Pharmacy Microteaches

Sticking on the critical appraisal theme, we have a look at tecovirimat, the antiviral suggested as an option for the treatment of monkeypox. How does it work, what does it do, how do we know, and how confident are we in the evidence base? As part of this, we have a think about the directness of evidence, and how far it might be sensible to extrapolate from the data we have to different clinical scenarios.

Going back to critical appraisal (we'll go back to finish the series of "what's the point of..." various different bits of pharmacy next time), we're having a look at the risks around getting your dog vaccinated against kennel cough. Are you going to catch kennel cough from them yourself? When we say "there's a theoretical risk" what do we mean? And if we know what we mean, do the people we're explaining things to take the same meaning from what we say? How do we help people to optimise the risks they might take in a world where we don't have definite numbers to work with?

Following on from last time's "what's the point of Medicines Information services", this time it's the turn of pharmacy QA. What do they actually do, and why might they be good people to know? Thanks to QA Hannah for QA'ing this one.

Following on from last time's podcast, we continue on a theme of having a look at some of the less often seen bits of pharmacy departments and services. This time out, it's Medicines Information (or Medicine Advice) services in the NHS. Back in the 1970s when they started, the world was a different place and information was hard to come by. But now, when you can get millions of guidelines and papers after a quick search of the internet, what function do they serve? With thanks to all those who helped to give me a pharmacy history lesson last year when MI in the UK turned 50!

Going in a slightly different direction with this episode, we're looking at bits of pharmacy and asking "what's the point?". But, you know, in a positive way. This time, what's the point of having a Drug and Therapeutics Group - a group in your organisation who get to decide which new medicines get used. What value does a DTG add, and what benefits does it deliver?

What is methenamine hippurate? Is it as good as prophylactic antibiotics for recurrent UTIs? And most importantly, how come the recent trial could, perfectly legitimately, say it was non-inferior whilst it also looking to the casual observer as being marginally less good? What does non-inferiority mean in clinical trials, and why do people get twitchy about delta values?

Gene therapy - it's here, and it's really expensive! What does onasemnogene abeparvovec do? How does how it works compare to other (also complicated and expensive) medicines? How strong can the evidence be if it's not from a randomised controlled trial? And, probably most importantly, why on earth does it have 10 syllables in its name and how might you go about butchering its pronunciation?

Why does Paxlovid interact with so many other medicines? How can we find out what it interacts with? What approaches can we take to work out what to do with this information? And can we pull out some general learning about how to manage drug-drug interactions, whether it's Paxlovid or something else?

What is sotrovimab, and how does it work against Covid? Why is it called sotrovimab and not sotrolimab? How come it has a risk reduction of 85% and 6% yet these are both true and both mean the same thing? And if you were asked how good it might be for your patient, what would you say?

Often, we get asked about temperature deviations, where medicines get stored by accident outside of what the manufacturers recommend. If something's been stored a couple of degrees warm for a couple of hours, it won't impact on product quality - but when do we need to start worrying? If a manufacturer says they don't have any data, how can you make informed decisions so that you don't waste NHS money throwing away medicines that are perfectly fine to use?