Chapter 1

2. Chapter 1 The Profession of Pharmacy

3. Chapter 1 Topics • Ancient Origins • Pharmacist • Pharmacy Technician • Pharmacy Workplace of Today

4. Learning Objectives • Describe the origins of pharmacy • Describe the four stagesof development of the pharmacy profession in the twentieth century • Enumerate the functions of the pharmacist • Discuss the educational curriculum for today’s pharmacy student • Explain the licensing requirements for pharmacists • Identify the duties and work environments of the pharmacy technician • Differentiate among the various kinds of pharmacies

5. Ancient Origins • Pharmacycomes from the Greek word pharmakon, meaning drug • Scientific approach to medicine began with the ancient Greeks • Hippocrates • Proposed that disease came from natural, not supernatural causes • Established the theory of humors(blood, phlegm, black bile, yellow bile)

6. Ancient Origins • Galen • Conducted animal experiments • Produced a systematic classification of drugs for treatment of disease • Galenical pharmacydescribed the process of creating extracts of active medicinals from plants • Diascorides • First century A.D. • De Materia Medica (standard text on drugs for 1500 years)

7. Ancient Origins • Dr. John Morgan • Eighteenth Century • Supported the separation of the professions of pharmacy and medicine

8. Terms to Remember • pharmakon • theory of humors • galenical pharmacy • De Materia Medica Learn more at American Institute of the History of Pharmacy (AIHP)

9. Discussion How has the profession and practice of pharmacy evolved since ancient times?

10. Pharmacist • The profession of pharmacy exists to safeguard the health of the public • The pharmacistis one who is licensed to prepare and dispense medications, counsel patients, and monitor outcomes pursuant to a prescription from a licensed health professional • The role of the modern pharmacist evolved • from compounder and dispenser • to providing medication information and preventing medication-related problems

11. Evolution of the Pharmacist’s Role During the twentieth century, the pharmacy profession has evolved through four stages. • Traditional Era • Scientific Era • Clinical Era • Pharmaceutical-care Era

12. Traditional Era • Early twentieth century • Formulation and dispensing of drugs from natural sources • Pharmacognosy • The study of the medicinal properties of natural products of animal, plant, and mineral origins • Galenical pharmacy • Techniques for preparing medications

13. Scientific Era • Began after World War II • Emergence of the pharmaceutical industry • Drugs made in factories, not apothecary shop • Pharmacy education emphasized sciences • Pharmacology • The scientific study of drugs and their mechanism of action including side effects • Pharmaceutics • Release characteristics of drug dose forms

14. Clinical Era • 1975: Millis Report, Pharmacists for the Future • New educational emphasis on clinical (patient-oriented) pharmacy • Pharmacokinetics • the activity of a drug within the body over a period of time; includes absorption, distribution, metabolism, and elimination • Pathophysiology • the study of disease and illnesses affecting the normal function of the body

15. Pharmaceutical-Care Era • 1990: Hepler and Strand defined • Pharmaceutical care • a philosophy that expanded the pharmacist’s role to include appropriate medication use to achieve positive outcomes with prescribed drug therapy • includes • Monitoring response to therapy • Educating patients and dispensing prescriptions • Visit the American Pharmacists Association (APhA)

16. Discussion How does the pharmaceutical care model affect the duties of pharmacists in the 21st Century? medication outcomes?

17. Terms to Remember

18. Role of the Pharmacist Today’s pharmacist: • Compounds and dispenses drugs • Gathers information about patients • Counsels on possible side effects and adverse reactions • Monitors for drug interactions • Screens, monitors, and advises for self-treatment with over-the-counter (OTC)products sold without a prescription • Provides drug information to other healthcare professionals • Advises on home healthcare supplies and medical equipment

19. Community Pharmacist • Dispenses drugs for exiting disease • Involved in patient care initiatives to prevent or identify disease • Administration of immunizations • screening for and educating about hypertension, diabetes, and other conditions • providing education about lifestyle choices and dietary supplements • Runs a business • hires and supervises employees • deals with insurance companies • maintains inventory

20. Hospital Pharmacist • Dispenses oral medications • Prepares and dispenses parenteral medications • Sometimes specializes, with advanced training in an area of patient care • Educates and counsels patients • Provides drug information • Administers a department • develops policies and procedures • purchases drugs and supplies • monitors drug use in the hospital • Learn more about hospital pharmacy at the web site of the American Society of Health-System Pharmacists (ASHP)

21. Home Healthcare Pharmacist • Prepares medications and IVs for home delivery and use • including IV nutrition and antibiotics • cancer chemotherapy • pain medications • Educates patient or caregiver on appropriate and safe medication use • Monitors patient’s response to prescribed therapies

22. Other Pharmacy Settings • Health maintenance organization (HMO) • Long-term care facilities • Specialized practice • psychiatry • drug abuse • Nursing homes • geriatrics

23. Nuclear Pharmacy • Nuclear pharmacist • Procures, stores, compounds, dispenses, and provides information about radioactive pharmaceuticals used for diagnostic and therapeutic purposes • Learn more about nuclear pharmacy at the Cardinal Web site

24. Education and Licensing Requirements • Education • 6 year program • 2 years prePharmacy • calculus, chemistry, biology • Pharmacy College Admission Test (PCAT) • Doctor of Pharmacy (PharmD) degree • basic science courses • practice setting experience • Residency in specialty area is optional • For a listing of accredited schools of pharmacy, visit the Web site for the American Association of Colleges of Pharmacy (AACP)

25. Education and Licensing Requirements • Licensing • required by all states • overseen by board of pharmacy • involves • graduation form an accredited college of pharmacy • passing state board certification examination • serving an internship • continuing education for license renewal

26. Discussion • What are the differences and similarities between and among the various pharmacy practice settings? • How does specialized training affect the role of the pharmacist?

27. Terms to Remember

28. Pharmacy Technician • A pharmacy technician, also called the pharmacy tech, is an individual working in a pharmacy who, under the supervision of a licensed pharmacist, assists in pharmacy activities that do not require the professional judgment of a pharmacist. • Regardless of practice setting, the pharmacy tech can assist with workload. • The pharmacist provides the final check on the original prescription with the medication bottle and label before counseling the patient.

29. Evolution of the Pharmacy Technician’s Role • Without pharmacy technicians, pharmacists would not have sufficient time for the duties involved in “pharmaceutical care.” • counseling patients • reviewing medication profiles • monitoring for side effects and adverse reactions • screening patients for disease • discussing cost-effective drug therapy options with the prescriber

30. Evolution of the Pharmacy Technician’s Role Safety Note! Pharmacy technicians play a valuable role in reducing the risk of medication errors.

31. Evolution of the Pharmacy Technician’s Role • Originally, many pharmacy techs were trained as medics in the military. • returned after service to take positions in hospitals • In community pharmacy the pharmacy tech evolved from clerk or cashier to a pharmacist’s assistant.

32. Evolution of the Pharmacy Technician’s Role • A pharmacy technician assists the pharmacist with routine functions. • leaves professional decision making and judgment calls to the pharmacist • Technician activities may range from ordering, stocking, and inventorying drugs to preparing the IV order to assisting in the dispensing process. • the pharmacist must always check his or her work • the pharmacist is responsible for patient counseling • the technician functions in strict accordance with standard written procedures and guidelines

33. Evolution of the Pharmacy Technician’s Role Safety Note! The pharmacy technicians works under the direction of the supervising pharmacist.

34. Evolution of the Pharmacy Technician’s Role • Central defining feature of the technician’s job is accountability to the pharmacist for the quality and accuracy of his or her work. • The essential differences in the duties of a pharmacist and a technician involve: • accountability • making decisions about the patient’s healthcare

35. Education and Licensing Requirements • Most state boards of pharmacy recognize the existence and importance of the pharmacy technician. • Each state board of pharmacy regulates: • the activities of pharmacy technicians • sometimes the ratio of pharmacy techs to pharmacists

36. Education and Licensing Requirements • In the past, on-the-job training was sufficient for the tech working in a pharmacy. • Now formal technician training programs train pharmacy technicians for their expanded roles. • Initially centered in hospitals to train staff in the necessary functions of the hospital pharmacy. • Now many programs are offered by community colleges and technical schools.

37. Education and Licensing Requirements • ASHP developed a model curriculum to meet the needs of all practice settings. • In some states pharmacy technicians must be certified to practice. • Academic programs help to prepare the student to pass the certification exam • For an up-to-date list of states requiring certification of pharmacy technicians, see the Pharmacy Technician Certification Board Web site

38. Discussion • What is the relationship between the duties of the pharmacy technician and those of the pharmacist? • How do the education and licensure of technicians and pharmacists relate to those duties?

39. Work Environments and Conditions • Pharmacy technicians are employed in most of the same settings as pharmacists • community pharmacies (i.e., drugstores) • hospital pharmacies • home healthcare and long-term care facilities • specialized area of practice (e.g., nuclear pharmacy) with additional training

40. Work Environments and Conditions • Pharmacy technicians usually work in clean, well-lighted, and well-ventilated environments. • To ensure a sterile environment and minimize infectious disease, many techs in the hospital and other practice settings work either in a “clean room” or under specialized ventilation cabinets called laminar flow hoods when they prepare infusions, total parenteral nutrition, or cancer chemotherapy. • Gowns, masks, hairnets, foot booties, and gloves are often needed in this environment.

41. Work Environments and Conditions • Pharmacy tech work requires standing, often for long hours. • Pharmacists and pharmacy technicians may be on call or work days, nights, weekends, and holidays. • At any time, 24 hours a day, some number of the estimated 250,000 pharmacy technicians currently employed are on the job.

42. broad knowledge of pharmacy practice dedication to providing a critical healthcare service to customers and patients high ethical standards willingness to follow instructions eagerness to learn an eye for detail manual dexterity facility in basic mathematics excellent communication skills good research skills ability to perform accurately and calmly in hectic or stressful situations ability to multi-task or work on several projects at the same time Characteristics A successful pharmacy technician must possess a wide range of skills, knowledge, and aptitudes.

43. Discussion What makes each of the listed characteristics of a pharmacy technician important?

44. Terms to Remember

45. Pharmacy Workplace of Today • Pharmacists work primarily in community and hospital pharmacies • Some go on to pursue further education and higher degrees, residencies, or fellowships • Other fields include managed care, mail-order pharmacy, home healthcare, long-term care, nuclear pharmacy, academia, drug information, sales, marketing, or research. • The need for both pharmacists and pharmacy technicians is expected to continue. • new life-saving drugs • increase in the aging population in the United States

46. Community Pharmacy • Three fifths of all pharmacists in the United States work in a community pharmacy (retail pharmacy). • an independent or chain pharmacy that dispenses prescription medications to outpatients

47. Community Pharmacy • Most community pharmacies are divided into • a back prescription area offering prescription merchandise and related items • a front area offering over-the-counter (OTC) drugs, toiletries, cosmetics, and greeting cards • Community pharmacies may be • independently owned small businesses • part of large retail chains • franchise operations • The recent trend is toward fewer independent pharmacies

48. Community Pharmacy A chain pharmacyis a community pharmacy that consists of several similar pharmacies in the region (or nation) that are corporately owned. • May be national or regional • in department stores (e.g., Wal-Mart, Target) • grocery stores (e.g., Kroger, Publix) • typical corner drugstores (e.g., Walgreens, Eckerds, CVS, Rite-Aid). • Located to allow for large-volume dispensing with heavy use of both pharmacy techs and automation • Administrative decisions are made at the corporate level

49. Community Pharmacy An independent pharmacyis a community pharmacy that is privately owned by the pharmacist. • May be owned and operated by a group of pharmacists (rather than a corporation) • A pharmacist owner makes his or her own decisions regarding the practice of pharmacy • more attention and time spent to keep customers • Most compounding of prescriptions is done in this type of pharmacy

50. Community Pharmacy A franchise pharmacy is member of a small chain of professional community pharmacies that dispense and prepare medications but are independently owned; sometimes called an apothecary. • Combines characteristics of independent business and large retail chain • A large retail company, the franchiser grants exclusive use of the company name and rights to sell company products to a store owner/operator, the franchisee • Most sell only medication and health-related products/services • VisitThe Medicine Shoppe