Why a neurology pharmacist is a necessary member of care teams

By their very nature, specialties are designed so physicians can focus their knowledge base and skill set on certain areas of the extremely broad and deep field of medicine. But the specialty of neurology itself is becoming increasingly complex, with disease states that vary widely and are treated quite differently, including the patient’s medication regime.

Just look at this partial list of the extremely unique — and often life-limiting or -threatening — disease states that a neurologist is called upon to diagnose and treat:

  • Amyotrophic lateral sclerosis (ALS, probably better known your patients as Lou Gehrig’s Disease)
  • Epilepsy
  • Headaches and migraines
  • Multiple sclerosis
  • Parkinson’s disease
  • Peripheral neuropathy
  • Stroke

Mitigate polypharmacy risks of ADEs

Patients with these conditions require special attention for a number of reasons, not the least of which are medication regimens that often include a complex array of specialty medications. Polypharmacy can increase the probability of having an adverse drug event, drug interaction or conflict with an underlying disease state. This is common with the medications used to treat epilepsy and other seizure disorders.

Also, there are a number of medications that require special counseling and/or ongoing monitoring. Medications for seizures and Parkinson’s often fall into this stratum, as often do meds for ALS, MS and stroke.

Further, many of these meds not only have significant potential for adverse effects but also carry a hefty price tag. This is typically a huge burden to patients that can devastate them and their families financially. Even with some of the manufacturer assistance programs available, insurance plans can be extremely reluctant to changing these meds throughout the typical “trial and error” therapeutic odyssey as providers seek to determine the best medication regimen for each unique patient. So the closer we can get it right the first time (or at least early on in treatment), the better all around.

Include a clinical pharmacist in care plan creation

Considering the complex nature of treating neurologic diseases, an “all-hands-on-deck” approach to patients’ care is often critical to optimal outcomes. Based on what I’ve just discussed, I’d suggest that one of these “hands” should be a highly skilled clinical pharmacist…a resource unfortunately too often unavailable to many neurology practices due to cost or access.

Pharmacists are particularly well-qualified to help neurologists navigate the complex waters of neurological treatment. Their training addresses many of the issues related to the safe and effective prescribing of neurology medications. For example, pharmacokinetic dosing of antiepileptic medication is a tenet of general pharmacy education. Providers can often off-load the dosing and management of these medications to a pharmacist, saving providers time they can use to focus on other aspects of the patient’s care.

Many pharmacists complete residency training and may even pursue advanced training programs specifically in neurology. With larger hospitals and health systems often having specialized units for neurologic intensive care, having such a pharmacist assist with these critically ill patients has become part of the optimal standard of care. But few practices — no matter their size — rarely have one on staff to deal with ongoing issues during the course of treatment. Fortunately, a doctor of pharmacy (PharmD) has deep clinical training above the typical pharmacist, and doesn’t necessarily require additional training to support treatment of neurologic disorders.

On an ongoing basis, clinical pharmacists on your extended care team can play an important role in monitoring drug levels, adjusting dose per protocol, and assessing drug efficacy that’s required for the continued use of certain specialty medications.

A clinical pharmacist can also bring additional perspective to the cost and insurance approval process required for many neurology medications. Pharmacists often help navigate the complexities of prescription insurance authorization and can aid patients and providers alike. The best medication treatment plan in the world isn’t going to do any good for the patient if they’re unable to have covered access the meds in the treatment plan.

Certainly, a pharmacist can assist in the acute dosing and administering of tPA for an ischemic stroke patient. But many questions remain in ongoing treatment, including such things as:

  • Does this antibiotic interact with the patient’s seizure treatment? Is it dosed correctly?
  • What should we do with a patient on warfarin with therapeutic INR levels who we’re now starting on phenobarbital?
  • The patient’s phenytoin level is still subtherapeutic. How should we change the dose? Are they separating administration from food or tube feeds? What was the trough level and what are the patient’s parameters for appropriate pharmacokinetic dosing?

Partner with a neurology pharmacy to provide quality care

For complex and often chronic conditions such as those diagnosed and managed by neurologists, experienced clinical pharmacists can play a vital role in the care-planning and ongoing management of patients affected by these often-crippling conditions. RxLive’s expert team of clinical pharmacists are here to help, by being cost-effectively and seamlessly integrated into any provider’s care team.

For more information on how we’re improving the patient and provider experience and patient outcomes, contact us here, at any time.

Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.