Psychiatric Pharmacy

[MolarGuy02]

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Hi all,
I was wondering if those of you who are doing your psychiatric residency have run into any psychiatric pharmacists.

I'm just curious how you as a whole view psychiatric pharmacists, and what duties in regard to inpatient care you have seen them attend to.

Also, have you seen them do things other than dispense medications (i.e., do they interact with patients?). Thank you in advance!

 

[Magree]

Hi:

I did a rotation at a VA hospital that had a pharmacist join in on rounds etc. He was TERRIFIC. Don't know if he was specially trained to do psych pharm or if it was just "happened" at this particular job. He acted as a reference to all the residents etc. Don't know if her interacted with patients or not. Hope this helps.

cheers,

M

 

[medcat3]

Yes, the Psychiatric Pharmacists that I have worked with are awesome. Anyway, the Psych Pharmacists (hereafter, PP) are an integral part of resident training and patient management. They attend pateint rounds every morning and offer input about the medications that the patients are on (and their potential side effects). Typically, a resident will start a patient on a particular med, and the PP can recommend another med or a cheaper, equally effective med if need be. The PP occasionally sees patients on an outpatient basis to follow certain drug levels but more or less they are there as an information resource for the physicians and resident physicians. They have limited patient contact on the wards and usually go through the attending or resident when they want to address certain issues regarding an in-patient. I have never seen a PP dispence meds...only unit nurses. Hope this helps!

 

[MolarGuy02]

Wow, that seems pretty interesting. I was just considering some options within the pharmacy career, and this seems like it could really fit my interests. Thank you both for replying, you guys have given me light on what psychiatric pharmacists do. 🙂

 

[ffpickle]

6 year bump.

I'm interested in psych pharm too. There were some great threads here about psychiatrist salaries, any ideas about psychiatric pharmacists' salaries?

 

[asarin]

Hello,
Well the salary definitely depends on the institution that you are working at. Speaking from experience the VA is excellent in terms of benefits and responsiblities that pharmacists are given. Private facilities may be more competitive compared to state or government agencies but can vary from state to state.

 

[BobA]

Love our PP at the VA. She's brilliant, and extremely helpful when it comes to difficult med questions. For instance, just last week I had to ask her about prescribing an antipsychotic to someone on Tikosyn (talked to cardiology also). It's super. They also do a lot of psychopharm teaching here which is fabulous. They have a level of understanding that even the best attending's don't.

 

[nitemagi]

Love our PP at the VA. She's brilliant, and extremely helpful when it comes to difficult med questions. For instance, just last week I had to ask her about prescribing an antipsychotic to someone on Tikosyn (talked to cardiology also). It's super. They also do a lot of psychopharm teaching here which is fabulous. They have a level of understanding that even the best attending's don't.

Indeed. They were the first to introduce me to the concept of the inverted U-curve with dopamine antagonists.

 

[TexasPhysician]

Responding to a 3 year old thread?

 

[whopper]

At the psychaitric hospital I work at, we have pharmacists specializing in psychiatric meds.

It does come in handy. This is a place where we have people resistant even on Clozaril and ECT.

I had a guy just a few days ago where I was considering Reserpine. He cannot take Clozaril due to his ANC going too low, can't take lithium due to poor renal health, can't take Depakote due to poor liver health, and he's very dangerous.

Some of the top psychiatrists in the country occasionally drop by here and review really tough cases and give advice.

Concerning the patient where I'm considering Reserpine, the case so far as been reviewed by over 4 psychiatrists, put through a pharm committee made of several M.D.s and pharmacists, and we're still mulling over it.

I'm even considering Tamoxifen because there's data it's a mood stabilizer. That's how bottom of the barrel his case is.

 

[nitemagi]

At the psychaitric hospital I work at, we have pharmacists specializing in psychiatric meds.

It does come in handy. This is a place where we have people resistant even on Clozaril and ECT.

I had a guy just a few days ago where I was considering Reserpine. He cannot take Clozaril due to his ANC going too low, can't take lithium due to poor renal health, can't take Depakote due to poor liver health, and he's very dangerous.

Some of the top psychiatrists in the country occasionally drop by here and review really tough cases and give advice.

Concerning the patient where I'm considering Reserpine, the case so far as been reviewed by over 4 psychiatrists, put through a pharm committee made of several M.D.s and pharmacists, and we're still mulling over it.

I'm even considering Tamoxifen because there's data it's a mood stabilizer. That's how bottom of the barrel his case is.

How about adding some lupron and calling it a day

 

[splik]

I had a guy just a few days ago where I was considering Reserpine. He cannot take Clozaril due to his ANC going too low, can't take lithium due to poor renal health, can't take Depakote due to poor liver health, and he's very dangerous.

Reserpine is a pretty powerful depressant however. Have seen patients develop severe depression on other VMAT inhibitors. Back in the day when it was a common antihypertensive (and very effective it was too) about 10% patients reportedly experienced suicidal ideation.

In terms of low neutrophil count with clozaril - have you talked to hematology about possible use of filgrastim (GCSF)? There is not much evidence but has been done. (http://www.ncbi.nlm.nih.gov/pubmed/12702898)

 

[nitemagi]

Reserpine is a pretty powerful depressant however. Have seen patients develop severe depression on other VMAT inhibitors. Back in the day when it was a common antihypertensive (and very effective it was too) about 10% patients reportedly experienced suicidal ideation.

In terms of low neutrophil count with clozaril - have you talked to hematology about possible use of filgrastim (GCSF)? There is not much evidence but has been done. (http://www.ncbi.nlm.nih.gov/pubmed/12702898)

Indeed. http://www.ncbi.nlm.nih.gov/pubmed/7525542
Though I swear I read somewhere there's then an increased risk of PML. Can't find the reference though.

 

[whopper]

Filgrastim is on the radar.

The problem now is that I'm switching jobs by next week, and I'll no longer have him. What'll likely happen is he'll go to someone that simply just cares for the guy as if it's a 9-5 job. Well yes, it is a 9-5 job, but some cases require the doctor to occasionally do exhaustive lit searches, confer with colleagues, and present in front of other doctors because the case is that difficult. This is one of those cases, but most of the doctors I know in the hospital would rather just keep the guy zonked on benzos instead of playing House (in a good way).

I had a patient in the same hospital, different unit 2 years ago, and the only thing known to help was Clozaril. She eventually developed an arrhythmia on it and had to be taken off. ECT was tried with no success. Since then she hasn't improved. I think Reserpine should be considered for her.

In cases like this, when Nasrallah shows up and reviews the case, he does tell clinicians Reserpine should not be completely off the table, but that the more conventional meds should be tried, and ECT should be considered before Reserpine.

 

[strangeglove]

Whopper: what about a calcium channel blocker?

 

[whopper]

That too is a great idea. I'm even considering pure dark chocolate. Seriously. I got a buddy with bipolar disorder, I've even seen the guy manic, and he had bad reactions to several mood stabilizers, though he hasn't been tried on any for years. The guy on his own tried nonmedical approaches to see if anything worked and per him, dark chocolate actually kept him stable-pure dark chocolate that he has to literally consume everyday. It made me wonder if this was worth putting into a study.

 

[splik]

high quality chocolate is rich in phenylethylamine which has mood boosting properties. there was a study a few years ago showing response to chocolate predicted a particular subtype of depression. not aware of anything for bipolar though.

 

[OldPsychDoc]

That too is a great idea. I'm even considering pure dark chocolate. Seriously. I got a buddy with bipolar disorder, I've even seen the guy manic, and he had bad reactions to several mood stabilizers, though he hasn't been tried on any for years. The guy on his own tried nonmedical approaches to see if anything worked and per him, dark chocolate actually kept him stable-pure dark chocolate that he has to literally consume everyday. It made me wonder if this was worth putting into a study.

I want to see your Disclosure Statement. Getting money under the table from Hershey and the Valentine's Lobby?

 

[whopper]

Haha...The guy is a professional model builder and sculptor. He has to eat large quantities of it..the nonsweetened kind that tastes like coffee grounds. The first time he told me this, I was telling him I know of no scientific data to back it up and recommended he see a doctor. He told me he did, for years, was put on lithium, Depakote, what have you and they worked, but he either could not continue his job that he loved or got very very sick. He's been on this chocolate thing for years and he tells me it's working.

I don't recommend anyone try what he did because there's no medical science behind it, but I got a case here where literally every single conventional med has been tried--and failed or the patient can't take it.

 

[Seahawksfan87]

Bump again....no one has yet given the salary for psychiatric pharmacists. Does anyone have a clue? I'm just wondering if its financially worth the residency training investment for me compared to retail.

Also I can't find that many job listings on this field or personal experiences.

 

[nitemagi]

Try posting that Q in the pharmacy forums. I don't go around asking my pharm colleagues about their salary.

 

[vistaril]

Bump again....no one has yet given the salary for psychiatric pharmacists. Does anyone have a clue? I'm just wondering if its financially worth the residency training investment for me compared to retail.

Also I can't find that many job listings on this field or personal experiences.

general clinical pharmacists require at least 1 year of a residency(sometimes2)...they'll also make less than retail pharmacicts.

I'd guess 90k for a clinical pharm vs 110-120 for retail