4Chapter 1 Topics Ancient Origins Pharmacist Pharmacy Technician Pharmacy Workplace of Today
5Ancient Origins Pharmacy comes from the Greek word, meaning drug Scientific approach to medicine began with the ancient GreeksHippocratesProposed that disease came from natural, not supernatural causesEstablished the theory of humors (blood, phlegm, black bile, yellow bile)
6Ancient MedicineAncient 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
7Ancient Origins Galen Conducted animal experiments Produced a systematic classification of drugs for treatment of diseaseGalenical pharmacy described the process of creating extracts of active medicinals from plantsFirst century A.D.De Materia Medica (standard text on drugs for 1500 years)
8Ancient Origins Dr. John Morgan Eighteenth Century Supported the separation of the professions of pharmacy and medicine
9PharmacistThe profession of pharmacy exists to safeguard the health of the publicThe pharmacist is one who is licensed to prepare and dispense medications, counsel patients, and monitor outcomes pursuant to a prescription from a licensed health professionalThe role of the modern pharmacist evolvedfrom compounder and dispenserto providing medication information and preventing medication-related problems
10Evolution of the Pharmacist’s Role During the twentieth century, the pharmacy profession has evolved through four stages.Traditional EraScientific EraClinical EraPharmaceutical-care Era
11Traditional Era Early twentieth century Formulation and dispensing of drugs from natural sourcesPharmacognosyThe study of the medicinal properties of natural products of animal, plant, and mineral originsGalenical pharmacyTechniques for preparing medications
12Scientific Era Began after World War II Emergence of the pharmaceutical industryDrugs made in factories, not apothecary shopPharmacy education emphasized sciencesPharmacologyThe scientific study of drugs and their mechanism of action including side effectsPharmaceuticsRelease characteristics of drug dose forms
13Clinical Era 1975: Millis Report, Pharmacists for the Future New educational emphasis on clinical (patient-oriented) pharmacyPharmacokineticsthe activity of a drug within the body over a period of time; includes absorption, distribution, metabolism, and eliminationPathophysiologythe study of disease and illnesses affecting the normal function of the body
14Pharmaceutical-Care Era 1990: Hepler and Strand definedPharmaceutical carea philosophy that expanded the pharmacist’s role to include appropriate medication use to achieve positive outcomes with prescribed drug therapyincludes-Monitoring response to therapy-Educating patients and dispensing prescriptions
15Role of the Pharmacist Today’s pharmacist: Compounds and dispenses drugsGathers information about patientsCounsels on possible side effects and adverse reactionsMonitors for drug interactionsScreens, monitors, and advises for self-treatment with over-the-counter (OTC) products sold without a prescriptionProvides drug information to other healthcare professionalsAdvises on home healthcare supplies and medical equipment
16Community Pharmacist Dispenses drugs for exiting disease Involved in patient care initiatives to prevent or identify diseaseAdministration of immunizationsscreening for and educating about hypertension, diabetes, and other conditionsproviding education about lifestyle choices and dietary supplementsRuns a businesshires and supervises employeesdeals with insurance companiesmaintains inventory
17Hospital Pharmacist Dispenses oral medications Prepares and dispenses parenteral medicationsSometimes specializes, with advanced training in an area of patient careEducates and counsels patientsProvides drug informationAdministers a departmentdevelops policies and procedurespurchases drugs and suppliesmonitors drug use in the hospitalLearn more about hospital pharmacy at the web site of the American Society of Health-System Pharmacists (ASHP)
18Home Healthcare Pharmacist Prepares medications and IVs for home delivery and useincluding IV nutrition and antibioticscancer chemotherapypain medicationsEducates patient or caregiver on appropriate and safe medication useMonitors patient’s response to prescribed therapies
19Other Pharmacy Settings Health maintenance organization (HMO)Long-term care facilitiesSpecialized practicepsychiatrydrug abuseNursing homesgeriatrics
20Nuclear Pharmacy Nuclear pharmacist Procures, stores, compounds, dispenses, and provides information about radioactive pharmaceuticals used for diagnostic and therapeutic purposesLearn more about nuclear pharmacy at the Cardinal Web site
21Education and Licensing Requirements 6 year program2 years prePharmacycalculus, chemistry, biologyPharmacy College Admission Test (PCAT)Doctor of Pharmacy (PharmD) degreebasic science coursespractice setting experienceResidency in specialty area is optionalFor a listing of accredited schools of pharmacy, visit the Web site for the American Association of Colleges of Pharmacy (AACP)
22Education and Licensing Requirements required by all statesoverseen by board of pharmacyinvolvesgraduation form an accredited college of pharmacypassing state board certification examinationserving an internshipcontinuing education for license renewal
23DiscussionWhat are the differences and similarities between and among the various pharmacy practice settings?How does specialized training affect the role of the pharmacist?
24Terms to Remembercompoundingover-the-counter (OTC)
25Pharmacy TechnicianA 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.
26Evolution of the Pharmacy Technician’s Role Without pharmacy technicians, pharmacists would not have sufficient time for the duties involved in “pharmaceutical care.”counseling patientsreviewing medication profilesmonitoring for side effects and adverse reactionsscreening patients for diseasediscussing cost-effective drug therapy options with the prescriber
27Evolution of the Pharmacy Technician’s Role Safety Note!Pharmacy technicians play a valuable role in reducing the risk of medication errors.
28Evolution of the Pharmacy Technician’s Role Originally, many pharmacy techs were trained as medics in the military.returned after service to take positions in hospitalsIn community pharmacy the pharmacy tech evolved from clerk or cashier to a pharmacist’s assistant.
29Evolution of the Pharmacy Technician’s Role A pharmacy technician assists the pharmacist with routine functions.leaves professional decision making and judgment calls to the pharmacistTechnician 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 workthe pharmacist is responsible for patient counselingthe technician functions in strict accordance with standard written procedures and guidelines
30Evolution of the Pharmacy Technician’s Role Safety Note!The pharmacy technicians works under the direction of the supervising pharmacist.
31Evolution 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:accountabilitymaking decisions about the patient’s healthcare
32Education 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 technicianssometimes the ratio of pharmacy techs to pharmacists
33Education 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.
34Education 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 examFor an up-to-date list of states requiring certification of pharmacy technicians, see the Pharmacy Technician Certification Board Web site
35DiscussionWhat 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?
36Work Environments and Conditions Pharmacy technicians are employed in most of the same settings as pharmacistscommunity pharmacies (i.e., drugstores)hospital pharmacieshome healthcare and long-term care facilitiesspecialized area of practice (e.g., nuclear pharmacy) with additional training
37Work 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.
38Work 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.
39Characteristics broad knowledge of pharmacy practice A successful pharmacy technician must possess a wide range of skills, knowledge, and aptitudes.broad knowledge of pharmacy practicededication to providing a critical healthcare service to customers and patientshigh ethical standardswillingness to follow instructionseagerness to learnan eye for detailmanual dexterityfacility in basic mathematicsexcellent communication skillsgood research skillsability to perform accurately and calmly in hectic or stressful situationsability to multi-task or work on several projects at the same time
40DiscussionWhat makes each of the listed characteristics of a pharmacy technician important?
42Pharmacy Workplace of Today Pharmacists work primarily in community and hospital pharmaciesSome go on to pursue further education and higher degrees, residencies, or fellowshipsOther 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 drugsincrease in the aging population in the United States
43Community PharmacyThree 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
44Community Pharmacy Most community pharmacies are divided into a back prescription area offering prescription merchandise and related itemsa front area offering over-the-counter (OTC) drugs, toiletries, cosmetics, and greeting cardsCommunity pharmacies may beindependently owned small businessespart of large retail chainsfranchise operationsThe recent trend is toward fewer independent pharmacies
45Community PharmacyA 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 regionalin 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 automationAdministrative decisions are made at the corporate level
46Community PharmacyAn 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 pharmacymore attention and time spent to keep customersMost compounding of prescriptions is done in this type of pharmacy
47Community PharmacyA 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 chainA large retail company, the franchiser grants exclusive use of the company name and rights to sell company products to a store owner/operator, the franchiseeMost sell only medication and health-related products/servicesVisit The Medicine Shoppe
48Community PharmacyPharmacy technicians employed in a community pharmacy typicallyaid the pharmacist in the filling, labeling, and recording of prescriptionsoperate and are responsible for the pharmacy cash registerstock and inventory prescription and over-the- counter (OTC) medicationsmaintain computerized patient recordsprepare insurance claim formsorder and maintain parts of the front-end stock
49Community PharmacyA 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 pharmacyRun by a centralized operation using both automation and pharmacy techsdispense and mail large volumes of prescriptions every daymore and more prescriptions are being filled by mail-order pharmacies
50Community Pharmacy Mail-order pharmacy Economies of scale allow lower acquisition costssavings to insurers and customersLimitations: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 wastageimpersonal counseling, which is limited to a drug printout or calling a toll-free numbertime delaysafety of delivery of pain medications through the mail
51DiscussionWhat are the advantages and disadvantages of each type of community pharmacy operation?
52Terms to Remember community pharmacy chain pharmacy independent pharmacyfranchise pharmacymail-order pharmacy
53Institutional Pharmacy Institutional pharmacies are organized under a corporate structure, following specific rules and regulations for accreditation.A pharmacy associated with any organized healthcare delivery systemhospital pharmacy is the most common examplemore recent examples of places where institutional pharmacies can be found include :home healthcarelong-term care facilitiesmanaged-care organizations
54Institutional 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 settingan 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 servicescarries out the functions of maintaining drug treatment records and ordering, stocking, compounding, repackaging, and dispensing medications and other supplies
55Institutional Pharmacy The pharmacy technician in a hospital settingtakes part in functions involving delivery, stocking, or inventorying of medications anywhere in the hospitalmay operate manual or computerized robotic dispensing machineryTypical hospital pharmacy staff may include:administrators with master’s degrees or PharmD degreesstaff pharmacists with Bachelor of Science (BS) degreesstaff and clinical pharmacists with PharmD degreespharmacy technicians
56Institutional 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 certifiedby paying for the certification examby giving raises to those who pass it
57Institutional 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 fieldThe home healthcare market continues to grow because of our aging society and as an alternative to the higher cost of hospitalizationsMany hospitalized patients are discharged as soon as possible to continue their recovery at home with IV solutions.
58Institutional Pharmacy Pharmacists and pharmacy technicians working in home healthcareprovide educational materialscarry out traditional compounding and delivery functionsprepare and provide infusions and infusion equipmentoften must be available for emergencies on a 24-hour basis
59Institutional 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 themselvesincludes adults who suffer from chronic (long-lasting) or such debilitating illnesses as stroke or Alzheimer’s diseaseboth medical and residential care is provided with very few discharges
60Institutional 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 hospitalizationmost patients are discharged from SCF to home when they have adequately recoveredOther 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
61Institutional Pharmacy Some long-term care facilities have an “in-house” pharmacyothers contract with a community pharmacy or allow each resident to choose his or her pharmacyLicensed pharmacistsestablish record-keeping systems related to controlled substancesreview drug regimensmonitor repackaging and storage of pharmaceuticalsensure that medications are uncontaminated and have not expirednote medication errors and adverse reactions or interactionseducate residents on drug therapies and self-medicationprovide medications to outpatients or residents on weekend leave
62Institutional Pharmacy The pharmacist may play a crucial role in ensuring regulatory compliancea licensed pharmacist must do a monthly check of each patient profile in a long-term care facilityThe professional organization for “geriatric” pharmacists is the American Society of Consultant Pharmacists (ASCP)Visit the ASCP Web site
63Institutional Pharmacy A pharmacy technician in a long-term care facility may:log prescriptions and refill orders via computerprepare billingsmaintain drug boxes or trays for emergenciespackage and label medicationsdeliver medications to the nursing homemaintain records, retrieve and organize patient chartsconduct inspections of drugs in inventory and in nursing stationsrepackage drugs in unit doses labeled for each patient
64Institutional 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 medicationmedication orders rarely change in this environment
65Managed CareManaged 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 yearsOne of the first managed-care organizations was Kaiser PermanenteAnother name for managed care is health maintenance organization (HMO)
66Managed CareHMOs encourage patients to take an active role in their own healthcare by:eating rightexercising oftenavoiding negative life-style choicesHMOs encourage patients to:have annual checkupsget all their immunizations on scheduleget 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
67Managed CareMost HMOs have their own staff physicians who are on salaryPatients who need a specialist must first get a referralHMOs have been successful in slowing the pace of the inflationary increases in healthcare without compromising the quality of careMany employers now include an HMO option on their health plans
68Managed Care Most HMOs are centralized primary-care clinics they serve patients with pharmacy, x-ray, and laboratory departments under one roofAn 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
69Managed CareThe formulary plus the use of low-cost generic drugs allows the organization to volume purchase select drugs to lower operational and patient costunlike a community pharmacy, an HMO pharmacy does not stock every brand of drug availableMany 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 productmost patients and physicians use the lower-cost alternatives whenever possible
70Managed CareAfter the patient sees the physician, the patient may go to the HMO pharmacy to fill a prescriptionPatients needing refills may call an automated telephone number to expedite processing and reduce waiting timesthis “time savings” also allows the pharmacist to spend more time reviewing the computerized medication profile and counseling the patient
71Managed CareThe pharmacy technician in managed care performs similar functions to those in the community pharmacyalthough insurance billing and cashiering are minimalClinical pharmacists may work closely with the primary-care physicians to better control chronic diseaseeducatingmonitoringadjusting doses of medications per physician-approved protocols
72DiscussionWhat are the similarities between and among the various institutional pharmacy environments?What are the differences?
73Institutional Pharmacy Terms to RememberPharmacy Workplace:Institutional Pharmacyinstitutional pharmacyhospital pharmacyhome healthcare pharmacylong-term care facilitymanaged carehealth maintenance organization (HMO)formulary
74Learning Objectives Describe the origins of pharmacy Describe the four stages of development of the pharmacy profession in the twentieth centuryEnumerate the functions of the pharmacistDiscuss the educational curriculum for today’s pharmacy studentExplain the licensing requirements for pharmacistsIdentify the duties and work environments of the pharmacy technicianDifferentiate among the various kinds of pharmacies
75DiscussionHow does the pharmaceutical care model affect the duties of pharmacists in the 21st Century? medication outcomes?
76Terms to Remember pharmacist pharmaceutics pharmacognosy pharmacokineticsgalenical pharmacypathophysiologypharmacologypharmaceutical care