The Family Practice Newsletter
March 2013
Inside this Issue

Pharmacy Curriculum
and Residencies

Diabetes Treatment in
Cancer Patients
Giant Eagle is no
longer offering FREE
diabetes meds!
Free Metformin IR
now available at
Meijer!
Pharmacy
Curriculum and
Residencies
who are expertly trained in medication
therapy. See Table 1 for a condensed
example of the curriculum at Ohio
Northern University (ONU) College of
Pharmacy, a 6 year doctor of pharmacy
(Pharm.D.) program.
Ryan Griffin, PharmD Candidate
The modules are the core part of the
pharmacy curriculum. During these
therapeutic modules, students learn
disease pathology, therapeutic options,
side effects, drug mechanisms of action,
medicinal chemistry, and clinical
application. Upon completion of all
required Pharm.D. schooling, graduates
can sit for the North American
Pharmacy Licensure Exam (NAPLEX)
and state law exam. After successfully
passing both exams, the graduate
becomes a licensed pharmacist and can
legally and independently practice
pharmacy.
Pharmacy is the health profession that
links the health sciences with the
chemical sciences and it is charged with
ensuring the safe and effective use of
medications. The scope of pharmacy
practice includes more traditional roles
such as compounding and dispensing
medications, but it also includes more
modern services related to health care,
including clinical services, reviewing
medications for safety and efficacy, and
providing drug information.
Pharmacists, therefore, are considered
the experts on drug therapy and aim to
optimize medication use and provide
patients with positive health outcomes.
Common professional activities that
pharmacists participate in include
diabetes education, medication therapy
management, drug dosing, appropriate
medication selection, drug dispensing,
smoking cessation, patient counseling,
researching drug information questions,
and point-of-care testing.
Pharmacy school prepares students to
enter the workforce as professionals
Not all newly licensed pharmacists enter
the workforce immediately. Another
career option is to participate in a
pharmacy residency.
General Pharmacy Residency
Information
 Optional bridge after becoming a
licensed pharmacist and before
entering the profession
 1-2 year postgrad training program
 Include focused mentoring from a
preceptor
Table 1 – ONU Pharmacy Curriculum
First Year
Second Year
Newsletter Contact Information:
Megan Keller, PharmD
MKELLER4@OhioHealth.com
Doctors Hospital Family Practice
2030 Stringtown Road, Suite 300
Grove City, Ohio 43123
Third Year
Fourth Year
Fifth Year
Sixth Year
1
Fall Semester
Spring Semester
Chemistry 1
Chemistry 2
Biology
Anatomy/Histology
Organic Chemistry 1
Organic Chemistry 2
Biostatistics
Applied Sciences of Pharmacy
Medical Microbiology
Physiology 1
Physiology 2
Biochemistry 1
Biochemistry 2
OTC Medications
Immunology
Biomedical Sciences Lab
Pharmaceutical Sciences Module 1
Pharmaceutical Science Module 2
Biomedical Sciences Module 2
Biomedical Sciences Module 1
Ambulatory Care Module
Cardiology Module
Pharmacy Admin. Module
Infectious Disease Module
Special Populations Module
GI / Oncology Module
Capstone
CNS Module
Advanced Practice Rotations (Rotations)
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The Family Practice Newsletter – March 2013
Post-Graduate Year 1 (PGY1)
 Pharmacists develop general
pharmacy and patient care skills in
a variety of areas
 Further enhances the skills you
learn in school/on rotations
Post-Graduate Year 2 (PGY2)
 Must complete a PGY1 first
 Pharmacists develop skills in a
focused area of pharmacy practice
o Cardiology, infectious
disease, oncology,
transplant, emergency, etc
Funding
 Residencies are a paid position with
a salary and often other benefits
o Salaries vary, the majority
are between $35,000 and
$40,000; however some
are more and others are
less
Diabetes Treatment
in Cancer Patients
Michael Spiller, PharmD Candidate
With the limited knowledge of diabetes
management in patients with cancer,
clinicians can encounter a multitude of
problems when caring for these patients.
Comparison of Medical and Pharmacy Residency
Medical Residency
Pharmacy Residency
Required
Yes
No
Length
3 or more years
1 or 2 years
Paid
Yes
Yes
Matching Process
Yes
Yes
Funding
Primarily Medicare
Hospital/college/corporation
In 2002, a study was done to look at the
prevalence of co-morbid conditions in
cancer patients. The authors included
patients with the 4 most common solid
tumors and found that an average of
14% of the patients with cancer also had
diabetes. With the rising prevalence of
diabetes, and research continually
showing links between insulin
resistance and an increased risk of
cancer, the number of patients with both
disease states may be even more
common today.
understanding of the effects the disease
states and drug-therapies have on each
other as well as how to best manage
them.
Diabetes and hyperglycemia in cancer
are associated with:
 Higher infection rates
 Shorter remission periods
 Shorter median survival times
 Higher mortality rates
The issue of controlling these combined
disease states is very complex. The
control of diabetes can affect the
cancers progression, and the cancer
chemotherapy can affect the control and
long-term complications of diabetes.
Therefore, it is important to have a basic
Chemotherapy induced problems with glucose control:
Solutions
Glucocorticoids: Routine use in treatment of many cancers (short term,
high dose)

Raises blood glucose

Effects postprandial glycemic control

Oral agents usually inadequate
Tube feeding/Total Parenteral Nutrition:

Hyperglycemia is a frequent complication
o Can lead to dehydration, DKA, and HHS1

Hypoglycemia if TPN is stopped abruptly
Dependent on type of diabetes and severity of BG increase.

Give steroids in multiple doses or IV over 24 hours

Insulin is the treatment of choice

May require 2-3x of the patient’s usual dose of basal and
prandial insulin
Nausea and Vomiting:

Common adverse effect of chemotherapy

Effect patient’s ability to eat or drink

Agents that cause >90% frequency of emesis
o Carmustine > 250 mg/m2
o Cisplatin ≥ 50 mg/m2
o Cyclophosphamide > 1,500 mg/m2
o Dacarbazine, Dactinomcin, Mechlorethamine,
Streptozocin










Monitor blood glucose every 4-6 hours
Adding 1 unit of regular insulin per 10g of carbohydrates and
titrate daily until controlled
Using a low carb formula will help with control
Titrate insulin before stopping TPN
Consider emetogenic potential of chemotherapy
Proper anti-emetic prophylaxis2
Small frequent meals
Increase frequency of BG monitoring
Consider short-acting secretagogue3 instead of sulfonylurea
(quicker peak and shorter half-life)
o Can be held if unable or unwilling to eat
Consider rapid acting insulin4 right after a meal
1
Hyperosmolar Hyperglycemic State 2If Dexamethasone is indicated, be aware of BG increase 3Nateglinide (Strarlix) and Repaglinide (Prandin)
Insulin Aspart (Novolog), Insulin Lispro (Humalog), Insulin Glulisine (Apidra)
4
2
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The Family Practice Newsletter – February 2013
Conditions commonly present in diabetics
Chemotherapy that can exacerbate conditions
Renal Complications
Cardiac Complications
Neuropathic Complications
Cisplatin
Anthracyclines
Cisplatin, Paclitaxel and Vincristine
References:
Pharmacy Curriculum and Residencies
1. American Society of Health-System Pharmacists. Education and training— positions: requirement for residency. www.ashp.org/DocLibrary/Best
Practices/EducationPositions.aspx (accessed 2013 Feb 14).
2. Ohio Northern Univerity. http://www.onu.edu/academics/the_rudolph_h_raabe_college_of_pharmacy/curriculum (accessed 2013 Feb 15)
3. American Society of Health-System Pharmacist. http://www.ashp.org/menu/Residents (accessed 2013 Feb 14)
Diabetes Treatment in Cancer Patients
1. Psarakis H. Clinical challenges in caring for patients with diabetes and cancer. Diabetes Spectrum. 2006;19:157-162.
2. Ko C, Chaudhry S: The need for a multidisciplinary approach to cancer care. J Surg Res 105:53–57, 2002
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