Nuclear Pharmacists Research Articles

The role of commerical nuclear pharmacy in the future practice of nuclear medicine

It has been estimated that today 70% to 80% of all radiopharmaceutical doses are dispensed through commercial nuclear pharmacy channels. These services are provided by the approximately 250 facilities in the United States, with some multisite corporations dispensing in excess of 20,000 unit-dose prescriptions per day. As pressures mount within health care institutions to reduce manpower, increase cost-effectiveness, increase participation in managed care contracts, and to seek outside vendors for many services that were previously provided in-house, the future role of the commercial nuclear pharmacy in the practice of nuclear medicine will only continue to increase. The essence of nuclear pharmacy practice is the dispensing of a full range of high quality radiopharmaceuticals in patient-specific unit doses. These doses must be delivered in a timely and cost effective manner, without compromising quality or patient safety. Commercial nuclear pharmacies have expanded to provide such varied functions as radiation safety and waste management, as well as consultative and marketing activities directed towards clinicians within a nuclear medicine practitioners own facility. In-service continuing education programs directed towards physicians and technologists are frequently offered by many commercial nuclear pharmacies. Changes in health care economics, merging and down-sizing in the hospital industry, and the overall impact of managed care on the viability of hospitals in general has resulted in slow growth, or even a small decline in the number of institutionally based nuclear pharmacists. As a result, nuclear medicine practitioners will be looking to the commercial nuclear pharmacies to meet a larger portion of their radiopharmaceutical needs, as well as to value added services, such as education and research and development. Specialized practice settings, such as nuclear cardiology and free-standing nuclear medicine clinics, are especially well suited to the services provided by commercial nuclear pharmacies. Involvement in the distribution of positron-emission tomography radiopharmaceuticals will continue to increase regardless of the results of current regulatory debates on this issue. In the future, nuclear medicine practitioners will look to the commercial nuclear pharmacies for an increasing portion of their radiopharmaceutical needs and the industry should be ready and able to meet these demands in a safe, timely, and cost efficient manner.

Investigational Radioimmunopharmaceuticals: Pharmaceutical Care Responsibilities and Opportunities

A recent survey of biotechnology-derived medicines and vaccines under development showed that the largest fraction of these were monoclonal antibodies for the detection and/or treatment of cancer. This article describes the role and function of the nuclear pharmacist in the initiation, development, and conduct of a prototype clinical trial in which a radiolabeledmonoclonal antibody (MAb) is used as a diagnostic imaging agent to detect the site of a tumor in a patient who is being managed in a hospital outpatient setting. Examples are used to illustrate selected pharmaceutical care issues in this investigational environment.

Innovative Nuclear Pharmacy Service

Objective To provide an overview of the investigational nuclear pharmacy service at the Medical University of South Carolina. Data Sources Referencess were selected from published bibliographies of nuclear pharmacy and hospital pharmacy articles and from specific-topic searches of the MEDLINE computerized database (all languages, through 1992). Study Selection Studies of clinical pharmacy functions that were considered relevant to the specialty practice of nuclear pharmacy were chosen. Data Extraction Studies were reviewed for internal consistency and appropriateness. Data Synthesis Data on the clinical impact of nuclear pharmacy services do not exist. Conclusions Based on our experience in establishing an investigational drug service, we conclude that nuclear pharmacists should take an active role in clinical investigations. The outcomes of this kind of involvement are very rewarding.

Pharmacotherapy specialty certification examination. IV. 1992 results and process modifications, including recertification. The 1992 Specialty Council on Pharmacotherapy, Board of Pharmaceutical Specialties.

Certification of pharmacotherapy specialists is proceeding smoothly. Modifications to the examination process, which include reapportioning domains, offering the examination at several sites, and establishing the recertification process, have occurred. The guidelines for petitioners and structure of specialization continue to receive the attention and interest of prospective candidates, pharmacy organizations, and the BPS. To date, 674 specialists have been certified in the approved specialties: 175 nuclear pharmacists, 236 nutrition pharmacists, and 263 pharmacotherapy specialists.

New Ruling Unfair to Nuclear Pharmacists

New Ruling Unfair to Nuclear Pharmacists

Pharmacy Practice Should Include Diagnostic Drugs: A Nuclear Pharmacist's Opinion and Commentary

Pharmacy Practice Should Include Diagnostic Drugs: A Nuclear Pharmacist's Opinion and Commentary

Brachytherapy: A Pharmacist's Perspective

Brachytherapy is treatment by implantation of one or more radioactive sources into, or near, a tumor or other cancerous area of the body. This form of cancer treatment presents new challenges for the nuclear (radiologic) pharmacist who is seeking additional unique roles within the specialty. The nuclear pharmacist is the obvious choice for active participation in brachytherapy procedures since his/her training and daily routine deals with the safe handling and use of radioactive materials. Before beginning treatment, the radioactive implant must be surveyed, calibrated, and leak tested, all of which are important aspects of nuclear pharmacy practice. Applying the basic principles of safe handling and use of radiopharmacouticals, the clinical nuclear pharmacist can easily master the art of actual implantation and removal of a brachytherapy source as well as its preparation for waste disposal. This article focuses on specifics of the brachytherapy procedure and how the clinical nuclear pharmacist can become an integral member of the brachytherapy team.

The Nuclear Pharmacist in Industry

Within the scope of the pharmaceutical industry, there are many traditional areas where the nuclear pharmacist can assume a useful role. These areas include. among others, research and development, quality assurance and quality control, clinical investigations, regulatory affairs, marketing and sales, and management and administration. In addition, nuclear pharmacists have the potential to become increasingly involved in the workforce of the medical device industry. The introduction of new generator systems, unique software packages for nuclear medicine, and devices to synthesize position-emission tomography (PET) radiopharmaceuticals are a few of the innovations that could benefit from the expertise of pharmacists. Overall, nuclear pharmacists have many options for roles to play within the pharmaceutical and medical device industries. © 1989 by W.B. Saunders Company.

The Nuclear Pharmacist as a Consultant and Drug Information Specialist

The provision of cognitive services, including drug information, is an extremely important function of the nuclear pharmacist. As pharmacy continues to evolve as an information-oriented, knowledge-based profession, nuclear pharmacists must maintain an active role in the dissemination of information related to the use of radiopharmaceuticals and other drugs associated with the broad area of radiology. Several examples are given to illustrate how nuclear pharmacists serve as clinical consultants and, in doing so, provide expertise in drug information. © 1989 by W.B. Saunders Company.

The Nuclear Pharmacist as a Radiation Safety Officer

The Radiation Safety Officer (RSO) is responsible for the safety of the staff, visitors, and patients who may work with, or come into contact with, radioactive materials. This responsibility often calls for establishing and enforcing radiation safety policies and procedures. The position of the RSO may have even greater dimensions at facilities where medical research uses radioactive materials or where radioactive sources are being implanted in cancer patients for therapy. Since the nuclear pharmacist handles radioactive solids, liquids, and/or gases on a daily basis, his knowledge and experience ideally qualify him to perform the duties of an RSO. Those duties and responsibilities include, but are not limited to, monitoring for environmental safety and personnel radiation exposure, monitoring of incoming and outgoing radioactive shipments, and verification that all record-keeping activities, possession quantities, and uses of radioactive material are in keeping with the facility's radioactive material license. Basically, the RSO is responsible for the safe use of any radioactive material from the time it arrives until the time it is removed for waste disposal. The following article reviews some of the duties of the RSO, and shows how easily the nuclear pharmacist can assume this role.

Nuclear Pharmacy and the Board of Pharmaceutical Specialties (BPS)

Nuclear pharmacy was officially recognized as a specialty area in pharmacy practice, the first specialty area so recognized, by the Board of Pharmaceutical Specialties in 1978. Subsequently, a certification examination was developed and administered for the first time in 1982. By 1988, 112 nuclear pharmacists had become board certified in nuclear pharmacy. Although little tangible value was initially associated with certification, certification is gradually accruing worth with recent recognition and acceptance by the Nuclear Regulatory Commission and the National Association of Boards of Pharmacy. A mechanism for recertification, which has been under development for several years, is nearing completion and will allow for periodic recertification of certified nuclear pharmacists.

Justification for Hospital-Based Nuclear Pharmacy Services

Diversification is the greatest survival strategy available to hospital pharmacy today. Nuclear pharmacy is a growing field within institutional pharmacy practice and can help ensure the profession's participation in new technologies and clinical support roles. Nuclear pharmacy practice parallels hospital pharmacy practice in many areas including procurement, compounding, dispensing, quality assessment, and drug use review. Particularly important to the practice of pharmacy are the clinical contributions by nuclear pharmacists in areas such as product selection, drug interactions and interferences, and assisting the physician in the interpretation of nuclear medicine imaging data. Hospital-based nuclear pharmacy services are closely allied with nuclear medicine and radiology, which have felt the effects of changing trends in third party reimbursement. It has been shown repeatedly that nuclear pharmacists can make an impact on the quality of nuclear medicine services, while improving the cost effectiveness of these services. For the past several years, only a few hospital pharmacies have made attempts to provide services to nuclear medicine or radiology departments. Pharmacy has a professional responsibility and obligation to become involved with the use of legend drugs routinely used (or soon to be introduced) within these departments. Nuclear pharmacy is an area in the hospital where pharmacy can make a solid financial impact and broaden its scope of recognition and value.

Magnetic Resonance Imaging Contrast Agents and the Nuclear Pharmacist

The nuclear pharmacist works with a very specific group of drugs. These drugs generally exhibit no toxic effects and are used almost exclusively for diagnosis. In the past these have been the radioactive drugs used in nuclear medicine and the iodinated contrast agents used in radiology. However, with the advent of magnetic resonance imaging (MRI), there is an additional class of drugs used in radiology, the magnetopharmaceuticals. These drugs are designed especially for increasing diagnostic sensitivity with MRI. This article is intended to provide topical insight into the basics of MRI and magnetopharmaceuticals.

Pharmacy Involvement With Positron-Emitting Radiopharmaceuticals

Positron emission tomography (PET) is an imaging process that relies on positron-emitting nuclides with very short physical half-lives (ranging from seconds to minutes). Exceptional resolution in PET imaging enables studies of the CNS (eg, highlighting deviant cell metabolism), and cardiovascular system (eg, identifying areas of reduced blood flow before coronary artery bypass surgery), among others. Increasing in popularity, PET radiopharmaceuticals pose a unique challenge to the nuclear pharmacist relative to product synthesis and quality control testing. Establishment of process validation programs with emphasis on quality, purity, and safety is all important. Various elements of process validation and quality control testing are discussed as they pertain to PET radiopharmaceuticals and the professional role of the nuclear pharmacist.

A Basic Overview of Radiopharmaceuticals and Their Relationship to Nuclear Pharmacy Practice

Radiopharmaceuticals are radioactive drugs used to diagnose and treat disease with radiation. Following patient administration of a radiopharmaceutical, γ-camera images are made of its localization and distribution within specific organs. The images obtained provide information that the nuclear medicine physician can use to make a diagnosis. Dynamic imaging studies provide functional information through measurement of the rates of accumulation and removal of the radiopharmaceutical by the organ. Static images provide morphologic information regarding organ size, shape, and position, the presence of space-occupying lesions, and relative function. In general, nuclear medicine studies can be used to determine whether a disease is present, to evaluate the progress of disease following drug therapy, and to evaluate drug-induced toxicity. Additionally, radiopharmaceuticals can be used to arrest certain types of illness through the localized in vivo destruction of diseased tissue with radiation. Nuclear pharmacists prepare radiopharmaceuticals, perform quality control tests to assure their identity, quantity, and purity before patient administration, and provide professional advice on the safe and efficacious use of these agents.

Bid purchasing of radiopharmaceuticals and radiopaque contrast media

Use of product standardization and competitive-bid purchasing for radiopharmaceuticals and radiopaque contrast media in a 1000-bed teaching hospital is described. The hospital's use of radiopharmaceuticals was reviewed, and all agents were listed with their product specifications and order quantity or frequency. Manufacturers and wholesalers were asked to submit unit prices for each of their products. Similar procedures were followed for radiopaque contrast media; wholesalers and manufacturers were asked to submit unit prices that would be guaranteed for a 12-month contract period. A nuclear pharmacist and radiologists reviewed the submitted bids and awarded contracts, basing their decisions primarily on product acceptability and selection criteria and then on relative costs of the agents. Annual costs were reduced 16% ($16,500) for radiopharmaceuticals and 21.3% ($66,500) for radiopaque contrast media. The program also resulted in decreased inventory of radiopaque contrast media and in faster and less expensive acquisition of emergency orders. Working with the radiology department to compile a standard list of radiopharmaceuticals and radiopaque contrast media and soliciting competitive bids by vendors of these products resulted in annual savings of more than $83,000.

Review of nuclear pharmacy practice in hospitals

An operational profile for nuclear pharmacy practice is presented, and the technical and professional role of nuclear pharmacists is reviewed. Key aspects of nuclear pharmacy practice in hospitals discussed are the basic facilities and equipment for the preparation, quality control, and distribution of radioactive drug products. Standards for receiving, storing, and processing radioactive material are described. The elements of a radiopharmaceutical quality assurance program, including the working procedures, documentation systems, data analysis, and specific control tests, are presented. Details of dose preparation and administration and systems of inventory control for radioactive products are outlined.