Optimal Compounding

Optimal Compounding is a closed-door pharmacy that specializes in veterinary compounding, hospice, and hormone replacement therapy. In my 5 weeks at Optimal Compounding thus far, I have had the opportunity to make a variety of different products including suspensions for cats, powders for horses, and vaginal creams for of course, humans. Of the products I've made, these are my most memorable experiences...

The very first product I got to compound on my own was a tuna flavored Benazepril HCl suspension for a cat. Who knew cats could be treated for hypertension? (How does one even figure out a cat has high blood pressure?) Turns out that Benazepril is indicated for chronic renal failure in cats and CHF in dogs...which maybe makes a little more sense? All in all, it's been an interesting experience working with such a unique patient population. Anyway, back to the compounding...it took me over 3 hours to make this suspension! Benazepril comes as a pink coated tablet, which I began by crushing with a mortar and pestle. The outer pink coating was extremely hard to crush so I was stuck using a homogenizer to mix the suspension with the other ingredients (totally forgot what else I added in it...glycerin?) for about an hour to no avail. If the preparation wasn't hard enough, one of the techs mistakenly wrote that the cat's owner wanted the suspension in 1ml pre-filled syringes...so in the middle of filling 30 individual syringes with 1ml of my pink speckled suspension, the pharmacist came by to point out that the prescription actually meant to dispense the suspension in an amber bottle and attach one 1ml syringe to the bottle. And after squirting all my syringes into the amber bottle, I was about 5 mls short since a lot was lost during the homogenizing and syringe-filling process. So I had to make more. On top of all that...a fish flavored benazepril suspension is the most terrible smelling flavor we have in the pharmacy. Lucky me!

Another one of my favorites was that I got to make an apple flavored metronidazole powder for a horse from start to finish. We dispense powders for horses in large powder jars that come with 5ml scoops and usually dispense enough powder for a total of 100 scoops per Rx. In order to know how much active and inactive ingredient to put into the powder, we calibrate each powder to the 5ml scoop. This is done by weighing the amount of powder that fills a scoop at least 5 times and then averaging the weights. A metronidazole powder contains metronidazole, powdered sugar, and apple flavoring in powder form. Since the scoops had already been calibrated for the powered sugar and apple flavoring, I only had to calibrate the scoop for the metronidazole powder. After doing that, I calculated how much of each powder to put into the formula based on percentages. Flavoring is usually about 11% for horse powders (don't quote me on this!), percentage of metronidazole depends on the specific strength of the Rx, and the rest is powdered sugar. So once that is figured out, all the powders are weighed out into a plastic ziplock bag and then shaken, rolled, and mixed for a very long time to ensure that it's all evenly distributed. After that, it's all poured into a powder jar, initialed, labeled, a 5ml scoop is taped to the outside, and it's ready for the pharmacist to check!

Other memorable experiences have been that I made a methimazole transdermal gel...without gloves. Being the silly naive 1 year of pharm school intern that I am, the name sounded like an antifungal to me, so I thought I'd be okay without gloves since gloves are usually only worn for vet and HRT compounding. When I was finished, after getting a lot of it on my hands since I had to dispense it in 1 ml syringes, the pharmacist told me it was a hyperthyroid medication...and I should watch out for symptoms of hypothyroidism since I didn't wear gloves. Guess that's why I still have 3 more years of pharmacy school to go through... :) (Luckily, no fatigue, sensitivity to cold, or muscle weakness was experienced)

I've also made a lot of capsules. Instead of the 10 that we learned to pack by hand in Pharm404 first semester, we have bulk capsule machines! These machines are pretty nifty and they allow us to make 100 and 200 capsules at a time. Much more efficient and easy to use. If you've never seen one of these...they are extremely ingenious creations...and I can't even begin to explain how it works. They're just fun and convenient.

Last week I made a progesterone vaginal cream and an alfalfa-flavored pergolide mesylate powder for horses. Pergolide was withdrawn for human use to treat Parkinson's due to negative effects on the heart, but it is still commonly used to treat Equine Cushing's Syndrome (ECS) in horses. Pergolide and phenylbutazone (NSAID) are the most commonly compounded meds for horses at Optimal is what I'm told.

I am sad to say that next week is my last week at Optimal Compounding, but after that it's 6 weeks at Komoto Pharmacy (retail...1200 scripts/day). At Optimal I also fill a lot of hospice prescriptions...but more on that later since this post has gotten kind of long...

Happy 4th of July weekend!

-N

Komoto Healthcare Company

Hi everyone! My name is Natalie Gong and I am proud to say that I will be a P2 this Fall. P1 year was tough, but we made it through! I am spending my summer interning with Komoto Healthcare Company based in California's central valley. This company first began as a small corner drugstore in Delano, CA, which, over the past 30 years has evolved to include two retail pharmacies, a compounding pharmacy, and a home infusion pharmacy. Komoto Healthcare Company is owned by Dr. Brian Komoto, a generous, easy-going, and dedicated pharmacist and entrepreneur. On my first day as an intern, Dr. Komoto told me that the main idea that led him to where he is today is the fact that he was "never afraid to take risks--even if it meant losing a little money here and there--as long as it was beneficial for the patient."

Shortly after it opened in 1981, at the request of a children's hospital, Komoto Pharmacy began compounding suspensions from tablets as heart medications for children. Their success in this endeavor led to the opening of Optimal Compounding in Bakersfield, CA, which specializes in the compounding of unique formulations for veterinary medications, hormone replacement therapies, and hospice medications. In 1990, Dr. Komoto began Integrated Care Services, a home infusion pharmacy in Visalia, CA. The company has continued to expand and shift throughout the years to fit the needs of the changing population throughout the central valley, state, and they even make a few deliveries to outside states. They have broadened their services to include diabetes and asthma therapy management programs as well as immunizations and home medical equipment.

I will be spending the first six weeks of my internship at Optimal Compounding pharmacy in Bakersfield on Monday through Wednesday and at Integrated Care Systems (ICS) in Visalia on Thursdays and Fridays. The following six weeks, I will be at Komoto Pharmacy in Delano on Monday through Wednesday, and at ICS on Thursdays and Fridays.

I actually completed my 3rd week of interning last week and have already learned and experienced so much! I just haven't had time to do any blogging until now. (The 1 hour and 10 min commute both ways to Bakersfield leaves me super exhausted). I just wanted to give you all a (semi) quick introduction...be prepared for a few stories later this week! :) Hope you all are having a great summer!

Until next time,
N