Pharmacy Practice & Ethics

Tareq Mukattash, PhD

Course ContentWeek Topics

1 Pharmacy history

1 - 3 Pharmacy services in different sectors

4 -5 Social and behavioral aspects of pharmaceutical wor k

6-7 Selecting, supplying and managing medicines

8 Ethics in healthcare

9 - 11

Ethics & practice 1:

-Patient rights

-Confidentiality

-Different patient groups (i.e, patients with termin al illness)

-Capacity & patients consent

12 - 13

Ethics & practice 2:

-Pharmaceutical work ethics

-Pharmaceutical research ethics

-Availability of medicines

-Unlicensed and off-label drugs

14 - 15 An introduction to laws governing pharmaceutical pr actices in Jordan

NB: all references are available at the University’ s library

(1) A glance at history

• Cavemen almost certainly rolled the first crude pills in their hands

• The earliest known prescriptions date back to at least 2700 BC and were wri)en by the Sumerians.

• Chinese pharmacy traces its origins to the emperor Shen Nung in about 2000 BC.

• Egyptian pharmacists were priests, and they learnt and practised their art in the temples.

• Greek philosophers began to influence medicine and pharmacy - not only observed nature, but sought to explain what they saw, gradually transforming medicine into a science

• Greek medicine continued with the rise of the Roman Empire

• The transition of pharmacy into a science received a major boost with the work of Dioscorides in the first century AD.

• In his Materia Medica

he describes nearly 500 plants and remedies prepared from animals and metals, and gives precise instructions for preparing them.

• The greatest influence on pharmacy was Galen (130 to 201 AD)

• He introduced many previously unknown drugs, and was the first to define a drug as anything that acts on the body to bring about a change.

• He gave his name to pharmaceuticals prepared by mechanical means (galenicals).

• The first privately owned drug stores were established by the Arabs in Baghdad in the eighth century.

• They built on knowledge acquired from both Greece and Rome, developing a wide range of novel preparations, including syrups and alcoholic extracts.

• One of the greatest of Arab physicians was Rhazes (865–925 AD).

• His principal work, Liber Continens, was to play an important part in Western medicine.

• These new ideas became assimilated into the practice of pharmacy across western Europe following the Moslem advance across Africa, Spain and southern France.

• The greatest figure in the science of medicine and pharmacy during this period was the Persian, Ali ibn Sina (980 to 1037 AD), who was known by the western world as Avicenna.

• His Canon Medicinae is a synopsis of Greek and Roman medicine.

• His teachings were treated as authoritative in the West well into the seventeenth century and they remain dominant influences in some eastern countries to this day

• In European countries exposed to Arab influence, pharmacy shops began to appear around the eleventh century

• Frederick II of Hohenstaufen provided a key link between east and west, and it was in Sicily and southern Italy that pharmacy first became legally separated from medicine in 1231 AD.

• European countries, pharmacy emerged as a separate occupation over the centuries which followed. German pharmacists, for example, formed themselves into a society in 1632 (Basel Oath).

• The first official pharmacopoeia, to be followed by all apothecaries, originated in Florence. Published in 1498

• The organisation of pharmacy

• In France, the pharmacien received official recognition with the establishment of the College de Pharmacie in 1777, which ushered in modern French pharmacy.

• During the 17th and 18th centuries many people in con>nental Europe passed the examinations for both pharmacy and medicine, and practised both.

• Early American pharmacy was heavily influenced by immigrants from Europe.

• An Irish pharmacist, Christopher Marshall, established the first such shop in Philadelphia in 1729.

• The American Pharmaceutical Association, open to ‘all pharmacists and druggists of good character’, was established some >me later, in 1852.

• Establishment of Pharmaceutical association around Europe, followed by the establishment of pharmacy schools and faculties.

• The practice of pharmacy

• Problems:

– Chain pharmacy & multiples!!

– The nature of retailing was changing

– The first dental register appeared in 1879

– World wars

– Poor people

• Steps forward:

– health insurance

– Separating dispensing and prescription

– Strength of societies

• Pharmaceutical industry, Branding.

• Professionalism versus commercialism

• The conflict between trade and profession has been a central issue throughout pharmacy’s history

• Pharmacists have always been paid for the products they sell, not the advice they give, and almost all engage in retail trade stretching beyond the strict confines of pharmacy

• It was undesirable for nonprofessional business to predominate in a pharmacy, and that the extension of this kind of business in pharmacies should be controlled

• THE EMERGENCE OF ‘THE NEW PHARMACY’: 1986 TO PRESENT

• By the early 1980s there was widespread uncertainty about the future of pharmacy, particularly community pharmacy.

• ‘one knew there was a future for hospital pharmacists, one knew there was a future for industrial pharmacists, but one was not sure that one knew the future for the general practice pharmacist’

• Pharmacy needed to re-invent itself. Some important initiatives were taken. In 1982, for example, the Na>onal Pharmaceu>cal Association (UK) began its ‘Ask Your Pharmacist’ campaign, in which it promoted the use by the public of their local pharmacy.But what was really needed was an independent and far-ranging inquiry into the profession.

• The Nuffield Report 1986 (UK):

• ‘to consider the present and future structure of the practice of pharmacy in its several branches and its potential contribution to health care and to review the education and training of pharmacists accordingly’.

• ‘we believe that the pharmacy profession has a distinctive and indispensable contribution to make to health care that is capable of still further development’

• ‘every prescription for a medicine must be seen by a pharmacist, and a judgement made by him as to what action is necessary’

• The extended role of the pharmacist:

• increasing the range of medicines available for sale by pharmacists

• the maintenance of patient medication records by pharmacists

• the extension of needle and syringe exchange schemes

• participation in health promotion campaigns

• having separate areas for providing advice and counselling.

• New age:

• Four key areas for pharmacy involvement were identified:

– the management of prescribed medicines

– the management of chronic conditions

– the management of common ailments (diseases)

– the promotion and support of healthy lifestyles.

• Is pharmacy returning to its roots?

• The ‘Ask Your Pharmacist’ campaign, the extended role, and the Pharmacy In A New Age initiative can be seen collectively as an attempt to draw pharmacists out of the dispensary (which was usually at the back of the shop), to the front of the shop where they would be more accessible to the public.

• Here they would be the– ‘first port of call’ for the public seeking medical attention

– they would be a source of advice and information about medicines to the public

– they would prescribe from an increasingly long list of recently deregulated medicines.

• At the same time as pharmacists were

becoming more accessible, doctors were

becoming less accessible.

• The changes in pharmacy practice in the last

quarter of the twentieth century represented

a shift away from a product-oriented

approach to medicines towards a patient-

focused one

• A BRIEF HISTORY OF HOSPITAL PHARMACY

• Pharmacy practice in hospitals can be traced back over many centuries, and the history of hospital pharmacy is closely allied to the history of hospitals.

• The history of hospital pharmacy can be considered within three time frames:

– An emergent period up to 1897

– a period of standardisa>on up to 1948

– a period of expansion and consolidation since then.

• The first hospitals in which it is known pharmacy was practised were the Roman military hospitals known as valetudinaria.

• As Europe converted to Christianity, so the Church began to care for the sick and needy.

• Many employed an apothecary and contained a dispensary. The apothecary usually combined the roles of resident medical officer and dispenser of medicines.

• Hospital pharmacy was never immune. It was nevertheless able to establish new activities which contributed to cost control, such as formulary development, and many pharmacists began to specialise in a particular area of clinical pharmacy, such as paediatrics or cardiology.

• Clinical pharmacy

• Clinical pharmacy is the branch of Pharmacy where pharmacists provide patient care that optimizes the use of medication and promotes health, wellness and disease prevention.

• Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics.

• Clinical pharmacists often collaborate with physicians and other healthcare professionals.

• Within the system of health care, clinical pharmacists are experts in the therapeutic use of medications.

• They routinely provide medication therapy evaluations and recommendations to patients and other health care professionals.

• Clinical pharmacists are a primary source of scientifically valid information and advice regarding the safe, appropriate, and cost-effective use of medications

• A more appropriate definition for clinical pharmacy is, "Clinical pharmacy is the branch of pharmacy which deals with

– various aspect of patient care

– dispensing of drugs

– advising patient on the safe and rational use of drug

• Basic components of clinical pharmacy practice:– Prescribing drugs

– Dispensing and administering drugs

– Documenting professional services

– Reviewing drug use

– Communication

– Counselling

– Consulting

• Scope of clinical pharmacy:– Drug Distribution

– Systems Drug Information

– Drug Utilization

– Drug Evaluation and Selection

– Medication Therapy

– Management Formal Education and Training Program

– Disease State Management