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2. The Profession of Pharmacy
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Chapter Topics
Origins of pharmacy practice
The pharmacy workplace of today
Evolution of the pharmacist’s role
Roles and responsibilities of the pharmacist and pharmacy technician
Educational requirements of the pharmacist and pharmacy technician
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Learning Objectives
Describe the cultural origins of pharmacy and their impact on the profession.
Discuss the four stages of development of the pharmacy profession in the twentieth century.
Differentiate the major roles and responsibilities of the pharmacist and pharmacy technician.
Understand the educational and licensing requirements of the pharmacist and pharmacy technician.
Differentiate among various pharmacy workplace environments.
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Origins of Pharmacy
Early Civilizations
Sickness was thought to be a curse.
Medicinal preparations were combined with magic, chants, and rituals.
Preparations were made from plants, animals, and minerals.
Clay tablets more than 5,000 years old found in Mesopotamia listed medicinal preparations.
These provided the basis for the modern-day formulary.
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6. Origins of Pharmacy (continued)
Traditional Eastern medicine
Relies on plant products and healing modalities. Some are used in Western culture today (such as ginseng).
Hippocrates
This Greek physician thought that disease had a physical explanation.
Pharmacy is derived from Greek word pharmakon, meaning drug or remedy.
He is the Father of Modern Medicine.
Galen
This Greek physician studied the effect of herbs on the body.
Galenical pharmacy is the practice of creating medicinal extracts from plants.
He is the Father of Modern Pharmacy.
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7. Origins of Pharmacy (continued)
Early Arabic civilizations identified pharmacists as qualified healthcare professionals.
In eleventh and twelfth century Europe, apothecaries and professional guilds were developed.
They oversaw chemist and pharmacist apprenticeships.
They led to universities and professional organizations and, later, state boards.
During the Renaissance, alchemy was on the rise, scientific thinking was on the decline.
During seventeenth century’s Scientific Revolution, many new scientific terms developed with Greek and Latin roots.
Alchemy – combined chemistry, metallurgy, physics, and medicine with astrology, mysticism, and spiritualism in order to turn something ordinary into something special
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8. Origins of Pharmacy (continued)
During the 1800s, pharmacists were more recognized as healthcare providers; physicians still operated most apothecaries.
Major cities in Europe had their own drug lists or pharmacopeia.
Martindale: The Extra Pharmacopoeia is still a useful reference today.
Native Americans combined herbal medicine with chants and prayers for healing.
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9. Origins of Pharmacy (continued)
In the ninteenth century, the medicine and pharmacy professions separated.
Pharmacists became the owners of apothecaries.
United States Pharmacopeia (USP), a formulary of drug standards, was developed in 1820.
American Pharmacists Association (APhA) formed in 1852 to address adulteration of imported drugs.
Community pharmacy focused on compounding herbs and chemicals.
In early twentieth century, pharmaceutical manufacturing became dominant.
By the 1950s, pharmacists compounded less, and pharmacy practice became more scientific.
Adulteration: the process of corrupting or tainting drug products by the addition of foreign, impure, or inferior substances that may be toxic
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10. Modern-Day Pharmacy Practice
Many new drugs are developed annually to keep up with medical advances.
As the population ages, an increasing number of prescriptions are expected.
To meet increasing demands on pharmacists, more pharmacy schools are opening; technician roles are expanding.
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11. The Pharmacy Workplace
Community Pharmacies
Independent pharmacies
Chain pharmacies
Franchise pharmacies
Mail-order pharmacies
Institutional Pharmacies
Hospital pharmacies
Long-term care facilities
Home healthcare systems
Managed-care pharmacy services
Nuclear pharmacies
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Community Pharmacies
Also called retail pharmacies
Employ the majority of pharmacists and pharmacy technicians
Operated by pharmacists who hold a BS or PharmD degree
Divided into a restricted prescription area and a front-end area
Bachelor of Science (BS)
Doctor of Pharmacy (PharmD)
Over the counter (OTC)
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13. Types of Community Pharmacies
Independent pharmacies
A pharmacist (or a small group of pharmacists) owns the pharmacy.
Decisions are made at the store level.
More attention and time is spent on customer service.
Most compounding is done in these, and some specialize in compounding.
Chain pharmacies
Corporations own and operate chain pharmacies.
Decisions are made at the corporate level.
They dispense large volumes.
Technicians and automation are heavily used in chains.
Examples include: Walgreens, CVS, Walmart, and Kroger.
Over the counter (OTC)
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14. Types of Community Pharmacies (continued)
Franchise pharmacies
One pharmacist owns a franchise.
Sometimes they are called apothecaries, which sell only medication and health-related products.
More personalized health care is provided here.
An example is Medicine Shoppe International.
Mail-order pharmacies
A centralized operation mails large volumes of prescriptions.
Patients have no direct contact with the pharmacy.
Examples include Medco and Express Scripts.
Over the counter (OTC)
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15. Institutional Pharmacies
A pharmacy associated with any organized healthcare delivery system is called institutional.
Hospital pharmacies are the most common examples.
Institutional pharmacists will have a BS or PharmD degree.
Some pharmacists will have an MBA and some will have completed a postgraduate residency.
Technicians typically must be certified and have experience to work in institutional pharmacies.
Bachelor of Science (BS)
Doctor of Pharmacy (PharmD)
Master of Business Administration (MBA)
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16. Types of Institutional Pharmacies
Hospital pharmacies
About 25% of pharmacists work in hospitals.
They prepare unit-dose systems, IV medications, and floor stock.
Many pharmacy technicians work in a “clean room.”
Intravenous (IV)
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17. Types of Institutional Pharmacies (continued)
Long-term care facilities
Extended-care facility (ECF) or nursing home
Medical and residential care is provided to older or disabled adults.
Skilled-care facility (SCF)
Around-the-clock nursing care is provided.
Medications may come from either an in-house pharmacy or a community pharmacy.
Home healthcare systems
Patient care services are provided at patient’s home.
Hospice care is provided for patients who are terminally ill.
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18. Types of Institutional Pharmacies (continued)
Managed-care or HMO
Centralized outpatient clinics and some hospitals
Clinic pharmacies and off-site pharmacies
Minimal cash or insurance transactions
Nuclear pharmacy
Compounds and dispenses sterile radioactive pharmaceuticals
Health maintenance organization (HMO)
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19. In the Know: True or False
A community pharmacy is also called a retail pharmacy.
true
Some independent pharmacies specialize in compounding.
Decisions are made at the store level in a chain pharmacy.
false
A hospital pharmacy mails large volumes of prescriptions.
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20. Development of Pharmacy in the Twentieth Century
Traditional Era
Scientific Era
Clinical Era
Pharmaceutical Care Era
Evolving role of the pharmacist to keep up with advances in science and medicine
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Traditional Era
The traditional era extended into the 1920s.
Pharmacists compounded more than 80% of prescriptions from natural sources.
Ingredients and doses were tailored to patients.
Pharmacists packaged, labeled, and dispensed medications.
Pharmacists-in-training served as apprentices rather than studying at universities.
Limited formal education focused on galenical pharmacy and pharmacognosy.
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Scientific Era
The pharmaceutical industry emerged in the 1950s.
Many new drugs and dosage forms were developed.
Drugs were less expensive and better quality than what individual pharmacists could compound.
Pharmacists became merchants of factory-made products.
To keep up with scientific advances, pharmacy schools added pharmacology to their curriculum.
By 1960, a five-year BS degree was required to become a pharmacist.
Bachelor of Science (BS)
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Clinical Era
The clinical era started in the mid-1960s.
Pharmaceutics was added to pharmacy school curricula.
Training shifted too much toward basic science and too far away from pharmacy practice.
Pharmacists were not fully utilized, did routine tasks, and dispensed medications.
Until 1969, it was not considered ethical for a pharmacist to label medication vials with the drug name or counsel patients.
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24. Clinical Era (continued)
The Millis Commission report came out in 1975.
“Pharmacists for the Future”
Defined pharmacy as a knowledge-based profession
Emphasized the clinical role of pharmacists
The Millis Commission led to new emphasis on clinical or patient-oriented pharmacy.
Pharmacists became dispensers of drug information.
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25. Clinical Era (continued)
More colleges adopted a six-year PharmD degree program.
Pharmacy schools added pharmacokinetics, biochemistry, therapeutics, and pathophysiology to curricula.
Laboratories moved from the schools to more patient-oriented practice settings.
Interdisciplinary experiences with physicians and residents became standard in pharmacy schools.
Doctor of Pharmacy (PharmD)
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26. Pharmaceutical Care Era
The pharmaceutical care era began in 1990.
Further development of the Millis Commission
Coined by Dr. Charles Hepler and Dr. Linda Strand
Expanded pharmacy to include ensuring positive outcomes for drug therapy
Patient-oriented focus in the hospital began to move to the community pharmacy and ambulatory clinics.
Patient counseling and medication monitoring became more accepted by physicians and consumers.
Doctor of Pharmacy (PharmD)
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27. Pharmaceutical Care Era (continued)
Medication therapy management (MTM) was integrated into pharmacy curriculum.
Recommending less costly medications
Identifying potential drug-drug interactions
Identifying potential adverse reactions
Counseling patients on adherence to therapy
MTM recognized by insurance companies providing reimbursement to pharmacists
Medication therapy management (MTM)
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28. In the Know: Short Answer
In the traditional era, most prescriptions were __________ by the pharmacist.
compounded
The Millis Commission led to an emphasis on what type of pharmacy practice?
clinical
Medication therapy management (MTM) is a key component of ______________.
pharmaceutical care
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29. Pharmacist Responsibilities: Traditional vs. Current Roles
The product-oriented practice focused on compounding.
A patient-oriented practice focuses on counseling and monitoring.
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30. Roles and Responsibilities of the Pharmacist
Gathering information on medical, medication, and allergy histories
Reviewing medication doses and screening for duplicate therapies
Counseling patients
Screening patients for chronic diseases
Educating patients on self-management of diseases
Monitoring for drug interactions
Screening patients for minor illnesses
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31. Roles and Responsibilities of the Pharmacist (continued)
Assisting and supporting patients to quit smoking
Providing recommendations regarding OTC medications, vitamins, herbs, and supplements
Providing drug information to other healthcare professionals
Providing advice about home healthcare supplies and medical equipment
Monitoring drug response in chronic diseases
Monitoring the safe use of controlled substances
Vaccinating high-risk patients
Over the counter (OTC)
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32. Site-Specific Pharmacist Responsibilities
Community pharmacy
Compounding both nonsterile and sterile medications
Packaging medications for nursing homes
Independent pharmacy
Identifying unmet needs in the community; offering new services
Hiring and supervising employees
Evaluating insurance contracts
Reconciling unpaid insurance claims
Maintaining and ordering inventory
Selling non–healthcare-related merchandise
Managing the overall retail operation
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33. Site-Specific Pharmacist Responsibilities (continued)
Institutional pharmacy
Entering physician’s orders
Preparing medications and IVs
Providing drug information
Recommending drug formulary changes
Educating nurses
Developing policies and procedures
Dispensing investigational and hazardous drugs
Providing medications to hospital units
Intravenous products (IVs)
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34. Site-Specific Pharmacist Responsibilities (continued)
Clinical specialists in large teaching hospitals
Accompanying physicians on morning rounds
Providing advice on appropriate medication use
Monitoring patients for adverse effects or drug interactions
Educating patients on medications prior to discharge
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35. Site-Specific Pharmacist Responsibilities (continued)
Home healthcare
Preparing medications and IVs for home use
Consulting
Reviewing medical and medication records monthly
Managed-care
Working with primary-care physicians to help control chronic diseases
Educating patients, monitoring and adjusting medications
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36. Educational Requirements for Pharmacists
Pharmacy school admission requirements
Two years of pre-pharmacy
Calculus, chemistry, physics, microbiology, and biology
Pharmacy College Admission Test (PCAT)
On-site interview
Prior pharmacy experience advisable
Pharmacy College Admission Test (PCAT)
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37. Educational Requirements for Pharmacists (continued)
Doctor of Pharmacy programs
Four year program
Challenging coursework
Practice experiences in community and hospital settings interspersed throughout curriculum
Fourth year spent in various practice settings
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38. Licensing Requirements for Pharmacists
Graduating from an accredited college of pharmacy
Passing a state board examination
Serving an internship under a licensed pharmacist
Continuing education required for renewal
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39. Traditional Pharmacy Technician Responsibilities
Answering the phone
Stocking the inventory
Operating the cash register
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40. Site-Specific Pharmacy Technician Responsibilities
Community Pharmacy
Greeting patients presenting or picking up prescriptions
Entering patient and prescription information into a computerized database
Assisting the pharmacist in filling, labeling, and recording prescriptions
Operating the pharmacy cash register
Stocking and inventorying prescription and OTC medications
Billing and resolving inventory claims
Over the counter (OTC)
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41. Site-Specific Pharmacy Technician Responsibilities (continued)
Hospital
Preparing sterile and hazardous products
Delivering, stocking, and inventorying medications
Operating manual or computerized robotic dispensing machinery
Pharmacy technicians play a valuable role in reducing the risk of medication errors.
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42. Site-Specific Pharmacy Technician Responsibilities (continued)
Long-term care
Repackaging drugs in unit dose carts labeled for each patient
Delivering medications to the nursing home
Conducting inspections of medications on nursing stations
Rather than work independently, the pharmacy technician works under the direction of the supervising pharmacist.
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43. In the Know: True or False
A pharmacy technician may enter allergy information into the computer database.
true
A pharmacy technician may counsel patients on over the counter medications.
false
A pharmacy technician may override drug interaction alerts when entering prescriptions.
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44. Roles and Responsibilities Compared
Pharmacy Technician
Pharmacist
Assumes routine functions that used to be performed by pharmacists
Gives work completed to the pharmacist for final check
Is held accountable to the pharmacist for the accuracy of medications dispensed
Does more patient-care activities, less dispensing activities
Oversees the technician’s work and provides the final check
Is ultimately accountable for the accuracy of medications dispensed
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45. Educational Requirements for Pharmacy Technicians
Technician training programs
Programs strive to prepare students for the certification exam.
Many are hospital based, some are offered in community colleges and technical schools.
Topics include medical terminology, pharmacology, dispensing procedures, sterile compounding, aseptic technique, pharmacy laws and regulations, pharmacy calculations, and communications.
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46. Educational Requirements for Pharmacy Technicians (continued)
Pharmacy Technician Certification Exam
The Pharmacy Technician Certification Board (PTCB) offers this exam.
Many employers require that technicians be certified initially or within a certain time period after hiring.
Pharmacy Technician Certification Exam (PTCE); Pharmacy Technician Certification Board (PTCB)
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47. Specialized Training Programs for Pharmacy Technicians
Sterile compounding
Program from Accreditation Council for Pharmacy Education (ACPE)
Nonsterile compounding
Program from the Professional Compounding Centers of America (PCCA)
Nuclear pharmacy technician (NPT)
Online self-study plus on-the-job training
Accreditation Council for Pharmacy Education (ACPE); Porcessional Compounding Centers of America (PCCA); Nuclear pharmacy technician (NPT)
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48. State Board Requirements for Pharmacy Technicians
Requirements vary among the states
Licensing or registration requirements
High school diploma or GED
Criminal background check
Completion of a formal training program
Certification requirements
Successful completion of approved pharmacy technician exam
Attend continuing education programs to maintain certification
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Summary
The profession of pharmacy has evolved from preparing natural medications to dispensing synthetic medications.
The primary mission of pharmacy is to safeguard the public and help patients achieve favorable medication outcomes.
Pharmacists are highly educated, licensed professionals.
Pharmacists dispense medications, information, and counseling to patients.
Pharmacists provide drug information to healthcare professionals.
Pharmacy technicians are paraprofessionals who work under the direct supervision of pharmacists.
Formal training programs and certification are becoming more important for pharmacy technicians.
There is a great demand for pharmacists and pharmacy technicians.
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