The Pharmacy Technician The Pharmacy Technician 44thth Edition Edition

Created by Dr. Bisrat Hailemeskel, Associate Professor and Director of Drug Information Services of the School of Pharmacy at Howard University

Copyright © 2010

Morton Publishing and

Perspective Press

The Pharmacy The Pharmacy Technician 4ETechnician 4E

Chapter 1Chapter 1Pharmacy & Health CarePharmacy & Health Care

Chapter OutlineChapter Outline

• Describe the origins of pharmacy Describe the origins of pharmacy • Medicine through the agesMedicine through the ages• Medicine in the 20Medicine in the 20thth Century Century• Pharmacy todayPharmacy today• Computers in pharmacyComputers in pharmacy

OriginsOrigins In earliest times, medicine was based inIn earliest times, medicine was based in

magic and religion.magic and religion.

Sumerians living around 4,000 BC Sumerians living around 4,000 BC believed that believed that demons were the cause of demons were the cause of illnessillness..

In many cultures, physicians were In many cultures, physicians were

priests, and sometimes considered as priests, and sometimes considered as gods.gods.

Ancient OriginsAncient Origins• EgyptianEgyptian

• ImhotepImhotep• Papyrus EbersPapyrus Ebers

• GreekGreek• AesculapiusAesculapius• Hippocrates - Hippocrates - Proposed that disease came from Proposed that disease came from

natural, not supernatural causes.Established the natural, not supernatural causes.Established the Hippocratic OathHippocratic Oath

• ChineseChinese• Shen Nung Penn TsaoShen Nung Penn Tsao

Dioscorides (First century)Dioscorides (First century) Wrote the first standard text/manual on drugs called Wrote the first standard text/manual on drugs called

De Materia Medica.De Materia Medica. Also called Also called PHARMACOPEIAPHARMACOPEIA Published 5 books that covered over 600 plants and Published 5 books that covered over 600 plants and

their healing propertiestheir healing properties Main influence for Western pharmaceutics for over Main influence for Western pharmaceutics for over

1600 years1600 years

Galen (Second century)Galen (Second century) GalenGalen• Established the Established the theory of humors theory of humors which needed to which needed to

be in balance for good healthbe in balance for good health (blood, phlegm, black (blood, phlegm, black bile, yellow bile)bile, yellow bile)

• Scientific approach – education, observation, and Scientific approach – education, observation, and logic which formed the cornerstone for Western logic which formed the cornerstone for Western medicinemedicine

Galenical pharmacy Galenical pharmacy The first pharmacy The first pharmacy Described the process of creating extracts of Described the process of creating extracts of

active medicinals from plantsactive medicinals from plants

Natural MedicineNatural Medicine

Besides looking to the supernatural, ancient man also Besides looking to the supernatural, ancient man also looked to the natural world for medical answers. looked to the natural world for medical answers.

Sources of Drugs Sources of Drugs - Drugs come from various sources - Drugs come from various sources and can be classified as: and can be classified as: NaturalNatural Synthetic: created artificiallySynthetic: created artificially Synthesized: (created artificially but in imitation of Synthesized: (created artificially but in imitation of

naturally occurring substances)naturally occurring substances) Semisynthetic: (containing both natural and Semisynthetic: (containing both natural and

synthetic components)synthetic components)

A Treatment for MalariaA Treatment for Malaria

One of the most deadly disease in world’s historyOne of the most deadly disease in world’s history Still deadly in developing countriesStill deadly in developing countries The first medicine was obtained from the The first medicine was obtained from the Bark of a Bark of a

Peruvian TreePeruvian Tree Cinchona –Cinchona – QuinineQuinine

Also called “Jesuite’s powder”Also called “Jesuite’s powder”

Cocaine, the First Anesthetic Cocaine, the First Anesthetic (numbing agent)(numbing agent)

The Indians of the Andes used to chew The Indians of the Andes used to chew coca leavescoca leaves for for its medicinal effects and also to increase enduranceits medicinal effects and also to increase endurance

CocaineCocaine is the active ingredient in the leavesis the active ingredient in the leaves Carl Koller,Carl Koller, a Viennese surgeon in 1884 used it as the a Viennese surgeon in 1884 used it as the

first local anestheticfirst local anesthetic which revolutionized surgery and which revolutionized surgery and dentistrydentistry

Because of its harmful properties when abused, other Because of its harmful properties when abused, other synthetic substitutes were produced such as synthetic substitutes were produced such as procain procain (Novacain®) (Novacain®) andand LidocaineLidocaine

Natural AspirinNatural Aspirin

The ancient Greek physician The ancient Greek physician HippocratesHippocrates and and Dioscorides Dioscorides both wrote about the pain relieving both wrote about the pain relieving ability of a plantability of a plant

The The bark of a white willow treebark of a white willow tree grew in the grew in the MediterraneanMediterranean

The active ingredient was identified more than 2,000 The active ingredient was identified more than 2,000 years later and called years later and called salicylic acidsalicylic acid

Because of the difficulty of taking salicylic acid by Because of the difficulty of taking salicylic acid by mouth, mouth, acetylsalicylic acid,acetylsalicylic acid, popularly known as popularly known as aspirin,aspirin, was developed was developed synthetically (man-madesynthetically (man-made))

It is the most widely used drug in the worldIt is the most widely used drug in the world

Foxglove – the First Heart Foxglove – the First Heart MedicineMedicine

The British Physician, The British Physician, William Withering William Withering published his published his study of the study of the foxglove plant. 1785foxglove plant. 1785

The active ingredient was The active ingredient was digitalis.digitalis. Widely used for heart failure, arrhythmyiasWidely used for heart failure, arrhythmyias Now is called – Now is called – digoxindigoxin Narrow therapeutic index windowNarrow therapeutic index window

Common Terms Used in PharmacyCommon Terms Used in Pharmacy PharmacologyPharmacology -The study of drugs (from the Greek -The study of drugs (from the Greek

pharmakonpharmakon means drug) means drug) Pharmacognosy Pharmacognosy - The study of physical, chemical, - The study of physical, chemical,

biochemical and biological properties of drugs as biochemical and biological properties of drugs as well as drugs from natural sourceswell as drugs from natural sources

PharmacopeiaPharmacopeia – An official listing of drugs and issues – An official listing of drugs and issues related to their userelated to their use

Pharmaceutical Pharmaceutical – Of or about drugs; also, a drug – Of or about drugs; also, a drug productproduct

PanaceaPanacea – A cure-all (from the Greek – A cure-all (from the Greek panakeia)panakeia) Materia Medica Materia Medica – A dictionary of medicinal plants– A dictionary of medicinal plants

Medicine History Timeline

• Boylston (18th Century) - The first person to administer smallpox vaccine.• Edward Jenner – successfully uses vaccine from milder

cowpox disease to inoculate against smallpox• Serturner (19th Century) - Extracts morphine from opium.• Pasteur (19th Century) – Proved that heat can be used to kill

microorganisms associated with food spoilage. Wide acceptance of the “Germ Theory”

• Banting & Best (20th Century) - Show that insulin lowers blood sugar in dogs and became a known drug to treat diabetes.

The First Antibiotic - PenicillinThe First Antibiotic - Penicillin Alexander FlemingAlexander Fleming discovered a fungus which discovered a fungus which

produces a chemical that kills bacteria.produces a chemical that kills bacteria.

He named it He named it penicillin.penicillin. PenicillinPenicillin was the was the first antibiotic drug.first antibiotic drug.

A pharmaceutical company A pharmaceutical company PfizerPfizer developed a developed a method to mass produce it, and it was used to method to mass produce it, and it was used to save millions of lives during the save millions of lives during the World War eraWorld War era..

Medicine History Timeline• 1950’s

• Watson and Crick: the two people who identified the structure of DNA genetic make up

• 1960 – 1990’s• The birth control pill was introduced• AZT becomes the first drug approved by the FDA

for AIDS treatment.• HAART (Highly Active Antiretroviral Therapy) is

introduced for AIDS treatment .

The 20The 20thth Century Century The average life span in the United States increased The average life span in the United States increased

by over twenty years in the 20th Century.by over twenty years in the 20th Century. 1900 – early 50’s……….. 2000 – 77.9 years1900 – early 50’s……….. 2000 – 77.9 years In the US the life span increased about 64% in the In the US the life span increased about 64% in the

last centurylast century

The 20The 20thth Century Century A major factor in the increased health and life A major factor in the increased health and life

expectancy seen in this century, was the dramatic expectancy seen in this century, was the dramatic growth in pharmaceutical medicine.growth in pharmaceutical medicine.

With the increasing availability of powerful drugs, With the increasing availability of powerful drugs, their their regulationregulation became more important than ever. became more important than ever.

Food and Drug Administration (FDA) Food and Drug Administration (FDA) was was established in response to this need to regulate the established in response to this need to regulate the sale and use of medication in the US.sale and use of medication in the US.

The Food and Drug Administration The Food and Drug Administration (FDA)(FDA)

Monitors drugs Monitors drugs before a drug is marketed before a drug is marketed in the in the United StatesUnited States

Also monitors after the drug is approved for sale to Also monitors after the drug is approved for sale to the public for any adverse effects – called the public for any adverse effects – called Post Post Marketing SurveillanceMarketing Surveillance

RecallsRecalls drugs if they have proven dangerous within drugs if they have proven dangerous within public safetypublic safety

Discovery of New DrugsDiscovery of New Drugs

Pharmaceutical companies spend Pharmaceutical companies spend 1/61/6 of their of their income on research and development.income on research and development.

Bringing drugs to market is a long and difficult Bringing drugs to market is a long and difficult process. process. Thousands of chemicals Thousands of chemicals must be tried.must be tried.

Drugs Drugs must go through an extensive testing and must go through an extensive testing and approval approval process before it can be made available to process before it can be made available to the public.the public.

The length of time from the beginning of The length of time from the beginning of development through testing and to ultimate FDA development through testing and to ultimate FDA approval is often approval is often more than ten yearsmore than ten years..

Pharmacists : Pharmacists : Consistently rated Consistently rated among top trusted among top trusted professionals in US professionals in US

Gallop poll (2008) Gallop poll (2008) 1.1. NursesNurses2.2. PharmacistsPharmacists3.3. Medical DoctorsMedical Doctors4.4. Police OfficersPolice Officers5.5. ClergyClergy

Pharmacy TodayPharmacy Today Prescription Prescription is a written paper for a drug product by a is a written paper for a drug product by a

licensed prescriber to treat a patient.licensed prescriber to treat a patient.

PrescriptionsPrescriptions filled increased by filled increased by 72%72% while the while the number of number of pharmacistspharmacists increased by increased by 15%15% (1997 – (1997 – 2007).2007).

Education and Licensing RequirementsEducation and Licensing Requirements

Pharmacists Education - Pharmacists Education - Doctor of Pharmacy Doctor of Pharmacy (PharmD) degree (PharmD) degree - 6 year program – the only degree - 6 year program – the only degree program to become a pharmacistprogram to become a pharmacist 2 years Pre-Pharmacy (calculus, chemistry, biology) 2 years Pre-Pharmacy (calculus, chemistry, biology) + 4 years of pharmacy education+ 4 years of pharmacy education Pharmacy College Admission Test (PCAT)Pharmacy College Admission Test (PCAT) Completes required Internship or practice setting Completes required Internship or practice setting

experienceexperience Residency in specialty area is optionalResidency in specialty area is optional

Education and Licensing RequirementsEducation and Licensing Requirements Pharmacists LicensingPharmacists Licensing

Required by all states, and overseen by Required by all states, and overseen by board of board of pharmacypharmacy

Pass certification exams: law and national boardsPass certification exams: law and national boards Perform experiential training under aPerform experiential training under a licensed licensed

pharmacistpharmacist Continuing education Continuing education for license renewalfor license renewal

30 hours every two years30 hours every two years States may differ on the type of continuing educationStates may differ on the type of continuing education

Pharmacy SettingsPharmacy Settings Community Pharmacies Community Pharmacies - Over 50,000 community - Over 50,000 community

pharmacies account for approximately half of the pharmacies account for approximately half of the distribution of prescription drugs.distribution of prescription drugs.

Hospitals Hospitals - The next greatest area of employment- The next greatest area of employment Mail order pharmaciesMail order pharmacies sell drugs by mail to patients. sell drugs by mail to patients.

The fastest growing area.The fastest growing area. Long-term care pharmacies Long-term care pharmacies provide drugs to patients provide drugs to patients

in nursing homes and other long-term facilities.in nursing homes and other long-term facilities. Managed care pharmacies Managed care pharmacies provide service to patients provide service to patients

in managed care insurance.in managed care insurance. Home care pharmacies Home care pharmacies provide drugs to patients in provide drugs to patients in

their home.their home.

Economic TrendsEconomic Trends

Computers in PharmacyComputers in Pharmacy Patient ProfilePatient Profile

Allows complete information about patients, Allows complete information about patients, including prescribers, insurer, and medication including prescribers, insurer, and medication history, and allergies; identifies drug interactions history, and allergies; identifies drug interactions for patients taking multiple medicationsfor patients taking multiple medications

BillingBilling Checks policies of third parties such as HMOs and Checks policies of third parties such as HMOs and

insurers; authorizes third party transactions and insurers; authorizes third party transactions and credit cards electronicallycredit cards electronically

Prescriber ProfilePrescriber Profile Includes state identification numbers and Includes state identification numbers and

affiliations with facilities and insurersaffiliations with facilities and insurers LabelingLabeling

Creates label, receipt, customer information, and Creates label, receipt, customer information, and usage instructionsusage instructions

Computers in PharmacyComputers in Pharmacy

PricingPricing Provides prices for medications and possible substitutes, Provides prices for medications and possible substitutes,

automatically updates prices, scans prices from bar codes.automatically updates prices, scans prices from bar codes. Education/CounselingEducation/Counseling

Patient information about drugs, usage, interactions, Patient information about drugs, usage, interactions, allergies, etc.allergies, etc.

Product SelectionProduct Selection Locates items by various means (brand name, generic Locates items by various means (brand name, generic

name, product code, category, supplier, etc.). Gives name, product code, category, supplier, etc.). Gives updates of prices and other product information.updates of prices and other product information.

InventoryInventory Adjusts inventor y as prescriptions are filled, analyzes Adjusts inventor y as prescriptions are filled, analyzes

turnover, produces status reports, automatically re-orders turnover, produces status reports, automatically re-orders based on inventory levels, and generates purchase orders.based on inventory levels, and generates purchase orders.

Terms To RememberTerms To RememberTerms To RememberTerms To Remember

1.1. Antibiotic Antibiotic 2.2. Antitoxin Antitoxin 3.3. Data Data 4.4. Hormones Hormones 5.5. Human genome Human genome 6.6. Materia medica Materia medica

7.7. Panacea Panacea 8.8. Pharmaceutical Pharmaceutical 9.9. Pharmacognosy Pharmacognosy 10.10. Pharmacology Pharmacology 11.11. Pharmacopeia Pharmacopeia 12.12. SyntheticSynthetic