Pharmacy

For other uses, see Pharmacy (disambiguation).

The mortar and pestle, one of the internationally recognized symbols to represent the pharmacy profession

Typical American drug store with a soda fountain, about 1905

Drug store restoration ca. 1920 at Collingsworth County Museum and Art Center across from the courthouse in Wellington, Texas

Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs. The word derives from the Greek: φάρμακον (pharmakon), meaning "drug" or "medicine"^[1] (the earliest form of the word is the Mycenaean Greek pa-ma-ko, attested in Linear B syllabic script^[2]).

The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are the experts on drug therapy and are the primary health professionals who optimize medication use to provide patients with positive health outcomes.

An establishment in which pharmacy (in the first sense) is practiced is called a pharmacy, chemist's or drug store. In the United States and Canada, drug stores commonly sell not only medicines, but also miscellaneous items such as candy (sweets), cosmetics, and magazines, as well as light refreshments or groceries.

The word pharmacy is derived from its root word pharma which was a term used since the 15th–17th centuries. In addition to pharma responsibilities, the pharma offered general medical advice and a range of services that are now performed solely by other specialist practitioners, such as surgery and midwifery. The pharma (as it was referred to) often operated through a retail shop which, in addition to ingredients for medicines, sold tobacco and patent medicines. The pharmas also used many other herbs not listed.

In its investigation of herbal and chemical ingredients, the work of the pharma may be regarded as a precursor of the modern sciences of chemistry and pharmacology, prior to the formulation of the scientific method.

Disciplines

Pharmacy, tacuinum sanitatis casanatensis (XIV century)

The field of Pharmacy can generally be divided into three primary disciplines:

• Pharmaceutics
• Medicinal chemistry and Pharmacognosy
• Pharmacy practice

The boundaries between these disciplines and with other sciences, such as biochemistry, are not always clear-cut; and often, collaborative teams from various disciplines research together.

Pharmacology is sometimes considered a fourth discipline of pharmacy. Although pharmacology is essential to the study of pharmacy, it is not specific to pharmacy. Therefore it is usually considered to be a field of the broader sciences.

Pharmacoinformatics is considered another new discipline, for systematic drug discovery and development with efficiency and safety.

Professionals

The World Health Organization estimates there are at least 2.6 million pharmacists and other pharmaceutical personnel worldwide.^[3]

Pharmacists

Main article: Pharmacist

Pharmacists are allied health professionals with specialised education and training who perform various roles to ensure optimal health outcomes for their patients through proper medication use. Many pharmacists are also small-business proprietors, owning the pharmacy in which they practice. Since pharmacists know about the chemical synthesis mode of action of a particular drug, and its metabolism and physiological effects on human body in great detail, they play an important role in optimisation of a drug treatment for an individual.

Pharmacists are represented internationally by the International Pharmaceutical Federation (FIP). They are represented at the national level by professional organisations such as the Royal Pharmaceutical Society in the UK, the Pharmacy Guild of Australia (PGA), the American Pharmacists Association (APhA), and the Pakistan Pharmacists Society (PPS). See also: List of pharmacy associations.

In some cases, the representative body is also the registering body, which is responsible for the regulation and ethics of the profession.

In the United States, specializations in pharmacy practice recognized by the Board of Pharmaceutical Specialties include: cardiovascular, infectious disease, oncology, pharmacotherapy, nuclear, nutrition, and psychiatry.^[4] The Commission for Certification in Geriatric Pharmacy certifies pharmacists in geriatric pharmacy practice. The American Board of Applied Toxicology certifies pharmacists and other medical professionals in applied toxicology.

Pharmacy technicians

Main article: Pharmacy technician

Pharmacy technicians support the work of pharmacists and other health professionals by performing a variety of pharmacy related functions, including dispensing prescription drugs and other medical devices to patients and instructing on their use. They may also perform administrative duties in pharmaceutical practice, such as reviewing prescription requests with doctor's offices and insurance companies to ensure correct medications are provided and payment is received.

History

Main article: History of pharmacy

Doctor and pharmacist, illustration from Medicinarius (1505) by Hieronymus Brunschwig.

The history of pharmacy as an independent science is relatively young. The origins of historiography pharmaceutical back to the first third of the s. XIX which is when the first historiographies that while not touching all aspects of pharmaceutical history is the starting point for the final start of this science.

Until the birth of pharmacy as an independent science, there is a historical evolution from antiquity to the present day that marks the course of this science, always connected to the medicine.

Types of pharmacy practice areas

Pharmacists practice in a variety of areas including retail, hospitals, clinics, nursing homes, mental hospitals, and regulatory agencies. Pharmacists can specialize in various areas of practice including but not limited to: hematology/oncology, infectious diseases, ambulatory care, nutrition support, drug information, critical care, pediatrics, etc.

Community pharmacy

19th century Italian pharmacy

Modern pharmacy in Norway

See also: Pharmacy automation

A pharmacy (commonly the chemist in Australia, New Zealand and the UK; or drugstore in North America; retail pharmacy in industry terminology; or Apothecary, historically) is the place where most pharmacists practice the profession of pharmacy. It is the community pharmacy where the dichotomy of the profession exists—health professionals who are also retailers.

Community pharmacies usually consist of a retail storefront with a dispensary where medications are stored and dispensed. The opening of the first drugstores are recorded by Muslim pharmacists in Baghdad in 754.^[5][6]

In most countries, the dispensary is subject to pharmacy legislation; with requirements for storage conditions, compulsory texts, equipment, etc., specified in legislation. Where it was once the case that pharmacists stayed within the dispensary compounding/dispensing medications, there has been an increasing trend towards the use of trained pharmacy technicians while the pharmacist spends more time communicating with patients. Pharmacy technicians are now more dependent upon automation to assist them in their new role dealing with patients' prescriptions and patient safety issues.

Pharmacies are typically required to have a pharmacist on-duty at all times when open. It is also often a requirement that the owner of a pharmacy must be a registered pharmacist, although this is not the case in all jurisdictions, such that many retailers (including supermarkets and mass merchandisers) now include a pharmacy as a department of their store.

Likewise, many pharmacies are now rather grocery store-like in their design. In addition to medicines and prescriptions, many now sell a diverse arrangement of additional items such as cosmetics, shampoo, office supplies, confections, snack foods, durable medical equipment, greeting cards, and provide photo processing services.

Hospital pharmacy

Main article: Hospital pharmacy

Pharmacies within hospitals differ considerably from community pharmacies. Some pharmacists in hospital pharmacies may have more complex clinical medication management issues whereas pharmacists in community pharmacies often have more complex business and customer relations issues.

Because of the complexity of medications including specific indications, effectiveness of treatment regimens, safety of medications (i.e., drug interactions) and patient compliance issues (in the hospital and at home) many pharmacists practicing in hospitals gain more education and training after pharmacy school through a pharmacy practice residency and sometimes followed by another residency in a specific area. Those pharmacists are often referred to as clinical pharmacists and they often specialize in various disciplines of pharmacy. For example, there are pharmacists who specialize in hematology/oncology, HIV/AIDS, infectious disease, critical care, emergency medicine, toxicology, nuclear pharmacy, pain management, psychiatry, anti-coagulation clinics, herbal medicine, neurology/epilepsy management, pediatrics, neonatal pharmacists and more.

Hospital pharmacies can often be found within the premises of the hospital. Hospital pharmacies usually stock a larger range of medications, including more specialized medications, than would be feasible in the community setting. Most hospital medications are unit-dose, or a single dose of medicine. Hospital pharmacists and trained pharmacy technicians compound sterile products for patients including total parenteral nutrition (TPN), and other medications given intravenously. This is a complex process that requires adequate training of personnel, quality assurance of products, and adequate facilities. Several hospital pharmacies have decided to outsource high risk preparations and some other compounding functions to companies who specialize in compounding. The high cost of medications and drug-related technology, combined with the potential impact of medications and pharmacy services on patient-care outcomes and patient safety, make it imperative that hospital pharmacies perform at the highest level possible.

Clinical pharmacy

Main article: Clinical pharmacy

Clinical pharmacists provide direct patient care services that optimizes the use of medication and promotes health, wellness, and disease prevention.^[7] Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often collaborate with physicians and other healthcare professionals to improve pharmaceutical care. Clinical pharmacists are now an integral part of the interdisciplinary approach to patient care. They work collaboratively with physicians, nurses and other healthcare personnel in various medical and surgical areas. They often participate in patient care rounds and drug product selection.

In most hospitals in the United States, potentially dangerous drugs that require close monitoring are dosed and managed by clinical pharmacists.^{[citation needed]}

Compounding pharmacy

Main article: Compounding

Compounding is the practice of preparing drugs in new forms. For example, if a drug manufacturer only provides a drug as a tablet, a compounding pharmacist might make a medicated lollipop that contains the drug. Patients who have difficulty swallowing the tablet may prefer to suck the medicated lollipop instead.

Another form of compounding is by mixing different strengths (g,mg,mcg) of capsules or tablets to yield the desired amount of medication indicated by the doctor. This form of compounding is found at community or hospital pharmacies or in-home administration therapy.

Compounding pharmacies specialize in compounding, although many also dispense the same non-compounded drugs that patients can obtain from community pharmacies.

Consultant pharmacy

Main article: Consultant pharmacist

Consultant pharmacy practice focuses more on medication regimen review (i.e. "cognitive services") than on actual dispensing of drugs. Consultant pharmacists most typically work in nursing homes, but are increasingly branching into other institutions and non-institutional settings.^[8] Traditionally consultant pharmacists were usually independent business owners, though in the United States many now work for several large pharmacy management companies (primarily Omnicare, Kindred Healthcare and PharMerica). This trend may be gradually reversing as consultant pharmacists begin to work directly with patients, primarily because many elderly people are now taking numerous medications but continue to live outside of institutional settings. Some community pharmacies employ consultant pharmacists and/or provide consulting services.

The main principle of consultant pharmacy is pharmaceutical care developed by Hepler and Strand in 1990.^[9][10]

Internet pharmacy

Main article: Online pharmacy

Since about the year 2000, a growing number of internet pharmacies have been established worldwide. Many of these pharmacies are similar to community pharmacies, and in fact, many of them are actually operated by brick-and-mortar community pharmacies that serve consumers online and those that walk in their door. The primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient and private method rather than traveling to a community drugstore where another customer might overhear about the drugs that they take. Internet pharmacies (also known as Online Pharmacies) are also recommended to some patients by their physicians if they are homebound.

While most internet pharmacies sell prescription drugs and require a valid prescription, some internet pharmacies sell prescription drugs without requiring a prescription. Many customers order drugs from such pharmacies to avoid the "inconvenience" of visiting a doctor or to obtain medications which their doctors were unwilling to prescribe. However, this practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and an individual's overall suitability for use of a medication. There also have been reports of such pharmacies dispensing substandard products.^{[citation needed]}

Of particular concern with internet pharmacies is the ease with which people, youth in particular, can obtain controlled substances (e.g., Vicodin, generically known as hydrocodone) via the internet without a prescription issued by a doctor/practitioner who has an established doctor-patient relationship. There are many instances where a practitioner issues a prescription, brokered by an internet server, for a controlled substance to a "patient" s/he has never met.^{[citation needed]} In the United States, in order for a prescription for a controlled substance to be valid, it must be issued for a legitimate medical purpose by a licensed practitioner acting in the course of legitimate doctor-patient relationship. The filling pharmacy has a corresponding responsibility to ensure that the prescription is valid. Often, individual state laws outline what defines a valid patient-doctor relationship.

Canada is home to dozens of licensed internet pharmacies, many of which sell their lower-cost prescription drugs to U.S. consumers, who pay one of the world's highest drug prices.^{[citation needed]} In recent years, many consumers in the US and in other countries with high drug costs, have turned to licensed internet pharmacies in India, Israel and the UK, which often have even lower prices than in Canada.

In the United States, there has been a push to legalize importation of medications from Canada and other countries, in order to reduce consumer costs. While in most cases importation of prescription medications violates Food and Drug Administration (FDA) regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers. There is no known case of any U.S. citizens buying Canadian drugs for personal use with a prescription, who has ever been charged by authorities.

Recently developed online services like Australia's Medicine Name Finder and the Walgreens' Drug Info Search provide information about pharmaceutical products but do not offer prescriptions or drug dispensations. These services often promote generic drug alternatives by offering comparative information on price and effectiveness.

Veterinary pharmacy

Veterinary pharmacies, sometimes called animal pharmacies, may fall in the category of hospital pharmacy, retail pharmacy or mail-order pharmacy. Veterinary pharmacies stock different varieties and different strengths of medications to fulfill the pharmaceutical needs of animals. Because the needs of animals, as well as the regulations on veterinary medicine, are often very different from those related to people, veterinary pharmacy is often kept separate from regular pharmacies.

Nuclear pharmacy

Main article: Nuclear pharmacy

Nuclear pharmacy focuses on preparing radioactive materials for diagnostic tests and for treating certain diseases. Nuclear pharmacists undergo additional training specific to handling radioactive materials, and unlike in community and hospital pharmacies, nuclear pharmacists typically do not interact directly with patients.

Military pharmacy

Military pharmacy is an entirely different working environment due to the fact that technicians perform most duties that in a civilian sector would be illegal. State laws of Technician patient counseling and medication checking by a pharmacist do not apply.^{[citation needed]}

Pharmacy informatics

Main article: Pharmacy informatics

Pharmacy informatics is the combination of pharmacy practice science and applied information science. Pharmacy informaticists work in many practice areas of pharmacy, however, they may also work in information technology departments or for healthcare information technology vendor companies. As a practice area and specialist domain, pharmacy informatics is growing quickly to meet the needs of major national and international patient information projects and health system interoperability goals. Pharmacists in this area are trained to participate in medication management system development, deployment and optimization.

Issues in pharmacy

Separation of prescribing from dispensing

In most jurisdictions (such as the United States), pharmacists are regulated separately from physicians. These jurisdictions also usually specify that only pharmacists may supply scheduled pharmaceuticals to the public, and that pharmacists cannot form business partnerships with physicians or give them "kickback" payments. However, the American Medical Association (AMA) Code of Ethics provides that physicians may dispense drugs within their office practices as long as there is no patient exploitation and patients have the right to a written prescription that can be filled elsewhere. 7 to 10 percent of American physicians practices reportedly dispense drugs on their own.^[11]

In some rural areas in the United Kingdom, there are dispensing doctors ^[12] who are allowed to both prescribe and dispense prescription-only medicines to their patients from within their practices. The law requires that the GP practice be located in a designated rural area and that there is also a specified, minimum distance (currently 1.6 kilometres) between a patient's home and the nearest retail pharmacy.

In other jurisdictions (particularly in Asian countries such as China, Malaysia, and Singapore), doctors are allowed to dispense drugs themselves and the practice of pharmacy is sometimes integrated with that of the physician, particularly in traditional Chinese medicine.

In Canada it is common for a medical clinic and a pharmacy to be located together and for the ownership in both enterprises to be common, but licensed separately.

The reason for the majority rule is the high risk of a conflict of interest and/or the avoidance of absolute powers. Otherwise, the physician has a financial self-interest in "diagnosing" as many conditions as possible, and in exaggerating their seriousness, because he or she can then sell more medications to the patient. Such self-interest directly conflicts with the patient's interest in obtaining cost-effective medication and avoiding the unnecessary use of medication that may have side-effects. This system reflects much similarity to the checks and balances system of the U.S. and many other governments.^{[citation needed]}

A campaign for separation has begun in many countries and has already been successful (like in Korea). As many of the remaining nations move towards separation, resistance and lobbying from dispensing doctors who have pecuniary interests may prove a major stumbling block (e.g. in Malaysia).^{[citation needed]}

The future of pharmacy

In the coming decades, pharmacists are expected to become more integral within the health care system. Rather than simply dispensing medication, pharmacists are increasingly expected to be compensated for their patient care skills.^[13] In particular, Medication Therapy Management (MTM) includes the clinical services that pharmacists can provide for their patients. Such services include the thorough analysis of all medication (prescription, non-prescription, and herbals) currently being taken by an individual. The result is a reconciliation of medication and patient education resulting in increased patient health outcomes and decreased costs to the health care system.^[14]

This shift has already commenced in some countries; for instance, pharmacists in Australia receive remuneration from the Australian Government for conducting comprehensive Home Medicines Reviews. In Canada, pharmacists in certain provinces have limited prescribing rights (as in Alberta and British Columbia) or are remunerated by their provincial government for expanded services such as medications reviews (Medschecks in Ontario). In the United Kingdom, pharmacists who undertake additional training are obtaining prescribing rights. They are also being paid for by the government for medicine use reviews. In Scotland the pharmacist can write prescriptions for Scottish registered patients of their regular medications, for the majority of drugs, except for controlled drugs, when the patient is unable to see their doctor, as could happen if they are away from home or the doctor is unavailable. In the United States, pharmaceutical care or clinical pharmacy has had an evolving influence on the practice of pharmacy.^[7] Moreover, the Doctor of Pharmacy (Pharm. D.) degree is now required before entering practice and some pharmacists now complete one or two years of residency or fellowship training following graduation. In addition, consultant pharmacists, who traditionally operated primarily in nursing homes are now expanding into direct consultation with patients, under the banner of "senior care pharmacy."^[15]

Pharmacy Journals

• List of Pharmacy Journals

See also

American Society for Pharmacy Law Apothecary Bachelor of Pharmacy, Master of Pharmacy, Doctor of Pharmacy Classification of Pharmaco-Therapeutic Referrals Clinical pharmacy Consultant pharmacist Evidence-based pharmacy in developing countries History of pharmacy Hospital pharmacy International Pharmaceutical Federation International Pharmaceutical Students’ Federation List of pharmacies List of pharmacy associations List of pharmacy organizations in the United Kingdom List of pharmacy schools

Nuclear pharmacy Online pharmacy Pharmaceutical company Pharmaceutical industry Pharmacogenetics Pharmacogenomics Pharmacognosy Pharmacology Pharmaconomist Pharmacy Automation - The Tablet Counter Pharmacy residency Pharmacy informatics Professional Further Education in Clinical Pharmacy and Public Health Raeapteek (one of the oldest continuously run pharmacies in Europe)

Pharmacy and Pharmacology portal

Symbols

The two symbols most commonly associated with pharmacy are the mortar and pestle and the ℞ (recipere) character, which is often written as "Rx" in typed text. The show globe was also used in English-speaking countries until the early 20th century. Pharmacy organizations often use other symbols, such as the Bowl of Hygieia which is often used in the Netherlands, conical measures, and caduceuses in their logos. Other symbols are common in different countries: the green Greek cross in France, Argentina, the United Kingdom, Belgium, Italy and Spain, the increasingly rare Gaper in the Netherlands, and a red stylized letter A in Germany and Austria (from Apotheke, the German word for pharmacy, from the same Greek root as the English word 'apothecary').

• 

  Bowl of Hygeia

• 

  The green Cross used in Greece, Spain, Italy, Argentina, France, Poland, the United Kingdom and other countries

• 

  Mortar and pestle

• 

  Prescription Symbol

• 

  The red stylized "A" (Apotheke) used in Germany

• 

  Rod of Asclepius

• 

  Hanging Show Globe

• 

  The Gaper used in the Netherlands

• 

  Identification Mark for Indian Pharmacist

Notes

1. ^ φάρμακον, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus Digital Library
2. ^ Palaeolexicon, Word study tool of ancient languages
3. ^ World Health Organization. World Health Statistics 2011 - Table 6: Health workforce, infrastructure and essential medicines. Geneva, 2011. Accessed 21 July 2011.
4. ^ Board of Pharmaceutical Specialties, Current Specialties
5. ^ Information taken from the abstract of Hadzović, S (1997). "Pharmacy and the great contribution of Arab-Islamic science to its development" (in Croatian). Medicinski arhiv 51 (1–2): 47–50. ISSN 0350-199X. OCLC 32564530. PMID 9324574. 
6. ^ Sharif Kaf al-Ghazal, Journal of the International Society for the History of Islamic Medicine, 2004 (3), pp. 3-9 [8].
7. ^ ^{a b} American College of Clinical Pharmacy, Clinical Pharmacy Defined
8. ^ American Society of Consultant Pharmacists, Frequently Asked Questions
9. ^ Strand LM (1990). "Pharmaceutical care and patient outcomes: notes on what it is we manage". Top Hosp Pharm Manage. 10 (2): 77–84. PMID 10128568. 
10. ^ Hepler CD, Strand LM (1990). "Opportunities and responsibilities in pharmaceutical care". Am J Hosp Pharm. 47 (3): 533–43. PMID 2316538. 
11. ^ American Association of State Compensation Insurance Funds, Prepackaged Drugs in Workers' Compensation
12. ^ British Medical Association, briefing on dispensing doctors, 30 January 2009 [1]
13. ^ American College of Clinical Pharmacy, Evidence of the Economic Benefit of Clinical Pharmacy Services: 1996–2000
14. ^ American Pharmacy Student Alliance (APSA)^{[unreliable source?]}
15. ^ American Society of Consultant Pharmacists, What is a Senior Care Pharmacist?

References

• Watkins, Elizabeth Siegel, “From History of Pharmacy to Pharmaceutical History,” Pharmacy in History, 51 (no. 1, 2009), 3–13.
• (Japanese) Asai,T. (1985). Nyokan Tūkai. Tokyo: Kōdan-Sha.
• (French) Titsingh, Isaac, ed. (1834). [Siyun-sai Rin-siyo/Hayashi Gahō, 1652], Nipon o daï itsi ran; ou, Annales des empereurs du Japon. Paris: Oriental Translation Fund of Great Britain and Ireland....Click link for digitized, full-text copy of this book (in French)
• High Performance Pharmacy - A landmark study in hospital pharmacy performance based on an extensive literature review and the collective experience of the Health Systems Pharmacy Executive Alliance.

External links

• Pharmacy Professionals Guide Guide for Pharmacy students and Teachers Pharmacists
• Navigator History of Pharmacy Collection of internet resources related to the history of pharmacy
• RPSGB Museum Information Sheets Illustrated information sheets on objects in the history of pharmacy
• History of Pharmacy Web Pages Perbo's History of Pharmacy Web Pages
• Soderlund Pharmacy Museum - Information about the history of the American Drugstore
• The Lloyd Library Library of botanical, medical, pharmaceutical, and scientific books and periodicals, and works of allied sciences
• American Institute of the History of Pharmacy American Institute of the History of Pharmacy—resources in the history of pharmacy
• International Pharmaceutical Federation (FIP) Federation representing national associations of pharmacists and pharmaceutical scientists. Information and resources relating to pharmacy education, practice, science and policy
• Pharmaboard FSR BioPharm German association of pharmacy students

Other

• The Virtual Library of Pharmacy - Extensive index of pharmacy-related resources, including information on careers in pharmacy, pharmacy schools, pharmaceutical companies, associations and conferences.