What Is Nuclear Pharmacy?


October 10, 2019

Nuclear pharmacy is a specialty area of pharmacy practice involved with the preparation of radioactive materials to improve and promote health through the safe and effective use of radioactive drugs to diagnose and treat specific disease states.

Nuclear pharmacists compound radiopharmaceuticals for nuclear medicine departments and outpatient diagnostic clinics. The specialty was the first pharmacy specialty established by the Board of Pharmaceutical Specialties (BPS) in 1978.

According to Gregory Smallwood, PharmD, FCCP, an associate professor and clinical coordinator of experiential education at PCOM School of Pharmacy, nuclear pharmacy is well suited for the people who are strong in math and science—especially physics.

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“The potential for employment is good,” he added. “You don’t have that many who go into it.”

What does a nuclear pharmacist do?

A nuclear pharmacist’s responsibilities include:

  • Ordering, receiving, storing and controlling inventory of radioactive drugs (radiopharmaceuticals), other drugs used in nuclear medicine, and related supplies.
  • Preparing radiopharmaceuticals by combining radioisotopes with reagent kits and compounding radiopharmaceuticals that are not commercially available.
  • Performing functional checks of instruments, equipment, and devices and determining radiopharmaceutical quality and purity.
  • Filling prescription orders.
  • Packaging, labeling, and transporting radiopharmaceuticals.
  • Properly handling hazardous chemicals and biological specimens.
  • Communicating radiopharmaceutical-related information to others.
  • Ensuring that patients receive proper preparation before radiopharmaceutical administration and trouble-shooting unanticipated outcomes.
  • Laboratory testing of new radiopharmaceuticals, new compounding procedures, and quality control methods and participating in clinical trials.
How do you become a nuclear pharmacist?

In order to become a nuclear pharmacist, you must complete training in basic areas of radiation physics and instrumentation, radiation protection, radiation biology, math related to radioactivity decay and radiopharmaceutical chemistry. In addition to the didactic training, practical training in a nuclear pharmacy is required. To become a Board of Pharmacy Specialties (BPS) Board Certified Nuclear Pharmacist® (BCNP), Smallwood explained, a pharmacist must:

  • Graduate from a pharmacy program accredited by the Accreditation Council for Pharmacy Education (ACPE) or a program outside the U.S. that qualifies that individual to practice in that jurisdiction (foreign-trained pharmacists must pass the Foreign Pharmacy Graduate Examination Committee examination).
  • Maintain a current, active license to practice pharmacy in the U.S. or another jurisdiction.
  • Complete up to 4,000 hours of experience in nuclear pharmacy, including a residency accredited by the American Society of Health-System Pharmacists (ASHP); an internship to satisfy the requirements of state boards of pharmacy; and experience in a nuclear practice in a licensed nuclear pharmacy or health care facility (up to 2,000 of the 4,000 required hours can be academic hours, including undergraduate or graduate courses in nuclear pharmacy, an MS or PhD program in nuclear pharmacy, and/or successful completion of a nuclear pharmacy certificate program).
  • Achieve a passing score on the BPS Nuclear Pharmacy Certification Examination.
How much do nuclear pharmacists make?

The salary for a nuclear pharmacists can vary depending upon location, experience, certifications and other skills. Pharmacists, in general, typically earn annual salaries in the low six-figures. A nuclear pharmacist in the U.S., according to Salary.com, can expect an average salary of $137,313 (as of August 2019).

Where do nuclear pharmacists work?

There are two main types of environments where nuclear pharmacists are employed. Institutional nuclear pharmacy is usually linked to a major medical center/hospital where preparations are made on-site. This is in contrast to the commercial centralized nuclear pharmacy where radiopharmaceuticals are prepared and then delivered to the hospital and/or clinic. While the quantity of radiopharmaceuticals used is relatively small in both settings, nuclear pharmacists must complete additional training in radiation safety regarding the compounding, preparation, and delivery of radioactive materials.

“There are risks involved because you are working with radioactive isotopes,” Smallwood said. "You have to wear a dosimeter to see how much radiation you are receiving and each facility has limits as to how much exposure you can have.” 

Most nuclear pharmacists, whether hospital-based or commercial, practice in a laboratory environment. The radiopharmaceuticals must be prepared, tested and shipped so that they are ready to administer when a patient arrives for a study. This usually translates into the pharmacy opening early in the morning and with one or more pharmacists working the “early shift” usually beginning at midnight. In addition, radiopharmaceuticals must be available 24/7 for emergencies and a nuclear pharmacist is on-call at times. The shifts and on-call are shared among the pharmacists.

"If you are not an early bird, [nuclear pharmacy] is not for you," Smallwood said.

All dosages are dispensed to the nuclear medicine physician who administers them to the patient and handles the insurance processing. There are delivery drivers who transport the doses to the physicians. The nuclear pharmacy is not open to the public due to the nature of the products used.

What is the job outlook for nuclear pharmacists?

Little or no growth is expected in pharmacist employment over the next decade according to the Bureau of Labor Statistics. The nuclear pharmacy specialty, according to Smallwood, is a particularly competitive field.

“There are job openings but the candidate has to be willing to relocate,” he said.

Where can you study to become a nuclear pharmacist?

PCOM School of Pharmacy offers a Doctor of Pharmacy (PharmD) degree that combines classroom and experiential learning to train pharmacists for careers in various healthcare environments, including nuclear pharmacy.

Smallwood said 18-25 students regularly participate in an elective Advanced Pharmacy Practice Experiences (APPE) at a nuclear pharmacy. The five-week rotation allows fourth-year pharmacy students to experience working as a nuclear pharmacist.

“It gives you a really good taste,” he explained.

Smallwood recommends those considering specializing in nuclear pharmacy participate in the elective as the academics and work hours are challenging.

Visit the PharmD application requirements page to learn about prerequisite coursework, GPA and PCAT scores, the admissions process and more at PCOM School of Pharmacy.

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Article updated Oct. 9, 2019. Information about nuclear pharmacy written by Gregory Smallwood, PharmD, FCCP.