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Overview  

Nuclear Pharmacy is a patient-oriented, specialized pharmaceutical care service, requiring scientific knowledge and judgment for the safe and efficacious use of diagnostic and therapeutic radioactive drugs. It was the first area in pharmacy to be formally recognized as a specialty practice. It essentially involves the safe, timely, and cost-effective delivery of a range of patient -specific radio pharmaceutical drugs in required doses.

History of Nuclear Pharmacy:
Nuclear pharmacy developed rapidly in the 1950s, with Abbott Laboratories selling the first radioactive drug in 1950. In 1964, a Technitium-99 (a radionuclide) generator was commercially available, which was followed by the availability of a number of Tc-99m based radiopharmaceuticals. The growth of nuclear medicine in the sixties fuelled the need for trained professionals to handle radiopharmaceuticals. The University of Southern California was the first university to provide a formal masters degree in radiopharmacy in 1969. By early seventies, nuclear pharmacy started distinguishing itself as a specialty practice, when registered pharmacists interested in the field assisted physicians in handling and using radiopharmaceuticals, and furthered their knowledge through professional interaction forums and organized training. In 1975, the American Pharmaceutical Association formed the Section on Nuclear Pharmacy. In 1978, The Board of Pharmaceutical Specialties (BPS) recognized nuclear pharmacy as a specialty practice.

How does a Nuclear Pharmacy function

A nuclear pharmacy dispenses drugs based on prescriptions, similar to any regular pharmacy. However, the difference lies in that the ’drugs’ here are ’radioactive’, and hence it requires special regulatory guidelines and safety measures to be followed. The dosages are prepared, quality and purity checked, and the drugs are dispensed to the nuclear medicine facilities or hospitals (instead of patients) by the ‘nuclear pharmacist’. 

Nuclear Pharmacy Settings
Nuclear pharmacies can be described mainly under three settings:
1. Institutional Nuclear Pharmacy
2. Commercial Nuclear Pharmacy
3. Dedicated Nuclear Pharmacies for Positron Emission Tomography (PET)

Institutional Nuclear Pharmacy
Large hospitals with nuclear pharmacy use the services of dedicated nuclear pharmacists, who are trained or certified in handling radioactive material, to meet their radiopharmaceutical needs, along with in-house radioisotope generator systems.  Institutional pharmacies may also be involved in teaching, research, and educating resident physicians, pharmacy and nuclear medicine technology students. 

Commercial Nuclear Pharmacy
Smaller hospitals looking for cost effective ways to meet their radiopharmaceutical needs gave rise to the concept of ‘centralized nuclear pharmacies’, which provide the services of a trained nuclear pharmacist who prepares and dispenses the required formulation to the subscribing facility on a need-based manner. Commercial nuclear pharmacies also provide other services like radiation safety consultations and radioactive waste management. They may also provide in-service continuing education programs to nuclear medicine and pharmacy professionals. 

Dedicated PET Nuclear Pharmacies 
A relatively new setting that is fast establishing with the growing indications for PET studies, PET pharmacies may also be involved in advisory and regulatory consultations to PET facilities. The positron emitting radionuclides used in PET procedures have very short half-lives, requiring geographical proximity of the pharmacy to the end-user facility; they emit higher levels of radiation, requiring specific radiation shielding; their processing is relatively complex, requiring specific training for the pharmacists; and they are produced in a cyclotron, whose functioning and requirements differs from a traditional radionuclide generator. The regulatory requirements of PET pharmacy also differ from traditional nuclear pharmacies to some extent. 

Professional Nuclear pharmacy Organizations 
There are a number of professional nuclear pharmacy organizations. Foremost among them include:

Section on Nuclear Pharmacy Practice of the APhA
Society of Nuclear Medicine
National Association of Nuclear Pharmacies

Significant Contributors to the field

Henri Becquerel: Discovered natural radioactivity
George de Hevesy: Demonstrated that radioactive substances can be used to prepare tracers.
Hermann Blumgart and Soma Weiss: Used radioactive tracers to study a biological process for the first time.
Hal O. Anger: Designed the scintillation Camera (Gamma Camera).
John E. Christian: A professor in the School of Pharmacy at Purdue University; developed radiopharmacy as a subject in the university, and documented the radiopharmaceutical monographs for the US pharmacopoeia.
William H. Briner: Father of Radiopharmacy; started the N.I.H. Radiopharmacy in 1958; developed principles and procedures for radiopharmacy services and quality assurance.

 

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