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• The study notes cover professional pharmacy practice, including its definition, medication use process, pharmacist roles, evolution, key concepts, and various practice settings.

Introduction to Professional Pharmacy Practice

• Pharmacy is the profession responsible for appropriate medication use, devices, and services to achieve optimal therapeutic outcomes, as defined by the American Pharmacists Association (APhA).
• Pharmacy should be seen as a knowledge base that provides a health service by focusing on drug understanding and effects.
• The medication-use process includes prescribing, transcribing, order interpretation, preparation, and dispensing of medications.
• Compounding pharmacy involves small-scale preparation of ointments, syrups, and various dosage forms.

Adverse Drug Effects (ADEs)

• ADEs are harmful effects from pharmaceutical products, not always directly related.
• Adverse drug reactions (ADRs) refer to unintended harmful effects directly related to a drug.
• Side effects are known effects of a drug.
• Allergies are the body's immune response to a drug, causing a cause-and-effect relationship.

Advanced Roles of Pharmacists

• Pharmacists provide drug-related information to other healthcare professionals.
• They participate in public and disease-state management programs to ensure proper medicine use.

Pharmacy Practice Explained

• Pharmacy practice involves reviewing and interpreting prescriptions.
• It includes compounding, labeling, and dispensing drugs with auxiliary labels like "NOT FOR ORAL USE, EXTERNAL USE ONLY".
• Drug product selection and medication-use evaluation (MUE) involves evaluating steps to determine efficacy and errors.
• Pharmacists monitor patients and intervene when necessary, identifying and correcting errors during medication use.
• It includes providing usage information for medications and non-pharmacological treatments.

Drugs vs. Medicines

• Drugs contain only the active pharmaceutical ingredient (API) and are in crude form, and cannot be consumed directly.
• Medicines include APIs plus excipients, are refined, and are directly administered to patients.
• All medicines are drugs, but not all drugs are medicines.

Evolution of Pharmacist Roles

• The role of pharmacists has evolved through four stages: Traditional Era, Scientific Era, Clinical Era, and Pharmaceutical Care Era.

Traditional Era

• In the early 20th century, drugs were formulated from natural sources.
• Pharmacognosy involved the systematic science of morphological, chemical, and biological properties of drugs, including their history, cultivation, collection, extraction, isolation, bio-assaying, quality control, and preparation of crude drugs of natural origin; this included the use of chromatography.
• Galenical Pharmacy: A branch of science dealing with medicine prepared by extracting active plant constituents, and checking for potency, strength, and purity.

Scientific Era

• Began after WWII (Sep 2, 1945), with the emergence of the pharmaceutical industry.
• Drugs were made in factories instead of apothecary shops.
• Pharmacology: Study of medicines and drugs, including action, use, and body effects; encompasses pharmacokinetics and pharmacodynamics.

Pharmacokinetics

• What the body does to the drug.
• Includes absorption, distribution, metabolism, and elimination (excretion).

Pharmacodynamics

• What a drug does to the body.
• Includes which receptors it binds to, and which systems/metabolic pathways it affects.

Pharmaceutics

• The science of drug preparation, dosage forms, and drug delivery systems.
• Takes into account the pharmacokinetics and pharmacodynamics of a drug, and its physical and chemical properties.

Clinical Era

• The Millis Report: Pharmacists of Future, came out in 1975.
• New educational emphasis on clinical patient-oriented pharmacy.
• Pharmacokinetics: Study of how the body interacts with administered substances over their exposure duration.
• Pathophysiology: Study of changes during disease, including processes/mechanisms.
• Physiology: Study of observed physical changes.

Pharmaceutical Care Era

• Helper and Strand in 1990 defined pharmaceutical care.
• Involves responsible drug therapy provision to improve quality of life.
• Pharmacists are medication experts and accessible healthcare team members that give assistance and advice on common ailments and healthcare matters.

Profession of Pharmacy

• Involves occupation, widespread training, study and mastery of information, a professional association, ethical codes, and certification procedures.

Professionalism in Pharmacy

• Includes knowledge/skills, commitment to self-improvement of skills/knowledge, service orientation, and pride.
• Additionally, it includes good client/patient relationships, creativity/innovation, trustworthiness, accountability, ethical decision-making, and leadership.

Scope of Pharmacy Practice Settings

• Includes community (retail) pharmacy and hospital pharmacy.
• Also includes clinical pharmacy, long term care facilities, academia, and the pharmaceutical industry.

Community (Retail) Pharmacy

• It is a business model providing services and playing roles in communities.
• Community pharmacists get involved in patient care initiatives (like identifying diseases), give immunizations, screening for hypertension/diabetes, and provide lifestyle/dietary education.

Hospital Pharmacy

• Comprises health care services like drug choosing, preparing, storing (medicines and devices), compounding, dispensing, and advising on safe/efficient use.
• IPD pharmacy dispenses medicines to hospitalized patients, while the OPD pharmacy serves non-hospitalized patients that need doctor consultation.
• The roles include dispensing oral and parenteral medications, specializing in patient care areas, educating/counseling patients, providing information, and administering a department.

Clinical Pharmacy

• Concerned with the science and practice of rational medication use.
• The 5 R's: right patient, right drug, right dose, right route of administration, and right time.
• The goal is to optimize medication therapy and promote health/disease prevention to produce maximum effect and be cost-effective and safe.
• Clinical pharmacists consult, analyze therapies, advise healthcare practitioners, provide pharmaceutical care, and oversee medication purchasing.
• They are also responsible for selection defining drug formularies in collaboration with doctors.

Additional Pharmacy Settings

• Drug Information: Seeking/evaluating information, organizing services for healthcare practitioners/patients, preparation, drug use studies/research.
• Long-Term Care Facilities: Residential care for people with disabilities/elderly who cannot care for themselves; differs from medical centers.
• Academia: Teaching and researching new APIs, drug formulae, and delivery systems.
• Academics hold Master's and PhD degrees.
• Lecturer Qualifications: MPhil / Master’s (18 years of education)
• Assistant Professor Qualifications: PhD
• Associate professor Qualifications: PhD + 10 years OR 5 years post PhD experience, 10 publications
• Professor Qualifications: PhD and 15 years/10 yrs past experience, 15 publications
• Pharmaceutical Industry: Produces prescription/non-prescription chemicals/medications.
• Industrial pharmacists perform research and development.
• Industrial pharmacists take on roles such as manufacturing quality control, sales marketing, regulatory affairs planning and management.

Additional Pharmacy Areas of Practice

Mail Order/Internet Pharmacies

• Pharmacists must review prescriptions and do appropriateness reviews.
• Pharmacists must call the prescriber if the script is unclear, has history issues, or there are patient allergy alert.

Nuclear Pharmacy

• Prepares radioactive materials to improve health through safe/effective drug use to diagnose and treat specific diseases; involves radionuclide therapy with agents like Lu-177 and Y-90.

Drug Information Centers (DICs)

• Provides unbiased, well-referenced and critically/evaluated information on any pharmacy aspect practice It helps the health care professionals, patients, caregivers and community.
• The service is offered through pharmacy departments to provide advice.
• DPIC Sources primary, secondary, & tertiary resources relating to medication and query
• Goals include offering swift and precise drug/poison data.

Responsibilities of Pharmacists

• Stimulation of effective use of drug information resources.
• Education of pharmacy students/residents as effective information providers.
• Creation of organized specialized databases. Improvement of drug therapeutics to meet drug info needs. Expanded role of pharmacist to information services to hospitals and and community. Improved availability and rational drug therapy use.
• Involved in recommending pharmacy and therapeutic committee (PTC), developing drug use policies, formulary consideration, and ADR reporting.
• Also involved in Drug Use Review (DUE)/evaluation, investigational drug programs, education/training, publications, and community services.

Systemic Approach to Answering a Question

• Steps to secure demographics, get background, determine the category of the question, create strategy for the search, complete analysis, formulate a response, and follow up.
• Types of Questions Include: product availability, adverse event, IV stability, dosage/administration.
• Types of Questions Include interactions, alternative medication and natural products, identification.
• Questions may also pertain to pharmacokinetics, therapeutics/efficacy, safety in pregnancy/nursing, and toxicity/poisoning.

Resource Monograph

• Drug monographs contain complete drug-related information, including its dosage forms and analysis.
• Contains include: Chemical name, Specific optical rotation, Formula, Loss on Drying, Solubility
• Contains include: Sulphated ash Pose, Identification, Pose, PH, and Assay

Safety Data Sheets

• Material Safety Data Sheets (MSDS) are provided for lab chemicals.
• Informs on substance use, solubility, handling, and spill/exposure protocols

Drug Literature Use

• Providing responses to questions on product concerns from patients and health workers.
• Documents providing evaluation/information on therapeutic issues.
• Updating personal growth and education.

Types of Literature Sources

• Primary sources include original materials (on which other researches are based). The most updated research, providing new information without interpretation. Examples: journals that publish them and urea experts that have reviewed the articles.
• Secondary Sources: Provides interpretation and evaluation of primary sources. Do not provide evidence. Use to identify information from other sources of drug information. Examples: Pubmed, Medcape, Medline, BIDS Embase. International Pharmaceutical Abstracts, Index Medicus
• Tertiary Sources: Key research findings and concepts providing of information distillation of primary and secondary data.

Literature Sources Advantages vs Disadvantages

• Advantage: Easy access and well-vetted Standards of best practice
• Disadvantage: Years of compilation require resources, and may contain dated material
• Examples: textbooks Compendia: Physicians Desk Reference (PDR) Handbook of injectable Drugs
• Examples: Examples: Dipiro's Pharmawtherapy: Pathophysiologi and pharmacopoera such as United States Pharmacopoeia and British

Literature Source Case Examples

• AHFS: The American Hospital Formulary Service update anually
• Monographs are updated throughout the year and used as Drug Information
• Pharmacotherapy: A pathyphysiologic Approach currently updated every 2 years

Names of Journals from Professional Practice Case Scenerio 1

• Pharmacology experimental therapeutics
• Archives Of Womens - Mental Health
• QJM: An international Journal of Medicine
• JAMA internal medicine Journal
• An international Journal of Medicine
• American Journal Of Health System Pharmacy
• American Journal of Medicine
• British Medical Journal(BMJ)
• Pediatric Clinic
• New England Journal of Medicine

Journals and Authenticity

• Primary literature provides the most authentic information in research articles and provides primary review.
• Secondary source articles give secondary review.

Pharmacopoeias, Formularies and Compendia

• The official book of drugs Standards prepared by any regulatory country or body.
• A "book containing a collection of monographs by authorized body”.
• "Pharmakon"("drug") and "Poieo" ("make").
• Contains any formula required or standrads to make a drug.

More Information on Formularies

• List of drug collection of formulas for preparation of medicinal preparation
• Contains of of therapeutic short and comprehensive.
• Short and comprehensive on therapeutics

Formula Example

• Pharmacopoeias Formularies = Drug Compendia

Importance of pharmacopoeia

• Maintain uniformity
• Control standards of drugs available in market
• Complete information on drugs and their dosage

Books in Formula Contains

• Components in pharmacopoeia
• Chemical Name
• Assay
• Formula (Direction) Rotation
• Specific Optical Rotation of plane polarization
• Solubility
• Loss and identification of Drying
• PH

Official vs Non-Official Books

• Books were written, complied, and published under strict supervision by the government.
• Non Official written, compiled, and published locally.
• Used as secondary reference sources

Example Official Books

British pharmaceutics code national formulary ###Example of Non-Official Books Applied and clinical pharmacology Katzung

• Tutorial Dharma

Auxiliary labels and LASA

• auxiliary labels give information about use of medicine and LASA are " look Alike-Say Alike”.

Labels given

Tall-Man lettering done by the FDA (food and drug administration) NOT FOR ORAL USE for external use only

Labels for medicine usage includes

Shake well before use Medication may cause drowsiness Must not crush or chew, and must swallow whole

Scored Tablet

• Label for tablets or medicine that can be broken.

BNF

• British national formulary is a directory of medication info for doctors, and gives drugs prescriptions to health practitioners. -Prescription codes guidelines and information -JFC are responsible for the British national formulary (BNF) -Regulatory bodies is the British Medical Association responsible and the royal pharmaceutical society? for medicine regulations. -Representative bodies include UK health department/the medicine and healthcare provider regulatory agencies. -Also, contains National Guideline producers, Dental Advisory Group Literature Source of a nurse prescriber's advisory group- Clinical expert and Consensus guidelines?

Examples of Medical Scenarios

• Gastrointestinal discomfort prescription of omeprazole for treating acid reflux.
• The recommendation to inject 4 mg of the medical product in 2 minutes.
• 27 weeks pregnant with diabetes requires the precription of metformin 500 mg BD

Presciptions Examples and Cautions

• Pregnancy not harm-ful but not more than 20MG daily.
• Side effects include Agitation and impotence.
• If patients are interracting, see appendix 1 and 10, and view labels from appendix