Saturday, June 2, 2012

BMT: and what's the half-life of that?

Posted by Anna at Saturday, June 02, 2012

Why the title? I am on rotation with Dr. Frame working with UMHS Adult Bone Marrow Transplant, and if you know only one thing about a drug, I recommend it be the half-life as you will undoubtedly be asked about it.

This is my first rotation, and I have now completed my 2nd week. I will say that the first week was definitely busy, overwhelming, and consisted of many late nights trying to get up to speed on what was going on with the patients in this service (refer to Roxanne's post for more details!). I think the stress of this was definitely eased by the classmates also on this rotation: Roxanne, Katrina, and Philip. You’ll see blog posts from the first two as well, so you will definitely get a feel for BMT if you follow us!

This service is quite different from many others. We have had anywhere from 21 to 27 patients on the floor total, with the majority of patients being scheduled admits. The patients come in about one week prior to their transplant in order to undergo the appropriate preparatory regimens. After transplant, they remain on the floor until they have recovered enough to thrive again on their own—typically, this takes at least two weeks after successful transplant. As a result, we will follow patients over a very long period of time and try to keep them as healthy as possible. Due to the nature of the transplant, the patients are severely immunocompromised for an extended period of time, making infection prophylaxis and treatment a crucial component to this rotation. Additionally we encounter a lot of nausea/vomiting issues, graft-versus-host disease, and any other disease state or chronic condition you can imagine. In BMT you see it all!

I am always curious as to what an average day looks like for each rotation, and here we have a pretty standard schedule:
  • I arrive around 7:30am to review patients for any issues that have come up overnight. I then modify or adjust recommendations as needed.
  • Rounds start around 8:30-9:00am. In attendance: Pharmacist, Pharmacy Students, Attending Physician, Nurse Practitioner/Physician Assistant. During rounds we will typically be ready to make any recommendations regarding our patients, and we are usually quizzed and questioned by Dr. Frame or the Attending Physician.
  • Rounds end anywhere from noon to 1:30pm. Then we grab a quick lunch!
  •  After lunch we meet with Dr. Frame to review our patients and any new developments. We will discuss any number of topics we have been assigned and also address any questions we have. Here we will also briefly present our patient cases and discuss what we need to prepare for the next day.
  •  Topic discussion with other oncology pharmacy students occurs at 3:00pm, where we meet with an Oncology Pharmacist to discuss pertinent topics to our patient population. This requires varying amounts of reading the night before.
  • 4:30pm: go home! At home I will do assigned readings, review my patients again, review material I feel needs more attention, and prepare for the next day!

So far, I have really enjoyed this rotation. It requires a lot of work, a lot of preparation, and you have to deal with a decent amount of stress regarding what questions you might be asked at any moment (often regarding mechanism of action and/or drug kinetics/half-life…) Overall, I have found it to be challenging but incredibly interesting!

In my next post, I hope to describe in more detail what types of interventions pharmacists (and pharmacy students!) make and how the pharmacist is a crucial member of the BMT team.

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