Tuesday, October 25, 2011

It's Not Boring, I Swear.

Posted by Matthew Lewis at Tuesday, October 25, 2011

Hello Readers.

I'm already in the groove for my newest rotation, which is drug info. This is my second rotation in the Veteran's Affair group of hospitals, but there is a huge difference between the hospitals, and I think that is because of financial support. For example, the Detroit VA does not have a residency program but Ann Arbor (and Battle Creek) do.

[As a side note on residencies, several students from my class hope to be placed in the VA system, but I've been told that there aren't any residencies available at the Ann Arbor VA site this year. This situation isn't unique to VA as the demand for pharmacy residencies continues to outpace the supply
nationwide. That means increasingly intense competition for limited slots. Michigan has one of the highest pharmacy residency placement rates in the country, but being a Michigan PharmD does not automatically make you the preferred candidate for a residency. Landing a residency still comes down to polished interviewing skills and an ability to package your talents in ways that make you stand out from the crowd.]

Back to the story at hand. As I mentioned, my current rotation is drug info. My preceptor, Dr. Ed Lehaie is a great guy and was recognized as preceptor of the year for 1999. The first day was all about getting paperwork in and computer access. I even answered some questions. Today, I answered a few more questions, particularly on replacements for the pain medication fentanyl because there is a drug shortage looming on the horizon. First, I did not even realize there were other drugs in the fentanyl family, so learning about those was interesting. I compared onsets and found appropriate doses through literature searches for sufentanil, remifentanil, and alfentanil. Finally, I did a little cost analysis.

You may have heard about drug shortages in the news, since they have gotten so bad people are dying from not getting proper medications on time. Part of drug information's job is to figure out how to work around these shortages. The other major part of drug information's job is to ... well, dispense drug information. This is usually in the form of approving medication requests that are off-label or extremely costly, such as cancer medications. We will also present new drugs and new research to our pharmacy and therapeutics (P&T) committee, where they can discuss what additional restrictions they want to place on drugs. VA P&T committees are quite different from normal P&Ts, in that each hospital has to follow the nationally mandated formulary decided upon by the national P&T. The local hospitals can only further restrict use.

That's the nuts and bolts of this rotation. I'm definitely going to be getting some weird questions, so I'll keep in touch to share them all.

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