Initiation of Nuclear Pharmacy at Pediatric Oncology Hospital in a Developing Country

1. Initiation of Nuclear Pharmacy at Pediatric Oncology Hospital in a Developing Country Mahmoud M. El-Sherif B. Pharm Department of Pharmaceutical Services Children’s Cancer Hospital 57357 - Egypt mahmoud.elsherif@57357.com

2. Children’s Cancer Hospital 57357 - Egypt Vision To  be  the  unique  worldwide  model  of  change towards  a  cancer‐free  childhood. Mission Building a sustainable foundation to   prevent and combat  cancer  through Research,  Smart  education  and  Quality  healthcare provided  with  passion  and  justice  to  alleviate  the  suffering  of children  with  cancer  and  their  families Free of charge. www.57357.org

3. Introduction • A radiopharmaceutical is a radioactive compound used for the diagnosis and therapeutic treatment of human disease. • The Major use of Radiopharmaceuticals is for diagnostic purposes. • Because they are administered to humans, they should be sterile and pyrogen free, and should undergo all quality control measures required of a conventional drug.

4. Introduction • At many developing countries : Radiopharmaceuticals and Contrast Dyes are not treated with the same care as other medications. Some healthcare personnel may not consider them even a medication. • The major cause of that is the absence of pharmaceutical services from Nuclear Medicine departments.

5. Baseline ??

6. Why having a nuclear pharmacy is important ? • In a nuclear pharmacy radiopharmaceuticals are prepared, stored, and dispensed primarily for human use, just as regular drugs are in a pharmacy. • The nuclear pharmacists can provide education and consultation to the patients and health care personnel in this field.

7. Why having a nuclear pharmacy is important ? • The nuclear pharmacist monitors adverse drug reactions , drug-drug interactions , drug-chemotherapy interactions and drug-food interactions. • Documentation and Follow up.

8. Initiating Nuclear Pharmacy • Pharmacist training for Radiation safety procedures ( attending training program for the use of radioactive materials and Radiation protection procedure held by Egyptian Atomic Energy Authority ).

9. Initiating Nuclear Pharmacy • Applying CCHE policies and procedures for : • Medication ordering • Order review • Pharmacy verify • Medication dispensing • Inventory procedures

10. Initiating Nuclear Pharmacy • Radiopharmaceutical dosing Update : • Doses of radiopharmaceuticals and contrast dyes were revised and updated according to the latest versions of product monographs, taking in consideration the sensitivity of devices available at CCHE

11. Initiating Nuclear Pharmacy • Setting up Documentation procedure integrated with Hospital Information System for : • Radiopharmaceutical use • Dose documentation • Dose labeling • Adverse drug reaction documentation

12. Initiating Nuclear Pharmacy • Starting improvement project for the Hot Lab used for preparing and compounding radiopharmaceuticals to meet the standards of producing a sterile and pyrogen free product . (modification process is not completed yet )

13. Nuclear Pharmacy • Nuclear Pharmacy ( also known as Radio Pharmacy ) serves : • Radiology Department • Nuclear Medicine Department • Radiotherapy Department

14. Nuclear Pharmacy • Commonly used Radiopharmaceuticals: • 18F - Flurodeoxyglucose • 99mTc - Dimercaptosuccinic Acid (Succimer) • 99mTc - Pentetate (DTPA) • 99mTc - Methylene diphosphonate (MDP) • 131I-Metaiodobenzylguanidine (131I-MIBG)

15. Radio Pharmacy • Commonly Used Contrast Dyes : • Iodinated Contrast Media : • Iohexol ( intravenous ) • Gadolinum Based Contrast Media : • Gadodiamide ( intravenous )

16. Achievements • All radiopharmaceuticals, contrast dyes and other medications including emergency and anesthesia medication, are regularly documented and managed with the same manner of any other medication. • Documentation of all pharmacy clinical interventions, adverse drug events and patient allergies

17. Achievements • Encouraging patient safety by : • Reviewing patient’s medication history and allergies before administration. • Checking kidney function and liver function on a regular base before using any contrast dye. ( including PET-CT scan )

18. Achievements • Integration with Hospital Information System served at reduction of contrast media usage by checking any duplication; specially during initial evaluation of new case, where both CT scan and PET-CT are required. In this case, PET-CT scan is modified to cover the required information with a single use of CT contrast media.

19. Thank you Mahmoud Mohamed El-SherifDepartment of Pharmaceutical Services Children’s Cancer Hospital 57357 - Egypt mahmoud.elsherif@57357.com