That doesn’t mean that I didn’t think the law exam was hard. I walked out of there feeling like I could have failed. The kicker is that NABP curves the exam so much that there is no excuse for failing it (unless of course you can’t speak english, but then maybe an english speaking career isn’t right for you…) . This is straight from the NABP:

The minimum acceptable passing score on the MPJE scale is 75. The passing score reported is NOT a percentage value. The score is calculated by first determining the candidate’s ability level on the MPJE and then comparing the candidate’s ability level to the predetermined minimum acceptable ability level established for the MPJE.

What this really means is that no one really knows what it means. What exactly is the “predetermined minimum acceptable ability level”? All I can tell you is that this magic level must be insanely low.

Let me explain. I would like to say that I took studying for New York State pharmacy law very seriously. In fact, I spent several days in a library studying. I could tell you exactly how long every type of record needs to be kept, what forms to use for which DEA function, prescribing privileges for optometrists, narcotic safe construction requirements, and a host of other law minutiae.

But whoever wrote the MPJE for New York didn’t seem to care about all that stuff. Instead I was asked to apply the law to weird situations that would likely never occur in real life. How weird? Here’s a fictional example:

Mrs. Jones’ seeing eye dog becomes rabid and runs into the pharmacy ripping open bottles and spewing saliva everywhere. To whom should you report this incident?

1. Local law enforcement
2. FDA
3. PETA
4. Board of Pharmacy
5. Your Mother-in-Law

I’m sure you get the idea. I was well prepared, but of all the questions I received, maybe on only 5% of them was I sure of the answer. How can someone only feel like they got 5% of the questions correct and walk out of the examination with an 87?  Maybe this means that the NABP has very low minimum standards for pharmacists, and after being in the profession for several years let me tell you: that doesn’t surprise me. I know many excellent pharmacists and I would say 99% of my colleagues are very competent at their jobs. But I have seen the bottom of the barrel and the pharmacists down there are so bad that I always had to wonder how they passed their board exams. Now I know how they did it.

I was going to write another post about the NAPLEX exam, but I think my feelings are so similar that I’ll just ditto it here. The one major difference with the NAPLEX is that while there were many tough clinical questions and patient profiles to wade through, as long as you can do basic pharmacy math (think algebra and no pharmacokinetics) you will pass.

Related posts:

1. NYS Pharmacy Wet Lab Part 1
2. NYS Pharmacy Wet Lab Part 2

Currently, as part of the last five weeks of my pharmacy education, I am spending some time at a dialysis center. Patients get brought in on three 4hr shifts during the day and are subsequently hooked up to friendly looking robot called the BBRAUN 566. While they sit there being amused by their personal TV and headphones, this machine sucks all the blood out of their body (not all at once of course) and removes waste and water before putting it all back in.

Isn’t it amazing that it takes a robot 5 feet tall and 3 feet wide to do the job of a kidney about the size of an adult fist? And not only that, but it’s not nearly as good at filtering waste as our actual kidneys. (Just as an aside, no one would argue that it took a very skilled designer to make the BBRAUN 566, but yet some claim that our kidney’s just happened by chance? Dum de dum dum…)

I spoke with one lady being dialyzed who told me how she ended up with in renal failure and received a kidney transplant in 1982. Since then she had lived a perfectly normal life with her new kidney until 1993 when she rejected the organ. She had such regret in her voice when she lamented the fact that she had not taken better care of herself after the surgery.

Another man was only 46 years old who had chronic high blood pressure that damaged his kidney’s so badly he ended up on dialysis three times a week. Were you thinking of not taking your blood pressure medicine this month? Pharmacists don’t recommend low blood pressure goals for our bottom line. High blood pressure is the second leading cause of renal failure behind diabetes.

I am only in my second week of the dialysis experience and I hope to add some more stories in a couple weeks.

No related posts.

The exam was scheduled for 8:00am and I arrived promptly at 6:50am just to make sure I would be there on time. I had heard from other students and from one of the proctors that if you wanted to be in the nicer of the two available labs you had to be there early so I made sure to be the first one there. Right before they let us in I felt like I could have thrown up I was so nervous.

After I was admitted into the testing room, I listened to them spout out a bunch of their pre-test jargon that nobody really hears and when the exam was passed out I felt like I was on the verge of a mental breakdown.

The first thing I did was the I.V. calculations. I did them almost nine times. I calculated my drip rates and infusion rates over and over and over until I was SURE that they were right. I had heard of a few people failing from that kind of error. I spent probably the entire first hour making sure the I.V. calculations were right. Let’s hope I didn’t miss anything stupid!

When I had to go into the I.V. room to actually make the bag, I did fine up until the proctor hit the timer and when trying to pull back air on the first syringe I inadvertently blocked the air flow to the plunger. I paused for about a solid minute thinking about what I had done and if I thought the proctor noticed. I decided I didn’t want that thought to haunt me for the next 6-8 weeks so I asked for a re-do which lost me 5 points on the I.V. product. I was so upset with myself. At one point during the second try, my hand was shaking so bad that the needle jumped out of my hand! I was lucky enough to catch it without compromising the sterility of the product. With three minutes to spare, I was done!

The remaining two products were a hydrocortisone/calamine/petrolatum ointement and a tamiflu suspension. The suspension was tricky because they didn’t give you the dose needed. The prescription just said it was for an 8kg child and was to be dosed for post-exposure prophylaxis. Luckily I had made several of these at the CVS that I work at and knew the correct dose, but I spoke to a few who didn’t. That was a lot trickier than I suspected it would be.

The ointment was fairly easy. There was an oddly worded question that implied two different answers that could be correct and from the people I spoke to the answers were split both ways. It will be interesting to see how they grade that question.

Anyway, now I just have to wait and see if I passed or not!

6-8 weeks of torture…

Related posts:

1. NYS Pharmacy Wet Lab Part 1
2. NYS Pharmacy MPJE and NAPLEX Exams

As of right now, I think I did fairly well on the written portion and I’m confidant that I passed it – especially after conferring with some of my friends after the exam. There was one tricky math question where we were asked to convert a 15mg/mL q4h dose of morphine to the equivalent dose in mL’s using a different strength (20mg/mL). It seemed pretty straightforward but I did not notice that they requested in the answer in mL’s per day and not mL’s per dose until the third time that I checked my work. Several people that I talked to missed that!

The errors and omissions part of the exam was the part I was dreading the most, but strangely enough it was the easiest part of the exam. One error that I found was a Toradol prescription where everything seemed to match up except the instructions read: “10mg po tid for 10 days”. This exceeded the max duration of 5 days for this drug. I can thank one of my retail preceptors for making sure I had this memorized completely.

There where a couple of old brand names for the medication error section that I did not recognize. For example, Sinequan has not really been used since the 1970′s and on the other side of the spectrum, Nexavar was only approved about 4 years or so ago for liver cancer (and doesn’t do a very good job at it either after looking it up!), but was not actually included in my coursework when during school. So I didn’t get any credit for those questions.

All things considered, it was a lot less stressful than I anticipated. I added up every question that I was not 100% sure about, and assuming I got them all wrong I’d still have an 80% on the exam which is good enough to pass with some wiggle room to spare.

Now the next test is the actual compounding portion!

Related posts:

1. NYS Pharmacy Wet Lab Part 2
2. NYS Pharmacy MPJE and NAPLEX Exams