pharmacy what it is and how it works third edition kelly william n

Now in its third edition, Pharmacy: What It Is and How It Works continues to provide a comprehensive review of all aspects of pharmacy, from the various roles of pharmacists to particul

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As the first baby boomers have reached 65, more prescriptions than ever are being

dispensed, and the need for properly trained pharmacists is critical Now in its

third edition, Pharmacy: What It Is and How It Works continues to provide

a comprehensive review of all aspects of pharmacy, from the various roles of

pharmacists to particular health care-related events to career planning information

Beginning with a brief historical perspective on the field, the book discusses the many

facets of the pharmacy profession It describes the role of pharmacists in different settings

and provides information ranging from licensing requirements to working conditions,

highlighting the critical role of pharmacists within the heath care system The author

examines the drug use process with sections on distribution, prescribing, dispensing, and

pricing He also discusses the role of pharmacy support personnel An expanded chapter

on informatics explores how pharmacy has evolved through information technology

and automation Additional chapters cover poison control, pharmacy schools, pharmacy

organizations, the drug approval process, and career development

Designed for classroom and professional use, the book contains numerous tools to

facilitate comprehension, including:

Features

• Learning objectives to help readers focus on the goals of each the chapter

• Informative tables and figures summarizing data

• Summary paragraphs tying in salient points

• Discussion questions and exercises to test assimilation

• “Challenges” that place the material in broader context

• Web sites and references to encourage further study

Used in many schools of pharmacy in the United States, Canada, and Europe, this

volume provides a look into the profession that is both broad and deep, supplying a

one-stop reference to a promising career

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What It Is and How It Works

Third Edition

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Essentials of Human Physiology for Pharmacy, Second Edition

Laurie Kelly McCorry

Essentials of Law and Ethics for Pharmacy Technicians, Third Edition

Basic Pharmacology: Understanding Drug Actions and Reactions

Maria A Hernandez and Appu Rathinavelu

Managing Pharmacy Practice: Principles, Strategies, and Systems

Andrew M Peterson

Essential Math and Calculations for Pharmacy Technicians

Indra K Reddy and Mansoor A Khan

Pharmacoethics: A Problem-Based Approach

David A Gettman and Dean Arneson

Pharmaceutical Care: Insights from Community Pharmacists

William N Tindall and Marsha K Millonig

Essentials of Pathophysiology for Pharmacy

Pharmaceutical and Clinical Calculations, Second Edition

Mansoor A Khan and Indra K Reddy

Strauss’s Federal Drug Laws and Examination Review, Fifth Edition Revised

Steven Strauss

Inside Pharmacy: Anatomy of a Profession

Raymond A Gosselin and Jack Robbins

Understanding Medical Terms: A Guide for Pharmacy Practice, Second Edition

Walter F Stanaszek, Mary J Stanaszek, Robert J Holt, and Steven Strauss

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CRC Press is an imprint of the

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PHARMACY

WILLIAM N KELLY

What It Is and How It Works

Third Edition

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this book: May you learn much and enjoy the profession of pharmacy as much as I.

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Contents

Foreword xxix

Preface xxxi

Acknowledgments xxxiii

About.the.Author xxxv

Chapter 1 What.Is.Pharmacy? 1

Introduction 1

Learning.Objectives 1

Pharmacy 1

What.Is.a.Profession? 2

Study.and.Training 2

Measure.of.Success 3

Associations 3

The.Business.of.Pharmacy 3

A.Brief.History.of.Pharmacy 3

Early.Development 3

Community.Pharmacy.in.Early.America 4

Hospital.Pharmacy.in.Early.America 6

What.Is.the.Purpose.of.Pharmacy? 8

What.Controls.Pharmacy? 8

Pharmacy.Licensure 8

State.Pharmacy.Laws 8

State.Pharmacy.Rules.and.Regulations 9

Federal.Laws 9

What.Shapes.Pharmacy? 9

Scope.of.Practice 9

Organizations 9

House.of.Delegates 10

Standards.of.Practice 10

Consensus.Conferences 10

Conference.Proceedings.and.White.Papers 10

Study.Commissions 12

Leadership 12

Peer.Review 14

Pharmacy.Ethics 14

The.Value.of.Pharmacy 16

Summary 16

Discussion.Questions.and.Exercises 17

Challenges 17

Web.Sites.of.Interest 17

References 18

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Chapter 2 The.Pharmacist 21

Introduction 21

Who.Are.Pharmacists? 21

Education.and.Training 22

Formal.Education 22

Internship 23

Licensure 23

Postgraduate.Training 24

Fellowships 25

Specialty.Certification 26

Continuing.Education 27

Postgraduate.Education 28

Characteristics.of.Pharmacists 28

Skills.and.Traits 28

Character.and.Virtues 29

Habits 30

Professionalism 31

What.Pharmacists.Do 32

Quality.Controller 32

Caregiver 33

Clinician 33

Problem.Solver 33

Advisor 34

Teacher 34

Manager,.Supervisor,.and.Leader 34

Owner 35

Researcher 35

Sales.Representative 35

Quality.Reviewer 36

Titles.and.Career.Paths 36

Job.Titles 36

Career.Paths 36

Expectations.of.Pharmacists 36

Supply.and.Demand.for.Pharmacists 37

The.Rewards.of.Being.a.Pharmacist 38

Intrinsic.Factors 38

Extrinsic.Factors 38

Job.Satisfaction 40

Job.Stress 40

Lifelong.Learning.and.Career.Planning 41

Job.Outlook 42

Summary 42

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Challenges 43

References 44

Chapter 3 Pharmacists.and.the.Health.Care.System 47

Introduction 47

Disease.Burden 48

Overview.of.the.Health.Care.System.in.the.United.States 48

Access.to.Care 49

Quality.of.Care 49

Cost 50

Financing 52

Private-Sector.Funding 52

Public-Sector.Funding 53

Paying.Providers 55

Affordable.Health.Care.Act 55

The.Delivery.of.Care 56

Patient-Centered.Care 56

The.Health.Care.Team 57

Prescribing.Authority 57

Patient.Confidentiality 57

The.Place.of.Drugs.in.the.Health.Care.System 58

The.Role.of.Pharmacists.in.the.U.S Health.Care.System 59

Societal.Purpose.of.Pharmacy 60

Pharmacy’s.Destiny 60

Accountable.Care.Organizations.and.the.Medical.Home 60

Opportunity 60

Summary 61

Challenges 61

References 62

Chapter 4 The.Drug.Use.Process 65

Introduction 65

What.Is.the.Drug.Use.Process? 65

Part.I—Drug.Products.and.Distribution 65

The.Drugs 66

Distribution.of.Drugs.from.Pharmaceutical.Manufacturers 68

Distribution.from.Drug.Wholesalers 68

Distribution.from.Distribution.Centers.and.Repackagers 69

Counterfeit.Drugs 69

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Self-Care.and.the.Role.of.OTC.Medication 70

Self-Care 70

Over-the-Counter.Medication 70

Complementary.and.Alternative.Medications 71

Dietary.Supplements 72

Tips.for.Consumers 72

Prescribing.Drugs 72

The.Prescription 73

Parts.of.a.Prescription 73

Types.of.Prescriptions 75

Writing.the.Prescription 75

Drug.Orders 75

Drug.Samples 75

Dispensing 76

Types.of.Retail.Pharmacies 76

Independent.Community.Pharmacies 77

Chain.Store.Pharmacies 77

Mass.Merchandiser.Pharmacies 77

Food.Store.Pharmacies 77

Mail-Order.Pharmacies 77

Outpatient.Pharmacies.in.Hospitals 78

Internet.Pharmacies 78

The.Dispensing.Process 78

Drug.Distribution.in.Organized.Health.Care.Settings 78

Drug.Sales 79

Drugs.Are.Big.Business 79

Why.Costs.for.Drug.Prescriptions.Are.Rising 80

Part.II—Medication.Use 81

Medication.Use.in.the.United.States 81

Drug.Pricing 82

Manufacturers 82

Multitier.Pricing 82

Prices.for.U.S.-Made.Drugs.in.Other.Countries 83

Buyers.and.Sellers.of.Prescription.Drugs 83

Drug.Wholesalers 83

Community.Pharmacy 83

Buying 83

Selling 84

Third-Party.Contracts 84

Medicaid.Patients 84

Medicare.Patients 85

Gross.Margin,.Reimbursement,.and.Making.a.Profit 85

Hospitals 85

Buying 86

Formularies 86

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Selling 86

Reimbursement 87

Managed.Care 87

Buying 87

Selling 88

Part.III—Patients 88

Economic.Value.of.Pharmaceuticals 88

Medication.Administration 88

Compliance.with.Taking.the.Medication.as.Prescribed 89

The.Problem 89

Cost 90

Solutions 90

Quality.Drug.Therapy 91

How.Drug.Therapy.Is.Monitored.and.Reviewed 92

Patient.Outcomes 93

Medication.Safety 93

Side.Effects 93

Adverse.Drug.Reactions 93

Allergic.Drug.Reactions 94

Drug–Drug.Interactions 94

Medication.Errors 94

Home.Medication 94

Control.of.the.Drug.Use.Process 94

Current.Issues.in.the.Drug.Use.Process 95

Nutriceuticals.and.Herbal.Medicines 95

Direct-to-Consumer.Advertising.of.Prescription-Only.Drugs 95

Importing.of.Drugs.from.Other.Countries 95

Rising.Number.of.Prescriptions.and.Not.Enough.Pharmacists 96

Summary 96

Challenges 97

References 97

Chapter 5 Pharmacy.Supportive.Personnel 101

Introduction 101

The.Pharmacy.Technician 102

Employment 102

Why.Pharmacy.Technicians.Are.Important 102

What.Pharmacy.Technicians.Do 103

Functions.of.Pharmacy.Supportive.Personnel 103

What.Pharmacy.Technicians.Need.to.Know 105

How.Pharmacy.Supportive.Personnel.Are.Trained 105

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Technician.Certification.and.Competency 107

Certification 107

Competency 108

Pharmacy.Technician.Organizations 108

Supervision.of.Pharmacy.Technicians 109

Being.a.Professional.Pharmacy.Technician 110

Earnings 111

Working.Conditions 111

Satisfaction 111

Advancement.and.Expanded.Roles 111

Job.Outlook 112

White.Paper.on.Needed.Changes 112

Summary 112

Challenges 113

Additional.Pharmacy.Technician.Texts.and.Resources 114

Acknowledgment 114

References 114

Chapter 6 Pharmacy.Informatics 117

Introduction 117

Information.Technology,.Automation,.and.Informatics 117

Improved.Safety 118

Improved.Patient.Care 119

Improved.Efficiency 119

Improved.Documentation.of.Care 119

Pharmacy.Informatics.in.the.Drug.Use.Process 119

Prescribing 119

E-Prescribing 120

Computerized.Prescriber.Order.Entry 120

Perfection 120

Dispensing 121

Administration 122

Monitoring 122

Education 122

Telepharmacy 123

Summary 124

Automation 124

A.Brief.History 124

Benefits.of.Pharmacy.Automation 124

Challenges.of.Pharmacy.Automation 125

Selecting.Pharmacy.Automation 126

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The.Market.for.Pharmacy.Automation 126

Types.of.Pharmacy.Automation 126

Tablet.Counters 126

Intravenous.Compounders 126

Dispensing.Machines 127

Safety.of.Automated.Devices 128

Automating.the.Pharmacy 129

Freeing.Pharmacists.for.Pharmaceutical.Care 130

The.Future 130

Summary 130

Challenges 131

Blog.Sites.of.Interest 132

Twitter.Addresses 133

Informatic.Pharmacists 133

Medical.Informatics 133

References 133

Chapter 7 Pharmaceutical.Care 137

Introduction 137

Theory.of.Practice 137

A.Brief.History.of.Pharmacy.Practice.in.the.United.States 138

The.Apothecary 138

Drug.Dispensing.and.Distribution 138

Clinical.Pharmacy 139

From.Clinical.Pharmacy.to.Pharmaceutical.Care 140

What.Is.Pharmaceutical.Care? 141

Elements.of.Pharmaceutical.Care 141

Responsible.Provision.of.Care 141

Direct.Provision.of.Care 142

Caring 143

Achieving.Positive.Outcomes 143

Improving.the.Patient’s.Quality.of.Life 144

Resolution.of.Medication-Related.Problems 144

Pharmaceutical.Care.versus.Clinical.Pharmacy 146

Learning.about.Pharmaceutical.Care 146

Providing.Pharmaceutical.Care 149

Standard.Process 149

Selecting.Patients.to.Monitor 150

Identifying,.Resolving,.and.Preventing.Medication-Related Problems 150

Identifying.Medication-Related.Problems 150

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Resolving.Medication-Related.Problems 150

Preventing.Medication-Related.Problems 151

Patient.Problem.List 151

Pharmaceutical.Care.Plan 152

Making.Cents.of.Pharmaceutical.Care 153

Why.Perform.Pharmaceutical.Care? 154

The.Patient 154

Problems.in.the.Drug.Use.Process 155

Drug-Related.Morbidity.and.Mortality 155

Pharmaceutical.Care.Works 156

Patients.Are.Spared.Medication-Related.Morbidity.and Mortality 156

Pharmaceutical.Care.Is.Cost-Effective 157

Patients.Love.Pharmaceutical.Care 157

Other.Health.Care.Practitioners.Love.Pharmaceutical.Care 157

Pharmacy.May.Become.a.True.and.Recognized.Clinical Profession 157

When.Will.All.Pharmacists.Practice.Pharmaceutical.Care? 158

Barriers.and.Challenges 158

The.Enemy.Within 158

Resource-Related.Constraints 158

Lack.of.Support 159

Legal.Barriers 159

Studies.Documenting.the.Value.of.Pharmaceutical.Care 159

Lack.of.Payment 159

Enablers.to.Pharmaceutical.Care 160

Changes.in.Pharmacy.Education 160

Certified.Pharmacy.Technicians 160

Function.Analysis.and.Workflow.Redesign 160

Collaborative.Practice.Agreements 160

Pharmacy.Automation.and.Information.Technology 160

Health.Care.Reform 161

Implementing.Pharmaceutical.Care 161

Changes.the.Profession.Needs.to.Make.Happen 161

Freeing.Pharmacist’s.Time.to.Provide Pharmaceutical Care 161

Leadership.and.Teamwork.in.Implementing Pharmaceutical.Care 162

Pharmaceutical.Care.in.the.Community.and.Hospital Environments 162

Documenting.Pharmaceutical.Care 162

Progress.in.Establishing.Pharmaceutical.Care 163

Emerging.Concepts 164

Summary 164

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Challenges 165

References 165

Chapter 8 Ambulatory.(Community).Pharmacy 169

Introduction 169

Types.of.Community.Pharmacies 170

Independent.Pharmacies 170

Chain.Store.Pharmacies 171

Supermarket.Pharmacies 172

Mass.Merchandiser.Pharmacies 172

Pharmacy.Demographics 173

Patient.Service.and.Satisfaction 173

Pharmaceutical.Care 174

Extent.and.Growth 174

Some.Bright.Spots 175

Disappointments 176

Challenges 176

Catalysts 177

Dispensing.Procedures.to.Advance.Pharmaceutical.Care 177

Accept.the.Prescription.and.Establish.the Pharmacist–Patient Relationship 177

Review.the.Prescription.and.Patient.Information 178

Data.Entry.and.Review.of.the.Patient’s.Medication.Profile 178

Review.of.Insurance.Coverage 178

Retrieve.the.Drug.or.Ingredients.from.Storage 179

Preparation.or.Compounding 179

Label.the.Prescription 180

Health.Literacy 180

Check.for.Proper.Dispensing 181

Drug.Use.Review.and.Dispensing 181

Medication.Delivery.and.Patient.Counseling 181

Whose.Job.Is.It? 183

Avoiding.Errors.in.the.Dispensing.Process 183

Dangerous.Medication.Errors 183

Reasons.for.Medication.Errors 184

Errors.versus.Mistakes 184

Not.Enough.Help 185

Community.Pharmacy.Services 186

Traditional.Services 186

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Prescription.Services 186

Over-the-Counter.Drugs 186

Newer.Services 187

Types.of.New.Services 187

Are.Patients.Using.These.New.Pharmacy.Services? 188

Examples.of.How.New.Services.Are.Offered 188

Payment.for.Community.Pharmacy.Care 188

Community.Pharmacist.Satisfaction 190

Positions.for.Pharmacists.in.Community.Pharmacy 190

Pharmacy.Interns 190

Community.Pharmacy.Residents 191

Staff.Pharmacists 191

Store-Level.and.District.Managers 191

Corporate.Management 191

Pharmacy.Ownership 191

Future.of.Community.Pharmacy.Practice 192

Implementing.Change.in.Community.Pharmacy.Practice 192

Summary 192

Challenges 193

References 194

Chapter 9 Health.System.Pharmacy 199

Introduction 199

Health.Systems 199

Hospitals 200

How.Hospitals.Started 200

Modern.Hospitals 200

Types.of.Hospitals 200

Hospital.Ownership 201

Hospital.Size 201

Hospital.Type 201

Hospital.Statistics 201

Hospital.Accreditation 201

Internal.Organization 202

Medical.Staff.Structure 202

Administrative.Structure 202

Patients 203

Health.Care.Team 203

Pharmacy.Department 204

Mission.of.Pharmacy 204

Control.of.Drugs 204

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Ensuring.Rational.Drug.Use 208

Clinical.Pharmacy.versus.Pharmaceutical.Care 212

Focusing.on.Patients.Needing.the.Most.Help 212

Avoiding.Medication.Misadventures 213

Practice.Models 214

Education.and.Training 214

Pharmacy.Staff 215

Pharmacists 215

Pharmacy.Managers 215

Pharmacy.Supervisors 216

Staff.Pharmacists.and.Clinical.Pharmacists 216

Pharmacy.Supportive.Personnel 217

Accreditation 217

2015.Initiative 218

Checking.on.Progress 218

Job.Satisfaction 218

Summary 219

Challenges 219

References 220

Chapter 10 Managed.Care.Pharmacy 223

Introduction 223

What.Is.Managed.Care? 224

Health.Maintenance.Organizations 226

Preferred.Provider.Organizations 228

Point-of-Service.Plans 228

Standards 229

Accreditation 229

Impact.of.Managed.Care 229

Good.Things/Bad.Things 229

Criticisms.of.Managed.Care 230

Pharmacy.Benefits.Managers 231

Impact.of.Managed.Care.on.Pharmacy 232

Impact.on.Community.Pharmacy 232

Impact.on.Pharmacy.in.Organized.Health.Care.Settings 232

Pharmacy.and.Therapeutics.Committee.and.the.MCO Formulary 233

Medication.Therapy.Management 234

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Selecting.a.Target 235

Developing.Measurement.Criteria 235

Monitoring.Drug.Use 235

Comparing.the.Actual.Drug.Use.versus.the.Ideal 236

Reporting.Results 236

Communicating.Results 236

Adjusting.Criteria.and.Performing.the.Review.Again 236

Education.of.Providers.and.Members 237

Member.Education 237

Provider.Education 237

Ambulatory.Clinics 238

Health.Outcomes 238

Pharmacoeconomic.Studies 239

Patient.Satisfaction 240

Quality.of.Life 241

Delivering.Pharmaceutical.Service.and.Care 241

Information.Systems 241

Prescription.Networks 242

Prescription.Benefit.Design 242

Partnerships 243

Continuity.of.Care 243

Disease.State.Management 244

Reducing.Medication.Errors 245

Being.a.Pharmacist.in.Managed.Care 245

Ethics 245

Opportunities 246

Summary 246

Challenges 247

References 247

Chapter 11 Home.Health.and.Hospice.Care.Pharmacy 251

Introduction 251

Background 251

Statistics 252

Home.Care.Agencies 252

Home.Infusions 253

Providing.Home.Care 253

Patient.Eligibility 254

Standard.Treatment 254

Home.Care.Patients 254

Accreditation 254

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Home.Health.Care.Pharmacy.Services 255

Total.Parenteral.and.Enteral.Nutrition 255

Home.Medical.Equipment 256

Opportunities 256

The.Pharmacist’s.Role.in.Home.Health.Care 256

Pharmacist.Functions 256

Competency.in.Home.Care 257

The.Pharmacist’s.Role.in.Hospice.Care 257

Career.Opportunities 257

Rewards.and.Satisfaction 258

Success.Stories 258

Summary 258

Challenges 259

References 260

Chapter 12 Long-Term.Care.Pharmacy 263

Introduction 263

The.Aging.Population 263

The.Elderly 264

Goals.of.Long-Term.Care 264

Diseases 264

Drug.Therapy.in.the.Elderly 264

Comorbidity 265

Physiological.Changes 265

Enhanced.Effects 266

Medication-Related.Problems 266

Polypharmacy 266

Long-Term.Care.Facilities 267

Nursing.Homes 267

Assisted.Living 267

Continuing.Care.Retirement.Community 267

Statistics 268

Quality.of.Care 268

Financing.Long-Term.Care 269

Consultant.Pharmacy.Practice 269

Settings 269

Federal.Laws 269

Managed.Care 270

Standards.of.Practice 270

Accreditation 270

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Services 270

Provider.Services 270

Consultant.Services 271

Drug.Safety 277

Growth.in.Long-Term.Care 277

Growth.in.Consultant.Pharmacy.Practice 277

Certification 278

Rewards.and.Satisfaction 278

Future.of.Consultant.Pharmacy.Practice 278

Summary 278

Challenges 279

References 280

Chapter 13 Government.Pharmacy 283

Introduction 283

U.S Public.Health.Service 283

Centers.for.Disease.Control.and.Prevention 284

Food.and.Drug.Administration 284

Indian.Health.Service 285

National.Institutes.of.Health 285

Federal.Bureau.of.Prisons 286

Environmental.Protection.Agency.(EPA) 286

Agency.for.Toxic.Substances.and.Disease Registry (ATSDR) 286

Agency.for.Healthcare.Research.and.Quality.(AHRQ) 287

Centers.for.Medicare.and.Medicaid.Services.(CMS) 287

Substance.Abuse.and.Mental.Health.Services Administration (SAMHSA) 287

Other.Areas 287

Commissioned.Corps 287

Department.of.Defense 288

U.S Army 289

U.S Navy 289

U.S Air.Force 290

Opportunities.with.the.DOD 290

Department.of.Veterans.Affairs 290

Consolidated.Mail.Outpatient.Pharmacy.System 291

Ambulatory.Pharmaceutical.Care 291

Independent.Prescribing.Privileges 292

A.Focus.on.Patient.Outcomes 292

Pharmacist.Career.Ladder.Program 293

Satisfaction 293

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Federal.Hospitals 293Drug.Enforcement.Administration.(DEA) 293Working.for.State.Government 294Rewards.and.Satisfaction 294Summary 294Discussion.Questions.and.Exercises 295Challenges 295Web.Sites.of.Interest 296References 296

Chapter 14 Drug.Information.and.Poison.Control 299

Introduction 299Learning.Objectives 299Drug.Information 300Brief.History 300Drug.Information.Centers 300Functions 301Answering.Drug.Information.Questions 301Drug.Evaluations 303Education 303Key.Resources 304Drug.Information.in.the.Pharmaceutical.Industry 304Marketing 304Value 304Drug.Information.Pharmacists 305Rewards.and.Satisfaction 305Future.of.Drug.Information 305Poison.Information 306Brief.History 306Poison.Control.Centers.Today 306Statistics 307Resources 307Cost-Effectiveness 307Answering.Poison.Questions 307Staffing 308Disaster.Planning.and.Terrorism 308The.Poison.Information.Pharmacist 308Rewards.and.Satisfaction 309Future.of.Poison.Information 309Summary 309Discussion.Questions.and.Exercises 309Challenges 310Web.Sites.of.Interest 310References 310

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Chapter 15 Pharmacy.Academia 313

Introduction 313Learning.Objectives 313A.Brief.History 314Schools.and.Colleges.of.Pharmacy 315Statistics 315Accreditation 315Structure 315Pharmacy.Students 316Supply.of.Pharmacists 316Pharmacy.Faculty 318Rank 318Tenure 318Faculty.Responsibilities 319Scholarship.of.Teaching 320Undergraduate.Teaching 321External.Doctor.of.Pharmacy.Degree 324Graduate.Education 324Delivery.Strategies 325Assessment.and.Evaluation 326The.Scholarship.of.Research 327Service 328Faculty.Evaluation 328Job.Satisfaction 329Preparation.for.an.Academic.Career 329Summary 329Discussion.Questions.and.Exercises 329Challenges 330Web.Sites.of.Interest 330References 331

Chapter 16 Pharmacy.Organizations 333

Introduction 333Learning.Objectives 333A.Brief.History 333The.Role.of.Pharmacy.Organizations 335The.Importance.of.Membership 335Pharmacy.Organizations 335Pharmacy.Practitioner.Organizations 336American.College.of.Apothecaries.(ACA) 336American.College.of.Clinical.Pharmacy.(ACCP) 336Academy.of.Managed.Care.Pharmacy.(AMCP) 336American.Pharmacists.Association.(APhA) 337American.Society.of.Consultant.Pharmacists.(ASCP) 337

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American.Society.of.Health-System.Pharmacists.(ASHP) 337International.Academy.of.Compounding.

Pharmacists (IACP) 337National.Community.Pharmacists.Association.(NCPA) 338National.Pharmaceutical.Association.(NPhA) 338Joint.Commission.of.Pharmacy.Practitioners.(JCPP) 338National.Alliance.of.State.Pharmacy

Associations (NASPA) 339Educational.Organizations 339Accreditation.Council.for.Pharmaceutical.Education

(ACPE) 339American.Association.of.Colleges.of.Pharmacy.(AACP) 339American.Foundation.for.Pharmaceutical

Education (AFPE) 339Special.Interest.Organizations 340American.Association.of.Homeopathic.Pharmacists

(AAHP) 340American.Association.of.Pharmaceutical

Scientists (AAPS) 340American.College.of.Veterinary.Pharmacists.(ACVP) 340American.Institute.of.the.History.of.Pharmacy.(AIHP) 340American.Society.for.Automation.on.Pharmacy.(ASAP) 341American.Society.of.Pharmacognosy.(ASP) 341American.Society.for.Clinical.Pharmacology.and

Therapeutics.(ASCPT) 341American.Society.for.Parenteral.and.Enteral.Nutrition

(ASPEN) 341American.Society.for.Pharmacy.Law.(ASPL) 342Association.of.Clinical.Research.Professionals.(ACRP) 342Christian.Pharmacists.Fellowship.International.(CPFI) 342Food.and.Drug.Law.Institute.(FDLI) 342International.Society.for.Pharmaceutical.Engineering

(ISPE) 342International.Society.for.Pharmacoepidemiology.(ISPE) 343International.Society.for.Pharmacoeconomics.and

Outcomes.Research.(ISPOR) 343Parenteral.Drug.Association.(PDA) 343Pediatric.Pharmacy.Advocacy.Group.(PPAG) 343Society.of.Veterinary.Hospital.Pharmacists.(SVHP) 344Pharmacy.Technician.Organizations 344American.Association.of.Pharmacy.Technicians.(AAPT) 344National.Pharmacy.Technician.Association.(NPTA) 344Pharmacy.Technician.Certification.Board.(PTCB) 344Pharmacy.Technician.Educators.Council.(PTEC) 345Pharmacy.Trade.Organizations 345Chain.Drug.Marketing.Association.(CDMA) 345

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Food.Marketing.Institute.(FMI) 345Generic.Pharmaceutical.Association.(GPhA) 345Healthcare.Distribution.Management.Association.(HDMA) 346National.Pharmaceutical.Council.(NPC) 346National.Association.of.Chain.Drug.Stores.(NACDS) 346Pharmaceutical.Care.Management.Association.(PCMA) 346Pharmaceutical.Research.and.Manufacturers.of.America.(PhRMA) 347Other.Organizations 347Board.of.Pharmacy.Specialties.(BPS) 347Commission.for.Certification.in.Geriatric.Pharmacy.

(CCGP) 347International.Pharmaceutical.Federation.(FIP) 347National.Association.of.Boards.of.Pharmacy.(NABP) 348United.States.Pharmacopeia.(USP) 348Should.Pharmacy.Organizations.Change? 348Summary 349Discussion.Questions.and.Exercises 349Challenges 350Web.Sites.of.Interest 350References 350

Chapter 17 How.Drugs.Are.Discovered,.Tested,.and.Approved 351

Introduction 351Learning.Objectives 351A.Brief.History.of.Drug.Discovery.and.Development 352How.New.Drugs.Are.Discovered 352Drug.Discovery 353Plant.Poisons 353Inorganic.Chemicals 353Drugs.from.Animal.Sources.(Biologics) 354Drugs.from.the.Seas 354Screening.for.New.Natural.Drug.Products 354Synthetic.Substitutes 354Biotechnology 355New.Methods.of.Drug.Design 355The.Drug.Researcher 355Pharmaceutical.Chemistry 355Clinical.Pharmacology 355Biopharmaceutics.and.Clinical.Pharmacokinetics 356Clinical.Toxicology 356Pharmaceutics 356Drug.Testing 356Animal.Testing 356Testing.in.Humans 357

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Phase.1.Clinical.Trials 358Phase.2.Clinical.Trials 358Phase.3.Clinical.Testing 358Who.Oversees.Research.on.Investigational.Drugs? 359Drug.Standards 360How.Drugs.Are.Approved.for.Use 360Classification.of.New.Drugs.by.the.FDA 361Chemical.Type 361Potential.Benefit 361Time.and.Cost.of.Drug.Development 361Drug.Manufacturing 363Generic.Drugs 363Drug.Efficacy.Study.Implementation.Drugs 363Homeopathic.Drugs 364Nonprescription.Drugs 364Postmarketing.Surveillance.of.New.Drugs 364Current.Issues.in.Drug.Development 365The.FDA.under.Fire 366Future.of.Drug.Discovery 366Summary 366Discussion.Questions.and.Exercises 367Challenges 367Web.Sites.of.Interest 368References 368

Chapter 18 The.Pharmaceutical.and.Biotechnology.Industry 371

Introduction 371Learning.Objectives 371Pharmaceutical.Companies 371Organizational 372Research.and.Development 373Regulatory.Affairs 373Manufacturing,.Production,.and.Quality.Control 373Medical.Affairs 374Sales.and.Marketing 374Trade.and.Professional.Relations 374Management.and.Administration 374Pharmacists.in.the.Pharmaceutical.Industry 374Working.in.Sales 375Working.in.Marketing 376Working.in.Advertising 376Working.in.Management.and.Administration 376Working.in.Research.and.Development 377Working.in.Medical.Affairs 377Working.as.a.Medical.Science.Liaison 377

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Working.in.Drug.Information 377Working.in.Medical.Writing 378Working.in.Outcomes.Research 378Working.in.Drug.Safety 378Working.in.Manufacturing,.Production,.and.Quality.Control 379Working.in.Trade.and.Professional.Affairs 379Working.in.Regulatory.Affairs 379Moving.from.Practice.to.the.Industry 379Female.Pharmacists.in.the.Pharmaceutical.Industry 380Satisfaction.and.Career.Advancement 380Case.Studies 381Criticisms.of.the.Industry 381Summary 381Discussion.Questions.and.Exercises 382Challenges 382Web.Sites.of.Interest 383References 383

Chapter 19 Other.Opportunities.for.Pharmacists 385

Introduction 385Learning.Objectives 385Alternative.Medicine 385Herbal.Medicines 385Folk.Remedies 386Megavitamins 386Homeopathy 386Use.of.Alternative.Medicines 386Pharmacists.and.Alternative.Medicines 386Association.Management 387Why.Consider.This.Opportunity? 387What.Do.Association.Pharmacists.Do? 387Getting.Started 388Consulting 388Services.and.Clients 388Education 388Public.Speaking 389Professional.Writing.and.Editing 389Consultant.to.the.Pharmaceutical.Industry 389Patient.Self-Care 389Setting.Up.Services.and.Providing.Staffing 390Home.Health.Services 390Proposals 390Fees 390Contracts 390Incorporation 390

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Hire.a.Good.Accountant 391Risks 391Rewards 391Compounding.Pharmacy 391Forensic.Pharmacy 392Information.Technology 392Medical.Education.and.Communications 392Mail-Order.Pharmacy 393Value.of.Mail-Order.Pharmacies 393What.It.Is.Like.Inside.a.Mail-Order.Pharmacy 393Largest.Mail-Order.Pharmacy.Provider 393Commercial.Mail-Order.Pharmacies 394Mail-Order.Practice 394Nuclear.Pharmacy 395Pharmacy.Benefit.Management 396Pharmacy.Law 396Pharmacoeconomics.and.Outcomes.Research 396Pharmacoepidemiology 396Pharmacy.Management 397Veterinary.Pharmacy 397Summary 397Discussion.Questions.and.Exercises 398Challenges 398Web.Sites.of.Interest 399References 399

Chapter 20 Career.Development 403

Introduction 403Learning.Objectives 403A.Career 403Career.Planning 404Common.Mistakes.Students.Make 404Avoiding.Common.Pitfalls 404Finding.Your.Job.as.a.Pharmacist 405More.Education 405More.Training 405Gaining.Employment 405Planning 406Assessment 406Self-Assessment 406Finding.Opportunities.on.Your.Own 407Developing.Your.Curriculum.Vitae 407Putting.It.Together 407Assessing.the.Opportunities 409The.Letter.of.Application 410

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The.Interview 411Changing.Jobs 413Differentiation 413Changing.from.One.Job.to.a.Similar.Job? 414Finding.a.New.Job 414Changing.Careers 414For.More.Information 414Summary 415Discussion.Questions.and.Exercises 415Challenges 416Web.Sites.of.Interest 416References 416

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Foreword

Pharmacy.is.a.wonderful.career;.one.of.the.reasons.is.the.wealth.of.opportunities.available.for.pharmacists Students.trying.to.decide.what.direction.to.pursue.are.well.served.to.seek.guidance.in.Dr William.Kelly’s.book Helpful.information.can.be.used.by.high.school.students,.guidance.counselors,.pharmacy.students,.pharmacy.technician.trainees,.pharmacists,.and.pharmacy.technicians

As.an.academician,.I.especially.appreciate.the.format.of.each.chapter After.a.brief.introduction,.several.learning.objectives.are.listed.to.help.the.reader.concentrate.on.the.main.points.of.the.chapter Informative.tables.and.figures.summarizing.data.are.sprinkled.throughout.almost.all.chapters After.chapter.summary,.the.“Challenges”.and.“Discussion.Questions.and.Exercises”.sections.are.useful.to.actively.engage.the.reader.to.reflect,.research,.and.discuss.important.issues.relevant.to.the.chapter Each.chapter.is.well.referenced.and.includes.the.section.“Web.Sites.of.Interest.”.Dr Kelly.provides.useful.information.on.the.development.of.the.pharmacy.profession,.includ-ing.the.important.topic.of.pharmaceutical.care The.descriptions.of.the.drug.use.pro-cess.and.drug.discovery.and.approval.processes.aid.the.understanding.of.medication.use About.half.of.the.chapters.deal.with.a.specific.career.area.in.detail Pharmacy.technicians will find the chapters devoted to pharmacy supportive personnel and.pharmacy.technology.and.automation.helpful

Faculty.mentors,.professional.advisors,.and.high.school.guidance.counselors.will.find.this.book.to.be.of.great.assistance.in.working.with.students.who.are.consider-ing.pharmacy.as.a.career.or.who.are.trying.to.decide.what.path.to.choose.within.the.career.of.pharmacy Decisions.on.career.choices.are.often.a.struggle.for.students The.availability.of.the.information.in.this.book.and.a.counselor.or.advisor.to.dis-cuss.ideas.with.the.student.would.be.ideal The.exercises.at.the.end.of.each.chapter.can.be.used.to.guide.the.thinking.and.reflection.of.the.student.as.well.as.provide.an.opportunity.for.the.student.actually.to.engage.in.performing.some.research.on.a.pharmacy-related.topic Many.of.the.exercises.could.be.adapted.to.almost.any.health.care.profession

ulty.member.using.the.book.as.a.required.text,.the.book.is.a.great.resource The.book.has.the.potential.to.be.used.as.a.textbook.for.a.pharmacy.orientation.course.or.a.required.or.elective.pharmacy.practice.course.or.as.an.additional.reference.for.any.course.concerning.health.professions Pharmacists.who.serve.as.preceptors.for.a.pharmacy.intern.will.also.find.this.book.of.value Many.preceptors.have.discussions.with.their.interns.about.various.aspects.of.pharmacy.practice,.and.this.volume.would.serve.as.an.anchor.or.frame.for.these.discussions Libraries.in.high.schools,.colleges.and.universities,.or.communities.should.add.this.book.to.their.collections.as.a.refer-ence.on.pharmacy.as.a.profession.and.a.career

Whether.the.reader.is.a.student.or.professional.looking.for.information.or.a.fac-Not.only.is.the.information.helpful.with.making.the.decision.to.pursue.pharmacy,.but.also.it.can.be.used.by.pharmacists.to.assist.in.continuous.professional.develop-ment Involvement.in.pharmacy.professional.organizations.(one.of.the.chapters).is

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essential.for.practicing.pharmacists.for.learning.and.to.provide.service.to.the.pro-vide.improvements.to.patient.care Dr Kelly.has.done.a.thoughtful.and.thorough.job in providing information that will assist future, new, and currently practicing.pharmacists.and.pharmacy.technicians

Pharmacy.is.a.wonderful,.satisfying.health.profession.that.will.continue.to.pro-Lisa A Lawson, PharmD

Dean, Philadelphia College of Pharmacy Barbara H Korberly Professor in Women’s Leadership and Health

Philadelphia, Pennsylvania

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Preface

I.was.8.years.old.when.I.fell.in.love.with.pharmacy In.the.early.1950s,.pharmacy.was.much.different.from.today The.corner.drugstore.was.the.only.place.you.could

go to have your prescription filled My corner drugstore was Barber’s Drugstore The.large.glass.window.in.front.of.the.store.framed.several.“show.globes”—large,.clear.glass.containers.filled.with.colored.water—a.symbol.of.pharmacy Some.of.the.show.globes.sat.in.ornate.stands.or.were.hung.from.the.ceiling The.window.also.had.interesting.displays.of.medical.items.and.the.latest.merchandise.to.purchase It.was.the.job.of.the.pharmacy.intern.to.change.the.displays.each.week

hood asset Barber’s Drugstore had a soda fountain where you could purchase a.Coke:.5¢.for.a.small.one.and.10¢.for.a.large.one

The.corner.drugstore.was.more.than.a.store.and.a.pharmacy It.was.a.neighbor-ters.in.glass.cases You.had.to.ask.for.what.you.wanted After.purchasing.an.item,.you.waited.as.they.pulled.white.paper.off.a.roller,.cut.it.to.size,.and.neatly.wrapped.your.package The.packages.were.always.tied.with.string

There.was.no.self-service.at.the.drugstore Products.were.placed.behind.the.coun-I.was.intrigued.with.the.pharmacist,.Mr Barber He.wore.a.crisp,.clean,.white.druggist’s.jacket;.was.well.respected.in.the.community;.and.was.everyone’s.friend He.always.took.time.to.say.hello.to.everyone.who.came.in.the.store I.asked.Mr Barber so many questions about pharmacy that he finally invited me behind the.counter.to.watch.him.work.with.the.medicine I.loved.what.I.saw—all.of.the.chemi-cals,.bottles,.and.equipment Mr Barber.compounded.most.of.the.medications,.mea-suring.and.mixing.the.ingredients,.pouring.the.medicine.into.tiny.colored.capsules,.and.then.putting.the.capsules.into.small.cardboard.boxes.that.measured.just.2.or.3.inches.wide He.carefully.placed.a.label.on.top.of.each.box

When.Mr Barber.asked.me.to.be.the.delivery.boy.and.to.do.odd.jobs.around.the.pharmacy,.I.was.delighted I.swept.the.sidewalk,.washed.the.front.window,.took.out.the.trash,.and.delivered.medicine.on.my.bike.each.day.after.school When.I.could,.I.watched.Mr Barber.prepare.and.dispense.medication I.could.not.read.the.prescrip-tions.because.they.were.in.Latin

When.I.reflect.on.those.days.and.think.about.what.pharmacy.is.like.today,.I.see.tremendous.change.and.progress Fifty.years.ago,.pharmacists.earned.a.4-year.bach-elor.of.science.degree Today,.they.earn.a.6-year.doctor.of.pharmacy.degree.Back.then,.pharmacists.filled.prescriptions.as.they.were.written.unless.the.pre-scription.was.for.an.obvious.overdose Pharmacists.were.not.to.question.the.doctor.about the.patient.or.the.intended use of the.prescription This.interfered.with.the

“doctor–patient”.relationship Today,.pharmacists.are.taking.responsibility.for.the.patient.and.for.the.outcome.patients.receive.from.their.medication Some.pharmacists.are allowed to prescribe medication, monitor a patient’s therapy, and recommend.initial.therapy.for.patients Some.doctors.request.pharmacists.to.perform.complex.mathematical.calculations.to.dose.critically.sick.patients.with.powerful.drugs

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in some community pharmacies work with patients, the patient’s doctor, and the.patient’s.insurance.company.to.manage.the.patient’s.disease.states Some.commu-nity.pharmacists.are.providing.immunizations.for.patients

There.are.times.I.have.been.impatient.with.the.profession.not.moving.forward.quickly enough That changed when I recently reread the 2009 Whitney Award.address by Paul Abramowitz, PharmD Paul graduated shortly after me from the.University.of.Michigan,.so.he.has.watched.most.of.the.same.changes.I.have.wit-nessed.in.pharmacy

In.explaining.the.metamorphosis.of.the.profession,.Dr Abramowitz.covered.the.period.from.1978.to.2009 I.was.surprised.at.his.documentation.of.so.many.changes,.many.of.which.I.had.forgotten This.long.list.of.accomplishments.changed.my.per-ception.that.the.profession.moves.too.slowly When.I.stood.back.and.looked,.I.could.see.how.many.changes.have.been.made.during.my.time.as.a.pharmacist

Doug Hepler, the chief architect of pharmaceutical care, in his 2010 Whitney.Award address, “A Dream Deferred,” discussed the issue of why, after 30 years,.pharmaceutical.care.has.not.been.universally.implemented Although.the.reasons.for.this.are.diverse,.the.dream.is.not.dead,.just.deferred At.the.end.of.his.address,.Dr Hepler.challenges.new.members.to.accept.the.legacy.built.by.the.many.hard-working.pharmacists.that.preceeded.them.to.keep.pursing.the.dreams.of.the.profession.This.book.is.written.not.only.to.teach.you.about.pharmacy.but.also.to.encourage.you.to.seize.the.vision.and.to.assert.your.professional.autonomy.on.behalf.of.patients.and.for.achieving.the.dream If.you.are.reading.this.book.because.you.are.a.student,.please.know.you.are.about.to.become.a.member.of.one.of.the.greatest.professions,.and.that.we.are.right.on.the.cusp.of.achieving.the.goal.of.becoming.a.true.clinical.profession If.you.are.a.student.pharmacist.reading.this,.I.want.you.to.know.that.I.believe.the.highest.and.most.dramatic.improvements.in.the.profession.are.going.to.occur.during.your.lifetime.as.a.pharmacist My.main.advice.is.to.always.practice.at.the.top.of.your.game,.make.sure.the.patient.is.always.your.primary.focus

Writing.the.book.has.been.a.wonderful.experience This.is.the.third.edition,.and.I.am.still.awed.and.proud.of.the.rich.history.and.accomplishments.of.pharmacy Many.pharmacists.have.worked.hard.to.make.pharmacy.what.it.is.today After.writing.the.book,.I.am.more.fascinated.with.pharmacy.than.ever.before

I.hope.you.enjoy.the.book

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Acknowledgments

I.could.not.have.completed.this.edition.of.Pharmacy: What It Is and How It Works.

without the help of my wife Trudy, who is a superb reference librarian She has.worked.on.all.three.editions,.doing.the.research,.sending.out.the.copyright.permis-sions,.and.proofreading This.book.is.starting.to.feel.like.a.third.child.of.ours.For.this.edition,.several.people.helped.with.revision.of.chapters.where.my.exper-tise.is.weak Thanks.go.to.John.Poikonen,.who,.by.the.time.he.finished.revising,.actually.rewrote.the.chapter.on.pharmacy.automation.and.technology This.is.a.fast-moving.part.of.the.profession,.and.John.is.the.expert.in.this.area Thank.yous.go.to.John.Reinhold,.a.consultant.pharmacist,.who.helped.update.the.chapter.on.long-term.care,.to.Martin.Job.who.helped.with.the.chapter.on.the.pharmaceutical.industry,.and.to.Steve.Caddick.who.added.some.material.on.compounding.pharmacy

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Dr Kelly.is.the.author.of.The Good Pharmacist: Characteristics, Virtues, and

Habits, published.in.2011,.and.Prescribed Medication and the Public Health: Laying

the Foundation for Risk Reduction,.published.in.2006

He lives with his wife, Trudy, in Oldsmar, Florida, and enjoys reading, ming,.golf,.spending.time.with.his.children.and.grandchildren,.stamp.collecting,.and.doing.medical.missionary.work

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1 What Is Pharmacy?

INTRODUCTION

When.asked.about.pharmacy,.most.people.will.say.that.pharmacy.is.a.drugstore.or.a.place.where.you.buy.your.medication Some.people.may.talk.about.pharmacists.(sometimes.druggists.if.the.person.is.over.age.50).and.drugs Most.people.do.not.think.about.pharmacy.as.a.profession

This chapter is a brief introduction to pharmacy It considers three basic.questions:

• What.is.pharmacy?

• What.is.the.purpose.of.pharmacy?

• What.is.the.value.of.pharmacy?

To.address.these.questions,.this.chapter.begins.with.information.on.the.nature.of.pharmacy.as.a.profession It.then.examines.a.brief.history.of.pharmacy,.what.shapes.it,.and.how.it.is.still.evolving.as.a.profession It.ends.with.a.discussion.of.the.value.of.pharmacy

PHARMACY

Pharmacy is a place, a profession, and sometimes a business A pharmacy is

a place where licensed pharmacists oversee the dispensing of medicine after

receiving a valid prescription or drug order written or electronically ted (e- prescribing) by a legal prescriber A pharmacy is not a drugstore Some.

transmit-.businesses.today.do.not.have.pharmacies.but.do.sell.medicines.bought.without.a.prescription (over the counter [OTC] drugs) along with other nonmedical items.such.as.cosmetics,.hardware,.and.magazines A.pharmacy.can.be.a.freestanding

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The.word.medicine.in.defining.pharmacy.(as.a.place).is.preferable.to.the.word.

drug , as is the word pharmacist over the word druggist In today’s society, drug usually.suggests.an.unlawful.drug.or.drug.abuse The.word.medicine.is.more.positive;.its.consumption.usually.improves.health The.word.druggist.is.derived.from.the negative.word.drug;.thus,.druggist.is.a.less-acceptable.term.for.pharmacist.

Pharmacists.are.registered.by.a.board.of.pharmacy.and.therefore.are.designated

registered pharmacists

.(RPh) However,.this.title.is.only.conferred.after.passing.rig-orous.national,.state.practice,.and.law.examinations The.preferred.term.is.licensed

pharmacist

The last part of defining pharmacy (as a place) includes the words legal

pre-scriber This is someone approved by the state legislature to prescribe drugs—a.licensed.physician,.dentist,.or.veterinarian.and.sometimes.a.physician’s.assistant.or.nurse.practitioner,.depending.on.the.state Pharmacists.must.always.be.vigilant.for.bogus.prescriptions.written.by.drug.abusers.who.are.trying.to.obtain.narcotics.and.other.controlled.substances.illegally

Pharmacy.also.means.the.practice.of.pharmacy.as.a.profession To.discuss.this.further,.we.need.to.explore.what.it.means.to.be.a.profession.and.a.member.of.a.pro-fession.(a.professional)

WHAT IS A PROFESSION?

A.profession.is.a.disciplined.group.of.individuals.who.adhere.to.ethical.standards.

and uphold themselves to and are accepted by the public The individuals in the.group.possess.special.knowledge.and.skills.in.a.widely.recognized.body.of.learning.derived.from.research,.education,.and.training.at.a.high.level They.are.prepared.to.exercise.this.knowledge.and.these.skills.in.the.interest.of.others.1

There.are.three.widely.and.commonly.recognized.characteristics.of.a.profession:

S tudy and t raining

Instruction and specialized training provided by a professional college over an.extended.period.of.time.provide.professional.students.with.the.knowledge.and.spe-cific.skills.to.practice.their.profession In.addition,.professional.students.learn.the.history,.attitudes,.and.ethics.of.the.profession They.also.must.accept.the.duties.and.responsibilities.of.being.a.professional Before.being.allowed.to.practice.in.the.pro-fession, the pharmacy graduate must submit to comprehensive national and state.examinations This is to assure the public that the applicant meets the minimum.requirements.to.practice.the.profession

Pharmacists.must.have.2.to.4.years.of.college.education.before.being.accepted.into.a.4-year.doctor.of.pharmacy.(PharmD).program.at.a.college.or.university,.for.a.total.of.6.to.8.years They.must.then.have.1,000.to.2,000.hours.of.internship.training.before.eligibility.to.take.licensure.examinations.on.drugs,.professional.practice,.and.the.law

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M eaSure of S ucceSS

Success.in.the.profession.is.based.on.service.to.the.needs.of.people,.for.which.the.professional.usually.receives.a.fee However,.the.primary.reward.for.a.true.profes-sional is in providing service to the client Note that in health care, the client is.the.patient The.focus.of.a.pharmacist’s.practice.should.be.on.the.patient.and.the.patient’s.needs Counseling.patients.without.financial.compensation.has.been.a.part.of.pharmacy.practice.since.its.beginning

a SSociationS

As a profession, each member works closely with other members and members

of other professions One of the mechanisms for close association is tional,.national,.state,.and.local.societies.composed.of.members.of.the.profession Members.network.with.one.another,.work.on.developing.or.improving.standards.of.the.profession,.and.attend.educational.sessions.to.improve.their.skills.or.learn.new.methods

interna-Pharmacists have many professional organizations at the local, state, national,.and international level (see Chapter 16, “Pharmacy Organizations”) Generously.sharing.information.with.each.other.without.hesitation.is.one.of.the.strengths.of.the.pharmacy.profession

t he B uSineSS of P harMacy

Pharmacy.can.also.be.a.business Pharmacists.who.own.their.own.pharmacy.or.are

managers.of.a.pharmacy.are.businesspeople.as.well.as.practitioners—patient.care.

providers Thus,.they.have.two.goals:.(a).to.care.for.patients.and.(b).to.make.enough.profit.to.stay.in.business

It.is.equally.important.for.pharmacists,.pharmacy.interns,.and.other.pharmacy.workers.in.a.pharmacy.business.to.understand.the.goals.of.the.business.and.to.do.all.they.can.to.help.make.the.business.successful The.more.they.do.this,.the.more.suc-cessful.the.business.will.be,.and.in.turn,.the.more.successful.they.will.become

A BRIEF HISTORY OF PHARMACY

e arly d eveloPMent

.However,.early.humans.most.likely.dis-covered.that.applying.water,.mud,.and.some.plants.soothed.the.skin By.simple.trial.and.error,.humans.slowly.discovered.things.in.nature.that.helped.them

The.earliest.known.record.of.the.art.of.the.apothecary—the.forerunner.of.the.

pharmacist—is.in.Babylon.(today’s.Iraq),.the.jewel.of.ancient.Mesopotamia.(now.Iran.and.previously.Persia) Practitioners.at.this.time.(ca 2600.B.C.).were.priests,.pharmacists,.and.physicians,.all.in.one The.Chinese.also.contributed.to.early.phar-macy.(ca 2000.B.C.)

From this point forward in history, the art of crude medicine preparation and.pharmacy.became.more.refined.by.the.Egyptians,.the.Greeks,.and.the.Romans One

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