Pharmacist can't give info on vitamin, supplement, nutrition?

[rivatnt]

Isn't this the role of a dietician or nutritionist?

But pharmacist can check if a certain vitamin interacts with the prescription being filled. And, only slightly related, stuff like grapefruit juice may interact with a medication?

- a pre-pharmacy student

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[bananaface]

Pharmacists can advise and give info on any of the above topics if they feel comfortable.

 

[LBS615]

Actually anyone who tries to give advice on diets- such as caloric level, balance of nutrients, proper amount of vitamins needed (especially if to an athlete), type of diet to follow, amount of weight to gain or lose, can be sued if they are not a registered dietitian/nutritionist and they try to give out diet advice, i.e. sports trainers- they can not call themselves nutritionists nor give out more than basic information, unless they are certified- my trainer was aware of this- one of the few. A pharmacist can give advice about food and drug interactions, or the difference between vitamin products. I would not advise them to try to tell a client what diet is best or anything more complicated than basic nutrition- i.e. correct vitamin C level or too avoid too much Vitamin A. Pharmacy students do not receive enough nutrition education to do that. I think they gave us 3 lectures in biochem and a good bit of what the professor said was incorrect. Same goes for med students- they get very litttle info on nutrition (unless they do a fellowship in it). One of my friend's who is a doctor said he will always leave that up to the dietitian b/c he did not have enough training in it. Nutrition is a pain in the butt area b/c everone thinks they are an expert in it when in fact very few are. Leave this area to those who are trained in it- the dietitians- they are the ones most current on nutrition information.
Hpe this helps- I feel qualified to answer given I am a pharmacy student as well as I have a BS and MS in nutrition and am a registered dietitian/licensed nutritionist.

P.S. the correct way to spell dietitian is like that- not dietician- that way is no longer used nor has been for a long time- it is antiquated.

 

[dgroulx]

We've learned TPN in two different classes this year. Depending on the hospital, a nutrtionist may formulate a TPN, or it may be the pharmacist's job. We had to learn it regardless.

 

[LBS615]

We've learned TPN in two different classes this year. Depending on the hospital, a nutrtionist may formulate a TPN, or it may be the pharmacist's job. We had to learn it regardless.

TPN is different than giving out nutritional advice. I was the resource dietitian at my hospital for TPN. I did it with the physicians- the pharmacist had no interaction except to make it. It depends on the hospital how much interaction the pharmacist and dietitian have with TPN. A pharmacist can become certified in nutrition support via ASPEN but I have heard it is a very difficult test. Usually the pharmD would do the electrolytes or the MD and the RD does the calories/ AA/CHO/lipids. I had one doctor (nephrologist)that would just right the order for dietitian(me) to formualte TPN calories and I was to able to adjust at free will- he trusted my judgement regarding lipid level depending on if diprivan was already being infused, as well as if D5 was being given- which would effect the cho level. We were also taught electrolytes in one lecture- I had multiple classes as well as tons of experience working on TPN as a RD student- I had to spend one whole day in the ICU working on one TPN case once. This is one area I am interested in as a future pharmacist.

 

[bananaface]

I don't think any of us have an interest in performing a nutritionist's role without the necessary background. That would be one of those "not in my comfort level" things that we would avoid.

My school offered a nutrition elective one quarter. Not all schools cover non-core topics to the same extent.

 

[LBS615]

I don't think any of us have an interest in performing a nutritionist's role without the necessary background. That would be one of those "not in my comfort level" things that we would avoid.

My school offered a nutrition elective one quarter. Not all schools cover non-core topics to the same extent.

Probably smart- I believe in leaving things to the experts- as I would usually tell patients to consult with their physician/pharmacist if I did not feel comfortable making reccomendations on vits/mins/supplements in relation to a patient's condition and any medication they were on.

 

[npage148]

Some are pretty simple and basic. We learned a litle in therapeutics that ive used.
some examples im comfortable giving advice on, dose and admininstration
Iron deficient anemia diagnosis by a doctor (not patient)
Calcium/vit D sup for bone density
folic acid for MTX or other folic acid pathway drug
Multivitamin for a healthy adult

Their drug interactions are easy enough to spot and predict.

Thing i wont do
OTC niacin for HDL, (hepatic failure)
wacky stuff, like high dose C or B's and other stuff to cure something (pt heard about cure in teh media/friend)
wacky suppliments taht probably have no medical merit

 

[sdn1977]

OP - are you asking if we give information in an acute inpatient, outpatient or extended care setting? Each one is different! I have done them all and if you are in an acute inpatient setting with a good dietary dept which interacts well with surgeons and GI folks - then you usually collaborate. Nowadays there are often protocols which take all the fun out of it. However, I have done what LBS615 refers to and actually followed the patients nutritional status and adjusted TPN (hopefully - your pt was not on diprivan for too long - very expensive way to sedate!) When our dept stocked the nutritional supplements, the pharmacists often had to field questions about them - which we hated! There are far too many questions about drugs for the staffing levels today. We gladly sent those onto materials management and referred all questions to dietary. Now - in an outpatient setting - you have questions everyday about supplements and you'd better have an answer! Learn about Ensure, Glucerna, Boost, Pedialyte, all the vitamins and minerals you stock. There really are folks out there who need your expertise and there are no dietitians available! Then - decide what you want to tell people about the "wacky" supplements - each one of us will decide what to say based on our level of education about them and our personal choices.

 

[dgroulx]

I had multiple classes as well as tons of experience working on TPN as a RD student- I had to spend one whole day in the ICU working on one TPN case once. This is one area I am interested in as a future pharmacist.

When you get to your rotations, take nutrition. I'm not taking it, but I talked with the preceptor who is in charge of the rotation at Tampa General. I had some questions after his lecture.

Off topic - He is an expert in his field, so that lecture was held at our campus and video taped for the other campuses to watch. This happens every once in a while. UF tries to get PharmDs with vast amounts of experience in certain areas. They have several locations where they can drive to and don't have to drive up to Gainesville.

 

[LBS615]

When you get to your rotations, take nutrition. I'm not taking it, but I talked with the preceptor who is in charge of the rotation at Tampa General. I had some questions after his lecture.

Off topic - He is an expert in his field, so that lecture was held at our campus and video taped for the other campuses to watch. This happens every once in a while. UF tries to get PharmDs with vast amounts of experience in certain areas. They have several locations where they can drive to and don't have to drive up to Gainesville.

That is cool that your school offers a rotation in nutrition. I went to UF undergrad (go gators!!) and loved it, but did not want to go back for masters or pharmD after I already lived there for four years. I heard there pharmacy school is very good. I am not sure if my school offers nutrition as an elective. I have looked into residencies for nutrition support and didn't see any in Florida.

 

[rivatnt]

I was referring to handling a patient in a retail pharmacy setting. I agree that we should not be giving advice on these thing if we don't have the training.

 

[Sosumi]

We have a one credit core "Principles of human nutrition" class. I didn't get much from it. They made it a web based class this year. It went over basic nutrition principles, diets, vitamins, TPNs, and requirements in chronic diseases, the elderly, infants, and pregnant.

Our therapeutics class also cover things such as vitamin B12, folic acid, and iron deficiency anemia and how to treat them, etc. We also had an elective in complementary alternative medicine which covers herbal/dietary supplements. We also covered them in both pharmacology and pharmaceutical chemistry.

So it really depends on your level of comfort, urgency, and risk/benefit on whether you want to refer the patient to a nutritionist or give them advice and recommendations on diet, nutrition, vitamins, and supplements. Patients are always wondering when and why they have to take so many medications. Diet and exercise are too often neglected. Sometimes walking 30 minutes a day can do more wonders than taking those metformin tablets twice a day.

 

[highlyfavored]

Actually anyone who tries to give advice on diets- such as caloric level, balance of nutrients, proper amount of vitamins needed (especially if to an athlete), type of diet to follow, amount of weight to gain or lose, can be sued if they are not a registered dietitian/nutritionist and they try to give out diet advice, i.e. sports trainers- they can not call themselves nutritionists nor give out more than basic information, unless they are certified- my trainer was aware of this- one of the few. A pharmacist can give advice about food and drug interactions, or the difference between vitamin products. I would not advise them to try to tell a client what diet is best or anything more complicated than basic nutrition- i.e. correct vitamin C level or too avoid too much Vitamin A. Pharmacy students do not receive enough nutrition education to do that. I think they gave us 3 lectures in biochem and a good bit of what the professor said was incorrect. Same goes for med students- they get very litttle info on nutrition (unless they do a fellowship in it). One of my friend's who is a doctor said he will always leave that up to the dietitian b/c he did not have enough training in it. Nutrition is a pain in the butt area b/c everone thinks they are an expert in it when in fact very few are. Leave this area to those who are trained in it- the dietitians- they are the ones most current on nutrition information.
Hpe this helps- I feel qualified to answer given I am a pharmacy student as well as I have a BS and MS in nutrition and am a registered dietitian/licensed nutritionist.

P.S. the correct way to spell dietitian is like that- not dietician- that way is no longer used nor has been for a long time- it is antiquated.

Do you think being a RD gives you an "edge" in pharmacy? What made you decide to switch careers? When you interviewed did this come up? I think having both degrees is great! Good for you!