P & T Update!

The three of us residents attended a VIHA Pharmacy and Therapeutics (P&T) meeting and listened in while the committee members worked through items on the agenda. These included medication use issues such as changes to the IV monograph to determine who may administer propofol and the decision to standardize the compounding of ‘pink lady,’ a medication used in the evaluation of chest pain in the ER. I found it interesting to see the level of detail that went into each decision and how accurate the wording of policy needed to be. For a change in IV monograph policy, interdisciplinary discussion was necessary to ensure that the document was interpreted correctly and that it reflected the desired changes in practice. There is definitely a whole lot of discussion that goes into a ‘word’!

The meeting ended with a very educational presentation of subsequent entry biologics (SEB). Dan Martinusen discussed how SEBs are not simply biologic generics. Biologics are synthesized through a biological system and are often more structurally complex and variable than drugs are chemically synthesized meaning that a SEM may not be equivalent to the originally marketed biologic.

It was a good primer as more and more biologics come off patent over the next six and the industry is faced with multiple SEBs, our P&T committee members (possibly one of us) will need to determine which of the SEBs to add to the VIHA formulary. This will involve taking into consideration factors such as the cost, demand and the difference in the pharmacokinetics and the pharmacodynamics of the SEB vs. the reference biologic.

During the didactic portion of our MUM rotation, we summarized the role of the of the VIHA P&T Committee and discussed it’s role in ensuring high-quality drug therapy for patients in hospital and in acting as a liaison between pharmacy and medical staff. Attending the P&T meeting was a great way to see this in action.

Medication Use Management

This week we were orientated to the role of the Medication Use Management (MUM) pharmacists including their role in provincial hospital formulary management and drug use evaluation. We had the unique experience of collaborating to write a Provincial Formulary Review draft with Lara, one of the lovely MUM pharmacists. We were charged with evaluating the evidence for the use of SMOFlipid, a lipid product available for TPNs (no relation to the lovable dragon from the Hobbit). Although this was just a small taste of the process, it gave me an appreciation of amount of research and time is invested into formulary request reviews. It was interesting to evaluate the literature and learn which factors need to be considered before adding a medication to formulary. Through this experience and the didactic portion of the rotation, I am more equip to answer interdisciplinary queries regarding the drug formulary, SAP medications and medication shortages. I am really looking forward to attending the P&T meeting in October! I will have to wait and see if the review we worked on is discussed then, I’ll keep you updated!