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smsc2009

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I am currently in high school and looking foward to a carrer in medicine, weather it be MD/DO or PharmD. I was reading about the different kinds of Pharmacy fields and was curious to know about Nephrology Pharmacy. Nephrologists are physicans who study the kidney. What are Pharmacists in this field? What do they typically do? After I complete my undergraduate if I were to go off to Pharmacy school I would complete a recidency + fellowship, correct? How long would that take. Nephrology Pharmacists work in a hospital setting I assume, right? I have always wanted to do something in medicine, so this is NOT about money, but I am just curious how much someone in Nephrology Pharmacy would make compared to some of the other fields of Pharmacy?
Thanks
 

sdn1977

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As soon as I say there are no Nephrology Pharmacists, one will come on here & say - here I am!!!!

However, there are pharmacists who specifically deal with acute &/or chronic nephrology problems - dialysis & transplant issues.

There is always a pharmacist on a transplant team - not for the surgical intervention, but to optimize the pt for the impending surgery or to assist with drug choice & dosing post transplant.

Likewise, there are pharmacists who consult with dialysis centers - but these are often outpt facilities which do just that - dialyize.

But...those of us who work everyday.....we all consider what the kidney is doing to the drug he/she is dispensing, giving advice on, considering, dosing, etc.

In every hospital....one of the pharmacist's jobs is to dose the drug based on the pts current renal function.....which could reflect a disease process, age or just the insult of a dye used in a diagnostic study. We want to change the dose of any drug which might become toxic in this time frame.

Likewise...in the outpt setting, we always need to have our communication skills developed so we can intervene when we sense a pt is in a compromised renal status. Take your grandparent who might be on many medications. They go along just fine every month, but....if they get a bit of a bug - perhaps from one of your cousins...and they suffer some diarrhea &/or just a bit of vomiting....well....their drugs make them more vulnurable to damage because of fluid shifts &/or electrolyte changes than your young cousin who just had a bit of flu.

So....where I am - I don't know of any particular pharmacist who just sees nephrology pts, unless they work in a transplant unit. But, my transplant units do not just kidneys, they do hearts, lungs, pancreas, colons, etc...


Does that help?
 

smsc2009

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As soon as I say there are no Nephrology Pharmacists, one will come on here & say - here I am!!!!

However, there are pharmacists who specifically deal with acute &/or chronic nephrology problems - dialysis & transplant issues.

There is always a pharmacist on a transplant team - not for the surgical intervention, but to optimize the pt for the impending surgery or to assist with drug choice & dosing post transplant.

Likewise, there are pharmacists who consult with dialysis centers - but these are often outpt facilities which do just that - dialyize.

But...those of us who work everyday.....we all consider what the kidney is doing to the drug he/she is dispensing, giving advice on, considering, dosing, etc.

In every hospital....one of the pharmacist's jobs is to dose the drug based on the pts current renal function.....which could reflect a disease process, age or just the insult of a dye used in a diagnostic study. We want to change the dose of any drug which might become toxic in this time frame.

Likewise...in the outpt setting, we always need to have our communication skills developed so we can intervene when we sense a pt is in a compromised renal status. Take your grandparent who might be on many medications. They go along just fine every month, but....if they get a bit of a bug - perhaps from one of your cousins...and they suffer some diarrhea &/or just a bit of vomiting....well....their drugs make them more vulnurable to damage because of fluid shifts &/or electrolyte changes than your young cousin who just had a bit of flu.

So....where I am - I don't know of any particular pharmacist who just sees nephrology pts, unless they work in a transplant unit. But, my transplant units do not just kidneys, they do hearts, lungs, pancreas, colons, etc...


Does that help?

So Nephrology Pharmacists help during transplants and distribute medication to people with kidney infections? Do they work in a Pharmacy? I am still a bit confused. I assume you go and do a residency after you have completed the PharmD. program? What other residency and fellowships are available besides Nephrology? Can Nephrology Pharmacists still work in a normal hospital or clinical pharmary?
Thanks for your help
 
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ForcedEntry

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Dialysis itself is a prescription; yet, you won't see a pharmacist dole it out, nor optimize it. Only a Nephrologist can choose the optimum therapy, hemo or peritoneal and which solution to use, i.e., Cobe 45X, Drake 36.83X, Acetate, Isomix, Dianeal, Extraneal, etc. They also prescribe the length of therapy, profile sodium and bicarbonate shifts, and even have a say in the type of dialyzer a dialysis clinic uses.

As SDN1977 pointed out, a pharmacist will adjust dosing based on clearances, or in a neph patients case, lack thereof. It isn't specific to kidney infections. End Stage Renal Disease, ESRD, is serious business.
 

sdn1977

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I guess I was not clear.

To my knowledge there are no "nephrology" pharmacists.

There are only pharmacists who work on services which deal with pts who have renal problems spcifically (ie renal transplant units) OR within an acute care facility in general. We ABSOLUTELY do NOT help during the transplant (are you meaning the surgery itself???) Those in transplant units deal primarily with dosing immunosupressants/antibiotics/antifungals/antiprotozoals, etc...

Any pt, at any time can become compromised renally. So, every pharmacist needs to know how to adjust a dose based on decreased renal function.

But as Forced explained - no - the pharmacist does not order dialysis. We are often called upon to tell someone if a drug can be cleared with dialysis, but we do not order the dialysis.

Check out the residency/fellowship thread. There are residencies in oncology, pediatrics, geriatrics, critical care, ambulatory care, etc....
 

smsc2009

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I guess I was not clear.

To my knowledge there are no "nephrology" pharmacists.

There are only pharmacists who work on services which deal with pts who have renal problems spcifically (ie renal transplant units) OR within an acute care facility in general. We ABSOLUTELY do NOT help during the transplant (are you meaning the surgery itself???) Those in transplant units deal primarily with dosing immunosupressants/antibiotics/antifungals/antiprotozoals, etc...

Any pt, at any time can become compromised renally. So, every pharmacist needs to know how to adjust a dose based on decreased renal function.

But as Forced explained - no - the pharmacist does not order dialysis. We are often called upon to tell someone if a drug can be cleared with dialysis, but we do not order the dialysis.

Check out the residency/fellowship thread. There are residencies in oncology, pediatrics, geriatrics, critical care, ambulatory care, etc....

Can Nephrology Pharmacists still work in a hospital or clinical pharmacy? It is just a residency and fellowship one would do, correct? I will check out that thread. In addition what does an Internal medicine Pharmacist do, can they also work in a hospital pharmacy? What would the fellowship be if I did a residency in Nephrology or Internal Medicine?
Thank you
 

Farmercyst

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Can Nephrology Pharmacists still work in a hospital or clinical pharmacy? It is just a residency and fellowship one would do, correct? I will check out that thread. In addition what does an Internal medicine Pharmacist do, can they also work in a hospital pharmacy? What would the fellowship be if I did a residency in Nephrology or Internal Medicine?
Thank you

Here's a link to different areas of specialization within pharmacy.

http://forums.studentdoctor.net/showpost.php?p=1700928&postcount=4

You'll notice some are named similarly to MD specializations, others are not. There's no real specialization in Nephrology or IM like there is for MDs just like I've never heard of a Nuclear Doctor (outside of science fiction). It might help to get semantics straight. In terms of nephrology, internal medicine, or gastroenterology (field names for MDs), your best bet would probably be critical care (ICU/NICU) or transplant. These pharmacists would most likely have the greatest exposure to drugs dealing with internal organ trauma (kidney/spleen/liver) or post-transplant immunosuppression (heart/lungs/kidney/liver). The drugs don't necessarily treat the organ, which is why they're not termed accordingly. They treat either the causes of the problem (antibiotics/fungals/protazoans) or reduce the symptoms of problems caused by organ trauma (diuretics/anticoagulants/narcotics.)

I'd check residencies listed at ASHP. You'll see the diversity of residencies out there for pharmacist trying to specialize.

http://www.ashp.org/s_ashp/residency_index.asp?CID=1212&DID=1254
 

smsc2009

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If you have a specialty like critical care, etc. Do you still work in a clinical or hospital pharmacy? I am confused at what you do differently with a specialty. If you work in a hospital would you do normal pharmacy work and then get called in certain situations?
Thanks
 

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If you have a specialty like critical care, etc. Do you still work in a clinical or hospital pharmacy? I am confused at what you do differently with a specialty. If you work in a hospital would you do normal pharmacy work and then get called in certain situations?
Thanks

Think of it this way. If you were an ER doctor, where would you work? Anywhere that has an ER. The only places with ERs are hospitals. If you were a critical care pharmacist you would work where ICUs/NICUs are located (mainly hospitals.) The other specialties also have their own niches. Some are strictly hospital, others cross multiple settings. If you can think of all the places a patient/doctor can ask for drug advice, there is typically a pharmacist in that setting. Transplantation, Oncology, Dialysis, Cardiology, etc. Some of these are outpatient clinics, others are inpatient specialty hospitals, hospice, retail, etc. There are threads on SDN devoted to what "clinical" pharmacy entails. I'll let you do your own reading on that.
 

smsc2009

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sdn1977,
I read in a previous post that you are a Pharmacists who works in the OR. I was curious what you do exacally, what is your role?
Thanks
 

sdn1977

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sdn1977,
I read in a previous post that you are a Pharmacists who works in the OR. I was curious what you do exacally, what is your role?
Thanks

Yeah - I do. Working in an OR can be tremendously boring if you don't know the people there. But - those boring times are made interesting by those I work with & are punctuated by intense moments of activity.

I'm responsible for all the anesthesia carts - making sure they're all ready to go by 5AM. In our facility, some carts are different from others, so its not just line 'em up & do 'em. I also reconcile the narcotics used - I know you're very young, so that means I make sure what has been used has been documented in the anesthesia record. I also make the cardioplegia fluids (these are IV fluids used during a heart surgery) for the following day or replace any that need replacing that day.

Finally, I respond to any unusual drug requests that are not on the anesthesia carts.....so I go in and out of the ORs. I do not do surgeries!!!!

Actually, after reading some of your questions, I've been thinking about this a bit. It appears to me as though you'd like to do something which involves acute medicine - a hospital setting perhaps, but for some reason....you also like or are being pushed into thinking about pharmacy. Am I at all close? It also seems to me that you're trying to find a "fit" for an occupation like ours into what you perceive is a practice setting you see yourself in....again - am I close?

This is all good & this is what dreams are made of. But...you can't hope to make a job out of something that is or is not there - particularly when you might not really know what specifically you'd like to do.

At this point, having not gone to college yet...you don't even know if you like chemistry enough to like pharmacy - and we are very, very chemistry intense (many years of chemistry!) - much more so than medicine. Also, if you give yourself enough time to go to college with an open mind - you'll find those areas of interest many of us didn't really find until we were there. Right now..you have an interest in working with very sick patients - in 4 years, you may have more of an interest in drug design of biologics, or bioengineering, or god-forbid - dentistry!;)

So.....having also been a mom of kids who also had to walk this path....this is what I'd suggest you do. First....work as hard as you can in school - not just to get good grades,, but to learn your material well. That's going to make college so much easier & much more fun. Then, find something in high school in which you can "expand" yourself - school politics, band, sports, leadership groups - all these will become important in not just your applications to college & later graduate schools, but also in finding our what kind of a person you are. Are you one to take a leadership role easily or are you one to help graciously after someone else sets the lead? Finally, during the summer or school breaks - volunteer at your local hospital. As a high school student, the most you might do is deliver flowers. But, if you stick with it, you'll have more involvement & be assigned to different units. This experience will also look very good on applications. Once you get to know some people, ask if you can chat up a pharmacist or a hospitalist or a respiratory tech.....there are lots of people who'll be happy to tell you what they do over a Coke. There are lots of jobs out there you'd never be able to imagine.

Good luck, have fun.......and don't close too many doors too soon!
 

smsc2009

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Yeah - I do. Working in an OR can be tremendously boring if you don't know the people there. But - those boring times are made interesting by those I work with & are punctuated by intense moments of activity.

I'm responsible for all the anesthesia carts - making sure they're all ready to go by 5AM. In our facility, some carts are different from others, so its not just line 'em up & do 'em. I also reconcile the narcotics used - I know you're very young, so that means I make sure what has been used has been documented in the anesthesia record. I also make the cardioplegia fluids (these are IV fluids used during a heart surgery) for the following day or replace any that need replacing that day.

Finally, I respond to any unusual drug requests that are not on the anesthesia carts.....so I go in and out of the ORs. I do not do surgeries!!!!

Actually, after reading some of your questions, I've been thinking about this a bit. It appears to me as though you'd like to do something which involves acute medicine - a hospital setting perhaps, but for some reason....you also like or are being pushed into thinking about pharmacy. Am I at all close? It also seems to me that you're trying to find a "fit" for an occupation like ours into what you perceive is a practice setting you see yourself in....again - am I close?

This is all good & this is what dreams are made of. But...you can't hope to make a job out of something that is or is not there - particularly when you might not really know what specifically you'd like to do.

At this point, having not gone to college yet...you don't even know if you like chemistry enough to like pharmacy - and we are very, very chemistry intense (many years of chemistry!) - much more so than medicine. Also, if you give yourself enough time to go to college with an open mind - you'll find those areas of interest many of us didn't really find until we were there. Right now..you have an interest in working with very sick patients - in 4 years, you may have more of an interest in drug design of biologics, or bioengineering, or god-forbid - dentistry!;)

So.....having also been a mom of kids who also had to walk this path....this is what I'd suggest you do. First....work as hard as you can in school - not just to get good grades,, but to learn your material well. That's going to make college so much easier & much more fun. Then, find something in high school in which you can "expand" yourself - school politics, band, sports, leadership groups - all these will become important in not just your applications to college & later graduate schools, but also in finding our what kind of a person you are. Are you one to take a leadership role easily or are you one to help graciously after someone else sets the lead? Finally, during the summer or school breaks - volunteer at your local hospital. As a high school student, the most you might do is deliver flowers. But, if you stick with it, you'll have more involvement & be assigned to different units. This experience will also look very good on applications. Once you get to know some people, ask if you can chat up a pharmacist or a hospitalist or a respiratory tech.....there are lots of people who'll be happy to tell you what they do over a Coke. There are lots of jobs out there you'd never be able to imagine.

Good luck, have fun.......and don't close too many doors too soon!


Your right on actually. I have thought about Anesthesia, and possibly Internal Medicine with a subspecialty in Nephrology. (MD/DO) (that is why I ask about Nephrology in Pharmacy) and Pharmacy (PharmD.). Your also right in the fact that I do want to work in a hospital. Again your right, I know little about Chemistry, not to much, but I have enjoyed the little things I have learned. I have already started to volunter at a hospital and plan on doing it for a long time. I have spoken to my local Pharmacist about subjects concerning school for Pharmacists, nothing to indeph (nothing concerning Pharmacy residencies) basic stuff, what they do, where they are needed, etc. He has encouraged me to go for the PharmD. saying that there are alot of good things happening in the career. I am a people person. The MD is something that has always been on my mind, even as a younger kid. (I come from a family that has a few MD's and DDS's) I have just always wanted to do something in medicine. I believe now is a good time to put my thoughts into actions, again I have known for many years that I want to do something in medicine. To be honest I just recently found out about the PharmD. and since have become interested in the field.
 
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