1. Instructor: Ryan Lambert-Bellacov
Welcome to Pharmacy 100
Instructor: Ryan Lambert-Bellacov

2. Overview of the course

3. Chapter 1 The Profession of Pharmacy
Pharmacy Practice for Technicians
fourth Edition
Don Ballington
Chapter 1 The Profession of Pharmacy
Copyright © Ballington editted by Ryan Lambert-Bellacov

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

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

6. Ancient Medicine
Ancient Egyptian Medicine -was highly advanced for the time (mummification)
Ancient Chinese Medicine - Zhang Liang invented an instrument named "Meng" which is considered to be precursor of modern stethoscope.
Ancient India Medicine- Indian snake root (Jones)
Ancient Greek Medicine- Hemlock and the dealth of Socrates

7. 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
First century A.D.
De Materia Medica (standard text on drugs for 1500 years)

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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)

18. 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

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

20. 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

21. Education and Licensing Requirements
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)

22. Education and Licensing Requirements
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

23. 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?

24. Terms to Remember
compounding
over-the-counter (OTC)

25. 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.

26. 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

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

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

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

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

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

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

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

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

35. 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?

36. 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

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

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

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

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

41. Terms to Remember
Pharmacy technician
Multi-task

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. 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

49. 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

50. 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

51. Discussion
What are the advantages and disadvantages of each type of community pharmacy operation?

52. Terms to Remember community pharmacy chain pharmacy
independent pharmacy
franchise pharmacy
mail-order pharmacy

53. 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

54. Institutional Pharmacy
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

55. Institutional Pharmacy
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

56. Institutional Pharmacy
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

57. Institutional Pharmacy
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.

58. Institutional Pharmacy
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

59. Institutional Pharmacy
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

60. Institutional Pharmacy
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

61. Institutional Pharmacy
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

62. Institutional Pharmacy
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

63. Institutional Pharmacy
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

64. Institutional Pharmacy
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

65. 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)

66. 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

67. 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

68. 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

69. 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

70. 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

71. 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

72. Discussion
What are the similarities between and among the various institutional pharmacy environments?
What are the differences?

73. Institutional Pharmacy
Terms to Remember
Pharmacy Workplace:
Institutional Pharmacy
institutional pharmacy
hospital pharmacy
home healthcare pharmacy
long-term care facility
managed care
health maintenance organization (HMO)
formulary

74. 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

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

76. Terms to Remember pharmacist pharmaceutics pharmacognosy
pharmacokinetics
galenical pharmacy
pathophysiology
pharmacology
pharmaceutical care