Sunday, June 15, 2014

The Final Rotation

Posted by Adam Loyson at Sunday, June 15, 2014

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.