Clinical assistant professor ’lives on the edge’

Rachel Klosko wasn’t always one who liked to live on the edge, but since completing her Doctor of Pharmacy degree and two residencies, she’s changed.

“When patients come in really sick, I used to be scared and nervous,” she said, “but now I love the high-adrenaline situations. Part of learning how to respond to help these very sick people is knowing what to expect and getting over that first bit of nerves.”

And Klosko has plenty of opportunities to test her nerves as a cardiology pharmacy specialist, new to the School of Pharmacy and Pharmaceutical Sciences this fall in her role as a clinical assistant professor of pharmacy practice.

Her path to pharmacy began in high school with a love of chemistry.

“Chemistry was my favorite subject,” and my mom said, ‘Why not look into pharmacy? That would fit your personality and your interests,” Klosko said. “So I completed an internship at a community pharmacy in high school and loved it.”

She then worked as a pharmacy technician before pharmacy school, where she liked being able to interact with patients.

“I just stuck with it,” she added. “I trusted my mom’s opinion, and it was a great fit for me.”

Then, she worked at a community hospital in Buffalo as a pharmacy intern and that’s when she realized she wanted to work in a hospital, where patients are most in need. “At the end of my P4 year, I knew I enjoyed the clinical component of pharmacy, specifically rounding with interdisciplinary teams,” Klosko said. “I did an APPE rotation in the surgical trauma ICU and thought it was one of the best experiences, so that solidified my interest in inpatient pharmacy practice.”

After earning her PharmD at the University of Buffalo through a 2+4 program, Klosko spent two years at The Ohio State University Wexner Medical Center, first completing a PGY-1 and then a PGY-2 Cardiology Pharmacy Residency. She’s now using her education at Guthrie Robert Packer Hospital, working with a healthcare team on its cardiac surgery service and coronary care unit.

Many of the patients she sees are usually quite sick, she said, presenting with heart failure, arrhythmias or acute heart attacks. Others are mildly sick or in need of a pacemaker or other device.

“I see patients present with a broad range of clinical conditions,” Klosko said. “At Guthrie, the patient population is elderly, so in terms of cardiology, patients also present with a wide variety of illness severities.”

But bottom line, Klosko likes the variety and helping people get well. “One of the things I like is that there are a lot of different ways we can make the patient better — ways the pharmacist can intervene for better patient outcomes,” she said.

She spends two days a week at Guthrie, going on rounds, visiting patients, with physicians and other members of the healthcare team. Her first day there, she said, in the cardiac surgery service, one patient had a traumatic brain injury, another a standard coronary bypass and a third had a thoracic surgery.

“I rounded with the medical team and brought up important medication recommendations,” Klosko said. “For example, one of the patients had severe statin intolerance and we were able to start the patient on ezetimibe (Zetia ®) (a non-statin cholesterol-reducing medication) from the outpatient pharmacy downstairs.”

After seeing the cardiac surgery patients, she rounded in the coronary care unit, starting with the intensive care patients, she said. The medical team saw about 10 patients, then did what is called table rounds, discussing the patients and potential plans.

Once the plans are developed, Klosko visits the patients with the medical team to discuss their care plans and answer questions. “The plans could include a whole variety of things, even things not cardiac-related,” she said. “As a pharmacist, I’m looking at taking care of the overall patient.”

Klosko is looking forward to precepting students late next spring at Guthrie. “Even as a PGY-2, I was able to precept PGY-1 residents,” she said. “It may seem intimidating, but once you do it, it’s really rewarding. The students are new and engaged and want to learn more.”

Until then, she’s teaching in the classroom on topics including pneumonia, tuberculosis and influenza. She’s also teaching population health and giving lectures in the toxicology elective and the pharmacogenomics course.

“In the spring, I’ll be teaching in more of my specialty areas, the critical care component of the special populations pharmacotherapeutics course. I will be one of the course coordinators” she said.

One problem with patients she sees who are critically ill is that, oftentimes, medications alone are not the answer, Klosko said. But she recalls one scenario that she played a role in. “I was in the Emergency Department and a patient came in who had arrested outside the hospital twice, so, at baseline, things weren’t looking good,” she said. “The patient was extremely acidotic (had high acid levels in the blood or body tissues) and it was a challenge for the physicians to intubate this patient. For me, this patient came in on so many different continuous IV medications, that one of my roles was to make sure we changed the patient over to our hospital supplied medications, so the team could run them through the IV pumps. The medications he came in on via EMS were not compatible with the hospital IV pump. I had to calculate dose rate conversions for each to ensure we transitioned him over to the correct dose based on drug concentrations in the IV bag.”

She also must learn what medications patients may have gotten at another facility or en route from emergency medical technicians, such as antibiotics or blood thinners, or if they had any cultures drawn.

Klosko admits that the hardest part of these acute situations is that they can be sad or overwhelming. “But the more you see those situations, the more you’re able to be more comfortable with them,” she said. “If you become too emotionally invested, you would be drained and unable to function. Our job is to help the patients and looking upset could be a disservice them and their families.”

“I’m not saying it never gets to me, but if you look at the overall outlook and the service you provide, if you look at it positively and see the victories, it makes what you do worth it.”

To relax? It has been really challenging during the pandemic as she transitioned from her residency in Ohio to Binghamton, but Klosko enjoys doing things outdoors like camping, and she also swims as often as she can.