Saturday, April 6, 2013

UMHS Drug Information

Posted by Kristen Gardner at Saturday, April 06, 2013

I completed my drug information rotation at UMHS with Dr. Abraham Bazzi as my preceptor of record (BTW He is awesome!). 

This rotation was really fun! The environment was more relaxed with an energetic primary preceptor and very knowledge and well-respected secondary preceptors.

The drug information service is a student run service with 2 students at the site per rotation block. You split the phone shift (9am-4pm) between the two of you such that one student answers the phone from 9am-12:30pm and the second student fields requests from 12:30pm-4pm. When the resident is on site, you run the question and response by the resident and only go to the preceptor as needed. When the resident is not there you will run the question/response by the preceptor of the day (the staff rotate this role through the rotation).

  • Complete a pharmacy & therapeutics (P&T) manuscript (my topic= antithrombin III)
  • Complete an external review of a compounding pharmacy
  • Answer drug information requests by phone, page, and email
  • Prepare an article for the UM Newsletter (my topic= tolvaptan associated liver enzyme elevations)
  • Complete 2 medwatch reports
  • Attend meetings with the preceptors (drug shortage conference calls, pre P&T meeting, P&T meeting, product vendor selection committee meeting, etc.)
  • Attend (per availability) the resident research proposals, final report, and CE sessions at the hospital

I like this rotation because you get to know the residents more and interact with all the preceptors. Each of them approach things differently and it is great to gain this perspective. They are all very friendly and knowledgeable.

At the end of the rotation, I came away with much more confidence answering drug information requests. Additionally, I no longer have a fear of, “Oh my, what am I going to be asked when I pick up this phone?” We are very lucky at UMHS to have extensive resources available at our fingertips. Several calls we get are from other institutions wanting to know our practices or protocols. It is quite remarkable.

A sample of the types of questions I was asked
  • Can we compound or obtain any quinacrine product?
  • What is the conversion from tablet to suspension formulation of megestrol acetate?
  • How to adjust carbamazepine dosage using serum levels
  • Can a patient taking Trileptal consume pomelo fruit? (FYI= research indicates that pomelo fruit (some varieties) inhibit CYP3A4 to an extent similar to grapefruit juice!); however, Trileptal is not primarily metabolized via this route…..
  • Drug interaction questions (LOTS OF THEM)
  • Alternative antidepressant for a patient who experience QT prolongation with fluoxetine
  • Recipes and whether or not tablets can be crushed/given via tubes somehow (LOTS OF THEM)
  • Options for administering selenium as a result of the never ending shortage of this trace element (Thank you Dr. Kraft)
  • Is a medication still good after being stored outside package insert parameters

  • Be cautious assuming everyone understands pharmacokinetic drug interactions related to CYP450 enzymes. In my experience, it is best to communicate using the both languages about 1) Drug A is a CYP2C9 substrate and Drug B is a CYP2C9 inhibitor; therefore 2) Drug B would be expected to inhibit the metabolism of Drug A resulting in increased levels of Drug A vs. expecting the other person to make the connection. I found this to be true more so among the nurses vs. physicians.
  • Always remember to consider alternatives/back-up plans when responding to drug information requests
  • When assessing whether medications can be administered down tubes, consider the formulation of the drug product. For example, when assessing this for dronabinol, the medication is formulated in sesame oil and is not soluble in water; therefore, in the absence of data we could not recommend for it to be given via this route as it would likely adhere to the tube and you could not rinse it down with an aliquot of water. 
  • Micromedex has some helpful therapeutic resources!!! Just search and try it out!

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