Knowledge on formulations is vital for clinical practice

As pharmacy moves forward, there will no doubt be necessary changes to the undergraduate pharmacy curriculum. However, we must ensure that the foundation knowledge that all pharmacists should have is not compromised. The pharmacist, in some instances, is all that stands between the patient and harm from their medicines. This may mean counselling in the correct use of their medicines, but it also means knowing the limitations of types of dosage forms.

The following brief account was told to me by the late Fridrun Podczeck, an honorary member of the Royal Pharmaceutical Society (RPS) and a former professor of pharmaceutics. Some four or five years ago, Fridrun was in hospital after having undergone surgery and was prescribed diclofenac sodium tablets 25mg. She was concerned when the nursing staff tried to administer half of a 50mg tablet to her. Diclofenac sodium tablets are enteric-coated. Enteric coating, as we all should know, is used either to protect the drug from the contents of the stomach (e.g. esomeprazole), or to protect the stomach from the drug (as in the case of diclofenac sodium). Diclofenac sodium is a non-steroidal anti-inflammatory drug (NSAID) that can cause gastric bleeding and this is why it is enteric-coated.

Fridrun asked to see the chief pharmacist, and asked why they were splitting an enteric-coated tablet. The answer was that it was to save money because the higher strength (50mg) split tablets were cheaper than the enteric-coated 25mg tablets. Further discussion ensued and Fridrun asked if the chief pharmacist had had any pharmaceutics lectures during the pharmacy degree programme. The answer came back that there had been pharmaceutics lectures but, because they were not compulsory, he did not attend them.

This all happened several years ago now, and from the timing, I estimate that the chief pharmacist in question would have registered as a pharmacist before the changes to the registration requirements in 2010, and the setting up of the General Pharmaceutical Council. I do not know the name of the hospital where this occurred, or any further details, and Fidrun, sadly, is no longer with us.

Was that pharmacist fit to practise? Did he have the patient’s best interests at heart? Were any other patients put at risk and potentially harmed in similar circumstances at that hospital? Was the pharmacy department at the university at fault in not making pharmaceutics lectures compulsory? Was the regulator at fault in not insisting on an adequate level of pharmaceutics training being part of the undergraduate degree programme? Or, if it was compulsory, why was the lack of compulsory lectures not picked up during the assessment of the university’s pharmacy degree course?

R. Christian Moreton

Waltham, Massachusetts, United States