Chp 1 Pharmacy PP

In the early days of medicine sickness was thought to be

a curse

in earlier times Medicinal preparations was combined with

prayers, chants, and rituals

early Preparations were made from

plants, animals, and minerals

_____ more than 5,000 years old lists medicinal preparations

Provided the basis for the

Mesopotamian clay tablets
modern-day formulary

Traditional Eastern Medicine

Relies on plant products and healing energy approaches

Some plants are in use in Western culture today (such as ginseng mostly seen as OTC products)

Traditional Western Medicine

Less religion-based, more dependent upon observation, theories and hypotheses, and scientific experimentation

Hippocrates,

“Father of Modern Medicine”
Greek physician who thought that disease had a physical explanation

“Pharmacy” term derived from the Greek word ____, meaning ____ or ____

pharmakon
drug or remedy

Galen

“Father of Modern Pharmacy”
Greek physician who studied the effect of herbs on the body

Galenical pharmacy

--the practice of creating medicinal extracts from plants

Early Arabic civilizations: first to develop __________, and they identified pharmacists as ___________

lists of drugs with dosage formulations
qualified healthcare professionals

In Egypt and Jerusalem, late 700s : Islamic governments established hospitals

served rich and poor, men and women
had separate wings for different kinds of surgery and care
example--the great Al-Mansur Hospital in Cairo

Jewish physician Moses ben Maimon (1135–1204)

wrote about common illnesses; focused on moderation, healthy living, and illness prevention practices; emphasized a sense of humble servitude toward the poor and rich.

In Europe: Christian monasteries became _________; monks grew ________ and provided __________________

storehouses of knowledge
medicinal herbs
free medicines and healthcare to local people.

11th and 12th century Europe:

apothecaries and the first professional guilds developed

Renaissance: alchemy _______, scientific thinking on the decline.

on the rise
the decline

Renaissance apothecary guilds:

oversaw apprentice training programs and set standards for the profession; considered the precursors of modern professional pharmacy associations and state boards of pharmacies

17th century Scientific Revolution:

many new scientific terms developed with Greek and Latin roots

Native Americans practiced herbal medicine, using

local plants like purple coneflower; shared with colonists

Pharmacists start to become owners

of apothecaries

United States Pharmacopeia (USP):

a formulary of drug standards developed in 1820.

First US pharmacy school:

Philadelphia College of Pharmacy opened in 1822

American Pharmacists Association (APhA):

formed in 1852 to address adulteration of imported drugs and develop professional practice standards

19th century:

pharmacists gained recognition as healthcare providers; physicians still operated most apothecaries

Pharmacy training programs focused on ____

pharmacognosy

pharmacognosy

--study of the medicinal functions of natural products and chemicals of animal, plant, and mineral origins

Late 1800s:

large-scale pharmaceutical manufacturing began

Pharmacists:

sell some mass-manufactured products, such as aspirin

US Pharmacies: commonly featured

soda fountains, which sold compounded tonics
Coca-Cola, Pepsi-Cola were developed by pharmacists.

First half of 1900s:

pharmacists still compounded more than 80% of prescriptions

Pharmacists-in-training: apprentices rather than
Pharmacy assistants:

studying at universities, though formal training existed.
also only received on-the-job training.

World War II 1939-1945:

increased need for care for the wounded increased the need for pharmacists and trained pharmacy assistants.

US Department of Defense started

formal training programs for medics and pharmacy technicians

American Society of Hospital Pharmacists (ASHP) formed in

1942

1950s, major pharmaceutical industry emerged

Many new drugs and dosage forms developed
Drugs were less expensive and more consistent quality than what individual pharmacists compounded

Pharmacists were:

merchants of factory-made products

Scientific advances:

pharmacy schools add pharmacology and pharmaceutics to curriculum

1960s Pharmacy students:

5-year B.S. degree; practiced on campus in simulated pharmacies; worked as interns in pharmacies

Pharmacists 20th century jobs and jobs they can't do:

not fully utilized, routine tasks, dispensed medications

Until 1969, not considered ethical for pharmacist to label medication vials or counsel patients

In 1968: ASHP developed national guidelines for

the training of “pharmacy aides” in hospitals, began their first hospital training program

Trained technicians: generally employed in

hospitals

I975: Millis Commission report came out

“Pharmacists for the Future”
Defined pharmacy as a knowledge-based profession
Emphasized the clinical role of pharmacists

The Millis Commission led to new

emphasis on clinical or patient-oriented pharmacy.

In the new clinical role, the pharmacist

advises patients and healthcare providers about the appropriateness and effects of specific drugs.

Earliest implementers of pharmacists as clinical care providers:

Health Maintenance Organizations (HMOs) and teaching hospitals

HMO pharmacists were encouraged to

work in teams with physicians, consulting on drug therapy for pain and chronic diseases management

To free up hospital pharmacists for clinical work:

formalized in-service training programs for pharmacy technicians developed

In 1970s, new hospital training programs for technicians:

learned to prepare IV solutions and other pharmacy tasks

Community pharmacy technicians: formal training programs developed.

In 1979, the Massachusetts College of Pharmacy began a pharmacy technician training program.

In 1981, Michigan became the first state to use an exam to test the qualifications of pharmacy technicians.

1990: pharmaceutical counseling era began

Dr. Charles Hepler and Dr. Linda Strand build upon and extend Millis Commission recommendations

Expanded pharmacist’s role to include ensuring positive outcomes for drug therapy

_______ degree program developed

Six-year PharmD

Pharmacy schools: added ________________________ to curricula

pharmacokinetics, biochemistry, therapeutics, and pathophysiology

_____ replace typewriters in pharmacy practice

Computers

_____________ developed and improved, increasing _____ and ______

Pharmacy software
productivity and safety

Drug insurance programs and generic medications ________
Previously, most drugs were ____ ____and paid for with ____.

expanded
brand name
cash

Need for computer-educated, trained pharmacy technicians grew
New technician tasks included

computerized entry of prescription orders and insurance billing information.

Pharmacy technician programs: developed in schools

of pharmacy, community colleges, and vocational schools

More states require a

pharmacy technician exam

In 1989, the __________________ formed

Pharmacy Technician Educators Council (PTEC)

Which Greek physician is considered the “Father of Modern Pharmacy?”

Galen

What was the major change in pharmacy between the beginning and the 2nd half of the 20th century?

Early in the 1900s, pharmacists mainly compounded medications. Later in the century, they became merchants of factory-made products.

What was the major finding of the 1975 Millis Commission report, which launched the clinical era of pharmacy?

It defined pharmacy as a knowledge-based profession.

More complexity in drug treatments:

potential for harmful side effects and drug interactions increased.

Recognition pharmacists had only had ________ ______ about patient __________, and ____ _________: more complete information needed.

partial information
allergies, drugs and supplements

Providers had _________ information on drug effects

insufficient

Pharmacist identified as ___________________ and ____ for patient medications

logical professional case manager
counselor

Electronic health records (EHR) allowed

sharing of health information between healthcare providers.

Patients also needed better and more information:

insufficient knowledge causing safety issues, waste.

Pharmacy MTM tasks help patients choose, use, and monitor their drugs to achieve best health outcomes:

Identifying potential drug-drug interactions
Identifying potential adverse reactions
Counseling patients on adherence to therapy
Identifying which drugs are covered by insurance

MTM now____ ___________ of pharmacist training

core component

Some insurance companies provide ______ to pharmacists for MTM.

reimbursement

Collaborative Practice Agreement (CPA):

a legal agreement outlining pharmacist role and fee in managing drug treatment for a prescriber’s patients

ASHP expanded its scope for reform and assessment ____ _________ _______ _____ -- still includes the PPMI.

into Practice Advancement Initiative (PAI)

Overall goal of PPMI:

empower the pharmacy team with better tools to direct and monitor patient outcomes

No time for pharmacists to do MTM if

bogged down in the daily business of the pharmacy and dispensing

PPMI utilizes _________, ________ _____ along with automation for _____________________________________

educated, certified technicians
improved data collection, drug dispensing, safety checks

Advanced Technician Practice Model features new roles for technicians:

Technician supervisors
Tech Check Tech roles
Informatics or business administration specialists
MTM support roles

Technicians may also get specialized training in

sterile compounding, chemotherapy, and other topics

Community Pharmacies List

Independent Pharmacies
Chain Pharmacies
Institutional Community Pharmacies
HMOs
Mail-Order or Warehouse Production Pharmacies

Institutional Pharmacies List

Hospital Pharmacies
Skilled Care Facilities
Home Healthcare Pharmacies
Specialty Compounding Pharmacies

Community Pharmacies are also called

retail pharmacies

Community Pharmacies Employ

majority of pharmacists and pharmacy technicians

Jobs in community pharmacy involve

more direct patient contact than jobs in other sectors of the industry.

Community Pharmacies Sell

prescription drugs, supplements, and medical supplies

Community Pharmacies Offer

delivery to long-term care facilities

Independent Pharmacies

A pharmacist (or small group of pharmacists) owns the pharmacy
Decisions made at store level
More attention and time spent on customer service.
Most compounding done; some specialize in compounding

Chain Pharmacies

Corporations own and operate
Decisions made at the corporate level.
Dispense large volumes
Technicians and automation heavily used

Institutional Community Pharmacies

Hospitals, universities have retail pharmacies—some open to public.
Decisions are made by institution, not at store level.

HMO Pharmacies

HMOs have pharmacies in their clinics that serve their members.
No insurance paperwork
Prescribers, nurses, pharmacists all have access to patient records.
Most drugs dispensed are from a formulary of approved drugs, which helps control costs.
Kaiser is an HMO with a pharmacy.

Mail-Order Pharmacies

A centralized operation, mails large volumes of prescriptions
Patients have little to no direct contact with the pharmacy.
Examples include Medco and Express Scripts.

Hospital pharmacies

Approximately 25% of technicians work in hospitals
Technicians fill medication orders, unit-dose medications, floor stock, crash carts
Specially trained pharmacy technicians work in a “cleanroom” to compound IVs

Home healthcare systems

Patient care services are provided at patient’s home.
Hospice care is provided for patients who are terminally ill.
Specialty hospice pharmacies and institutional pharmacies serve this population

Long-Term Care Facilities (SCF)

Assisted Living Facility (ALF) or nursing home: medical and residential care provided to older or disabled adults
Skilled-Nursing Facility (SNF): around-the-clock nursing care provided, including the administration of IV solutions.
May have an on-site pharmacy or be served by an outside pharmacy

Specialty Compounding Pharmacies

Infusion pharmacy: specializes in IV solutions, parenteral nutrition, injections– some do sterile hazardous compounding, chemotherapy drugs
Nuclear pharmacies: prepares medications using radioactive substances
Staffed by pharmacists and technicians with special training

A community pharmacy is also called a retail pharmacy.

True

Some independent pharmacies specialize in compounding.

True

Decisions are made at the store level in a chain pharmacy.

False

Gather patient information on

medical, medication, and allergy histories (with technician)

Review medication doses;

screen for duplicate therapies, dangerous allergies, and drug interactions

Counsel patients on best

drug therapies