What It Is
Nuclear pharmacy is a specialty area within pharmacy practice where specially trained and credentialed pharmacists prepare and dispense radiopharmaceutical prescription dosages in patient-specific, ready-to-administer form. Sound daunting? It isn’t. Most of us consider nuclear pharmacy to be a very interesting and challenging specialty practice area. Yes, it is challenging, but it is also very rewarding.
What exactly are radiopharmaceuticals and what are they used for? Radiopharmaceuticals are radioactive legend drugs (formerly called “tracers”) that are used in the diagnosis and treatment of disease Most are for injection and expire within a few hours of preparation while others are prepared for oral administration, inhalation or instillation.
Where can you find nuclear pharmacists? Since nuclear pharmacists have a wide choice of practice sites… almost anywhere! They can be found in commercial nuclear pharmacies such as Mallinckrodt Inc., Cardinal Health, GE Healthcare, Independent nuclear pharmacies as well as at hospitals and universities. They can be found in corporate marketing, sales, and regulatory affairs departments along with manufacturing facilities.
There is a sub-specialty of nuclear pharmacy that utilizes radiopharmaceutical drugs prepared onsite in a machine called a cyclotron. The “PET pharmacist” or Position Emission Tomography pharmacist is responsible for monitoring the operation of the cyclotron and synthesizing PET radiopharmaceuticals, as well as performing various tests to ensure high quality. Most PET radiopharmaceuticals are extremely short-lived and have half lives ranging from 110 minutes to a few seconds.
Did you know that nuclear pharmacy was the first recognized pharmacy specialty?
Training and Credentialing
In order to function as a nuclear pharmacist, there is a minimum amount of training necessary, in addition to having a license to practice pharmacy. A total of 700 hours of training consisting of 200 hours of specialized coursework or didactic training and 500 hours of practical experience are necessary. The specialized coursework or didactic training component can be obtained from several academic institutions for graduate pharmacists and as undergraduate coursework for pharmacy students. Universities that provide this training include Ohio State University, Purdue University, University of Arkansas for the Medical Sciences, University of New Mexico, University of North Carolina at Chapel Hill, University of Oklahoma, University of Tennessee, and Washington State University. Many other Universities provide elective courses in Nuclear Pharmacy.
After the training is completed, the nuclear pharmacist has attained what is called “authorized nuclear pharmacist” status and may begin practicing. In some states, additional licensing is required. Florida has a separate licensing program for nuclear pharmacists, while other states including Connecticut and New York require the pharmacist to submit their training to the state board of pharmacy for recognition as a nuclear pharmacist.
An additional credential that the nuclear pharmacist may obtain is Board Certification through the Board of Pharmaceutical Specialties. The BCNP credential which stands for “Board Certified Nuclear Pharmacist” is recognized by both state and federal regulatory agencies as recognition of appropriate training for nuclear pharmacists.
Did you know that most nuclear pharmacists did not have training or experience upon hire? Each company provides training so that the pharmacist can successfully attain authorized nuclear pharmacist status.
Duties of a Nuclear Pharmacist
The nuclear pharmacist must skillfully juggle inventory, dose preparation schedule and delivery of dosages in order to ensure patient care is optimized. Just as a community pharmacist must order stock from a wholesaler, the nuclear pharmacist orders radiopharmaceuticals from one of the radiopharmaceutical manufacturers. The radiopharmaceutical supply chain is truly a wonder of logistics. The orders placed are generally delivered later that evening due to the short-lived nature of the drugs.
The nuclear pharmacist must be knowledgeable in the concept of exponential decay as each radiopharmaceutical has a physical half life associated with it. This means that the nuclear pharmacist is handling drugs that are continually decaying away and must be administered within hours of preparation.
The nuclear pharmacist must be knowledgeable in the chemistry of radiopharmaceuticals because most of them are prepared extemporaneously. Following preparation, the pharmacist must perform chemical tests to ensure high quality.
The nuclear pharmacist must be knowledgeable in aseptic processing as most of the doses dispensed are for injection.
Sound like a challenge so far?
Most nuclear pharmacists, whether hospital-based or commercial, practice in a laboratory environment. The radiopharmaceuticals must be prepared, tested and shipped so that they are ready to administer when a patient arrives for a study. This usually translates into the pharmacy opening early in the morning and with one or more pharmacists working the “early shift” usually midnight on. In addition, radiopharmaceuticals must be available 24/7 for emergencies and the nuclear pharmacist is on-call at times. The shifts and on-call are shared among the pharmacists. The pharmacy usually closes around 5 PM and a pharmacist is on-call until the early shift arrives.
There are no third-party insurance forms, adjudication procedures, or credit card verifications involved in nuclear pharmacy. All dosages are dispensed to the nuclear medicine physician who administers them to the patient and handles the insurance processing. Instead of drive-thru’s, there are delivery drivers who transport the doses to the physicians.
The nuclear pharmacy is not open to the public due to the nature of the products used. Most prescriptions are transferred to the pharmacy via telephone or facsimile, although electronic prescribing is on the horizon.
Nuclear pharmacists are paid at the market rate or above. Total compensation, however, is usually higher due to the availability of on-call and overtime pay. Annual monetary bonuses are typical as well as various award programs in the form of items selected from gift catalogues for good performance in the area of health and safety.
Nuclear pharmacists have ample advancement opportunities should they desire to pursue them. Commercial nuclear pharmacists may start out as a staff pharmacist and advance to pharmacy manager within a few years. Pharmacy manager jobs are plentiful in this specialty practice area. Regional management positions and corporate positions including those in Marketing, Sales and Regulatory Affairs represent other opportunities.
There is an abundance of information on the internet about the nuclear pharmacy profession. Following are a few to get you started:
The Nuclear Pharmacy (Great starting place with job postings, links to clinical information, industry information, nuclear training, etc.)
You can find postings for nuclear pharmacy careers at most pharmacy recruiting sites.
Richard A. Nickel, MS, RPh
2006-2007 Chair-Elect APhA-APPM Nuclear Pharmacy Practice Section