The
mortar and pestle, an internationally recognized symbol to represent the pharmacy
profession
Pharmacy (from the Greek φάρμακον = drug) is the health profession that links the health sciences with the
chemical sciences, and it is charged with ensuring the safe use of medication. The scope of pharmacy practice includes more traditional roles such as compounding and dispensing
medications on the orders of physicians, and it also includes more modern services related to patient care, including clinical services, reviewing medications for safety and efficacy, and providing drug
information. Pharmacists, therefore, are experts on drug therapy and are the primary health
professionals who optimize medication use to provide patients with positive health outcomes.
Disciplines
The field of Pharmacy can generally be divided into three primary disciplines:
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.
There are various specialties of pharmacy practice. Specialization in pharmacy practice is typically based on the place of
practice or practice roles including: community, hospital, clinical pharmacy,
consultant, locum, drug information, regulatory
affairs, industry, and academia.
Other specializations in pharmacy practice recognized by the Board of Pharmaceutical
Specialties include: cardiovascular, infectious disease, oncology,
pharmacotherapy, nuclear, nutrition, and psychiatry.[1] 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.
Pharmacists
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Pharmacists are highly-trained and skilled healthcare professionals who perform various
roles to ensure optimal health outcomes for their patients. Many pharmacists are also small-business owners, owning the pharmacy in which they practice.
Pharmacists are represented internationally by the International
Pharmaceutical Federation (FIP). They are represented at the national level by professional organisations such as the Royal Pharmaceutical Society of Great Britain (RPSGB), the Pharmacy Guild of Australia (PGA), and the American Pharmacists Association (APhA). See also: List of pharmacy associations.
In some cases, the representative body is also the registering body, which is responsible for the ethics of the profession. Since the Shipman Inquiry, there has been a move in the UK to separate the two
roles.
History of Pharmacy
Muslim Pharmacy
The advances the Middle East made in botany and chemistry led them to substantially develop pharmacology, Al-Razi (865-915),
for instance, acted to promote the medical uses of chemical compounds. al-Zahrawi (936-1013) pioneered the preparation of
medicines by sublimation and distillation. His Liber servitoris is of particular interest, as it provides the reader with
recipes and explains how to prepare the `simples’ from which were compounded the complex drugs then generally used. Sabur Ibn
Sahl (d 869), was, however, the first physician to initiate pharmacopoedia, describing a large variety of drugs and remedies for
ailments. Al-Biruni (973-1050) wrote one of the most valuable Islamic works on pharmacology entitled Kitab al-Saydalah
(The Book of Drugs), where he gave detailed knowledge of the properties of drugs and outlined the role of pharmacy and the
functions and duties of the pharmacist. Ibn Sina, too, described no less than 700 preparations, their properties, mode of action
and their indications. He devoted in fact a whole volume to simple drugs in his Canon. Of great impact were also the works by
al-Maridini of Baghdad and Cairo, and Ibn al-Wafid (1008-1074), both of which were printed in Latin more than fifty times,
appearing as De Medicinis universalibus et particularibus by `Mesue' the younger, and the Medicamentis simplicibus by
`Abenguefit'. Peter of Abano (1250-1316) translated and added a supplement to the work of al-Maridini under the title De Veneris.
al-Muwaffaq’s contributions in the field are also pioneering. Living in the tenth century, he wrote The foundations of the true
properties of Remedies, amongst others describing arsenious oxide, and being acquainted with silicic acid. He made clear
distinction between sodium carbonate and potassium carbonate, and drew attention to the poisonous nature of copper compounds,
especially copper vitriol, and also lead compounds. For the story, he also mentions the distillation of sea-water for
drinking.[2]
Types of pharmacy practice settings and roles
Community pharmacy
19th century Italian pharmacy
Modern pharmacy in Norway
A pharmacy (commonly the chemist in Australia, New Zealand and the UK; or drugstore in North America; 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 household items such as cosmetics,
shampoo, bandages, office
supplies, candy, and snack foods.
Hospital pharmacy
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Pharmacies within hospitals differ considerably from community pharmacies. Some pharmacists
in hospital pharmacies may have more complex clinical medication management issues whereas pharmacists in community pharmacies
often have more complex business and customer relations issues.
Because of the complexity of medications including specific indications, effectiveness of treatment regimens, safety of
medications (i.e., drug interactions) and patient compliance issues ( in the hospital and at home) many pharmacists practicing in
hospitals gain more education and training after pharmacy school through a pharmacy practice residency and sometimes followed by
another residency in a specific area. Those pharmacists are often referred to as clinical pharmacists and they often specialize
in various disciplines of pharmacy. For example, there are pharmacists who specialize in haematology/oncology, HIV/AIDS,
infectious disease, critical care, emergency medicine, toxicology, nuclear pharmacy,
pain management, psychiatry, anticoagulation clinics, herbal medicine, neurology/epilepsy
management, paediatrics, neonatal pharmacists and more.
Hospital pharmacies can usually be found within the premises of the hospital. Hospital pharmacies usually stock a larger range
of medications, including more specialized medications, than would be feasible in the community setting. Most hospital
medications are unit-dose, or a single dose of medicine. Hospital pharmacists and trained pharmacy technicians compound sterile
products for patients including total parenteral nutrition (TPN), and other
medications given intravenously. This is a complex process that requires adequate training of personnel, quality assurance of products, and adequate facilities. Some hospital pharmacies have decided to
outsource high risk preparations and some other compounding functions to companies who
specialize in compounding.
Clinical pharmacy
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Clinical pharmacists provide direct patient care services that optimizes the use of
medication and promotes health, wellness, and disease prevention.[3] Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement
initially began inside Hospitals and clinics. Clinical pharmacists often collaborate with
Physicians and other healthcare professionals.
Compounding pharmacy
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Compounding is the practice of preparing drugs in new forms. For example, if a drug manufacturer only provides a drug as a
tablet, a compounding pharmacist might make a medicated lollipop that contains the drug.
Patients who have difficulty swallowing the tablet may prefer to suck the medicated lollipop instead.
Compounding pharmacies specialize in compounding, although many also dispense the same non-compounded drugs that patients can
obtain from community pharmacies.
Consultant pharmacy
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Consultant pharmacy practice focuses more on medication regimen review (i.e. "cognitive services") than on actual dispensing
of drugs. Consultant pharmacists most typically work in nursing homes, but are increasingly
branching into other institutions and non-institutional settings.[4] Traditionally consultant pharmacists were usually independent business owners, though in the United
States many now work for several large pharmacy management companies (primarily Omnicare,
Kindred Healthcare and PharMerica). This trend
may be gradually reversing as consultant pharmacists begin to work directly with patients, primarily because many elderly people
are now taking numerous medications but continue to live outside of institutional settings. Some community pharmacies employ
consultant pharmacists and/or provide consulting services.
Internet pharmacy
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Since about the year 2000, a growing number of Internet pharmacies have been established
worldwide. Many of these pharmacies are similar to community pharmacies, and in fact, many of them are actually operated by
brick-and-mortar community pharmacies that serve consumers online and those
that walk in their door. The primary difference is the method by which the medications are requested and received. Some customers
consider this to be more convenient and private method rather than traveling to a community drugstore where another customer
might overhear about the drugs that they take. Internet pharmacies (also known as Online Pharmacies) are also recommended to some
patients by their physicians if they are homebound.
While most Internet pharmacies sell prescription drugs and require a valid
prescription, some Internet pharmacies sell prescription drugs without requiring a prescription. Many customers order drugs from
such pharmacies to avoid the "inconvenience" of visiting a doctor or to obtain medications which their doctors were unwilling to
prescribe. However, this practice has been criticized as potentially dangerous, especially by those who feel that only doctors
can reliably assess contraindications, risk/benefit ratios, and an individual's overall suitability for use of a medication.
There also have been reports of such pharmacies dispensing substandard products. Of course as history has shown, substandard
products can be dispensed by both Internet and Community pharmacies, so it is best that the buyer
beware.
Canada is home to dozens of licensed Internet pharmacies, many which sell their lower-cost prescription drugs to U.S.
consumers, who pay the world's highest drug prices. However, there are Internet pharmacies in many other countries including
Israel, Fiji and the UK that serve customers worldwide.
In the United States, there has been a push to legalize importation of medications from
Canada and other countries, in order to reduce consumer costs. While in most cases importation of
prescription medications violates Food and Drug Administration (FDA)
regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers. There is
no known case of any U.S. citizens buying Canadian drugs for personal use with a prescription, who has ever been charged by
authorities.
Nuclear pharmacy
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Nuclear pharmacy focuses on preparing radioactive materials for diagnostic tests and for treating certain diseases. Nuclear
pharmacists undergo additional training specific to handling radioactive materials, and unlike in community and hospital
pharmacies, nuclear pharmacists typically do not interact directly with patients.
Issues in pharmacy
Separation of prescribing from dispensing
In most jurisdictions (such as the United States), pharmacists are regulated separately from physicians. Specifically, the
legislation stipulates that the practice of prescribing must be separate from the practice of dispensing.[citation needed] These jurisdictions also usually
specify that only pharmacists may supply scheduled pharmaceuticals to the
public, and that pharmacists cannot form business partnerships with physicians or give them
"kickback" payments. However, the American Medical Association (AMA) Code
of Ethics provides that physicians may dispense drugs within their office practices as long as there is no patient exploitation
and patients have the right to a written prescription that can be filled elsewhere. 7 to 10 percent of American physician
practices reportedly dispense drugs on their own.[5]
In other jurisdictions (particularly in Asian countries
such as China, Hong Kong, Malaysia, and Singapore), doctors are
allowed to dispense drugs themselves and the practice of
pharmacy is sometimes integrated with that of the physician, particularly in traditional
Chinese medicine.
In Canada it is common for a medical clinic and a pharmacy to be located together and for the ownership in both enterprises to
be common, but licensed separately.
The reason for the majority rule is the high risk of a conflict of interest. Otherwise, the physician has a financial
self-interest in "diagnosing" as many conditions as possible, and in exaggerating their seriousness, because he or she can then
sell more medications to the patient. Such self-interest directly conflicts with the patient's interest in obtaining
cost-effective medication and avoiding the unnecessary use of medication that may have side-effects. This system reflects much similarity to the checks and balances sytem of the
U.S. and many other overnments.
A campaign for separation has begun in many countries and has already been successful (like in Korea). As many of the remaining nations move towards separation, resistance and lobbying from dispensing doctors
who have pecuniary interests may prove a major stumbling block (e.g. in Malaysia).
The future of pharmacy
In the coming decades, pharmacists are expected to become more integral within the health care system. Rather than simply
dispensing medication, pharmacists will be paid for their patient care skills.[6]
This paradigm shift has already commenced in some countries; for instance, pharmacists in Australia receive remuneration from the Australian Government
for conducting comprehensive Home Medicines Reviews. In the United Kingdom, pharmacists (and nurses) who undertake additional
training are obtaining prescribing rights. They are also being paid for by the government for medicine
use reviews. In the United States, the Clinical pharmacy movement has had an
evolving influence on the practice of pharmacy.[7]
Moreover, the Doctor of Pharmacy (Pharm.D.) degree is now required before entering
practice and many pharmacists now complete one or two years of residency training following graduation. In addition,
consultant pharmacists, who traditionally operated primarily in nursing homes are now expanding into direct consultation with patients, under the banner of "senior care
pharmacy."[8]
See also
Symbols
The two symbols most commonly associated with pharmacy are the mortar and pestle and the ℞ (recipere)
character, which is often written as "rx" in typed text. Pharmacy organizations often use other symbols, such as the
Bowl of Hygieia, conical measures, and
caduceuses in their logos. Other symbols are common in different
countries: the green Greek cross in France and the
United Kingdom, 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 Greek root as the English word 'apothecary').
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The green Greek Cross used in Argentina, France and the United Kingdom
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The red stylized "A" used in Germany and Austria
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References
External links
Wikimedia Commons has media related to:
Other
- Pharmer - Pharmaceutical Information Online.
- The Virtual Library of Pharmacy - Extensive index
of pharmacy-related resources, including information on careers in pharmacy, pharmacy schools, pharmaceuticaul companies,
associations and conferences.
- Pakistan Pharmacists Society - National
association of pharmacists to promote and expand their role in public health and patient care in Pakistan.
- Pharmacist's Letter - Unbiased, research
based resource for pharmacists and pharmacy technicians on new developments in drug therapy
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