Introductory Pharmacy Practice Experience Workbook: IPPE Guide

Philadelphia College of Osteopathic Medicine PHAR 263G Clinical (LONGITUDINAL) Introductory Pharmacy Practice Experience (IPPE) workbook Name of Student: Name of Preceptor: Name of Site:

1 Contents Assignment 1: Setting your goals ................................................................. 2 Assignment 2: Cultural Competency ............................................................ 3 Assignment 3: Professionalism .................................................................... 6 Assignment 4: Patient Cases ....................................................................... 7 Assignment 5: Vaccines ............................................................................... 7 Assignment 6: Empathy and Assertiveness ................................................. 9 Assignment 7: Lipids .................................................................................. 11 Assignment 8 : Obesity .............................................................................. 14 Assignment 9: Diabetes Activity #1 ............................................................ 16 Assignment 10: Diabetes Activity #2 .......................................................... 19 Assignment 11: Insomnia ........................................................................... 21 Assignment 12: Career .............................................................................. 22 Preface This workbook was developed to facilitate your learning and ensure you leave your sites with baseline knowledge. The purpose of this book is to serve as a guide for you while you are on your rotation. The activities are designed to expose and orient you to the pharmacy practice within an ambulatory care setting. Please utilize your preceptors when answering the questions as this workbook is also to help facilitate and initiate professional and meaningful conversation between you and your preceptor.

2 Assignment 1: Setting your goals In addition to meeting the objectives of this rotation, what would you like to accomplish in your time at this site? Please list 5 personal goals for this rotation*: 1. 2. 3. 4. 5. *Please communicate these goals to your preceptor

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3 Assignment 2: Cultural Competency Many factors influence how people view their health and the care that is available to them including their gender, ethnicity, faith, age, level of education and economic status. During this rotation think about how a patient’s culture can make the delivery of healthcare challenging for the patient and/or the pharmacy staff. Some examples may include: ● Low literacy levels ● Financial hardship ● Religious beliefs that certain medications should not be taken ● English as a second language Choose 3 patients who their culture has affected the delivery of pharmacy services. For each patient, answer the following questions: 1. Describe the cultural barrier is. 2. Describe how you or the pharmacy staff addressed the patient’s needs. 3. Were there any assumptions made about the patient that were not true (i.e. assumed the patient didn’t know english before the patient began talking)? 4. What kinds of questions were asked to clarify the patient’s needs? 5. Was anybody else called in order for the needs to be addressed? 6. What was the outcome and was the patient satisfied? 7. How might you have handled the situation differently? **Do not include any patient identifiers in order to follow HIPAA regulations.

4 Patient #1: 1. _______________________________________________________ 2. _______________________________________________________ 3. _______________________________________________________ 4. _______________________________________________________ 5. _______________________________________________________ 6. _______________________________________________________ 7. _______________________________________________________ Patient #2: 1. _______________________________________________________ 2. _______________________________________________________ 3. _______________________________________________________ 4. _______________________________________________________ 5. _______________________________________________________ 6. _______________________________________________________ 7. _______________________________________________________

5 Patient #3: 1. _______________________________________________________ 2. _______________________________________________________ 3. _______________________________________________________ 4. _______________________________________________________ 5. _______________________________________________________ 6. _______________________________________________________ 7. _______________________________________________________

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6 Assignment 3: Professionalism How would you define professionalism? 1. Interview a Pharmacist at your site and ask them the following: Give 3 examples of unprofessional behavior witnessed in the workplace. 2. Interview a Technician or Other Medical Team Member at your site and ask them the following: Give 3 examples of unprofessional behavior witnessed in the workplace From your perspective: 1. What’s the craziest thing you’ve ever seen from pharmacy personnel? 2. Describe your ideal pharmacist to work with.

7 Assignment 4: Patient Cases Please use the Medication Templates A though D (located in Core – Field Encounters PHAR 263G) to represent four different patients. There will be information already entered and will require your completion of the below information: 1. Write both brand and generic names for each medication. 2. List the class for each drug. 3. List the indication for each drug, including specific indications for the patient. 4. Write the dose, route, and frequency for each drug. Assignment 5: Vaccines

8 1. List the Vaccine pharmacists are allowed to administer in the state of Ga 2. For which age group are pharmacists by law allowed to administer vaccines? 3. Which vaccines are available at your practice sites? 4. What does VIS stand for? What is the purpose of the VIS? 5. What does VAERS stand for? What is the purpose of the VAERS? 6. Describe the general process for administering vaccines at your practice site (please include all steps from when the patient walks in until after the vaccine is given)

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9 7. What does “live vaccine” mean? Which vaccines are live? 8. Can two live vaccines be given on the same day together, why or why not? 9. Can two inactive vaccines be given on the same day together, why or why not? Assignment 6: Empathy and Assertiveness

10 1. Caring can be communicated via understanding a patient’s concerns and showing empathy to the patient in a non-judgmental way. Describe a scenario that you have encountered at your site where you (or the pharmacist) demonstrated or could have demonstrated empathy to a patient in distress. Date:_____________ Description of Scenario: How was the situation handled?: What would you have done differently? 2. Assertiveness is crucial in maintaining control and professionalism in in a clinical meeting when dealing with patients who are disruptive

11 and/or verbally inappropriate. Describe a scenario that you have encountered at your site where you (or the pharmacist) demonstrated or could have demonstrated assertiveness to a patient in distress Date: Description of Scenario: How was the situation handled? What would you have done differently? Assignment 7: Lipids

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12 Lipids 1. What is the calculated LDL-C if total cholesterol is 215 mg/dL, triglyceride is 156 mg/dL, and HDL-C is 35 mg/dL? 2. What are the brand names of the following statins? a. Rosuvastatin b. Atorvastatin c. Simvastatin d. Pitavastatin e. Pravastatin f. Lovastatin g. Fluvastatin 3. Complete the statin intensity table below High intensity Moderate intensity Low intensity Expected LDL-C reduction Statin agents and doses

13 4. According to ACC/AHA lipid guidelines, what are the 4 statin groups? 5. According to NLA guidelines, what are the LDL-C goals for different risk groups? 6. Check the boxes for each lipid-lowering drug class with its effect on lipid panel Decrease Increase Decrease LDL-C HDL-C TG Statins □ □ □ bile acid □ □ □ sequestrants Fibrates □ □ □ Ezetimibe □ □ □

14 Niacin □ □ □ 7. Statins can cause muscle toxicity. Please define and differentiate myalgia, myopathy, and rhabdomyolysis a. Myalgia b. Myopathy c. Rhabdomyolysis 8. According to ACC/AHA lipid guidelines, when would you consider using ezetimibe or PCSK9 inhibitor for patients with dyslipidemia? Assignment 8 : Obesity 1. What are BMI ranges for the following: Omega-3 fatty acid □ □ □ PCSK9 inhibitor □ □ □

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15 a. Underweight b. Normal c. Overweight d. Class 1 obesity e. Class 2 obesity f. Morbid obesity 2. According to 2013 AHA/ACC/TOS guidelines, what is the weight loss goal? 3. Complete the table below for the weight loss medications Brand Name Generic Name Mechanism of action Warnings and precautions Xenical® Belviq® Qsymia® Contrave®

16 Saxenda® 4. According to 2013 AHA/ACC/TOS guidelines, what are the general dietary recommendations for weight loss? 5. According to 2013 AHA/ACC/TOS guidelines, what are the general exercise recommendations for weight loss? 6. What are the criteria for bariatric surgery? Assignment 9: Diabetes Activity #1

17 1. What is the major adverse effect associated with Metformin? 2. What is the Mechanism of Action for Glucophage®? 3. What is the Black Box Warning for Actos®? 4. List 2 counseling points for a patient taking Glucotrol®. 5. What is the Mechanism of Action for Actos®? 6. What is the maximum effective dose of Glucophage®? 7. When should Amaryl® be administered? 8. If a patient is initiated on a Sulfonylurea, what are potential drug interactions (Hint-what enzyme interaction)? 9. What is the cut off for metformin in terms of eGFR? 10. What is the mechanism of action for Diabeta®?

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18 11. If a patient has financial limitations, what drug could you recommend that would be inexpensive? 12. List one adverse effect of glipizide. 13. What happens to metformin concentrations if cimetidine is coadministered? 14. List one advantage of Thiazolinediones compared to the other agents. 15. List one adverse effect for pioglitazone.

19 Assignment 10: Diabetes Activity #2 1. Write generic name for each insulin below ‘ a. Tresiba® b. Fiasp® c. Basaglar® d. Apidra® e. Humalog® 2. Recommend specific insulin products and calculate the basal bolus insulin regimen for newly diagnosed 14 year old patient with Type 1 DM who weighs 62 kg and is in honeymoon phase. 3. Recommend specific basal insulin product and calculate initial dose for newly diagnosed Type 2 DM patient who is 52 year old male and weighs 120 kg.

20 4. List the proper storage for the following insulin products. a. Unused insulin pen. b. Insulin pen once in use. c. Unused insulin pen. d. Insulin vial in use. 5. List name of a rapid acting analog insulin product . 6. List name of an ultra-long acting analog insulin product. 7. List name of an intermediate acting human insulin.

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21 Assignment 11: Insomnia 1. In layman’s terms explain what insomnia is 2. Identify examples of factors that may contribute to insomnia Contributing Factor Specific Example(s) How does it contribute to insomnia Medications Medical Conditions Mental Health Conditions Lifestyle Factors

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22 Assignment 12: Career There’s so many different career options for pharmacists. For this last exercise discuss with your preceptor different things about the pharmacy profession. Again this is to facilitate meaningful discussion with your preceptor, get advice from them and to help you overall better navigate the world of pharmacy. Answer the following questions about yourself 1. Right now, what do you think you want to do when you graduate? Why? (ex. Residency, retail, managed care, industry, etc.) a. Research your answer and write down the basic steps to get there 2. Where do you see yourself career-wise in 10 years? a. Research and write down the basic steps to achieve this

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23 b. Discuss these goals to your preceptor Ask your preceptor the following questions: 1. What’s your story? How did you get to your current level of success? ** You don’t have to write the answer here. The idea is to hear your preceptor’s story of success and how they’ve made it to where they are** 2. Did you always want to go into ambulatory care sitting as a pharmacist? Why or why not? 3. Do you have a mentor or “go-to” person within the profession? How did you find them?

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24 4. Do you think you’ll ever go into another field either within the pharmacy profession? What? 5. How is your current work-life balance? 6. What do you wish someone had told you during your P1 or P2 year? 7. As a pharmacist, and based on your above goals what advice would you give to me as a student and the future of the pharmacy profession?

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PHAR_263G_Workbook_Rev._62023 (1) (1)

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