Pharmacy
For other uses, see Pharmacy (disambiguation).
sponsibilities, the pharma offered general medical adPharmacy is the science and technique of preparing vice and a range of services that are now performed
solely by other specialist practitioners, such as surgery
and midwifery. The pharma (as it was referred to) often
operated through a retail shop which, in addition to ingredients for medicines, sold tobacco and patent medicines.
Often the place that did this was called an apothecary
and several languages have this as the dominant term,
though their practices are more akin to a modern pharmacy, in English the term apothecary would today be
seen as outdated or only approproriate if herbal remedies
were on offer to a large extent. The pharmas also used
many other herbs not listed. The Greek word Pharmakeia
(Greek: φαρμακεία) derives from pharmakon (φάρμακον), meaning “drug”, “medicine” (or “poison”).[1][n 1]
In its investigation of herbal and chemical ingredients, the
work of the pharma may be regarded as a precursor of the
modern sciences of chemistry and pharmacology, prior to
the formulation of the scientific method.
1 Disciplines
The Apothecary or The Chemist by Gabriël Metsu (c. 1651–67)
and dispensing drugs. It is a health profession that links
health sciences with chemical sciences and aims to ensure
the safe and effective use of pharmaceutical drugs.
The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related
to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are the experts on drug
therapy and are the primary health professionals who optimize use of medication for the benefit of the patients.
An establishment in which pharmacy (in the first sense)
is practiced is called a pharmacy (this term is more
common in the United States) or a chemist’s (which is
more common in Great Britain). In the United States
and Canada, drugstores commonly sell drugs, as well
as miscellaneous items such as confectionery, cosmetics,
office supplies, and magazines and occasionally refreshPharmacy, tacuinum sanitatis casanatensis (14th century)
ments and groceries.
The word pharmacy is derived from its root word pharma The field of pharmacy can generally be divided into three
which was a term used since the 15th–17th centuries. primary disciplines:
However, the original Greek roots from pharmakos imply sorcery or even poison. In addition to pharma re• Pharmaceutics
1
2
3 HISTORY
• Medicinal Chemistry and Pharmacognosy
• Pharmacy Practice
The boundaries between these disciplines and with other
sciences, such as biochemistry, are not always clearcut. Often, collaborative teams from various disciplines
(pharmacists and other scientists) work together toward
the introduction of new therapeutics and methods for patient care. However, pharmacy is not a basic or biomedical science in its typical form. Medicinal chemistry is
also a distinct branch of synthetic chemistry combining
pharmacology, organic chemistry, and chemical biology.
Pharmacology is sometimes considered as the 4th discipline of pharmacy. Although pharmacology is essential
to the study of pharmacy, it is not specific to pharmacy.
Both disciplines are distinct.Those who wish to practice
both pharmacy (patient oriented) and pharmacology (a
biomedical science requiring the scientific method) receive separate training and degrees unique to either discipline.
In some cases, the representative body is also the registering body, which is responsible for the regulation and
ethics of the profession.
In the United States, specializations in pharmacy practice recognized by the Board of Pharmaceutical Specialties include: cardiovascular, infectious disease, oncology,
pharmacotherapy, nuclear, nutrition, and psychiatry.[4]
The Commission for Certification in Geriatric Pharmacy certifies pharmacists in geriatric pharmacy practice. The American Board of Applied Toxicology certifies pharmacists and other medical professionals in applied toxicology.
2.2 Pharmacy technicians
Main article: Pharmacy technician
Pharmacy technicians support the work of pharmacists
and other health professionals by performing a variety
of pharmacy related functions, including dispensing prescription drugs and other medical devices to patients and
Pharmacoinformatics is considered another new disciinstructing on their use. They may also perform adminispline, for systematic drug discovery and development
trative duties in pharmaceutical practice, such as reviewwith efficiency and safety.
ing prescription requests with medics’s offices and insurance companies to ensure correct medications are provided and payment is received.
2
Professionals
The World Health Organization estimates that there are
at least 2.6 million pharmacists and other pharmaceutical
personnel worldwide.[3]
2.1
Pharmacists
Main article: Pharmacist
Pharmacists are healthcare professionals with specialised
education and training who perform various roles to ensure optimal health outcomes for their patients through
the quality use of medicines. Pharmacists may also
be small-business proprietors, owning the pharmacy in
which they practice. Since pharmacists know about the
mode of action of a particular drug, and its metabolism
and physiological effects on the human body in great detail, they play an important role in optimisation of a drug
treatment for an individual.
A Pharmacy Technician in the UK is considered a health
care professional and often does not work under the direct supervision of a pharmacist (if employed in a hospital pharmacy) but instead is supervised and managed by
other senior pharmacy technicians. In the UK the role of
a PhT has grown and responsibility has been passed on to
them to manage the pharmacy department and specialised
areas in pharmacy practice allowing pharmacists the time
to specialise in their expert field as medication consultants spending more time working with patients and in
research. A pharmacy technician once qualified has to
register as a professional on the General Pharmaceutical
Council (GPhC) register. The GPhC is the governing
body for pharmacy health care professionals and this is
who regulates the practice of pharmacists and pharmacy
technicians.
In the US, pharmacy technicians perform their duties under supervision of pharmacists. Although they may perform, under supervision, most dispensing, compounding
and other tasks, they are not generally allowed to perform
the role of counseling patients on the proper use of their
medications.
Pharmacists are represented internationally by the
International Pharmaceutical Federation (FIP). They are
represented at the national level by professional organisations such as the Royal Pharmaceutical Society in 3 History
the UK, the Pharmaceutical Society of Australia (PSA),
the Canadian Pharmacists Association (CPhA), and the Main articles: History of pharmacy and List of pharmaAmerican Pharmacists Association (APhA), See also: cists
List of pharmacy associations.
The earliest known compilation of medicinal substances
3
writing a five volume book in his native Greek Περί
ύλης ιατρικής in the 1st century AD. The Latin translation De Materia Medica (Concerning medical substances)
was used a basis for many medieval texts, and was built
upon by many middle eastern scientists during the Islamic
Golden Age. The title coined the term materia medica.
The earliest known Chinese manual on materia medica is the Shennong Bencao Jing (The Divine Farmer’s
Herb-Root Classic), dating back to the 1st century AD. It
was compiled during the Han dynasty and was attributed
to the mythical Shennong. Earlier literature included
lists of prescriptions for specific ailments, exemplified by
a manuscript “Recipes for 52 Ailments”, found in the
Mawangdui tomb, sealed in 168 BC. Further details on
Chinese pharmacy can be found in the Pharmacy in China
article.
Physician and Pharmacist, illustration from Medicinarius
(1505) by Hieronymus Brunschwig.
was the Sushruta Samhita, an Indian Ayurvedic treatise
attributed to Sushruta in the 6th century BC. However,
the earliest text as preserved dates to the 3rd or 4th century AD.
In Japan, at the end of the Asuka period (538–710) and
the early Nara period (710–794), the men who fulfilled
roles similar to those of modern pharmacists were highly
respected. The place of pharmacists in society was expressly defined in the Taihō Code (701) and re-stated
in the Yōrō Code (718). Ranked positions in the preHeian Imperial court were established; and this organizational structure remained largely intact until the Meiji
Restoration (1868). In this highly stable hierarchy, the
pharmacists—and even pharmacist assistants—were assigned status superior to all others in health-related fields
such as physicians and acupuncturists. In the Imperial
household, the pharmacist was even ranked above the two
personal physicians of the Emperor.[7]
Many Sumerian (late 6th millennium BC – early 2nd millennium BC) cuneiform clay tablets record prescriptions There is a stone sign for a pharmacy with a tripod, a morfor medicine.[5]
tar, and a pestle opposite one for a doctor in the Arca[8]
Ancient Egyptian pharmacological knowledge was dian Way in Ephesus near Kusadasi in Turkey. The currecorded in various papyri such as the Ebers Papyrus rent Ephesus dates back to 400 BC and was the site of
of 1550 BC, and the Edwin Smith Papyrus of the 16th the Temple of Artemis, one of the seven wonders of the
world.
century BC.
In Baghdad the first pharmacies, or drug stores, were established in 754,[9] under the Abbasid Caliphate during
the Islamic Golden Age. By the 9th century, these pharmacies were state-regulated.[10]
The advances made in the Middle East in botany and
chemistry led medicine in medieval Islam substantially to
develop pharmacology. Muhammad ibn Zakarīya Rāzi
(Rhazes) (865–915), for instance, acted to promote the
medical uses of chemical compounds. Abu al-Qasim alZahrawi (Abulcasis) (936–1013) pioneered the preparation of medicines by sublimation and distillation. His
Liber servitoris is of particular interest, as it provides the
reader with recipes and explains how to prepare the `simples’ from which were compounded the complex drugs
then generally used. Sabur Ibn Sahl (d 869), was, howDioscorides, De Materia Medica, Byzantium, 15th century
ever, the first physician to initiate pharmacopoedia, describing a large variety of drugs and remedies for ailIn Ancient Greece, Diocles of Carystus (4th century BC)
ments. Al-Biruni (973–1050) wrote one of the most valuwas one of several men studying the medicinal proper[6] able Islamic works on pharmacology, entitled Kitab alties of plants. He wrote several treatises on the topic.
Saydalah (The Book of Drugs), in which he detailed the
The Greek physician Pedanius Dioscorides is famous for
4
3 HISTORY
properties of drugs and outlined the role of pharmacy and
the functions and duties of the pharmacist. Avicenna, too,
described no less than 700 preparations, their properties,
modes of action, and their indications. He devoted in
fact a whole volume to simple drugs in The Canon of
Medicine. Of great impact were also the works by alMaridini of Baghdad and Cairo, and Ibn al-Wafid (1008–
1074), both of which were printed in Latin more than fifty
times, appearing as De Medicinis universalibus et particularibus by 'Mesue' the younger, and the Medicamentis
simplicibus by 'Abenguefit'. Peter of Abano (1250–1316)
translated and added a supplement to the work of alMaridini under the title De Veneris. Al-Muwaffaq’s contributions in the field are also pioneering. Living in the
10th century, he wrote The foundations of the true properties of Remedies, amongst others describing arsenious oxThe mortar and pestle, one of the internationally recognized symide, and being acquainted with silicic acid. He made clear bols to represent the pharmacy profession
distinction between sodium carbonate and potassium carbonate, and drew attention to the poisonous nature of
copper compounds, especially copper vitriol, and also
lead compounds. He also describes the distillation of seawater for drinking.[11]
In Europe pharmacy-like shops began to appear during
the 12th century. In 1240 emperor Frederic II issued a
decree by which the physician’s and the apothecary’s professions were separated.[12] The first pharmacy in Europe
(still working) was opened in 1241 in Trier, Germany.
Typical American drug store with a soda fountain, about 1905
Sign of the Town Hall Pharmacy in Tallinn, operating continuously from at least 1422
In Europe there are old pharmacies still operating
in Dubrovnik, Croatia, located inside the Franciscan
monastery, opened in 1317; and in the Town Hall Square
of Tallinn, Estonia, dating from at least 1422. The oldest
is claimed to have been set up in 1221 in the Church of
Santa Maria Novella in Florence, Italy, which now houses
Drug store restoration ca. 1920 at Collingsworth County Museum
a perfume museum. The medieval Esteve Pharmacy, lo- and Art Center across from the courthouse in Wellington, Texas
cated in Llívia, a Catalan enclave close to Puigcerdà, also
now a museum, dates back to the 15th century, keeping
albarellos from the 16th and 17th centuries, old prescription books and antique drugs.
4.2
Hospital pharmacy
4
Types of pharmacy practice areas
See also: Community pharmacy and Pharmacy automation
Pharmacists practice in a variety of areas including community pharmacies, hospitals, clinics, extended care facilities, psychiatric hospitals, and regulatory agencies.
Pharmacists can specialize in various areas of practice including but not limited to: hematology/oncology, infectious diseases, ambulatory care, nutrition support, drug
information, critical care, pediatrics, etc.
A pharmacy (commonly the chemist in Australia, New
Zealand and the UK; or drugstore in North America; retail pharmacy in industry terminology; or Apothecary,
historically) is the place where most pharmacists practice the profession of pharmacy. It is the community
pharmacy where the dichotomy of the profession exists—
health professionals who are also retailers.
4.1
Community pharmacies usually consist of a retail storefront with a dispensary where medications are stored and
dispensed. According to Sharif Kaf al-Ghazal, the opening of the first drugstores are recorded by Muslim pharmacists in Baghdad in 754.[9][13]
Community pharmacy
5
In most countries, the dispensary is subject to pharmacy legislation; with requirements for storage conditions, compulsory texts, equipment, etc., specified in legislation. Where it was once the case that pharmacists
stayed within the dispensary compounding/dispensing
medications, there has been an increasing trend towards
the use of trained pharmacy technicians while the pharmacist spends more time communicating with patients.
Pharmacy technicians are now more dependent upon automation to assist them in their new role dealing with patients’ prescriptions and patient safety issues.
19th-century Italian pharmacy
Pharmacies are typically required to have a pharmacist
on-duty at all times when open. It is also often a requirement that the owner of a pharmacy must be a registered
pharmacist, although this is not the case in all jurisdictions, such that many retailers (including supermarkets
and mass merchandisers) now include a pharmacy as a
department of their store.
Likewise, many pharmacies are now rather grocery storelike in their design. In addition to medicines and prescriptions, many now sell a diverse arrangement of additional items such as cosmetics, shampoo, office supplies, confections, snack foods, durable medical equipment, greeting cards, and provide photo processing services.
4.2 Hospital pharmacy
Classic symbols at the wall of a former German pharmacy
Main article: Hospital pharmacy
Pharmacies within hospitals differ considerably from
community pharmacies. Some pharmacists in hospital
pharmacies may have more complex clinical medication
management issues whereas pharmacists in community
pharmacies often have more complex business and customer relations issues.
Modern pharmacy in Norway
Because of the complexity of medications including specific indications, effectiveness of treatment regimens,
safety of medications (i.e., drug interactions) and patient
6
4 TYPES OF PHARMACY PRACTICE AREAS
compliance issues (in the hospital and at home) many
pharmacists practicing in hospitals gain more education
and training after pharmacy school through a pharmacy
practice residency and sometimes followed by another
residency in a specific area. Those pharmacists are often referred to as clinical pharmacists and they often
specialize in various disciplines of pharmacy. For example, there are pharmacists who specialize in hematology/oncology, HIV/AIDS, infectious disease, critical care, emergency medicine, toxicology, nuclear pharmacy, pain management, psychiatry, anti-coagulation
clinics, herbal medicine, neurology/epilepsy management, pediatrics, neonatal pharmacists and more.
potential drug interactions, adverse drug reactions, and
assess patient drug allergies while designing and initiating a drug therapy plan.[15]
4.4 Ambulatory care pharmacy
Since the emergence of modern clinical pharmacy, ambulatory care pharmacy practice has emerged as a unique
pharmacy practice setting. Ambulatory care pharmacy is
based primarily on pharmacotherapy services that a pharmacist provides in a clinic. Pharmacists in this setting often do not dispense drugs, but rather see patients in office
Hospital pharmacies can often be found within the visits to manage chronic disease states.
premises of the hospital. Hospital pharmacies usually In the U.S. federal health care system (including the VA,
stock a larger range of medications, including more spe- the Indian Health Service, and NIH) ambulatory care
cialized medications, than would be feasible in the com- pharmacists are given full independent prescribing aumunity setting. Most hospital medications are unit-dose, thority. In some states such North Carolina and New
or a single dose of medicine. Hospital pharmacists and Mexico these pharmacist clinicians are given collabotrained pharmacy technicians compound sterile products rative prescriptive and diagnostic authority.[16] In 2011
for patients including total parenteral nutrition (TPN), the board of Pharmaceutical Specialties approved amand other medications given intravenously. This is a com- bulatory care pharmacy practice as a separate board
plex process that requires adequate training of person- certification. The official designation for pharmacists
nel, quality assurance of products, and adequate facilities. who pass the ambulatory care pharmacy specialty certiSeveral hospital pharmacies have decided to outsource fication exam will be Board Certified Ambulatory Care
high risk preparations and some other compounding func- Pharmacist and these pharmacists will carry the initials
tions to companies who specialize in compounding. The BCACP.[17]
high cost of medications and drug-related technology,
combined with the potential impact of medications and
pharmacy services on patient-care outcomes and patient
4.5 Compounding pharmacy
safety, make it imperative that hospital pharmacies perform at the highest level possible.
Main article: Compounding
Compounding is the practice of preparing drugs in new
forms. For example, if a drug manufacturer only provides
a drug as a tablet, a compounding pharmacist might make
Main article: Clinical pharmacy
a medicated lollipop that contains the drug. Patients who
have difficulty swallowing the tablet may prefer to suck
Pharmacists provide direct patient care services that op- the medicated lollipop instead.
timizes the use of medication and promotes health, wellness, and disease prevention.[14] Clinical pharmacists care Another form of compounding is by mixing different
for patients in all health care settings, but the clini- strengths (g,mg,mcg) of capsules or tablets to yield the
cal pharmacy movement initially began inside hospitals desired amount of medication indicated by the physician,
and clinics. Clinical pharmacists often collaborate with physician assistant, Nurse Practitioner, or clinical pharphysicians and other healthcare professionals to improve macist practitioner. This form of compounding is found
pharmaceutical care. Clinical pharmacists are now an at community or hospital pharmacies or in-home adminintegral part of the interdisciplinary approach to patient istration therapy.
care. They often participate in patient care rounds drug Compounding pharmacies specialize in compounding, alproduct selection.
though many also dispense the same non-compounded
The clinical pharmacist’s role involves creating a compre- drugs that patients can obtain from community pharmahensive drug therapy plan for patient-specific problems, cies.
4.3
Clinical pharmacy
identifying goals of therapy, and reviewing all prescribed
medications prior to dispensing and administration to the
patient. The review process often involves an evalua- 4.6 Consultant pharmacy
tion of the appropriateness of the drug therapy (e.g., drug
choice, dose, route, frequency, and duration of therapy) Main article: Consultant pharmacist
and its efficacy. The pharmacist must also monitor for
4.7
Internet pharmacy
Consultant pharmacy practice focuses more on medication regimen review (i.e. “cognitive services”) than
on actual dispensing of drugs. Consultant pharmacists most typically work in nursing homes, but are
increasingly branching into other institutions and noninstitutional settings.[18] Traditionally consultant pharmacists were usually independent business owners, though
in the United States many now work for several large
pharmacy management companies (primarily Omnicare,
Kindred Healthcare and PharMerica). This trend may
be gradually reversing as consultant pharmacists begin to
work directly with patients, primarily because many elderly people are now taking numerous medications but
continue to live outside of institutional settings. Some
community pharmacies employ consultant pharmacists
and/or provide consulting services.
7
online and those that walk in their door. The primary
difference is the method by which the medications are
requested and received. Some customers consider this to
be more convenient and private method rather than traveling to a community drugstore where another customer
might overhear about the drugs that they take. Internet
pharmacies (also known as online pharmacies) are also
recommended to some patients by their physicians if they
are homebound.
While most Internet pharmacies sell prescription drugs
and require a valid prescription, some Internet pharmacies sell prescription drugs without requiring a prescription. Many customers order drugs from such pharmacies to avoid the “inconvenience” of visiting a doctor or
to obtain medications which their doctors were unwilling
to prescribe. However, this practice has been criticized
The main principle of consultant pharmacy is developed as potentially dangerous, especially by those who feel
by Hepler and Strand in 1990.[19][20]
that only doctors can reliably assess contraindications,
risk/benefit ratios, and an individual’s overall suitability
for use of a medication. There also have been reports of
4.7 Internet pharmacy
such pharmacies dispensing substandard products.[21]
Of particular concern with Internet pharmacies is the
Main article: Online pharmacy
ease with which people, youth in particular, can obtain
Since about the year 2000, a growing number of Internet
controlled substances (e.g., Vicodin, generically known
as hydrocodone) via the Internet without a prescription
issued by a doctor/practitioner who has an established
doctor-patient relationship. There are many instances
where a practitioner issues a prescription, brokered by
an Internet server, for a controlled substance to a “patient” s/he has never met. In the United States, in order
for a prescription for a controlled substance to be valid,
it must be issued for a legitimate medical purpose by a
licensed practitioner acting in the course of legitimate
doctor-patient relationship. The filling pharmacy has a
corresponding responsibility to ensure that the prescription is valid. Often, individual state laws outline what
defines a valid patient-doctor relationship.
Canada is home to dozens of licensed Internet pharmacies, many of which sell their lower-cost prescription
drugs to U.S. consumers, who pay one of the world’s
highest drug prices.[22] In recent years, many consumers
in the US and in other countries with high drug costs,
have turned to licensed Internet pharmacies in India, Israel and the UK, which often have even lower prices than
in Canada.
In the United States, there has been a push to legalize importation of medications from Canada and other
countries, in order to reduce consumer costs. While in
most cases importation of prescription medications violates Food and Drug Administration (FDA) regulations
and federal laws, enforcement is generally targeted at inCanisters of pills from a mail order pharmacy.
ternational drug suppliers, rather than consumers. There
is no known case of any U.S. citizens buying Canadian
pharmacies have been established worldwide. Many of drugs for personal use with a prescription, who has ever
these pharmacies are similar to community pharmacies, been charged by authorities.
and in fact, many of them are actually operated by brickand-mortar community pharmacies that serve consumers
8
4.8
5 ISSUES IN PHARMACY
Veterinary pharmacy
Veterinary pharmacies, sometimes called animal pharmacies, may fall in the category of hospital pharmacy, retail pharmacy or mail-order pharmacy. Veterinary pharmacies stock different varieties and different strengths
of medications to fulfill the pharmaceutical needs of animals. Because the needs of animals, as well as the regulations on veterinary medicine, are often very different
from those related to people, veterinary pharmacy is often kept separate from regular pharmacies.
4.9
Nuclear pharmacy
Main article: Nuclear pharmacy
Nuclear pharmacy focuses on preparing radioactive materials for diagnostic tests and for treating certain diseases. Nuclear pharmacists undergo additional training
specific to handling radioactive materials, and unlike in
community and hospital pharmacies, nuclear pharmacists
typically do not interact directly with patients.
4.10 Military pharmacy
and complex disease states such as cancer, hepatitis, and
rheumatoid arthritis.[23] Unlike a traditional community
pharmacy where prescriptions for any common medication can be brought in and filled, specialty pharmacies carry novel medications that need to be properly
stored, administered, carefully monitored, and clinically
managed.[24] In addition to supplying these drugs, specialty pharmacies also provide lab monitoring, adherence
counseling, and assist patients with cost-containment
strategies needed to obtain their expensive specialty
drugs.[25] It is currently the fastest growing sector of the
pharmaceutical industry with 19 of 28 newly FDA approved medications in 2013 being specialty drugs.[26]
Due to the demand for clinicians who can properly manage these specific patient populations, the Specialty Pharmacy Certification Board has developed a new certification exam to certify specialty pharmacists. Along with
the 100 question computerized multiple-choice exam,
pharmacists must also complete 3,000 hours of specialty
pharmacy practice within the past three years as well as
30 hours of specialty pharmacist continuing education
within the past two years.[27]
5 Issues in pharmacy
Military pharmacy is an entirely different working envi5.1 Separation of prescribing from disronment due to the fact that technicians perform most dupensing
ties that in a civilian sector would be illegal. State laws of
Technician patient counseling and medication checking
In most jurisdictions (such as the United States),
by a pharmacist do not apply.
pharmacists are regulated separately from physicians.
These jurisdictions also usually specify that only pharmacists may supply scheduled pharmaceuticals to the public,
4.11 Pharmacy informatics
and that pharmacists cannot form business partnerships
with physicians or give them “kickback” payments. HowMain article: Pharmacy informatics
ever, the American Medical Association (AMA) Code
of Ethics provides that physicians may dispense drugs
Pharmacy informatics is the combination of pharmacy within their office practices as long as there is no patient
practice science and applied information science. Phar- exploitation and patients have the right to a written premacy informaticists work in many practice areas of phar- scription that can be filled elsewhere. 7 to 10 percent of
macy, however, they may also work in information tech- American physicians practices reportedly dispense drugs
nology departments or for healthcare information tech- on their own.[28]
nology vendor companies. As a practice area and specialist domain, pharmacy informatics is growing quickly In some rural areas in the United Kingdom, there are dis[29]
to meet the needs of major national and international pa- pensing physicians who are allowed to both prescribe
tient information projects and health system interoper- and dispense prescription-only medicines to their patients
ability goals. Pharmacists in this area are trained to par- from within their practices. The law requires that the
ticipate in medication management system development, GP practice be located in a designated rural area and that
there is also a specified, minimum distance (currently 1.6
deployment and optimization.
kilometres) between a patient’s home and the nearest retail pharmacy. This law also exists in Austria for general
physicians if the nearest pharmacy is more than 4 kilo4.12 Specialty pharmacy
meters away, or where none is registered in the city.
Main article: Specialty pharmacy
In other jurisdictions (particularly in Asian countries such
as China, Malaysia, and Singapore), doctors are allowed
Specialty pharmacies supply high cost injectable, oral, in- to dispense drugs themselves and the practice of pharfused, or inhaled medications that are used for chronic macy is sometimes integrated with that of the physician,
9
One of a chain of pharmacies in Mexico City, Mexico, named
“Doctor Discount,” March 2010.
particularly in traditional Chinese medicine.
In Canada it is common for a medical clinic and a pharmacy to be located together and for the ownership in both
enterprises to be common, but licensed separately.
The reason for the majority rule is the high risk of a conflict of interest and/or the avoidance of absolute powers.
Otherwise, the physician has a financial self-interest in
“diagnosing” as many conditions as possible, and in exaggerating their seriousness, because he or she can then
sell more medications to the patient. Such self-interest
directly conflicts with the patient’s interest in obtaining
cost-effective medication and avoiding the unnecessary
use of medication that may have side-effects. This system reflects much similarity to the checks and balances
system of the U.S. and many other governments.
A campaign for separation has begun in many countries
and has already been successful (as in Korea). As many
of the remaining nations move towards separation, resistance and lobbying from dispensing doctors who have pecuniary interests may prove a major stumbling block (e.g.
in Malaysia).
from the Australian Government for conducting comprehensive Home Medicines Reviews. In Canada, pharmacists in certain provinces have limited prescribing rights
(as in Alberta and British Columbia) or are remunerated by their provincial government for expanded services
such as medications reviews (Medschecks in Ontario). In
the United Kingdom, pharmacists who undertake additional training are obtaining prescribing rights and this
is because of pharmacy education. They are also being
paid for by the government for medicine use reviews. In
Scotland the pharmacist can write prescriptions for Scottish registered patients of their regular medications, for
the majority of drugs, except for controlled drugs, when
the patient is unable to see their doctor, as could happen if they are away from home or the doctor is unavailable. In the United States, pharmaceutical care or
clinical pharmacy has had an evolving influence on the
practice of pharmacy.[32] Moreover, the Doctor of Pharmacy (Pharm. D.) degree is now required before entering
practice and some pharmacists now complete one or two
years of residency or fellowship training following graduation. In addition, consultant pharmacists, who traditionally operated primarily in nursing homes are now expanding into direct consultation with patients, under the
banner of “senior care pharmacy.”[33]
6 Pharmacy journals
• List of Pharmacy Journals
7 See also
• American Society for Pharmacy Law
• Apothecary
• Bachelor of Pharmacy, Master of Pharmacy, Doctor
of Pharmacy
5.2
The future of pharmacy
In the coming decades, pharmacists are expected to become more integral within the health care system. Rather
than simply dispensing medication, pharmacists are increasingly expected to be compensated for their patient
care skills.[30] In particular, Medication Therapy Management (MTM) includes the clinical services that pharmacists can provide for their patients. Such services include
the thorough analysis of all medication (prescription,
non-prescription, and herbals) currently being taken by
an individual. The result is a reconciliation of medication and patient education resulting in increased patient
health outcomes and decreased costs to the health care
system.[31]
This shift has already commenced in some countries; for
instance, pharmacists in Australia receive remuneration
• Classification of Pharmaco-Therapeutic Referrals
• Clinical pharmacy
• Consultant pharmacist
• Evidence-based pharmacy in developing countries
• History of pharmacy
• Hospital pharmacy
• International Pharmaceutical Federation
• International Pharmaceutical Students’ Federation
• List of pharmacies
• List of pharmacy associations
10
9
• List of pharmacy organizations in the United Kingdom
• List of pharmacy schools in the United States
• List of pharmacy schools
NOTES AND REFERENCES
• Green cross and Bowl of Hygieia used in Europe
(with the exception of Germany and Austria) and
India
• Simple green cross, also used in Europe and India
• Nuclear pharmacy
• Red “A” (Apotheke) sign, used in Germany
• Online pharmacy
• Similar red “A” sign, used in Austria
• Pharmaceutical company
• The mortar and pestle, used in the United States and
Canada
• Pharmaceutics
• Pharmaceutical industry
• Pharmacogenetics
• Pharmacogenomics
• Pharmacognosy
• A hanging Show globe, formerly used in the United
States
• The Gaper, formerly used in the Netherlands
• The symbol used on medical prescriptions, from the
Latin Recipe
• Pharmacology
• Pharmaconomist
9 Notes and references
• Pharmacy Automation - The Tablet Counter
• Pharmacy residency
• Pharmacy informatics
• Professional Further Education in Clinical Pharmacy and Public Health
• Raeapteek (one of the oldest continuously run pharmacies in Europe)
• Telepharmacy
8
Symbols
The two symbols most commonly associated with pharmacy in English-speaking countries are the mortar and
pestle and the ℞ (recipere) character, which is often written as “Rx” in typed text. The show globe was also
used until the early 20th century. Pharmacy organizations often use other symbols, such as the Bowl of Hygieia which is often used in the Netherlands, conical measures, and caduceuses in their logos. Other symbols are
common in different countries: the green Greek cross
in France, Argentina, the United Kingdom, Belgium,
Ireland, Italy, Spain, and India, the increasingly rare
Gaper in the Netherlands, and a red stylized letter A in
Germany and Austria (from Apotheke, the German word
for pharmacy, from the same Greek root as the English
word 'apothecary').
• Bowl of Hygieia, the internationally recognised
symbol of pharmacy (the profession)
• Rod of Asclepius, the internationally recognised
symbol of medicine
Notes
[1] Its earliest attested form in Greek could be the Mycenaean
, pa-ma-ko, written in the Linear B syllabic script and
found on the PY Un 1314 tablet; this tablet is also found
listed as PY Vn 1314 or PY Sb 1314.[2]
References
[1] φάρμακον. Liddell, Henry George; Scott, Robert; A
Greek–English Lexicon at the Perseus Project.
[2] “PY 1314 Vn + frr. (Cii)". DĀMOS: Database of
Mycenaean at Oslo. University of Oslo.Raymoure, K.A.
“pe-re”. Minoan Linear A & Mycenaean Linear B.
Deaditerranean.“The Linear B word pa-ma-ko”. Palaeolexicon. Word study tool of ancient languages.
[3] World Health Organization. World Health Statistics 2011
- Table 6: Health workforce, infrastructure and essential
medicines. Geneva, 2011. Accessed 21 July 2011.
[4] Board of Pharmaceutical Specialties, Current Specialties
[5] John K. Borchardt (2002).
“The Beginnings of
Drug Therapy: Ancient Mesopotamian Medicine”.
Drug News & Perspectives 15 (3):
187–192.
doi:10.1358/dnp.2002.15.3.840015. ISSN 0214-0934.
PMID 12677263.
[6] Edward Kremers, Glenn Sonnedecker (1986). "Kremers
and Urdang’s History of pharmacy". Amer. Inst. History
of Pharmacy. p.17. ISBN 0931292174
[7] Titsingh, Isaac. (1834) Annales des empereurs du japon,
p. 434.
[8] has photos
11
[9] Hadzovic, S (1997). “Pharmacy and the great contribution of Arab-Islamic science to its development”.
Medicinski Arhiv (in Croatian) 51 (1-2): 47–50. ISSN
0025-8083. OCLC 32564530. PMID 9324574.
[10] al-Ghazal, Sharif Kaf (October 2003). “The valuable contributions of Al-Razi (Rhazes) in the history of pharmacy
during the Middle Ages” (PDF). Journal of the International Society for the History of Islamic Medicine 2 (4):
9–11. ISSN 1303-667X. OCLC 54045642.
[27] Specialty Pharmacy Certification Board
[28] American Association of State Compensation Insurance
Funds, Prepackaged Drugs in Workers’ Compensation
[29] British Medical Association, briefing on dispensing doctors, 30 January 2009
[30] American College of Clinical Pharmacy, Evidence of the
Economic Benefit of Clinical Pharmacy Services: 1996–
2000
[11] Levey M. (1973), ‘ Early Arabic Pharmacology’, E. J.
Brill; Leiden.
[31] American Pharmacy Student Alliance (APSA)
[12] History of Pharmacy Web Pages - Sweden´s oldest pharmacies
[32] American College of Clinical Pharmacy, Clinical Pharmacy Defined
[13] Sharif Kaf al-Ghazal, Journal of the International Society
for the History of Islamic Medicine, 2004 (3), pp. 3-9 [8].
[33] American Society of Consultant Pharmacists, What is a
Senior Care Pharmacist?
[14] American College of Clinical Pharmacy. The definition
of clinical pharmacy. Pharmacotherapy 2008;28(6):816817.
[15] Burke JM, Miller WA, Spencer AP, et al. (2008).
“Clinical pharmacist competencies” (PDF). Pharmacotherapy 28 (6): 806–815. doi:10.1592/phco.28.6.806.
[16] Knapp, KK; Okamoto, MP; Black, BL (2005). “ASHP
survey of ambulatory care pharmacy practice in health
systems-−2004”. American Journal of Health-System
Pharmacy 62 (3): 274–84. PMID 15719585.
[17] BPS Approves Ambulatory Care Designation; Explores
New Specialties in Pain and Palliative Care, Critical Care
and Pediatrics
[18] American Society of Consultant Pharmacists, Frequently
Asked Questions
[19] Strand LM (1990). “Pharmaceutical care and patient outcomes: notes on what it is we manage”. Top Hosp Pharm
Manage. 10 (2): 77–84. PMID 10128568.
[20] Hepler CD, Strand LM (1990). “Opportunities and responsibilities in pharmaceutical care”. Am J Hosp Pharm
47 (3): 533–43. PMID 2316538.
[21] Protecting Patients from Counterfeit and Other Substandard Drugs/Supply Chain Threats
[22] London Free Press Regional News Archive, Canada Internet Pharmacy Merged In $3.8 Million Deal
[23] NBCH Action Brief: Specialty Pharmacy. Specialty Pharmacy December, 2013. Accessed 27 October 2014.
[24] Wild, D. Specialty Pharmacy Continuum Carving a Specialty Niche Within the ACO Model.” Volume 1 (Summer
Issue). August, 2012.
[25] Shane, RR (15 August 2012). “Translating health care
imperatives and evidence into practice: the “Institute of
Pharmacy” report.”. American Journal of Health-System
Pharmacy 69 (16): 1373–83. doi:10.2146/ajhp120292.
PMID 22855102.
[26] “Health Care Cost Drivers: Spotlight on Specialty Drugs”
(PDF). September 2014. Retrieved 27 October 2014.
10 References
• Watkins Elizabeth Siegel (2009). “From History of
Pharmacy to Pharmaceutical History”. Pharmacy in
History 51 (1): 3–13.
• (Japanese) Asai,T. (1985). Nyokan Tūkai. Tokyo:
Kōdan-Sha.
• (French) Titsingh, Isaac, ed. (1834). [Siyun-sai
Rin-siyo/Hayashi Gahō, 1652], Nipon o daï itsi
ran; ou, Annales des empereurs du Japon. Paris:
Oriental Translation Fund of Great Britain and Ireland....Click link for digitized, full-text copy of this
book (in French)
• High Performance Pharmacy - A landmark study
in hospital pharmacy performance based on an extensive literature review and the collective experience of the Health Systems Pharmacy Executive Alliance.
11 External links
• Excipient selection for injectable / parenteral formulations
12 External links
• Pharmacy Professionals Guide Guide for Pharmacy
students and Teachers Pharmacists
• Navigator History of Pharmacy Collection of internet resources related to the history of pharmacy
• Soderlund Pharmacy Museum - Information about
the history of the American Drugstore
12
• The Lloyd Library Library of botanical, medical,
pharmaceutical, and scientific books and periodicals, and works of allied sciences
• American Institute of the History of Pharmacy
American Institute of the History of Pharmacy—
resources in the history of pharmacy
• International Pharmaceutical Federation (FIP) Federation representing national associations of pharmacists and pharmaceutical scientists. Information
and resources relating to pharmacy education, practice, science and policy
• Pharmaboard German association of pharmacy students
12
EXTERNAL LINKS
13
13
13.1
Text and image sources, contributors, and licenses
Text
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13.2
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