Carley Puckett
Amy Denson
Organic Chemistry II
22 March 2018
Carley Puckett
Amy Denson
Organic Chemistry II
22 March 2018
Specialization in Pharmacy
Society often views pharmacy as an occupation in which medication is sorted and given to a patient at a drug store. Though some pharmacists do serve a broad range of people, some have a very targeted audience. Though they are not particularly common, specializations in pharmacy do exist. A few examples of said specializations are psychiatric pharmacy, geriatric pharmacy, pediatric pharmacy, and nuclear pharmacy. Pharmacy is a complex occupation in which many concentrations can exist.
The school of pharmacy curriculum, in general, teaches basic pharmacology and toxicology while touching on different specializations. Some further instruction, however, can be required when a doctor of pharmacy desires to extend their career to a specialized area of medicine. In 1976, the Board of Pharmacy Specialties, BPS, was created. This corporation served to qualify certified pharmacists to specialize deeper into the field of pharmaceuticals. The establishment’s main goal from the beginning has been to reach out to certain groups of people in order to ensure the best and most comfortable life possible. Currently, the BPS has established seven specializations in the field: “Nuclear Pharmacy, Nutrition Support Pharmacy, Pharmacotherapy, Psychiatric Pharmacy, Oncology Pharmacy, Ambulatory Care Pharmacy, Critical Care Pharmacy, Pediatric Pharmacy, Geriatric Pharmacy, Cardiology Pharmacy, Infectious Diseases Pharmacy” (Lawson).
The Board of Pharmacy Specialties operates by instituting the requirements needed in order to work in a concentration. They create the criteria and administer the exams that certify pharmacists who are seeking to expand their profession. In order to qualify for specialization, the pharmacist must hold an active license and have experience within the specialty he or she desires. The amount of experience varies according to the specialization chosen. They will also have to pass an examination. Each examination will contain 175 multiple choice questions relevant to the field of study (Lawson).
Though certain pharmacists specialize, this does not mean that they are not qualified in the general area. Each specialized pharmacist will complete the required curriculum for a general pharmacy degree. The curriculum necessary for a doctorate in pharmacy does instruct pharmacists on how to treat patients such as geriatrics and psychiatrics, but it does not often teach all that is required to specialize. When a pharmacist has a passion for a certain state, they will study further into the profession and thus, specialize (Carter).
Psychiatric pharmacy is a crucial specialization that should receive more recognition. Fortunately, in recent years, there has been an advancement in the amount of colleges that train pharmacists to specialize in psychiatric pharmacy. Today, 75% of United States colleges that offer the pharmacy program commissioned at least one psychiatric pharmacist. According to the John Hopkins Medical Institute, 26% of all Americans will be diagnosed with a mental or psychiatric illness in their lifetime. Psychiatric conditions are also life-long and often have no cure. They require constant treatment. These patients will undoubtedly require medical attention for these disorders. Because of this statistic, it is clear that pharmaceuticals are needed to cater to these individuals. Drugs that target these conditions encapsulate 13% of the 300 drugs that are most commonly prescribed. Specialized pharmacists are needed to specifically reach patients suffering from these psychiatric issues (Cates et al.).
As discussed prior, psychiatric conditions are extremely common in society. Not only are they large in number, but they are also vast in variety. There are mood disorders, eating disorders, anxiety disorders, and personality disorders. This only names a few; the list is endless. As one can imagine, if the list of disorders is vast, the amount of treatments is massive. Specialism in this field is crucial in keeping all of the medicines in order and making sure patients receive the care they deserve (Cates et al.).
Contrary to popular societal belief, pharmacists do not solely prescribe and deliver medicines. Pharmacists receive a lot of training in counseling patients on what the pharmaceuticals aim to remedy. They are also trained to teach clients the correct dosages and proper ways to take the medications. A psychiatric pharmacy specialization would aid those who chose to specialize in psychiatric medication to properly equip patients for what they need to know when taking medication: side effects, dosage, additional information (Cates et al.).
Another important specialization is geriatric pharmacy. It is evident that care for the elderly has and will always exist. Because the elderly in general are more fragile, their bodies can often not handle major surgery. For this reason, most serious illnesses are treated with medication. “Prescription medications are generally targeted to each individual medical problem identified in a given patient and are prescribed to effect a cure, improve symptoms, and stabilize, or at the very least, slow decline in that condition” (Keys et al.) As the previous quote stated, a cure is not always what the medicine aims to find. Often, the purpose of the medicine is to ensure comfort and stabilize the patients as they live with an illness (Keys et al.).
Senior adults, on average, will be prescribed more than one medication. Often times, the amount of medication they are prescribed is quite vast. Specialization in the field of geriatrics is crucial to ensure that all of the medication reacts properly with each other. Steven Atkinson stated in his book Geriatric Pharmacology, that out of all hospitalizations of the elderly, 30% occurred as a result of an error in medication. Another issue can arise because of the excessive amount of medication: confusion. Because the geriatric patients are taking so many medications, it is easy to get them mixed up. This is where pharmaceutical counseling is crucial. Geriatric counseling differs from normal pharmaceutical counseling. The elderly should be seen as a separate group in which certain combinations of medicines are no longer safe. Because of these unique crossover issues, geriatric specialism is very important. As a specialized geriatric pharmacist, one would not only learn how the medicines react, but also how to properly train patients in taking and organizing their medications (Atkinson).
Today, there are around 4,400 board certified geriatric pharmacists. These pharmacists often work in nursing homes where they have one on one consultations with patients. Some geriatric pharmacists do not even distribute medication. Their sole job is to train and counsel patients (Atkinson).
Pediatric pharmacy is another area that has need for specialization. Pediatric pharmacy caters to people ranging from newborns to 18 years of age. Most medication that is manufactured today is created for the adult body. Michelle Meadows stated, “Only 20 percent of 30 percent of drugs approved by the Food and Drug Administration are labeled for pediatric use.” It is also more difficult to test medications on infants and children due to ethical reasons; therefore, an extensive knowledge on drugs can be critical in determining the safety of using a particular drug on a child (Meadows).
Though the age range they deal with is large, it is important to remember that infants have drastically different dosages than adolescents. Most pediatric pharmacists live by these words, “kids are not just little adults." When it comes to children and infants, weight plays a major factor in dosage. With adults, on the other hand, dosages are often determined by age and that age’s ideal weight (Simpson). However, because of the variance in the weights of children, dosages are often given according to an individual child’s weight, but it is also important to remember that children metabolize medication at a different rate than adults. This also plays a key role in determining dosage (Meadows).
Pharmacists also check vital signs. It is important to note that the vital signs of a pediatric patient will vary from an adult patient. For example, a high heart rate for an adult may be above 100 beats per minute. For an infant, however, this is quite normal and no medication is necessary. All of the vital signs will vary when it comes to age. It is important to remember this when determining the health of a child (Simpson).
When it comes to counseling, a pediatric pharmacist does not necessarily counsel the children. For infants and young children, a lot of the information will be relayed to the parents of the child. Delivery is an important factor when it comes to children because it is often difficult to have a child willingly take medication. A pediatric pharmacist will help to equip parents with the best knowledge in treating their child. Medication is often snuck into formula, or some type of pureed food. Adolescents, on average are capable of taking and organizing their own medication but the information is still shared with their guardians (Simpson).
The condition that caused a spark in interest in specialization was nuclear pharmacy. This branch was the first to ever be an official specialization for a pharmacy degree. Nuclear pharmacists focus on the use of radiopharmaceuticals (Shaw and Ice). Nuclear pharmacy is perhaps the most complex specialization. It is often dangerous and involves cautious care and the use of fume hoods. The specialization of nuclear pharmacy often has the pharmacist creating a radiopharmaceutical (Page).
Nuclear pharmacists use a cyclotron. A cyclotron is a machine in which nuclear reactions take place. The radiopharmaceuticals are created when a vacuum causes charged particles to move rapidly causing increased energy. After this occurs, the charged particles are transferred to a more stable element. This causes a nuclear reaction to occur, and thus, a radiopharmaceutical is formed. Because this process is so complex, it is important that there are specialized pharmacists who choose this as their expertise (Page).
It is clear that some pharmacists will choose to specialize in disorders, but some pharmacists will choose to specialize further. As stated before, it is a common misconception that pharmacists solely distribute drugs and counsel the public. However, some pharmacists work behind the scenes. Most pharmacy students do not even realize that further specialization can occur. Michelle Foust, Pharm.D., stated, "None of us knew about this opportunity when we were in school," says Foust. "And my parents still don't know what it is that I do” (Hede). The opportunity she is referring to is the option of working behind the scenes. Michelle is a certified pharmacist who spends her days working in labs developing medication. In order to further specialize into the field of research, pharmacist will earn a standard pharmacy degree and then further advance their degree into clinical research (Hede).
There are many benefits to specializing deeper into the field of pharmacy. First of all, it is quite simple. Through experience and a short examination, one can be certified as a specialized pharmacist. One obvious benefit is the well-being of the people being treated. When a pharmacist specializes in a certain condition, the people who are treated benefit greatly because they are being served by a person who has extensively studied their condition. Though salaries will differ depending on varying factors, on average a specialized pharmacist will receive more income than a general doctor of pharmacy. The increase in income, however, is usually quite slim. Through weighing the pros and cons, it is clear that every pharmacist should consider specialization (Lawson).
Overall, pharmacy is a vast field in which many specializations can be earned. There are many different options for many different people. Pharmacy is often considered to be a boring job that will cause your feet to hurt after a day’s work. Pharmacy, however, can be very complex and exciting. Though it is not for everyone, specializations help to broaden the range of people who may pursue a pharmacy career. Whether one wants to cater to the general public, a specific disorder or condition, or create the medicine themselves, pharmacy is an excellent career choice that is always changing.