Chapter 1

PHARMACY
The Right Choice for a Promising Future

Pharmacy
The word Pharmacy is derived from the Greek work Pharmakon , meaning drug.

The word Pharmacy has two meanings :

it is a place or shop where drugs or medicines are sold.

General sense

Professional sense
it is the profession, the members of which deal with drugs.

# Pharmacy is the art and science of preparing and

dispensing medications and the provision of drug and related information to the public. Or

Pharmacy is the study of the science of drugsWhere they come from? How they act on the body? How to turn drugs into medicines?

Pharmacist 5 A pharmacist is one who is educated

and licensed to prepare and dispense drugs and to provide drug and related information to the public-An expert on drugs. I am a Pharmacist I am a specialist in medications I am a custodian of medical information I am a companion of the physician I am a counselor to the patient I am a guardian of public health This is my calling This is my pride.

Dosage Forms
also known as Pharmaceuticals. It is defined as a preparation devised to make possible the administration of medications in measured or prescribed amount.

Definition Of Terms

Drug
is any agent intended for use in the diagnosis, mitigation, treatment, cure, prevention of disease of man or in animal as well.

Drug & Medicine

A drug is any substance that acts on the living body to alter the physiological process and are used for the prevention, diagnosis and treatment of diseases. A medicine is any drug which has a definite form & dose and are therapeutically used for the treatment of diseases of living subjects.

Pharmaceutical Preparations are the forms in which

drugs are prepared by the pharmacist for administration in the treatment of the sick.

Dosage is the giving of medicine or other therapeutic agent in

prescribed amount.

Shelf - life refers to the length of time that a drug produced

may remain on the pharmacist shelf in the original packages and under usual environmental conditions and retain an acceptable level of its potency and overall quality.

Stability refers to the maintenance of the original physical,

chemical and therapeutic properties over extended period of time or until the expiry date assigned.

DRUGS
= stimulates the cardiac muscle, CNS, GIT = some have the opposite effects = render blood more coagulable or less coagulable = increase the hemoglobin content of the erythrocytes = reduce serum cholesterol, or expand blood volume = can be used to reduce pain, fever, thyroid activity, rhinitis, insomnia, gastric acidity, motion sickness, blood pressure and mental depression.

DRUGS
= can combat infectious disease, destroy intestinal worms, or act as antidotes against the poisoning effects of other drugs = can assists in smoking cessation or alcohol withdrawal or can modify obsessive compulsive disorders. = used to treat common infections, benign prostatic hyperplasia, cancer, cardiovascular disease, asthma, glaucoma, Alzheimers disease, male impotence. = to diagnose diabetes, liver malfunction, tuberculosis, or pregnancy and others

DRUGS
= can prevent pregnancy, assists fertility, and sustain
life itself. = can replenish a body deficient in antibodies, vitamins, hormones, electrolytes, protein, enzymes, or blood. Examples: Mydriatic = dilate the pupil of the eye Miotics = constrict or diminish pupillary size Emetics= induce vomiting Diuretic = increase the flow of urine Antiemetic = prevents vomiting Expectorant = increase respiratory tract fluid Cathartic/Laxative = evacuate bowel Note: other drugs decrease the flow of urine, diminish body secretions, or induce constipation

SOURCES OF NEW DRUGS

1. Naturally occurring materials in both plants and animals Examples: Ergot, Opium, Curare, Cinchona 2. Synthesis of organic compounds whose structure are closely related to those naturally occurring compounds Examples: Morphine, Atropine, Cortisone, Cocaine 3. Pure synthesis in which no attempt has been made to pattern after a known naturally occurring compounds exhibiting some activity Examples: Antihistamines, Barbiturates, Diuretics, Antiseptics

New Drug May Be Derived From 1. Plant or animal source 2. By products of microbial growth 3. Through chemical synthesis 4. Molecular modification 5. Biotechnology

Process of drug discovery and development is complex Include:

1. Organic 8. Toxicologists

2. Physical and analytical chemist 9. Hematologists 3. Biochemist 4. Molecular biologists 5. Bacteriologists 6. Physiologists 7. Pharmacologists 10. Immunologists 11. Endocrinologists 12. Pathologists 13. Biostatisticians 14. Clinical pharmacists/others

The most effective routes of administration must be determined 1. Oral 2. Rectal 3. Parenteral

and guidelines for the dosage recommend for persons of varying ages 1. Neonates 2. Children 3. Adult/geriatrics

weights, and states of illness have to be established

To facilitate administration of the drug by the selected routes, appropriate dosage forms, such as 1. Tablets 2. Ointments 3. Suppositories/others

are formulated and prepared

Each particular product is a formulation unique unto itself 1. Active ingredients 2. Non therapeutic or pharmaceutical ingredients

Pharmaceutical Ingredients: fillers,

thickeners, solvents, suspending agents, tablet coatings and disintegrants, stabilizers flavors, colorants, preservatives and others

THE HERITAGE OF PHARMACY

The First Apothecary

- priestcraft - pharmakon - connotes charm, drugs that can be used for good and evil

Apothecarys Failure 1. Due to impotent or inappropriate 2. Underdosage 3. Overdosage 4. Poisoning

Apothecarys Success
1. Attribute to experience 2. Mere coincidence of appropriate drug selection 3. Natural healing 4. Inconsequential effect of the drug, or placebo effects

Early Drugs
Ebers papyrus - a continuous scroll some 60 feet
long and foot wide dating to the 16th century.

- 800 formulas or prescriptions being described and more than 700 drugs mentioned. - the drugs are chiefly botanical - acacia, castor bean, fennel - the vehicles of the day were: beer, wine, milk and honey.

- many pharmaceutical formulas employed 2 dozen or more medicinal agents, a type of preparation is called

Polypharmacal Polypharmacal

Egyptians commonly used:

1. Mortar and pestles 2. Hand mills 3. Sieves 4. Balances for their compounding of suppositories, gargles, pills inhalations, troches, lotions ointments, plasters and enemas

Sumerian Clay Tablet

= worlds oldest written prescription =preparation of the seed of carpenter plant, gum resin of markhazi, and thyme, all pulverized and dissolved in beer, and combination of powdered roots of moon plant and white pear tree, also dissolved in beer.

Introduction of the Scientific Viewpoint

Greek physician, is credited with the introduction of scientific pharmacy and medicine - oath of ethical behavior for the healing profession - honored by being called the Father of Medicine

Hippocrates -

Dioscorides - Greek physician and botanist, deal with botany as an applied science of pharmacy - De Materia Medica study of naturally occurring materials - today known Pharmacognosy pharmakon=drug; gnosis= knowledge - some of the drugs are opium, ergot and hyoscyamus

Claudius Galen -Greek pharmacistphysician - credited with 500 treatises on medicines and some 250 others on philosophy, law, and grammar - originated many preparations of vegetable drugs by mixing or melting the individual ingredients that the field of pharmaceutical preparations was once commonly referred to as Galenic Cerate - introduced cold cream, called Galens cream

Emperor Frederick II
-officially separate medicine and pharmacy -regulate the practice of pharmacy called Two Sicilies.

Aureolus Theophrastus Hohenheim

Bombastus

von

- Swiss physician and chemist who called himself Paracelsus - He believed it was possible to prepare a specific medicinal agent to combat each specific disease and introduced a host of chemical substances to internal therapy.

EARLY RESEARCH
KARL WILHELM SCHEELE lactic acid, citric acid, oxalic acid, tartaric acid and arsenic acid, glycerin, methods of preparing calomel and benzoic acid FRIEDRICH SERTURNER isolation of morphine from opium JOSEPH CAVENTOU AND JOSEPH PELLETIER isolation of quinine and cinchonine from cinchona

MAGENDIE
isolation of strychnine and brucine from nux vomica, vomica, administration of strychnine in animals, the first experimental in medicine resulting to convulsion and asphyxia (stopping of pulse)

PAUL EHRLICH methylene blue as antimalarial, followed by plasmoquine and atabrine also antimalarial, then SALVARSAN (#606) for syphilis THE CHEMICAL REVOLUTION PENICILLIN first antibiotic produced by several molds

ASPIRIN by Charles Gerhardt, derived salicin, pain killer and antiinflammatory PRONTOSIL the first antibacterial by Gerhard Domagk. Prontosil is converted in the body to SULFANILAMIDE. SULFONAMIDE (diuretic) Pelletier and Pierre Robiquet - isolated caffeine, and
Robiquet independently separated codeine from opium.

Contemporary examples of drugs isolated from natural source

1. Paclitaxel -Taxol - antitumor activity derived from the Pacific yew tree (Taxus baccata) employed in the treatment of metastatic carcinoma of the ovary 2. Vincaleukoblastine - antineoplastic drug - from Vinca rosea 3. Digoxin - cardiac glycoside - from Digitalis lanata

DRUG STANDARDS 1. USP/NF published in 1820 from Greek word PHARMAKON meaning drug POIEIN meaning to make

Pharmacopeia

COMBINATION: RECIPE or FORMULA required to make or to prepare drug

PARTS OF THE MONOGRAPH

1. Generic or nonproprietary name 2. Graphic or Structural formula 3. Empirical formula 4. Molecular weight 5. Established chemical name 6. Drugs chemical abstract service/CAS registry number 7. Statement of chemical purity 8. Packaging and storage 9. Labeling 10. USP Reference standard 11. Identification 12. Assay

OTHER PHARMACOPEIAS 1. USPDI 2. HPUS = homoios pathos meaning similar meaning disease

= Samuel Hahnemann 3. IP 4. Other pharmacopeias 5. EP or Ph Eur

Controlled Substances/5 Categories called SCHEDULES

SCHEDULE 1
*almost all drugs are illegal *have high potential for dependence and abuse

EXAMPLES: Heroin, LSD, Marijuana, mescaline, peyote, methaqualone

Controlled Substances/5 Categories called SCHEDULES

SCHEDULE 2
* highly addictive * remain in medical use because no satisfactory non addictive alternative medication is available * renewal of Rx is not allowed w/o a new Rx from Physician EXAMPLES: Cocaine, Amphetamines, Morphine, some Barbiturates

Controlled Substances/5 Categories called SCHEDULES

SCHEDULE 3
* some potential for abuse or dependence * Rx can be renewed up to 5 times in 6 months if Physician authorized

EXAMPLES: Acetaminophen or aspirin with codeine; some appetite suppressants, hydrocodone

Controlled Substances/5 Categories called SCHEDULES

SCHEDULE 4
* less likely to cause dependence or to be abuse as much as the drugs in S-3 * Rx are covered by the same regulations that govern S-3

EXAMPLES: Diazepam, Chloral hydrate, Phenobarbital, diphenoxin

Controlled Substances/5 Categories called SCHEDULES

SCHEDULE 5
* they contain small amounts of narcotics regulated * they are least likely to be abused

EXAMPLES: Some antidiarrheal medications; cough medications, dihydrocodeine, diphenoxylate

FDA INFORMATION RECEIVED

1. A list of all drug products 2. A list of all drug products broken down by labeled indications or pharmacologic activity 3. A list of all products, broken by manufacturer 4. A list of all products active ingredient 5. A list of all products inactive ingredient 6. A list of all products containing particular ingredient 7. A list of all products newly marketed or remarketed 8. A list of all products discontinued 9. All labeling of drug product 10. All advertising of drug product

The Mission Of Pharmacy The Mission of Pharmacy is to serve society as the profession responsible for the appropriate use of medications, devices, and services to achieve optimal therapeutic outcomes

Pharmacy - is the health profession that concerns itself with the knowledge system that results in the discovery, development, and use of medications and medication information in the care of patients. It encompasses the clinical, scientific, economic, and educational aspects of the professions knowledge base and its communication to others in the health care system. Society - encompasses patients, other health-care providers, health-policy decision makers, corporate health benefits managers, the healthy public, and other individuals and groups to whom health care and medication use are important.

Appropriate - refers to the pharmacists responsibility to ensure that a medication regimen is specifically tailored for the individual patient, based on accepted clinical and pharmacological parameters. Evaluate the regimen to assure maximum safety, cost effectiveness, and compliance by the patient. Medications - refers to legend and non legend agents used in the diagnosis, treatment, prevention, and/or cure of disease. Devices - refers to the equipment, process, biotechnological entities, diagnostic agents, or other products that are used to assists in effective management of the medication regimen. Services - refers to patient, health professional and public education services, screening and monitoring programs, medicationregimen management, and related activities that contribute to effective medication use by patients. Optimal therapeutics - outcomes declares the professions ultimate contribution to public health. Pharmacy asserts it unique rights, privileges, and responsibilities-accepts the attendant liabilities-associated with medication use.

Pharmaceutical Care - is that component of pharmacy practice which entails the direct interaction of the pharmacist with the patient for the purpose of caring for that patients drug related needs. The mission of the pharmacist is to provide pharmaceutical care. Pharmaceutical care is the direct, responsible provisions of medication-related care for the purpose of achieving definite outcomes that improve a patients quality of life. Pharmaceutical care is patient-centered, outcomes oriented pharmacy practice that requires the pharmacist to work in concert with the patient and the patients other healthcare providers to promote health, to prevent disease, and to assess, monitor, initiate,and modify medication use to assure that drug therapy regimens are safe and effective. The goal of pharmaceutical care is to optimize the patients health-related quality of life and achieve positive outcomes, within realistic economic expenditures.

Pharmacy Practice Standards

1. General management and administration POSDICON, establishes pricing, administers budgets and negotiates, develop and maintain a purchasing and inventory system 2. Processing the prescription verifies Rx for legality and physical and chemical compatibility, checks patients record before dispensing Rx, measures quantities needed to dispense Rx, performs final check of finished Rx, dispense Rx. 3. Patient care function clarifies patients understanding of dosage, integrates drug with patient information, advises patient of potential drug-related conditions, refers patient to other health care resources, monitors and evaluates therapeutic response of patient, reviews and/or seeks additional drug-related information 4. Education of health care professionals and patients organizes, maintains, and provides drug information to other health care professionals, organize and/or participates in in-pharmacy education programs for other pharmacists, recommends regarding drug therapy to physician or patient, develops and maintains system for drug distributions and quality control

Thank You