H-IPPE: Special Formulations

I spent a day in Special Formulations area tucked into a small corner in the back of the Central Inpatient Pharmacy.  This was one of the days I looked forward to the most for the IPPE.  I ACTUALLY enjoy compounding because it is more like old school pharmacy (as the chemist or apothecary).  Most medications come straight from the manufacturer as a pill, but some have to be prepared into an IV bag or oral syringe.  Compounding changes a manufactured product into something else.  This is where the mortar and pestle of the pharmacy come from, and they had a huge mortar.

During our short tour, I realized that it pretty much looked just like my chemical storerooms in the high schools but with a variety of drugs instead of salts, vinegars and aluminum foil.  Also the graduated cylinders and beakers were much larger.  I only got through two compounds today, while my preceptor whizzed through almost 10.  Though She has been a tech at UNC for over 20 years and before that she was a pharmacist in Peru.  Very nice lady and super helpful.  Here's what our IPPE students got to make during our month:

• Nimodipine - Comes in capsules that must be punctured and drained to create an oral solution patients with feeding tubes. Indicated for Subarachnoid Hemmorage
• Vancomycin - Injectable, lypholized that must be reconstituted (with Sterile Water for Injection) and mixed with Ora-Sweet and Sterile Water for Irrigation to create an oral solution. Indicated for bacterial infection
• Mafenide - Yellowish powder that must be added to 1L of Sterile Water for Irrigation. Indicated to prevent infections in burn patients.
• Magic Mouthwash - A mixture that contains nystatin, diphenhyrdamine and sterile water. Indicated for oral candidiasis
• Ursodiol - Comes in capsules that must be unscrewed and finely ground and mixed in a mortar. Indicated for the treatment of primary biliary cirrhosis

For some reason, many of my classmates dislike compounding.  It is just like cooking.  You follow a recipe, except that you have to accurately record the ingredients that you use (Amount, Name, Manufacturer, Lot Number, and Expiration Date).  Some pharmacies focus entirely on compounding and ship out to local hospitals.  But also, some compounding pharmacies have found trouble with their products and over stepping their bounds (that is a post for another day).  If you like baking or you enjoyed chemistry labs, you would have enjoyed a day with Special Formulations.