1 foundations of physical pharmacy

Topics to Cover during this Session
 General Introduction
 Scope of Pharmacy Profession
 Early History of Pharmacy
 Antiquity Pharmacy
 Middle Ages Pharmacy
 Modern Pharmacy
 Pharmacy Practice and the Personnel (Global perspectives)
 The Origins of Pharmacy Practice
 The Pharmacy Workplace of Today
 The Pharmacist
 The Concept of Pharmaceutical Care
 Education and Licensing for Pharmacists
 View of both Global and National Morden Pharmacy

General Introduction
to
Foundations of Physical Pharmacy
• Antiquity
Pharmacy
• Middle Ages
Pharmacy
• Modern Pharmacy
• Doctor and
pharmacist,
illustration from
Medicinarius (1505)
by Hieronymus
Brunschwig.
• Pharmacy,
tacuinum
sanitatis
casanatensis
(XIV century)
• Modern pharmacy in Norway

Then What is Pharmacy?
 Pharmacy is the art and science of preparing and dispensing medications and
the provision of drug-related information ta the public.
 It involves the interpretation of prescription orders; the compounding, labeling,
and dispensing of drugs and devices; drug product selection and drug utilization
reviews; patient monitoring and intervention; and the provision of cognitive
services related to use of medications and devices.
 The American Pharmacists Association describes the mission of pharmacy as
serving society as "the profession responsible for the appropriate use of
medications, devices, and services to achieve optimal therapeutic out comes.“
 Pharmacy should be conceived basically as a knowledge system that renders a
health service by concerning itself with understanding drugs and their effects.~
Thus, pharmaceutical care is a necessary element of total health care.
 The current philosophy or approach to professional practice in pharmacy is
designated as pharmaceutical care. - this concept holds that the important role
of the pharmacist is "the responsible provision of drug therapy for the purpose
of achieving definite outcomes that improve a patient's quality of life.~
 Pharmacists, then, are those who are educated and licensed to dispense drugs
and to provide drug information-they are experts on medications.
 They are the most accessible member of national health care team, and often
are the first source of assistance and advice on many common ailments and
health care matters.

Scope of Pharmacy
(National Training Requirements)
 There is currently one professional national degree program designed for
pharmacy: Bachelor of Pharmacy (BPharm).
 The BPharm curriculum has been designed with period requirement of 5
academic years to complete the degree requirements, broken into pre-
clinical and clinical academic years.
 Pharmacy Technologists who hold the diploma certificates from Evelyn
Hone College and relevantly ratified training institutions for DipPharm may
be admitted to a Bachelor of pharmacy degree program for the country, in
which instance the combined period of study may be longer than 5
academic years (DipPharm time period plus 3 years of BPharm time
period).
 Pre-clinical yearly Courses: Numeracy (mathematics), Physical science,
Chemical science and biological science designed to teach the principles
and respective applications of which find their way into many of the upper-
level professional pharmacy courses.
 Clinical or Professional yearly Courses: Basic to national designed
pharmacy curricula are courses in medicinal chemistry, pharmaceutics,
pharmacology, biopharmaceutics, clinical-pharmacy, Social sciences ,
various Administrative management courses of pharmaceutical
procedures, pharmacy law and ethical codes of conducts.

Scope of Pharmacy
(Career Range)
 Job opportunities for pharmacists globally are grow ing up at fast rate
mainly due to the following:
 increased pharmaceutical needs of a larger and older population.
 the scientific advances providing more drug range and products for
the prevention, diagnosis, treatment of diseases, new developments
in administering medication; and increasingly well-informed
consumers who are sophisticated about health care and eager for
more detailed information about drugs and their effects.
 The following are present time career options in pharmacy practice
globally:
 Community pharmacy
 National Health systems (Hospital) pharmacy
 Industrial pharmacy
 Nuclear pharmacy
 Administrative & Government Service Pharmacy
 Pharmaceutical education & Academic Pharmacy
 Pharmaceutical journalism
 Organizational management Pharmacy
 etc

Evolution of Pharmacy
(EARLY HISTORY OF PHYSICAL PHARMACY)
Since humanity's earliest past, pharmacy has been a
part of everyday life.
Excavations of some of mankind's oldest
settlements, such as Shanidar (ea 30,000 BeE),
support the Colltention that prehistoric peoples
gathered plants for medicinal purposes.

Evolution of Pharmacy (continued)

 With the above in mind, let us try to follow three
historical categories:
• Antiquity Pharmacy
• Middle Ages Pharmacy
• Modern Pharmacy

 When organized settlements arose in the great fertile valleys of the Nile, the Tigris and
Euphrates, the Yellow and Yangtze, and the Indus Rivers, changes occurred that gradually
influenced the concepts of disease and healing.
 The History of the Pharmacy and Pharmacology dates back to the medieval times with priests,
both men and women, who ministered to the sick with religious rites as well - These changes
are evident among the remains of the great civilizations of Mesopotamia and Egypt of the
second millennium BCE, whose clay tablets and papyri document the beginnings of rational
drug use in the West.
 For the Babylonians, medical care was provided by two classes of practitioners: the asipu
(magical healer) and the asu (empirical healer).
 Building on the foundations laid by previous natural philosophers such as Thales (ca 590 BCE),
Anaximander (ca 550 BCE), Parmenides (ca 470 BCE), and Empedocles (ca 450 BCE), the
Hippocratic (ca 425 BCE) writers constructed a rational explanation of illness.
 Most Greek medicines were prepared from plants, and the first great study of plants in the West
was accomplished by Theophrastus (ca 370-285 BCE), a student of Aristotle. His example of
combining information from scholars, midwives, root diggers, and traveling physicians was
emulated 300 years later by Dioscorides (ca 65 AD).
 Through the teachings and writings of Galen, a Greek physician who practiced in Rome in the
2nd century AD, the humoral system of medicine gained ascendancy for the next 1500 years.
HISTORY OF PHYSICAL PHARMACY (Continued)

 Many peoples of the world continue the close association of drugs, medicine, and
religion or faith.
 Specialization first occurred early in the 9th century in the civilized world around
Baghdad.
 In the Western half of the Roman Empire, such medical knowledge became
especially valuable as civilization crumbled in the years following 400 AD.
 It gradually spread to Europe as alchemy, eventually evolving into chemistry as
physicians began to abandon beliefs that were not demonstrable in the physical
world.
 Physicians often both prepared and prescribed medicines; individual pharmacists not
only compounded prescriptions but manufactured medicaments in bulk lots for
general sale.
 Not until well into the 19th century was the distinction between the pharmacist as a
compounder of medicines and the physician as a therapist generally accepted.

 The origin of the word "pharmacy" is generally ascribed to the
Greek pharmakon ("remedy").
 It has been suggested that there is a connection with the
Egyptian term ph-ar-maki ("bestower of security"), which the
god Thoth, patron of physicians, conferred as approbation on a
ferryman who had managed a safe crossing.
• The notion of an Egyptian origin has
a certain romantic appeal, but in all
likelihood the word "pharmacy" and its
many cognates derive, like so many
other scientific terms, from the Greek,
Pharmakon

 As much as 80,000 years ago, people of the Paleolithic period were
interested in the flora around them to engrave a variety of plants, bones
and deer antlers.
 It is fruitless to try to determine when Pharmaceutical practice started
because Pharmacy in a rudimentary form existed before the word (before
Antiquity Pharmacy).
 Combining different agents, or compounding, was considered as an art
form practiced by Priests, and Doctors.
 The first known chemical processes were carried out by the artisans of
Mesopotamia, Egypt, and China.
 Most of these craftspeople were employed in temples and palaces,
making luxury goods for priests and nobles.
 In the temples, the priests especially had time to speculate on the origin
of the changes they saw in the world about them.
 Their theories often involved magic, but they also developed
astronomical, mathematical, and cosmological ideas, which they used in
attempts to explain some of the changes that are now considered

Ancient Beliefs and Treatments
 Medicine has been practiced for thousands of years
 Remedies such as herbals have been used throughout
history
 Many popular beliefs have disappeared, for example:
Trephining – a cut made into the skin of the skull to give
disease a portal to leave through for all the severe
illnesses caused by evil spirits
Physician, 15th century.
A dentist with silver forceps
and a necklace of large
teeth, extracting the tooth of
a seated man.
England - London; 1360-
1375.
 Tribal shamans (medicine men) had gift of being able to
communicate with spirits
 Other illnesses cured by the placebo effect – patients believed
so strongly in the treatment rendered that they were cured
 Many Sumerian cuneiform clay tablets record prescriptions
for medicine as early as late 6th millennium BC - early 2nd
millennium BC).[3]
Sumerian inscription in monumental
archaic style, c. 26th century BC
(Antiquity)

Antiquity in Babylon
 Babylon
 jewel of ancient Mesopotamia
[cradle of civilization]
 earliest known record of
practice of the art of the
apothecary.
 Practitioners of healing in this era
(about 2600 B.C.) were priest,
pharmacist and physician, all in
one.
 Medical texts on clay tablets of
Mesopotamia (800 tablets)
record first the symptoms of
illness, the prescription and
directions for compounding, then
an invocation to the gods.
PHARMACY IN ANCIENT
BABYLONIA

 Shen Nung (2000 B.C.)
 Father of Chinese Pharmaceutics
 Emperor who started Chinese Pharmacy
 sought out and investigated the medicinal
value of several hundred herbs
 tested many of them on himself
 wrote the first Pen T-Sao (The Botanical
Basis of Pharmacy), or native herbal,
recording 365 drugs, 11,000 Rx handed
down by oral tradition
 Still worshiped by native Chinese drug guilds
as their patron god
 Medicinal plants include podophyllum,
rhubarb, ginseng, stramonium, cinnamon
bark, and, in the boy's hand, ma huang, or
Ephedra.
 Pharmaceutical records - clay tablets & long
scrolls in 2000 BC.
 Earlier literature included lists of prescriptions for
specific ailments, exemplified by a manuscript
"Recipes for 52 Ailments", found in the
Mawangdui tomb, sealed in 168 BC.
 The earliest known Chinese manual on materia
medica is the Shennong Bencao Jing (The
Divine Farmer's Herb-Root Classic), dating back
to the 1st century AD.
 However, the earliest text as preserved dates to
the 3rd or 4th century AD.
PHARMACY IN ANCIENT CHINA
Antiquity in China

Antiquity in Egypt
Antiquity and modernity stand
side-by-side in Egypt's chief
Mediterranean seaport of
Alexandria.
DAYS OF THE
PAPYRUS EBERS
Egyptian medicine dates
from about 2900 B.C
 Ancient Egyptian pharmacological knowledge
was recorded in various papyri such as the
Ebers Papyrus of 1550 BC, and the Edwin
Smith Papyrus of the 16th century BC.
 Papyrus Ebers (1500 B.C.)
 best known and most important
pharmaceutical record
 21 yard (60 ft) long, contains 700 drug prep
of Egyptians [gargles, suppositories,
inhalations, poultices, ointments]
 a collection of 800 prescriptions,
mentioning 700 drugs
 might have been dictated to a scribe by a
head pharmacist as he directed
compounding activities in the drug room
 Pharmacy in ancient Egypt was conducted by
two or more echelons [higher authority]:
 gatherers and preparers of drugs
 "chiefs of fabrication," or head pharmacists
 Use of mortars, pestles, hand mills, sieves
& weighing scales

 1200 BC
 Book of Sirach – creation of medicines by God
 Genesis – myrrh as astringent, carminative
and protectant
 Exodus – olibanum (frankinscence)
Biblical Records

Antiquity in India
 The earliest known
compilation of medicinal
substances was ARIANA
the Sushruta Samhita, an
Indian Ayurvedic treatise
attributed to Sushruta in
the 6th century BC.
A typical Ayurvedic Pharmacy
An idol of Dhanvantari at an
Ayurveda Expo in Bangalore

Antiquity In the Mediterranean
 Terra Sigillata (Sealed Earth)
 One of the first therapeutic agents to
bear a trademarks as a means of
identification of source and of gaining
customers' confidence
 a clay tablet originating on the
Mediterranean island of Lemnos before
500 B.C.
 One day each year clay was dug from a pit
on a Lemnian hillside in the presence of
governmental and religious dignitaries
 Washed, refined, rolled to a mass of
proper thickness
 formed into pastilles and impressed
with an official seal by priestesses,
then sun-dried
 The tablets were then widely distributed
commercially
TERRA SIGILLATA - AN EARLY
"TRADEMARKED" DRUG

Antiquity in Greece
 The first culture to consider these ideas scientifically was
that of the Greeks.
 From the time of Thales, about 600 BC, Greek
philosophers were making logical speculations about the
physical world rather than relying on myth to explain
phenomena.
 Thales himself assumed that all matter was derived from
water, which could solidify to earth or evaporate to air.
 His successors expanded this theory into the idea that four
elements composed the world: earth, water, air, and fire.
 Democritus thought that these elements were composed of
atoms, minute particles moving in a vacuum.
 Others, especially Aristotle, believed that the elements
formed a continuum of mass and therefore a vacuum could
not exist.
 The atomic idea quickly lost ground among the Greeks, but
it was never entirely forgotten.

 When it was revived during the Renaissance, it formed
the basis of modern atomic theory (see Atom and
Atomic Theory).
 Hippocrates [460 BC] - rationalization of treatment
(from magical to rational )
 Father of Medicine
 Fundamentals of scientific method
 Concept of homeostasis
 Theory of humoral pathology
 Disease as a disturbance of body’s fluids blood,
phlegm, yellow and black bile
 Pharmakon –drug as healing remedy
 Theophrastus [300 B.C.]
 greatest early Greek philosophers and natural
scientists
 Father of Botany
 observations and writings dealing with the medical
qualities and peculiarities of herbs are accurate,
even in the light of present knowledge
Antiquity in Greece (Continued)
THEOPHRASTUS -
FATHER OF BOTANY

Antiquity in Turkey
 Mithridates VI [about 100
B.C.]
 King of Pontus
 Father of Toxicology
 Studied the art of poisoning
and the art of preventing and
counteracting poisoning
 used himself as well as his
prisoners to test poisons and
antidotes
 Mithridatum
 His famed formula of
alleged pan-antidotal
powers
 popular for over a thousand
years
MITHRIDATES VI - THE
ROYAL TOXICOLOGIST

Middle Ages
Formal Medicine Practice in Its Infancy
 Plagues killed many people
 Microbes not known were to be responsible
for many diseases
 Prayer–most common form of treatment
alone became inadequate
 Hippocrates – 3rd generation physician -
Believed life consisted of a balance of four
elements linked to qualities of good health:
wet, dry, hot, cold
 Illnesses resulted in imbalance of four
humors – blood, phlegm, yellow bile, black
bile
 This become the center of evidence- based
investigations Hippocrates [460 BC] - rationalization
of treatment ( from magical to
rational )

Middle Ages (Continued)
Infancy of Medicine
 Four humors were linked to the
four elements:
 Blood = air - Cold
 Phlegm = water - water
 Yellow bile = fire - Hot
 Black bile = earth - Dry
 Treatment: bloodletting, laxatives
 Hippocrates–responsible for advancements in medicine
 His observations included effects
of food and climate
 First physician to record patient’s medical illnesses
 Promoted rest and eating light foods
Vaticanus graecus 277, 10v-11r: Table of
contents in a fourteenth-century
Hippocratic Corpus manuscript. Marcus
Fabius Calvus owned this manuscript,
transcribed it in his own hand, and used
it in the preparation of his 1525 Latin
translation.
DIOSCORIDES - A SCIENTIST
LOOKS AT DRUGS
Pedanios Dioscorides (1st century A.D.)
 Father of Pharmacology
 Botanist/ pharmacologist
 De Materia Medica ( 600 plants & 90 minerals)
 recorded what he observed, promulgated excellent rules for
collection of drugs, their storage and use ( The Herbal)
 His texts were considered basic science as late as the
sixteenth century.

 On the Art of Healing, most
famous writing
 practiced and taught both
Pharmacy and Medicine in
Rome
 First Pharmacist/Botanist
 associated with Galenicals
(tinctures, fluidextracts,
syrups, ointments)
 A class of
pharmaceuticals
compounded by
mechanical means
 originator of the formula for a
cold cream, essentially
similar to that known today
 Many procedures Galen
originated have their
counterparts in today's
modern compounding
laboratories
 Compilations:
 Antidotaria – similar to dispensatories
 Receptaria – more modest formularies
GALEN - EXPERIMENTER IN
DRUG COMPOUNDING
Galen (130-200 A.D.)

 Damian, the apothecary, and
Cosmas, the physician
 Twin brothers of Arabian
descent, and devout Christians
 offered the solace of religion as
well as the benefit of their
knowledge to the sick who visited
them
 Their twin careers were cut short
in the year 303 by martyrdom
 For centuries their tomb in the
Syrian city of Cyprus was a
shrine. Churches were built in
their honor in Rome and other
cities
 After canonization, they became
the patron saints of Pharmacy
and Medicine, and many
miracles were attributed to them.
DAMIAN AND COSMAS -
PHARMACY'S PATRON SAINTS
Damian and Cosmas

 Pharmacomedical services - lay practitioners
and clerics
 Monasteries
 remained to be the centers of intellectual
life
 Where remnants of the Western
knowledge of Pharmacy and Medicine
were preserved (fifth to twelfth centuries)
 Monks
 Collected and cultivated medicinal plants
 Distilled aromatic and cordial flowers
 prepared herbs according to the art of the
apothecary for the benefit of the sick and
injured
 Herb gardens such as the ones used by
monks may still be found in monasteries in
many countries.
 Famous manuscripts:
 De Viribus Herbarum (Herbs Used by
the People) – Abbot Odo in France
 Causae et Curae – Abbess Hildegard
in Germany

Arabs
 separated the arts of apothecary
and physician [Italy, Spain,
France]
 first privately owned drug stores
- established in Baghdad late in
the eighth century
 preserved much of the Greco-
Roman wisdom and added to it
 developed syrups, confections,
conserves, distilled waters and
alcoholic liquids
 Made their own treaties –
influential and authoritative in
Europe when translated into
Latin
 Came up with more refined and
elegant way of administering
drugs
THE FIRST APOTHECARY SHOPS
 When the Moslems swept
across Africa, Spain and southern
France, they carried with them a
new pattern of Pharmacy which
western Europe soon assimilated.

Avicenna
 Ibn Sina (about 980-1037 A.D.)
 called Avicenna by the
Western world
 “Persian Galen” - This also is
among the brilliant contributors
to the sciences of Pharmacy
and Medicine during the
Arabian era
 He was a Pharmacist, poetic
physician, philosopher and
diplomat
 His pharmaceutical teachings
were accepted as authority in
the West until the 17th century;
and still are dominant influences
in the Oriental world
AVICENNA - THE "PERSIAN GALEN"

EDICT of 1231
 Magna Carta of Pharmacy
 Public pharmacies began to
appear in the 17th century
 12th century – public
pharmacies [Italy & France]
 Some still remained under
church control.
 Pharmacy was separated from
Medicine [about 1240 A.D] in
Sicily and southern Italy
 Frederick II of Hohenstaufen
 Emperor of Germany
 first European edict completely
separating the responsibilities
of pharmacists from those of
Medicine, and prescribing
regulations for their professional
practice
SEPARATION OF PHARMACY AND MEDICINE

Transition Period –
Middle Ages to Modern Europe
 Magna Carta (document
acknowledging rights) of the
Pharmacy profession [1240]
 Made Pharmacy an independent
branch of public welfare service
 Limited the number of
pharmacies
 Fixed prices of remedies
 Required official supervision to
pharmaceutical practice
 Made the use of a prescribed
formulary (fixed formula for a
certain drug) compulsory
 Evolution of individual standards
and responsibilities in urban
centers like Italy, Spain, France
SEPARATION OF PHARMACY AND MEDICINE

10th-15th Centuries
 Moses Ben Maimon (1135-1204)
 Maimonides as known
 Spanish Rabbi, whose
prayer was written in
many scrolls given during
graduation
 Published glossary of
drug terms and manual of
poisons
Rambam Maimonides
Rabbi & Doctor
•Maimonides was the foremost
representative of the school of thought that
is designated as Jewish Aristotelianism.
•In consequence of the invasion of Muslim
Spain by the Almohads, his family left
Córdoba while he was a child and after an
interval settled in 1159/1160 in Fez,
Morocco, a country which, like Andalusia,
was ruled by the Almohads.
•He lived there until 1165.
•Maimonides received his philosophical,
scientific, and legal training in Spain and
the Maghreb and prided himself on
belonging to the Andalusian (rather than
the Oriental) school of philosophy.

 Paracelsus – He revolutionized pharmacy
 Philippus Aureolus Theophrastus
Bombast von Hohenheim
 Superiority over Celsus, herbalist
 “Luther of Medicine”
 Introduced medically active
“quintessences” (pure and concentrated
essence of a substance) from natural
resources
 Transformed pharmacy from
botanical science to chemical science
 He replaced 4 body fluids to 3
chemical constituents namely:
 Sulfur – combustibility
 Mercury – liquidity
 Salt - stability
 Disease was a chemical abnormality to
be treated with chemicals
10th-15th Centuries
Philippus Aureolus
Paracelsus
Paracelsus (1493-1541)
•Figures in the history of medicine,
alchemy, and occultism
•Full name Auraelus Philippus
Theophrastus Paracelsus Bombast von
Hohenheim,
•Physician and exponent of the hermetic
philosophy was renowned under the name
of Paracelsus.
•He was born December 26, 1493, in
Einsideln, near Zürich, Switzerland. His
father, the natural son of a prince, himself
a physician, desired that his only son
should follow the same profession.

Evolutionary History
of Pharmacy

 Brief overview of profession roots as outlined below, that is study history from its
origin in ancient Babylonia through the middle of the twentieth century
 Pharmacy in ancient times:
 It was practiced in prehistoric times as people instintinctively used the water,
plants and earth around them for soothing compresses on wounds and ailments
 As civilization dawned in ancient Mesopotamia (about 2600 B.C.), Babylonian
healing practitioners combined the responsibilities of priest, physician, and
pharmacist, some oldest pharmacy records are found in Sumerian clay
cuneiform tablets that date about 200 B.C.
 Retailers of drugs were concentrated on certain street in Babylon by 2111 B.C
 An ancient china (circa 200 B.C), legend tells that emperor Shen Nung
investigated the medical properties of hundreds of herbs, and he recorded 365
native herbal drugs in the first pen T’sao
 Egyptian priest, prepared medicines, ebers papyrus dates from 1900-1100 B.C
contains 800 prescriptions using 700 drugs, of particular note in the papyrus is
inclusion of quantities of substances
 Many modern dosage forms are referred to in the ebers papyrus (gargles, snuffs,
inhalations, suppositories…..)
This brief account highlights the history
of pharmacy as professional practice

 Pharmacy in ancient times:
 Ancient Greece lived the father of botany, Theophrastus (300 B.C) , his
observations about the medicinal qualities of herbs have proven
uncannily accurate
 Hippocrates of course formulated the theory of the four humors that
parallel the four elements (air- blood, water- phlegm, earth-black bile,
fire- yellow bile)
 He summarised that disease was caused by an imbalance of these bad
humors
 Ancient Rome, Galen (A.D 130-200)
 Developed principles of preparing and compounding medicinal agents
 Sought to restore humeral balances within a patient by the use of
medicine of opposing qualities
Pharmacy History (Continued)

 Pharmacy differentiate during middle ages:
 Thanks to the Arab world that pharmaceutical knowledge grew
considerably
 Pharmacy as a separate activity began to develop and privately
owned pharmacies were established in Islamic lands
 First known apothecary shop was opened in Baghdad in the 18th
century, and the Muslims carried this concept into Europe during
wars and other excursions into Africa, Spain, southern France
 Ibn Sina (circa 980-1037)- Avicenna- intellectual giant, he was a
physician, poet, philosopher, diplomat, companion of Persian princes
and rulers
 His Canon Medicinae brought together the best knowledge of the
Greeks and Arabs into a single medical text
 German emperor Frederick II issued an edict in about 1240 that
legally separated pharmacy from medicine in southern Italy and Sicily

 The Renaissance (Pharmacists Flourished):
 Pharmacists Flourished Too
 Re-examined the Greek and roman tents
 The Swiss physician Pearcelsus (1493-1541) introduce two ideas that
disease might be localized in a specific organ, and some plants
contained minute quantities of active chemical
 Emerging of professional associations of pharmacists
 Pharmacist was under jurisdiction of Guild of grocers, which
monopolized the drug and spice trade
 King James I granted a charter recognizing the society of apothecaries
of London
 Imbalance of acid and alkaline substances in the body theory, humpty

 Pharmacy in the United State of America (the early days):
 Increased recognition and application of the scientific method in the 1700s,
modern pharmacy emerged
 Progress in organic, inorganic chemistry, immunology, and chemotherapy began
to change pharmacy from empirically based profession to a knowledge based one
 4 types of pharmacist: the dispensing physician, the apothecary shop, the general
store, and te wholesale druggist
 Pharmacy in the United State of America (the nineteenth century)
 Begin manufacturing and selling chemical in the late 1700s, basis of establishing
pharmaceutical companies
 World was changing from agriculturally based economy to an industry based one
 Manufacturing of drugs using newly discovered principles of chemistry
 Microbial basis of many disease
 Smallpox vaccine of Jenner
 Isolation of drug morphine from opium
 National pharmacopeia, 1820, in senate chambers of the U.S. capital in
Washington
 1800s states were issuing licenses to apothecaries
 1st was south Carolina
 1821 the Philadelphia college of pharmacy was founded, 1st pharmacy
organization in the united states , other schools followed quickly

 Pharmacy in the United State of America (the nineteenth century)
 National pharmacopeia, 1820, in senate chambers of the U.S.
capital in Washington
 1800s states were issuing licenses to apothecaries
 1st was south Carolina
 1821 the Philadelphia college of pharmacy was founded, 1st
pharmacy organization in the united states , other schools followed
quickly
 In the later half, pharmacy apprentices with several years’
experience in apothecary shops would attend school for a limited
amount of time before coming licensed pharmacist
 A physician chemist at the university of Michigan changed that.
Albert Perscott believed that the scientific foundation of pharmacy
should be laid first through didactic educational programs and only
then should the student attempt to learn the practical side of the
trade through an apprenticeship
 He was rejected as a delegate at the 1871 AphA convention in St. Louis but
time proved him right!

 Twentieth century pharmacy (business or a profession):
 … if the preparation of medicine is taken from the apothecary
and he becomes merely the dispenser of them, his business is
shorn of half its dignity and importance, and he relapses into a
simple shopkeeper”(W. Procter, chief problem for 20th
century)
 After world war II, the military had an urgent need for penicillin,
which had lain dormant in Fleming's laboratory for 0 years. The
technology, scientific knowledge and need were present all at
once
 The art of compounding rapidly become less important
 The knowledge about the drugs, their mechanisms of actions,
and their side effects become much more complicated
 More and more products were produced ready to dispense,
pharmaceutical industry become stronger

Pharmacy Practice
&
The Personnel
(Global Perspectives)

52
Presentation Topics
 This subject lesson should reflect on the
following:
 The Origins of Pharmacy Practice
 The Pharmacy Workplace of Today
 The Pharmacist
 The Concept of Pharmaceutical Care

© Paradigm Publishing, Inc. 53
Learning Objectives
 Describe the origins of pharmacy.
 Differentiate among the various kinds of pharmacies.
 Describe four stages of development of the
pharmacy profession in the twentieth century in the
world and relate it to our national present time.
 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.

Origins of Pharmacy Practice
 Ancient Egyptians compiled lists of drugs known as
 Formularies
 Dispensatories
 Pharmacopeias
 This was beginning of an empirical approach to medicine
 Greeks first took a scientific approach to medicine.
 Pharmacy comes from the ancient Greek pharmakon, meaning
 Drug
 Remedy
 Hippocrates , “Father of medicine” at the time
 Believed illness was physical rather than spiritual
 Used scientific principles to
 Identify disease
 Determine the cause of disease
 Treat disease

 Dioscorides (first century A.D.)
 Wrote De Materia Medica (On Medical Matters)
 Included infoCrmation on
 Herbal remedies
 Usage
 Side effects
 Quantities
 Dosages
 Storage
Origins of Pharmacy Practice (C0ntinued)
 Galen, Greek physician (130 – 200 A.D.) “Father of
pharmacy”
 Organized six centuries of knowledge
 Conducted animal experiments
 Produced classification of drugs

Pharmacy practice evolved in the Middle Ages:
 Persian Empire
 Introduced dosage formulation
 Identified pharmacist as health professional
 Western Europe
 Developed apothecary concept
 Created professional guilds for pharmacy training
European Renaissance (A.D 1350 – 1650)
 Rise of alchemy
 Emergence of science and publishing
 Rudimentary testing and research
 Major cities developed own drug lists
 Apothecaries still run by physicians

 Pharmacy in the U.S. followed European model.
 Professions of physician and pharmacist eventually separated.
 The U.S. developed its own pharmacopeia in 1820.

 Terms to Remember
 Alchemy - European practice during the Middle
Ages that combined elements of chemistry,
metallurgy, physics, and medicine with astrology,
mysticism, and spiritualism

 Discussion
 How was disease thought of in early civilization?
 How was the disease treated then?
 What are some of the contributions to the practice of
pharmacy from around the world?
Asia
Greece
Roman Empire
Arabia
Europe

Pharmacy Work Places
(Global Perspectives)
 Community Pharmacies
 Institutional Pharmacies

Pharmacy Workplace

Community Pharmacies
 60% of U.S. pharmacists work in community (or retail) pharmacies
 Many types of community pharmacies
 Chain
 Independent
 Compounding
 Franchise
 Mail-order
 Chain pharmacy
 High-volume locations
 Department store (Target, Wal-Mart)
 Grocery store (Kroger, Publix)
 Drugstore (Walgreens, CVS, Rite-Aid)
 Heavy use of pharmacy technicians and automation

Community Pharmacies (continues)
 Independent pharmacy
 Owned and operated by one or a group of pharmacists
 Compounding pharmacy
 Specializes in preparations that are not commercially available
 Franchise pharmacy
 Combines aspects of independent and chain pharmacies
 Provides more personalized service
 Mail-order pharmacy
 Centralized, automated operation
 Economies of scale may mean lower prices

 Community Pharmacy - any independent, chain,
or franchise pharmacy that dispenses prescription
medications to outpatients; also called a retail
pharmacy
 Chain Pharmacy - community pharmacy that
consists of several similar pharmacies in the region
(or nation) that are corporately owned

 Discussion
 Why has there been a trend toward fewer
independent pharmacies?
 What are the advantages and limitations of mail-order
pharmacies?

 Can be found in many organizations
 Hospitals
 Home healthcare systems
 Long-term care facilities
 Managed-care services
 Nuclear pharmacies
 Home healthcare pharmacies
 Deliver services and supplies to patients at home
 Provide oral and IV meds
 Often available on 24 hour basis
 Must educate patient on safe use of meds
 Long-term care facilities
 Higher level of care than home health care
 Some have in-house pharmacy
 Some contract with local pharmacy
Institutional Pharmacies

Institutional Pharmacies (continued)
 Managed-care pharmacy services
 Encourage health maintenance
 Usually have an approved drug list, or formulary
 Often have a tiered pricing plan
 Lowest price for generic drug
 Higher price for “preferred” brand name drug
 Highest price for “nonpreferred” brand name drug
 Nuclear pharmacies
 Dispense radioactive pharmaceuticals
 Require specialized equipment, training, and
certifications
 Usually located off-site

 Institutional Pharmacy - a pharmacy that is organized under a corporate
structure, following specific rules and regulations for accreditation
 Hospital Pharmacy - an institutional pharmacy that dispenses and prepares
drugs and provides clinical services in a hospital setting
 Nuclear Pharmacy - a specialized practice that compounds and dispenses
sterile radioactive pharmaceuticals to diagnose or treat disease
 Home Healthcare - the delivery of medical, nursing, and pharmaceutical
services and supplies to patients at home
 Home Healthcare pharmacy - a pharmacy that dispenses, prepares, and
delivers drugs and medical supplies directly to the home of the patient
 Long-term Care facility - an institution that provides care for geriatric and
disabled patients; includes extended-care facility (ECF) and skilled-care
facility (SCF)
 Managed care - a type of health insurance system that emphasizes keeping
the patient healthy or diseases controlled in order to reduce healthcare costs
 Health maintenance organization (HMO) - an organization that provides
health insurance using a managed care model
 Formulary - a list of drugs that have been preapproved for use by a
committee of health professionals; used in hospitals, in managed care, and
by many insurance providers

 Discussion
 How does the HMO approach affect the price of
medications?

EvolutionofthePharmacist’sRole
TheRoleofthePharmacist
EducationandLicensing
The Pharmacist
(The Ten Point-Credit Pharmacist)

 Four stages in the twentieth century especially in the American setting:
 Traditional era
 Scientific era
 Clinical era
 Pharmaceutical care era
 Traditional era (pre−World War II)
 Focus on natural botanicals
 Drugs compounded by pharmacist
 Training emphasized pharmacognosy
 Scientific era (post−World War II)
 Rise of pharmaceutical industry
 New drugs synthesized and mass-produced
 Pharmacist more of a retailer
 Educational focus on pharmacology
Evolution of the Pharmacist’s Role

 Clinical era (early 1960s)
 Some felt focus had shifted too far toward basic scientific knowledge.
 Millis Commission emphasized clinical role of pharmacists.
 Profession became more patient-oriented.
 Pharmaceutical care era (1990s)
 Expanded patient-oriented focus
 Updated profession mission to include
 Patient counseling
 Medication monitoring
Evolution of the Pharmacist’s Role

 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 with
professional characteristics as displayed above.
 Pharmacognosy - the study of medicinal functions of natural
products of animal, plant, or mineral origins
 Pharmacology - the scientific study of drugs and their
mechanisms of action
 Pharmaceutics - the study of the release characteristics of
specific drug dosage forms
 Pharmacokinetics - individualized doses of drugs based on
absorption, distribution, metabolism, and elimination
 Therapeutics - the study of applying pharmacology to the
treatment of illness and disease states
 Pathophysiology - the study of disease and illnesses affecting
the normal function of the body
 Pharmaceutical Care - a philosophy of care that expanded the
pharmacist’s role to include appropriate medication use to
achieve positive outcomes with prescribed drug therapy

 Discussion
 How did the Millis Commission change the role of the
pharmacist?

The Role of the Pharmacist
 Traditional focus was compounding
 Pharmacist now spends more time:
 Gathering patient information
 Advising and informing patients
 Monitoring drug interactions and responses
 Providing drug information to other healthcare professionals
 In addition to dispensing drugs, community pharmacist:
 Creates patient care initiatives to identify and prevent disease
 Administers immunizations, such as flu shots
 Screens and educates patients regarding high blood pressure, diabetes, etc
 Community pharmacist must also be a business person and entrepreneur:
 Hires and supervises employees
 Manages insurance contracts and claims
 Maintains inventories
 Sells non-medical merchandise
 Manages retail operation

 Hospital pharmacist may:
 Be specialized (pediatric, neonatal, critical care, cancer, etc.)
 Advise physicians on appropriate medication use
 Be responsible for educating patients about their drugs upon
discharge
 Hospital pharmacist typically:
 Provides drug information
 Recommends formulary changes
 Educates other health practitioners on drugs
 Develops policies and procedures
 Dispenses investigational and hazardous drugs
 Maintains inventories
 Home healthcare pharmacist may prepare meds and IVs for:
 Nutrition
 Antibiotics
 Chemotherapy
 Pain management
The Role of the Pharmacist (continued)

 Pharmacist in long-term care facilities or nursing
homes often
 Creates recordkeeping systems for controlled
substances
 Reviews residents’ drug regimens
 Monitors handling of on-site drugs
 Educates residents regarding drug therapies
 Helps ensure regulatory compliance
The Role of the Pharmacist (continued)

 Discussion
 In what ways does the modern-day pharmacist
impact patients’ health and safety considering the
positive qualities of qualified pharmacist?

The Pharmaceutical Care 1
(GENERAL PRINCIPLES OF HEALTH CARE)

UNIT 1
GENERAL INTRODUCTION
“Many people spend their HEALTH to gain
WEALTH, and later on, spend all their
WEALTH in a desperate effort to regain
HEALTH.”

Health Care Background
 Physical malady has been one of man’s greatest
adversaries.
 Only during the past 100 years has medicine developed
weapons to fight disease effectively.
 Vaccines, modern drugs and surgical procedures, state-of-
the art instruments and clear understanding of sanitation
and nutrition have an immense impact on human well-
being.
 Like semioticians, physicians, pharmacists and other
health care professionals utilize clues to identify or
diagnose a specific disease or injury.
 While diagnosing disease and choosing the best treatment
certainly require scientific knowledge and technical
skills, health care professionals must apply these abilities
in innovative ways.

Health Care Background (continued)

 Medicine (Latin medicus, “physician”), is the science and art
of diagnosing, treating and preventing disease and injury.
 It is a Healing Art.
 Its aims are to help people live longer, happier, having
more active lives with less suffering and disability.
 Medical scientists engage in a constant search for new
drugs, effective treatments and more advanced technology.
 Contemporary health care practitioners can prevent, control
or cure hundreds of diseases.
 In addition, medicine has become a part of the health care
industry.
 It is considered to be one of the largest industries in the
world, and among the leading employers in most
communities.


 At the turn of the 20th century, many men and women were
frail by age 40.
 The average man born in 1900 had a life expectancy of 47.3
years.
 Effective treatments for disease were so scarce that doctors
could carry all their drugs and instruments in a small black
bag.
 By the end of the 20th century, medical advances had
caused life expectancy to increase to 76 years.
 People today remain independent and physically active into
their 80s and 90s.
 The fastest-growing age group in the population now
consists of people aged 85 and over.
 This medical expansion has been expensive though
innovative to professions such as pharmacy, medicine etc

History of Heath Care
 Our understanding of prehistoric medical practice is from
the study of ancient pictographs that show medical
procedures, as well as the surgical tools uncovered from
anthropological sites of ancient societies.
 Serious diseases were of primary interest to early humans,
although they were not able to treat them effectively.
 Many diseases were attributed to the influence of
malevolent demons that were believed to project an alien
spirit, a stone, or a worm into the body of the unsuspecting
patient.
 These diseases were warded off by incantations, dancing,
magic charms and talismans, and various other measures.

 If the demon managed to enter the body of its victim, either in the
absence of such precautions or despite them, efforts were made to
make the body uninhabitable to the demon by beating, torturing and
starving the patient
 The alien spirit could also be expelled by potions that caused
violent vomiting, or could be driven out through a hole cut in the
skull.
 This procedure, called trepanning, was also a remedy for insanity,
epilepsy and headache.
History of Heath Care (continued)

 Surgical procedures practiced in ancient societies included cleaning
and treating wounds by cautery (burning or searing tissue),
poultices, and sutures, resetting dislocations and fractures, and
using splints to support or immobilize broken bones.
 Additional therapy included laxatives and enemas to treat
constipation and other digestive ills.
 Perhaps the greatest success was achieved by the discovery of
the narcotic and stimulating properties of certain plant extracts.
 So successful were these that many are still of use today, including
digitalis, a heart stimulant extracted from foxglove.
 Several systems of medicine, based primarily on magic, folk
remedies, and elementary surgery, existed in various diverse
societies before the coming of the more advanced Greek medicine
about the 6th century b.c.
History of Heath Care (continued)

Health Care Professionals
(General)
 Some 11.6 million people work in health care in
Abroad.
 They include about 778,000 physicians, 2.1 million
registered nurses and 160,000 dentists.
 Most of them work in health care services, which
involve diagnosing and treating patients.
 Others work in research, teaching or administration
of medical facilities.

 The profession of pharmacy has a unique body
of knowledge and skills to contribute in our
health–care system.
 The pharmacist not only dispenses the
appropriate drug product but also has the
knowledge to assure safe and rational use of
drugs with Pharmacist attached analogies .
(Pharmacists)

1. Assisting in the selection of appropriate drug therapy.
2. Preparing, compounding and manufacturing drugs for
individualized patients.
3. Dispensing and packaging the prescribed drug
products including proper labeling.
4. Advising and educating patients on proper use of
drugs.
5. Monitoring the outcome and responses of patients to
the effect of drugs, both beneficial and adverse.
6. Serving as a community resource person on drug and
health information.
(Early Functions of the Pharmacist )

 Pharmaceutical Care Giver
 Researcher
 Manager
 Communicator
 Leader
 Life-long learner
 Decision-maker
 Entrepreneur
 Teacher
 Agent of Positive Change
(The Ten Star Pharmacist )

 There is concern among health care–providers
over the:
 potential abuse of drug substances
 misuse of drug substances
 inappropriate use of drugs
 the resulting increase in health care cost
 patient suffering out of drug usage.
(Important Consideration)

Disease vs Health
 “Disease comes only when the body’s vital defenses have
been broken down through improper diet and harmful
indulgences. Lack of health means lack of vital resistance
against germs and bacteria. Lack of health means lack of
immunity from disease”.
 “To cure any disease therefore it is only necessary to build
health, after which the body can be left on its own to
correct itself and overcome disease. This is possible as long
as the disease has not yet advanced to such a state where
more drastic measures like surgery, become necessary.”

The Patient-Oriented Professional
 There is need for professionals who are patient–oriented
and able to apply and provide drug knowledge to improve
drug use in the health care system.
 Pharmacy Training Institutions - some have responded
by providing clinical training for their undergraduates and
Zambia is included.
 This new breed of pharmacists is more clinically and
patient–oriented and better prepared to dispense drug
knowledge as well as drug products unlike in the past
where pharmacists training was more focused on drug
discovery, storage and supply
 The prime aim is to attain success in the goals for therapy
through the provision of pharmaceutical care, pharmacist
must approach the patient–counseling (a very important
component of pharmaceutical care), an encounter as a
HELPER and EDUCATOR.

The Traditional Pharmacist
 Pharmacists have traditionally been involved in the
preparation and dispensing of medications, at the
direction of the physician.
 As such, they have been strongly allied with the medical
profession and hence, with the view that the health
professional should be in control of the patient -
Pharmaceutical care, as part of comprehensive patient
care, must be the organizing force for the profession of
pharmacy.

The Model
 But, with the shift in the model of pharmacy from a focus
on the medication to a focus on the patient, there is need
for a shift also in the pharmacist’s approach as well.
 This shift can be described as moving from the health
professional–centered “MEDICAL MODEL” to the
patient – centered “HELPING MODEL.”

The Helping Approach:
Relationship between Pharmacist and Patient
 MEDICAL MODEL
 Patient is passive
 Basis for trust is expertise and the
authority of pharmacist
 Pharmacist identifies problem and
determine solutions
 Patient is dependent on
pharmacist
 parent – child relationship
 HELPING MODEL
 Patient is actively involved
 Trust is based on personal relationship
developed over time
 Pharmacist assist patients in exposing
problem and possible solution
 Patient develops self confidence to
manage problems
 equal relationship

Patient Quality of Life
 PQL - The pharmacist therefore must learn to view medication’s
use from the patient’s perspective and his/her primary concern is
the Patient Quality of Life or the welfare of humanity and the relief
of human suffering.
 An Oath - “I will use knowledge and skills to the best of my ability
in serving the public and other health professional.”
 Health - a goal to strive for but is not obtainable, because no one
ever achieves a “state of complete mental, physical and social
well being”
 Cure - comes from Latin word “ CURA” which means, in
particular ,
 Care - means providing for the welfare of another.
 attentive conscientiousness of devotion
 the concepts of care convey a compassionate state of being
and not merely an attitude.
 involves a profound respect for the “otherness” of the other.


Therapeutic Relationship
 This is built on dialogue and commitment with
health service recipients.
 It is an alliance between a practitioner and a
patient, formed to meet a patient’s health
care needs.

Health Care
CHARACTERISTICS OF CARING BEHAVIOR: THE VITAL
COMPONENTS OF THE THERAPEUTIC RELATIONSHIP
 Mutual respect
 Honesty/ Authenticity
 Open Communication
 Cooperation
 Collaboration between patient
and practitioner
 Empathy
 Sensitivity
 Promotion of patient
independence
 Seeing the patient as a person
 Exercising patience and
understanding
 Trust

 Competence
 Putting the patient first
 Offering reassurance
 Confidence
 Paying attention to the patient’s physical and emotional
comfort
 Supporting the patient
 Offering advocacy
 Assuming responsibility for intervention
 Being willing to be held accountable for all decisions
made and recommendations given.
CHARACTERISTICS OF CARING BEHAVIOR: THE VITAL
COMPONENTS OF THE THERAPEUTIC RELATIONSHIP
(Continued)

HEALTH CARE:
HEALTH CARE NEEDS OF A PATIENT
 Medical Care
 Mental Health Care
 Dental Care
 Pharmaceutical Care
 Nursing Care
 Chiro-Practice Care
 Pediatric Care
 Eye/Nose/Ear Care
 Physiotherapy care
 Geriatric Care
 Surgical Care
 Nutritional Care
 Maternal Care
 Laboratory Care
 Environment Community Care
 Health Life Rehabilitatory care

Primary Care (continued)
 is distinguished by being “front–line” or
“first contact” care
 person–centered (rather than disease or
organ system centered),
 comprehensive in scope, rather than being
limited to illness episodes or by organ
systems or disease process involved

 Interactions with patients and other
health care providers
COUNSEL
CONSULT
EDUCATION
(Interactions with Others)

 Rules
 Roles
 Relationship
 Responsibilities
(4 R’s of Philosophy of Practice)

Pharmaceutical Care
 According to Hepler and Strand, is the responsible provision of
therapy for the purpose of achieving definite outcomes that
improve the patients quality of life
 sometimes called “PHARMACIST CARE”
 a PRACTICE in which the practitioner takes responsibility for a
patient’s drug – related needs, and is held ACCOUNTABLE for
this COMMITMENT.
 applying knowledge to promote well being of others
 requires responsiveness, sensitivity and commitment to others
 a generalist practice that emphasizes health, prevention and
care.
 a form of primary health care.

 The recognition of a social need
 The patient–centered approach
 Caring as a modus operandi
 Specific responsibilities to identify,
resolve, and prevent drug therapy
problems
Pharmaceutical Care
(Philosophy)

1. patient–centeredness
2. addressing both acute and chronic conditions
3. emphasizing prevention
4. implementing documentation systems that continuously
record patient need and care provided
5. being accessible to front – line first contact
6. ensuring integration of care
7. being accountable
8. placing emphasis on ambulatory patient
9. including education/ health promotional intervention
Pharmaceutical Care
(Focus)

1. cure of disease
2. elimination or reduction of symptoms
3. arrest or slowing of a disease process
4. prevention of disease or symptoms
Pharmaceutical Care
(Outcomes)

 PATIENT CARE PROCESS
 PRACTICE MANAGEMENT SYSTEM
PROCESS
 PHILOSOPHY OF PRACTICE
Pharmaceutical Care
(Practice)

 A general understanding of how people feel
about being ill, the seriousness of the
disease (patient’s susceptibility to other
factors)
1. DENIAL – “not me”
2. ANGER – “why me?”
3. DEPRESSION – ‘yes, me!”
4. BARGAINING – “yes me, BUT….”
5. ACCEPTANCE – “I’m ready”
Pharmaceutical Care
(Operational / Practice Factors)

 Don’t assume patients had information from the doctor
 Don’t assume patients understand all information given
 Don’t assume patients have resources to comply
 Don’t assume patients don’t care or stupid
 Don’t assume patients will comply if they understand
 Don’t assume others will monitor of follow – up
 Don’t assume patients will voluntarily seek help or
information if there are problems
Pharmaceutical Care
(Operational Vital Points)

TRADITIONAL
PHARMACY
CLINICAL
PHARMACY
PHARMACEUTICAL
CARE
Primary
Focus
Rx order or
OTC request
Physicians or
Other health
professionals
PATIENT
Continuity Upon
demand
Disconti-
nuous
CONTINOUS
Strategy Obey Find fault or
prevention
ANTICIPATE
or IMPROVE
Orientation Drug product Process OUTCOMES
Pharmaceutical Care
(Uniqueness)

 concerned with the prevention as well as the treatment of disease.
 “ It is more difficult to convince a person what he must do to
stay well than it is to convince an individual what he must do to
get well once he is sick………….”
 When a person is ill, he will generally seek help. When he is
well, he will not, as a rule, seek help to remain well, yet he must
take positive steps to maintain good health.
 He cannot take these steps unless he is aware of them. Even
then, he may not take action unless he is educated as to why
he must do so and encourage to take action.
 Because of his accessibility, professional knowledge and
training, the pharmacist is in a premier position to play an
important role in maintaining the health of his community by
serving as a health educator.
Health Care

 Patients on medications experience a lot of “drug
misadventures” – adverse effects, side effects, drug
interactions, errors in the use of medication and non–
compliance.
 All these call for the pharmacist’s intervention, for her to
do patient counseling – disseminate the proper
information as to what the patient should and should not
do while on medication.
 This is to MINIMIZE WASTE and MAXIMIZE BENEFITS
of medical treatments.
 Pharmacist must now get involved in Pharmaceutical
care for the following reasons:
 Improve Patient’s Quality of Life Years
 High Cost of Health Care today
Health Care
(Pharmacist Roles)

1. Reduce drug–related morbidity and its subsequent cost to
individual and society.
2. Improve patient’s Quality of Life (QOL)
3. Reassures that a medication is safe and effective.
4. Patient get additional explanation about their illness and
medication that they did not receive from their physicians
because they were too rushed, too upset or too
embarrassed to ask.
5. Assist patients on self–care (the pharmacist is always the
first person that a patient will turn to in order to discuss a
variety of problems).
6. Assist patients in non-medication related problem.
Benefits of Pharmaceutical Care and
Patient Counselling on Drug use
(Pharmacist Roles)

OLD PARADIGM
 Emphasis on acute patient
care
 Emphasis on treating illness
 Responsible for individual
patients
 All providers are essentially
similar
 Success achieved by
increasing market share of
inpatient admissions
 Goal is to fill beds
 Hospitals, physicians, and
health plans are separate
NEW PARADIGM
 Emphasis on the continuum of
care
 Emphasis on maintaining and
promoting wellness
 Accountable for the health of
define populations
 Differentiation based on ability
to add value
 Success achieved by
increasing the number of
covered lives and keeping
people well
 Goal is to provide care at the
most appropriate level
 Integrated health delivery
system
Health Care
(Transformation)

1. The role of the pharmacist has evolved from a product–
oriented to a patient–oriented professional.
2. This role modification has been extremely healthy for both
patient and pharmacist.
3. Pharmacists should view themselves as dispensers of
therapy and drug effect interpretations as well as drug
themselves.
4. In the future, pharmacy services must be evaluated on
patient outcome rather than the number of prescriptions
dispensed
5. And pharmacy must evolved toward interpretation and
patient consultation, related to the use of medication
technologies.
Health Care
(Pharmacist New Role)

 Modern training in pharmacy has taken a primary consideration of changing
roles of the professions in the modern time, hence changing the approach in
training process.
 Doctor of Pharmacy (PharmD) for American system
 5-year program
 Colleges may require
 3years of prepharmacy education
 Pharmacy College Admission Test (PCAT)
 On-site interview
 Acceptance is extremely competitive
 Many students start as pharmacy techs
 Pharmacy coursework is challenging:
 Basic science courses from several fields
 Practice and internships throughout program
 Final year spent in practice settings
 Hospitals, clinics, and community pharmacies
 Home health care and nursing homes
Education and Licensing
for Pharmacist

for Pharmacist
(Oath Message of a Pharmacist)

EvolutionofthePharmacist’sRole
TheRoleofthePharmacist
EducationandLicensing
The Pharmacy Technician
(The Ten Point-Credit Pharmacist Assistant)

Evolution of the
Pharmacy Technician’s Role
 Apprentices were forerunners of today’s pharmacy
techs.
 Need for techs increased with expanded pharmacist
role.
 Many techs originally trained as military medics in an
informal manner (job-on-training basis).
 Role evolved from clerk/cashier to pharmacist’s
assistant. – expected to articulate the issues of
pharmaceutical care service.
 Global view is that rather than working independently,
the pharmacy technicians / techs works under the
direction of the supervising pharmacist.

Evolution of the
(continued)
 Pharmacy techs in a community pharmacy typically
ideally
 Enter prescription information into database
 Helps the pharmacist fill, label, and record
prescriptions
 Operates cash register
 Stocks and inventories medications
 Maintains patient records
 Bills insurance claims where applicable
 Pharmacy technicians must play a valuable role in
reducing the risk of medication errors through the
provision of technical advice towards pharmaceutical
care provision.

Evolution of the
(continued)
 Pharmacy tech in a hospital setting does many of the same tasks
as a tech in a community pharmacy and may also
 Operate robotic dispensing machinery
 Carry out compounding procedures when required and
available (Prepare sterile and sometimes hazardous products
etc)
 Pharmacy tech in a long-term care or nursing home may
 Log and refill prescriptions via computer
 Maintain drug boxes for emergencies
 Package, label, and deliver medications
 Maintain records and patient charts
 Conduct inspections of drug inventories
 Repackage drugs in unit doses

 Pharmacy Technician - an individual working in a pharmacy who, under
the supervision of a licensed pharmacist, assists in activities not
requiring the professional judgment of a pharmacist; also called the
pharmacy tech or tech

 Discussion
 How do the duties of the pharmacy technician differ
depending on the setting? How are they the same?

 HPCZ regulates:
 The activities of pharmacy techs
 The ratio of pharmacy techs to pharmacists within a
pharmacy
 Formal technician training programs have been
developed:
 In the beginning, on-the-job training was sufficient,
 Original training was hospital and community-based.
 All the national pharmaceutical training programs
are now developed and ratified by Higher Education
Authority and HPCZ
for Pharmacy Technicians

 For the national requirements, pharmacy techs must be certified to
practice:
 All pharmacies in the country require techs to be certified upon
hire or employed as pharmacists assistants.
 Some pharmacy employers encourage techs to become
certified by
 Paying for the individual registration fees
 Any other charges for their formal recognition
 Some Specialized health areas of practice require additional
training qualifications:
 Sterile and nonsterile compounding
 Nuclear pharmacy
 HPCZ require ongoing education or CPD for the pharmaceutical
practitioners to keep knowledge and skills updated
for Pharmacy Technicians
(continued)

 In the British Isles, trade in drugs
and spices was monopolized by
the Guild of Grocers, which had
jurisdiction over the apothecaries.
 Upon persuasion by the
philosopher-politician, Francis
Bacon, King James I granted a
charter in 1617 which formed a
separate company known as the
"Master, Wardens and Society of
the Art and Mystery of the
Apothecaries of the City of
London" over vigorous protests
of the grocers. This was the first
organization of pharmacists in the
Anglo-Saxon world.
THE SOCIETY OF
APOTHECARIES OF LONDON
Both Global and National View of
Modern Pharmacy (Europe)

 Today modern pharmacist deals with complex pharmaceutical
remedies far different from the elixirs, spirits, and powders
described in the Pharmacopeia of London (1618) and the
Pharmacopeia of Paris (1639).
 In the U.S. today, major medicines, those regarded as having
the greatest therapeutic value, are selected for inclusion in
the Pharmacopeia of the United States, first published in
1820, by a Committee on Revision on which all colleges of
medicine and pharmacy, all state medical and pharmaceutical
associations, and the U.S. surgeon general are represented.
Modern Global View of Pharmacy (Continued)

 Pharmacy, science of compounding and dispensing medication; also,
an establishment used for such purposes.
 Modern pharmaceutical practice includes the dispensing, identification,
selection, and analysis of DRUGS.
 Pharmacy began to develop as a profession separate from medicine in
the 18th cent., and in 1821 the first U.S. school of pharmacy was
established in Philadelphia.
 Pharmacy, practice of compounding and dispensing drugs; also the
place where such medicinal products are prepared.
 Pharmacy is an area of materia medica, that branch of medical science
concerning the sources, nature, properties, and preparation of drugs.

 Pharmacists share with the chemical and medical profession
responsibility for discovering new drugs and synthesizing organic
compounds of therapeutic value.
 In addition, the community pharmacist, or druggist, is increasingly
called upon to give advice in matters of health and hygiene.
 Pharmacology (fär´me-kòl¹e-jê), study of the changes produced in
living animals by DRUGS, chemical substances used to treat and
diagnose disease.
 It is closely related to other scientific disciplines, particularly
BIOCHEMISTRY and PHYSIOLOGY.
 Areas of pharmacologic research include mechanisms of drug
action, the use of drugs in treating disease, and drug-induced side
effects.

 Modern Professional Societies Act:
 Replaced Guild of Grocers [self-governed] in the UK
 Opened schools of pharmacy or encouraged
institutions to do so
 Modified the rules by which one was allowed to
practice pharmacy to prolonged apprenticeship (4-8
yrs)
 Obligatory examinations were given [Germany] –
1725 (18th century)
 West European Pharmacy
 Matured during the 17th century
 Put up organized activities and a periodical literature
 Standardized proliferating formulas of varying
compositions, which lead to creation of official
pharmacopoeia
 Dispensatorium Pharmacopolarum –official book
of drug standards in Cologne, Florence, Rome
 Ricettario Florentino – 1st Official Pharmacopeia of
European world
 Lititz Pharmacopeia – hospital formulary used
during revolutionary war in Pennsylvania
Apothecary
Adventur
Modern Global View of Pharmacy Practice
(Continued)

 USP:
 1820 in Philadephia by USP Convention
 Goal : to select official drugs and set up standards for identity,
purity and assay methods
 Members: Physicians (1820), Pharmacists (1850)
 Charles Rice – 1st pharmacist to be the chairman; USP VI
 French Pharmacist
 Bernard Courtois – iodine in algae, bromine (sea water)
 Joseph Caventou & Pierre Pelletier– quinine, caffeine
 Pierre Robiquet – codeine
 Henri Moissan – flourine by electrolytic methods
 German Pharmacists
 Frederick Serturner – morphine
 Johannes Buchner – salicin from willow bark, nicotine from
tobacco; aspirin and nicotinic acid production
 Rudolf Brandes & Philipp Geiger– hyoscyamine and atropine
(Continued)

 Modern Age (18th century)
 William Withering – digitalis, digoxin
 Karl Scheele – arsenic, chlorine, glycerin, organic acids
 Edward Jenner – eradication of small pox
 20th Century Spharmaceutical cientists
 Paul Ehrlich – chemoTx, Arsphenamine – syphilis
 Frederick Banting & Charles Best – insulin
 Gerhardt Domagk – Prontosil (Sulfa drug), for hemolytic
streptococci
 Alexander Fleming – penicillin
 Selman Waksman – streptomycin
 Jonas Salk – injectable vaccine for polio
 Albert Sabin – oral vaccine for polio
(Continued)

 The rapid change from hand methods
to machine methods of production that
characterized the Industrial Revolution
found a ready application in pharmacy,
especially under the impact of the
scientific developments of the
nineteenth century.
 Phytochemistry and synthetic chemistry
created new derivatives of old drugs
and new chemical entities of medicinal
value that strained the capacity of the
individual pharmacy.
 Large scale drug manufacturing had its
strong hold on society with the advent
of machines and patents.
matters of health and hygiene.
Modern Global View of Industrial Revolution

The Declining Art of the Apothecary
 Industrialization had an impact on every aspect of the activity of
the pharmacist.
 First, it led to the creation of new drugs, drugs that the
individual pharmacist’s own resources could not produce.
 Second, many drugs that the individual pharmacist was able to
produce could be manufactured more economically, and in
superior quality, by industry.
 Third, industry assumed responsibility traditionally vested in the
pharmacist for the quality of the medication.
 The plethora of proprietary medicines, widely and often
blatantly advertised, deprived the pharmacist of a market for
private specialties; it forced the pharmacist to become a vendor
of questionable merchandise; it opened the way to much
broader competition from merchants, grocers and pitchmen
than the pharmacist had previously encountered.

 The nineteenth century did not see the end of the art of
compounding, but the art did give way, however
grudgingly, to new technology.
 It has been estimated that a "broad knowledge of
compounding" was still essential for 80 percent of the
prescriptions dispensed in the 1920s.
 Although pharmacists increasingly relied on chemicals
purchased from the manufacturer to make up
prescriptions, there still remained much to be done
secundum Artem.
 They spread their own plasters, prepared pills (of aloes
and myrrh or quinine and opium, for example), prepared
powders of all kinds, and made up confections,
conserves, medicated waters, and perfumes.
The Community Pharmacy Practice

 They put up tinctures (of laudanum, paregoric, and
colchicum) in five gallon demijohns.
 And they frequently combined into a single dosage from
several medicines, which normally today would be
written and dispensed as separate prescriptions.
 Further more, they were often called upon to provide
first aid and medicines for such common ailments as
burns, frostbite, colic, flesh wounds, poisoning,
constipation, and diarrhea.
 In addition to maintaining a prescription laboratory,
pharmacists usually carried the disliked but necessary
patent and proprietary remedies along with herbs and
locally popular nostrums of their own compounding.
The Community Pharmacy Practice
(Continued)

 The most notable change in pharmacy in modern times has been the
virtual disappearance of the preparation and compounding of
medicines.
 Whereas in the 1920s, 80 percent of the prescriptions filled in
American pharmacies required a knowledge of compounding, by the
1940s the number of prescriptions requiring compounding had
declined to 26 percent.
 As far back as 1971, only 1 percent, or less, of all prescriptions
combined two or more active ingredients.
 Moreover, the pharmacist’s commitment to maintaining the quality of
the drugs dispensed has been reduced to knowing such facts as the
length of shelf life and the effect of exposure to light and judging the
reliability and reputations of the manufacture.
 All this meant that the pharmacist’s education and activities had to
undergo change.
 At the same time that the scientific education of pharmacists was
steadily becoming more demanding, their role in the provision of
health care was becoming more and more circumscribed.

The Twentieth Century Pharmacist

The Twentieth Century Pharmacist (continued)
 Moreover, they were increasingly subject to government and institutional
requirements that diminished the importance of the patient-pharmacist relation.
 And, especially in the United States and Great Britain, competition from
prescription departments in chain and department stores tended to demean both
the role and the dignity of the pharmacist as a health-care professional.
 The urban blight that attacked the neighborhoods was inevitably a threat to the
friendly neighborhood pharmacist.
 The reaction to these conditions was apparent in the drop in the production of
graduates of American schools of pharmacy who were planning to go into the
field of community pharmacy. In 1947, about 90 percent of graduates planned to
go into some aspect of community pharmacy; in 1973, that figure had dropped
to 76.6 percent; in 1988 it stood at 57.1 percent.

COMPOUNDING TODAY
 Custom Compounding pharmacies are on the rise.
 Physicians, medical institutions and patients are realizing more then
ever the importance of tailoring an individuals medications to
specifically meet there needs.
 A majority of the Pharmacists that are going back to compounding
are doing so for the love of the science and interest in the patients
well being. Being able to be in the role of a problem solver opens the
doors to creativity and genius that the medical industry has been
eagerly adopting for the last decade.
National Pharmacy
Ridgeway Pharmacy in Lusaka The Location of Zambia in Africa

 Colonization era of early 18th century, driving force to globalization of
Pharmacy Research, Training, Development and Professional
Practice to Africa:
 The colonization movement was as result of Western European
Industrial Era movement leading to various segmentation of Africa
into present territorial divisions.
 The result of this segmentation of the African continent was the
creation of African states, including Zambia.
 Zambia is one of the many former British colonies with a blend of
British pharmaceutical services delivery structures.

 In 1941, there was a legally recognized legal framework controls of
pharmacy services in Zambia through the Act of Pharmacy, Poisons &
Medicines to control pharmaceutical commodities and pharmacy
practice,
 Regulation of pharmacy practice was separated from Pharmacy,
Poisons & Medicines Act to Medical and Allied Professions Act of
1965, Cap 544 passed as an act of Zambian Parliament
 It was amended in 1977 and 1996 with the relocation of Act chapter
from Cap 544 to Cap. 297 of the Zambian laws.
 In August 2004, National & Health Services Act of 1995 was repealed
Coat of Arms
Modern National View of Pharmacy
Map of ZambiaMap of Zambia

Reference:
1. Pharmacy What It is and How it Works - Kelly WN, 2002 by RS Press LLC
2. Pharmaceutical Dosage Calculations: A Ratio-Proportional Approach, 2nd
Edition, by Gloria D. Pickar, 2007

Study Questions
 Define the following terms:
 [Pharmacy, Apothecary, Pharmaceutical compounding, Ayurvedic Pharmacy, Antiquity Pharmacy,
Middle Ages Pharmacy, Modern Pharmacy, Retail pharmacy, Alchemy, Remedy, Drug, Medicine,
Cure, Care, Trephining, Millennium, Symptoms, Renaissance, Disease, Illness, Microbes, Civilization,
Herbal remedies, Usage, Side effects, Quantities, Dosages, Storage, Pharmacopeia, Pharmacognosy,
Pharmacology, Pharmaceutics, Pharmacokinetics, Therapeutics, Pathophysiology, Evolution, Patient
counseling, Nutrition, Antibiotics, Chemotherapy, Pain management, Semiotician, Physician,
Pharmacist, Diagnosis, Mutual respect, Honesty/ Authenticity, Open Communication, Cooperation,
Collaboration, Empathy, Sensitivity, Promotion, Competence, Assurance, Confidence, etc]
 Respond to the following questions:
 State and explain the main three historical categories of chronological order of development
 In line with historical background of originality of pharmacy, How was disease thought of in
early civilization and how was it treated.
 What are some of the contributions to the practice of pharmacy from around the world regions
such as Asia, Greece, Roman Empire, Arabia, Europe.
 Why has there been a trend toward fewer independent pharmacies in some world
pharmaceutical established operations as compared to those of national institutes
 Historically, how has the role of the pharmacist evolved overtime to its present time
nature
 Write on the ways the modern-day pharmacist has impact ed patients’ health and
safety

 Group work discussional questions:
 With references to the reasons, physicochemical properties and basic components of available
pharmaceutical dosage forms on the national health market, describe the main advantages
and disadvantages of such marketable dosage form systems when used for respective
pharmaceutical care provision
 Write on the ‘Ten Star Pharmacist’ concept
 Write on the vital components of the therapeutic relationship to the professional
Characteristics of caring behavior
 Anticipate on the philosophical views of pharmaceutical care concept for peoples’ health care
service provision

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