CHAPTER ONE

PHARMACY AND HEALTH CARE

Learning Objectives

Understanding of basic history and development of the use of medicines.

Understanding the role of natural drugs.Understanding the role of scientific discovery.Knowledge of major developments in modern

pharmacy.Knowledge of basic environments of

pharmacy practice.Understanding the importance of computers

to pharmacy.

Origins

In earliest times, medicine was based on magic and religion.

Ancient people believed that demons were the cause of illness.

They knew nothing about bacteria and viruses and tended to assume that any medical problem they did not fully understand must, at least in part, be caused by demons.

Ancient Egypt

Imhotep

2640 BC

Imhotep is considered a founder of ancient Egyptian medicine. He performed surgeries and used established methods for examining, diagnosing, and treating patients. Like other healers during this time, spiritual beliefs were an important part of his practice.

Ancient GreeceHippocrates

460 BC

Hippocrates was a Greek philosopher and mathematician born in 460 BC on the island of Cos, Greece. He developed a number of ideas about the way in which the body worked. These ideas were extremely important in the switch from supernatural to natural forms of medicine. Hippocrates’ arguments were based upon principles of science. This was a change in how people viewed health.

He became known as the founder of medicine and was regarded as the greatest physician of his time.

The Greek God of Medicine

Greek Mythology

Asclepius was a Greek hero who later became the Greek god of medicine and healing.

Asclepius used the knowledge of surgery, the use of drugs, love potions and incantations to heal.

According to mythology, Asculapius had a number of children including Hygieia, the goddess of health (from whose name comes the word "hygiene") and Panaceia, the goddess of healing (from whose name comes the word "panacea" for a universal remedy).

Natural World

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

Early man knew that plants and other natural materials had the power to treat or relieve illness.

Sumerians (4000 BC) used about 250 natural medicines derived from plants, many are still used today.

Early Chinese MedicineEmperor Shen Nung

Around 3000 BC, Emperor Shen Nung is said to have begun eating plants and other natural materials to determine which were poisonous and which were beneficial.

One of the first known practitioners of “trial and error” drug testing.

Established 365 “herbs” that could be used for health treatment.

Nature’s Medicine

Malaria– disease caused by a protozoan parasite. Symptoms include fever, chills, nausea, flu-like illness, and, in severe cases, coma, and death.In the 1820’s the first effective treatment for malaria came from the bark of a Peruvian tree, which contains quinine.

The first anesthetic—Indians of the Andes chewed coca leaves for their medicinal effects. When chewed, coca acts as a mild stimulant and suppresses hunger, thirst, pain, and fatigue. In 1884 it was used as a local anesthetic by Carl Koller, aViennese surgeon.

Nature’s Medicine

Nature’s Aspirin— Hippocrates and Dioscorides both wrote about the pain relieving ability of the bark of a white willow tree. In the 1800’s, more than 2,000 years later, the active ingredient in the willow bark, salicylic acid, was made by chemists. This lead to the development of Acetylsalicylic acid (aspirin) and this medication would eventually became the most widely used drug in the world.

The 20th Century

In 1900 the average person lived into their early 50’s (I would be in my last years ) But by the year 2000 the life expectancy rose to age 77.9 in the United States and is getting higher.

The growth of hospitals, advances in treatment of disease, and improved medical technology, better understanding of nutrition and health, and the rapid increase in the number of effective drugs and vaccines have all contributed to this change in improved life experience.

The 20th Century

A major factor in the increased health and life expectancy seen in this century was the dramatic growth in pharmaceutical medicine.

After the success of using salicylic acid from willow bark became and increased interest in creating man-made or synthetic medicine.

Living Longer

In 1929, Alexander Fleming, a doctor and researcher at St. Mary's Hospital in London, England, published a paper on a chemical he called "penicillin", which he had isolated from a mold, Penicillium notatum. Penicillin, Fleming wrote, had prevented the growth of a neighboring colony of germs in the same petri dish.

Dr. Fleming was never able to purify his samples of penicillin, but he became the first person to publish the news of its germ-killing power.

Living Longer

Howard Florey, Ernst Chain and Norman Heatley expanded on Fleming's work in 1938, at Oxford University. They and their staff developed methods for growing, extracting and purifying enough penicillin to prove its value as a drug.

1942, Pfizer Pharmaceutical Company was able to develop a method for mass production of the drug.

A period of intense research and discovery in the field of antibiotics began.

The 20th Century

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

Patenting new discoveries is an important part of pharmaceutical development process since it protects against illegal copying of the discovery.

Leaders and governments had to regulate the use of medicinal drugs because of their effect on the population’s health.

Standards for distribution and use had to be made.

1906 Pure Food and Drug Act

First government attempt to establish consumer protection in the manufacture of food and drugs.

Required all drugs marketed in the United States meet minimal standards of strength, purity, and quality.

Demanded that drug preparations containing morphine have a labeled container indicating the ingredient morphine.

Established first two references– United States Phamacopoeia (USP) and National Formulary (NF)

Tragic Event

A need to revise the 1906 Food and Drug Act arose in 1937 with a tragic incident involving the drug Sulfanilamide. Sulfanilamide was a drug commonly used to treat streptococcal infections. It was produced in tablet and powder forms, but not in a liquid form that would have been easier for children to take. The S.E. Massengill company decided to develop a liquid form of Sulfanilamide. Massengill’s chief chemist and pharmacist, Harold Cole Watkins, found that diethylene glycol was a good medium for the elixir Sulfanilamide. The new substance had a nice appearance and a pleasant taste. What Watkins did not realize was that diethylene glycol, which is more commonly known as antifreeze, is a deadly poison. Unfortunately, the existing law did not require any kind of pharmacological studies proving that a drug is safe, and 240 gallons of Elixir Sulfanilamide went on the market.

Tragic event

The people who took this drug, many of them children being treated for sore throats, suffered tremendously before they eventually died. They were ill between one and three weeks, and experienced stoppage of urine, severe abdominal pain, nausea, vomiting, stupor, and convulsions. The pain was severe and unrelenting, and eventually 107 people died.

Food and Drug Administration (FDA) 1938

Established more specific regulations to prevent tampering with drugs, foods and cosmetics.

All labels must be accurate and include generic names.

All new products must be approved by the FDA before public release.

“Warning” labels must be present on certain preparations.

Prescription and non prescription drugs must be shown to be effective as well as safe.

1970 Controlled Substance Act

Established by the Drug Enforcement Administration (DEA).

Set much tighter controls on specific groups of drugs: those that were being abused by society.

Isolated the abused and addicting drugs into five levels, or schedules, according to their degree of danger.

Demanded security of controlled substances.Set limitations on the use of prescriptions.Each prescriber of these substances had to

register with the DEA and obtain a DEA registration number.

The Drug Industry

The discovery of new drugs requires a major investment of time, research and development.

Bringing new drugs to the market is a long and difficult process in which the vast majority of research does not produce a successful drug.

Once a useful drug is created, it must undergo extensive testing and approval before it can be made available to the public.

The length of time from the beginning of development through testing to FDA approval is often more than 10 years.

Pharmacy Today

A “prescription” drug is one that has been ordered or “prescribed” by a physician or other licensed prescriber to treat a patient.

The pharmacist has consistently been rated as one of the most highly trusted professionals in the U.S.

Pharmacists give patients advice and provide information about the medications they take, both prescribed and over-the-counter.

Pharmacists make recommendations about less expensive generic substitutes for a prescribed drug

Pharmacy Today

Education-- To become a pharmacist, an individual must have earned a Doctor of Pharmacy (PharmD) degree from a college of pharmacy, pass a state licensing exam, and perform an internship working under a licensed pharmacist.

Between 1999 and 2005 the number of new prescriptions filled increased by 24.4% while the number of pharmacists increased by only 14.8%

Economic Trends

From 1970 to 2000, the cost of health care in the U.S. rose over 1,500 percent! And just from 2000-2005 cost rose an estimated 48%, to a total of $2.016 trillion.

Government, industry and consumers are looking for ways to control the costs of care.

Drugs are a small piece of overall health care expenses, but they must be included in the effort to cut costs.

Pharmacy Settings

Primary environments for a pharmacist and pharmacy technician are:

Community pharmaciesHospitalsMail order businessLong-term care facilitiesManaged careHome care

Computers in Pharmacy

Pharmacy use powerful computerized tools that help productivity.

Computerized pharmacy management systems put customer profiles, product, inventory, pricing and other essential information within easy access. They also automate elements like label printing, inventory management, stock reordering, and billing.

Terminology

Synthetic with chemicals, combining simpler chemicals into more complex compounds, creating a new chemical not found in nature as a result.

Pharmacology the study of drugs—their properties, uses, application, and effects.

Materia medica generally pharmacology, but also refers to the drugs in use.

Terminology

Pharmacopeia an authoritative listing of drugs and issues related to their use.

Pharmaceutical of or about drugs: also, a drug product.

Panacea a cure-allAntitoxin a substance that acts against a toxin in the

body; also, a vaccine containing antitoxins, used to fight disease.

Antibiotic a substance which harms or kills microorganisms like bacteria and fungi.

Human genome the complete set of genetic material contained in a human cell.