Chapter 1 The Profession of Pharmacy Learning Objectives

Chapter 1 The Profession of Pharmacy

Learning Objectives • Describe the various cultural origins of pharmacy and their impact on the profession today. • Discuss the four stages of development of the pharmacy profession in the twentieth century. • Differentiate the major roles and responsibilities of the pharmacist and the pharmacy technician.

Learning Objectives • Understand the educational and licensing requirements for today’s pharmacist and pharmacy technician. • Differentiate among various workplace environments such as community and institutional pharmacies.

In the beginning…. • Pharmacy has undergone significant change. • Beginning as an ancient art combining nature’s elements with spiritualism or magic. • Now a scientific pursuit. • Pharmacists and pharmacy technicians educated and trained to ensure the well-being of the patient population.

The Origins of Pharmacy Practice • How was sickness or disease thought to be in early civilizations? • The use of drugs in healing is as old as civilization itself. • Modern archaeologists have unearthed clay tablets listing hundreds of medicinal preparations. • Early inhabitants used the trial-and-error method to compile lists of drugs, pharmacopeias, or dispensatories. • Modern day formularies are based on these drug lists.

Emergence of Traditional Eastern and Western Medicine • Far East cultures relied mainly on the healing properties of plants and herbs. • Traditional Eastern medicine involves the use of botanicals. • What herbal treatments from the Far East do we still use in Western culture today?

Traditional Western Medicine • Hippocrates (ca. 460 -370 BCE), famous Greek physician, known as what? • Illness had a rational and physical explanation. The four humors must be in correct balance to maintain health. What are the four humors? • Pharmacy comes from the ancient Greek word pharmakon, meaning “drug or remedy. ”

Traditional Western Medicine • Dioscorides, Greek physician, is credited with writing one of the world’s greatest pharmaceutical texts: De Materia Medica (On Medical Matters). • What is included in this text? • De Materia Medica has served as the standard reference text for drugs and is considered the forerunner of modern-day references such as the United States Pharmacopeia (USP) and Physician’s Desk Reference (PDR).

Traditional Western Medicine • Galen (129 -216 CE), notable Greek physician. • Galen studied the effects of herbal medicine on the human body, leading to the term galenical pharmacy, or the process of creating extracts of active medicinals from plants. • Why is Galen is known as “The Father of Pharmacy”?

Roots of the Pharmacy Profession • The Middle Ages, the profession of pharmacy was evolving in Persian and European empires. • Arabic civilizations were some of the first cultures to develop a list of drugs and dosage forms (pills, syrups, extracts), and to identify the pharmacist as a qualified healthcare professional. • Apothecary (pharmacy) modeled after ancient Greek and Arabic cultures. • Professional guilds led to the training of chemists and pharmacists which led to the rise of formalized universities and professional organizations.

Roots of the Pharmacy Profession • Questions arose during the Renaissance (1350 -1650 CE) in Europe of Greek, Roman, and Arabic influences on the profession of pharmacy. • Alchemy combined elements of chemistry, metallurgy, physics, and medicine with astrology, mysticism, and spiritualism. • What did alchemy claim?

Roots of the Pharmacy Profession • During the Renaissance was the emergence of hospitals and pharmacies run by religious orders. • These facilities served the larger communities by providing free health care and medicines to the poor. • 17 th century led to advances in pharmacy practice with the publishing of scientific and medical research. • Greek and Latin root words, prefixes, and suffixes were used and are still used today in the scientific naming of many medical terms.

Herbal Medicine and Apothecaries • The list of medicinal agents grew with the arrival of exotic plants and spices. • Chemistry and botany was now a required skill of pharmacists. • Many apothecary shops in the 1800’s were still operated by physicians even though pharmacists were being increasingly recognized.

Herbal Medicine and Apothecaries • Herbal medicine was common practice in the early colonization of the United States. • What herbal medicines are still used today?

Roles of Early Pharmacy Practitioners • Pharmacists in the colonies were druggists, doctors, merchants or storekeepers. • Until the 19 th century physicians typically owned the dispensary that distributed drugs to patients. • Development of the United States formulary known as the United States Pharmacopeia (USP). • What does the current USP provide?

Roles of Early Pharmacy Practitioners • 1852, the American Pharmacist Association (APh. A) addressed adulteration of imported drugs. • Late 1800’s community pharmacist compounded many herbs and chemicals for medicinal use. • 1886, John Pemberton, began to sell a tonic called Coca-Cola. • 1893, Caleb Bradham, created Pepsi-Cola.

Roles of Early Pharmacy Practitioners • 20 th century pharmaceutical manufacturing began to take hold. • The traditional compounding tasks (formulating own liquids, powders and rolling their own pills) became less common, pharmacy became more scientific and technical. • American Society of Health-System Pharmacists (ASHP) is credited with many innovations in practice and training programs.

Modern-Day Pharmacy Practice • With the explosion of scientific research and accessibility of information, the pharmacy profession is able to keep pace with medical advances. • Compounding has evolved from a trial-anderror process to an exact science. • Pharmacists and technicians work together to fill more than 4 billion prescriptions each year.

The Pharmacy Workplace of Today • Pharmacy technicians are employed in a variety of pharmacy settings such as community pharmacies (drugstores), hospital pharmacies, home healthcare systems, and long-term care facilities. • At any time, 24 hours a day, some of the estimated 334, 000 technicians in the United States are at work in a pharmacy.

Community Pharmacies • Most pharmacists and technicians work in community pharmacies, retail pharmacies. • The ratio of pharmacists to technicians is dictated by the state board of pharmacy. (There is no limiting ratio in Missouri) • Most community pharmacies are divided into restricted prescription area and front-end merchandise.

Independent Pharmacies • Independent pharmacy – a community pharmacy owned and usually operated by one pharmacist or group of pharmacists. • The owner makes decisions regarding practice of pharmacy, with more time and attention spent on customer service. • Some independent pharmacies have developed into compounding pharmacies – specializing in the preparation of nonsterile (sometimes sterile) preparations not commercially available.

Chain Pharmacies • Chain pharmacy – national or regional, typical corner drugstore (Wal-Mart, Target, Kroger, Publix, Walgreens, CVS, Rite-Aid). • Chain pharmacies are typically located in metropolitan areas with heavy use of technicians and automation. • A chain pharmacy is owned by a corporation, administrative decisions made at the corporate level. • Some chains have established walk-in clinics.

Franchise Pharmacies • Franchise pharmacy – combines characteristics of an independent with a chain pharmacy. • Franchisors are granted exclusive use of company name and rights to market and sell company products. • Franchise pharmacies attempt to provide personalized health care. • A franchise pharmacies typically has one pharmacist (owner) and one technician.

Mail-Order Pharmacies • Mail-order pharmacies – one of the fastestgrowing types of pharmacies. • A centralized operation using extensive automation and technicians to dispense and mail large volumes of prescriptions every day. • What advantages & disadvantages are there to using mail-order pharmacies?

Institutional Pharmacies • Institutional pharmacy – a pharmacy associated with any organized healthcare system. • Hospital pharmacy is the most common example of an institutional pharmacy. • Other examples include: long-term care facilities, home healthcare systems, managedcare organizations, and nuclear pharmacies.

Hospital Pharmacies • ¼ of all pharmacists work in a hospital setting. • Hospital pharmacists and technicians prepare, or supervise preparation of, unit-dose, IV, and extensive floor stock medications. • Many technicians in the hospital work in a “clean room” environment. • To work in a “clean room” requires education, training, and certification.

Long-Term Care Facilities • Long-term care (LTC) facility has different levels. • Extended-care facility (ECF) provides services to older adults or disable residents who can no longer provide activities of daily living (ADL). • Skilled-care facility (SCF) is limited to patients requiring more round-the-clock care. • Facilities that treat patients with chronic or acute psychiatric disorders or rehabilitation facilities are additional examples of long-term care facilities.

Home Healthcare Systems • Home healthcare – delivery of medical, nursing, and pharmacy services to patients who remain at home. • Home healthcare systems are expected to grow as our population ages. • Home healthcare pharmacies – provide IV and oral medications and must often be available 24/7. • Hospice care – is a form of home healthcare.

Managed-Care Pharmacy Services • Managed-care has grown dramatically. • Kaiser Permanente, was an early managed-care or health maintenance organization (HMO). • An HMO provides health insurance for medical and pharmacy services using a managed-care model. • The HMO philosophy is based on the idea that keeping patients of all ages healthy, decreases hospitalization and ER visits, lowering the costs to the healthcare system.

Managed-Care Pharmacy Services • Most HMO’s are centralized primary-care clinics serving adult, pediatric and OB/GYN patients. • Offering pharmacy, X-ray, and laboratory services on-site. • HMO’s, like hospitals, have an approved formulary (drug list). • HMO pharmacies and responsibilities of the technician are similar to community pharmacies. • Effective use of technicians allows pharmacists to provide more time counseling patients, resulting in lower costs and fewer medication errors.

Nuclear Pharmacy • Nuclear pharmacy – highly specialized practice compounding and dispensing sterile radioactive pharmaceuticals for diagnostic or therapeutic uses. • Staffed by pharmacists and technicians with advanced training and certification in radiation safety. • Pharmacy personnel must always wear badges that monitor radiation exposure.

The Pharmacist • The role of the pharmacist is to safeguard the health of the public (patients). • Pharmacists today are highly trained and educated to meet the demands of today’s pharmacy. • Pharmacists must be vigilant in their responsibilities: detecting an error; problematic combination of drugs; dangerous use of a drug; and interaction of medication with food, drink, or environment.

Evolution of the Pharmacist’s Role • The role of the pharmacist, during the 20 th century, has changed dramatically to keep pace with medical and scientific advances. • There are four distinct eras: – The Traditional Era – The Scientific Era – The Clinical Era – The Pharmaceutical Care Era

Traditional Era • Beginning of the 20 th century, pharmacists formulated and compounded medications from natural sources. • Prescriptions were compounded by hand, using a mortar and pestle, ingredients and dosages tailored to individual patients. • Less than 1% of all prescriptions today are compounded. • Pharmacists-in-training served as apprentices, learning the trade in pharmacies rather than sitting in a classroom. • Pharmacognosy – the knowledge of the medicinal functions of natural products from animal, plant, or mineral origins was a piece of the limited education pharmacist focused on at this time.

Scientific Era • Post WWII period, pharmaceutical manufacturers, like Eli Lilly, Merck and Pfizer, developed and tested new drugs and dosage forms. • Synthesized, developed and mass-produced theses medications were more economical and better quality. • Educational institutions increased the emphasis on the sciences and expanded the pharmacy curriculum. • Pharmacology – the scientific study of drugs and their mechanisms of action, was a required course of study. • 1960, a five-year BS degree was required.

Clinical Era • Combining the traditional role of pharmacist with a dispenser of drug information to the patient and physician. • Pharmaceutics – the study of how drugs are introduced to the body, was added to the pharmacy curriculum. • There was a feeling that training had shifted too far into the sciences, away from the actual practice of pharmacy. • 1973, the American Association of Colleges of Pharmacy (AACP) reevaluated the mission of the pharmacy profession. • Development of clinical- or patient-oriented pharmacy resulted in a change to the pharmacy curriculum and the adoption of the Pharm. D degree program.

Clinical Era • New courses were also developed: – Pharmacokinetics – individualizing doses of drugs based on absorption, distribution, metabolism, and excretion from the body. – Therapeutics – the study of applying pharmacology to the treatment of illness and disease states – Pathophysiology – the study of disease and illnesses affecting the normal function of the body.

Pharmaceutical Care Era • Pharmaceutical care – expands the mission of the pharmacy profession to include responsibility for ensuring positive outcomes for drug therapy. • “Medication therapy management” (MTM) may include recommending a less costly drug to a physician, identifying a potential serious drug interaction, or counseling a patient. • MTM practices are being recognized by insurance copies, providing reimbursement for pharmacist interventions. • What role can a technician play in MTM’s?

Current Role and Responsibilities of a Pharmacist • Pharmacists today dispense drugs for existing disease but also create patient care initiatives to prevent or identify future disease. • The tasks that the pharmacist takes on goes well beyond what is mentioned above, see pgs. 16 -17. • How can technicians help a pharmacist with their specific tasks in today’s pharmacies?

Additional Responsibilities • Based on the pharmacy setting pharmacists may have specific responsibilities. – Community Pharmacies: nonsterile and sterile compounding; dispense and send medications in special packaging; business person and entrepreneur; hires and supervises employees – Institutional Pharmacies: order entry; prepare medications and IV’s; education; policy and procedures; counseling patients

Educational Requirements of a Pharmacist • Education of a pharmacist has transformed from an apprenticeship to a full-time study of the sciences in an academic setting. • Early 1800’s, the Philadelphia College of Pharmacy became the first school to offer courses in pharmaceutical sciences and grant pharmacy-specific diplomas. • 1868, the University of Michigan offered formal education and degree programs in pharmacy. • Late 1800’s, the APh. A encouraged state governments to regulate the pharmacy profession, pass formal certification examinations to obtain a licensure to practice.

Educational Requirements of a Pharmacist • Until 1920, formal education requirements were not required in order to take an exam to become a pharmacist; applicants must have completed 3 or 4 year apprenticeship in a pharmacy. • Today, all colleges of pharmacy offer a Pharm. D degree. – Pre-pharmacy course work – The Pharmacy College Admission Test (PCAT) > 80 – GPA of 3. 5 – 4. 0 – Challenging course work

Licensing Requirements of a Pharmacist • Graduate from an accredited college of pharmacy. • Pass a state board certification exam. • Serve an internship under a licensed pharmacist either during and/or after formal schooling. • Specific continuing education requirements may be required to renew licenses. • Licensing and professional oversight are carried out by the state boards of pharmacy.

The Pharmacy Technician • The modern-day pharmacist would not be possible without well-trained, educated, and certified pharmacy technicians. • Pharmacy technicians allow the pharmacist to spend more time doing other things, while technicians assume routine functions/tasks. • Technicians assist with workload by entering patient and prescription information into the computer, prepare medication to be dispensed, and provide customer service.

Evolution of the Pharmacy Technician’s Role • Early 20 th century, “pharmacy assistants” were the predecessors of pharmacy technicians. • Training was received via seasoned pharmacy professionals; early pharmacy technicians were also trained as military medics. • Once a part-time floor stock and cashier, now the pharmacy technician is an invaluable assistant to the pharmacist in all pharmacy settings.

Current Role and Responsibilities of a Pharmacy Technician • A central piece to a technician’s job is accountability to the pharmacist for the quality and accuracy of their work. • The pharmacist takes final responsibility (and liability) for the technician’s actions. • In a community setting technicians may: – – – Meet and great patients Enter patient information Assist the pharmacist Operate cash register Stock and inventory Billing and resolving online insurance claims

Current Role and Responsibilities of a Pharmacy Technician • Similar tasks to that of a community pharmacy technician may be performed in a hospital setting. • Long-term care setting responsibilities also mirror those of the community and hospital pharmacy technicians. • Technicians must possess certain personal characteristics to successfully contribute to patient care. • What are some of those personal characteristics?

Current Role and Responsibilities of a Pharmacy Technician • Specific duties of a pharmacy technician will vary depending on the pharmacy setting and the needs of the workplace. • Technicians must act in accordance with state and federal pharmacy laws, as well as individual facilities policies and procedures. • There are some tasks that are solely the responsibility of the pharmacist. • What are those tasks?

Educational Requirements of a Pharmacy Technician • On the job training use to be sufficient but as the role of the pharmacist has expanded so has the role of the technician. • Formal training programs have been developed to better train technicians to assist the pharmacist. • The National Association of Boards of Pharmacy (NABP) is working to develop standards with each state in the educational curriculum of pharmacy technicians.

Educational Requirements of a Pharmacy Technician • Course work may include: introduction to practice; medical terminology; pharmacology; calculations; and some degree of experiential training. • Programs are designed to better prepare the student to pass a pharmacy technician certification exam. • Certification is encouraged in some pharmacy settings; required in order to work in a hospital.

State Board Requirements of a Pharmacy Technician • State jurisdictions require licensure, registration, or certification of pharmacy technicians. • http: //www. pharmace. com/state-by-staterequirements-to-become-a-pharmacytechnician. html • Certification requires successful completion of a standardized national pharmacy technician exam. • Certification is maintained by completing 20 continuing education credits biannually.

Healthcare Team • Health care is a collaborative effort between physicians, nurse practitioners, dentists, vets, nurses, and pharmacists. • Paraprofessionals like pharmacy technicians, physician assistants, dental assistants, hygienists, vet assistants, and licensed practical nurses assist professionals in routine but necessary tasks. • Pharmacy technicians assist pharmacists allowing pharmacists more time to meet the mission of the profession: to ensure positive outcomes for drug therapy in the patient population.

• This workforce solution was funded by a grant awarded by the U. S. Department of Labor’s Employment and Training Administration. The solution was created by the grantee and does not necessarily reflect the official position of the U. S. Department of Labor. The Department of Labor makes not guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or tis completeness, timeliness, usefulness, adequacy, continued availability, or ownership. This work by Mineral Area College is licensed under the Creative Commons Attribution 4. 0 International License. Created by Jennifer Majeske, Mineral Area College

Resources • Picture on slide 2 – The Dark Side of the Moon is provided with permission from James True • Picture on slide 15 – Echinacea Fatal Attraction by F. D. Richards is licensed under CC BY • Picture on slide 15 – Fresh ginger rhizome by Frank C. Müller is licensed under CC BY