Pharmacy Practice for Technicians – Vocabulary (Chapter 1: Origins, Roles, MTM/CPAs, Licensure)
Healthcare Teams and the Role of Pharmacists and Technicians
Optimal patient care is a collaborative effort among healthcare professionals, not just a doctor–patient relationship. Teams include physicians, physician assistants, nurse practitioners, dentists and dental hygienists, nurses, and pharmacy personnel.
In the United States, pharmacists and pharmacy technicians work together to fill 4.5 billion prescriptions each year. This collaboration is central to efficiency and patient safety. The system is often described as the “backbone” of healthcare because technicians handle hands-on tasks (gathering information, filling prescriptions and medication orders) while pharmacists oversee, check, approve work, and provide drug information and education to providers and patients.
Pharmacists counsel on drugs and supplements, monitor therapies, and collaborate with other healthcare team members to achieve optimal outcomes. Certified, well-trained pharmacy technicians are essential for reliable drug-therapy counseling and monitoring because of the specialized knowledge required.
Pharmacy technicians perform a wide range of functions beyond simple prescription filling, contributing to patient care and helping to curb pharmacy-related costs and medication errors.
This chapter emphasizes understanding the origins of the profession, contemporary workplaces, and current education/licensing requirements. It also references ASHP/ACPE Accreditation Standards (Appendix B).
The material grounds the profession in both historical context and current practice, highlighting ethics, licensure, certification, and career pathways.
Key terms to understand for practice:
Medication Therapy Management (MTM): a set of services provided to optimize therapeutic outcomes for patients.
Collaborative Practice Agreements (CPAs): formal agreements that authorize pharmacists to perform patient care services under defined protocols with other providers.
ASHP Practice Advancement Initiative (PAI) and Pharmacy Practice Model Initiative (PPMI): initiatives aimed at advancing pharmacy practice and integrating pharmacists more fully into patient care models.
Licensure, Certification, Registration: different means by which professionals are authorized to practice; important distinctions for both pharmacists and technicians.
Pharmacy Technician licensure/certification/registration, and related academic/legal requirements for practice.
Career pathways for technicians with a Certified Pharmacy Technician (CPhT) credential.
The Origins of the Profession (Section 1.1)
Early foundations: sickness was often viewed as punishment or a spiritual condition (demons or evil spirits). Healers (priests, shamans, medicinal healers) identified spiritual causes and remedies. Herbal remedies were also used, blending prayers, chants, and rituals with medicinal knowledge. Indigenous healers across cultures retain extensive knowledge of medicinal plants. Contemporary drug companies seek this traditional knowledge for new medications.
Transition from art to science: pharmacy evolved from an art of compounding to a science of pharmacology, safety standards, quality assurance, and technology-based practice. The profession moved from backrooms of village apothecary shops to settings that serve specific patient populations.
Early medications and formularies: ancient tablets from Mesopotamia listed hundreds of medicinal preparations from plants, animals, and minerals. Early pharmacists compiled pharmacopeias or dispensatories; modern-day formularies serve as lists of drugs used by carriers and healthcare systems.
Eastern Medicine Roots: traditional Eastern medicine relied on botanicals (e.g., ginseng) and holistic approaches; foundational texts include the Ebers Papyrus (circa 1500 BCE) with more than 700 prescriptions. Sushruta, a Hindu surgeon (6th century BCE), authored the Sushruta Samhita, detailing hundreds of surgical procedures, over 1,000 medical conditions, and the medicinal use of more than 500 plants. Ayurveda emphasizes balance among natural forces in the body and includes herbs, exercise, diet, and lifestyle changes.
Greek Roots
Hippocrates (ca. 460–370 BCE) shifted illness to a physical basis, introduced systematic observation, and formulated a lexicon for medical terminology. He is regarded as the “Father of Modern Medicine” and authored the Hippocratic Oath (do no harm).
Dioscorides (40–90 CE) authored De Materia Medica (On Medical Matters), a foundational pharmaceutical text describing herbal remedies, side effects, dosages, and storage. It served as a standard for 15 centuries and influenced later pharmacological references (e.g., USP-NF).
Galen (130–216 CE) dissected animals to study anatomy and identified active ingredients in plants, giving rise to galenical pharmacy (preparing active ingredients into dosing forms such as juices, saps, and oils). Galen is often called the “Father of Pharmacy.”
Etymology: the word pharmacy derives from the ancient Greek pharmakon, meaning “drug or remedy.”
Arabic Medicine Roots: Arab and Persian traditions developed drug dosage formulations for tablets, syrups, and extracts and regulated state-run pharmacies. Cosmas and Damian (approx. 270–303 CE) are linked as patron saints of medicine/pharmacy in the Arab and Greek worlds. They provided care without charge, influencing the ethical framework of pharmacy in the Middle East and Europe.
The Middle Ages: ethics and institutions
Islamic empires established hospitals that cared for the sick; Al-Mansur Hospital in Cairo (12th–13th centuries) trained both men and women and practiced care for the rich and poor. This era emphasized service to the poor, a principle that persists in making medications affordable for those with limited means.
In Europe, Christian monasteries and abbeys housed and disseminated healing knowledge, grew medicinal gardens, and provided care and free medicines to the community; these monasteries are precursors to modern charitable healthcare institutions.
Jewish-Arab physicians influenced medical and pharmaceutical ethics in Northern Africa. Moses ben Maimon (Maimonides) stressed moderation, healthy living, and illness prevention; his ideas influenced pharmacy ethics and were reflected in graduation ceremonies in the U.S. in the early 20th century.
The Pharmacy Shop and early regulation
By the 11th–12th centuries in Western Europe, physicians often managed their own dispensaries. Sicily’s Edict of Salerno (1241) required medications to be produced by qualified chemists in registered shops, restricting physicians from running pharmacies. This catalyzed the development of separate pharmacy practice and regulated compounding.
Apothecaries and pharmacy shops often operated in back rooms similar to small chemistry labs. Leeching, purging, and herbal preparations were common, with herbs like Digitalis purpurea used for heart problems. Some minerals and bitter-tasting compounds were used to purge or balance humors.
The First Guilds
European trade guilds emerged, combining elements of trade unions and professional associations. Apprenticeships trained chemists and apothecaries. English apothecaries were part of the Grocers Guild for centuries; many pharmacies today are located in or near large grocery stores due to historical guild practices.
The Renaissance: alchemy and the apothecary guilds
The Renaissance (approximately 1350–1650 CE) saw pharmacists moving toward alchemy, blending chemistry, metallurgy, physics, and medicine with astrology and mysticism. The goal was to discover potent natural substances and elixirs, sometimes considered supernatural or “supervaluable.”
The term apothecary derives in part from the Dutch word droge waere, meaning “dry goods,” referring to dried herbs and spices; the word apothecary emerged from apotheca, a storage place for dry goods. Artwork such as Hieronymus Brunschwig’s A Pharmaceutical Lesson and David Teniers the Younger’s The Alchemist illustrate early pharmacy practice and the role of assistants in alchemical work.
The Scientific Revolution and Exploration
The 17th century emphasized scientific methods, with European scholars adopting Greek and Latin root words for new discoveries. Botanical knowledge grew as explorers returned with new plants and drugs. Early pharmacognosy involved studying the medicinal properties of natural products.
In North America during the early colonial period (early 1600s to late 1700s), herbal medicine was common, with Native Americans contributing knowledge about local plants. Examples include purple coneflower (Echinacea) for immunity, wild ginger for stomachache, and saw palmetto for prostate health.
Early pharmacists in settler colonies were few; medicine often followed European models, with apothecary shops gradually becoming independent from physicians as the profession evolved.
Early Pharmaceutical Manufacturing and the Need for Standards
By the 1800s, pharmacists were recognized as specialized healthcare providers who compounded and dispensed medications. Physicians referred patients to chemists for compounded prescriptions. Pharmacists relied on their own knowledge to prepare dosages and formulations.
A group of eleven physicians met in 1820 to standardize common drug recipes; they produced the precursor to the US Pharmacopeia (USP). The USP and its evolving form became the US Pharmacopeial Convention (USP) and later the USP-National Formulary (USP-NF), setting quality standards for prescription, OTC, homeopathic, and dietary supplement products, as well as sterile and hazardous compounding.
The First American Pharmacy Schools and Associations
The United States initially lacked formal pharmacy schools. In 1822, the Philadelphia College of Pharmacy became the first U.S. institution offering formal courses in pharmaceutical sciences and diplomas for pharmacists. Apprenticeships remained common learning pathways.
In 1852, the American Pharmaceutical Association (APhA) was organized to standardize professional practice, address drug quality, and promote licensure. The APhA advocated for standards in drug ingredients, compounding, and dosages and encouraged state regulation requiring licensure through formal examinations for pharmacists.
Education, Mass Manufacturing, and Industry Growth
Additional universities worldwide began offering formal pharmacy education and degrees, often focusing on pharmacognosy—the study of medicinal use of natural products and chemicals from natural origins. Pharmacists-in-training continued to be apprentices in many contexts.
By the late 1800s, large-scale pharmaceutical manufacturing expanded, with collaboration between universities and manufacturers to develop and produce new compounds. Although herbal ingredients remained common, mass-manufactured artificial chemicals began to supplement compounded preparations (e.g., Bayer’s synthesis of acetylsalicylic acid to produce aspirin in 1899).
Aspirin became a widely used medication for pain, inflammation, and, later, prevention of blood clots in high-risk patients.
Commercial and social aspects of pharmacy practice
Throughout much of the 19th and early 20th centuries, pharmacy soda fountains were common in the United States, where pharmacists prepared flavored beverages and confections. Coca-Cola was created by John Pemberton (1886) and Coca-Cola’s original formula contained cocaine; it was later reformulated to remove cocaine and replace it with caffeine. Caleb Bradham (1893) created Pepsi-Cola. Technicians assisted with soda fountain operations in pharmacies.
Soda fountains declined with the rise of bottled beverages in the 1960s, but the social role of pharmacists as community-centered providers persisted. During Prohibition, many drugstores continued to operate soda fountains for customers.
Connections to current practice
The historical development—standardization, formal education, professional associations, ethical guidance, and evolving roles—forms the foundation of today’s practice. Modern pharmacy practice integrates clinical roles (MTM, CPAs, patient counseling) with a robust regulatory framework (licensure, certification, registration) and ongoing professional advancement initiatives (PAI/PPMI). The chapter references Appendix B for ASHP/ACPE accreditation standards, underscoring the ongoing emphasis on quality, safety, and competency in pharmacy education and practice.
Key Concepts and Terms (Summary of Core Terms from Section 1.x)
Pharmacy technician licensure, certification, and registration: different pathways and requirements for practice; essential for ensuring baseline competencies and patient safety.
Certification terminology: CPhT (Certified Pharmacy Technician) credential; pathways to advanced roles.
MTM (Medication Therapy Management): patient-centered services provided to optimize therapeutic outcomes.
CPAs (Collaborative Practice Agreements): formal agreements enabling pharmacists to provide expanded patient care under protocols.
ASHP PAI (Practice Advancement Initiative) and PPMI (Pharmacy Practice Model Initiative): initiatives driving expansion of pharmacist roles and integration of pharmacy practice into patient care models.
Drug formularies and pharmacopoeias (pharmacopoeia vs formulary): historical and modern lists guiding drug selection and use.
Galenical pharmacy: the historical practice of extracting active ingredients into dosing forms; historical term for early pharmaceutical compounding.
Pharmacognosy: study of medicinal substances derived from natural products (plants, animals, minerals).
Ebers Papyrus, Sushruta Samhita, De Materia Medica, Hippocrates, Dioscorides, Galen: foundational texts and figures in the historical development of medicine and pharmacy.
Words of origin: pharmakon (drug/remedy); apothecary; pharmacist; alchemist; grocers vs apothecaries.
Notable Historical Figures and Texts
Sushruta (6th century BCE): Sushruta Samhita; Ayurveda; 500+ plant-based medicines; 1000+ medical conditions.
Ebers Papyrus (circa 1500 BCE): 110 pages; >700 prescriptions.
Hippocrates (ca. 460–370 BCE): four humors; father of modern medicine; Hippocratic Oath.
Pedanius Dioscorides (40–90 CE): De Materia Medica; 1000+ substances; herbal remedies; pharmacology precursor.
Claudius Galen (130–216 CE): galenical pharmacy; father of pharmacy; extensive work on active ingredients and formulation.
Cosmas and Damian (approx. 270–303 CE): patron saints linking Arab and Greek-medical worlds; exemplars of care for the poor.
Moses ben Maimon (Maimonides, 1135–1204 CE): ethics of care, moderation, and healing; influence on professional ethics.
Standards, Education, and Regulation Milestones
1820: Eleven physicians meet in Washington, DC to standardize compounding recipes; formation of early formulary guidance later reflected in USP.
1822: Philadelphia College of Pharmacy becomes the first U.S. school offering formal pharmacy education and diplomas.
1852: American Pharmaceutical Association (APhA) established to promote professional standards and licensure.
USP/USP-NF: U.S. Pharmacopeia and National Formulary establish quality standards for prescription, OTC, homeopathic, and dietary supplements, including sterile and hazardous compounding.
The first U.S. pharmacy schools and associations helped professionalize practice and set licensure expectations for pharmacists; licensure requirements emerged through state regulation.
The Transition to Mass Production and Modern Commercial Practice
Late 1800s: Emergence of mass-manufactured drug products; increasing collaboration between universities and industry; shift from herbal to synthetic/chemically manufactured compounds (e.g., aspirin synthesized by Bayer in 1899).
Coke-era and soda fountains: pharmacists operated soda fountains as social and business hubs; Coca-Cola (1886) and Pepsi-Cola (1893) originated in drugstores; Coca-Cola originally contained cocaine before reformulation; these historical practices influenced community pharmacy roles and social settings in drugstores.
Education and regulation evolved to support standardized practice, quality control, and patient safety; the modern system of licensure, certification, and accreditation is a direct lineage from these early efforts.
Relevance to Today
The origins and evolution of pharmacy underpin today’s emphasis on patient safety, standardized compounding, and ethical care.
The contemporary pharmacy workforce relies on formal education, licensure, and ongoing professional development to support MTM, CPAs, and expanded pharmacist roles in patient care teams.
Understanding historical texts, ethical codes, and regulatory milestones helps explain why current practice emphasizes collaboration, standardization, and continuous improvement in the pharmacotherapy process.
Key Dates and Quantities (for quick reference)
4.5 imes 10^9 prescriptions filled annually in the U.S. (approximately 4.5 billion).
Ebers Papyrus: approximately 110 pages; dating to around 1500 ext{ BCE}; contains >700 prescriptions.
Ayurveda foundational texts and Sushruta’s contributions: Sushruta Samhita; ~6^{th} ext{ century BCE}; herbal medicinal knowledge covering ~500 plants and >1000 conditions.
Hippocrates: ca. 460-370 ext{ BCE}; four humors (blood, phlegm, yellow bile, black bile); oath of ethics.
Dioscorides: De Materia Medica, first century CE (≈ 40-90 ext{ CE}); >1000 substances.
Galen (c. 130-216 ext{ CE}): galenical pharmacy; foundational for extraction of active ingredients.
1241: Edict of Salerno—physicians forbidden from running pharmacists’ shops; regulated pharmacy practice.
1617: Apothecaries split from Grocers Guild; Worshipful Society of Apothecaries established in London.
1780s–1800s: rise of chemical and pharmacognostic investigation; later formula standardization.
1820: USP formed to standardize drug recipes; precursor to modern pharmacopoeia.
1822: Philadelphia College of Pharmacy—the first U.S. pharmacy school.
1852: American Pharmaceutical Association (APhA) established to promote standards and licensure.
1899: Bayer synthesizes aspirin (acetylsalicylic acid); mass-produced drug.
1886: Coca-Cola created by John Pemberton; Cocaine initially included in formula; later replaced with caffeine.
1893: Pepsi-Cola created by Caleb Bradham; soda fountain practice linked to pharmacy culture.
Appendix: Additional Notes
The chapter points to Appendix B for in-depth ASHP/ACPE Accreditation Standards relevant to Pharmacy Technician education and practice.
The material emphasizes the integration of ethics, history, regulation, and practical skills needed for technicians to support pharmacists and the healthcare team effectively.