Pharm.

E IIT 1

PHARMACY

Pharmacy is the health profession that links the health Sciences with
the chemical
sciences and it is charged with ensuring the safe and effect
ive use of pharmaceutical
drugs. The word derives from the Greek Pharmacon, "drug
medicine". The earliest form
of the word is the Mycenaean Greek pa-ma-ko,

The scope of pharmacy practice includes more traditional roles

such as compounding and
dispensing medications, and it also includes more modern servic
es related to health care,
including clinical services, reviewing medications for safety
and efficacy, and providing
drug information. Pharmacists, therefore, are the experts
on drug therapy and are the
ptimary health professionals who optimize medication
use to provide patients with
positive health outcomes.

An establishment in which pharmacy (in the first sense) is practiced is called a

pharmacy, chemist's or (in the United States) drug
store. US drug stores commonly sell.
not medicines, but also misce!aneous items such
as candy (sweets), cosmetics, and
magazines, as well as light refreshments or groceries.

The word pharmaey is derived from its root word

pharma which was a term used since
the 15%) 7% centuries. In addition to pharma responsibili
ties, the pharma offered general
<——-— ~mnedical advice and a range of services that are now
performed solely by other specialist
Practitioners, such as surgery and midwifery. The pharm
a (as it was referred to) often
\
operated through a retail shop which, inaddition to
ingredients for ‘medicines, sold
tobacco and patent medicines. The pharitias. also used
many other herbs not listed.

In its investigation of herbal and chemical ingredient

s, the work of the pharma may be
regarded as a precursor of the modem sciences of chemi
stry and pharmacology, prior to
the formulation of the sciettific method.

Pharm E II Ts 1, 2, 3 - ESP
 Symbols
The two symbols most commonly associated with pharmacy are mortar and pestle and
the Re (recipere) character, which is often written as "rx" in typed text. The show globe
was also used in English speaking countries until the early 20" century. Pharmacy
organizations often use other symbols, such as the Bow! of Hygieia which is often used in
the Netherlands, conical measures, and caduceuses in their logos. Other symbols are
common in different countries: the green Greek cross in France, Argentina, the United
Kingdom, Belgium, Italy, and Spain, the increasingly-rare Gaper in the Netherlands, and
a red stylized letter A in Germany and ‘Austria (from Apotheke, the German word for
pharmacy. from the same-Gréek root as the English word 'apothecary’).

i
ee a ce gre ml
ee
The green Greek Cross

ce
}
1
‘used in Spain, {
‘
r
= . ‘Argentina, France, (Mortar and pestle Recipe symbol
Bowl of Hygeia Poland, the United i

Kingdom and other

countries
Speer Vani ee Nee ai pees Sea

The red stylized “A™ Caduceus (used Rod of Asclepius Hanging Show a
Used in Germany erroneously) Globe

Pharm E [I Ts 1, 2,3 - ESP

 Pharm. E If
T 2
Disciplines of pharmacy

The field of Pharmacy can generally be divided into three primary disciplines:
® Pharmaceutics

¢ Medicinal chemistry and Pharmacognosy

_® Pharmacy practice

The boundaries between these disciplines and with other sciences, such as biochemistry,
are not always clear-cut; and often, collaborative teams from various disciplines research
together.

Pharmacology is sometimes considered a fourth discipline of pharmacy. Although

pharmacology is essential to the study of pharmacy, it is not specific to pharmacy.
Therefore it is usually considered to be a field of the broader sciences.

e Pharmacoinformatics

New discipline for systematic drug discovery and developmert with efficiency and
safety. Other specializations in pharmacy practice recognized by the Board of
Pharmaceutical Specialities include: cardiovascular, infectious diseases, oncology,
pharmacotherapy, nuclear, nutrition, and psychiatry. The Commission for certification in
Geriatric Pharmacy certifies pharmacists in geriatric pharmacy practice. The American
Board of Applied Toxicology certifies pharmacists and other medical professionals in
applied toxicology.

Types of pharmacy practice areas

Pharmacists practice in a variety of areas including retail, hospitals, clinics, nursing
homes, drug industry, and regulatory agencies. Pharmacists can specialize in various
areas of practice including but not limited to: haematology/oncology, infectious diseases,

Pharm E IJ Ts 1, 2, 3 - ESP
 ambulatory care, nutrition support, drug information, critical care, paediatrics, etc.

Community pharmacy

A pharmacy (commonly the chemist in Australia, New Zealand and the UK; or
drugstore in North America; retail pharmacy in industry terminology; or Apothecary,
historically) is the place where most pharmacists practice the profession of pharmacy. It
is the community pharmacy where the dichotomy of the profession exists — health
professionals who are also retailers.

Community pharmacies usually consist of a retail storefront with a dispensary where

medications are stored and dispensed. The dispensary is subject to pharmacy legislation,
with requirements for storage conditions, compulsory texts, equipment, etc., specified in
legislation. Where it was once the case that pharmacists stayed within the dispensary
compounding/dispensing medications, there has been an increasing trend towards the use
of trained pharmacy technicians while the pharmacist spends more time communicating
with patients.

All pharmacies are required to have a pharmacist on-duty at all times when open. In
many jurisdictions, it is also a requirement that the owner of a pharmacy must be a
registered pharmacist (R.Ph.). This latter requirement has been revoked in many
jurisdictions, such that many retailers (including supermarkets and mass merchandisers)
now include a pharmacy as a department of their store.

Likewise, many pharmacies are now rather grocery store-like in their design. In addition
to medicines and prescriptions, many now sell a diverse arrangement of additional items
such as cosmetics, shampoo, office supplies, confections, snack food, durable medical
equipment, greeting cards, and provide photo processing services.
[Other types: Hospital Pharmacy, Clinical Pharmacy, Compounding Pharmacy,
Consultant Pharmacy, Internet Pharmacy, Veterinary Pharmacy, Nuclear
Pharmacy, Military Pharmacy, Pharmacy Informatics]
2

Pharm E II Ts 1, 2,3 - ESP

 Pharm. E JI 7 3

The future of pharmacy

In the coming decades, pharmacists are expe

cted to become more integral within the
health care system. Rather than simply dispensi
ng medication, pharmacists will be paid
for their patient care skills,

Medication Therapy Management (MTM)

— A practice of pharmacy currently being
taught at schools of pharmacy nationwide inclu
des the clinical services that pharmacists
can provide for their patients. Such servi
ces include the thorough analysis of all
‘medication (prescription, non-prescription
, and herbals) currently being taken by
an
individual. The result is a reconciliation of medi
cation and patient education resulting in
increased patient health outcomes and decr
eased costs to the health care system.

This shift has already commenced in some countries: for instance, pharmacists in
: hol ima ma S a
- Australia receive» remuneration from
Australian Government for conducting . .
A Holy _ ; ApProveh
comrehengive Home Medicine So
s Reviews. In Canada, pharmacists . .
In certain provinces
have limited prescribing rights (as in Alberta
and British Columbia) or are remunerated
by their provincial government for expanded
services such as medications reviews
(Medschecks in Ontario). In the United King
dom, pharmacists who undertake additional
training are obtaining prescribing rights.
They are also being paid for by the gove
rnment
for medicine use reviews. - rojesto
In the United States, pharmaceutical care
or clinical pharmacy has had an evolving
influence on the practice of pharmacy. More
over, the Doctor of Pharmacy (Pharm. D.)
degree is now required before entering pract
ice and some pharmacists now complete one
or two years of residency or fellowship training following graduation. In addition,
Consultant pharmacists, who traditionally
operated primarily in nursing homes, are
now
©xpanding into direct consultation with
patients, under the banner of "senior
care
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 Pharm
E II T 4

Pharmacist

Pharmacists are health professionals who practice the science of pharmacy. In their
traditional role, pharmacists typically take a request for medicines from a prescribing
health care provider in the form of a medical prescription, evaluate the appropriateness of
the prescription, dispense the medication to the patient and counsel them on the proper
use and adverse effects of the medication. In this role pharmacists act as a learned
intermediary between physicians and patients and thus ensure the safe and effective use
of medications. Pharmacists also participate in disease-state management, where they
optimize and monitor drug therapy or interpret medical laboratory results — in
collaboration with physicians and/or other health professionals.
Advances into prescribing medication and in providing public health advice and services
are occurring in Britain as well as the United States and Canada. Pharmacists have many
areas of expertise and are a critical source of medical knowledge in clinics, hospitals,

medical laboratory and community pharmacies throughout the world. Pharmacists also
hold positions in the pharmaceutical industry as well as pharmaceutical education and
research and development institutions.

In much of the United Kingdom and the British Commonwealth pharmacists are
customarily sometimes referred to as chemists (or dispensing chemists), a usage which
can, especially without a context relating to the sale or supply of medicines, cause
confusion with scientists in the field of chemistry. This term is a historical one, since
some pharmacists passed an examination in Pharmaceutical Chemistry (PhC) set by the
then Pharmaceutical Society of Great Britain in 1852 and these were known as
"Pharmaceutical Chemists". This title is protected by the Medicines Act 1968 section 78.

The 1852 Pharmacy Act, June 30 established a register of Pharmaceutical Chemists in

Great Britain, restricted to those who had taken the Society's exams. However, the Act
did not restrict the practice of pharmacy to examined and registered people, nor provide a

Farm E JI T 4 (ESP) {
 legal definition for the trade and practice of pharmacy. This was
first done by the
Pharmacy Act of 1868.

{n the near future it is proposed by the Draft Pharmacy Order

2009 that the title
“phammacist" be restricted to those who register with a new
Regulatory body — the
General Pharmaceutical Council ~ due to be established to take
this role over from the
Royal Pharmaceutical Society of Great Britain in 2010.

Nature of the work

Historically, the fundamental role of pharmacists is to distribute
drugs that have been
prescribed by a healthcare practitioner to patients. In more modem
times pharmacists
advise patients and health care providers on the selection, dosage
s, interactions, and side
effects of medications. Pharmacists monitor the health and progre
ss of patients to ensure
the safe and effective use of medication. In some cases, pharma
cists may practice
compounding (mixing ingredients to form medications);
however, most medicines are
produced by pharmaceutical companies in a standard dosage
and drug delivery form. In
some jurisdictions, pharmacisis have prescriptive authori
ty to either independently
prescribe under their own authority or in collaboration with
a primary care physician
through an agreed upon protocol.

Pharmacists are trained in pharmacology, pharmacognosy, chemistry, pharmaceutical

chemistry, microbiology, pharmacy practice (including drug interactions, medicine
monitoring, medication management), pharmaceutics; pharmacy law, physiology,
anatomy, biochemistry, pharmacokinetics, drug delivery,
pharmaceutical care,
nephrology, hepatology, and compounding medications.
Additional curriculum covers
diagnosis with emphasis on laboratory tests, disease
state management, therapeutics and
prescribing (selecting the most appropriate medication for
a given patient),

One of the most important roles that pharmacists are

currently taking on is one of
pharmaceutical care, Pharmaceutical care involves
taking direct responsibility for patients

Farm E I T 4 (ESP) 2
 3. Antimalarial drugs: treating malaria
4. Antibiotics: inhibiting germ growth
5. Antiseptics: prevention of germ growth near burns, cuts and wounds

Types of medications (type of pharmacotherapy)

For the gastrointestinal tract (digestive system)

For the cardiovascular system
drug)
For the central nervous system (psychiatric medication and psychoactive
For pain and consciousness (analgesic drugs)
For musculo-skeletal disorders
For the eye
For the ear, nose and oropharynx
For the respiratory system
For endocrine problems
For the reproductive system or urinary system
For contraception
For obstetrics and gynecology /gynaecology/
For the skin
For infections and infestations
For the immune system
For allergic disorders
For nutrition
For neoplastic disorders
For diagnostics
For euthanasia

Prescription practice
adverse
Drugs which are prescription only are regulated as such because they can impose
trials
effects and should not be used unless necessary. Medical guidelines and clinical
but
required for approval are used to help inform doctors’ prescriptions of these drugs,
are
errors can happen. Reasons to not prescribe drugs such as interactions or side effects
called contraindications.

on and
Errors include overprescription and polypharmacy, misprescription, contraindicati
on of a
lack of detail in dosage and administration instructions. In 2000, the definiti
nce was
prescription error was studied using a Delphi method conference; the confere
motivated by ambiguity in the what a prescription error is and a need to use a uniform
definition in studies.

PHARM EII Ts 5, 6, 7 ESP

 Pharm. E U T 6
History of Pharmacology
fAncient Pharmacology, Medieval Pharmacology]

Modern pharmacology

For most of the nineteenth century, drugs were not highly effective, leading Oliver
Wendell, Sr. to famously comment in 1842 that “if all medicines in the world were
thrown into the sea, it would be all the better for mankind and all the worse for the
fishes".

During the First World War, Alexis Carrel and Henry Dakin developed the Carrel-Dakin
method of treating wounds with irrigation, Dakin's solution, a germicide which helped
prevent gangrene.

In the inter-war period, the first anti-bacterial agents such as the sulfa antibiotics were
developed. The Second World War saw the introduction
of widespread and effective
antimicrobial therapy with the development and mass production of penicillin antibiotics,
matie possible by the pressures of the war and the collaboration of British scientists with
the American pharmaceutical industry.

Medicines commonly used by the late 1920s included aspirin, codeine, and morphine for
pain; digitalis, nitroglycerine, and quinine for heart disorders, and insulin for diabetes.
Other drugs included antitoxins, a few biological vaccines, and a few synthetic drugs. In
the 1930s antibiotics emerged: first sulfa drugs, then penicillin and other antibiotics.
Drugs increasingly became "the center of medical practice". In the 1950s other drugs
emerged including corticosteroids for inflammation, rauwolfia alkaloids as_ tranquilizers
and antihypertensives, antihistamines for nasal allergies, xanthines for asthma, and
typical antipsychotics for psychosis. As of 2008, thousands of approved drugs have been
developed. Increasingly, biotechnology is used to discover biopharmaceuticals.

PHARM EII Ts 5, 6, 7 ESP

 In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine, were
designed in laboratories and slowly came into preferred use. Although often accepted as
an advance in some ways, there was some opposition due to serious adverse effects such
as tardive dyskinezia. Patients often opposed psychiatry and refused or stopped taking the
drugs when not subject to psychiatric control.

Governments have been heavily involved in the development and sale of drugs. In the
U.S., the Elixir Sulfanilamide disaster led to the establishment of the Food and Drug
Administration (FDA), and the 1938 Federal Food, Drug, and Cosmetic Act required
manufacturers to file new drugs with the FDA. The 1951 Humphrey-Durham

Amendment required certain drugs to be sold by prescription. In 1962 a subsequent

amendment required new drugs to be tested for efficacy and safety in clinical trials.

Until the 1970s, drug prices were not a major concem for doctors and patients. As more
drugs became prescribed for chronic illnesses, however, costs became burdensome, and
by the 1970s nearly every U.S. state required or encouraged the substitution of generic
drugs for higher-priced brand names. This also led to the 2006 U.S. law, Medicare Part
D, which offers Medicare coverage for drugs.

As of 2008, the United States is the leader in medical research, including pharmaceutical
development. U.S. drug prices are among the highest in the world, and drug innovation is
correspondingly high. In 2000, U.S. based firms developed 29 of the 75 top-selling drugs;
. firms from the second-largest ‘market, Japan, developed eight, and the United Kingdom
contributed 10. France, which imposes price controls, developed three. Throughout the
1990s outcomes were similar.

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PHARM E Il Ts 5, 6, 7 ESP

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 Pharm. E 117

Environmental impact of pharmaceuticals

(“PPCPs” ') —
- Pharmaceuticals and personal care products in the environment

has also been an environmental

Since the 1990s water contamination by pharmaceuticals
in}the environment through human
issue of congern, Most pharmaceuticals are deposited
water treatment
consumption and excretion, and are often filtered ineffectively by waste
in the water, they can have diverse,
plants which are rot designed to manage them. Once
limited. Pharmaceuticals may also be
subtle effects on organisms although research is
al, runoff from sludge fertilizer and
deposited in the environment through improper dispos
fo. 2009, an investigative report by
reclaimed wastewater irrigation, and leaky sewage.
had legally released 271 million
Associated Press concluded that U.S. manufacturers
was the antiseptics phenol and
pounds of drugs into the environment, 92% of which
drugs released by manufacturers as
hydrogen peroxide. It could not distinguish between
that an estimated 250 million
opposed to the pharmaceutical industry. It also found
ging were discarded by hospitals and
pounds of pharmaceuticals and contaminated packa
long-term care facilities.
|
ig a branch of pharmacology and a form of
Pharmacoenvironmentology
TT hPa a
pharmeovigilance Ww ich’ deals with entry of chemicals or drugs into the environment
with those
after elimination from human and animal post-therapy. It deals specifically
pharmacological agents that have impact on the environment via elimination through
Ecopharmacology is concerned
living organisms subsequent to pharmacotherapy, while
onment through any route and at any
with the entry of chemicals and drags into the envir
(ecosystem), as a consequence.”
concefitration disturbing the balance of ecology
of "PPCPs" irrespective of doses
Ecopharniacology is a broad term that includes studies
and route of entry into environment.

' Pharmaceutical and Personal Care Products

PHARM BIL Ts 5, 6, 7 ESP

ee ogy
NATURE OF THE WORK
Pharmaceutical care involves taking direct responsibility for patients,
-> and their disease states, medications, and the management of each in order to improve
the outcome for each patient.

Pharmaceutical care has many benefits that include, but are not limited to:
1. decreased medication errors,
2. increased patient compliance in medication regimen,
3. better chronic disease state management,
4. strong pharmacist-patient relationship,
5. decreased long-term costs of medical care.

Pharmacists are often the first point of contact for patients with health inquiries.
This means that pharmacists have large roles in the assessing of medication management in
patients, and in referring patients to physicians.

These roles may include, but are not limited to:

clinical medication management, the assessment of patients with undiagnosed or diagnosed
conditions and for decisions about the clinical medication management required, specialized
monitoring of disease states, reviewing medication regimens, monitoring of treatment
regimens, delegation work, general health monitoring, compounding medicines, general
health advice, providing specific education to patients about diseased states and
medications, oversight of dispensing medicines on prescription, provision? of
nonprescription medicines, counseling and advice on optimal use of medicines, advice and
treatment of common ailments, referrals to other health professionals if needed, dosing
drugs in renal and hepatic failure?, pharmacokinetic evaluation, education of physicians and
other healthcare providers on medications and their proper use, limited prescribing of
medications only in collaboration with other healthcare professionals, providing
pharmaceutical information, promoting public health by administering immunizations.

DRUGS
Drugs are chemical compounds that modify the way the body and mind work. Most people
think that these biological activities should help or heal sick people or animals. There is
however no known drug that is not harmful or even poisonous at high doses, and much of
the scientific work on the drugs has attempted to widen the gap between effective and toxic
doses.
The word drug has acquired bad connotations in the recent years because the widespread
abuse of a few chemicals that affect the central nervous system has become a serious
sociological problem. Nevertheless, drugs act on many other organs in the body, can benefit
as well as harm the nervous system, and have made possible a revolution in the way
modern doctors treat diseases.

PHARMACEUTICAL DRUGS
A pharmaceutical drug, also referred to as medicine, medication, or medicament, can be
loosely defined as any chemical substance intended for use in the medical diagnosis, pure
treatment, or prevention of disease.

CLASSIFICATION
Medications can be classified in various ways, such as by chemical properties, mode or
route of administration, biological system affected, or therapeutic effects.
An elaborate and widely used classification system is Anatomical therapeutic chemical
classification system (ATC-system).

The World Health Organisation (WHO) keeps a list of essential medicines.

Assembling of classes of medicine includes:
1. antipyretics: reducing fever,
2. analgesics: reducing pain (painkillers)

3. antimalarial drugs....