A: I get the “trust me, I can provide you with adequate contraception so you don’t have to keep your legs together” vibe. And I like it. N: Because why would you wanna keep your legs together. YN: I’ve always thought that this Katz atrium is beautiful although it always has terrible lighting. You managed to take a great picture there so I commend you for that. But the blur of the background makes me think you needed a special lens or something,. You know like how you might need a special lense for close-up photography of plants and insects like those BBC documentaries. (Yes that is a short joke but the position is CAPSI Junior so it’s in good taste.)
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A: Love that professional look. It screams “I can be trusted with a spreadsheet” J: “Low commitment volunteer opportunities”. We promote mediocracy here. I: Volunteer hours/credit for minimal effort? I’m sold!!! #whyworkwhenyoudonthaveto N: Ahh, my eyes. My eyes hurt. Am I hungover or is the background just too… white & bright? W: Well at least she’s making good use of photoshop “crop background” functions A: You could be having a seizure. N: Or have I just died from the PEBC studying. A: You could never tell… #notsureifposterforvpadmin #orjustdeadfromstudying #pharmlife YN: Alisha, you were like a VP Admin for our integrated case group! So I know you will do well. As for the poster, there is so much blank space that if I was not paying attention I might think it was actually a poster for None of the Above.
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W: So the question of the day - how does one play basketball in heels? N: Good question. I thought sports reps knew how to dress appropriately for these things #jeez J: Do you model balls or play with balls? A: You can do many things with balls, J. It’s a matter of how you play. *crickets chirping* I: Plus points for the outfit choice though #stylin #slay N: Not really feelin’ that bright blue font though. It clashes with … well pretty much everything. I: It doesn’t even match the APSA blue. W: That’s the REAL tragedy here. YN: Yeah that APSA logo gives me night market vibes - like I’m browsing through fake designer clothing. DK: Photo says professional, font says third grade science project.
Is this what you had in mind for “providing incentive”, Katina?
PHARMACY QUARTERLY 09 Left: iStockphoto_retrorocket Right: YouTube user YouGoPro.
SAMPLE
YN: Oh, Winnie, don’t forget that I am the only one who can make mugshot election posters. It’s basically in the APSA Constitution at this point. #ThrowbackTo2016
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W: OMG I can’t decide if this looks like a student ID photo or a mugshot for a serial killer. A: Or a wannabe crime boss. N: It contrasts with the softer font and color at the bottom of the poster. I: Sign that he’s a killer mobster. But with a heart. S: It could also pass for a hair product commercial. I mean, look at that face structure. J: Sorry Darryl, but that shirt actually makes you look like some Chinese Triad member… I don’t know who helped you take this picture but they definitely did not make things any better. Look at that shade on your face. YN: The off-white colour of the lower half of the poster is aesthetically pleasing; good choice. But why the hot air balloons? Do you really think we can make it overseas in anything but a plane??
W: I didn’t realize we were advertising for the new Netflix hit “The Secret Alcoholic Lives of Pharmacy Students”. N: Not sure if poster for VP social… or just a PSA for the dangers/pleasures of counselling while intoxicated #liverenzymeselevated #thatGGTisskyhigh I: But that’s red wine, lots of resveratrol for cancer prevention. A+++ W: Also, why are we voting to read the CPS at our next social event? A: No. No. NO. NOT THE CPS. STOP HAUNTING MEEEEEEEE. I: This is doing nothing for the 4th year’s PEBC nerves. Let’s outtie. VP Social is supposed to relax us. Jeez. J: The only thing I like about this poster is that cat. DK: Purfect photo setting: the dungeon wine cellar where you keep your cat hostage. YN: The wine is surely just a prop. #MakePharmacyLitAgain By the way, if you look closely at these two posters don’t actually use the same photo. Amazing.
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Pharmacist Awareness Month 2017
What is PAM? Pharmacist Awareness Month (PAM) is an annual month of events that takes place across Canada. During PAM, pharmacists and pharmacy students take the opportunity to advocate for our profession to the public and to other health care professions. We raise awareness about the increasing role that pharmacists play in health case, beyond dispensing. It is also a time when students can learn more about the diversity that pharmacy has to offer. We invite you to join us throughout the month at a variety of events to learn about, and to support our profession! This year at the U of A, each week during PAM will have a theme: • March 1-3: Antibiotics Awareness Week • March 6-10: Heart Health Week • March 13-17: Mental Wellness Week • March 20-24: Health and Nutrition Week • March 27-31: Lung Health Week
Don’t forget to grab you PAM pin and advocate for pharmacy! Take pictures with your pin and use the hash tag #UAlbertaPAM2017 to be entered to win prizes! This year as a part of PAM, we will be inviting students from the faculties of pharmacy, medicine, and nursing to gain insight into the workings of an interdisciplinary health care team. A healthcare team specializing in psychiatry from Grey Nuns hospital will explain their unique approach to solving a schizophrenia case, as well as their views on how interdisciplinary care functions in real world practice. We encourage students from all health care faculties to attend and learn about how they can incorporate team-based health care into their future practices. Each year PAM gives students the opportunity to get involved in educating Canadians about the incredible contributions that pharmacists make to our health care system. This year, we will be hosting several public health clinics, including those focusing on
blood pressure, osteoporosis and smoking cessation. We will also be hosting lunch & learns, with topics such as antimicrobial stewardship and travel medicine. We will be celebrating the end of PAM with a speedmentorship social mixer at Devaney’s on Saturday, April 1 at 7pm. The mixer will be a great night of networking and socializing where you will have an opportunity to learn more about our profession from practicing pharmacists working in a variety of fields. We will be celebrating the great strides that our profession has made, and looking towards our future. We look forward to seeing you there! If you have any questions, suggestions or want to volunteer, please email us at marlin@ualberta. ca or smhanson@ualberta.ca! - Marline Aizouki VP CAPSI Sr., Sean Hanson VP-External (Chairs of the PAM Committee)
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SKIING
Pharmacy’s Media Problem By Danial Khan
Pharmacists have been huddled into a subsection of professions that no one in popular media particularly cares about. This poses a problem as our profession adopts a bigger role in health care and as we try to educate the public on our widened scope of practice. Doctors are professionals that benefit from constant exposure. That is not to say that television shows like House MD are excellent representations of the medical practice, but they deserve some credit. Gregory House, the titular character played by accomplished actor Hugh Laurie, is a brilliant doctor, but he is selfish, rude and suffers from a self-destructive opioid addiction. However, that is not the point. Media in this case is important because it provides a window for a basic level of exposure. Let’s take House MD, and strip the show down to its bare
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representation of the medical practice (essentially the show minus all the story nonsense). Actually, let’s do a little experiment. Put down this magazine, log onto Netflix and watch the subpar House MD episode “Occam’s Razor” (season 1, episode 3). Pffft, it’s not like you were studying anyways. You back yet? In this episode, the doctors, led by House, are dashing and quick. They are highly intelligent, skilled and fiercely caring. People who make mistakes, incorporate teamwork in their practice and make tough decisions. Although there is a healthy dose of drama, this representation of doctors is consistent throughout the episodes of the show I have seen. Even good-old grumpy Dr. House will fight tooth or nail for what he believes is right for his patient. That is good.
The problem is that an uninvolved and disengaged representation of pharmacists is also consistent. Throughout the show, pharmacists take a backseat in patient treatment. House leads a multidisciplinary team with several specialists but no pharmacist. In that very episode, when a conversation between one of House’s colleagues and a pharmacist takes place over a drug error, our make-belief colleague responds with the old “I’m just a pharmacist but…” Ugh. Gag me with a USPgrade measuring device. Why is this relevant? Well, the media we consume has an effect on us. It influences our ideas and, if the media is profound enough, dictates our interests. It shapes our perceptions on things. Per most conservative estimates, 5.3 million Canadians pay for a Netflix
In the Media subscription. That is a lot of people watching a lot of shows with a lot of ideas. I challenge you to list other medical dramas featuring pharmacists in a prominent role. How we are viewed in the media plays a big role in how successful we are in outreach. We are currently winding down our highly successful Pharmacist Awareness Month, which I would argue is wrongly named. People are aware of what a pharmacist does, they just don’t see the full picture of our practice. However, “Recognizing the Full Scope and Dispelling Myths about Pharmacy Practice” Month doesn’t have a great ring to it, so I digress. I don’t propose we hold showrunners accountable for not representing our profession well, but to anyone committed to pharmacy, this is a little frustrating. If anything, this can serve as a rallying cry for pharmacists to become the professionals some aspire to write about. The ones who are on the front lines of patient care. Because right now, we are to doctors what chartered accountants are to stock brokers in the business world.
House, MD is the property of NBCUniversal Television Distribution.
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Editor’s Response
Editor’s Response Danial brought up a great point: don’t believe everything you see on TV! You may find it surprising that I have actually never watched House before. Of course, I did get to watch the episode you mentioned. Just to give you some of my first impressions of the show, I can tell you that I am extremely surprised to see such a nihilistic protagonist on such a popular program. Hugh Laurie, the actor who plays Dr House is an Englishman, so he’s doing a great general American accent. Besides the star of the show, the other physicians have great banter among themselves and with House. The whole medical approach of the story is quite in-depth. Some of the medical explanations are similar to what I might expect from reading a brief pharmacology description on RxTx or Lexicomp. In fact, it’s a surprise to me that they thought this level of explanation was appropriate for the target audience of the show, the general public. Maybe pharmacists sell themselves short when they feel the need to come up with analogies for counselling! It is for these reasons that I was simply stunned to see how little detail the writers put into the pharmacy aspect of this episode. As shown on the previous page, the pharmacist says “I’m just the pharmacist but I think I
know what cough medicine looks like.” This is indeed an unrealistic statement from a lay pharmacy assistant, let alone a pharmacist of any era. The show conveniently avoids referring to that cough medicine by name, which is probably deliberate. It is highly unlikely that the young patient in the show presented as he did with cough and was given an Rx for a prescription antitussive. The writers suspend logic in order to bring this cough medicine into play, even while going to a lot of detail on diagnostic details that occupied much of the first half of the show. Spoiler alert: the episode “Occam’s Razor” hinges on a community pharmacist mixing up a “cough medication” with a colchicine tablet that looks very similar. This gout treatment suppresses neutrophil activity so the poor guy ends up suppressing his immune system as he uses what he thinks is a cough medication. The premise relies on lack of understanding by both the pharmacist and physicians on how you can differentiate between tablets using a tool. Even in 2004, when this show was released, such a tool must have been around. Even if we consider, perhaps, that neither the pharmacy nor House’s clinic was completely up-to-date, the resources to figure out this issue are surely just a phone call away.
House is even scurrying through the hospital pharmacy looking for some medication that looks similar to the one the patient was taking. He is digging through bottles and bottles of medication while the hospital dispensary pharmacist stands there. Surely this HCP is of some use to you, Dr. House! If the community pharmacist was unable to help you identify the tablet, another pharmacist might still be able to! Overall, I agree with Danial’s assessment of this episode. The pharmacist is portrayed falsely and this made the profession look bad. There is no doubt that the influence of a show like House, and the fact that this was one of its earliest episodes, makes this portrayal especially worrying. Pharmacists already have to worry about how so many other things may affect the image of the profession. A certain percentage of patients can be expected to just get fed up with some aspect of the healthcare system at some point. But when it comes to pharmacy, the apparent profit motive of the private pharmaceutical industry and even community pharmacy makes this sentiment especially distressing. If not for our own sakes, we must correct these perceptions where we see them for the benefit of the public at-large. - Yusuf Nasihi, Co-editor
Blue and Gold Another edition of Blue and Gold took place on March 4th at Northlands Expo Centre. Thanks to Kasia Babyn, her social committee, and everyone else who were involved in bringing Blue and Gold to reality, I think I can confidently say that it was a great night for everyone. I would like to congratulate everyone who received an award this year, and I would also like to encourage everyone to apply for various awards available through APSA next year. The performances presented this year were amazing throughout all years. Between the tough competition, the winner of this year was the Class of 2017! Congratulations on making a winning strike before graduating! I hope you rock n’ roll going forward as well. Jasmine Han
2017
2018 2018
2019
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2020
PHARMACY HOROSCOPES Like fortune cookies but without the cultural appropriation. BY Danial Khan LIBRA (sept 23 - oct 22) It’s Pharmacists’ Awareness Month! Be sure to participate in all the fun activities to promote our profession!
SCORPIO (OCT 23 - NOV 21)
Aries (Mar 20 - Apr 19)
Congrats to all the participants of Blue and Gold 2017, especially the Class of 2017 for winning it all! Not bad after getting cut out of the PharmD thing, eh?
Taurus (Apr 20 - May 20)
Baby, are you a schedule 2 drug? Because I should definitely consult a professional before I get involved with you.
There are two ways of spreading light: to be the candle or the mirror that reflects it – Edith Wharton
Sagittarius (Nov 22 - Dec 21)
Gemini (May 21 - Jun 20)
You have a brain in your head. You have feet on your shoes. You can steer yourself any direction you choose – Dr. Seuss
Capricorn (Dec 22 - Jan 19) In Europe, you can buy these tiny, spreadable Nutella packs. They are so convenient. They don’t sell them in North America for some reason.
Aquarius (Jan 20 - Feb 18)
April showers may bring May flowers, but what brings April showers? March procrastination! So hit them books!
Cancer (Jun 21 - Jul 22) Go to bed with dreams. Wake up with plans. #MondayMotivation
Leo (Jul 23 - Aug 22)
What ever happened to Jackie Chan? Like, he was in that new “Karate Kid” movie with Will Smith’s kid and then he disappeared? If you know, feel free to email me at dkhan@ ualberta.ca
Exam season is coming and it won’t be easy; however, don’t forget that diamonds are made under pressure!
Pisces (Feb 19 - Mar 19)
Virgo (Aug 23 - Sep 22)
That APSA card in your pocket is beautiful on both sides! Check the back for awesome deals to take advantage of!
I got up, went to Rite Aid, Hoping that the pharmacy department had the right aid – Kendrick Lamar (don’t we all Kendrick?)
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PQ PAM CONTEST Now that we’re midway into PAM season, we’re sure that you’ve attended all the lunch and learns, attended a health promotion clinic, and also told all your friends and family about our extended scope of practice… right? Here’s your chance to prove it to us! Submit a photo of yourself and/or your friends promoting our profession of pharmacy to the PQ Facebook group by Friday, March 31st @ 11:59 PM and we will randomly select a winner!
Did you really enjoy last month’s unscramble? Here’s another one just for fun (answers are upside down below).
TRILMSEVOIA EPALBZAEROR TRXMECZOLAIOO Mometasone Losartan Cotrimoxazole
EAMSEMTOON
RSLTOAAN
Rabeprazole Oseltamivir From top to bottom: