September 3, 2021

by Justin Cole, Pharm.D., BCPS

A primer on nuclear pharmacy

Nuclear pharmacy is a specialty pharmacy practice that focuses on the use of radioactive drugs, or radiopharmaceuticals. Common diagnostic procedures like a cardiac stress test rely on radiopharmaceuticals to clearly image particular organs in the body, such as the heart. Dr. Andrew Brown, Manager of Quality Assurance in the Pharmacy Practice Division of Nuclear and Precision Health Solutions at Cardinal Health, explains that this is like adding a “flashlight” to a drug that is illuminated wherever it goes in the body. However, the utility of radiopharmaceuticals is also an important part of therapeutics. Imaging attaching a “hand grenade” to a compound instead of a flashlight, with the intent of damaging the targeted cells. This therapeutic approach has been a mainstay for certain thyroid disorders, accomplished through the use of radiopharmaceuticals.

… nuclear pharmacies require skilled nuclear pharmacists to serve as the radiopharmaceutical experts.
Radiopharmaceuticals have a limited window for use, as they are constantly and rapidly decaying. They also can have risks if unintended radiation exposure happens anywhere along the medication use process, from preparation to administration. Thus, nuclear pharmacies require skilled nuclear pharmacists to serve as the radiopharmaceutical experts. They are often found closely integrated with nuclear medicine departments, nuclear medicine physicians, and patients. The preparation, transportation, and administration of radiopharmaceuticals are heavily regulated by state boards of pharmacy, departments of transportation, the Nuclear Regulatory Commission, and other regulatory bodies. Pharmacists in this role must maintain an understanding of these regulations to ensure the safety and efficacy of each product.

Drivers of change in radiopharmaceuticals

Nuclear pharmacy in the United States has experienced constant change, and the pace of this change continues to accelerate. Initially, many nuclear pharmacies were found in large medical centers. As the use of radiopharmaceuticals expanded across the nation, the production of these agents became more centralized. Looking into the future, Dr. Andrew Brown believes that two additional shifts are on the horizon: expansion of the use of positron-emitting isotopes and development of novel therapeutic radiopharmaceuticals that can select for specific cells or other molecular targets. Positron-emitting isotopes are the new and improved “flashlights” of medical imaging, while therapeutic radiopharmaceuticals are the “hand grenades” of nuclear medicine. According to Brown, “If you can get a drug that isolates to a cancer cell line, you can usually treat it.” Additionally, new standards from the United States Pharmacopeia will change the way radiopharmaceuticals are handled, prepared, stored, and transported. Expect to see GPS-enabled tracing and the use of data analytics to improve processes and care in the future.

To hear more about innovation in nuclear pharmacy, listen to our latest episode of DISRxUPT, a podcast of the Cedarville University Center for Pharmacy Innovation. In this episode, Dr. Andrew Brown talks more about nuclear pharmacy and changes that he expects to see in this practice area into the future.

Dr. Justin Cole is the Director of the Center for Pharmacy Innovation. He also serves as Associate Professor and Chair of Pharmacy Practice in the Cedarville University School of Pharmacy. Dr. Cole’s interests include pediatrics, pharmacogenomics, immunizations, healthcare leadership, and pharmacy practice advancement.

The Cedarville University School of Pharmacy is equipping its Doctor of Pharmacy students to be on the leading edge of healthcare innovation. Cedarville’s Pharm.D. students are fully prepared to begin a rewarding career as a pharmacist and to use their calling to make a difference for Christ as they serve with excellence and compassion.

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