Friday, July 24, 2015

Meetings, Meds, and Monographs: Drug Information Rotation

Posted by Stephanie Burke at Friday, July 24, 2015

Already done with rotation 2 – time flies! I had my Drug Information (DI) rotation these past 5 weeks, and I learned a ton! I’ve got a pretty good grasp on where to find information for different types of DI questions. The questions I received ranged anywhere from ‘what are the clinical manifestations that could result following accidental injection of a nasal solution of drug A’ to ‘can drug X be crushed and flushed through a G-tube’ to ‘we have a patient who is allergic to sulfites – can you review the ingredients of the attached list of medications for presence/absence of sulfites?’ Not your typical, everyday stuff, but now I have some familiarity with the types of clinical questions that could arise and where I could look to find information. I consider it a great skill to have acquired early on in my rotation schedule.

In addition to answering phone calls and emails from the inquiring minds of our UM providers and researchers, the DI folk also attend a number of different committee meetings. On this rotation, I went to committee meetings for anesthesia, cancer, pain, inventory, and glycemic control. It’s great having our DI pharmacists present because they bring a solid understanding of the available literature, and the meetings help the DI staff stay up-to-date on new information. My personal favorite was the Glycemic Committee meeting given my interest in diabetes mellitus. There was a monograph presentation on Afrezza, the newer inhaled insulin product, and also a discussion on the concentrated insulins that have been surfacing in recent years. Lots of cool stuff in my opinion!!! My hope is to continue attending these monthly meetings in future rotations when I am back in Ann Arbor (out of area rotation 3). If that is the case, I’m sure you’ll see more fun stuff on that in future posts J

One of my other favorite components of this rotation was the monograph project (or in my case, 3 total monographs!). The monographs I prepared will be presented at future Pharmacy and Therapeutics Committee meetings for consideration for formulary addition. The first drug assigned to me was mifepristone. This is a very interesting (and controversial) medication. Used as an investigational drug since 1985, mifepristone was FDA-approved in 2000 for termination of pregnancy through 49 days gestation. The drug had already been adopted in a number of European and Scandinavian countries prior to its approval in the United States. The brand name for this indication was MifeprexTM, produced by Danco Laboratories. Twelve years later, mifepristone was approved for another indication – management of hyperglycemia in patients with impaired glucose tolerance or type 2 diabetes secondary to endogenous Cushing’s syndrome. This brand, KorlymTM, was produced by Corcept Therapeutics. Same active ingredient, two different brands, indications, and manufacturers. Take a look at the pharmacology of mifepristone to see how it could work for two very different conditions!

The third monograph I wrote was for U-300 glargine (ToujeoTM). Again related to diabetes, it was of significant interest to me. The clinical trials that Sanofi-Aventis completed showed, overall, that U-300 glargine was non-inferior to Lantus in blood glucose control, and in some cases, produced less nocturnal hypoglycemia. There were no significant differences in adverse effect profiles between the two. The primary concern we see with adding U-300 glargine to formulary is safety. There have absolutely been medical errors when someone draws up the concentrated product thinking it’s the unconcentrated, or a provider fails to correctly calculate the volume needed given the number of units of insulin. Many things could go wrong here when used in the inpatient setting. For those unaware, insulin is a high alert medication, and there must be effective and appropriate protocols in place to ensure safe use of insulin products.

Drug Information was an excellent experience. It challenges you to dig deep into the inquiries that come in, and also to consider all the data you’ve gathered and make a clinical recommendation. The rotation also better familiarizes you with drug information resources which will be invaluable to any type of work that you do.


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