Wednesday, September 24, 2014

Compounding in Pharmacy School

One of the more stressful parts of Pharmacy School so far has been compounding.  Compounding prepares a specific product for a specific patient.  As opposed to manufacturing that provides a more generalized approach.  You can remove excipients that might cause allergic reactions or you can simply change one formulation for another.  A lot of this is done for pediatrics turning a large tablet into a liquid.  So far in three semesters, we have made creams, sticks, solutions, and suppositories.

The actual compounding can be fun.  Manipulating ingredients to help a patient.  The stress comes from rest of the process.  We have a quiz on the various formulations in the form of questions written by the man who wrote the textbook regarding compounding.  We must complete a compounding record that includes the manufacturer, lot number, and exact amounts of every ingredient.  We counsel our TA as if s/he were the patient, so we memorize the major counseling points.  And every product is tested to make sure it is within 10% for the stated strength.  If your products falls outside of 10%, you have to come back and remake it.  If you are too far outside, especially too high, you have "killed the patient" and receive a zero without the option to remake it.

But I learned last week that not every pharmacy student goes through this.  In fact, only half of the pharmacy schools do any compounding at all!!!  For some, compounding is little more than an elective course that students take for a semester.  Few compound as regularly as we do.  Of those, very few routinely test the products for accuracy.  And we seem to be the only school that tests every product that gets made.  That means that they just go through the motions and hope that the products are good.

Much of this comes from budgeting concerns.  Compounding is expensive.  I know.  I bought lab supplies for my classroom.  It's not easy.  Checking the products takes more money and time.  Things that can be rare in a pharmacy school.

But compounding is important.  A study randomly checked some compounded products from some pharmacies and found a wide range of accuracy, from drastically underdosing (essentially a placebo) to dramatically overdosing (more than 400%).   A lot of the range comes from technique.  We hear a lot about quantitative transfer.  We routinely make 10% extra product to account for loss.  But in all, compounding is an important skill.  A licensed pharmacist may never, ever compound during there career.  But all pharmacists should know how to do it.  It's like parallel parking.  I avoid parking that way, but to get my driver's license I had to display enough control of a car to complete the task.  Maybe compounding should become an essential part of a PharmD degree.

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