In last week's newsletter, we began a repeat of a series of newsletters/information related to compounding in the event of terrorist attacks or natural disasters. The pharmacist's role in such events is extremely important, and the International Journal of Pharmaceutical Compounding feels this information warrants a reminder. This week, we discuss the pharmacists' involvement during such emergencies.

Pharmacists' Involvement in Disaster Planning

Pharmacists' involvement in disaster planning is the first step in preparing for a terrorist attack. A formulary should be developed to include primary and secondary treatments for the effects of chemical, biological, and nuclear weapons. Variables in the dosing of antibiotics, antitoxins, vaccines, and prophylactic treatments for adolescent and pediatric patients should not be overlooked. The use of chemotherapeutics (and their respective teratogenic effects) in pregnant patients should be noted in each treatment protocol. Because a chemical, biological, or nuclear attack will create drug shortages (e.g., the current shortage of beta-lactam antibiotics), pharmacists should have preplanned procedures for rationing and should be involved in agreements for support from a network of pharmacies.

Pharmacists can also provide valuable information when the agent used in an attack may not be clear, such as in an unusual outbreak of infections. Because they often see hundreds of patients daily, pharmacists can help detect unusual occurrences that might be related to bioterrorism. For example, pharmacists might observe cases of a disease that is not endemic, unusual patterns of antibiotic resistance, atypical clinical presentations, case distribution in a certain geographic region, unusually high numbers of cases, and morbidity and mortality rates that deviate from the baseline.

After a terrorist incident occurs, pharmacists working with limited assets will be asked to provide medications in a very short time. In preparation for this situation, pharmacists should maintain current, accurate information on product procurement and manufacturing options. Self-reliant and adaptable, compounding pharmacists can provide drug treatment alternatives to lessen the damage from an attack. Formulations and procedures for extemporaneous compounding must be created, reviewed, and tested before an emergency occurs. Pre-established reference publications, bulk materials, source information, and pharmaceutical items (e.g., antibiotics, antidotes, antitoxins, other supportive-care agents) will facilitate hands-on training in the treatment of victims of biological, chemical, or nuclear attacks. In addition to providing pharmaceuticals, pharmacists can disseminate supplies such as gloves, gowns, masks, and respirators; provide information about dosages and vaccination schedules; and counsel patients.

Assistance is available from the federal government's Strategic National Stockpile, which has prepared "12-hour push packages" for immediate response. These caches of pharmaceuticals, antidotes, and medical supplies are designed to provide a broad range of items that may be needed in the early hours after an event. The packages are positioned in strategically located secure warehouses for deployment to designated sites within 12 hours of a federal decision to distribute these assets. The push packages contain bulk-packaged dosage forms such as tablets; there may be several hundred thousand in a drum, and they will need to be repackaged into units for distribution to patients.

Loyd V. Allen, Jr., PhD, RPh
Editor-in-Chief
International Journal of Pharmaceutical Compounding
Remington: The Science and Practice of Pharmacy Twenty-second edition

Articles and complete issues on the topics of terrorism and natural disasters have been published in the International Journal of Pharmaceutical Compounding. To see a list, including some available for free, go to:
https://ijpc.com/​Products/​Search​ByKeyword.cfm​?searchstr​=terrorism%20​disaster.