Pharmacy orientation

Pharmacy
It is the art and science of preparing and dispensing
medications and the provision of drug related
information to the public. It involves the interpretation
of prescription orders; the compounding, labeling and
dispensing of drugs and devices; drug product selection
and drug utilization reviews (DURs involve a comprehensive
review of patients' prescription and medication data before, during, and after
dispensing to ensure appropriate medication decision making and positive
patient outcomes); patient monitoring and intervention; and
the provision of cognitive services related to use of
medications and devices.
Pharmaceutics
Pharmaceutics is the discipline of pharmacy that deals
with the process of turning a new chemical entity or
old drugs into a medication to be used safely and
effectively by patients.
It can also be defined as “ the science of dosage form
design”.
Hospital Pharmacy
The department or services in a hospital which is
under the directions of a professionally competent,
legally qualified pharmacist and from which all
medications are supplied to the nursing units and other
services, where special prescriptions are filled for
ambulatory patients (emergency patients) and out
patients (OPD), where pharmaceuticals are
manufactured in bulk, where narcotics and other
prescribed drugs are dispensed, where biologicals are
stored and dispensed.
Where injectable preparations should be prepared and
sterilized and where professional supplies are often
stocked and dispensed.
Hospital pharmacist participate in patient education
programs, poison control center activities, preparation
of patient drug use profiles, parenteral nutrition
program participation, cooperating in the teaching and
research program of the hospital, communicating new
product information to nursing services and other
hospital personnel and dispensing
radiopharmaceuticals.
Responsibilities of hospital pharmacist
1.Effective administration and management of a
pharmacy department in an institution
The pharmacist must have good management and
administrative skills. He must be familiar with the
health care system.
Broad areas of administrative and management
responsibilities includes
Planning and integrating professional services
Budgeting
Inventory control (supervision of supply and storage)
Cost review
Cost effectiveness (the minimum expenditures
necessary to achieve health care results)
Audit
Maintenance of records and preparation of reports
For this purpose hospital pharmacist should be
familiar with the organization of hospital.
Pharmacy activities must be coordinated with medical,
nursing and other services.
Hospital pharmacist is responsible for maintenance of
records which may be legally or administratively
required. These may include
Data on prescription dispensed
Controlled drugs dispensed
Drug purchase etc.
2. Assimilation and provision of comprehensive
information on drugs and their actions
The pharmacy department is the primary source of
information concerning drugs.
The pharmacy must maintain the appropriate
information source and make arrangements for the
transmission of these information's to the professional
staff and to patients.
The pharmacist must have knowledge of drug action
such as absorption, distribution, metabolism and
excretion of drugs, drug interaction with other drugs,
food or diagnostic agents, effects of a disease state on
the drug action and miscellaneous patient and drug
variables.
He must be knowledgeable in chemistry,
pharmacology, toxicology, pathophysiology,
pharmaceutics, therapeutics and patient care
techniques.
3. Development and conduct of a product formulation
and packaging program.
He must respond to the need for special dosage form
and formulations not available commercially.
An adequate understanding of the principle involved in
the formulation and preparation of pharmaceutical
dosage form is needed.
This involves the concept of biopharmaceutics,
bioavailability, pharmacokinetics, pharmaceutics,
stability, physicochemical kinetics, microbiology,
quality assurance, and techniques of medication
administration.
Hospital pharmacist is also responsible for the
preparation of IV admixtures and total parenteral
nutrition as well as he must be familiar with
radiopharmaceuticals.
4. Conduct and participation in research
Hospital pharmacist must be prepared to participate in
clinical research originated by the medical staff and to
conduct pharmaceutical research or initiate research
himself.
5. Development and conduct of patient oriented
services
These services includes
Drug information
Collection of pharmacy patient data base
Patient education
The monitoring and auditing of therapeutic regimens
Drug use review
The monitoring of specific adverse drug reactions to
decrease their incidence
6. Conduct of and participation in educational
activities
The director of pharmacy is responsible for training
new personnel and for carrying educational programs
for pharmacists and pharmacy supportive personnel's.
7. Development and conduct of a quality assurance
program for pharmaceutical services
A major responsibility of this department is the
assurance of the quality of its services and product
dispensed coupled with a controlled program for the
distribution of drugs throughout the institution.
Industrial Pharmacy
The industrial pharmacist work involves the
manufacture and distribution of drugs and medicinal
products.
This involves quality control, product development,
formulation, production, management, research and
sale.
The work of pharmacist in industry is about
discovering safe and effective new drugs, developing
them into new medicines and marketing the finished
product to customer.

Discovery…..Formulation……Marketing
Departments
Sale
Marketing
Medical affairs
Research and development
Production
Quality control
Legal and regulatory affairs
Management and administration
1. Sale
The sale area is one of the way for pharmacist to get
into pharmaceutical industry.
The sale representative usually call upon physicians,
pharmacists, nurses and in some cases dentists and
veterinarians and provide them comprehensive
information about the drugs and encourage them about
the appropriate use of the drug.
Usually the candidates are selected having good
personality, effective oral communication skills and a
strong interest in selling.
Most pharmaceutical companies offer excellent
benefits packages such as company cars, expensive
reimbursement, travel and medical allowance, medical
insurance for the family and reimbursement for
education program.
2. Marketing
This department is responsible for developing and
implementing marketing plans to promote company
products to the appropriate audience.
In some industries the department is divided into
Prescription product marketing and OTC product
marketing
In other firms the marketing is divided into therapy
areas
Such as cardiovascular or respiratory products
Most marketing departments include
Marketing research
Which analyze business trends, sale histories of the
company products, competitive information's,
prescribing and recommendation habits of the
practitioners and new business opportunities within
the market.
Marketing strategy/planning
Which is responsible for anticipating and developing
products and services to meet the needs of the market
place in long term (when a segment of customers is not effectively
served by existing providers and the company develops and promotes
products or services to match).

Product management
Which oversees the overall marketing plan for a
specific product and is responsible for the profits and
losses generated by that product.
Life cycle management
Which evaluates new uses for the product and support
research to study these uses leading to new indications
(minoxidil spray)
Promotion
Which develops the promotional activities for the
product.

A degree of pharmacy may be helpful but is not

required generally for a marketing position.
Understanding the health care delivery system,
general business principles and a basic knowledge of
R & D, manufacturing, QA and distribution are
helpful in obtaining a position in the marketing
department.
The MBA would be an appropriate advance degree
and is helpful in marketing department.
3. Medical affairs department
This department provides information and services to
health care practitioners, give presentations to
practitioners, does sale training and obtain the output
of though leaders (experts in the field with innovative
ideas).
4. Research and development
Pharmacist in industry are also engaged in R & D of
new drugs or new indications or dosage form for new
existing products.

5. Production
Pharmacist working in production often work in
managerial position. They plan to fulfill the company
needs and planning for the plant facilities, equipment's
and personnel's who will be needed to meet the
company's production goals.
They are also responsible for establishing and
administering manufacturing procedures and control
to ensure the production of high quality products.
6. Quality control department
This department is responsible to conduct assays and
quality assurance tests to maintain the quality of their
products. QA activities begins while the safety and
efficacy of new products are being established.
The R & D, manufacturing and QA department of the
company jointly established final production and QA
specification for new products.
The QA department establishes sampling and testing
procedures to make certain that each lot of product
meets both company and FDA specifications.
The system also ensure the potency (effectiveness),
purity and dose to dose uniformity of the product.
This department also ensures the stability of the
finished dosage form and appropriate expiry dates.
This department also checks not only for the quality
and quantity of active ingredients but also for the
uniformity of active drug.
7. Legal department or regulatory affairs
department
Pharmacist in this department provide legal consult on
the laws and regulations for marketing
pharmaceuticals.
This department handles the interaction between the
company and the medicine regulatory bodies of the
country.
This department is responsible for process like
Investigational new drug application IND
New drug application NDA etc.
IND: this application intends to provide sufficient data
to the FDA that it is reasonable to begin clinical tests
of new drugs on humans
NDA: NDA contains all of the information's and data
that the FDA requires for market approval of a drug
Management and administration
Pharmacist at the managerial and administrative
position have the responsibility that the department
function smoothly and achieve its objectives.
Retail pharmacy
Retail is an establishment for selling of the products or
services in individual units to the final consumer for
consumption
Currently, the professional activities of retail
pharmacist are confined to the traditional role such as
Dispensing
Recommending
And selling of OTC drugs and health aids
The international retail roles of the pharmacist
include
Clinical services and managerial services
Clinical services includes
Patient counseling
Consulting with physicians
Developing patient medication profile
Calling the prescriber for refill
Screening for drug interaction
Checking for allergic reactions
Patient counseling may consist of necessary
information and answering the routine questions
regarding drugs, their preparation (reconstitution),
proper use etc.
The prescriber consultation areas include
Way to lowers the cost of drugs
Alternative choices
Patient complaints against the side effects of a given
drug.
The managerial activities of a retail pharmacist
include purchasing, inventory control, stocking
shelves and supervising the technicians
Retail categories
Based on services, retail outlets can be divided into
two categories
1. Independent pharmacy
An independent retail pharmacy is a set up with a
single retail store without branches or any contractual
agreement with others.
It exist at a single location. However, it may be selling
all drug categories including or excluding narcotics
and other controlled drugs
It has the following advantages
Require less investment
No profit sharing
Freedom in control and from restriction
Disadvantage
Unable to attract or retain a qualified person
Chain pharmacy
Chain pharmacy stores are branched stores existing at
various locations but operating under a common
ownership. It was first initiated by Farmacia, a
subsidiary Ferozesons, Nowshera.
Umar pharmacy
Cure pharmacy
D. Watson chemist
Advantages
More credibility
Wide geographical coverage
Economical buying due to bulk purchase making more
profit
Able to attract qualified person because of having a
job structure
Efficient as can afford more employees, better
services, sale training et.
Promotional activities can be initiated with more
investment
Superstore
Drug superstore is one carrying drugs along with a
wide variety of commodities. The pharmacy has
allocated a separate area within the unit. It attracts
more consumer traffic due to wide variety of
commodity available.
Community pharmacy
Pharmacist in community pharmacy dispense
medications, council patients on the use of
prescription and over the counter medications and
advise physician about patient medication therapy.
They also advise patient about general health topics
such as diet, exercise and stress management and
provide information on products such as medical
equipment's or health home care supplies.
Some community pharmacist provide specialized
services to help patients with condition such as
diabetes, asthma, smoking cessation or high blood
pressure.
They also keep computerized record of patient drug
therapy to prevent harmful drug interactions.
They are also responsible for the preparation of sterile
solutions which are administered IV. Many of them
are involved in extemporaneous preparations.
1. Dispense prescription medicines to the public
2. Ensure that different treatments are compatible
3. Check dosage and ensure that medicines are
correctly and safely supplied and labelled
(pharmacists are legally responsible for any
dispensing errors)
4. Supervise the preparation of any medicines (not all
are supplied ready made-up by the manufacturer)
5. Keep a register of controlled drugs for legal and
stock control purposes
6. Communicate with doctors about prescriptions
7. Sell over-the-counter medicines
8. Advise the public on the treatment of minor ailments
9. Advise patients of any adverse side-effects of medicines
or potential interactions with other medicines/treatments
10. Prepare dosette and cassette boxes, usually for the
elderly, but also for those with memory/learning difficulties
or who have several combinations of tablets to take, where
tablets are placed in compartments for specified days of the
week
11. Undertake Medicine Use Reviews (MUR), an advanced
service to help patients understand how their medicines
work and why they have to take them
12. Manage a needle and syringe exchange
13. Offer specialist health checks, such as blood
pressure and cholesterol monitoring and diabetes
screening
14. Run stop-smoking clinics and weight-reduction
programs
15. Arrange the delivery of prescription medicines to
patients
16. Manage, supervise and train pharmacy support
staff
17. Manage finance and budgets
18. Keep up to date with current pharmacy practice,
new drugs and their uses
Forensic pharmacy
It is the application of the drug sciences to legal issues.
Forensic pharmacists engage in professional work relating
to litigation (legal process, court case etc.), the regulatory
(supervisory) process, or the criminal justice system.
Forensic pharmacy is not an exotic (unusual) field. Many
issues concerning society are relevant to forensic
pharmacy including substance abuse control, impaired
driving, crime, fraud, date rape, and employment testing
for drugs. Pharmacists may provide valuable testimony
(proof) in cases involving drunk driving, homicide
(murder), suicide, malpractice, child abuse, personal
injury cases, patents (copyrights), and so on.
Pharmacist Malpractice
Pharmacists have been sued (charged) for many
reasons including dispensing the wrong medication,
compounding errors, failure to detect interactions,
failure to contact prescribers about excessive dosages,
and failure to warn patients about side effects.
Clinical pharmacists can be liable for improperly
monitoring drug therapy. Malpractice cases against
pharmacists generally require testimony from another
pharmacist.
Most lawyers will not file lawsuits against pharmacists
unless an affidavit is obtained from another
pharmacist expressing an opinion of negligence. This
pharmacist expert witness would express an opinion
supporting the allegations of malpractice.
Malpractice against other health professionals
The forensic pharmacist can assist lawyers regarding
malpractice cases of other health professionals, for
example physicians and nurses. If the case involves an
adverse drug reaction, the pharmacist can testify about
causation. The pharmacist can also testify about
alternative therapies with less risk. The pharmacist can
provide opinions about medications that can prevent
disease complications. For example, if a patient
develops renal failure from diabetes or hypertension,
the pharmacist can discuss medications that would have
prevented or reduced the risk of kidney damage.
Blood Levels
Certain drugs have a narrow therapeutic range and need
to be closely monitored (eg digoxin, theophylline,
lithium, etc). Clinical reasons for which to draw blood
samples include high doses and borderline doses, signs of
toxicity occurring, lack of a therapeutic effect, or
suspected poor adherence. Toxicology analysis is a
common part of the forensic autopsy (post-mortem ) and
often forensic pharmacists are consulted to interpret drug
levels. Numerous changes occur postmortem that may
increase or decrease the blood level detected at autopsy.
The postmortem blood level may not reflect an
antemortem blood level.
Drugs, Alcohol, and Driving
The forensic pharmacist can interpret the levels of
blood alcohol and discuss the typical effects from
different alcohol levels. Pharmacists can apply
pharmacokinetics to estimate the level of alcohol at
the time of the alleged event. Pharmacokinetics
calculations can especially be helpful if an extended
time period exists between the incident and time of
collection.
Certain medications can have additive effects with
ethanol, that is lower levels of ethanol will produce
greater effects. Other medications can alter the
absorption or metabolism of ethanol. Certain disease
states may make a person susceptible to the effects of
ethanol. Pharmacists can provide input regarding these
other factors relating to alcohol consumption such as
personal injury cases.
Criminal Cases
The work of forensic pharmacists may be needed in
various types of criminal cases. This includes cases
where the drug or poison was used as a weapon, or
where medications impair the mental capacity of the
defendant or victim.
The effects of drugs on victims are often related to
criminal cases. Medications are often used as agents
for suicide and in suicide attempts. Drugs and poisons
have been used as tools of homicide.
Drugs have been used to facilitate sexual assault,
especially in dating situations. The most well-known
date rape drug is flunitrazepam, although alcohol is
the most common agent. Other well-known date rape
drugs include gamma-hydroxybutyrate (GHB) and
ketamine. In theory, any drug that has sedating, mind
alerting effects, or impairs memory could be used to
facilitate a sexual assault. Chemical weapons have
been used in terrorism and continue to be risk to this
day.
Off-Label Drug Use
A pharmaceutical company may only market the drug for
conditions that the FDA has approved. However, health
care providers may prescribe marketed medications for
uses other than FDA-approved uses. These are referred
to as ‘‘unlabeled’’ or ‘‘off-label’’ uses.
Prescribing offlabel medications is in itself not
malpractice. Many off-label uses of medications are
appropriate and medically necessary. The forensic
pharmacist may offer testimony about the need for
unlabeled indications and provide insight into
appropriate use of that medication.
Fraud and White-Collar Crime
Types of fraud related to forensic pharmacy include:
1. Scientific Fraud: Submitting intentional false data
for publication in a book or journal.
2. Quackery: The promotion of remedies that lack
scientific support to consumers or health
professionals.
3. Drug Diversion: Obtaining controlled substances
for misuse or abuse.
4. Health care Fraud: Submitting intentionally false
data to insurance companies.
5. Occupational Fraud and Abuse: This is in no way
limited to pharmacy and or even the health care
industry.
6. Record Tampering: Improper changes in the writing
in the medical records after a lawsuit has been
initiated or fear lawsuit after an unexpected
occurrence.
7. Counterfeit Drugs