Wednesday, January 8, 2014

Who You Gonna Call? Drug Info!

Posted by Rachel Lebovic at Wednesday, January 08, 2014

While I don’t want to become a drug information pharmacist, my drug information rotation at the Ann Arbor VA was a worthwhile experience. When any health care professional in the Ann Arbor VA doesn’t know the answer to a medication-related question, they have the opportunity to call the drug information pharmacist (my preceptor, Dr. Ed LaHaie). Most often, the physician, nurse, or pharmacist with the question already looked at a few drug information resources and either couldn’t find the answer or found conflicting information. Then, it was my turn to delve deeper into drug information resources, primary literature, and/or call the manufacturer to try to answer the clinician’s question.

I received a wide variety of questions during my time at the VA. For example, one practitioner asked if losses in word-finding ability have been reported with gabapentin, a medication often used in diabetic neuropathy. A pharmacist called to ask if there were any clinically relevant drug interactions between a patient’s current medications and konjac root, an herbal product reported to lower cholesterol and stimulate weight loss. A physician wondered if alendronate, a medication for osteoporosis, would be absorbed in a patient whose stomach had been surgically removed due to gastric cancer. Yet another clinician asked if there were data to support the use of mifepristone, an abortifacient, in patients with Cushings disease. After responding to these questions and many more, I feel I have a better understanding of which references are best suited to answer different types of questions.

In addition to answering drug information questions, I also wrote a new drug monograph and prepared an hour-long presentation to the pharmacists at the VA. My new drug monograph explained the efficacy and safety of vortioxetine, a new anti-depressant medication. One of the most time-consuming but educational parts of the monograph was the appendix, in which I created a detailed chart comparing the data from eleven clinical trials that studied vortioxetine. The hour-long presentation I created on this rotation was titled, “Update on the Management of Crohn’s Disease.” Since I am interested in teaching pharmacy students as part of my career, I enjoyed the process of researching a topic and developing an engaging presentation that I thought the audience would find useful. I was proud that the pharmacists in the audience seemed interested in the presentation and asked pertinent questions.

Lastly, throughout this rotation I gained insight into some of the administrative roles a drug information pharmacist might have. My preceptor, Dr. LaHaie, approves (or denies) all of the non-formulary drug requests for the Ann Arbor VA. Non-formulary medications are those that are not allowed to be ordered for a patient, unless the patient’s case warrants special approval. I enjoyed discussing some of these non-formulary drug requests with my preceptor because they frequently involved interesting ethical dilemmas. Dr. Lahaie also serves on the Pharmacy and Therapeutics (P&T) Committee and the Drug Shortages Committee at the VA, so I was able to attend these meetings and gain insight into the decisions and work that goes on behind the scenes to determine which medications will be on the formulary and ways to work around drug shortages.

In all, I gained valuable experience during my drug information rotation at the VA. I missed seeing patients and I still think I am better suited for a clinical specialist position on an inpatient multidisciplinary team, but the drug information skills I developed will help me be a better clinical pharmacist.

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