Tuesday, September 28, 2010

Call Me Beep Me if you Wanna Reach Me...

Posted by Alex at Tuesday, September 28, 2010

Rotation #3 for me is drug information at U of M. Today I worked the call center and had some interesting calls....

A nurse practitioner (NP) called explaining how a patient reacted to spironolactone with rash and hives. She was wondering if the patient could be switched to eplerenone, which is also an aldosterone antagonist. The NP had concerns about cross-reactivity between the 2 agents. Patient can tolerate furosemide, and also has a sulfa allergy.

So I proceeded to search Micromedex, Lexi-Comp and PubMed to find any information about aldosterone and eplerenone cross-reactivity. No mention about cross-reactivity. Then I recalled the patient has sulfa allergy so decided to search that term in the monographs of the 2 drugs. I saw spironolactone has metabolites containing sulfur...so then I thought, "OH! that's why the patient had a reaction" Then...I proceeded to look at Goodman & Gilman to look at the STRUCTURES of aldosterone and eplerenone. Turns out aldosterone contains a sulfur atom, and eplerenone does not. I discussed my findings with my preceptor and we came to the conclusion that switching from aldosterone to eplerenone should be safe.

So what's the point of my story?

My knowledge gained from the medicinal chemistry courses actually came to use! In my formal write up to the NP, I was tempted to be a geek and write about the "sulfur moiety of the chemical structure"...but I just stood with saying "sulfur atom in the structure."

To be honest, I was intimidated at first to take phone calls to answer drug information questions mainly from other health professionals. However, I am finding it fun because people call asking for your advice. I research the question asked, then I follow up, and the caller is really grateful for the help...it's a great feeling to be a great source of information. I am also learning things I don't think I would otherwise know. For example, I learned today that the Fluvirin vaccine is stable in 77 degrees fahrenheit for up to 72 hours after 1 excursion. Pretty random, huh?

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