They don’t only dispense medicine, but also advise doctors on the best course of medication and ensure patients take their medication correctly.
Most patients in hospital see the pharmacist as someone they go to when they need a prescription filled. What is not so obvious to them is that more than just dispensing medicine, the pharmacist plays an important role in ensuring effective treatments for patients.
#1 Pharmacists advise doctors on the best course of medication
“Pharmacists spent four to nine years in pharmacy school learning how drugs affect the body and how the body processes drugs. They are well-trained in how medications are absorbed, distributed in the body, metabolised and excreted, and this places them in a good position to advise the right medicine for the disease, the right dose and the right way of using it,” says Dr Lim Tze Peng, Senior Principal Pharmacist Researcher.
"For example, some antibiotics mainly go into the bloodstream and remain there, while others don't stay as much in the blood but move into the tissues. To treat a bloodborne infection, the pharmacist will suggest an antibiotic that stays in the bloodstream."
Pharmacists also have vast knowledge of how medications interact, so they know the potential unwanted effects to look out for, and what can or cannot be given together. Dr Cassandra Chang, Senior Clinical Pharmacist, explains, “Some medicines shouldn’t be taken together, or they have to be spaced apart. For example, carbamazepine - a drug prescribed for nerve pain - reduces the efficacy of the blood thinner rivaroxaban by half. If a doctor prescribes rivaroxaban for a patient who is on carbamazepine, the pharmacist will suggest switching to another blood thinner, or replacing carbamazepine with another drug that has no interaction with rivaroxaban.”
Tze Peng adds that "if the patient is not getting the right medicine in the right dose, or not using his medicine correctly, he will not be getting the most effective therapy."
#2 Pharmacists check that patients are taking their medicine as prescribed
When filling a prescription, the pharmacist is always on the alert to ensure the right drug, the right dose and the right way of using it.
Cassandra recounts an incident where a patient on warfarin came for a refill much too soon. “She said she had no more medication. Looking at her collection history and date, I noted that she had been given 30 days of medication upon discharge. But it's only 10 days past, so where is the rest of the medication? That raised a red flag and I asked the patient how she had been taking her medication. Apparently, her helper had been giving her three tablets a day instead of one daily. I immediately ordered lab tests for the patient. She was at an increased risk of very serious and possibly fatal bleeding. I called the doctor at once to assess the patient. She was admitted and treated with Vitamin K to reverse the blood thinning effects of warfarin."
#3 Pharmacists research and develop new treatment strategies
Sometimes, we may have the right medicine but it is not useful for the patient. “This happens in the case of antibiotic resistant bacteria,” explains Tze Peng. “When the lab reports tell us that almost all the antibiotics available are useless against the identified bacteria, what then can we do for the patient?”
To develop new treatment strategies, Tze Peng conducts research to find new antibiotic combinations that can treat deadly bacterial infections in the most effective manner.
“If an antibiotic is ‘useless’ against multi-drug resistant bacteria, would combining two such antibiotics make them less ‘useless’ and provide a potential lifeline to the infected patient? This inkling gave birth to our guided antibiotic combination therapy that is used to treat multi-drug resistant bacterial infections. The team discovered that there is no one magic combination that is effective against all kinds of multi-drug resistant bacteria. However, we developed a test that allows us to screen between 100 to 200 different antibiotic combinations quickly so we can find which combinations are most effective. Based on the patient’s clinical profile, we then select a first or second choice antibiotic combination for treatment.”
As medical problems become increasingly complex, coupled with the rapid advancement in technology, pharmacists with advanced training are well-positioned to play lead roles within the multi-disciplinary care teams in the clinical and research settings, to push the envelope in improving patient care. Adds Tze Peng, “Dispensing medicine to patients is still a critical job, however, I hope more people recognise that pharmacists actually do a lot more to contribute to effective treatments for patients.”
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