Lightning McQueen fast. That is how quick my rotations seemed
to go by in my final year of pharmacy school. For those of you who have joined
me in completing their pharmacy education, congratulations! For those starting
rotations or beginning your summer break, I write to you about my final
rotation with the pediatric emergency department team.
As a prelude, the foundation of this pharmacy rotation was
similar to that of the adult emergency department rotation I completed last
August. Nonetheless, I was very excited to work with children and soon
discovered the many unique pharmacy aspects there are to consider when working
with this young population. I started the rotation with a bang and the
excitement just kept building from there!
A diverse population
Children make up approximately a quarter of the population. Yet,
about 60% of medications do not have FDA approval or dosing recommendations for
pediatric patients. From premature infants to children big enough to be
considered adults, several challenges exist when considering pharmacotherapy
for children. There are differences in pharmacokinetics and pharmacodynamics,
limited evidence for medication use, and lack of appropriate formulations.
With much of the data extrapolated from adult patients, I quickly
found working in pediatric pharmacy more of an art than a science. Recognizing
that children are not just little adults, I was faced with the challenge of taking
absorption, distribution, metabolism, and elimination into consideration for
each individual patient. Dosing was no longer constant, but calculated per body
weight and surface area. Vital signs and laboratory values were also different
from adult patients, which drove home the need for pediatric health care
providers to have an eye for detail and accuracy.
Ready to work
Realizing that standardized treatment algorithms for disease
states in pediatrics are extremely hard to come by, I rolled up my sleeves and prepared
to round up treatment evidence in the National Library of Medicine. Monitoring patient
admissions, I quickly discovered the wide level of acuity that children present
with when arriving at the emergency department. Although there were a large
number of children with low acuity conditions, such as mild playground injuries,
but there were also many that required extensive health care provider input.
These cases included asthma exacerbations, anaphylactic emergencies, traumatic
brain injury, diabetic ketoacidosis, seizures, headache/migraines, cystic
fibrosis, and many others.
As the student pharmacist on rotation, I was responsible for
assisting physicians and recommending treatment options, providing transitions
of care medication reconciliations, antibiotic kinetics, and counseling about
discharge medications. This was no ordinary rotation though. I experienced a
heart-tugging desire to do everything I could to help the sick children.
Another really neat aspect of my rotation was extensively helping
the health care team with incoming traumas. It was not uncommon for me to
anticipate the use and draw up a wide array of medications for resuscitation
(epinephrine, atropine, calcium, magnesium), along with those used for rapid
sequence intubation (procedure for a breathing tube), antiarrhythmics,
anti-seizures, and medications used for pain control. I also frequently
communicated information about the rate of administration and methods of drug
delivery. I was always up to the challenge, knowing that each second counted.
Dream come true
Finishing my rotations as a student pharmacist has been
bittersweet. I have had amazing hands-on learning experiences, great
preceptors, and will miss the many opportunities to make a difference in so
many different health care environments. From working with patients with
chronic kidney disease on dialysis to studying the implications resulting from
the New England Compounding Center meningitis outbreak to providing medication
therapy management services to Native Americans, I couldn't have asked for a
better final year. I can’t wait to use my knowledge gained to make an immediate
impact after graduation.
Looking to the future, I am happy to announce that I have
recently accepted a job offer to work at FDA in the Office of Generic
Drugs–Division of Bioequivalence as a pharmacist project manager. In this role,
I will supervise a team of pharmacologists and will act as a lead liaison to
industrial applicants. As someone who has dreamed about entering the public
health field right out of pharmacy school, I couldn't be more excited to see where
the future takes me!
I have really enjoyed writing about my rotations in the UofM College of Pharmacy's On Rotation blog and hope I shed light on the rotations and highlighted new
career opportunities that you might want to pursue in the future. I look
forward to new practitioner life and continue to support the pharmacists of
tomorrow.
Once again, congratulations to all of this year’s graduating
pharmacists!
Adam Loyson is
a 2014 graduate.
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