Lara Albrechcinski is a final-year PharmD candidate at the St. John’s University College of Pharmacy and Health Sciences.
As student pharmacists, we are familiar with the roles and responsibilities that a pharmacist has in the community; pharmacists are well-known for being one of the most trusted and accessible health care professionals for patients. However, the pharmacy profession extends beyond one-on-one patient care and medication reconciliation. One of the many ways that pharmacists can make an impact is through nuclear pharmacy.
During one of my recent APPE rotations, I had the opportunity to shadow a nuclear pharmacist and learn about this unique field of medicine.
Creating radiopharmaceuticals
Nuclear pharmacy involves compounding radioactive drugs, or radiopharmaceuticals, for nuclear medicine departments or outpatient clinics so they can diagnose or treat specific diseases; for example, radiopharmaceuticals are used in positron emission tomography (PET) scans to look for signs of cancer, heart disease, or brain disorders.
There are many different types of radiopharmaceuticals based on which isotope is created. The radiopharmaceuticals manufactured at my APPE site were called florbetapir F-18 (Amyvid), and F-18 fludeoxyglucose (FDG).These drugs are made through a multi-step process in a machine called a cyclotron. To keep it simple, the cyclotron accelerates atomic and sub-atomic particles in a spiral motion using a radiofrequency field (RF), similar to the RF used in radio station broadcasts, and powerful magnets that are many times stronger than the Earth’s magnetic field. Once the particles gain sufficient energy, electrons are extracted and strike a carbon extraction foil within the cyclotron to become protons. A proton is fired into a target holder; in the case of FDG, the proton comes from hydrogen gas and the target holder contains oxygen-18 enriched water. The nucleus of the target material absorbs a proton and transforms into a new radioactive element. The F-18 isotope is then transferred to a chemistry module to be trapped, prepared, radiolabeled, hydrolyzed, and purified to produce FDG. This process of creating radiopharmaceuticals takes about 2 hours.
Since the half-life of FDG is 110 minutes, there is a small window of time in which this medication can be used. Each batch has to be made the day of the patient’s procedure. Therefore, a nuclear pharmacist usually clocks into work at 4:00 AM.
A nuclear pharmacist is also in charge of scheduling doses and shipments to facilities, overseeing the creation of each batch of radiopharmaceuticals, performing quality-control testing, and sterile compounding of each medication. What’s special about sterile compounding for these drugs is that in addition to normal sterile conditions, the nuclear pharmacist uses mechanical arms through a closed hood in order to lessen their potential radiation exposure. In fact, nuclear pharmacists and technicians never come into contact with the radiopharmaceuticals they create without some sort of shielding. When all the precautions and safety measures are taken, nuclear pharmacy is not as dangerous as it might sound!
A rewarding rotation
Nuclear pharmacy would be great for individuals who have an interest in radiochemistry, are well-versed in compounding, and prefer less one-on-one patient interaction. Not only was my APPE experience unique, informative, and interesting, it felt incredibly rewarding to handle these special drugs that benefit multiple patients each day. In areas like nuclear pharmacy, pharmacists can truly make a difference in health care.