Pharmacy

Last updated
Pharmacy
PharmacistsMortar.svg
Occupation
NamesPharmacist, Chemist, Doctor of Pharmacy, Druggist, Apothecary or simply Doctor
Occupation type
Professional
Activity sectors
health care, health sciences, chemical sciences
Description
Education required
Doctor of Pharmacy, Master of Pharmacy, Bachelor of Pharmacy, Diploma in Pharmacy
Related jobs
Doctor, pharmacy technician, toxicologist, chemist, pharmacy assistant, other medical specialists
The Apothecary or The Chemist by Gabriel Metsu (c. 1651-67) Metsu, Gabriel - L'Apothicaire - c. 1651-1667.jpg
The Apothecary or The Chemist by Gabriël Metsu (c. 1651–67)

Pharmacy is the science and technique of preparing, dispensing, and review of drugs and providing additional clinical services. It is a health profession that links health sciences with pharmaceutical sciences and aims to ensure the safe, effective, and affordable use of drugs. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, the pharmacy is classified as a community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies are considered clinical pharmacy. [1]

Drug Chemical substance having an effect on the body

A drug is any substance that, when inhaled, injected, smoked, consumed, absorbed via a patch on the skin, or dissolved under the tongue causes a physiological change in the body.

Contents

The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are the experts on drug therapy and are the primary health professionals who optimize use of medication for the benefit of the patients.

Compounding creation of a particular pharmaceutical product to fit the unique need of a patient

Pharmaceutical compounding is the creation of a particular pharmaceutical product to fit the unique need of a patient. To do this, compounding pharmacists combine or process appropriate ingredients using various tools.

Health care Prevention of disease and promotion of wellbeing

Health care or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals in allied health fields. Physicians and physician associates are a part of these health professionals. Dentistry, midwifery, nursing, medicine, optometry, audiology, pharmacy, psychology, occupational therapy, physical therapy and other health professions are all part of health care. It includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.

Pharmacist healthcare professional who practices in pharmacy

Pharmacists, also known as chemists or druggists, are health professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use. Pharmacists undergo university-level education to understand the biochemical mechanisms and actions of drugs, drug uses, therapeutic roles, side effects, potential drug interactions, and monitoring parameters. This is mated to anatomy, physiology, and pathophysiology. Pharmacists interpret and communicate this specialized knowledge to patients, physicians, and other health care providers.

An establishment in which pharmacy (in the first sense) is practiced is called a pharmacy (this term is more common in the United States) or a chemist's (which is more common in Great Britain). In the United States and Canada, drugstores commonly sell medicines, as well as miscellaneous items such as confectionery, cosmetics, office supplies, toys, hair care products and magazines and occasionally refreshments and groceries.

Cosmetics substances used to enhance the appearance or odor of the human body

Cosmetics are substances or products used to enhance or alter the appearance of the face or fragrance and texture of the body. Many cosmetics are designed for use of applying to the face, hair, and body. They are generally mixtures of chemical compounds; some being derived from natural sources, and some synthetic or artificial. Cosmetics applied to the face to enhance its appearance are often called make-up or makeup. Common make-up items include: lipstick, mascara, eye shadow, foundation, blush, and contour. Other common cosmetics can include skin cleansers, body lotions, shampoo and conditioner, hairstyling products, perfume and cologne.

Office supplies item regularly used in offices by businesses and other organizations

Office supplies are consumables and equipment regularly used in offices by businesses and other organizations, by individuals engaged in written communications, recordkeeping or bookkeeping, janitorial and cleaning, and for storage of supplies or data. The range of items classified as office supplies varies, and typically includes small, expendable, daily use items, consumable products, small machines, higher cost equipment such as computers, as well as office furniture and art.

Toy Thing to be played with

A toy is an item that is used in play, especially one designed for such use. Playing with toys can be an enjoyable means of training young children for life in society. Different materials like wood, clay, paper, and plastic are used to make toys. Many items are designed to serve as toys, but goods produced for other purposes can also be used. For instance, a small child may fold an ordinary piece of paper into an airplane shape and "fly it". Newer forms of toys include interactive digital entertainment. Some toys are produced primarily as collectors' items and are intended for display only.

In its investigation of herbal and chemical ingredients, the work of the pharma may be regarded as a precursor of the modern sciences of chemistry and pharmacology, prior to the formulation of the scientific method.

Chemistry is the scientific discipline involved with elements and compounds composed of atoms, molecules and ions: their composition, structure, properties, behavior and the changes they undergo during a reaction with other substances.

Pharmacology Branch of biology concerning drugs

Pharmacology is the branch of biology concerned with the study of drug or medication action, where a drug can be broadly defined as any man-made, natural, or endogenous molecule which exerts a biochemical or physiological effect on the cell, tissue, organ, or organism. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function. If substances have medicinal properties, they are considered pharmaceuticals.

Disciplines

Pharmacy, tacuinum sanitatis casanatensis (14th century) 42-aspetti di vita quotidiana, medicine,Taccuino Sanitatis, .jpg
Pharmacy, tacuinum sanitatis casanatensis (14th century)

The field of pharmacy can generally be divided into three primary disciplines:

Pharmaceutics is the discipline of pharmacy that deals with the process of turning a new chemical entity (NCE) or old drugs into a medication to be used safely and effectively by patients. It is also called the science of dosage form design. There are many chemicals with pharmacological properties, but need special measures to help them achieve therapeutically relevant amounts at their sites of action. Pharmaceutics helps relate the formulation of drugs to their delivery and disposition in the body. Pharmaceutics deals with the formulation of a pure drug substance into a dosage form. Branches of pharmaceutics include:

Pharmacognosy study of medicines derived from natural sources

Pharmacognosy is the study of plants or other natural sources as a possible source of drugs. The American Society of Pharmacognosy defines pharmacognosy as "the study of the physical, chemical, biochemical and biological properties of drugs, drug substances or potential drugs or drug substances of natural origin as well as the search for new drugs from natural sources".

The boundaries between these disciplines and with other sciences, such as biochemistry, are not always clear-cut. Often, collaborative teams from various disciplines (pharmacists and other scientists) work together toward the introduction of new therapeutics and methods for patient care. However, pharmacy is not a basic or biomedical science in its typical form. Medicinal chemistry is also a distinct branch of synthetic chemistry combining pharmacology, organic chemistry, and chemical biology.

Pharmacology is sometimes considered as the 4th discipline of pharmacy. Although pharmacology is essential to the study of pharmacy, it is not specific to pharmacy. Both disciplines are distinct. Those who wish to practice both pharmacy (patient oriented) and pharmacology (a biomedical science requiring the scientific method) receive separate training and degrees unique to either discipline.

Pharmacoinformatics is considered another new discipline, for systematic drug discovery and development with efficiency and safety.

Professionals

The World Health Organization estimates that there are at least 2.6 million pharmacists and other pharmaceutical personnel worldwide. [2]

Pharmacists

Convent pharmacy exhibited at the Museo nazionale della scienza e della tecnologia Leonardo da Vinci of Milan. Farmacia conventuale Museo scienza e tecnologia Milano.jpg
Convent pharmacy exhibited at the Museo nazionale della scienza e della tecnologia Leonardo da Vinci of Milan.

Pharmacists are healthcare professionals with specialised education and training who perform various roles to ensure optimal health outcomes for their patients through the quality use of medicines. Pharmacists may also be small-business proprietors, owning the pharmacy in which they practice. Since pharmacists know about the mode of action of a particular drug, and its metabolism and physiological effects on the human body in great detail, they play an important role in optimisation of a drug treatment for an individual.

Pharmacists are represented internationally by the International Pharmaceutical Federation (FIP). They are represented at the national level by professional organisations such as the Royal Pharmaceutical Society in the UK, Pharmacy Guild of Australia (PSA), Canadian Pharmacists Association (CPhA), Indian Pharmacist Association (IPA), Pakistan Pharmacists Association (PPA), and the American Pharmacists Association (APhA). (See also: List of pharmacy associations.)

In some cases, the representative body is also the registering body, which is responsible for the regulation and ethics of the profession.

In the United States, specializations in pharmacy practice recognized by the Board of Pharmacy Specialties include: cardiovascular, infectious disease, oncology, pharmacotherapy, nuclear, nutrition, and psychiatry. [3] The Commission for Certification in Geriatric Pharmacy certifies pharmacists in geriatric pharmacy practice. The American Board of Applied Toxicology certifies pharmacists and other medical professionals in applied toxicology.

Pharmacy technicians

Pharmacy technicians support the work of pharmacists and other health professionals by performing a variety of pharmacy related functions, including dispensing prescription drugs and other medical devices to patients and instructing on their use. They may also perform administrative duties in pharmaceutical practice, such as reviewing prescription requests with medic's offices and insurance companies to ensure correct medications are provided and payment is received.

A Pharmacy Technician in the UK has recently been referred to by some as a professional. Legislation requires the supervision of certain pharmacy technician's activities by a pharmacist. The majority of pharmacy technicians work in community pharmacies. In hospital pharmacies, pharmacy technicians may be managed by other senior pharmacy technicians. In the UK the role of a PhT in hospital pharmacy has grown and responsibility has been passed on to them to manage the pharmacy department and specialised areas in pharmacy practice allowing pharmacists the time to specialise in their expert field as medication consultants spending more time working with patients and in research. Pharmacy technicians are registered with the General Pharmaceutical Council (GPhC). The GPhC is the regulator of pharmacists, pharmacy technicians and pharmacy premises.

In the US, pharmacy technicians perform their duties under supervision of pharmacists. Although they may perform, under supervision, most dispensing, compounding and other tasks, they are not generally allowed to perform the role of counseling patients on the proper use of their medications.

Education requirements

There are different requirements of schooling based on the area of pharmaceuticals a student is seeking. In the United States, the general pharmacist will attain a Doctor of Pharmacy Degree (Pharm.D.). The Pharm.D. can be completed in a minimum of six years, which includes two years of pre-pharmacy classes, and four years of professional studies [4] . After graduating pharmacy school, it is highly suggested that the student go on to complete a one or two year residency, which provides valuable experience for the student before going out independently to be a generalized or specialized pharmacist.

The curriculum [5] created for a Pharm.D. is made up of 208-credit hours. Of the 208-credit hours, 68 are transferred-credit hours, and the remaining 140-credit hours are completed in the professional school. There are a series of required standardized tests that students have to pass throughout the process of pharmacy school. The standardized test to get into pharmacy school is called the Pharmacy College Admission Test (PCAT). In a student's third professional year in pharmacy school, it is required to pass the Pharmacy Curriculum Outcomes Assessment (PCOA). Once the Pharm.D. is attained after the fourth year professional school, the student is then eligible to take the North American Pharmacist Licensure Exam (NAPLEX) and the Multistate Pharmacy Jurisprudence Exam (MPJE) to work as a professional pharmacist. [6]

History

Physician and Pharmacist, illustration from Medicinarius (1505) by Hieronymus Brunschwig. Legenogapotekeren.jpg
Physician and Pharmacist, illustration from Medicinarius (1505) by Hieronymus Brunschwig.

The earliest known compilation of medicinal substances was the Sushruta Samhita , an Indian Ayurvedic treatise attributed to Sushruta in the 6th century BC. However, the earliest text as preserved dates to the 3rd or 4th century AD.

Many Sumerian (late 6th millennium BC – early 2nd millennium BC) cuneiform clay tablets record prescriptions for medicine. [7]

Ancient Egyptian pharmacological knowledge was recorded in various papyri such as the Ebers Papyrus of 1550 BC, and the Edwin Smith Papyrus of the 16th century BC.

Dioscorides, De Materia Medica, Byzantium, 15th century Dioscorides De Materia Medica Byzantium 15th century.jpg
Dioscorides, De Materia Medica , Byzantium, 15th century

In Ancient Greece, Diocles of Carystus (4th century BC) was one of several men studying the medicinal properties of plants. He wrote several treatises on the topic. [8] The Greek physician Pedanius Dioscorides is famous for writing a five volume book in his native Greek Περί ύλης ιατρικής in the 1st century AD. The Latin translation De Materia Medica (Concerning medical substances) was used a basis for many medieval texts, and was built upon by many middle eastern scientists during the Islamic Golden Age.

Pharmacy in China dates at least to the earliest known Chinese manual, the Shennong Bencao Jing (The Divine Farmer's Herb-Root Classic), dating back to the 1st century AD. It was compiled during the Han dynasty and was attributed to the mythical Shennong. Earlier literature included lists of prescriptions for specific ailments, exemplified by a manuscript "Recipes for 52 Ailments", found in the Mawangdui, sealed in 168 BC.

In Japan, at the end of the Asuka period (538–710) and the early Nara period (710–794), the men who fulfilled roles similar to those of modern pharmacists were highly respected. The place of pharmacists in society was expressly defined in the Taihō Code (701) and re-stated in the Yōrō Code (718). Ranked positions in the pre-Heian Imperial court were established; and this organizational structure remained largely intact until the Meiji Restoration (1868). In this highly stable hierarchy, the pharmacists—and even pharmacist assistants—were assigned status superior to all others in health-related fields such as physicians and acupuncturists. In the Imperial household, the pharmacist was even ranked above the two personal physicians of the Emperor. [9]

There is a stone sign for a pharmacy with a tripod, a mortar, and a pestle opposite one for a doctor in the Arcadian Way in Ephesus near Kusadasi in Turkey. [10] The current Ephesus dates back to 400 BC and was the site of the Temple of Artemis, one of the seven wonders of the world.

In Baghdad the first pharmacies, or drug stores, were established in 754, [11] under the Abbasid Caliphate during the Islamic Golden Age. By the 9th century, these pharmacies were state-regulated. [12] [ unreliable source? ]

The advances made in the Middle East in botany and chemistry led medicine in medieval Islam substantially to develop pharmacology. Muhammad ibn Zakarīya Rāzi (Rhazes) (865–915), for instance, acted to promote the medical uses of chemical compounds. Abu al-Qasim al-Zahrawi (Abulcasis) (936–1013) pioneered the preparation of medicines by sublimation and distillation. His Liber servitoris is of particular interest, as it provides the reader with recipes and explains how to prepare the `simples’ from which were compounded the complex drugs then generally used. Sabur Ibn Sahl (d 869), was, however, the first physician to initiate pharmacopoedia, describing a large variety of drugs and remedies for ailments. Al-Biruni (973–1050) wrote one of the most valuable Islamic works on pharmacology, entitled Kitab al-Saydalah (The Book of Drugs), in which he detailed the properties of drugs and outlined the role of pharmacy and the functions and duties of the pharmacist. Avicenna, too, described no less than 700 preparations, their properties, modes of action, and their indications. He devoted in fact a whole volume to simple drugs in The Canon of Medicine . Of great impact were also the works by al-Maridini of Baghdad and Cairo, and Ibn al-Wafid (1008–1074), both of which were printed in Latin more than fifty times, appearing as De Medicinis universalibus et particularibus by 'Mesue' the younger, and the Medicamentis simplicibus by 'Abenguefit'. Peter of Abano (1250–1316) translated and added a supplement to the work of al-Maridini under the title De Veneris. Al-Muwaffaq’s contributions in the field are also pioneering. Living in the 10th century, he wrote The foundations of the true properties of Remedies, amongst others describing arsenious oxide, and being acquainted with silicic acid. He made clear distinction between sodium carbonate and potassium carbonate, and drew attention to the poisonous nature of copper compounds, especially copper vitriol, and also lead compounds. He also describes the distillation of sea-water for drinking. [13] [ verification needed ]

In Europe pharmacy-like shops began to appear during the 12th century. In 1240 emperor Frederic II issued a decree by which the physician's and the apothecary's professions were separated. [14] "The first pharmacy in Europe (still working) was opened in 1241 in Trier, Germany." [15]

Sign of the Town Hall Pharmacy in Tallinn, operating continuously from at least 1422 Raeapteek sign.jpg
Sign of the Town Hall Pharmacy in Tallinn, operating continuously from at least 1422

In Europe there are old pharmacies still operating in Dubrovnik, Croatia, located inside the Franciscan monastery, opened in 1317; and in the Town Hall Square of Tallinn, Estonia, dating from at least 1422. The oldest is claimed to have been set up in 1221 in the Church of Santa Maria Novella in Florence, Italy, which now houses a perfume museum. The medieval Esteve Pharmacy, located in Llívia, a Catalan enclave close to Puigcerdà, also now a museum, dates back to the 15th century, keeping albarellos from the 16th and 17th centuries, old prescription books and antique drugs.

The mortar and pestle, one of the internationally recognized symbols to represent the pharmacy profession PharmacistsMortar.svg
The mortar and pestle, one of the internationally recognized symbols to represent the pharmacy profession
Typical American drug store with a soda fountain, about 1905 PostcardSimsburyCTAELathropsDrugStoreCirca1905.jpg
Typical American drug store with a soda fountain, about 1905
Drug store restoration ca. 1920 at Collingsworth County Museum and Art Center across from the courthouse in Wellington, Texas Drug store restoration, Wellington, TX IMG 6178.JPG
Drug store restoration ca. 1920 at Collingsworth County Museum and Art Center across from the courthouse in Wellington, Texas

Practice areas

Pharmacists practice in a variety of areas including community pharmacies, hospitals, clinics, extended care facilities, psychiatric hospitals, and regulatory agencies. Pharmacists themselves may have expertise in a medical specialty.

Community pharmacy

19th-century Italian pharmacy NatMuseum.Ravenna.jpg
19th-century Italian pharmacy
Classic symbols at the wall of a former German pharmacy Ancienne Pharmacie avec symboles sur la mur.JPG
Classic symbols at the wall of a former German pharmacy
Modern pharmacy in Norway Selvvalg.jpg
Modern pharmacy in Norway

A pharmacy (commonly the chemist in Australia, New Zealand and the UK; or drugstore in North America; retail pharmacy in industry terminology; or Apothecary, historically) is the place where most pharmacists practice the profession of pharmacy. It is the community pharmacy where the dichotomy of the profession existshealth professionals who are also retailers.

Community pharmacies usually consist of a retail storefront with a dispensary where medications are stored and dispensed. According to Sharif Kaf al-Ghazal, the opening of the first drugstores are recorded by Muslim pharmacists in Baghdad in 754. [11] [16]

In most countries, the dispensary is subject to pharmacy legislation; with requirements for storage conditions, compulsory texts, equipment, etc., specified in legislation. Where it was once the case that pharmacists stayed within the dispensary compounding/dispensing medications, there has been an increasing trend towards the use of trained pharmacy technicians while the pharmacist spends more time communicating with patients. Pharmacy technicians are now more dependent upon automation to assist them in their new role dealing with patients' prescriptions and patient safety issues.

Pharmacies are typically required to have a pharmacist on-duty at all times when open. It is also often a requirement that the owner of a pharmacy must be a registered pharmacist, although this is not the case in all jurisdictions, such that many retailers (including supermarkets and mass merchandisers) now include a pharmacy as a department of their store.

Likewise, many pharmacies are now rather grocery store-like in their design. In addition to medicines and prescriptions, many now sell a diverse arrangement of additional items such as cosmetics, shampoo, office supplies, confections, snack foods, durable medical equipment, greeting cards, and provide photo processing services.

Hospital pharmacy

Pharmacies within hospitals differ considerably from community pharmacies. Some pharmacists in hospital pharmacies may have more complex clinical medication management issues whereas pharmacists in community pharmacies often have more complex business and customer relations issues.

Because of the complexity of medications including specific indications, effectiveness of treatment regimens, safety of medications (i.e., drug interactions) and patient compliance issues (in the hospital and at home) many pharmacists practicing in hospitals gain more education and training after pharmacy school through a pharmacy practice residency and sometimes followed by another residency in a specific area. Those pharmacists are often referred to as clinical pharmacists and they often specialize in various disciplines of pharmacy. For example, there are pharmacists who specialize in hematology/oncology, HIV/AIDS, infectious disease, critical care, emergency medicine, toxicology, nuclear pharmacy, pain management, psychiatry, anti-coagulation clinics, herbal medicine, neurology/epilepsy management, pediatrics, neonatal pharmacists and more.

Hospital pharmacies can often be found within the premises of the hospital. Hospital pharmacies usually stock a larger range of medications, including more specialized medications, than would be feasible in the community setting. Most hospital medications are unit-dose, or a single dose of medicine. Hospital pharmacists and trained pharmacy technicians compound sterile products for patients including total parenteral nutrition (TPN), and other medications given intravenously. This is a complex process that requires adequate training of personnel, quality assurance of products, and adequate facilities. Several hospital pharmacies have decided to outsource high risk preparations and some other compounding functions to companies who specialize in compounding. The high cost of medications and drug-related technology, combined with the potential impact of medications and pharmacy services on patient-care outcomes and patient safety, make it imperative that hospital pharmacies perform at the highest level possible.

Clinical pharmacy

Pharmacists provide direct patient care services that optimizes the use of medication and promotes health, wellness, and disease prevention. [17] Clinical pharmacists care for patients in all health care settings, but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often collaborate with physicians and other healthcare professionals to improve pharmaceutical care. Clinical pharmacists are now an integral part of the interdisciplinary approach to patient care. They often participate in patient care rounds for drug product selection.

The clinical pharmacist's role involves creating a comprehensive drug therapy plan for patient-specific problems, identifying goals of therapy, and reviewing all prescribed medications prior to dispensing and administration to the patient. The review process often involves an evaluation of the appropriateness of the drug therapy (e.g., drug choice, dose, route, frequency, and duration of therapy) and its efficacy. The pharmacist must also monitor for potential drug interactions, adverse drug reactions, and assess patient drug allergies while designing and initiating a drug therapy plan. [18]

Ambulatory care pharmacy

Since the emergence of modern clinical pharmacy, ambulatory care pharmacy practice has emerged as a unique pharmacy practice setting. Ambulatory care pharmacy is based primarily on pharmacotherapy services that a pharmacist provides in a clinic. Pharmacists in this setting often do not dispense drugs, but rather see patients in office visits to manage chronic disease states.

In the U.S. federal health care system (including the VA, the Indian Health Service, and NIH) ambulatory care pharmacists are given full independent prescribing authority. In some states such North Carolina and New Mexico these pharmacist clinicians are given collaborative prescriptive and diagnostic authority. [19] In 2011 the board of Pharmaceutical Specialties approved ambulatory care pharmacy practice as a separate board certification. The official designation for pharmacists who pass the ambulatory care pharmacy specialty certification exam will be Board Certified Ambulatory Care Pharmacist and these pharmacists will carry the initials BCACP. [20]

Compounding pharmacy

Compounding is the practice of preparing drugs in new forms. For example, if a drug manufacturer only provides a drug as a tablet, a compounding pharmacist might make a medicated lollipop that contains the drug. Patients who have difficulty swallowing the tablet may prefer to suck the medicated lollipop instead.

Another form of compounding is by mixing different strengths (g, mg, mcg) of capsules or tablets to yield the desired amount of medication indicated by the physician, physician assistant, Nurse Practitioner, or clinical pharmacist practitioner. This form of compounding is found at community or hospital pharmacies or in-home administration therapy.

Compounding pharmacies specialize in compounding, although many also dispense the same non-compounded drugs that patients can obtain from community pharmacies.

Consultant pharmacy

Consultant pharmacy practice focuses more on medication regimen review (i.e. "cognitive services") than on actual dispensing of drugs. Consultant pharmacists most typically work in nursing homes, but are increasingly branching into other institutions and non-institutional settings. [21] Traditionally consultant pharmacists were usually independent business owners, though in the United States many now work for several large pharmacy management companies (primarily Omnicare, Kindred Healthcare and PharMerica). This trend may be gradually reversing as consultant pharmacists begin to work directly with patients, primarily because many elderly people are now taking numerous medications but continue to live outside of institutional settings. Some community pharmacies employ consultant pharmacists and/or provide consulting services.

The main principle of consultant pharmacy is developed by Hepler and Strand in 1990. [22] [23]

Internet pharmacy

Canisters of pills from a mail order pharmacy. Mail order pharmacy dispensers.jpg
Canisters of pills from a mail order pharmacy.

Since about the year 2000, a growing number of Internet pharmacies have been established worldwide. Many of these pharmacies are similar to community pharmacies, and in fact, many of them are actually operated by brick-and-mortar community pharmacies that serve consumers online and those that walk in their door. The primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient and private method rather than traveling to a community drugstore where another customer might overhear about the drugs that they take. Internet pharmacies (also known as online pharmacies) are also recommended to some patients by their physicians if they are homebound.

While most Internet pharmacies sell prescription drugs and require a valid prescription, some Internet pharmacies sell prescription drugs without requiring a prescription. Many customers order drugs from such pharmacies to avoid the "inconvenience" of visiting a doctor or to obtain medications which their doctors were unwilling to prescribe. However, this practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and an individual's overall suitability for use of medication. There also have been reports of such pharmacies dispensing substandard products. [24]

Of particular concern with Internet pharmacies is the ease with which people, youth in particular, can obtain controlled substances (e.g., Vicodin, generically known as hydrocodone) via the Internet without a prescription issued by a doctor/practitioner who has an established doctor-patient relationship. There are many instances where a practitioner issues a prescription, brokered by an Internet server, for a controlled substance to a "patient" s/he has never met.[ citation needed ] In the United States, in order for a prescription for a controlled substance to be valid, it must be issued for a legitimate medical purpose by a licensed practitioner acting in the course of legitimate doctor-patient relationship. The filling pharmacy has a corresponding responsibility to ensure that the prescription is valid. Often, individual state laws outline what defines a valid patient-doctor relationship.

Canada is home to dozens of licensed Internet pharmacies, many of which sell their lower-cost prescription drugs to U.S. consumers, who pay one of the world's highest drug prices. [25] In recent years, many consumers in the US and in other countries with high drug costs, have turned to licensed Internet pharmacies in India, Israel, and the UK, which often have even lower prices than in Canada.

In the United States, there has been a push to legalize the importation of medications from Canada and other countries, in order to reduce consumer costs. While in most cases importation of prescription medications violates Food and Drug Administration (FDA) regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers. There is no known case of any U.S. citizens buying Canadian drugs for personal use with a prescription, who has ever been charged by authorities.

Veterinary pharmacy

Veterinary pharmacies, sometimes called animal pharmacies, may fall in the category of hospital pharmacy, retail pharmacy or mail-order pharmacy. Veterinary pharmacies stock different varieties and different strengths of medications to fulfill the pharmaceutical needs of animals. Because the needs of animals, as well as the regulations on veterinary medicine, are often very different from those related to people, veterinary pharmacy is often kept separate from regular pharmacies.

Nuclear pharmacy

Nuclear pharmacy focuses on preparing radioactive materials for diagnostic tests and for treating certain diseases. Nuclear pharmacists undergo additional training specific to handling radioactive materials, and unlike in community and hospital pharmacies, nuclear pharmacists typically do not interact directly with patients.

Military pharmacy

Military pharmacy is an entirely different working environment due to the fact that technicians perform most duties[ example needed ] that in a civilian sector would be illegal.[ citation needed ] State laws of Technician patient counseling and medication checking by a pharmacist do not apply.[ citation needed ]

Pharmacy informatics

Pharmacy informatics is the combination of pharmacy practice science and applied information science. Pharmacy informaticists work in many practice areas of pharmacy, however, they may also work in information technology departments or for healthcare information technology vendor companies. As a practice area and specialist domain, pharmacy informatics is growing quickly to meet the needs of major national and international patient information projects and health system interoperability goals. Pharmacists in this area are trained to participate in medication management system development, deployment and optimization.

Specialty pharmacy

Specialty pharmacies supply high cost injectable, oral, infused, or inhaled medications that are used for chronic and complex disease states such as cancer, hepatitis, and rheumatoid arthritis. [26] Unlike a traditional community pharmacy where prescriptions for any common medication can be brought in and filled, specialty pharmacies carry novel medications that need to be properly stored, administered, carefully monitored, and clinically managed. [27] In addition to supplying these drugs, specialty pharmacies also provide lab monitoring, adherence counseling, and assist patients with cost-containment strategies needed to obtain their expensive specialty drugs. [28] It is currently the fastest growing sector of the pharmaceutical industry with 19 of 28 newly FDA approved medications in 2013 being specialty drugs. [29]

Due to the demand for clinicians who can properly manage these specific patient populations, the Specialty Pharmacy Certification Board has developed a new certification exam to certify specialty pharmacists. Along with the 100 question computerized multiple-choice exam, pharmacists must also complete 3,000 hours of specialty pharmacy practice within the past three years as well as 30 hours of specialty pharmacist continuing education within the past two years. [30]

Pharmaceutical sciences

The pharmaceutical sciences are a group of interdisciplinary areas of study concerned with the design, action, delivery, and disposition of drugs. They apply knowledge from chemistry (inorganic, physical, biochemical and analytical), biology (anatomy, physiology, biochemistry, cell biology, and molecular biology), epidemiology, statistics, chemometrics, mathematics, physics, and chemical engineering. [31]

The pharmaceutical sciences are further subdivided into several specific specialties, with four main branches:

As new discoveries advance and extend the pharmaceutical sciences, subspecialties continue to be added to this list. Importantly, as knowledge advances, boundaries between these specialty areas of pharmaceutical sciences are beginning to blur. Many fundamental concepts are common to all pharmaceutical sciences. These shared fundamental concepts further the understanding of their applicability to all aspects of pharmaceutical research and drug therapy.

Society and culture

Etymology

The word pharmacy is derived from Old French farmacie "substance, such as a food or in the form of a medicine which has a laxative effect" from Medieval Latin pharmacia from Greek pharmakeia (Greek : φαρμακεία) "a medicine", which itself derives from pharmakon (φάρμακον), meaning "drug, poison, spell" [36] [37] [n 1] (which is etymologically related to pharmakos ).

Separation of prescribing and dispensing

Separation of prescribing and dispensing, also called dispensing separation, is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug.

In the Western world there are centuries of tradition for separating pharmacists from physicians. In Asian countries it is traditional for physicians to also provide drugs.

In contemporary time researchers and health policy analysts have more deeply considered these traditions and their effects. Advocates for separation and advocates for combining make similar claims for each of their conflicting perspectives, saying that separating or combining reduces conflict of interest in the healthcare industry, unnecessary health care, and lowers costs, while the opposite causes those things. Research in various places reports mixed outcomes in different circumstances.

The future of pharmacy

In the coming decades, pharmacists are expected to become more integral within the health care system. Rather than simply dispensing medication, pharmacists are increasingly expected to be compensated for their patient care skills. [39] In particular, Medication Therapy Management (MTM) includes the clinical services that pharmacists can provide for their patients. Such services include the thorough analysis of all medication (prescription, non-prescription, and herbals) currently being taken by an individual. The result is a reconciliation of medication and patient education resulting in increased patient health outcomes and decreased costs to the health care system. [40]

This shift has already commenced in some countries; for instance, pharmacists in Australia receive remuneration from the Australian Government for conducting comprehensive Home Medicines Reviews. In Canada, pharmacists in certain provinces have limited prescribing rights (as in Alberta and British Columbia) or are remunerated by their provincial government for expanded services such as medications reviews (Medschecks in Ontario). In the United Kingdom, pharmacists who undertake additional training are obtaining prescribing rights and this is because of pharmacy education. They are also being paid for by the government for medicine use reviews. In Scotland the pharmacist can write prescriptions for Scottish registered patients of their regular medications, for the majority of drugs, except for controlled drugs, when the patient is unable to see their doctor, as could happen if they are away from home or the doctor is unavailable. In the United States, pharmaceutical care or clinical pharmacy has had an evolving influence on the practice of pharmacy. [41] Moreover, the Doctor of Pharmacy (Pharm. D.) degree is now required before entering practice and some pharmacists now complete one or two years of residency or fellowship training following graduation. In addition, consultant pharmacists, who traditionally operated primarily in nursing homes are now expanding into direct consultation with patients, under the banner of "senior care pharmacy". [42]

In addition to patient care, pharmacies will be a focal point for medical adherence initiatives. There is enough evidence to show that integrated pharmacy based initiatives significantly impact adherence for chronic patients. For example, a study published in NIH shows "pharmacy based interventions improved patients' medication adherence rates by 2.1 percent and increased physicians' initiation rates by 38 percent, compared to the control group". [43]

Pharmacy journals

Symbols

The two symbols most commonly associated with pharmacy in English-speaking countries are the mortar and pestle and the ℞ ( recipere ) character, which is often written as "Rx" in typed text. The show globe was also used until the early 20th century. Pharmacy organizations often use other symbols, such as the Bowl of Hygieia which is often used in the Netherlands, conical measures, and caduceuses in their logos. Other symbols are common in different countries: the green Greek cross in France, Argentina, the United Kingdom, Belgium, Ireland, Italy, Spain, and India, the increasingly rare Gaper in the Netherlands, and a red stylized letter A in Germany and Austria (from Apotheke, the German word for pharmacy, from the same Greek root as the English word "apothecary").

See also

Notes and references

Notes
  1. Its earliest attested form in Greek could be the Mycenaean 𐀞𐀔𐀒, pa-ma-ko, written in the Linear B syllabic script and found on the PY Un 1314 tablet; this tablet is also found listed as PY Vn 1314 or PY Sb 1314. [38]
References
  1. Thomas D (November 2018). Clinical Pharmacy Education, Practice and Research. ISBN   9780128142769.
  2. World Health Organization. World Health Statistics 2011 - Table 6: Health workforce, infrastructure and essential medicines. Geneva, 2011. Accessed 21 July 2011.
  3. Board of Pharmacy Specialties, Current Specialties
  4. "Pharmacist Certification and Course Requirements". Learn.org. 2013–2018. Retrieved 6 April 2018.CS1 maint: Date format (link)
  5. "Pharmacy Student handbook 2017-2018" (PDF). KU Pharmacy. August 2017. Retrieved 6 April 2018.
  6. "Pharmacy Student Handbook 2017-2018" (PDF). KU Pharmacy. August 2017. Retrieved 6 April 2018.
  7. John K. Borchardt (2002). "The Beginnings of Drug Therapy: Ancient Mesopotamian Medicine". Drug News & Perspectives. 15 (3): 187–192. doi:10.1358/dnp.2002.15.3.840015. ISSN   0214-0934. PMID   12677263.
  8. Edward Kremers, Glenn Sonnedecker (1986). " Kremers and Urdang's History of pharmacy ". Amer. Inst. History of Pharmacy. p.17. ISBN   0931292174
  9. Titsingh, Isaac. (1834) Annales des empereurs du japon, p. 434.
  10. has photos
  11. 1 2 Hadzovic, S (1997). "Pharmacy and the great contribution of Arab-Islamic science to its development". Medicinski Arhiv (in Croatian). 51 (1–2): 47–50. ISSN   0025-8083. OCLC   32564530. PMID   9324574.
  12. al-Ghazal, Sharif Kaf (October 2003). "The valuable contributions of Al-Razi (Rhazes) in the history of pharmacy during the Middle Ages" (PDF). Journal of the International Society for the History of Islamic Medicine. 2 (4): 9–11. ISSN   1303-667X. OCLC   54045642.
  13. Levey M. (1973), ‘ Early Arabic Pharmacology’, E. J. Brill; Leiden.
  14. History of Pharmacy Web Pages - Sweden´s oldest pharmacies Archived 23 June 2011 at the Wayback Machine
  15. "The History of Pharmacy. Eminent Scientists".
  16. Sharif Kaf al-Ghazal, Journal of the International Society for the History of Islamic Medicine, 2004 (3), pp. 3-9 [8].
  17. American College of Clinical Pharmacy. The definition of clinical pharmacy. Pharmacotherapy 2008;28(6):816-817.
  18. Burke JM, Miller WA, Spencer AP, et al. (2008). "Clinical pharmacist competencies" (PDF). Pharmacotherapy. 28 (6): 806–815. doi:10.1592/phco.28.6.806.
  19. Knapp, KK; Okamoto, MP; Black, BL (2005). "ASHP survey of ambulatory care pharmacy practice in health systems--2004". American Journal of Health-System Pharmacy. 62 (3): 274–84. PMID   15719585.
  20. BPS Approves Ambulatory Care Designation; Explores New Specialties in Pain and Palliative Care, Critical Care and Pediatrics
  21. American Society of Consultant Pharmacists, Frequently Asked Questions
  22. Strand LM (1990). "Pharmaceutical care and patient outcomes: notes on what it is we manage". Top Hosp Pharm Manage. 10 (2): 77–84. PMID   10128568.
  23. Hepler CD, Strand LM (1990). "Opportunities and responsibilities in pharmaceutical care". Am J Hosp Pharm. 47 (3): 533–43. PMID   2316538.
  24. Protecting Patients from Counterfeit and Other Substandard Drugs/Supply Chain Threats
  25. London Free Press Regional News Archive, Canada Internet Pharmacy Merged In $3.8 Million Deal Archived 26 April 2012 at the Wayback Machine
  26. NBCH Action Brief: Specialty Pharmacy. Specialty Pharmacy December, 2013. Accessed 27 October 2014.
  27. Wild, D. Specialty Pharmacy Continuum Carving a Specialty Niche Within the ACO Model." Volume 1 (Summer Issue). August, 2012.
  28. Shane, RR (15 August 2012). "Translating health care imperatives and evidence into practice: the "Institute of Pharmacy" report". American Journal of Health-System Pharmacy. 69 (16): 1373–83. doi:10.2146/ajhp120292. PMID   22855102.
  29. "Health Care Cost Drivers: Spotlight on Specialty Drugs" (PDF). September 2014. Retrieved 27 October 2014.
  30. Specialty Pharmacy Certification Board
  31. American Association of Pharmaceutical Scientists. "Introduction to Pharmaceutical Science" . Retrieved 30 May 2016.
  32. Lees P, Cunningham FM, Elliott J (2004). "Principles of pharmacodynamics and their applications in veterinary pharmacology". J. Vet. Pharmacol. Ther. 27 (6): 397–414. doi:10.1111/j.1365-2885.2004.00620.x. PMID   15601436.
  33. Ermak, Gennady (2015). Emerging Medical Technologies. World Scientific. ISBN   978-981-4675-80-2
  34. Rhodes, edited by Gilbert S. Banker, Christopher T. (2002). Modern Pharmaceutics, 1 (5th ed.). Hoboken: Informa Healthcare. ISBN   0824744691
  35. American Society of Pharmacognosy
  36. Pharmacy (n.) - Online Etymology Dictionary
  37. φάρμακον . Liddell, Henry George ; Scott, Robert ; A Greek–English Lexicon at the Perseus Project.
  38. "PY 1314 Vn + frr. (Cii)". DĀMOS: Database of Mycenaean at Oslo. University of Oslo.Raymoure, K.A. "pe-re". Minoan Linear A & Mycenaean Linear B. Deaditerranean. "The Linear B word pa-ma-ko". Palaeolexicon. Word study tool of ancient languages.
  39. American College of Clinical Pharmacy, Evidence of the Economic Benefit of Clinical Pharmacy Services: 1996–2000
  40. American Pharmacy Student Alliance (APSA)[ unreliable source? ]
  41. American College of Clinical Pharmacy, Clinical Pharmacy Defined
  42. American Society of Consultant Pharmacists, What is a Senior Care Pharmacist? Archived 23 October 2006 at the Wayback Machine
  43. Brennan, Troyen A.; Dollear, Timothy J.; Hu, Min; Matlin, Olga S.; Shrank, William H.; Choudhry, Niteesh K.; Grambley, William (1 January 2012). "An integrated pharmacy-based program improved medication prescription and adherence rates in diabetes patients". Health Affairs (Project Hope). 31 (1): 120–129. doi:10.1377/hlthaff.2011.0931. ISSN   1544-5208. PMID   22232102.

Related Research Articles

Medical prescription

A prescription is a health-care program implemented by a physician or other qualified health care practitioner in the form of instructions that govern the plan of care for an individual patient. The term often refers to a health care provider's written authorization for a patient to purchase a prescription drug from a pharmacist.

Prescription drug licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained

A prescription drug is a pharmaceutical drug that legally requires a medical prescription to be dispensed. In contrast, over-the-counter drugs can be obtained without a prescription. The reason for this difference in substance control is the potential scope of misuse, from drug abuse to practicing medicine without a license and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.

A Doctor of Pharmacy is a professional doctorate in pharmacy. In some countries, it is a first professional degree, and a prerequisite for licensing to practice the profession of pharmacy or to become a Clinical pharmacist. Pharm.D program has significant experiential or clinical education components in introductory and advanced levels. Experiential education prepares graduates to be practice-ready as they already spent a significant amount of time training in areas of direct patient care.

Pharmacotherapy is therapy using pharmaceutical drugs, as distinguished from therapy using surgery, radiation, movement, or other modes. Among physicians, sometimes the term medical therapy refers specifically to pharmacotherapy as opposed to surgical or other therapy; for example, in oncology, medical oncology is thus distinguished from surgical oncology.

American Society of Health-System Pharmacists is a professional organization that represents pharmacists who serve as patient care providers in acute and ambulatory care settings. The organization’s 45,000 members include pharmacists, student pharmacists, and pharmacy technicians. For more than 75 years, ASHP has been at the forefront of efforts to improve medication use and enhance patient safety.

Pharmaceutical policy is a branch of health policy that deals with the development, provision and use of medications within a health care system. It embraces drugs, biologics, vaccines and natural health products. Pharmaceutical policy includes:

Clinical pharmacy is the branch of pharmacy in which clinical pharmacists provide direct patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often work in collaboration with physicians, nurse practitioners, and other healthcare professionals. Clinical pharmacists can enter into a formal collaborative practice agreement with another healthcare provider, generally one or more physicians, that allows pharmacists to prescribe medications and order laboratory tests.

In Denmark, pharmaconomists are experts in pharmaceuticals who have trained with a 3-year tertiary degree. Pharmaconomy describes either their professional practice or their training courses.

Pharmacy residency is education a pharmacist can pursue beyond the degree required for licensing as a pharmacist.

The basic requirement for pharmacists to be considered for registration is an undergraduate or postgraduate pharmacy degree from a recognized university. In many countries, this involves a four- or five-year course to attain a master of pharmacy degree (MPharm). In the United States of America, students graduating after January 1, 2003, must complete a doctor of pharmacy degree to become a licensed pharmacist. This same requirement has been coming into place in other countries such as Canada and France.

Pharmacy (shop) facility where medicines are sold

A pharmacy is a retail shop which provides prescription drugs, among other products. At the pharmacy, a pharmacist oversees the fulfillment of medical prescriptions and is available to give advice on their offerings of over-the-counter drugs. A typical pharmacy would be in the commercial area of a community.

Psychiatric pharmacy, also known as mental health pharmacy, is the area of clinical pharmacy specializing in the treatment of people with psychiatric illnesses through the use of psychotropic medications. It is a branch of neuropsychiatric pharmacy, which includes neurologic pharmacy.

Telepharmacy Pharmacy care by telecommunication

Telepharmacy is the delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with a pharmacist. It is an instance of the wider phenomenon of telemedicine, as implemented in the field of pharmacy. Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs, and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing. Remote dispensing of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities.

Pharmacy in the United Kingdom has been an integral part of the National Health Service since it was established in 1948. Unlike the rest of the NHS pharmacies are largely privately provided apart from those in hospitals, and even these are now often privately run.

Separation of prescribing and dispensing, also called dispensing separation, is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug.

Collaborative practice agreement

A collaborative practice agreement (CPA) is a legal document in the United States that establishes a legal relationship between clinical pharmacists and collaborating physicians that allows for pharmacists to participate in collaborative drug therapy management (CDTM).

In the United StatesVeterinary pharmacy is a field of pharmacy practice, in which veterinary pharmacists may compound medications, fill prescriptions, and manage drug therapies for animals. Veterinary pharmacists are licensed pharmacists who specialize in the distribution of medications for animals. This differs slightly from the title of "veterinary pharmacy specialist," who might additionally work in consulting, research, and education for veterinary pharmacy. Regular pharmacists in a variety of settings come into play in the preparation and dispensing of animal medications as well. As veterinarians treat a wide variety of animals with a wide variety of products, pharmacists can help manage these treatments through their compounding and drug knowledge. Compounding is often necessary for animal patients, as they require different dosages and medication forms from humans. Through compounding, pharmacists can adjust a medication for an animal so it is more appealing in taste or appearance. While there is currently no required veterinary pharmacy curriculum in place by the Accreditation Council for Pharmacy Education, the American Veterinary Medical Association understands that some veterinary education might be beneficial to pharmacists as community pharmacies continue to supply animal medications.

The pharmacy management system, also known as the pharmacy information system, is a system that stores data and enables functionality that organizes and maintains the medication use process within pharmacies.

References