1. The Pharmacy Technician 4 th 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

2. The Pharmacy Technician 4E Chapter 1 Pharmacy & Health Care

3. Chapter Outline Describe the origins of pharmacyDescribe the origins of pharmacy Medicine through the agesMedicine through the ages Medicine in the 20 th CenturyMedicine in the 20 th Century Pharmacy todayPharmacy today Computers in pharmacyComputers in pharmacy

4. Origins In earliest times, medicine was based in magic and religion. In earliest times, medicine was based in magic and religion. Sumerians living around 4,000 BC believed that demons were the cause of illness. Sumerians living around 4,000 BC believed that demons were the cause of illness. In many cultures, physicians were priests, and sometimes considered as gods. In many cultures, physicians were priests, and sometimes considered as gods. E.g. Imhotep (born 3,000 BC) became the Egyptian god of medicine. E.g. Imhotep (born 3,000 BC) became the Egyptian god of medicine.

5. Ancient Origins Hippocrates - Proposed that disease came from natural, not supernatural causes.Hippocrates - Proposed that disease came from natural, not supernatural causes. Established the theory of humors which needed to be imbalanced for good health (blood, phlegm, black bile, yellow bile).Established the theory of humors which needed to be imbalanced for good health (blood, phlegm, black bile, yellow bile). Beyond Hippocrates - an approach to medicine in which natural causes were examined scientifically, gradually grew to become the dominant approach to treating human illness. Beyond Hippocrates - an approach to medicine in which natural causes were examined scientifically, gradually grew to become the dominant approach to treating human illness.

6. Natural Medicine Besides looking to the supernatural, ancient man also looked to the natural world for medical answers. Besides looking to the supernatural, ancient man also looked to the natural world for medical answers. Sources of Drugs - Drugs come from various sources and can be classified as: Sources of Drugs - Drugs come from various sources and can be classified as: Natural. Natural. Synthetic: created artificially. Synthetic: created artificially. Synthesized: (created artificially but in imitation of naturally occurring substances). Synthesized: (created artificially but in imitation of naturally occurring substances). Semisynthetic: (containing both natural and synthetic components). Semisynthetic: (containing both natural and synthetic components).

7. A Treatment for Malaria One of the most deadly disease in world’s history. One of the most deadly disease in world’s history. Still deadly in developing countries. Still deadly in developing countries. The first medicine was obtained from the Bark of a Peruvian Tree. The first medicine was obtained from the Bark of a Peruvian Tree. Cinchona – Quinine Cinchona – Quinine Also called “Jesuit’s powder.” Also called “Jesuit’s powder.” After the Spanish order of priests After the Spanish order of priests who sent it to the new world who sent it to the new world

8. Cocaine, the First Anesthetic (numbing agent) The Indians of the Andes used to chew coca leaves for its medicinal effects and also to increase endurance. The Indians of the Andes used to chew coca leaves for its medicinal effects and also to increase endurance. Cocaine is the active ingredient in the leaves. Cocaine is the active ingredient in the leaves. Carl Koller, a Viennese surgeon in 1884 used it as the first local anesthetic which revolutionized surgery and dentistry. Carl Koller, a Viennese surgeon in 1884 used it as the first local anesthetic which revolutionized surgery and dentistry. Because of its harmful properties when abused, other synthetic substitutes were procain (Novacain®) and Lidocain. Because of its harmful properties when abused, other synthetic substitutes were procain (Novacain®) and Lidocain.

9. Natural Aspirin The ancient Greek physician Hippocrates and Dioscorides both wrote about the pain relieving ability of a plant. The ancient Greek physician Hippocrates and Dioscorides both wrote about the pain relieving ability of a plant. The bark of a white willow tree grew in the Mediterranean. The bark of a white willow tree grew in the Mediterranean. The active ingredient was identified more than 2,000 years later and called salicylic acid. The active ingredient was identified more than 2,000 years later and called salicylic acid. Because of the difficulty of taking salicylic acid by mouth, acetylsalicylic acid, popularly known as aspirin, was developed synthetically (man-made). Because of the difficulty of taking salicylic acid by mouth, acetylsalicylic acid, popularly known as aspirin, was developed synthetically (man-made). It is the most widely used drug in the world. It is the most widely used drug in the world.

10. Common Terms Used in Pharmacy Pharmacology -The study of drugs (from the Greek pharmakon means drug). Pharmacology -The study of drugs (from the Greek pharmakon means drug). Pharmacognosy - The study of physical, chemical, biochemical and biological properties of drugs as well as drugs from natural sources. Pharmacognosy - The study of physical, chemical, biochemical and biological properties of drugs as well as drugs from natural sources. Pharmacopeia – An official listing of drugs and issues related to their use. Pharmacopeia – An official listing of drugs and issues related to their use. Pharmaceutical – Of or about drugs; also, a drug product. Pharmaceutical – Of or about drugs; also, a drug product. Panacea – A cure-all (from the Greek panakeia). Panacea – A cure-all (from the Greek panakeia). Materia Medica – A dictionary of medicinal plants. Materia Medica – A dictionary of medicinal plants.

11. Dioscorides (First century) Wrote the first standard text/manual on drugs called De Materia Medica. Wrote the first standard text/manual on drugs called De Materia Medica. Also called PHARMACOPOEIA. Also called PHARMACOPOEIA. Published 6 books that covered over 600 plants and their healing properties. Published 6 books that covered over 600 plants and their healing properties. His book was used for 1500 years. His book was used for 1500 years.

12. Galen (Second century) Galen Galen Conducted animal experiments. Conducted animal experiments. Produced a systematic classification of drugs for treatment of disease. Produced a systematic classification of drugs for treatment of disease. Galenical pharmacy Galenical pharmacy The first pharmacy. The first pharmacy. Described the process of creating extracts of active medicinals from plants. Described the process of creating extracts of active medicinals from plants.

13. Foxglove – the First Heart Medicine The British Physician, William Withering published his study of the foxglove plant. The British Physician, William Withering published his study of the foxglove plant. The active ingredient was digitalis. The active ingredient was digitalis. Widely used for heart failure. Widely used for heart failure. Now is called – digoxin. Now is called – digoxin. Former President Bush was on digoxin for a racing heart called atrial fibrillation. Former President Bush was on digoxin for a racing heart called atrial fibrillation.

14. Ancient Origins Boylston (18 th Century) - The first person to administer smallpox vaccine. Serturner (19 th Century) - Extracts morphine from opium. Pasteur (19the Century) - was the first scientist who Showed that heat can be used to kill microorganisms associated with food spoilage. Banting & Best (20 th Century) - Show that insulin lowers blood sugar in dogs and became a known drug to treat diabetes.

15. The First Antibiotic - Penicillin Alexander Fleming discovered a fungus which produces a chemical that kills bacteria. Alexander Fleming discovered a fungus which produces a chemical that kills bacteria. He named it penicillin. He named it penicillin. Penicillin was the first antibiotic drug. Penicillin was the first antibiotic drug. A pharmaceutical company Pfizer developed a method to mass produce it, and it was used to save millions of lives during the World War era. A pharmaceutical company Pfizer developed a method to mass produce it, and it was used to save millions of lives during the World War era.

16. Ancient Origins 1950’s Watson and Crick: are 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.

17. The 20 th Century The average life span in the United States increased by over twenty years in the 20th Century. The average life span in the United States increased by over twenty years in the 20th Century. 1900 – early 50’s……….. 2000 – 77.9 years. 1900 – early 50’s……….. 2000 – 77.9 years.

18. The 20 th Century A major factor in the increased health and life expectancy seen in this century, was the dramatic growth in pharmaceutical medicine. A major factor in the increased health and life expectancy seen in this century, was the dramatic growth in pharmaceutical medicine. With the increasing availability of powerful drugs, their regulation became more important than ever. With the increasing availability of powerful drugs, their regulation became more important than ever. Food and Drug Administration (FDA) was established in response to this need to regulate the sale and use of medication in the US. Food and Drug Administration (FDA) was established in response to this need to regulate the sale and use of medication in the US.

19. The Food and Drug Administration (FDA) Monitors drugs before a drug is marketed in the United States Monitors drugs before a drug is marketed in the United States Also monitors after the drug is approved for sale to the public for any adverse effects – called Post Marketing Surveillance Also monitors after the drug is approved for sale to the public for any adverse effects – called Post Marketing Surveillance Recalls drugs if they have proven dangerous within public safety Recalls drugs if they have proven dangerous within public safety

20. Discovery of New Drugs Pharmaceutical companies spend 1/6 of their income on research and development. Pharmaceutical companies spend 1/6 of their income on research and development. Bringing drugs to market is a long and difficult process. Thousands of chemicals must be tried. Bringing drugs to market is a long and difficult process. Thousands of chemicals must be tried. Drugs must go through an extensive testing and approval process before it can be made available to the public. Drugs must go through an extensive testing and approval process before it can be made available to the public. The length of time from the beginning of development through testing and to ultimate FDA approval is often more than ten years. The length of time from the beginning of development through testing and to ultimate FDA approval is often more than ten years.

21. OBRA ’90 requires that pharmacist counsel all Medicaid patients.

22. Pharmacy Today Prescription is a written paper for a drug product by a licensed prescriber to treat a patient. Prescription is a written paper for a drug product by a licensed prescriber to treat a patient. Prescriptions filled increased by 27% while the number of pharmacists increased by 15% (1997 – 2007). Prescriptions filled increased by 27% while the number of pharmacists increased by 15% (1997 – 2007).

23. Education and Licensing Requirements Pharmacists Education - Doctor of Pharmacy (PharmD) degree - 6 year program – the only degree program to become a pharmacist. Pharmacists Education - Doctor of Pharmacy (PharmD) degree - 6 year program – the only degree program to become a pharmacist.  2 years Pre-Pharmacy (calculus, chemistry, biology)  + 4 years of pharmacy education.  Pharmacy College Admission Test (PCAT).  Completes required Internship or practice setting experience. Residency in specialty area is optional. Residency in specialty area is optional.

24. Education and Licensing Requirements Pharmacists Licensing Pharmacists Licensing Required by all states. Required by all states. Overseen by board of pharmacy/governing body Overseen by board of pharmacy/governing body To become a pharmacist involves: To become a pharmacist involves: Graduation from an accredited college of pharmacy. Graduation from an accredited college of pharmacy. Passing a state board certification examination. Passing a state board certification examination. Perform experiential training under a licensed pharmacist. Perform experiential training under a licensed pharmacist. Continuing education for license renewal. Continuing education for license renewal.

25. The Top 5 trusted professions in the United States Gallop poll (2008) 1. Nurses 2. Pharmacists 3. Medical Doctors 4. Police Officers 5. Clergy

26. Pharmacy Settings Community Pharmacies - Over 50,000 community pharmacies account for half of the sales of prescription drugs. Community Pharmacies - Over 50,000 community pharmacies account for half of the sales of prescription drugs. Hospitals - The next greatest area of employment Hospitals - The next greatest area of employment Mail order pharmacies sell drugs by mail to patients. Mail order pharmacies sell drugs by mail to patients. The fastest growing area. The fastest growing area. Long-term care pharmacies provide drugs to patients in nursing homes and other long-term facilities. Long-term care pharmacies provide drugs to patients in nursing homes and other long-term facilities. Managed care pharmacies provide service to patients in managed care insurance. Managed care pharmacies provide service to patients in managed care insurance. Home care pharmacies provide drugs to patients in their home. Home care pharmacies provide drugs to patients in their home.

27. Economic Trends

28. Computers in Pharmacy Patient Profile Patient Profile Allows complete information about patients, including prescribers, insurer, and medication history, and allergies; identifies drug interactions for patients taking multiple medications. Allows complete information about patients, including prescribers, insurer, and medication history, and allergies; identifies drug interactions for patients taking multiple medications. Billing Billing Checks policies of third parties such as HMOs and insurers; authorizes third party transactions and credit cards electronically. Checks policies of third parties such as HMOs and insurers; authorizes third party transactions and credit cards electronically. Prescriber Profile Prescriber Profile Includes state identification numbers and affiliations with facilities and insurers. Includes state identification numbers and affiliations with facilities and insurers. Labeling Labeling Creates label, receipt, customer information, and usage instructions. Creates label, receipt, customer information, and usage instructions.

29. Computers in Pharmacy Pricing Pricing Provides prices for medications and possible substitutes, automatically updates prices, scans prices from bar codes. Provides prices for medications and possible substitutes, automatically updates prices, scans prices from bar codes. Education/Counseling Education/Counseling Patient information about drugs, usage, interactions, allergies, etc. Patient information about drugs, usage, interactions, allergies, etc. Product Selection Product Selection Locates items by various means (brand name, generic name, product code, category, supplier, etc.). Gives updates of prices and other product information. Locates items by various means (brand name, generic name, product code, category, supplier, etc.). Gives updates of prices and other product information. Inventory Inventory Adjusts inventor y as prescriptions are filled, analyzes turnover, produces status reports, automatically re-orders based on inventory levels, and generates purchase orders. Adjusts inventor y as prescriptions are filled, analyzes turnover, produces status reports, automatically re-orders based on inventory levels, and generates purchase orders.

30. Terms To Remember 1. Antibiotic 2. Antitoxin 3. Data 4. Hormones 5. Human genome 6. Materia medica 7. Panacea 8. Pharmaceutical 9. Pharmacognosy 10. Pharmacology 11. Pharmacopeia 12. Synthetic