Pharmacology Mastered!!

NICU baby

     On March 27, my world was blessed with the arrival of my son, Matthew Caswell Herrera. He was born at 0909 weighing 6 lbs and 9 oz. That weekend gave me some more unorthodox clinical experience. The induction process gave me experience with misoprostol and pitocin, as well as bupivicaine and fentanyl (in the epidural). In order to get my mind off the discomforts of labor, I made a checklist of the drugs that we had studied in the program that I have had "clinical experience" with this year. The list consisted of the above mentioned medications as well as all the medications used during my adventure with appendicitis in September, such as pipercillin/tazobactam, morphine, and scopolamine and pylocarpine used in my anesthesia process. 

home and healthy

     After completing the NBME in March, the only courses left were the electives and my volunteer work. My favorite elective was probably the course on cardiobiology. The topics that the course covered ranged from atherosclerosis, to arrhythmias, to effects of diabetes on cardiovascular health, to congenital heart defects. The two topics that I chose to present were concerning the effects of dantrolene on ventricular arrhythmias and the effects of N-acetylcysteine on congenital heart defects in offspring of diabetic mothers. It was particularly gratifying to see the potential new uses of drugs that we had already studied for other purposes. 

contemplating the effects of
N-acerylcysteine on congenital heart defects

     Having completed the masters program, I am now going to move to Hawaii to be with my husband, who is stationed there serving with the Army. Once there, I will be able to consider the career options that are now available to me with the knowledge that I have acquired from this program. Whether I chose pharmacy school or medical school or some other path entirely, I know that I will be well-prepared after having studied pharmacology here at Tulane. Overall, I am truly thrilled to get to continue on my medical and professional journey with my new family. It was a particularly unique blessing to get to go through the entire masters program with my son always cheering me on and studying with me. 

(total community service hours: 36) 

Marching on through March

     This month was guilded by the completion of the NBME! We have completed both Principles in Pharmacology and Medical Pharmacology and the remainder of the term is focused only on electives. With this post, I thought it profitable to give my advice for studying for this exam. 
     There are about a million and a half resources out there designed to help you do your best on the NBME. I think the hardest part of the test was not the test itself or even studying for it, but rather filtering through the plethora of resources and choosing from them which to study. Depending on your goals, I think choosing about four study supplements is wise. Any more than that and you are merely going to suffer from diminishing returns (or what in economics, they call the marginal cost). Any fewer and you may risk not studying enough. 

Sample Practice question

Sample Practice Question Explanations

     The two most helpful tools I used were PharmWiki and Practice Exams. The practice exams were particularly challenging, in that they frequently forced me to put a few concepts together. They were also extremely helpful, because they explained why the right answer was correct and why each of the other options was wrong, as well as summing up a key learning objective from the question. These were extremely challenging and I found that after mastering these questions, the NBME questions were much easier. PharmWiki also had very helpful quizzes that I used. I found that with these, however, the goal was more to solidify my foundation rather than apply it to particularly "tricky" situations. This being said, I felt that the PharmWiki quizzes did an excellent job of solidifying crucial concepts in order for me to apply them competently on more complicated questions. 
     I also used First Aid and DeJa Review as resources. First Aid was a very dry, but helpful resource. It had very effective mnemonics and useful summary tables that highlighted the most important side effects, mechanisms of action, and indications for drugs. DeJa Review is a book of questions. Basically, it is a series of flashcards in book format. There are questions on the left side of the page with the answers on the right side of the page. So you go through the questions quizzing yourself to see if you can get the question right. This was definitely helpful for solidifying fundamental concepts much more than for application of knowledge. But, without the foundation of knowledge you cannot apply the knowledge! Here I must take a pause and thank my dear mother, to whom I sent the DeJa Review book and requested that she call me and ask me the questions so that I could answer them. Her patience and dedication to helping me were undoubtedly instrumental in helping me prepare for the NBME. (More than once did she arouse me from peaceful, though lazy napping slumber in order to ask me questions!) Using these four, I found that it was easy to see high yield concepts, because they were emphasized by each learning resource. There were some concepts presented in one source that was not brought up in another, but there were many things that were emphasized in all four resources and this helped me see that "This is important!!!" 
     Other than that, I am now preparing for the final leg of my journey in pharmacology as well as the birth of my favorite study buddy! My son will be here this weekend and that shall be extremely exciting. However, I will miss him kicking during a test trying to remind me of the right answer. ;) 

Mardi Gras and More ...

Adventuring in New Orleans     

     In the span of only 6 weeks or so, I have had 5 exams and 2 presentations. Needless to say, this semester has started out very top-heavy. Additionally, we now have the stress of the NBME shelf exam looming. I have begun my studying for it by reorganizing my notes and going online to find helpful mnemonics and tutorials to assist my retention. I have been impressed with how well the information is returning from the storage in the far depths of my memory. The PharmWiki quizzes are also extremely helpful in my studying. I am very grateful to my classmates who have shared helpful tips like FirstAid for the Shelf, and others resources like unto it. At this moment, we only have 2 more exams remaining before the shelf exam. Afterwards, we will have completed both the Medical Pharmacology and Principles of Pharmacology classes and have only electives remaining ....and having my baby somewhere in there. 

Beignets and Hot Chocolate at Cafe du Monde

    

Last week, we had our Mardi Gras and "Spring Break." The brief respite from academic endeavors was certainly welcome. I only vicariously took part in the wild Mardi Gras festivities. After the break, I got to hear the many adventures of my classmates and their hedonistic galavanting during Mardi Gras. Only after Mardi Gras did I feel it was safe for me to go out and experience more of New Orleans. One of my friends came to visit me and we did a "Scavenger Hunt" tour (by Crazy Dash) in the French Quarter and we both got to experience our first beignets! And we had them at Cafe du Monde, no less! (Yes, I have been in New Orleans for over six months, yes this was the first time I had beignets.) We enjoyed sightseeing at the Moon Walk and treated ourselves to an epicurean delight going on a cruise up the Mississippi on the Steamboat Natchez. I was very impressed that it is a genuine steamboat, just like one that Mark Twain would have ridden! The only other steamboat in America is in Louisville, Kentucky. To end the break, my sister came and joined us for my Baby Shower, which was a marvelous way to reenergize before resuming my studies once again. 

     Adventures in Research

     My volunteering work has been going very well. I go work for the Anesthesiology Research Department in data collection every Tuesday morning from 0900 - 1200. The tedium is rather insipid, but I am able to learn a great deal. As I collect the patient data, I am also able to see what procedures were performed, and that is definitely my favorite part. I never have a clue what any of the procedures are, but that is why there is the great world wide web! When I do not know what a procedure is, I google it to find out what it is. (Most of this is from Wikipedia or WebMD) 
Possibly the most dramatic procedure that I saw was one to correct Pectus Excavatum or Sunken Chest Syndrome. This can be corrected by a variety of techniques. The Racitch Technique is an invasive open chest surgery where the Doctor can fully see the chest and remove the excess cartilage from the sternum, then a metal bar is placed to support the sternum and hold it in place for healing. The Nuss Procedure is less invasive, but equally dramatic. Two incisions are made on either side of the chest and then a curved metal rod is passed through from one side to the other in a concave position and then it is flipped to the convex position. This process pushes the sternum out and corrects the deformity. And what is even more amazing is that this is a procedure done in pediatrics, usually from around 6-10 years of age! Wikipedia also mentions a few other means to correct pectus excavatum, including the Robicsek technique and the magnetic mini-mover technique.

(Volunteer hrs- 21 hrs)

Beginning the Adventures of the Final Semester!

     Having fully recovered from the stresses of exams from this past semester with a well-deserved trip to paradise, where my husband is stationed (must be nice having been "ordered" to go to Hawaii), I am now motivated to resume my studies. The semester has begun with a rather heavy schedule which is responsible for keeping me in the warmth of the south, while my Army Unit is suffering a winter storm in the North East for war exercise training...I am sure I will make it up somehow.
     We have begun our block on reproductive and endocrine pharmacology, which is full of interesting and controversial drugs. The Cell Control class is very similar to the Molecular and Cellular Pharmacology class in its rigorous and in-depth research focus, but I enjoy that because the intensity and stress forces me to learn more than I ever imagined.
     

Research-
What I thought I would do

     Last semester I completed online training classes for the Anesthesiology Volunteer Research Program and so I get to begin the new year with a new adventure! ...in the dreary tedious reality that is data collection. My first assignment is to collect information for a clinical study that aims to ascertain whether preoperative protocols affect the efficiency of elective surgery. Basically, the study wants to show that with proper screening done BEFORE the day of surgery, last minute cancellations can be eliminated or at lea

Research-
What I actually do

st minimized and this will result in more appointments on time and the ability to treat more patients. Though this may seem intuitive, scientific data is required to show this in order to make a significant impact in the health care field. This is yet another experience I have had that truly illustrates the vast expanse of medicine and what it entails. Although it is certainly not my area of interest, medical management is extremely important and relevant to providing optimal health care. It is rather counter productive to have doctors with expertise who cannot see patients because scheduling and mismanagement interfere. Better management leads to more efficient care and better care, because more patients can be given the care they need.

(volunteer hrs- 12 hrs)