Pharmacy
Pharmacy (from Greek pharmakeia, use of drugs, from pharmakon, drug) 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 medication. The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to patient 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. The term is also applied to an establishment used for such purposes.
- Disciplines
- Pharmacists
- History of pharmacy
- Types of pharmacy practice areas
- The future of pharmacy
- Pharmaceutical Symbols
Disciplines
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.
There are various specialties of pharmacy practice. Specialization in pharmacy practice is typically based on the place of practice or practice roles including: community, hospital, clinical pharmacy, consultant, locum, drug information, regulatory affairs, industry, and academia.
Pharmacists
Pharmacists are highly-trained and skilled healthcare professionals who perform various roles to ensure optimal health outcomes for their patients. Many pharmacists are also small-business owners, owning the pharmacy in which they practice.
History of pharmacy
Muslim pharmacy
In the field of pharmacy, the first drugstores were opened by Muslim pharmacists in Baghdad in 754, while the first apothecary shops were also founded by Muslim practitioners.
The advances made in the Middle East by Muslim chemists in botany
and chemistry led Muslim physicians to substantially develop
pharmacology. Muhammad ibn Zakariya Razi (Rhazes) (865-915), for
instance, acted to promote the medical uses of chemical compounds. Abu
al-Qasim al-Zahrawi (Abulcasis) (936-1013) pioneered the preparation of
medicines by sublimation and distillation. His Liber servitoris is of
particular interest, as it provides the reader with recipes and
explains how to prepare the `simples’ from which were compounded the
complex drugs then generally used. Sabur Ibn Sahl (d 869), was,
however, the first physician to initiate pharmacopoedia, describing a
large variety of drugs and remedies for ailments. Al-Biruni (973-1050)
wrote one of the most valuable Islamic works on pharmacology entitled
Kitab al-Saydalah (The Book of Drugs), where he gave detailed knowledge
of the properties of drugs and outlined the role of pharmacy and the
functions and duties of the pharmacist. Ibn Sina (Avicenna), too,
described no less than 700 preparations, their properties, mode of
action and their indications. He devoted in fact a whole volume to
simple drugs in The Canon of Medicine. Of great impact were also the
works by al-Maridini of Baghdad and Cairo, and Ibn al-Wafid
(1008-1074), both of which were printed in Latin more than fifty times,
appearing as De Medicinis universalibus et particularibus by `Mesue'
the younger, and the Medicamentis simplicibus by `Abenguefit'. Peter of
Abano (1250-1316) translated and added a supplement to the work of
al-Maridini under the title De Veneris. Al-Muwaffaq’s contributions in
the field are also pioneering. Living in the 10th century, he wrote The
foundations of the true properties of Remedies, amongst others
describing arsenious oxide, and being acquainted with silicic acid. He
made clear distinction between sodium carbonate and potassium
carbonate, and drew attention to the poisonous nature of copper
compounds, especially copper vitriol, and also lead compounds. For the
story, he also mentions the distillation of sea-water for drinking.
Chinese Pharmacy
The beginnings of pharmacy in China are ancient. It stemmed from Chinese alchemy. Shennong is said to have tasted hundreds of herbs to test their medical value. The most well-known work attributed to Shennong is the The Divine Farmer's Herb-Root Classic. This work is considered to be the earliest Chinese pharmacopoeia. It includes 365 medicines derived from minerals, plants, and animals. Shennong is credited with identifying hundreds of medical (and poisonous) herbs by personally testing their properties, which was crucial to the development of Traditional Chinese medicine.
Japanese pharmacy
In ancient Japan, the men who fulfilled roles similar to those of
modern pharamacists were highly respected. The place of pharmacists in
society was expressly defined in the Taiho Code (701) and re-stated in
the Yoro Code (718). Ranked positions in the pre-Heian Imperial court
were established; and this organizational structure remained largely
intact until the Meiji Restoration (1868). In this highly stable
hierarchy, the pharmacists -- and even pharmacist assistants -- were
assigned status superior to all others in health-related fields such as
physicians and acupuncturists. In the Imperial household, the
pharmacist was even ranked above the two personal physicians of the
Emperor.
Types of pharmacy practice areas
Pharmacists practice in a variety of areas including retail, hospitals, clinics, nursing homes, drug industry, 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
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 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.
All pharmacies are required to have a pharmacist on-duty at all times when open. In many jurisdictions, it is also a requirement that the owner of a pharmacy must be a registered pharmacist (R.Ph.). This latter requirement has been revoked in many 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 household items such as cosmetics,
shampoo, bandages, office supplies, candy, and snack foods.
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 haematology/oncology, HIV/AIDS, infectious disease, critical care, emergency medicine, toxicology, nuclear pharmacy, pain management, psychiatry, anticoagulation clinics, herbal medicine, neurology/epilepsy management, paediatrics, neonatal pharmacists and more.
Hospital pharmacies can usually 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.
Clinical pharmacy
Clinical pharmacists provide direct patient care services that
optimizes the use of medication and promotes health, wellness, and
disease prevention. 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. 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.
Compounding pharmacy
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.
Compounding pharmacies specialize in compounding, although many also dispense the same non-compounded drugs that patients can obtain from community pharmacies.
Consultant pharmacy
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. Traditionally consultant pharmacists were usually independent
business owners. 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.
Internet 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. Of course as history has shown, substandard products can be dispensed by both Internet and Community pharmacies, so it is best that the buyer beware.
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/practioner who has an established doctor-patient relationship. There are many instances where a practioner issues a prescription, brokered by an internet server, for a controlled substance to a "patient" s/he has never met. 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 which sell their lower-cost prescription drugs to US consumers, who pay the world's highest drug prices. However, there are Internet pharmacies in many other countries including Israel, Fiji and the UK that serve customers worldwide.
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 fullfill 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
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.
Issues in pharmacy
Separation of prescribing from dispensing
In most jurisdictions, pharmacists are regulated separately from
physicians. Specifically, the legislation stipulates that the practice
of prescribing must be separate from the practice of dispensing. 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.
In other jurisdictions (particularly in Asian countries such as China, Hong Kong, 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. 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 of the governments.
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).
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 will be paid for their patient care skills.
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 the
United Kingdom, pharmacists (and nurses) who undertake additional
training are obtaining prescribing rights. They are also being paid for
by the government for medicine use reviews. Pharmaceutical care or
Clinical pharmacy has had an evolving influence on the practice of
pharmacy. Moreover, the Doctor of Pharmacy (Pharm.D.) degree is now
required before entering practice and many 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."
Pharmaceutical Symbols
World-wide thre are many symbols, Signs and Badges used to represent Pharmacy.
A number of these symbols enjoy particularly widespread usage, and are explained and illustrated below. There is no standard representation of them, but the illustrations on this sheet have been chosen to give the simplest and clearest image available for each one.
Major Pharmaceutical And Medical Symbol
1.
The one snake on a staff symbol is called the serpent of Epidaurus on
the staff of Aesculapius, and can be seen in the bottom left quarter of
the shield on the crest of the Royal Pharmaceutical Society of Great
Britain. Aesculapius was one of the Greek Gods of medicine, and is
usually depicted carrying a staff with a snake coiled around it. The
snake was a symbol of wisdom, immortality and healing in Middle and far
Eastern cultures far older than that of ancient Greece, although its
association with Aesculapius has been attributed to snakes used at a
temple dedicated to him in Epidaurus in the north eastern Peloponnese.
This symbol is often considered particularly suitable for pharmacy.
2.
The bowl with a snake coiled around it is called the bowl of Hygeia
with the serpent of Epidaurus, and is a variant on the above. Hygeia
was Aesculapius’s daughter and a Greek Goddess of health. Her symbol
was a serpent drinking from a bowl. The vessel is usually depicted with
a long stem and a shallow, wide bowl as seen here. It also is
considered suitable for pharmacy. The bowl of Hygeia with serpent of
Epidaurus shown here is the symbol for Hungarian pharmacists.
3.
The symbol of two snakes on a staff is called the Caduceus. The staff,
depicted with wings, is that of Mercury (Roman) or Hermes (Greek),
messenger of the Gods and also God of commerce. (The Greek root of the
word Caduceus means “herald’s wand”). The history and meaning of this
symbol is complicated. In the West it has been adopted as a symbol of
medicine since the 19th century, probably because of its similarity to
the serpent of Epidaurus on the staff of Aesculapius. It is generally
considered less suitable for pharmacy than the one snake motif, but is
more popular for use as a general medical symbol. The Caduceus shown
here is from the 1888 Chambers Encyclopaedia
4.
The serpent around a palm tree symbol is used by French and Portuguese
pharmaceutical bodies, and was introduced in the 19th century. The
snake is associated with healing, as discussed above, but here has a
more specific meaning. The palm tree represents the vegetable kingdom,
the serpent the animal kingdom, and the rocks at the palm tree’s base
the mineral kingdom. The serpent and palm tree shown here is the design
used by the Portuguese Order of
Pharmacists.
5.
The Green Cross was first introduced in the as a pharmaceutical symbol
in continental Europe in the early 20th century as a replacement for
the Red Cross. The Red Cross, previously used by some medical
institutions and by continental pharmacists, was adopted by the
International Red Cross in 1863, necessitating the need for an
alternative. The Green Cross was not used in Britain until 1984, when
it was adopted by the Royal Pharmaceutical Society of Great Britain as
a standard symbol for British pharmacy. The Society stipulated that it
should be produced in a specified shade of green, or in black and
white, and that the words pharmacy or pharmacist, or the Society’s
name, should appear with it.
6.
The mortar and pestle has long been used as a pharmaceutical symbol in
Britain and on the European mainland, and is still widely employed as a
pharmacy shop sign in Scotland. The mortar and pestle are tools of
traditional pharmacy, hence their use as an easily recognisable visual
motif. The mortar and pestle symbol shown here is a stylised
Scandinavian version.
7.
The carboy, a glass vessel with a globular base tapering to a narrow
neck, was commonly displayed filled with brightly coloured liquids in
pharmacy shop windows well into the second half of this century, and
has come to be a symbol of pharmacy. The term carboy is a corruption of
the Persian word qarabah or qarrabah, meaning “large flagon”, and the
carboy is thought to originate from the Near East, where drug sellers
used large glass vessels, filled with coloured liquids, especially
rosewater and wine, in their stalls. There is some debate over exactly
when glass carboys were introduced in Britain, but it is thought to
have been sometime in the late 17th or early 18th century. Early
examples were usually dark hued glass. By the late 18th century they
were recorded by observers as a characteristic and attractive feature
of the chemists and druggists shop window, and have retained a strong
association with pharmacy ever since. The carboy illustrated here is a
“swan neck” type from Maw Son & Sons Catalogue of 1903.
8. The recipe sign appears at the start of prescriptions. Although universally accepted as an abbreviation of “recipe” (Latin for ‘take thou’), it has also been suggested that it is the astronomical sign of the planet Jupiter.