084068 1st case

Study Unit

The Profession ofPharmacyBy

Deborah Berlekamp, R.Ph.

Reviewed By

Gary F. Mead, R.Ph., M.H.A.

About the Author

Deborah Berlekamp, R.Ph., graduated cum laude with a five-year

bachelor of science degree in 1981 from the University of Toledo

College of Pharmacy in Toledo, Ohio. After graduation, she worked

in a variety of pharmacy practice settings, including retail, hospital,

and nursing home facilities. She has worked with and trained many

pharmacy technicians while on the job. Berlekamp was the original

coordinator of the Pharmacy Technology Program at Mercy College

of Northwest Ohio. She also supervised the pharmaceutics laboratory

in the Pharmacy Practice Department at the University of Toledo.

Deborah has been a member of the Pharmacy Technician

Educators Council, the American Society of Health System

Pharmacists, the Ohio Society of Health System Pharmacists, and

the Ohio Pharmacists Association. She is a past president of the

Toledo Area Society of Hospital Pharmacists and a past president

of the University of Toledo College of Pharmacy Alumni Association.

She has been active at local and state levels of pharmacy organiza-

tions and maintains an enthusiastic interest in the pharmacy

profession and the formal education of pharmacy technicians.

Deborah currently manages the pharmacy department at The Pharm

in Bowling Green, Ohio.

This study unit was reviewed by Gary Mead, R.Ph., M.H.A.

Copyright © 2008 by Penn Foster, Inc.

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08/18/08

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Welcome to the exciting world of pharmacy! This study unit

describes the profession of pharmacy and the ever-expanding

role of the pharmacy technician. First, we’ll look at the history

of pharmacy and the educational requirements of pharmacists.

Next comes an overview of the legal aspects of pharmacy.

Then, we’ll take a quick look at the typical duties of the

community pharmacy technician. We’ll also explore the variety

of workplace opportunities for the competent pharmacy techni-

cian, including community pharmacy, hospital pharmacy,

long-term care pharmacy, and mail-order distribution. Finally,

we’ll explore the role of professionals related to pharmacy

including pharmacologists, toxicologists, and allied health

professionals.

iii

Previe

wPrevie

wWhen you complete this study unit, you’ll beable to

• Discuss the educational requirements for pharmacists

• Identify the laws that regulate the pharmacy profession

• List the basic duties of a community pharmacy technician

• List various types of pharmacies and the opportunitiesthey offer the skilled pharmacy technician

• Explain the educational, certification, and licensingrequirements for pharmacists and technicians

• Understand the role of other healthcare professionalsand how they relate to pharmacy

Remember to regularly check “My Courses” on your student homepage.

Your instructor may post additional resources that you can access to

enhance your learning experience.

v

Contents

Contents

INTRODUCTION TO PHARMACY 1Pharmacy Today 1Education and Training of Pharmacists 5Laws Regulating the Profession 9Professional Pharmacy Organizations 12

PHARMACY TECHNICIANS 15Background 15Duties of Pharmacy Technicians 16Career Opportunities for Pharmacy Technicians 26Certification, Registration, Licensure, and Education 27Pharmacy Technician Organizations 31

AN OVERVIEW OF PHARMACY SETTINGS 33Ambulatory Pharmacies 33Institutional Pharmacies 37Long-Term Care Facilities 39Internet Pharmacies 39

PHARMACY-RELATED PROFESSIONALS 41Pharmacologists 41Toxicologists 42Poison Control Specialists 43Allied Health Professionals 43

SELF-CHECK ANSWERS 45

1

INTRODUCTION TO PHARMACY

Pharmacy TodayWelcome to the profession of pharmacy technology. You’re

about to embark on a journey that will lead you to a reward-

ing career. Pharmacy technicians are a very important part of

the ever-changing world of healthcare. The changes occurring

in healthcare directly affect the profession of pharmacy,

causing the pharmacy technician profession to grow rapidly.

There’s a long history behind the growth of pharmacy techni-

cians as educated professionals.

Not long ago, technicians were referred to as clerks or secre-

taries and were often unrecognized and unappreciated for

their contributions to the profession. They were trained on

the job and had a wide range of involvement in the pharmacy

area, from ringing up a cash register to mixing and labeling

medications.

Today, knowledgeable pharmacy technicians perform many

of the tasks that pharmacists used to perform. To better help

patients, pharmacists must spend more time counseling

them, providing drug information, and reviewing the use of

their medications. Technicians have become more valuable

as assistants by completing the tasks that pharmacists must

leave behind. Though ultimately under the supervision of

the pharmacist, pharmacy technicians provide invaluable

assistance as they work confidently to fulfill many of the

responsibilities behind the retail, or community, pharmacy

counter or behind the scenes in an institutional pharmacy.

The Profession of Pharmacy

The Profession of Pharmacy2

Since certain high standards must be met by all healthcare

professionals, pharmacy technicians are increasingly being

required by employers, and even state boards of pharmacy, to

prove that they’re sufficiently knowledgeable and competent to

work in a pharmacy setting. Technicians must demonstrate

that they’ve reached and will maintain a certain level of

knowledge. Many study in formal training programs, take

voluntary certification exams, and attend continuing education

classes. Education and certification pave the way for increased

pay and the opportunity for advancement. In addition, an

ever-changing healthcare environment and the involvement

of interested professionals have helped pharmacy technicians

to become appreciated, recognized, and promoted.

In some form or other, healthcare has existed for centuries.

In ancient days, some people were considered to be healers.

Rest, proper diet, exercise, and stress reduction were often

used to treat those who were ill. Also, early physicians often

used medicinals that were made from natural sources, such as

plants, minerals taken from the ground, and animals. Many

of the techniques that were used by ancient physicians are

still being used by advanced medical practitioners today.

As medicine and pharmacy evolved, pharmacy became

recognized as a separate profession (Figure 1). Just as there

were quack doctors, there were unscrupulous pharmacists

who claimed to be healers but in reality were only trying to

make a profit. Laws were subsequently written to prevent

these people from taking advantage of the public. As new

medications became available, it was obvious that all medica-

tions needed to be tested for safety and effectiveness. The

United States, as well as many other countries, developed

regulations to ensure that drugs are sold honestly and used

properly and safely.

Today, doctors diagnose ailments and take the necessary

steps to help people recover. They may order tests, suggest

therapy, or write a prescription for medication. Physicians

and other healthcare professionals, including dentists,

ophthalmologists, and veterinarians, may also prescribe,

or order, drugs. Patients then visit their local pharmacies,

where the prescriptions are dispensed by highly trained

pharmacists and the technicians who assist them.

The Profession of Pharmacy 3

What does it mean to dispense? Much more is done behind a

prescription counter than meets the eye. Many people don’t

appreciate the fact that it takes considerable thought and

work to fill a prescription properly. There are thousands of

medications to choose from. The pharmacist must be able to

decipher handwriting and interpret the correct meaning of

the prescription. He or she must make sure that the proper

medications are selected, that the proper quantities are

counted, and that a complete and accurate label is placed

on the container. This entire process is called dispensing.

FIGURE 1—The American Institute ofthe History of Pharmacy is a greatsource of information related to thehistory of pharmacy, including thehistory of drug research, manufac-turing, and medicines in society.


In addition to dispensing medications, the pharmacist must

counsel patients about the medicinal therapy related to their

conditions. Many records must be maintained for legal

purposes. Insurance companies must be billed, and rejected

claims must be handled. There are countless laws that must

be adhered to. All of this can produce a stressful environment

if the employees aren’t competent, efficient, and reliable. For

this reason, the profession needs educated technicians.

Pharmacists, who are the most highly trained professionals

in medication therapy, must be able to not only dispense

medications, but explain how to use each medication correctly.

Even in the busiest pharmacies, pharmacists must take the

time to give requested advice to each patient whose prescrip-

tions are filled there. There’s a great need for patients and

their caregivers to understand the proper use of the drugs

being prescribed. As a result, pharmacists are spending more

time with each patient, making absolutely sure that each is

receiving the best drug therapy possible. Many healthcare

professionals believe that pharmacists should spend even

more time with patients. This is another reason why the

pharmacy profession needs educated technicians.

Pharmacists are considered drug information specialists.

In addition to counseling patients, they should review the

patient’s medication history each time a prescription is filled

and contact physicians with suggestions when neccessary.

Pharmacists also need to talk with patients to ensure that

medications are working properly and contact physicians

when there’s a problem. Pharmacists also advise doctors

and other healthcare professionals on how to prescribe

medications properly. In fact, some pharmacists write

prescriptions for drugs, depending on the state in which they

practice.

Today, because of the public’s call for high-quality, affordable

healthcare, the entire industry is changing. Recent changes

have forced pharmacy professionals and educators to examine

the way pharmacy is practiced. New laws and policies, as

well as the constant development of new drugs, are compelling

pharmacists to spend most or all of their time counseling and


tailoring drug therapy to the particular needs of patients.

This leaves much work to be done by the trained pharmacy

technician.

The ways in which healthcare is being paid for has led to new

pharmacy practice settings. These settings are different from

the usual drugstore or hospital. Traditional pharmacies in

small, local drugstores are disappearing while large grocery

store chains and super centers have pharmacies located

within their stores. Retail pharmacies now face competition

from health maintenance organizations (HMOs) and other

managed care insurance organizations, as well as mail-order

and Internet pharmacies. You’ll learn more about how HMOs

and other managed care plans affect prescription insurance

coverage later in your program. Also, pharmacy departments

in hospitals are often merging with one another. The word

institution is being used as a more general word for hospital,

and institutional pharmacy is often used in place of hospital

pharmacy.

In the future, there will be fewer hospitals and a greater

number of long-term care and home healthcare practices.

In home healthcare, not only do healthcare professionals

treat those who are sick or injured, but patients’ families are

trained to provide care as well. These personal caregivers

have been forced to assume much more responsibility than

they would in a hospital setting and therefore require guid-

ance from supporting healthcare professionals, including the

pharmaceutical team (Figure 2).

Education and Training of PharmacistsOne of a pharmacist’s primary responsibilities is to use his

or her knowledge of drugs—how those drugs affect the body

and how they interact—to promote the health of the public

and protect the public from harm. A pharmacist acquires

this knowledge through years of education and hours and

hours of on-the-job experience.


Drugs are very complicated and can sometimes do more

harm than good if used improperly. New prescription drugs

come to the market practically every day. Pharmacists must

help other healthcare professionals to understand these new

drugs and make them aware of problems that can occur.

Since drug abuse is on the rise, it’s also an important duty of

pharmacists to make sure that drugs aren’t misused.

The college education involved in training pharmacists has

changed over the past 50 years, and it continues to change.

In the past, most pharmacists had five years of college

education. There are a few pharmacists practicing today who

have had only four years of college. Either group has been

awarded the bachelor of science (B.S.) degree in pharmacy.

All pharmacists with a bachelor of science degree in pharmacy

are called registered pharmacists and have the initials R.Ph.

after their names.

FIGURE 2—Elderly patientsrely on their pharmaciststo explain why and howthey should take theirmedications.


Today, most pharmacy colleges offer a pharmacy degree

called the Pharm.D., or doctor of pharmacy degree. This

degree may be obtained in two ways: entry-level and add-on.

The six-year Pharm.D. degree is now the pharmacy profes-

sion’s entry-level degree. Entry-level programs are begun and

completed at the same institution and provide continuity in

the overall educational program. Many, if not all, of these

pharmacy students really take seven years of classes in a

six-year period by attending college for two summers during

the normal summer vacation time.

Some pharmacy colleges offer an add-on Pharm.D. degree.

Pharmacists who graduated with a B.S. in pharmacy may

“add on” the Pharm.D. degree by attending two more years

of college. This type of Pharm.D. program isn’t offered at all

pharmacy colleges, which makes it difficult for some who

wish to obtain the advanced degree.

Pharmacy students must take a variety of basic classes,

including writing, sociology, history, ethics, philosophy,

psychology, and communications. They must also have a broad

background in advanced math, chemistry, and biology. They

take chemistry and biology classes throughout their college

education. They take many classes that teach how each drug

works in the body. All of the side effects and interactions of

each drug with other drugs, food, and diseases are learned.

Pharmacy students learn how to make medications from

basic ingredients in a laboratory. They learn about the various

types of machinery and processes used to make medications

on a much larger scale in factories. They also study the

chemical structures of all available drugs and learn which

parts of these chemicals make the drugs work in the body and

which parts of the chemicals cause side effects. In addition,

pharmacy students learn the many laws that must be

followed to dispense a drug properly. There are also many

laws about drug packaging, labeling, and record keeping that

students must learn.

Pharmacists must apply what they’ve learned to help

patients and other healthcare professionals use medications

wisely. In fact, the first and foremost duty of a pharmacist

is to help patients with their medications. They learn how


to communicate difficult drug information to doctors, but

they also learn how to communicate the same information on

a simpler level to the average person.

Today, the doctor of pharmacy degree includes the traditional

classwork of the R.Ph. degree, as well as a full year devoted

to hands-on experience. Students must now have experience

in hospital, retail, and clinical pharmacy. Students must also

pick elective rotations, which are usually in specialties that

they might eventually pursue. Examples of elective clerkships

include hematology/oncology, veterinary pharmacy, and the

pharmaceutical industry.

Most graduates of a pharmacy college choose a career as a

pharmacist. Some may choose to further their education by

obtaining a degree other than a Pharm.D. Options are a

master’s degree (two additional years) or a Ph.D. (three or

four additional years). With these advanced degrees, the

student can pursue careers in teaching, research and report

writing, or hospital administration.

Pharmacists who wish to become specialists in a certain area

may do so through examinations that are governed by one of

the following organizations: the Board of Pharmaceutical

Specialties (BPS), the American Society of Health System

Pharmacists (ASHP), or the American College of Clinical

Pharmacy (ACCP). Each specialty has eligibility and experience

requirements, as well as a comprehensive exam covering that

particular specialty. For example, a pharmacist who has suc-

cessfully completed the requirements and examination for

oncology pharmacy will have the initials BCOP (Board Certified

in Oncology Pharmacy) after his or her name and degree.

The practical experience that must be obtained while attending

college can help students decide which area of practice best

suits them. As previously mentioned, practical experience can

be obtained through internships, externships, and clerkships.

As a pharmacy technician, you’ll come into contact with these

undergraduates regularly. Each state has its own definition

and requirements for internships, externships, and clerkships.


Laws Regulating the ProfessionPharmacists must adhere to many laws. A complete discus-

sion of these laws will be provided in a later study unit. To

begin our look at the legal aspects of the field of pharmacy,

we’ll discuss how pharmacists are licensed and their basic

legal responsibilities in a pharmacy.

Licensing of Pharmacists

In the United States, all pharmacists must take and pass a

registration examination in the state(s) in which they wish to

practice. This exam is written and governed by the National

Association of Boards of Pharmacy (NABP). The exam may be

taken only by graduates from an accredited, or approved,

college of pharmacy. Those who attend a five- or six-year

program take the same exam.

Other types of exams are available for those who wish to

prove that they’ve achieved a higher level of knowledge.

Although these specialty exams aren’t required, they give

more credentials to clinical pharmacists who have studied

beyond the basic requirements.

To become registered, pharmacy students must also have

completed a practical experience requirement Every state has

a licensing board called the state board of pharmacy. Among

other things, the state board of pharmacy helps to administer

the exam to graduates. When a pharmacist completes all of

these requirements, he or she is licensed and registered.

The requirements for technicians will be discussed later in

this study unit.

The R.Ph. or Pharm.D. degree allows the pharmacist to work

as an employee in a pharmacy. A copy of the pharmacist’s

license must be displayed prominently at the pharmacist’s

place of employment. If the pharmacist is employed in more

than one location, he or she must display the license at the

location he or she works most often. If this license isn’t

renewed, the pharmacist may not practice pharmacy. The

owner or director of a pharmacy must be able to prove that


all of the employed pharmacists have current licenses. The

licenses are usually photocopied and kept on file for state

board inspections.

The North American Pharmacist Licensure Examination

(NAPLEX) is required in all U.S. jurisdictions except California,

which administers its own exam. Most states also require

the pharmacist to pass a drug law examination known as the

Multistate Pharmacy Jurisprudence Examination (MPJE). In

addition, some states require pharmacists to pass a laboratory

or practice exam to ensure that they can prepare and dispense

medications safely and correctly. Today, all state boards of

pharmacy require pharmacists to complete an internship or

externship of approximately 1500 hours before being licensed.

In most states, the pharmacist’s license is renewed every year

by sending a fee plus an update on where he or she has

practiced for the past year. Some state boards of pharmacy

want to know exactly where the pharmacist has practiced

and what types of functions he or she has performed. Most,

if not all, states require the pharmacist to notify the state

board if he or she relocates from his or her private residence,

or changes his or her primary place of practice. In most

states, the pharmacist must report continuing education

credits on the renewal application. Most states require phar-

macists to obtain approximately 15 continuing education (C.E.)

credits per year to obtain relicensure.

License to Operate Pharmacies

Every pharmacy that dispenses drugs must display a terminal

distributor’s license. This license is purchased by the pharmacy

and signed by the pharmacist in charge. The person who

signs the license is ultimately responsible for all activity that

occurs within the pharmacy.

This isn’t to say that other pharmacy employees aren’t

responsible for their activities, but it does imply that the

pharmacist in charge must make every possible attempt to

ensure and prove that all laws, rules, and regulations are

followed in that pharmacy. The government is also concerned


about knowing where to find the licensed pharmacist, so that

he or she can be questioned concerning any illegal activity

related to the pharmacy.

Drugs that require a prescription are considered dangerous

and may be ordered only by a physician (or in some states by

a pharmacist or physician assistant, as well). The written

order for a drug is called a prescription. The law that made

prescriptions a requirement for dangerous drugs is part of

the Food, Drug, and Cosmetic Act. This act was written very

early in the 1900s in response to some awful things that

happened to people because of medicine. For example,

several deaths occurred due to toxic additives. In the 1950s,

amendments were added to the Food, Drug, and Cosmetic Act.

In 1951, the Durham-Humphrey Amendment was passed by

Congress and required prescriptions for dangerous drugs.

This amendment stated exactly what must be on a prescrip-

tion before the medication could be filled for a patient by a

pharmacy. Another amendment, the Kefauver-Harris

Amendment, regulated the pharmaceutical industry, major

manufacturers, and researchers of drugs. This amendment

required that studies be done to prove that a new drug is

safe and effective for human use. It also required sanitary

conditions at the manufacturing facilities. A drug made or

dispensed in a facility or pharmacy that has unsanitary

conditions is called an adulterated drug.

Labeling a filled prescription is also defined by law. The label

that’s created in a pharmacy must be complete and correct.

The label, which is placed on the outside of the container

includes important information. If any information is missing,

the prescription is referred to as misbranded. The labeling

law also applies to labels that come from the manufacturer.

If the required information isn’t there, again, the container is

said to be misbranded. Adulterated or misbranded drugs may

not be dispensed to the public. In addition to lost income,

many pharmacies have lost their licenses to operate because

these laws were broken.


Professional Pharmacy OrganizationsThere are many professional organizations that pharmacists

and technicians can join. It’s very important to become

involved in these organizations since the members are the

ones who become the leaders, and the leaders are the ones

who help provide direction to the profession. The members

of the various pharmacy and technician organizations help

lawmakers to determine policies by presenting an organized

voice to the policymakers.

Each organization has chapters on national, state, and local

levels. These associations may be headed by volunteers, or

they may pay people to run them. The leaders are very

important sources of information. They help to form policy

and law, depending on the desires of their members.

In addition to the organizations listed below, there are several

organizations devoted solely to the professional needs of

pharmacy technicians. You’ll learn about these organizations

later in this study unit.

The American Pharmacists Association (APhA)

The American Pharmacists Association (APhA) was founded in

1852 as The American Pharmaceutical Association. It involves

related organizations at state and local levels so that phar-

macists have a voice in the collective opinion of the organiza-

tion. Members vote on issues at local levels and then send

their opinions to higher levels. The executive director of the

APhA speaks with national politicians whenever a major

issue affecting the pharmacy profession must be addressed.

Members represent many pharmaceutical specialties.

Technicians and other pharmaceutical professionals may

become associate members of APhA.

The American Society of Health-SystemPharmacists (ASHP)

The American Society of Health-System Pharmacists (ASHP)

changed its name from the American Society of Hospital

Pharmacists (ASHP) to reflect the changes in pharmacy and

healthcare such as the mergers of many hospitals and clinics


into larger health systems. The ASHP serves its membership

in the same way that the APhA does and often works closely

with the APhA. The ASHP supports pharmacists who practice

in hospitals, health maintenance organizations, long-term care

facilities, home care, and other components of healthcare

systems. ASHP membership includes those in hospital,

health system, consulting, home healthcare pharmacy, and

HMOs—just about everyone except those who work solely in

retail pharmacy. The majority of members are pharmacists,

but there are associate memberships for others, including

technicians. ASHP provides technician-focused continuing

education, as well as resources and member services for

technicians.

The American Association of Colleges ofPharmacy (AACP) and the Pharmacy TechnicianEducators Council (PTEC)The American Association of Colleges of Pharmacy (AACP)

and the Pharmacy Technician Educators Council (PTEC) are

made up of those who are concerned with the education of

pharmacy professionals. The exchange of ideas among these

members is aimed at the continual improvement of education.

Although they’re small compared to the above organizations,

as educators their voices have an important influence on

pharmacy policy.

The Board of Pharmaceutical Specialties (BPS)In 1973, a task force on pharmaceutical specialties was

developed by the APhA. Out of this task force, the Board of

Pharmaceutical Specialties (BPS) was born. The BPS recog-

nizes specialties in pharmacy practice and sets standards

for certification in these specialties. It evaluates individuals

seeking certification and serves as a coordinating agency for

pharmacy specialties. These specialties include nutrition

support pharmacy and pharmacotherapy, as well as nuclear,

hematology/oncology, and psychiatric pharmacy.


Self-Check 1

At the end of each section of The Profession of Pharmacy, you’ll be asked to pause and

check your understanding of what you’ve just read by completing a “Self-Check” exercise.

Answering these questions will help you review what you’ve studied so far. Please

complete Self-Check 1 now.

1. The entry-level degree required for pharmacists is the _______.

2. Another name for a retail pharmacy is a(n) _______ pharmacy.

3. The largest organization for pharmacists is called the _______.

4. The process of writing orders for medications by physicians is called _______.

5. The process of filling and labeling prescriptions to be given to a patient is called _______.

Check your answers with those on page 45.


PHARMACY TECHNICIANS

BackgroundMany duties that were performed in the past by pharmacists

are now being performed by pharmacy technicians, often

referred to as pharm techs. However, by law, all technicians

must work under the supervision of a pharmacist. Before we

take a look at the general duties of pharmacy technicians,

let’s review the following historical events that highlight the

development of the pharmacy technician profession.

• February 1969—Rhode Island Hospital initiates a formal

technician training program.

• November 1978—The state of Washington initiates

registration-type licensure of pharmacy technicians

graduated from Board-of-Pharmacy–approved training

program.

• June 1979—The Association of Pharmacy Technicians is

founded in California.

• April 1981—The Association of Pharmacy Technicians

becomes a national organization.

• June 1981—The Michigan Pharmacists’ Association

initiates an examination-based certification program for

pharmacy technicians.

• September 1983—ASHP accredits first technician

training program (Thomas Jefferson University Hospital).

• January 1987—Illinois Council of Hospital Pharmacists

begins to develop a technician certification program.

• March 1988—APhA House of Delegates endorses the

term pharmacy technician.

• 1992—Creation of an APhA Task Force for the scope

of Pharmacy Practice Project and a subgroup entitled

“The Focus Panel on Pharmacy Technicians”


• March 1995—ASHP holds the first meeting of a

Technician Advisory Group charged with advising ASHP

on actions, products, and services with respect to the

development of pharmacy technician as a well-defined

occupation in pharmacy practice.

• December 2001—The Pharmacy Technician Certification

Board (PTCB) expands its corporate partnership to

include the National Association of Boards of Pharmacy

(NABP). PTCB’s corporate partners become ASHP, APhA,

ICHP, the Michigan Society of Health-System

Pharmacists, and the NABP.

• July 2006—NPTA invited to join USP and to appoint a

delegate to the US Pharmacopeial Convention, which is

the membership body of the US Pharmacopeia. (The

USP Convention is a unique forum that brings together

medicine, pharmacy, and other healthcare professions

and sciences, industry, government, trade and consumer

groups, as well as international organizations.)

• October 2006—The Pharmacy Technician Certification

Board (PTCB) certified more than 250,000 pharmacy

technicians for its professional designation, Certified

Pharmacy Technician (CPhT).

Duties of Pharmacy TechniciansPharmacy technicians perform a variety of duties in diverse

pharmacy settings. In the next section, we’ll take a look at

several pharmacy settings in which technicians might find

employment. Here, we’ll take an introductory look at the

general duties of a community pharmacy tech. You’ll learn

about the duties of technicians working in many other phar-

macy settings later in your program.

As a pharmacy technician, you’ll have many responsibilities

in addition to filling medication prescriptions. You’ll also

assist the pharmacist in such tasks as ordering, receiving,

stocking, and returning medications and supplies (Figure 3).


We’ll look at all of the duties of a pharmacy technician in

great detail throughout your pharmacy technician program.

In addition to the duties mentioned above, you’ll often interact

with patients, customers, and other healthcare professionals,

whether face-to-face or by phone. It’s important to maintain a

professional demeanor as you interact with patients, customers,

and fellow employees.

Greeting the Customer

Greeting customers is a primary responsibility of many

pharm techs. Greeting someone in person should always be

done in a professional manner. If you’re unfamiliar with the

customer, begin by introducing yourself and asking how you

can be of help. As a pharmacy technician, you’ll need to be

friendly, helpful, and pleasant to each and every customer.

FIGURE 3—Being a pharmacy technician can be a fulfilling career because your careful, accurate workwill be appreciated by both pharmacists and patients.


Customers are often ill or injured themselves or are caring

for loved ones who are ill or have been injured, and it’s helpful

to realize the stress they may be under. Even if you’re not the

outgoing type, a smile and an attitude of cooperation are

appreciated by those you interact with while on the job.

Practice smiling at yourself in the mirror and speaking in a

pleasant, nonthreatening tone of voice. You’ll be well on your

way to greeting the public in a professional manner.

Answering and Screening Telephone Calls

The telephone rings often in a pharmacy. As a technician, you

might be tasked with taking and screening calls within the

pharmacy. The principles that apply to a face-to-face greeting

also apply to a greeting on the telephone: Try to be helpful

and pleasant. Always identify your organization (pharmacy

name, institution department, etc.) and yourself. The following

boxed text contains several examples of professional greetings

that you may use when answering the telephone in a pharmacy.

Common Telephone Greetings Used in a Retail Pharmacy

“Hello, this is Santa Ana Pharmacy, Dianne speaking. How may I

help you?”

“Miller’s Pharmacy. This is Joe Brown, pharmacy technician. May I

help you?”

Common Telephone Greetings Used in a Hospital Pharmacy

“Mercy Hospital Department of Pharmaceutical Care. This is Deb

Baker, pharmacy technician. May I help you?”

“Hello, St. Augustus Pharmacy I.V. Therapy Room. This is John.

How may I help you?”

Telephone Greeting That May Be Used

in a Nursing Home Pharmacy

“Mountain Lake Home Distribution. This is Julietta. How may I

direct your call?”


Pharmacists appreciate technicians who are comfortable with

answering and screening calls. This allows them to concen-

trate on pharmaceutical care that often has life-threatening

consequences. Pharmacists continually look for problems

and errors when filling and checking prescriptions. Constant

interruptions can lead to errors or oversights.

Pharmacy technicians play an important role in the pharmacy

by answering simple questions when they can, transferring

calls to appropriate personnel, and understanding which

calls need to be transferred to the pharmacist.

Whether the question comes by phone, e-mail, or in person,

the rule to follow is that any question that requires medical

counseling or judgment must be answered by a pharmacist.

Any question that doesn’t require professional judgment may

be answered directly by a technician or transferred to an

appropriate staff member. The following sample questions

and statements are commonly encountered in a community

pharmacy. Notice that pharmacists must answer questions

requiring professional judgment. Technicians may answer

other questions.

SAMPLE QUESTION/STATEMENTS PHARMACIST TECHNICIAN

What time is your next delivery? ✓

How much does my prescription cost? ✓

I think I got the wrong medication. ✓

I would like to order a refill on my heart pill. ✓

May I take my pill with meals? ✓

I need a printout for my meds last year. ✓

Is this drug safe to take if I’m pregnant? ✓

My name is spelled incorrectly on the label. ✓

What color is a Motrin 400 mg tablet? ✓

I found some pills in my daughter’s pocket. Can youhelp me identify them? ✓

I can’t open the childproof cap because of my arthritis.May I have the nonchildproof kind? ✓


At times, you may be unsure about which questions to

answer. When in doubt, always ask the pharmacist. It’s a

good idea to mention to the pharmacist any questions about

medications that you’ve answered, even if they were extremely

simple. Pharmacists are always looking for red flags, or warn-

ings of potential problems. Sharing information regarding a

patient’s question may lead the pharmacist to detect a problem

that requires action on his or her part.

Receiving Prescriptions to Be Filled

Although we’ll cover prescriptions in detail later in your pro-

gram, let’s take a brief look at the steps taken when receiving

a prescription to be filled. An original prescription can arrive

at the pharmacy in several ways: the patient might bring it to

the pharmacy, the doctor’s office might phone or fax it, or it

might be sent electronically from the physician’s office to the

pharmacy.

Each new prescription is assigned a unique number that’s

entered into the patient’s profile. If the patient is new to the

pharmacy, he or she will probably be required to complete a

new patient profile form. If the patient has used the pharmacy

in the past, ask if there have been any changes since his or

her last prescription was filled (Figure 4). Always remember

that all patient medical information is protected health

information (PHI) and generally can be disclosed only to

provide treatment, perform routine work within the pharmacy,

and obtain payment. Any patient information gathered

during an intake for a new patient or obtained through

a conversation with a patient is strictly confidential and

should never be repeated outside the work of the pharmacy.

Most pharmacies now use electronic database systems to

store pertinent patient medical information, including pay-

ment information such as insurance prescription plans or

workers’ compensation. With patients’ insurance plans

changing often, it’s important to ask if there have been any

changes in coverage since the patient’s last visit. You’ll learn

much more about handling insurance information later in

your program.


Prescriptions may be refilled if the prescriber has given permis-

sion on the face of the prescription or by later authorization.

Refills might be telephoned by the patient to the pharmacy

through an automated refill system or requested by the patient

or caregiver at the counter. Refills use the same prescription

number assigned to the original prescription.

Filling Prescription Orders in the Drug Delivery orDistribution Process

Pharmacy technicians help pharmacists to fill prescriptions

and physician’s orders. This process is called dispensing in

the retail/outpatient environment and drug distribution in

the institutional environment. Prescription orders are the

drug orders received in an ambulatory environment, and drug

orders received in an institution are called medication orders.

Medication orders are also sometimes referred to as physician’s

orders, though physician’s orders encompass other directions

for treatment such as diet and physical therapy. We’ll look at

the process of filling prescriptions for both ambulatory and

institutional work in much greater detail later in your program.

FIGURE 4—Technicians should greet patients in a warm and courteousmanner and obtain the information necessary to complete the patientprofile as accurately as possible.


For now, here are the basic steps for filling a prescription in

a retail setting:

1. Receive the order.

2. Review the prescription for completeness and correctness.

3. Enter important information into the computer.

4. Prepare the label for the prescription.

5. Retrieve the correct drug from the shelf.

6. Fill the prescription container with the correct quantity

of medication.

7. Place the label on the correct container. (In some states,

this may be done only by a pharmacist.)

8. Double-check all work. (A pharmacist must check the

technician’s work.)

9. Place the filled container in a retail bag for final purchase.

10. Distribute the drug to the patient.

Filing Prescriptions and Reports, Record Keeping,and Billing

As a pharmacy technician, it’s quite likely that you’ll be

responsible for filing any paperwork related to prescriptions,

physician’s orders, and reports. Just as with handling pre-

scriptions, accurately filing paperwork (or saving and moving

electronic files on a computer) is of utmost importance. These

duties will be covered in more detail later in your program.

Ordering and Receiving Medications and Supplies

All pharmacies must have medications and supplies, which

are called inventory, or stock. Medications and related items

are usually ordered for the pharmacy through a wholesaler.

Wholesalers sell drugs at wholesale prices to many different

types of pharmacies. As a pharmacy technician, you’ll play

an important role in inventory management and you should

know how most of the inventory is supplied to your pharmacy.

You’ll learn more about ordering and receiving medications


and supplies later. As you work through this program, keep

in mind that there are job opportunities for technicians in the

wholesale environment.

Returning Drugs to the Wholesaler

Returns are the drugs that must be returned to the whole-

saler or distributor. There are three main reasons why a drug

must be returned to the seller:

1. The drug was ordered in error.

2. The wholesaler filled the order incorrectly.

3. The drug has expired, or is outdated or damaged.

The technician or purchasing coordinator must take care of

this process, including keeping proper records of the returns.

Return policies vary widely from company to company. The

buyer or technician must be aware of the policy of each

company. Handling expired drugs requires attention to

assure safety. There are return goods specialty companies

that handle the disposal of expired drugs. We’ll explore the

correct methods of returning drugs later in your program.

Using Technology

Advances in computer technology have touched every aspect

of our lives, and no place is that more evident than in the

pharmacy. Nearly all pharmacies have computer systems to

handle everything from patient profiles to prescription labels

to insurance claim submissions. Today, telephone calls are

answered using interactive voice response (IVR) systems,

physicians send prescriptions through electronic prescribing

systems, automated machines reduce dispensing tasks, and

robots deliver patient medications from hospital pharmacy

departments to nursing areas. In addition, bar code technology

has changed the way inventory is handled.

Pharmacy technicians should be trained by their employers

to work with the technology used in the pharmacy. However,

even before your first job as a technician, you can take steps

to make your on-the-job training easier. Become familiar with


computer basics—even a keyboarding course will make you a

more efficient pharmacy employee. Later in your program,

you’ll be introduced to basic computer hardware and soft-

ware, as well as software designed for pharmacy-related

activities. You’ll also learn much more about IVR systems,

bar coding, and electronic prescribing.

Professionalism

Just as it’s important to keep yourself and your workspace

clean and neat, it’s important to conduct yourself professionally.

In addition to your knowledge of pharmacy, communication

skills are vitally important to your professional conduct. The

way you present yourself reflects on your entire department.

If you dress, act, and speak professionally, your entire

department will benefit. Patients and customers will have

confidence in both your care and capabilities and those of the

entire pharmacy staff.

Professional dress, or attire, is a must (Figure 5). Many

pharmacies have some sort of dress code. To maintain a

professional image, you should adhere to it. Most pharmacies

require that clean, pressed lab coats or jackets be worn.

White is the most acceptable color, but your pharmacy may

allow other colors or prints. Male employees might be

required to wear a tie.

You may need to have a logo patch on your pocket or sleeve.

A tag with your name and title is also essential. Shoes should

be neat and clean. White walking shoes are best. Some phar-

macies won’t allow sneakers, and most won’t allow jeans.

You may be required to wear scrubs when working in hospitals

and sterile product areas. Scrubs are light cotton shirts and

pants that are laundered and sterilized by the hospital laun-

dry system.

Traditionally, you would greet nonpharmacy personnel by

their title and last name, unless you knew them personally.

For example, Don Smith is Mr. Smith. Mary Weber is Miss,

Mrs., or Ms. Weber. You should try to determine which title a

woman prefers if you don’t already know. This was, and still

is, considered a courteous manner to address patients and

customers. However, with the advent of patient confidentiality


laws, many medical professionals now refer to patients by

first name only so as not to disclose their last names to

bystanders or others in a waiting area. Your pharmacy will

most likely have a policy concerning how you’re expected to

address patients and customers.

Whenever you encounter hard-to-pronounce names, learn the

correct pronunciation even if you have to ask the person. Then

practice it. People appreciate your effort to pronouce their names

properly. This is good public relations. Always call a physician

“Doctor” when you’re at work, even if you know him or her

personally. This type of professional respect is important.

Nonverbal parts of a face-to-face greeting are important as

well. Your genuine concern for patients, customers, and fellow

employees will be reflected in both your facial expression and

body language.

Imagine yourself working in a busy hospital department. An

unhappy staff member arrives at the pharmacy window, and

you’re the one to greet her. She’s upset because, for whatever

reason, a patient’s medication didn’t arrive as expected. She

feels that it’s the fault of the pharmacy, and she’ll probably

be unfriendly. How will you respond?

FIGURE 5—Always wear neat, clean, professional clothing.


Now, imagine yourself in a community pharmacy. A mother

with a very sick and cranky baby has handed you a prescrip-

tion. She demands to know when it will be ready and how

much it will cost. How will you respond? The answer to these

and countless other situations is to respond professionally.

Try to be pleasant and helpful, even if the other person isn’t.

You can lessen the customer’s anger or frustration by under-

standing and showing genuine concern. Use your professional

knowledge to do what you can, and then courteously refer

anything you can’t handle to the pharmacist.

Medication Safety

As a pharmacy staff member, a technician is responsible for

always providing the highest quality of care to the patient.

Attention to detail and careful work reduces errors related to

medication distribution. If all staff members aren’t diligent in

their work, errors can be introduced along the path from

accepting the prescription, to entering information into the

patient profile, dispensing, and delivery to the patient. Errors

can be kept to a minimum by checking and rechecking the

medication to be dispensed before it reaches the patient.

Pharmacists rely on specialized computer programs to alert

them to potential errors, but these software programs are

only as accurate as the information entered by the pharma-

cist or technician.

Career Opportunities for PharmacyTechniciansThere are many job opportunities for pharmacy technicians.

Any workplace that requires a basic knowledge of medications

or dispensing services requires technicians with experience or

a solid education. Hospital, retail, and home healthcare phar-

macies, as well as long-term care facilities, employ technicians

in many areas. They employ technicians to fill and mix med-

ications; take care of billing, paperwork, and record keeping;

handle inventory; perform computer and robot maintenance;

and supervise other personnel.


There are some employment opportunities that aren’t directly

related to the day-to-day tasks you’ve been trained to perform

as a pharmacy technician, but you may be hired to perform

them with your specialized knowledge and on-the-job training.

There are highly specialized fields such as nuclear pharmacy

where radioactive pharmaceuticals are used to diagnose and

treat patients. Trained pharmacy technicians handle and

compound these radioactive materials and control the storage

and delivery of them.

As you continue your studies and gain experience in the field,

you might eventually consider attending college to pursue an

education in teaching. As the field of pharmacy continues to

grow and the requirements for educated technicians become

higher, there will be a demand for more pharmacy technician

training programs. You might find that you’re well-suited to

teach other individuals the skills they’ll need to join this

ever-expanding field of study.

Small pharmaceutical companies may hire educated techni-

cians to join their sales team or to work in research and

development. Other avenues for you to explore when you

finish your education include related fields such as medical

insurance billing and auditing. In addition, you might also

find employment with a company that develops and services

automated distribution systems. There are also companies that

design, develop, and distribute computer software to handle

pharmacy inventory and patient profiles. If you’re confident of

your knowledge and have additional education or experience

that would qualify you to apply for pharmacy-related employ-

ment, by all means do so.

Certification, Registration, Licensure,and EducationRequirements for employment as a pharm tech aren’t as

stringent as they are for pharmacists. In fact, many techs are

still receiving on-the-job training. Changes in the pharmacy

profession have caused an increased demand for educated

technicians.


State boards of pharmacy may impose a variety of different

requirements for pharmacy technician training. You should

contact the state board of pharmacy to obtain the require-

ments applicable to pharmacy technicians in your state.

Pharm techs have become nationally recognized for the

important functions they perform in a pharmacy. In 1995,

the Pharmacy Technician Certification Board (PTCB) sponsored

its first national voluntary certification exam for pharmacy

technicians. Currently, the exam is offered during four, five-

week windows of time at locations throughout each state.

These exams began with input from the Michigan

Pharmacist’s Association and the Illinois Council of Hospital

Pharmacists, who strongly believe in training and testing

qualified pharmacy technicians. Now, the PTCB is the major

force in the writing, grading, and promotion of the exam.

Booklets on how and where to take the exam are available by

calling a state pharmacist’s association.

Some employers require pharm techs to be certified by passing

the PTCB exam. Some chain pharmacies require technicians

to pass an exam developed for that chain. To become an

asset to any pharmacy staff, learn as much as possible about

the duties and responsibilities of a pharmacy technician, and

then take the PTCB exam. If you take the certification exam

voluntarily, it will most likely be accepted if it becomes

required by law. Once certified as a pharmacy technician,

you may use CPhT after your name, which stands for

Certified Pharmacy Technician.

Currently, there’s no uniform national requirement for

education, certification, registration, or licensure of pharmacy

technicians, and the requirements vary widely from state to

state. However, The American Society of Health System

Pharmacists (ASHP), the American Pharmaceutical

Association (APhA), and the Pharmacy Technician Educators

Council (PTEC) are three organizations that have recently

been very active in helping to form a uniform national policy

on pharmacy technicians.

The following table compares the education and licensure

requirements of pharmacists and technicians.


Let’s look at certification, registration, and licensure.

• Certification is a process by which a person proves a certain

level of competence in a particular area. Certification is

considered to be voluntary and isn’t regulated by a

government agency.

• Registration is a process by which a person’s name is

placed on a list of qualified personnel so that the activities

of personnel may be monitored.

• Licensure is government-sponsored permission to practice

a certain occupation after competency has been shown.

With licensure, independent practice is possible.

The ASHP and APhA have agreed to endorse voluntary certifi-

cation for pharmacy technicians. However, many believe that

registration would also be appropriate for technicians since

pharmacists are required to be registered.

While most state boards of pharmacy still require the

licensed pharmacist to be responsible for all activity in the

pharmacy, some do allow the technician to be completely

responsible for his or her duties. The recommendation for

licensure of technicians probably won’t receive endorsement

by national organizations in the near future, but registration

of technicians will probably be necessary.

COMPARISON OF THE EDUCATION AND LICENSURE REQUIREMENTS

PHARMACIST TECHNICIAN

Education/Training 5 to 7 years or more 2 years or fewer

Licensure Mandatory None

Registration Mandatory Some states

Certification For specialty areas only; strictlyvoluntary

Voluntary from government; requiredby many employers

Continuing Education Requirements vary by state; themajority of states require C.E.

Once voluntary passage of certifica-tion is obtained, C.E. required tomaintain certification


Some states require a mandatory training period before a

person becomes a pharmacy technician. Available programs

range in length from less than six weeks to up to two years.

Some pharmacies still prefer to train technicians in their

own manner, but this limits the technician’s employment

possibilities. Any pharmacy would be very fortunate to have

a technician who has had formal education.

The ASHP and the APhA fully support the formal education

and voluntary certification of pharmacy technicians. The

ASHP even has a committee that accredits these programs.

Accredited programs have the committee’s “stamp of approval.”

Accreditation is the process by which a program is accredited,

or approved.

To maintain certification, technicians must complete a

reapplication form every two years and pay the applicable

fees. Most importantly, technicians must obtain (and report

to the PTCB) 20 hours of continuing education every two years

(Figure 6). This education may be received in many ways.

Membership in pharmacy or technician organizations will

help meet these requirements fairly easily. These organizations

produce monthly magazines and sponsor seminars on a variety

of interesting and timely subjects related to pharmacy.

FIGURE 6—Continuingeducation provides manyopportunities to broadenyour knowledge and skillsin the field of pharmacy.


Pharmacy Technician Organizations

The National Pharmacy Technician Association

The National Pharmacy Technician Association (NPTA) is

the world’s largest professional organization established

specifically for pharmacy technicians. The association

supports pharmacy technicians and the professional work

they perform in pharmaceutical care. NPTA provides support

for pharmacy technicians practicing in retail, independent,

hospital, mail order, home care, long-term care, nuclear,

military, correctional facility, formal education, training,

management, and sales. Membership in NPTA includes a

subscription to Today’s Technician magazine as well as

Tech Trends, an electronic newsletter. NPTA offers continuing

education credits and a series of specialization and certifi-

cate programs for pharmacy technicians. The programs

focus on educating pharmacy technicians in specialized

fields of pharmacy practice and the healthcare industry.

The American Association of Pharmacy Technicians

The American Association of Pharmacy Technicians (AAPT) has

been one of the major forces in promoting the acceptance and

appreciation of pharmacy technicians. AAPT provides leadership

and represents the interests of its members to the public as

well as healthcare organizations. AAPT remains a not-for-profit

organization with an all-volunteer staff.

Look for opportunities to join organizations that work to sup-

port the work of pharmacy technicians and provide education

and news related to the growing and ever-changing pharmacy

technician profession.


Self-Check 2

1. _______ is the process supported by the APhA and the ASHP for the demonstration of a certain level of knowledge by pharmacy technicians.

2. A technician who passes the PCTB certification exam will be allowed to use the initials_______ after his or her name.

3. Technicians must report 20 hours’ worth of _______ every two years to maintain certification.

4. _______ is the process by which a person’s name is placed on a list. _______ is recognitionby a government agency that a certain specified level of competence has been reached inorder to practice a profession.

5. The educational council that helps form policy on pharmacy technician education is called the _______.

6. The _______ provides a series of certificate programs offered to pharmacy technicians whowish to further their careers in specialized areas of pharmacy.

7. To this day, the _______ remains a not-for-profit organization with an all-volunteer staff.



AN OVERVIEW OF PHARMACYSETTINGS

Ambulatory PharmaciesThe most familiar type of ambulatory pharmacy is the com-

munity pharmacy. Other types of pharmacies that fall under

the umbrella of ambulatory pharmacies are clinics, mail

order pharmacies, and managed care pharmacies.

The ambulatory pharmacy is a place for patients and their

caregivers to purchase prescription and and nonprescription

medications and to get professional advice concerning those

medications. It often offers blood pressure-, cholesterol-, and

glucose-monitoring services, educational programs, counseling,

and durable medical equipment. Durable medical equipment

(DME) refers to items people need during recovery from an

illness or injury or as they age. DME includes canes, walkers,

wheelchairs, commodes, and even hospital beds.

Prescription drugs (Rx) are those that must be prescribed

by a physician. Prescription drugs require a certain amount

of supervision while being taken by a patient. Prescription

drugs must undergo rigorous testing before they’re approved

by the Food and Drug Administration (FDA) for use, and they

have the potential to cause serious harm or death if used

improperly. Of course, nonprescription drugs may also cause

harm if taken excessively or used for a purpose other than

for what they were intended.

Only physicians and other select healthcare personnel may

prescribe dangerous drugs, and they must do so in a lawful

manner. The dispensing of dangerous drugs is accompanied

by strict laws that must be followed by all pharmacy personnel.

Later in your program, we’ll take a look at several laws that

have been enacted pertaining to prescription drugs.

Over-the-counter (OTC) drugs are those that are available

without a prescription and are generally considered to be

safe for use by anyone who wishes to use them according to

direction. OTC drugs may be sold by any proprietor, or store-

owner, who wishes to sell them. They don’t even have to be


sold in a pharmacy. Even though relatively safe taken by

themselves, OTC drugs may cause reactions in people who

are taking prescription drugs or who have certain medical

conditions.

Some drugs are “in between” prescription and over-the-

counter status. These drugs must be kept behind the counter

and may be given to a patient if the pharmacist determines

that they’re medically necessary. These drugs may not be

sold in a nonpharmacy setting. These types of drugs include

such items as codeine-containing cough syrups and insulin.

Drugs sold in an ambulatory pharmacy are most often meant

to be taken orally or applied topically to the skin, ears, eyes,

or mouth.

Ambulatory pharmacies serve the “walk-in” customer.

Pharmacy staff members of ambulatory pharmacies are often

the first source of medical advice for patients and their care-

givers. Ambulatory pharmacists encounter many people and

provide their prescription needs daily. These pharmacists

must be knowledgeable about a wide variety of drugs and are

now required by laws and regulations to offer counseling, or

prescription advice, to all patients.

The increase in counseling services by community pharma-

cists is partly due to OBRA ’90, a law passed by the federal

government that contained a pharmacy-related clause.

OBRA ’90 (the Omnibus Budget Reconciliation Act of 1990)

recognized that pharmacists could help save healthcare

costs by counseling patients who were receiving government

assistance. It required all patients on welfare programs to be

offered counseling by the pharmacist. Many state boards of

pharmacy decided that this was a good idea and have

required that all patients be offered counseling in a retail

pharmacy, not just those receiving government assistance.

This type of counseling, however, has been done by good

pharmacists for years.

The pharmacist may also offer educational programs that

teach people about their diseases and the medications they

take. Patients who have asthma, high blood pressure, high

cholesterol, and diabetes can find local pharmacies with

programs that cater to them. Ambulatory pharmacists and


technicians need to enjoy interacting with the public. They

need to know how to deal with all sorts of people, whether

they’re patients or customers.

Community Pharmacies

Community pharmacies include large chain drugstores,

smaller privately owned pharmacies, grocery store pharmacies,

and large discount store pharmacies. These pharmacies sell

nonprescription over-the-counter (OTC) medications as well

as prescription medications. They also often sell durable

medical equipment and supplies. Today, most community

pharmacies are located within larger stores that provide

many additional items for sale for the pharmacy customers’

convenience (Figure 7).

Chain drugstores constitute a huge business with revenues

of billions of dollars per year. Unlike small pharmacies in the

past, they’re not owned by the pharmacist but by stockholders

or private business owners. Most chain drugstores have

many commodities to sell besides prescriptions; indeed, the

pharmacy itself is often located at the back of the store, past

all of the greeting cards, groceries, toys, and cosmetics.

FIGURE 7—Community pharmacies carry prescription drugs, over-the-counter medications, first-aid supplies. Many community pharmacies alsocarry many types of durable medical equipment.


Marketing strategies make sure that customers must walk

past enticing merchandise lining the aisles before reaching

the pharmacy in the rear of the store.

Large chains and wholesale clubs have increased buying

power because they can buy large quantities of products,

including medications, which leads to lower prices. Buying

large quantities of products allows them to offer larger

discounts to the public. With the high price of medications,

discounted services are a big attraction for many people.

Two of the most powerful pharmacy organizations are the

National Association of Retail Druggists (NARD) and the

National Association of Chain Drug Stores (NACDS). These

associations often represent the business interests of phar-

macy. They’re also a good source of continuing education for

the technician.

In some states, community pharmacies accept the prescrip-

tion and then forward it to a centralized location to be filled.

The prescription is then delivered to the community pharmacy

to be dispensed to the customer. This system affords the

patient discounted pricing while still providing personalized

services expected from a community pharmacy.

Pharmacy technicians perform both technical and adminis-

trative tasks to support the pharmacist in a community

pharmacy setting. We’ll take a look at the skills and duties

of a community pharmacy technician in great detail as you

progress through your program.

Clinic PharmaciesAnother type of ambulatory pharmacy has developed in

response to the changing healthcare insurance in the

United States. Now there are clinic pharmacies for patients

covered under managed care insurance plans such as health

maintenance organizations (HMOs) and preferred provider

organizations (PPOs). These types of healthcare programs are

meant to support the physician and other healthcare profes-

sionals with guidelines for medical care and prescription

drug use. Since there’s oversight of all patients’ medical

and pharmaceutical care in these managed care settings,

pharmacy technicians might have additional duties related

to collecting and reporting data related to dispensed drugs.


Mail Order Pharmacies

Mail order pharmacies provide many of the services of a

community or clinic pharmacy, including filling prescriptions

and providing information about drugs, their side effects, and

interactions with other medications. A physicians can write a

prescription for a three-month supply so that the patient pays

only one copay instead of three. Mail order facilities use

large automated dispensing machines. Since prescriptions

are filled from a main distribution center and mailed to the

patient, pharmacy technicians in a mail order setting have

little interaction with the customer.

Home Healthcare Pharmacies

Home healthcare is becoming a large segment of ambulatory

pharmacy. With shortened hospital stays and an aging

population, there’s a high demand for many pharmaceutical

services for the homebound patient. In addition to traditional

oral and topical prescriptions, these patients often require

infusion, inhalation, and nutritional therapy. Pharm techs

working in the field of home healthcare will require the skills

of community technicians as well as skills specific to preparing

medications for treatments administered by inhalation and

intraveneous routes.

Institutional PharmaciesInstitutional pharmacies refer to facilities such as hospitals

and rehabilitation centers. Long-term care facilities that

provide acute patient care may also fall into this category.

An institutional pharmacy usually serves only inpatients, or

patients who have been admitted for a certain length of time.

In the past, patients were sometimes admitted to the hospital

for relatively minor ailments. But today, patients in a hospital

are very sick, and those who aren’t considered to be very ill are

often cared for on an outpatient basis or in a rehabilitation

setting. Outpatients receive treatment and recover from ill-

ness or injury at home. Patients requiring continued medical


care might be cared for in skilled care setting. Insurance

companies refuse to pay for patients who stay in a hospital

unless it can be proven that it’s medically necessary to do so.

The pace in an institutional pharmacy is usually fast, as in

retail practice, but the types of medications and the filling

and delivery procedures can be very different. Acute care

facilities provide many different types of medications. There

are the traditional medications administered orally, rectally,

or topically—though in an institutional setting these are

distributed to patients in single-dose packets, rather than in

larger quantities typically provided by an ambulatory phar-

macy. Unit-dose medications are often dispensed via large

automated machines such as the Pyxis and SureMed systems.

This type of unit-of-use delivery is used in most hospital

pharmacies to control costs and raise efficiency.

Pharmacy technicians working in an institutional setting

might also be responsible for preparing medications to be

administered to the patient parenterally, which literally means

that the medications aren’t absorbed in the intestines. These

routes would be by intraveneous, intramuscular injections, or

by inhalation (Figure 8).

FIGURE 8—Pharm techswho work in a hospital’spharmacy department areoften trained to performadditional duties such as preparing drugs for IV therapy.


Some hospital pharm techs are responsible for preparing

chemotherapy drugs. You’ll learn more about the specialized

duties of an institutional pharm tech later in your program.

Long-Term Care FacilitiesPatients residing in long-term care facilities require pharma-

ceutical care that’s different from the care needed by patients

in either ambulatory or acute care hospital settings. These

facilities often care for elderly individuals or chronically ill

patients whose pharmaceutical needs differ from both acute

care patients and ambulatory patients suffering from short-

term illnesses or injuries. However, long-term care patients’

medication needs require supervision by the pharmacy team to

monitor changes and possible drug interactions. There’s a

growing need for pharmacy technicians to support the

expanding area of long-term pharmaceutical care.

Internet PharmaciesMore and more individuals are turning to the Internet for

their medications and medical supplies. They value the privacy

and convenience of shopping online as well as the financial

savings often associated with Internet sales. Many Internet

pharmacies offer patients an opportunity to ask drug-related

questions and obtain answers from pharmacists via the com-

pany’s Web site.

Technicians employed at Internet pharmacies will have duties

similar to those in mail-order distribution facilities, working

with large volumes of medications each day. As with other

Internet sales, phamarceutical sales will continue to grow

and technicians can expect expanding opportunities for

employment in this pharmacy setting.


Self-Check 3

1. List three types of ambulatory pharmacies.

__________________________________________________________

__________________________________________________________

__________________________________________________________

2. List three types of institutional pharmacies.

__________________________________________________________

__________________________________________________________

Questions 3–5: Indicate whether the following statements are True or False.

______ 3. Ambulatory pharmacies dispense both OTC and Rx medications, but do not sell DME,

because the sale of DME requires special permits that vary from state to state.

______ 4. The drawback of Internet pharmacies is the inability of a patient to ask a pharmacist

questions related to his or her prescription medication.

______ 5. Ambulatory pharmacies often offer services such as blood pressure screening and

glucose monitoring.



PHARMACY-RELATED PROFESSIONALS

PharmacologistsPharmacologists are scientists who study how drugs act in the

body. Although pharmacists must study pharmacology in

college, they also take many other courses that prepare them

for their work as pharmacists. In contrast, pharmacologists

focus primarily on the actions and effects of drugs. They study

both the desired effects of drugs as well as their undesirable

effects, or side effects.

While pharmacists learn about drugs that are already known

to be safe for human use, pharmacologists conduct the

research to make sure these drugs are safe and effective.

Pharmacologists often discover new drugs and new uses for

existing drugs. They write textbooks for pharmacy and medical

students, and they test drugs before and during the process

of approval by the FDA.

Pharmacologists are “doctors of pharmacology.” In other

words, they’ve gone through at least eight years of college

study and have earned the designation “Ph.D.” after their

name. They usually work in laboratories, testing new and

existing drugs on different kinds of animals such as guinea

pigs and mice. They may become involved in testing old drugs

for new uses, such as trying antidepressant medications for

migraine headaches. They may also be involved in drug inter-

action studies to test if two or more drugs can be safely used

together. They may conduct these studies on their own or in

cooperation with a university or a pharmaceutical company.

Pharmacologists often publish the results of their research.

Many other professionals are interested in these drug studies,

so pharmacologists write articles for magazines, books, and

journals. Pharmacologists also often have teaching responsi-

bilities at colleges or universities. They may educate many

students, including student doctors, dentists, pharmacists,

optometrists, or veterinarians, about drugs used for medical

therapy.


ToxicologistsThe training and duties of toxicologists are similar to those

of pharmacologists. Toxicologists also have the “Ph.D.” or

“doctor” designation. While the pharmacologist’s primary

focus is the study of how drugs work in the body, the toxi-

cologist studies overdoses and the toxic effects of drugs and

other chemicals. There’s a saying often related in toxicology,

“the dose makes the poison,” which means that every sub-

stance is toxic to some degree; it eventually depends on the

amount. Even water can be toxic to the body in too large a

volume. An overdose of a medication occurs when someone

takes too much of a drug, which then produces ill effects or

even death. The toxicology profession also deals with the

detection of poisons and antidotes for poisons (Figure 9).

FIGURE 9—Toxicologistsoften study the adverseeffects of substances onliving organisms, includ-ing the route, amount,and duration of exposure.


Poison Control SpecialistsPoison control specialists are often pharmacists, nurses, or

pharmacologists who answer questions and give advice at

poison control centers. Poison control centers are usually

associated with a local hospital or institution and are

designed to help the public. They answer questions about

overdoses and accidental ingestion of poisonous substances

such as cleaning products. They provide quick counseling to

callers about what should and shouldn’t be done. There are

many times when frantic parents call with questions about

something their young child has swallowed. The person

answering the phone is knowledgeable about many kinds of

potential problems and must also know exactly where to find

important information when necessary. The situations they

encounter can be a matter of life and death, and they need

to know how to deal with panic. Technicians are a very use-

ful resource in poison control centers.

Allied Health ProfessionalsAllied health professionals include many health professionals

who work regularly with pharmacists and technicians. These

professionals include doctors, nurses, physical therapists,

radiology and x-ray technicians, laboratory technicians,

medical office assistants, and billing specialists, just to

name a few. You should familiarize yourself with the basic

duties of each of these related medical professionals so that

you have an appreciation for their contribution to the health-

care community.


Self-Check 4

1. What does a pharmacologist study?

__________________________________________________________

2. What does a toxicologist study?

__________________________________________________________

3. What do poison control specialists answer questions about?

__________________________________________________________

4. What does “allied health” refer to?

__________________________________________________________


45

Answers

Answers

Self-Check 1

1. Pharm.D.

2. community

3. ASHP (The American Society of Health-System

Professionals)

4. prescribing

5. dispensing

Self-Check 2

1. Voluntary certification

2. CPhT

3. continuing education

4. Registration, Licensure

5. PTEC

6. NPTA (The National Pharmacy Technician Association)

7. AAPT (The American Association of Pharmacy

Technicians)

Self-Check 3

1. Community, clinic, mail order, and managed care

2. Hospital, rehabilitation, long-term acute care

3. False

4. False

5. True

Self-Check Answers46

Self-Check 4

1. A pharmacologist studies how drugs work in the body.

2. A toxicologist studies overdoses of drugs and other toxic

substances and their antidotes.

3. Poison control specialists answer questions about drug

overdoses and accidental ingestion of poisons.

4. Allied health professionals are those persons who are

involved with patient healthcare in some way, including

x-ray technicians, physical therapists, nurses, lab tech-

nicians, medical office assistants, and billing specialists.

084068 1st case

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