Voice of the Mid-Columbia | Kennewick, Pasco and Richland, Wash. |
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closeSunday, Feb. 03, 2008
Mix & match: Some Tri-City pharmacists still making medicines on site
By Laura Kate Zaichkin, Herald staff writer
Anne Henriksen asks two questions when she interviews a possible employee:
"Do you like to cook?" and "When you cook or bake, are you a mad scientist or are you more of a clean cook?"
Potential hires also must enjoy the work place's aromas of marshmallow, cotton candy and creme de menthe and be comfortable using tools that bake, roll and mix concoctions.
Henriksen said those who are comfortable with a spatula usually are successful in her line of work.
But she isn't a chef at the Tri-Cities' newest restaurant.
Henriksen is a compound pharmacist at Richland Clinic Pharmacy and uses her oven to bake tablets, a special mill to roll and reduce particle sizes in creams and an electronic mortar and pestle to mix compounds and standardize medications' concentrations.
"Remember back in the day when your pharmacist would be back behind the counter mixing?" she asked.
These old-fashioned pharmacies are coming back into style after a hiatus that came with the rise of commercial medications in the 1950s and 1960s, Henriksen said. "It's very old fashioned, yet it's very cutting edge at the same time."
Years ago pharmacists used to have to hand pack capsules and hope the same doses were in each pill.
Today, compound pharmacists have the help of capsule machines to pack medications into dozens of capsules at a time. And though mortars and pestles still are used daily, machines that roll and mix compounds aid pharmacists in being more precise.
The art and science of preparing customized medications for patients never went away, said Valerie Silva, a compound pharmacist at Malley's Pharmacy in Richland.
"It did go down, though," she said.
In the 1930s and 1940s, about 60 percent of medications were compounded, according to the Professional Compounding Centers of America, a Houston-based organization that provides Accreditation Council for Pharmacy Education-accredited training and is a resource for member pharmacies.
With the advent of drug manufacturing, many pharmacists went from being a preparer of medications to a dispenser of manufactured medications, according to the PCCA.
But, "over the past 20 years, things have been swinging the other way," Silva said.
"We're not there to compete with commercial products," she added. "It's when somebody needs something that isn't out there."
Barbara Braendlein's 16-month-old daughter, Ava, has a mitochondrial condition in which one of the symptoms is poor growth, so she needs medications in lower doses not available commercially.
"They can get the dosage very accurate," the Pasco mom said. "They're also fantastic at making it palatable."
Braendlein has been getting Ava's compound medications at Malley's for about five months. The pharmacists there have helped customize Ava's current three medications by turning them into liquids and flavoring the compounds -- she tried tutti frutti most recently.
"It's our best pharmacy experience ever," she said.
Some patients turn to compound medicines because they need them in a form that can be administered in non-traditional ways, such as through a cream, foam, liquid, suppository or gummy candy.
Other patients are allergic or sensitive to ingredients in commercial medications, such as lactose or starch. And true vegetarians or those who do not eat pork often ask for compound medications because most commercial capsules are made with gelatin, a meat-based product.
"A lot of consumers are really wanting something that is tailored to them," Henriksen said.
Compounding pharmacists are the MacGyvers of the trade, Henriksen said. When she visits physicians in the area who prescribe compounds, she brings a tool kit featuring different ways to administer medications. She has tools that look like nail polish bottles and brushes, spray bottles and hand pumps. Henriksen also has a mold for a "rectal rocket" suppository for hemorrhoids.
Silva and Henriksen said compounding requires cooperation between the pharmacist, doctor and patient.
Dr. Shakti Matta, a pediatrician at Richland's Pediatrics For You, said he prescribes compounds about five times a month.
He said he will often call a compound pharmacist before prescribing a compound to a patient and relies on compound pharmacists when he needs advice on doses or how to best administer a medication.
"There's a lot of room for partnership here," he said.
Richland Clinical Pharmacy and Malley's pharmacists say more and more physicians in the area prescribe compounds.
Malley's makes about 10 to 12 compounds a day, while Richland Clinical, which has been actively compounding for about a year, usually fills a couple compound prescriptions a day.
Most people pay out of pocket for compound prescriptions, Silva and Henriksen said, though most insurance companies reimburse the cost of many compound prescriptions.
Though most pharmacists are trained in compounding at pharmacy school, the only PCCA-member pharmacies in the area are Malley's, Richland Clinic, Cork's Pharmacy in Kennewick, Densow's Pharmacy in Richland, Medicine Shoppe in Walla Walla and Professional Pharmacy in Moses Lake, according to the PCCA.
Of the PCCA members, Malley's, Richland Clinic, Medicine Shoppe and Professional Pharmacy fill compounds on a regular basis. Professional Pharmacy is a sterile compounding pharmacy that can compound injectables, eyedrops and other medications that need to be produced in a sterile environment.
Malley's and Richland Clinic's patients aren't just humans either. Many are animals because dosages vary based on size, and animals can be difficult to administer medication to.
Flavors such as bacon, ham, fish and chicken are used for pets, and medications can be turned into tasty treats.
Silva knows just how tasty many of the medications are. She usually samples them to make sure the flavors mask the compound. Bacon isn't so bad, she said, while the fish flavors are overwhelming. Tasty human flavors at Malley's include vanilla butternut, pina colada, raspberry and Kahlua, she said.
"Some of them are appealing to us and some of them are not," she said, adding that she never thought she would be asked to taste-test medicines.
Taste-testing is just another part of the creative process of compounding, like knowing how well medications mix, what flavors will cover a compound and how to suspend medication in liquid.
"It's just like cooking," said Beverly Charvet, Malley's compounding technician. "It's baking and measuring and putting things in the refrigerator.
"And you've got to do the dishes afterward."
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