Thread by @mmPharmD

👇🏻 An intro to Monica, a pharmacist. Inspired by @Sarah_Mojarad (who I've followed for a while to learn all sorts of Twitter and SoMe tricks. Now here to flip the tables!)

(Disclaimer: this is being written while the kiddos are taking baths, so expect distractions and a prolonged writing period.) 🛀

I fell into pharmacy after getting a job in retail pharmacy after my 1st year of college. I think I was pre-med (read: no idea what to do with my life).

At my job, I saw the pharmacists standing behind computers, wearing white coats, and thought "I could do that!"

Hahahaha. Little did I know how different pharmacy was.

I transferred into pharmacy school for my 3rd year.

Yep! Pharmacy school is 6 years & we graduate with a doctorate of pharmacy

You can either do all 6 years out of HS, or you can get a bachelor's & do the last 3-4 yrs

I attended @MCPHS in Boston.

I quickly realized retail/community wasn't for me and wanted to do a residency for additional, optional training.

I thought I was going to be an ambulatory care pharmacist and work in the VA.

The MATCH ... had other plans

Pharmacist residencies go through a MATCH process similar to physicians. To my horror (just kidding, it was fate) I matched @TuftsMedicalCtr

During my 1st general residency year I found ID and fell in love with it

[Narrator: she hated it in pharm school]

In pharmacy, the 2nd residency year (also still optional) is when you can choose to specialize in an area:

- Cardiology
- Transplant
- Oncology
- Emergency medicine
- Pediatrics
- Geriatrics

And obviously, the best one, INFECTIOUS DISEASES!

My 1st job out of residency was as the first ID pharmacist at a community hospital in CT. How cool (and challenging!) to establish a brand spanking new practice?! We started pharmacist-dosed vanco protocols. I got the micro lab to display MIC values ... it was cool but ...

Obvi I wanted to be in Boston. So a year later I accepted a clinical coordinator position @BIDMChealth.

I rounded with ID physicians, precepted pharmacy students & residents, mentored staff.

Get this: I even got (still get) to lecture to Harvard med students!

Inpatient ID pharmacy is awesome! We expanded from 1 ... to 2 ... to now 3 pharmacists plus 2 ID residents.

Additionally the antimicrobial stewardship program was created. All broad/new antibiotics need approval from the ASP prior to being used.

The ASP makes sure it's the right drug for the right patient at the right dose and for the right duration. We help with drug allergies. With resistant bacteria. With drug interactions. With switching to drugs taken by mouth. With stopping drugs all together.

In short, they try to protect antibiotics for the future, to make sure they are still active for when you get an infection.

Studies have shown how valuable ASPs are. And how integral pharmacists are to those programs.

There are regulations that state each hospital / long term care / nursing home / outpatient clinic needs to have an ASP ... and they should be co-run by an ID pharmacist & physician. #Teamwork

But after 9.5 years, a new opportunity came for me to still work @BIDMChealth (ahem, the official hospital of the @RedSox) but ... to work OUTPATIENT!

So now I am an outpatient pharmacist specializing in infectious diseases.

Patients come in for follow up to inpatient infections, for tuberculosis, for latent TB, for other mycobacterial infections, for HIV, for hepatitis C, and other infection care.

I help physicians & my NP choose the best therapy, counsel on taking the meds, advise on drug interactions, help obtain medications, help with copays, choose alternative drugs or dosing methods if the home situation is not stable, rec oral meds, rec stopping therapy ....

The OTHER half of my job is OPAT.

What's OPAT?

Glad you asked.

Outpatient parenteral antimicrobial therapy.

Patients need IV antibiotics for weeks but DON'T HAVE TO STAY IN THE HOSPITAL TO FINISH THERAPY! 🙌

This is a lot of coordination with home infusion companies, visiting nursing companies, outpatient laboratories, nursing homes, etc etc.

OPAT is so hot right now.

During COVID, I've been able to work remotely from home.

Lots of communication with my physicians/NP about our patients (email, page, text, call). Lots of counseling with patients over the phone. Lots of documentation in the computer systems.

Other things I/pharmacists are involved in:

National organizations: @SIDPharm @ASHPOfficial @ACCP @IDSAInfo @SHEA_Epi

All of these have been very vocal & prominent during COVID. SIDP created a series of youtube videos critiquing the data on potential COVID drugs

There are PHENOMENAL quality

(did you know pharmacists are the drug experts? We will scrutinize clinical trials & endpoints & statistics to a whole 'nother level)

I was able to contribute to the zinc video.

Other pharmacists, bc of our skills & involvement, have been co-authors on national COVID guidelines (@IDSAInfo and @NIHCOVIDTxGuide to name a few).

Advocacy is another cornerstone of pharmacy.

Whether it be affordable drugs, mis-information, vaccination, provider-status, ability to provide PrEP, access to safe injection supplies ...

Through many of our state & national organizations we try to shape legislature

Education is big too.

Many ID pharmacists are faculty at colleges. Many of us do research & publish papers. We get invited to lecture at national meetings (many times to diverse audiences of pharmacists, physicians, nurses, microbiologists, etc etc).

Many of us are editors or on editorial boards of various medical and pharmacy journals. Some are text book authors too.

One of the best ways to learn antibiotics is via "Antibiotics Simplified" written by 2 ID Pharmacists @JGPharmD and @ConanMacDougall

Probably the best thing about ID pharmacists is that no 2 jobs are alike. Our jobs keep evolving because ... well ... bacteria keep evolving. And ... we LOVE working collaboratively with others! Pharmacists, physicians, nurses, micro, infection prevention ....

I lost track of what this thread was about. 🤓

If you've read this far, you're pretty awesome. ♥️

Oh, hey. Know what was missing from this entire thread?

Counting pills.

While an extremely important function of pharmacists, many, many of us don't do that in our daily jobs.