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Hospital pharmacy work experience: CDs, gentamicin and vancomycin

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I started the day in the dispensary shadowing the assistantwho oversees the running of the dispensary, she explained the workflow processand she writes every phone call down to keep a record of all queries andrequests. I then shadowed a dispenser labelling medication, she oftenhad to make a decision of how much of the medicine to supply, which is verydifferent to the situation in a community pharmacy. I learnt that when theyreceive prescriptions for HIV patients the patient’s name is not actuallylisted, they are just given a number to uphold their confidentiality. I alsosaw the process of handing over controlled drugs (CDs) to nurses and filling in the necessary paperwork required, also in the dispensary where they keep the CDs the cupboards arenot labelled with their contents for security. When CDs are dispensed there are3 checks instead of the normal 2 for extra safety. For some mental healthprescriptions you often have a photograph attached to identify the patient,which is especially useful for the nurses, as the patients are not always ableto answer questions such as their name and date of birth.

After lunch I shadowed a pharmacist on a respiratory ward,there a patient had endocarditis and was prescribed gentamicin and vancomycin, Ilearnt that they are both large hydrophilic molecules so they are notmetabolised in the liver, instead they go through the kidney therefore it isimportant to monitor the patients renal function. This is achieved throughusing creatine as a surrogate marker of glomerular filtration rate. The level of the antibiotics inthe body are monitored by peaks and troughs in the blood test results, the twoways to reduce a trough are to reduce the frequency of administration or toreduce the dose . I learnt that another indication for vancomycin is to treat Clostridium difficile in the gut, thisis because when taken orally the drug molecule is too large to be absorbed intothe bloodstream so it just acts in the gut where needed.

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