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Chapter 1

The Profession

of Pharmacy

Chapter 1 Topics

• Ancient Origins

• Pharmacist

• Pharmacy Technician

• Pharmacy Workplace of Today

Learning Objectives

• Describe the origins of pharmacy

• Describe the four stages of 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

Ancient Origins

• Pharmacy comes 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)

Ancient Origins

Galen

• Conducted animal experiments

• Produced a systematic classification of drugs for

treatment of disease

• Galenical pharmacy described 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)

Ancient Origins

Dr. John Morgan

• Eighteenth Century

• Supported the separation of the professions of

pharmacy and medicine

• pharmakon

• theory of humors

• galenical pharmacy

• De Materia Medica

Terms to Remember

Learn more at American Institute of the History of Pharmacy (AIHP)

Discussion

How has the profession and practice of

pharmacy evolved since ancient times?

Pharmacist

• The profession of pharmacy exists to safeguard the health of the public

• The pharmacist is 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

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

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

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

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

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)

Discussion

How does the pharmaceutical care model

affect the duties of pharmacists in the 21st

Century? medication outcomes?

Terms to Remember

• pharmacist • pharmaceutics

• pharmacognosy • pharmacokinetics

• galenical pharmacy • pathophysiology

• pharmacology • pharmaceutical care

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

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

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)

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

Other Pharmacy Settings

• Health maintenance organization (HMO)

• Long-term care facilities

• Specialized practice

– psychiatry

– drug abuse

• Nursing homes

– geriatrics

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

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)


• 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

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?

Terms to Remember

• compounding

• over-the-counter (OTC)

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.

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


Technician’s Role

Pharmacy technicians play a valuable role in

reducing the risk of medication errors.

Safety Note!


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.


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


Technician’s Role

The pharmacy technicians works under the

direction of the supervising pharmacist.

Safety Note!


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


• 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


• 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.


• 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

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?

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


• 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.


• 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.

Characteristics

• 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

A successful pharmacy technician must possess a wide range of skills, knowledge, and aptitudes.

Discussion

What makes each of the listed

characteristics of a pharmacy technician

important?

Terms to Remember

•Pharmacy technician

•Multi-task

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

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

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

Community Pharmacy

A chain pharmacy is 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

Community Pharmacy

An independent pharmacy is 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

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

Visit The Medicine Shoppe

Community Pharmacy

Pharmacy technicians employed in a community pharmacy typically

• aid the pharmacist in the filling, labeling, and recording of prescriptions

• operate and are responsible for the pharmacy cash register

• stock and inventory prescription and over-the-counter (OTC) medications

• maintain computerized patient records

• prepare insurance claim forms

• order and maintain parts of the front-end stock

Community Pharmacy

A mail-order pharmacy is a large-volume centralized pharmacy operation that uses automation to fill and mail prescriptions to the patient.

– somewhat related to retail pharmacy

Run by a centralized operation using both automation and pharmacy techs

– dispense and mail large volumes of prescriptions every day

– more and more prescriptions are being filled by

mail-order pharmacies

Community Pharmacy

Mail-order pharmacy

• Economies of scale allow lower acquisition costs

– savings to insurers and customers

• Limitations:

– if the patient experiences a side effect or adverse reaction, or the physician changes the medication, then the drug savings could be offset by drug wastage

– impersonal counseling, which is limited to a drug printout or calling a toll-free number

– time delay

– safety of delivery of pain medications through the mail

Discussion

What are the advantages and disadvantages

of each type of community pharmacy

operation?

Terms to Remember

• community pharmacy

• chain pharmacy

• independent pharmacy

• franchise pharmacy

• mail-order pharmacy

Institutional Pharmacy

Institutional pharmacies are organized under a

corporate structure, following specific rules and

regulations for accreditation.

• A pharmacy associated with any organized

healthcare delivery system

– hospital pharmacy is the most common example

– more recent examples of places where institutional

pharmacies can be found include :

• home healthcare

• long-term care facilities

• managed-care organizations


A hospital pharmacy is an institutional pharmacy that dispenses and prepares drugs and provides clinical services in a hospital setting.

• One fourth of all pharmacists work in a hospital setting

– an institution that offers 24-hour healthcare service; that has six or more beds, a governing authority, and an organized medical staff; and that offers nursing and pharmacy services

– carries out the functions of maintaining drug treatment records and ordering, stocking, compounding, repackaging, and dispensing medications and other supplies


• The pharmacy technician in a hospital setting

– takes part in functions involving delivery, stocking, or inventorying of medications anywhere in the hospital

– may operate manual or computerized robotic dispensing machinery

• Typical hospital pharmacy staff may include:

– administrators with master’s degrees or PharmD degrees

– staff pharmacists with Bachelor of Science (BS) degrees

– staff and clinical pharmacists with PharmD degrees

– pharmacy technicians


• Hospital pharmacies (and drugstore chains) are

more likely than community pharmacies to require

that pharmacy technicians be certified.

• Some pharmacy employers encourage technicians

to become certified

– by paying for the certification exam

– by giving raises to those who pass it


A home healthcare pharmacy is a pharmacy that

dispenses, prepares, and delivers drugs and medical

supplies directly to the home of the patient.

• Spiraling hospitalization costs, regulatory changes, and

advances in parenteral therapies have created an

explosion in this field

• The home healthcare market continues to grow because

of our aging society and as an alternative to the higher

cost of hospitalizations

– Many hospitalized patients are discharged as soon as possible

to continue their recovery at home with IV solutions.


• Pharmacists and pharmacy technicians working in

home healthcare

– provide educational materials

– carry out traditional compounding and delivery

functions

– prepare and provide infusions and infusion equipment

– often must be available for emergencies on a 24-hour

basis


A long-term care facility is an institution that

provides care for geriatric and disabled patients.

• An extended-care facility (ECF) provides

institutional services predominantly to older adults

or disabled “residents” who unable to provide for

routine or medical care for themselves

– includes adults who suffer from chronic (long-lasting)

or such debilitating illnesses as stroke or Alzheimer’s

disease

– both medical and residential care is provided with very

few discharges


• Skilled-care facilities (SCF) are limited to patients

requiring more round-the-clock nursing care (such

as IV infusions) or recovery after a recent

hospitalization

– most patients are discharged from SCF to home when

they have adequately recovered

• Other long-term care facilities include patients

with acute or chronic psychiatric disorders or

rehabilitation facilities for those with serious

traumatic brain or spinal cord injuries


• Some long-term care facilities have an “in-house” pharmacy– others contract with a community pharmacy or allow each

resident to choose his or her pharmacy

• Licensed pharmacists– establish record-keeping systems related to controlled

substances

– review drug regimens

– monitor repackaging and storage of pharmaceuticals

– ensure that medications are uncontaminated and have not expired

– note medication errors and adverse reactions or interactions

– educate residents on drug therapies and self-medication

– provide medications to outpatients or residents on weekend leave


• The pharmacist may play a crucial role in ensuring

regulatory compliance

– a licensed pharmacist must do a monthly check

of each patient profile in a long-term care

facility

• The professional organization for “geriatric”

pharmacists is the American Society of Consultant

Pharmacists (ASCP)

Visit the ASCP Web site


A pharmacy technician in a long-term care facility may:

• log prescriptions and refill orders via computer

• prepare billings

• maintain drug boxes or trays for emergencies

• package and label medications

• deliver medications to the nursing home

• maintain records, retrieve and organize patient charts

• conduct inspections of drugs in inventory and in nursing

stations

• repackage drugs in unit doses labeled for each patient


• In-house pharmacies may provide a 7-day supply of

medication in “blister packs.”

• Community pharmacies fill medication carts or trays

with a 30-day supply of medication

– medication orders rarely change in this environment

Managed Care

Managed care is a type of health insurance system

that emphasizes keeping the patient healthy of

diseases controlled to reduce healthcare costs.

• A relatively new form of healthcare that has grown

dramatically over the past 35 years

– One of the first managed-care organizations was Kaiser

Permanente

• Another name for managed care is health

maintenance organization (HMO)

Managed Care

• HMOs encourage patients to take an active role in their own healthcare by:

– eating right

– exercising often

– avoiding negative life-style choices

• HMOs encourage patients to:

– have annual checkups

– get all their immunizations on schedule

– get necessary laboratory (like a cholesterol or sugar test) and diagnostic tests (like a pap smear or mammogram) to detect early diseases, which may be surgically correctible

Managed Care

• Most HMOs have their own staff physicians who are on

salary

– Patients who need a specialist must first get a referral

• HMOs have been successful in slowing the pace of the

inflationary increases in healthcare without

compromising the quality of care

• Many employers now include an HMO option on their

health plans

Managed Care

• Most HMOs are centralized primary-care clinics

– they serve patients with pharmacy, x-ray, and

laboratory departments under one roof

• An HMO, like a hospital, usually has an approved

drug list or formulary that has been

recommended by a drug information pharmacist

and approved by the medical staff

Managed Care

• The formulary plus the use of low-cost generic drugs allows the organization to volume purchase select drugs to lower operational and patient cost

– unlike a community pharmacy, an HMO pharmacy does not stock every brand of drug available

• Many HMO pharmacies have a tiered pricing plan so that patients pay one price for a generic drug, a higher price for a “preferred” brand name drug, and an even higher price for a “nonpreferred” brand name product

– most patients and physicians use the lower-cost alternatives whenever possible

Managed Care

• After the patient sees the physician, the patient may

go to the HMO pharmacy to fill a prescription

• Patients needing refills may call an automated

telephone number to expedite processing and reduce

waiting times

– this “time savings” also allows the pharmacist to spend

more time reviewing the computerized medication profile

and counseling the patient

Managed Care

• The pharmacy technician in managed care performs

similar functions to those in the community pharmacy

– although insurance billing and cashiering are minimal

• Clinical pharmacists may work closely with the

primary-care physicians to better control chronic disease

– educating

– monitoring

– adjusting doses of medications per physician-approved

protocols

Discussion

• What are the similarities between and

among the various institutional pharmacy

environments?

• What are the differences?

Terms to Remember

Pharmacy Workplace:


• institutional pharmacy

• hospital pharmacy

• home healthcare pharmacy

• long-term care facility

• managed care

• health maintenance organization (HMO)

• formulary

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