Intranasal midazolam and diazepam are now commercially available. You may notice increased demand from your prescribers for these products because patients may feel that the nasal formulation is less intrusive in comparison to rectal diazepam.
Also many providers may choose to use these products instead of diazepam rectal gel because of administration concerns… as the nasal formulations are deemed easier to administer by caregivers and/or school nurses.
Pharmacists, be careful when dispensing the 15mg and 20mg intranasal diazepam products — please note that each intranasal dose is 7.5mg per nostril for the 15mg product and 10mg per nostril for the 20mg product. This can be somewhat confusing initially as the 5mg and 10mg products do not follow the same pattern of being one-half of the listed dose per nostril (please read package insert to better understand).
Lastly, please refer to the package inserts of each product to ensure dosing is appropriate. In particular for pediatric patients. Please ensure that your prescribers directions are accurate, and that your patients and caregivers understand how to administer the product. Access to these products may be slower than normal due to the pandemic; thus make sure your patients know which pharmacies in their community dispense the product, so that they can make informed decisions prior to and after discharge from the hospital.
***Note: Please refer to the FDA package inserts, your pharmacy’s drug information resources, your state board of pharmacy policies, and your clinical judgement prior to dispensing. And if you still have further questions please never hesitate to contact the drug manufacturer. Information in this blog post does not substitute for your own clinical judgement. ***
***Patients, please discuss all medical and pharmacy options with your physician. This blog post does not substitute for an individual one on one consultation with your physician. In all cases of emergency please always call 911***
On 12/17/2020 the episode entitled “Flavor or not to Flavor: Getting kids to take their medications” was published, and I was fortunate to appear as Anthony’s featured guest. When I listened to the finished product, I could really tell the effort Anthony puts forth into the production of this show; the quality of his podcast is excellent!
I really enjoyed the opportunity to speak with him, and it’s great to see a pharmacist like himself continue to push the profession forward through his practice of podcasting.
You can view the episode at the following links:
After you review that episode, please also take the time to view the bank of podcasts Anthony has taken the time to produce in the past!
Thanks for your time!
February 2016 I wrote an email to Tony Hsieh who at the time was the CEO of Zappos. I read articles and viewed videos where he discussed his philosophies on business and the management of people while completing my studies for my MBA.
Of the topics he discussed, The Quit Now Bonus fascinated me the most. The idea was that you would give employees an incentive to quit immediately if they felt as though they were trapped or in search of professional opportunities elsewhere.
From a business perspective this killed two birds with one stone. The business would relinquish an employee that no longer wanted to work at the company on good terms with a bonus payment to help them transition to the next phase of their professional life.
From the employees perspective, you couldn’t blame the employer for not giving you an out. And from the employer’s perspective — they couldn’t be seen as trapping you in a contract that you couldn’t get out of. In effect, employers would be helping the employee secure opportunities elsewhere — perhaps even in another state or country by giving you a “quit bonus”.
Thus, from the very beginning, if you took a job at Zappos, there was an unspoken understanding that the relationship was built on the terms of mutual benefit.
Employees would be compensated at a fair wage and benefits and the employer had expectations that you would provide excellent performance and service. If at any point there was a breakdown in trust, and the employee felt they needed to move on professionally, you would give them the incentive to leave immediately rather than languish on with poor performance.
I never expected an email back from Tony, but I wanted to leave him a note thanking him for his efforts. He was letting his ideas become openly shared for public consumption. Which isn’t the easiest thing to do. And because of his ideas and efforts, he was making the lives of business leaders that much more easy by rendering us pieces of his “playbook” on how to manage people.
The toughest thing that you can do in any business is the management of people. Building a motivated workforce that can meet the daily demands of customers while providing excellent communication and customer service is difficult. And, I felt that Tony was running a business in which he understood that building a happy workforce that did not feel trapped or constrained was a key ingredient in building a successful brand and therefore a successful business.
Two weeks later, Tony’s chief of communications emailed me back. He thanked me for my encouraging words and offered me Tony ‘s book for free. The book that he wrote is entitled Delivering Happiness: a path to profits, passion, and purpose.
Sadly, Tony Hsieh passed away November 27, 2020. However, his legacy and achievements in the business world live on. His business philosophies on how to effectively manage people will certainly be studied and mimicked by future business leaders.
In my previous post I discussed a mnemonic that I’ve begun to use to stay focused on maximizing my daily activities. I’m also currently listening to the audiobook Atomic Habits. I’ve only started it recently, but it’s definitely a good audio book to have. You can listen to it while completing tasks around your home. I thoroughly enjoy self help books, and the genre typically manifests itself into one overarching theme.
That theme as you may have guessed it, is that your thoughts create your realities. And that once you begin to accept that outlook; you can manifest yourself into the person you believe yourself to be. Your family understands you to be that person, your friends, your peers, even strangers will begin to see you as the person whom you recognize yourself to be.
What’s great about the book Atomic Habits, is that the author gives us a framework for how these subconscious ideas of who we think we are set the foundation for the habits we begin to take on in keeping with this identity.
As I’ve state previously, DR. CC provides me with a gentle reminder to hold firm in the notion that dependability, reliability, consistency, and seeing things to completion are the necessary habits to take the thoughts I have about who I am, and turn these thoughts into positive outcomes and performances.
In short, examine your thoughts. Because this is the first step in altering your current reality. Put the appropriate inputs into your mind, to create the outputs you desire; because simply put…you are who you believe yourself to be.
- I met you while on my last rotation in 2012. Over the years I’ve learned about your background, and to me you have a fascinating biography. Can you tell the readers about your personal journey towards earning a Doctor of Pharmacy, and your initial experiences as a practicing Pharmacist. How has your journey impacted your approach to providing patient care?
My journey definitely has twists and turns. I had always dreamed of being an astronaut. From the age of 6 to the age of 21 when I was told I couldn’t fly at the USAFA, Since I was dead set on being an astronaut what a difficult situation to deal with at a young adult age. When I started my active military duty I was assigned to be a pharmacy technician at Langley AFB and I discovered this whole industry of pharmacy. The pharmacist I worked with encouraged me and I was lucky enough to have a pharmacy school in my hometown, The University of Toledo.
After I got a medical discharge thanks to a motorcycle accident that left me with a broken pelvis that did not fuse correctly, I applied to the University of Toledo School of Pharmacy. I returned to school as a divorced single mom who lived in a motel for a year.
After 6 years of pre-pharm and pharmacy school, I emerged from the University of Toledo as a full fledged Doctor of Pharmacy. Reflecting back, my school experience was a very positive one. The College of Pharmacy staff was very supportive and helpful. They really did help me to make good decisions that prepared me to be a proactive member of a healthcare team. I think this foundation as well as the experience I received from the military and internships in different environments (hospital, retail and long term care) gave me a great base to start my career.
- You have the personality in which you don’t meet strangers. Did this initially translate to your pharmacy practice? Did you always feel this confident when you first started practicing; or have you gained more and more confidence with each year of practice?
I think being what is considered a nontraditional student and an older student definitely impacted my approach to health care. Having needed ongoing healthcare due to my broken pelvis, being a mom of a child who had asthma and then later having one with a bleeding disorder, my experiences with various aspects of health care helped shaped my attitude towards performing as a pharmacist. I knew before I finished school that I wanted to be a pediatric pharmacist and I tried to get as much experience as I could while in school. I also had an incredible mentor Dr. Cindy Dusik whose passion for pediatric pharmacy was extremely contagious. She made it very clear to me that the path I had chosen — I would need to tread very carefully and I would need to have the utmost attention to detail.
Thank goodness the “military way” of doing pharmacy helped prepare me for this as well. Passion, commitment, and determination were all in my DNA. These aligned with the main pillars of pharmacy. To ethically and responsibly serve those who are in need of our help and our compassion.
As you know, I never really meet strangers, just someone that I have to find the line of commonality with. I think it becomes easier with experience. I think the military definitely helps with this as there is always someone new to get to know so you get plenty of practice. My confidence in my ability to find the right answer definitely grew with experience. I was lucky that I had the military experience because technicians in the military dispense which is reserved for pharmacists in the civilian sector; so as a young pharmacist, I definitely had a little more confidence, but since I was taking care of pediatric patients that confidence was always tempered with cautiousness. I was told that as a pediatric pharmacist it would take a year to become familiar and 5 years to be good and that’s pretty much the case. Even now, I am grateful that I have a great team that I work with that helps to make sure I am making the best decision. Experience truly helps you appreciate having a team that is all moving in the same direction.
- You’ve practiced pharmacy in both the hospital and retail pharmacy settings; how has your life circumstances, background, and education helped you navigate the in’s and out’s of both pharmacy leadership and effectively formulating rationale clinical recommendations to pharmacy peers, physicians, and nurses?
I had the opportunity to serve as Supervisor of Operations for several years at the hospital I currently work at. In order to help the department go through several transitions, I had to use all the tools I had in my toolbox and learn some new ones.
I was challenged to learn how to negotiate, understand and compromise over and over again. I had to take a few classes in order to hone these skills. It did not always come easily. I had to work with several different teams that had different sets of goals and I often had to teach others how the pharmacy department would fit into those processes.
Within the department we had to establish new processes and of course change is always difficult. I had to learn how to work with the team in order to make sure all needs were being met. I had to use what I learned about leading from USAFA, UofT, the military and life. Every life lesson that you learned will be challenged when you are trying to get things done with a team of people. You will find there may be multiple ways to get to an endpoint, but you can only work with the resources that you have. You learn to be flexible and adaptable and at the end of the day, you win as long as the whole team gets to the goal safely. One thing I always focused on was the people. It was important to me to make sure my staff understood that they were important and that we supported them. Work life balance was very important. When working with a multigenerational staff, it was important to understand the different requirements of the different age groups from the standpoint of the personnel that were chosen. I always had an open door policy and I made it clear that they had access to me whenever they needed it. I was extremely devoted to my staff and in return I had a staff that performed well.
- What advice would you give new grads in helping them earn the trust and respect of both their patients and peers? What things can they do to remain relevant and stay confident in their pharmacy practice?
My advice to new grads is simple, first find a place that fits who you are and do the type of pharmacy that you want to do. Then find a place where the people hold the same principles. The work is the work, at the end of the day; it’s the people you work with that usually make a workplace great.
When starting a job, acknowledge that you are a rookie pharmacist. You have a few tools in your toolbag but you need so many more in order to perform your job well. Listen and learn. There is something to learn in every encounter. Keep performing self evaluations to check your personal progress.
Take advantage of learning opportunities and make sure you always position yourself for success. Network and talk to people who are doing the things you want to do. This is important to make sure you are moving in the direction you truly want to go. Pharmacy is a very close knit industry. Everyone knows everyone and news travels extremely fast so make sure you protect your “brand”.
- You’ve taught multiple pharmacy technician courses throughout your career. You’ve helped countless young men and women enter the pharmacy technician profession. How has educating pharmacy technicians helped you develop a greater understanding of the profession? Do you foresee pharmacy technicians gaining a greater role in pharmacy practices across the United States?
The work of the pharmacy technician is extremely important in this industry. I think because of starting as a technician, this aspect of the industry is personal. When I got the opportunity to teach the pharmacy technician program at a local community college 11 years ago, I definitely thought it was a great and important opportunity. I understand that a technician makes or breaks a pharmacy. So my hope was to those who were interested in this industry, I wanted to be a positive influence and work hard to make sure they understood the requirements of the industry and what this profession could do for them personally. Because I have worn so many hats personally and professionally, and I am truly interested in helping people be the best versions of themselves, I try to bring a perspective that lets them know, I see them as a person and let’s work together to help you meet your goals.
The role of the technician is becoming more technical across the states. More is being required of technicians so that they can fulfill the changing requirements. Teaching technicians forces me to stay abreast of industry trends and changes. I see the changes as a good impact. The changes bring different opportunities for technicians to work in different aspects on the team. Giving them more responsibility is going to help the pharmacy be more efficient. The industry is recognizing that a well trained technician is a truly valuable part of the team. There are more requirements for education and certification. I am a huge proponent of growing the role so that it is more of a terminal job.
- As a person that’s been in the seat of hiring and firing. What skills do pharmacy students need to focus on while in pharmacy school to separate themselves from the pack? With the decrease in demand for Pharmacists in the market, what suggestions would you give to both new grads and recently laid off Pharmacists that are looking for jobs in this tight market?
That’s a great question. I think the new grads definitely have to be more strategic and flexible in their job planning. They may have to look at locations that do not have a pharmacy school in order to gain the experience they desire to have. I would also suggest that they take advantage of the new educational opportunities like dual PharmD and MBA or JD programs.
Also make sure they are networking and taking the time to meet people that are in decision making roles during their rotations. Talk to the classes that have recently graduated and ask them for their input as to the industry and what would they do differently to prepare. I have met several pharmacists after working in one aspect of industry and have decided to make changes.
This can be very challenging. I think industry wide, it is difficult to get a hospital position after working for years in retail. I think it’s important to stay current on what changes are going on in the other parts of the industry. Earning certificates in the aspect of pharmacy you are interested in will definitely speak to your dedication and determination to stay current. Take advantage of opportunities to network. Join your local organizations. Don’t give up. It may be difficult but keep working to find the change that you need for your life.
- You’ve helped thousands of patients throughout your years of practice. What has been your ultimate goal in your practice of pharmacy? What keeps you pressing forward during the tough days at the pharmacy?
This year marks thirty years that I have worked in this industry. It doesn’t feel that long but the numbers don’t lie unfortunately. I have seen many changes in the industry and I am excited about the changes that are coming. Watching our industry get more technological has been a lot of fun. I have always liked gadgets and tech so this aspect has been a lot of fun.
Even though I have been in the industry for a while, I never think that I am near the end of my career. I enjoy seeing the changes, the breakthroughs, the advancements. There is always a new aspect to learn or work through. It also fits my personality. I like solving problems and helping people so it makes sense to me.
I still look at the industry with awe and wonder. It challenges me and it has afforded me a great career and allowed me to do some really cool things personally. I’ve enjoyed working in different aspects of the industry. I have gotten to teach, speak, supervise and even review a couple of new gadgets. I’ve gotten to work and meet some really great people and I like to think that I have helped a few folks along the way. That’s what keeps me going forward. To whom much is given, much is required, and I still have a lot to do.
- You are a world traveler. Do you geek out over pharmacy memorabilia during your travels? How has travelling affected your outlook on pharmacy practice back here in the United States.
I love to travel. I have visited a few pharmacies as I’ve traveled, sometimes out of necessity. Luckily generic names are very similar everywhere. I don’t necessarily collect pharmacy memorabilia but I have grabbed a mortar and pestle or two. The pharmacy industry is highly regulated here in the states so as far as practice goes, we are in a great place. Some other places have been more aggressive at incorporating technology in their operations, however, we are starting to change here when the technology definitely adds layers of safety to our practice.
- Anything else you have to add for the readers? Freestyle questions and/or statements.
After all these years, I still see pharmacy as a good career choice. There are a lot of opportunities that are afforded working in this industry. Direct practice, research, academia, IT etc…..I have been blessed to have formed a great team and great relationships that make serving in this industry very rewarding.
I always knew I wanted to help people but was unsure in what capacity. In my first year of undergrad, I took an overview course and learned the basics of various health professions. Once the course was finished, I decided a career in pharmacy was the path for me.
I did not consider entrepreneurship until after I graduated pharmacy school. Once I realized my purpose, I knew pharmacy entrepreneurship was the path I needed to take to fulfill that purpose.
I have been most influenced by Mr. Eugene Walker and Dr. Pilar Murphy. Mr. Walker is the first pharmacist I remember. He worked for Eckerd Drugs in my hometown. My mother was the Assistant Manager and when we would visit her store, Mr. Walker was always extra kind. My mother spoke of him in high regard and that was the first time I remember being introduced into the world of pharmacy. I reconnected with him during my third year of undergrad. I interviewed for a job with a pharmacist in my hometown and Mr. Walker was there! He wasn’t physically working but I think he may have been there in a consultant capacity. Dr. Pilar Murphy was one of my preceptors in pharmacy school. After graduation she became one of my go-to pharmacists for advice. She showed so much compassion and kindness to me as a student and after graduation. She is the epitome of going above and beyond for her patients and people. Since the first night I heard her speak at a PERC conference, I’ve aspired to emulate the same level of compassion and kindness.
I enjoy reading and hiking and my new hobby (thanks to the COVID-19 pandemic) is gardening. I am the owner of A² Pharmacy Solutions LLC, a boutique pharmacy that offers healthcare conference consulting and speaking services and community education. I love creating digital content on social media, YouTube and on my podcast, The Rx Factor. You can find me on all social media: @doctorlany. New episodes every Saturday of The Rx Factor Podcast on Anchor, Spotify and Apple Podcast apps. New videos every Friday on the Doctor Lany YouTube page.
Don’t be afraid to take the road less traveled and create your own niche in pharmacy. Also, the pharmacy world is very small so don’t forget the golden rule!
Life is not a dress rehearsal. It is the grand finale. Live life for yourself and be content with your decisions for the day. You won’t always win but do not be afraid to try. Be open-minded. Read a book. Beyond what you know to be “right” and “true” is a sea of other “rights” and “truths”.
Dr. Brian Brown, PharmD is a practicing CVICU/Cardiac Transplant Pharmacist at John Hopkins ALL Children’s Hospital in St. Petersburg, FL. I met Brian in 2012 while he was completing his PGY1 residency at Children’s of Alabama.
In the fall of 2012 we became co-workers. I only had the opportunity to work with Brian for 1 year, but in that year I learned a great deal from him. I gravitated to Brian’s passion for the practice of pharmacy, his thoroughness in completing tasks, and his ability to consistently give 100 percent of his energy to serve others through the practice of pharmacy.
We became good friends in the years that we spent together at Children’s. Professionally, it’s been great to bounce ideas off of a pharmacy savant. Personally, it’s been great to know Brian because he’s a good person. I’m thankful for Brian and count him as a friend. He is a good man, smart, a hard worker, loyal, thoughtful, and compassionate.
I’m thankful Brian has taken the time to be apart of “Profiles in Pharmacy“; he has a wealth of knowledge and expertise to share to our readers today.
1) When did you realize that you wanted to be a Pharmacist?
I decided that I wanted to become a pharmacist at the end of my freshman year of college. I knew I wanted to go into the medical field and was in the pre-med track. Throughout my freshman year I had several different people tell me how they thought I would be a great pharmacist so I decided to apply for a job at a pharmacy and give it a try. After a few months of working in the pharmacy environment I changed from the pre-med to the pre-pharmacy track.
2) When you were in pharmacy school, did you always know you would be a clinical pharmacist working in a Hospital Setting?
No, I did not. My experience on entering pharmacy school only consisted of retail and that was where I was heading in my mind. It wasn’t until my fourth year of pharmacy school when I was on a neurology rotation with my preceptor Jody Rocker, that I really started considering the clinical track. I finally decided to pursue a residency and become a clinical pharmacist a few rotations later when I was completing a Pediatric Intensive Care Unit rotation with the amazing Kelley Norris.
3) How are you able to maintain your composure during Codes (cardiac arrest)? What advice would you give students desiring to work in a critical care environment do to prepare themselves for your rotation? What would you tell new pharmacists about what to do to be better in Code situations?
Maintaining your composure can be difficult but it is essential in code situations. It is important to know that you are there for a job of preparing and getting medications to the patient in a quick and accurate manner, and that you are the best person there for that job. Be sure to stay focused on the why you are there. I also do not like clutter, so keeping a clean work station helps me out a lot, since I am able to locate my medications and supplies easily. Additionally, repetition and practice help with composure in code situations. Continue to practice your skills and keep them tuned up by attending simulation events and going to debriefings after an actual event to discuss with others areas for improvement.
I really don’t expect much at the beginning of my rotations in terms of preparation beforehand. Working in a pediatric cardiac intensive care unit, it is a very special niche of multiple specialties rolled into one. Pediatrics, much less pediatric cardiac, is not common to see taught in schools of pharmacy, so I plan to start everyone at the beginning of the rotation at square one and then grow from there. As future pharmacists though, I do expect the students to be up on their mechanisms of actions and adverse effects of the medications that they are seeing and recommending.
For new pharmacists, I would say to take a deep breath and relax as much as possible. Maintaining your composure and trying to get rid of the nerves will help you out a lot. Practice, practice, practice! Attend simulations and go to debriefings after events occur and listen to all the feedback that is given. Be sure to learn your algorithms so that you can try to predict what medications will be needed next. That way, you can stay a few steps ahead. Furthermore, don’t be afraid to ask for help from others. Call another pharmacist or grab a nurse to help pull medications up. You are not there alone.
4) Who are the Pharmacists that have influenced you the most and why?
There are two pharmacists who immediately come to mind. The first is Kelley Norris, who was my PICU preceptor as a student. Kelley’s rotation is where many of my pharmacy career decisions were solidified. I decided on her rotation to pursue residency, to go into pediatrics, and to also critical care. I learned so much on her rotation from clinical thinking skills, to interacting with providers, to continually pushing myself to learn every single day. I have definitely seen myself modeling my own rotations after Kelley’s model.
The second is Brenda Gorman. I met Brenda during my PGY1 residency year and she became my unofficial mentor. Brenda was always patient with me and pushed me more than I ever thought possible. I also learned a lot about the inner workings and politics of pharmacy and about becoming a mentor myself. I am grateful to still call Brenda a close friend and a highly respected colleague.
5) What would you like the readers to know about you, and your practice?
I have been very fortunate to have had multiple amazing experiences at an early age, and I contribute that to seeing multiple places and getting to know as many people in the profession as I can. If you are able to complete your residency programs in different states, then take that opportunity. See as many ways, as many formularies, and many computer systems as possible as it will widen your knowledge and make you more marketable. As for my practice, I primarily split my time taking care of patients in a pediatric cardiac intensive care unit and a congenital diaphragmatic hernia unit. I also float to the PICU, NICU, and ER. Working in pediatrics is an exciting and challenging experience since there is not much literature to help guide your decisions at times; and every medication/dose that you recommend is calculated specifically for that individual patient.
6) Where do you see pharmacy residencies in the coming years? Personally, I would have never imagined the expansion of residencies that has taken place over the past 10 years. Do you think the federal government will get involved and subsidize residencies, much like what has occurred with Graduate Medical Education?
Pharmacy residencies have definitely taken off over the past several years and it has been difficult to keep up with the supply of residency programs over the growing demand. Another thing, which is excellent for the profession, is the expansion of roles and responsibilities that pharmacists are allowed to complete, which is why it is important to advocate to your state and federal government to continue to advance the profession. I believe that as pharmacist responsibilities continue to grow, residency program will become even more essential to train new pharmacist to perform these tasks successfully. Another item that has been bounced around some, and I do think we are still a little way away from, will be to addition of the PGY3 residency program. PGY1 pharmacy residency programs are able to receive program reimbursement through CMS, however, there have been a lot of issues where CMS has threatened to remove this funding due to arbitrary audit requirements. This is why it is important for pharmacists to stay involved in organizations and reach out to members of congress to continue to support and advocate for the profession. Hopefully we will see an increase of support and funding for residency programs in the future.
7) What’s your pet peeve in the pharmacy?
Hmmm, there are actually several for me. But one of my biggest ones will be procrastination in regards to verifying or getting medications to the floors for the patients. I always try to remind everyone that there is a patient sitting at the other end of what we are doing.
8) Thanks for your time, what words of advice would you like to impart on student pharmacists across the country?
For the students across the country I would definitely start by saying keep an open mind and get as much of a wide range of experiences as possible. Try to book a challenging fourth year to keep you learning and seeing different aspects of the pharmacy world. Unfortunately, some rotations may still fall flat, and if so, pick one medication a day and look up its mechanism of action and common adverse effects. Keep pushing yourself in those situations. I would also strongly recommend finding a preceptor, work colleague, professor, someone to become your mentor. Having a knowledgeable mentor can make a world of difference in your growth as a pharmacist. And finally, don’t get hung up on setbacks. Those situations can lead us in a new and better direction, and we are able to have experiences we never would have thought about otherwise because of those setbacks.