Drug Information at the University of Michigan

Posted by Alison Van Kampen at Wednesday, September 19, 2012

Well, rotation number 3 is over, and I had a blast.  Most people will tell you before P4 year starts that Drug Information is a boring rotation, but I must beg to disagree.  I found this to be a really fun rotation that really suited my personality. 

The environment was very low key, which I like, and it didn't hurt that we had lots of space to work as opposed to being crammed down in B2 and fighting to find an available computer.  It also helped that all of the people in the Drug Information Service were great to work with (and I'm not just saying this because I know that they will be reading this post).  My primary preceptor was Dr. Stumpf and I also spent a lot of time with Dr. Bazzi, Dr. Dasse, and Dr. Sweet.  In addition, my fellow student, Matt Perez, and I spent a lot of time with the new resident as wekk. Everyone was very nice, they were helpful when I worked on projects and answered question, and they gave some pretty sound advice for the future.

I found the tasks and projects that we were assigned to be helpful, interesting, and often challenging.  Everyday we were responsible for taking a phone shift.  On the phone shift we would take calls from various people regarding unusual drug questions.  Questions would come in from everyone from physicians, pharmacy faculty, nurses, outpatient pharmacies, and lay-people. The majority of questions had to do with stability of a drug that was left out of the refrigerator (which often resulted in a long call to the manufacturer) but other questions were very interesting and required extensive research.  Here are just a few:

Is it safe to use sedative hypnotics in a patient that has insomnia related to Lewy Body Dementia? and if so, which ones?

Why is it that for all SSRIs, increased risk of bleeding is listed as an interaction with Clopidogrel, but fluoxetine has the added interaction of decreased efficacy of fluoxetine? What is different about fluoxetine?

Should a woman taking medications that compromise her immune system avoid contact with her grandchildren who recently received a live varicella vaccine? and if so for how long?

Are there any concerns, other than lack of efficacy, for a 14 month old patient that was being administered expired CellCept for the past 2 months?

In addition to answering these questions, we also had small projects like filling out MedWatch forms, learning about and determining the pros and cons of various sources of information (there are way more out there than you can imagine), finding ways to critically evaluate journal articles and the statistics they publish, and attending meetings at the hospital.  

We had two larger projects as well.  One was writing a newsletter article, mine was about the possible association between maternal use of SSRIs during pregnacy and Persistent Pulmonary Hypertesion of the Newborn, which was pretty cool.  The other large project was creating and delivering a P&T presentation on a new drug to the Drug Information staff.  This was exciting because I got to research and learn everything about a new drug, Carfilzomib, and learn more about the disease state that it treats, multiple myeloma.

Overall, I really liked this rotation.  There was very little patient interaction, which was good and bad.  Also because I'm not good at being put on the spot, I really liked that I was able to thoroughly research my answer to a question before delivering an answer. AND I was able to learn a lot of interesting and unsusal things about drugs (interesting and unusual has always been very attractive to me).  I would definitely recommend this site to anyone for their Drug Information Rotation.

Chugging Along

Posted by Matthew Lewis at Monday, November 07, 2011

First, I want to clarify something that I may have confused some people about. The Ann Arbor VA does have residency spots open for next year (2012-2013), and many of my classmates are quite serious about doing residency at some VA, either in Michigan or across the country. It's just that this current year there are no U of M grads as residents and all the current residents expected to have a Wolverine present due to our proximity. This coming year I'm sure we'll have at least one because of all the interest in the program and the Ann Arbor VA being a good fit.

Moving along, it's beyond the halfway point and I'm still feeling pretty good. I'm working on my projects and answering drug questions along the way. I feel pretty confident that most questions you will see on drug info has to do with "off label" indications or non-formulary drugs. As my preceptor explained, the doctors and nurses have more access to drug information from things like their iPhone or Blackberry than they ever had before.

Another thing I learned is that every pharmacist has their own way of practicing with their own habits and favorite drugs. It came to my attention for non-formulary drug requests, where doctors make their case for pharmacy to supply something that may cost more or be last line therapy for a patient. My preceptor does not like to approve particular tube feeding formulations without exacting data which shows a clear benefit which must be a better clinical outcome like going home earlier. On the other hand, he is more lenient with appetite stimulators for cancer patients. He's not a hypocrite since he does get data for both things, but in any evaluation, there is some subjective clinical decision making process that must go on. It'll be interesting to see when I practice what issues will be things I go on crusades for or against and what type of drugs I favor and try to avoid while keeping in mind the care the patient needs.