Comprehensive Study Notes on the Scope, History, and Profession of Pharmacy

Scope and Definitions of Pharmacy

• Definition of Pharmacy: Pharmacy is defined as the profession concerned with the art and science of preparing suitable and convenient materials for distribution and use in the treatment and prevention of diseases. These materials are derived from both natural and synthetic sources.
• Breadth of Knowledge: The field embraces comprehensive knowledge regarding:
  • Identification and selection of drugs.
  • Pharmacologic action.
  • Preservation and combination of substances.
  • Analysis and standardization of drugs and medicines.
• Distribution and Safety: It includes the proper and safe distribution and use of medications. This applies to medicines dispensed via prescription from licensed professionals (Physicians, Dentists, or Veterinarians) and instances where drugs are legally sold directly to the consumer.
• Etymology: The word "pharmacy" is derived from the Greek word "pharmakon," which means medicine or drug.
• The Pharmacist: A pharmacist is a person of drugs or an expert on drugs, occupying a unique position that embraces complete drug expertise.
• Traditional vs. Modern Roles:
  • Traditional Roles: Compounding and dispensing medications.
  • Modern Services: Clinical services, reviewing medications for safety and efficacy, and providing drug information.
  • Goal: Pharmacists serve as the primary health professionals who optimize medication use to provide patients with positive health outcomes.

The Healthcare Linkage

• Prescribing Professionals: The professionals primarily interested in the therapeutic value, toxicology, and the effect of drugs on patients include:
  • Physicians.
  • Dentists.
  • Veterinarians.
• Professional Link: Pharmacy is the specific health profession that links the health sciences with the chemical sciences. It is charged with ensuring the safe and effective use of pharmaceutical drugs.

Symbols of the Medical and Allied Medical Professions

• Course Symbols:
  • Optometry: Represented by a symbol labeled "D."
  • Medicine: Represented by a symbol labeled "P."
  • Dentistry: Represented by a symbol labeled "T."
  • Physical Therapy: Represented by a specialized symbol.
  • Radiologic Technology: Represented by a specialized symbol.
  • Nursing: Represented by a specialized symbol.
  • Pharmacy: Represented by the abbreviation "PHA."
  • Veterinary Medicine: Represented by the number "$3$."
  • Medical Technology: Represented by a specialized symbol.

The Bowl of Hygieia

• Depiction: The symbol depicts the Greek goddess Hygieia holding a patera (medicine bowl) with a snake tamely coiling around the bowl.
• Symbolic Interpretations:
  • Harmony: Viewed by some as a symbol of living in harmony with Mother Earth.
  • The Patient: The snake may symbolize the patient, reflecting their choice of whether or not to partake of the medicine to help themselves.
  • Wisdom and Healing: Linked to ancient beliefs that snakes possess wisdom and healing powers.

History of Pharmacy: A Chronology for Pharmacists

• Early Records and Figures:

  • Sumerian: The earliest known formulary in recorded history.
  • Eber Papyrus: An Egyptian manuscript ($1500\,B.C.$) containing a collection of $800$ prescriptions pertaining to pharmacy and therapy.
  • Babylon ($2000\,B.C.$): Earliest known record of the practice of apothecary; clay tablets recorded symptoms of illness, prescriptions, and compounding directions.
  • Hippocrates: Famous Greek physician.
  • Theophrastus: Known as the Father of Botany; known for preparing medicines and leaving prescriptions for family members.
  • Dioscorides: Wrote an important book on materia medica, which became a standard encyclopedia of drugs for centuries.
  • Galen ($130\text{--}200\,AD$): A Roman physician who experimented with compounded drugs. A class of pharmaceuticals called "Galenicals" is named after him. He was the foremost teacher of preparing and dispensing medicines.
  • Cosmas and Damian ($350\,AD$): Patron saints of pharmacy and medicine.
  • Terra Sigillata (Sealed Earth): The first therapeutic agent to bear a trademark. It was a clay tablet from the island of Lemnos (before $500\,B.C.$). It was refined, formed into pastilles, impressed with an official seal by priestesses, and sun-dried.

• $12^{th}$ and $13^{th}$ Century:

  • $1178$: Pharmacists mentioned in French records.
  • $1179$: Guild of Pepperers established in London.
  • $1225$: Apothecary shop established at Cologne.
  • Mid-$13^{th}$ Century: Frederick II codified the separation of the practice of pharmacy from medicine.

• $15^{th}$ to $17^{th}$ Century:

  • $1499$: Guild Pharmacopoeia published in Florence, Italy.
  • $1546$: Dispensatorium of Valerus Cordus was adopted as the first pharmacopoeia by the government of Nuremberg, Germany.
  • $1589$: Galileo demonstrated the law of falling bodies.
  • $1618$: First London Pharmacopoeia was published.
  • $1665$: Sir Isaac Newton discovered the law of gravitation.
  • $1680$: Leewenhoeck discovered yeast plants.

• $18^{th}$ Century:

  • $1731$: Philadelphia Hospital founded.
  • $1736$: First legal act related to pharmacy in America enacted in Virginia.
  • $1765$: John Morgan becomes an influential advocate for prescriptions in the United States.
  • $1773$: Scheele isolates oxygen; in $1774$, he discovered chlorine.
  • $1776$: Christopher Marshall, an American pharmacist, cares for wounded soldiers.
  • $1783$: Pharmacist Pillatre de Roxier makes the first human flight in a balloon.
  • $1784$: Fowler introduces Fowler’s solution.
  • $1787$: Ergot introduced in obstetrics by Paullitzky.
  • $1798$: Jenner publishes work on vaccination.

• $19^{th}$ Century:

  • $1805$: Serturner reports the isolation of morphine from opium.
  • $1811$: Iodine discovered by Courtois, a French pharmacist.
  • $1818$: Caventou and Pelletier isolate strychnine.
  • $1820$: First edition of the United States Pharmacopoeia published. Pelletier and Caventou isolate quinine and other alkaloids.
  • $1821$: Philadelphia College of Pharmacy founded.
  • $1825$: American Journal of Pharmacy published.
  • $1826$: Bromine discovered by pharmacist Balard. Ethyl alcohol synthesized by Hennel.
  • $1827$: Wohler synthesizes urea.
  • $1828$: New York College of Pharmacy founded.
  • $1831$: Chloroform prepared independently by Liebig and Soubeiran.
  • $1832$: Codeine isolated by French pharmacist Pierre Robiquet.
  • $1833$: Carbolic acid and Aniline prepared by German pharmacist.
  • $1842$: Crawford Long performs an operation using ether as anesthesia.
  • $1843$: Oliver Wendell Holmes points out that puerperal fever is contagious.
  • $1848$: First drug import law enacted.
  • $1852$: American Pharmaceutical Association (APhA) founded.
  • $1883$: First National Retail Druggist Association founded.
  • $1888$: First National Formulary issued by the APhA.
  • $1889$: Serum therapy introduced by Von Behring and Kitasato.
  • $1893$: Aspirin discovered by A. Eichengrun and Felix Hoffman.
  • $1894$: Roentgen discovered X-rays.
  • $1898$: Radium discovered by the Curies. National Association of Retail Druggists (NARD) founded.
  • $1899$: Walter Reed proves mosquitoes carry yellow fever.

• $20^{th}$ Century:

  • $1900$: American Association of Colleges of Pharmacy founded.
  • $1906$: Passage of the Pure Food and Drug Act.
  • $1912$: First Assembly of the International Pharmaceutical Federation.
  • $1922$: Banting and Best isolate insulin.
  • $1928$: Sir Alexander Fleming discovers penicillin.
  • $1935$: Prontosil (first sulfa drug) introduced by G. Domagk.
  • $1940$: First clinical trials of penicillin by Florey and Chain.
  • $1941$: American Society of Hospital Pharmacists founded.
  • $1944$: Antibiotic activity of streptomycin announced.
  • $1949$: Cortisone and acetylcholine introduced for rheumatic arthritis.
  • $1951$: First International Pharmacopoeia published by the World Health Organization.
  • $1952$: Chlorpromazine introduced into psychiatry, opening the field of psychopharmacology.
  • $1955$: Salk poliomyelitis vaccine released for general use.
  • $1959$: Synthetic medications of natural penicillin introduced.
  • $1962$: Important amendments to the Federal Food and Drug Act.
  • $1973$: US Supreme Court decision regarding pharmacist ownership control of pharmacies.

Evolution of Pharmacy Practice

• Ancient Beliefs: Diseases were once thought to be caused by God's anger. Magicians or religious figures (albularyos) were involved in treatment.
• Early Pharmaceutical Forms: Adopted by early curanderos (quack doctors):
  1. Macerations in cold and hot water.
  2. Infusions or decoctions in oil of curative plant parts.
  3. Poultices and powders.
  4. Resinous plasters and salves with a waxy base.
  5. Inhalations, fumigations, and empyreumatic products.
• Middle Ages: Monasteries became centers of healing. Monks maintained herbal gardens. Following the collapse of trade, Arabs accepted the works of Galen and Dioscorides. They improved aesthetics via silvering of pills and the use of syrups.
• Renaissance: The development of the printing press aided information dissemination.
  • Paracelsus: Father of Toxicology. He advocated for drug preparation from crude plant and mineral substances and stated: "All things are poison and nothing is without poison."
• Transition to Modernity:
  • Scientific disciplines became professionalized in colleges and manufacturing after $1850$.
  • Industrial research led to analgesics, antipyretics, and sedatives (chloral hydrate).
  • The B.S. Pharmacy curriculum was extended to $5$ years to emphasize physical sciences.

Clinical Pharmacy and Patient Care

• Definition: Clinical pharmacy is a field where pharmacists provide patient care that optimizes medication therapy and promotes health and disease prevention.
• Key Responsibilities:
  • Assess patient health problems.
  • Determine if prescribed medications meet patient needs and goals.
  • Evaluate appropriateness and effectiveness of medications.
  • Recognize untreated health problems.
  • Follow patient progress and medication effects.
  • Consult with physicians and other healthcare providers to select the best therapy.
  • Advise patients on how to take medications.

Career Opportunities in Pharmacy

• Community and Consultant Pharmacy:
  • Approximately $6$ out of $10$ pharmacists practice in this setting.
  • Focus on the "wellness" movement and preventive medicine counseling.
  • Handle over $2$ billion inquiries annually from patrons.
• Hospitals and Institutions:
  • Includes nursing homes, extended care facilities, and HMOs.
  • Pharmacists serve as members of the healthcare team (with physicians and nurses) and are authoritative sources of drug information.
  • Responsible for drug distribution systems, allergy screening, and adverse effect monitoring.
  • Specialized areas: Nuclear pharmacy, poison information, IV therapy, pediatrics, oncology, and psychiatry.
  • Managed Care: Includes drug utilization review (DUR) to identify inappropriate prescribing.
• Pharmaceutical Industry:
  • Roles in marketing, research, product development, quality control, sales, and administration.
  • Medical Service Representatives: Call on healthcare professionals to explain product merits.
• Academic Pharmacy:
  • Working in colleges/schools of pharmacy in teaching, research, and public service.
  • Roles as "educator/practitioners" and consultants.
• Other Fields:
  • Public Health Service, Food and Drug Administration (FDA), and armed services.
  • Boards of Pharmacy: Legal boards that govern practice, employing executive officers and inspectors.

The Ten-Star Pharmacist

This framework summarizes the essential roles future pharmacists must possess:

1. Care-giver: Provides caring services (clinical, analytical, technological, or regulatory). Must be comfortable interacting with individuals and populations in an integrated system.
2. Decision-maker: Foundation of work is the appropriate, efficacious, and cost-effective use of resources. Requires ability to evaluate, synthesize, and decide on actions.
3. Communicator: Occupies the position between physician and patient. Requires confidence and skills in verbal, non-verbal, listening, and writing communication.
4. Leader: Assumes a leadership position in the community's welfare, especially where other providers are scarce. Involves compassion, empathy, and effective management.
5. Manager: Effectively manages resources (human, physical, fiscal) and information. Must also be comfortable participating as part of a team managed by others.
6. Life-long-learner: Commitment to continuous learning beginning in pharmacy school and lasting throughout the career. Must "learn how to learn."
7. Teacher: Responsibility to assist in training the next generation. Offers opportunities to fine-tune existing skills and gain new knowledge.
8. Entrepreneur: Capability to conduct market surveys, plan, direct, and manage a new pharmacy business.
9. Researcher: Conducts research to investigate new molecules and design new models of practice.
10. Agent for positive change: Leads in creating changes in practice to improve patient care, services, and interprofessional collaboration.