pharmacy what it is and how it works third edition kelly william n

PHARMACY
What It Is and
How It Works
Third Edition
WILLIAM N. KELLY

CRC Press


PHARMACY
What It Is and
How It Works
Third Edition


Pharmacy : What It Is and How It Works, Third Edition
William N. Kelly
Essentials of Law and Ethics for Pharmacy Technicians, Third Edition
Kenneth M. Strandberg
Essentials of Human Physiology for Pharmacy, Second Edition
Laurie Kelly McCorry
Pharmaceutical Dosage Forms and Drug Delivery
Ram I. Mahato
Basic Pharmacokinetics
Mohsen A. Hedaya
Basic Pharmacology: Understanding Drug Actions and Reactions
Maria A. Hernandez and Appu Rathinavelu
Managing Pharmacy Practice: Principles, Strategies, and Systems
Andrew M. Peterson
Essential Math and Calculations for Pharmacy Technicians
Indra K. Reddy and Mansoor A. Khan

Pharmacoethics: A Problem-Based Approach
David A. Gettman and Dean Arneson
Pharmaceutical Care: Insights from Community Pharmacists
William N. Tindall and Marsha K. Millonig
Essentials of Pathophysiology for Pharmacy
Martin M. Zdanowicz
Quick Reference to Cardiovascular Pharmacotherapy
Judy W. M. Cheng
Essentials of Pharmacy Law
Douglas J. Pisano
Pharmacokinetic Principles of Dosing Adjustments: Understanding the Basics
Ronald D. Schoenwald
Pharmaceutical and Clinical Calculations, Second Edition
Mansoor A. Khan and Indra K. Reddy
Strauss’s Federal Drug Laws and Examination Review, Fifth Edition Revised
Steven Strauss
Inside Pharmacy: Anatomy of a Profession
Raymond A. Gosselin and Jack Robbins
Understanding Medical Terms: A Guide for Pharmacy Practice, Second Edition
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, and Steven Strauss


PHARMACY
What It Is and
How It Works
Third Edition
WILLIAM N. KELLY

Boca Raton London New York

CRC Press is an imprint of the
Taylor & Francis Group, an informa business


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To all the student pharmacists required to read
this book: May you learn much and enjoy the
profession of pharmacy as much as I.



Contents
Foreword................................................................................................................xxix
Preface...................................................................................................................xxxi
Acknowledgments............................................................................................... xxxiii
About the Author..................................................................................................xxxv
Chapter 1 What Is Pharmacy?............................................................................... 1
Introduction........................................................................................... 1
Learning Objectives.............................................................................. 1
Pharmacy...............................................................................................1
What Is a Profession?............................................................................ 2
Study and Training...........................................................................2
Measure of Success.......................................................................... 3
Associations......................................................................................3
The Business of Pharmacy............................................................... 3
A Brief History of Pharmacy................................................................ 3
Early Development........................................................................... 3
Community Pharmacy in Early America.........................................4
Hospital Pharmacy in Early America...............................................6

What Is the Purpose of Pharmacy?....................................................... 8
What Controls Pharmacy?....................................................................8
Pharmacy Licensure.........................................................................8
State Pharmacy Laws.......................................................................8
State Pharmacy Rules and Regulations............................................9
Federal Laws....................................................................................9
What Shapes Pharmacy?.......................................................................9
Scope of Practice.............................................................................. 9
Organizations................................................................................... 9
House of Delegates......................................................................... 10
Standards of Practice...................................................................... 10
Consensus Conferences.................................................................. 10
Conference Proceedings and White Papers................................... 10
Study Commissions........................................................................ 12
Leadership...................................................................................... 12
Peer Review.................................................................................... 14
Pharmacy Ethics............................................................................. 14
The Value of Pharmacy....................................................................... 16
Summary............................................................................................. 16
Discussion Questions and Exercises................................................... 17
Challenges........................................................................................... 17
Web Sites of Interest............................................................................ 17
References........................................................................................... 18
vii


viii

Contents

Chapter 2 The Pharmacist.................................................................................... 21
Introduction......................................................................................... 21
Learning Objectives............................................................................ 21
Who Are Pharmacists?........................................................................ 21
Education and Training....................................................................... 22
Formal Education........................................................................... 22
Internship........................................................................................ 23
Licensure........................................................................................ 23
Postgraduate Training....................................................................24
Fellowships.....................................................................................25
Specialty Certification....................................................................26
Continuing Education..................................................................... 27
Postgraduate Education..................................................................28
Characteristics of Pharmacists............................................................28
Skills and Traits..............................................................................28
Character and Virtues.................................................................... 29
Habits.............................................................................................. 30
Professionalism............................................................................... 31
What Pharmacists Do.......................................................................... 32
Quality Controller.......................................................................... 32
Caregiver........................................................................................ 33
Clinician......................................................................................... 33
Problem Solver............................................................................... 33
Advisor...........................................................................................34
Teacher............................................................................................34
Manager, Supervisor, and Leader...................................................34
Owner............................................................................................. 35
Researcher...................................................................................... 35
Sales Representative....................................................................... 35
Quality Reviewer............................................................................ 36

Titles and Career Paths....................................................................... 36
Job Titles......................................................................................... 36
Career Paths.................................................................................... 36
Expectations of Pharmacists............................................................... 36
Supply and Demand for Pharmacists.................................................. 37
The Rewards of Being a Pharmacist................................................... 38
Intrinsic Factors.............................................................................. 38
Extrinsic Factors............................................................................. 38
Job Satisfaction...............................................................................40
Job Stress........................................................................................40
Lifelong Learning and Career Planning............................................. 41
Job Outlook......................................................................................... 42
Summary............................................................................................. 42
Discussion Questions and Exercises................................................... 42


Contents

ix

Challenges........................................................................................... 43
Web Sites of Interest............................................................................ 43
References...........................................................................................44
Chapter 3 Pharmacists and the Health Care System........................................... 47
Introduction......................................................................................... 47
Learning Objectives............................................................................ 47
Disease Burden.................................................................................... 48
Overview of the Health Care System in the United States................. 48
Access to Care................................................................................ 49
Quality of Care............................................................................... 49

Cost................................................................................................. 50
Financing........................................................................................ 52
Private-Sector Funding.............................................................. 52
Public-Sector Funding............................................................... 53
Paying Providers............................................................................. 55
Affordable Health Care Act................................................................ 55
The Delivery of Care........................................................................... 56
Patient-Centered Care..................................................................... 56
The Health Care Team................................................................... 57
Prescribing Authority..................................................................... 57
Patient Confidentiality.................................................................... 57
The Place of Drugs in the Health Care System................................... 58
The Role of Pharmacists in the U.S. Health Care System.................. 59
Societal Purpose of Pharmacy.......................................................60
Pharmacy’s Destiny........................................................................60
Accountable Care Organizations and the Medical Home...................60
Opportunity....................................................................................60
Summary............................................................................................. 61
Discussion Questions and Exercises................................................... 61
Challenges........................................................................................... 61
Web Sites of Interest............................................................................ 62
References........................................................................................... 62
Chapter 4 The Drug Use Process......................................................................... 65
Introduction......................................................................................... 65
Learning Objectives............................................................................ 65
What Is the Drug Use Process?........................................................... 65
Part I—Drug Products and Distribution............................................. 65
The Drugs.......................................................................................66
Distribution of Drugs from Pharmaceutical Manufacturers.......... 68
Distribution from Drug Wholesalers.............................................. 68

Distribution from Distribution Centers and Repackagers.............. 69
Counterfeit Drugs........................................................................... 69


x

Contents

Self-Care and the Role of OTC Medication........................................ 70
Self-Care......................................................................................... 70
Over-the-Counter Medication........................................................ 70
Complementary and Alternative Medications................................ 71
Dietary Supplements...................................................................... 72
Tips for Consumers........................................................................ 72
Prescribing Drugs................................................................................ 72
The Prescription............................................................................. 73
Parts of a Prescription.................................................................... 73
Types of Prescriptions.................................................................... 75
Writing the Prescription................................................................. 75
Drug Orders.................................................................................... 75
Drug Samples................................................................................. 75
Dispensing........................................................................................... 76
Types of Retail Pharmacies............................................................ 76
Independent Community Pharmacies........................................ 77
Chain Store Pharmacies............................................................ 77
Mass Merchandiser Pharmacies................................................ 77
Food Store Pharmacies.............................................................. 77
Mail-Order Pharmacies............................................................. 77
Outpatient Pharmacies in Hospitals.......................................... 78
Internet Pharmacies................................................................... 78

The Dispensing Process................................................................. 78
Drug Distribution in Organized Health Care Settings........................ 78
Drug Sales........................................................................................... 79
Drugs Are Big Business................................................................. 79
Why Costs for Drug Prescriptions Are Rising...............................80
Part II—Medication Use..................................................................... 81
Medication Use in the United States.............................................. 81
Drug Pricing........................................................................................ 82
Manufacturers................................................................................. 82
Multitier Pricing........................................................................ 82
Prices for U.S.-Made Drugs in Other Countries........................ 83
Buyers and Sellers of Prescription Drugs........................................... 83
Drug Wholesalers........................................................................... 83
Community Pharmacy.................................................................... 83
Buying........................................................................................ 83
Selling........................................................................................84
Third-Party Contracts....................................................................84
Medicaid Patients...........................................................................84
Medicare Patients........................................................................... 85
Gross Margin, Reimbursement, and Making a Profit.................... 85
Hospitals......................................................................................... 85
Buying........................................................................................ 86
Formularies................................................................................ 86


Contents

xi

Projecting Drug Costs............................................................... 86

Selling........................................................................................ 86
Reimbursement.......................................................................... 87
Managed Care................................................................................ 87
Buying........................................................................................ 87
Selling........................................................................................ 88
Part III—Patients................................................................................ 88
Economic Value of Pharmaceuticals................................................... 88
Medication Administration................................................................. 88
Compliance with Taking the Medication as Prescribed................. 89
The Problem.............................................................................. 89
Cost............................................................................................90
Solutions.........................................................................................90
Quality Drug Therapy......................................................................... 91
How Drug Therapy Is Monitored and Reviewed................................92
Patient Outcomes................................................................................. 93
Medication Safety............................................................................... 93
Side Effects..................................................................................... 93
Adverse Drug Reactions................................................................. 93
Allergic Drug Reactions.................................................................94
Drug–Drug Interactions.................................................................94
Medication Errors...........................................................................94
Home Medication................................................................................94
Control of the Drug Use Process.........................................................94
Current Issues in the Drug Use Process.............................................. 95
Nutriceuticals and Herbal Medicines............................................. 95
Direct-to-Consumer Advertising of Prescription-Only Drugs......... 95
Importing of Drugs from Other Countries..................................... 95
Rising Number of Prescriptions and Not Enough Pharmacists....... 96
Summary.............................................................................................96
Discussion Questions and Exercises...................................................96

Challenges...........................................................................................97
Web Sites of Interest............................................................................97
References...........................................................................................97
Chapter 5 Pharmacy Supportive Personnel....................................................... 101
Introduction....................................................................................... 101
Learning Objectives.......................................................................... 101
The Pharmacy Technician................................................................. 102
Employment...................................................................................... 102
Why Pharmacy Technicians Are Important..................................... 102
What Pharmacy Technicians Do....................................................... 103
Functions of Pharmacy Supportive Personnel.............................. 103
What Pharmacy Technicians Need to Know.................................... 105
How Pharmacy Supportive Personnel Are Trained.......................... 105


xii

Contents

Technician Certification and Competency........................................ 107
Certification.................................................................................. 107
Competency.................................................................................. 108
Pharmacy Technician Organizations................................................ 108
Supervision of Pharmacy Technicians.............................................. 109
Being a Professional Pharmacy Technician...................................... 110
Earnings........................................................................................ 111
Working Conditions...................................................................... 111
Satisfaction................................................................................... 111
Advancement and Expanded Roles.............................................. 111
Job Outlook....................................................................................... 112

White Paper on Needed Changes...................................................... 112
Summary........................................................................................... 112
Discussion Questions and Exercises................................................. 113
Challenges......................................................................................... 113
Web Sites of Interest.......................................................................... 114
Additional Pharmacy Technician Texts and Resources.................... 114
Acknowledgment............................................................................... 114
References......................................................................................... 114
Chapter 6 Pharmacy Informatics....................................................................... 117
Introduction....................................................................................... 117
Learning Objectives.......................................................................... 117
Information Technology, Automation, and Informatics.................... 117
Improved Safety................................................................................ 118
Improved Patient Care....................................................................... 119
Improved Efficiency.......................................................................... 119
Improved Documentation of Care..................................................... 119
Pharmacy Informatics in the Drug Use Process............................... 119
Prescribing.................................................................................... 119
E-Prescribing................................................................................ 120
Computerized Prescriber Order Entry......................................... 120
Perfection...................................................................................... 120
Dispensing.................................................................................... 121
Administration.............................................................................. 122
Monitoring.................................................................................... 122
Education...................................................................................... 122
Telepharmacy............................................................................... 123
Summary...................................................................................... 124
Automation........................................................................................ 124
A Brief History............................................................................. 124
Benefits of Pharmacy Automation................................................ 124

Challenges of Pharmacy Automation........................................... 125
Selecting Pharmacy Automation.................................................. 126


Contents

xiii

The Market for Pharmacy Automation............................................. 126
Types of Pharmacy Automation................................................... 126
Tablet Counters........................................................................ 126
Intravenous Compounders....................................................... 126
Dispensing Machines............................................................... 127
Safety of Automated Devices....................................................... 128
Automating the Pharmacy................................................................. 129
Freeing Pharmacists for Pharmaceutical Care.................................. 130
The Future......................................................................................... 130
Summary........................................................................................... 130
Discussion Questions and Exercises................................................. 131
Challenges......................................................................................... 131
Web Sites of Interest.......................................................................... 131
Blog Sites of Interest......................................................................... 132
Twitter Addresses.............................................................................. 133
Informatic Pharmacists................................................................ 133
Medical Informatics..................................................................... 133
References......................................................................................... 133
Chapter 7 Pharmaceutical Care......................................................................... 137
Introduction....................................................................................... 137
Learning Objectives.......................................................................... 137
Theory of Practice............................................................................. 137

A Brief History of Pharmacy Practice in the United States............. 138
The Apothecary............................................................................ 138
Drug Dispensing and Distribution............................................... 138
Clinical Pharmacy........................................................................ 139
From Clinical Pharmacy to Pharmaceutical Care............................ 140
What Is Pharmaceutical Care?.......................................................... 141
Elements of Pharmaceutical Care................................................ 141
Responsible Provision of Care................................................. 141
Direct Provision of Care.......................................................... 142
Caring...................................................................................... 143
Achieving Positive Outcomes.................................................. 143
Improving the Patient’s Quality of Life................................... 144
Resolution of Medication-Related Problems........................... 144
Pharmaceutical Care versus Clinical Pharmacy............................... 146
Learning about Pharmaceutical Care............................................... 146
Providing Pharmaceutical Care........................................................ 149
Standard Process.......................................................................... 149
Selecting Patients to Monitor....................................................... 150
Identifying, Resolving, and Preventing Medication-Related
Problems....................................................................................... 150
Identifying Medication-Related Problems............................... 150


xiv

Contents

Resolving Medication-Related Problems................................ 150
Preventing Medication-Related Problems............................... 151
Patient Problem List..................................................................... 151

Pharmaceutical Care Plan............................................................ 152
Making Cents of Pharmaceutical Care........................................ 153
Why Perform Pharmaceutical Care?................................................. 154
The Patient.................................................................................... 154
Problems in the Drug Use Process............................................... 155
Drug-Related Morbidity and Mortality........................................ 155
Pharmaceutical Care Works.............................................................. 156
Patients Are Spared Medication-Related Morbidity and
Mortality....................................................................................... 156
Pharmaceutical Care Is Cost-Effective........................................ 157
Patients Love Pharmaceutical Care.............................................. 157
Other Health Care Practitioners Love Pharmaceutical Care....... 157
Pharmacy May Become a True and Recognized Clinical
Profession..................................................................................... 157
When Will All Pharmacists Practice Pharmaceutical Care?............ 158
Barriers and Challenges............................................................... 158
The Enemy Within................................................................... 158
Resource-Related Constraints................................................. 158
Lack of Support....................................................................... 159
Legal Barriers.......................................................................... 159
Studies Documenting the Value of Pharmaceutical Care....... 159
Lack of Payment...................................................................... 159
Enablers to Pharmaceutical Care................................................. 160
Changes in Pharmacy Education............................................. 160
Certified Pharmacy Technicians.............................................. 160
Function Analysis and Workflow Redesign............................. 160
Collaborative Practice Agreements......................................... 160
Pharmacy Automation and Information Technology.............. 160
Medication Errors.................................................................... 161
Health Care Reform.......................................................................... 161

Implementing Pharmaceutical Care.................................................. 161
Changes the Profession Needs to Make Happen.......................... 161
Freeing Pharmacist’s Time to Provide
Pharmaceutical Care..........................................................161
Leadership and Teamwork in Implementing
Pharmaceutical Care................................................................ 162
Pharmaceutical Care in the Community and Hospital
Environments................................................................................ 162
Documenting Pharmaceutical Care.................................................. 162
Progress in Establishing Pharmaceutical Care................................. 163
Emerging Concepts........................................................................... 164
Summary........................................................................................... 164


Contents

xv

Discussion Questions and Exercises................................................. 164
Challenges......................................................................................... 165
Web Sites of Interest.......................................................................... 165
References......................................................................................... 165
Chapter 8 Ambulatory (Community) Pharmacy................................................ 169
Introduction....................................................................................... 169
Learning Objectives.......................................................................... 169
Types of Community Pharmacies..................................................... 170
Independent Pharmacies............................................................... 170
Chain Store Pharmacies............................................................... 171
Supermarket Pharmacies.............................................................. 172
Mass Merchandiser Pharmacies................................................... 172

Mail-Order Pharmacies................................................................ 173
Pharmacy Demographics.................................................................. 173
Patient Service and Satisfaction........................................................ 173
Pharmaceutical Care......................................................................... 174
Extent and Growth....................................................................... 174
Some Bright Spots........................................................................ 175
Disappointments........................................................................... 176
Challenges.................................................................................... 176
Catalysts....................................................................................... 177
Dispensing Procedures to Advance Pharmaceutical Care................ 177
Accept the Prescription and Establish the
Pharmacist–Patient Relationship.................................................. 177
Review the Prescription and Patient Information........................ 178
Data Entry and Review of the Patient’s Medication Profile......... 178
Review of Insurance Coverage..................................................... 178
Retrieve the Drug or Ingredients from Storage............................ 179
Preparation or Compounding....................................................... 179
Label the Prescription................................................................... 180
Health Literacy............................................................................. 180
Check for Proper Dispensing....................................................... 181
Drug Use Review and Dispensing................................................ 181
Medication Delivery and Patient Counseling............................... 181
Whose Job Is It?................................................................................ 183
Avoiding Errors in the Dispensing Process...................................... 183
Dangerous Medication Errors...................................................... 183
Reasons for Medication Errors..................................................... 184
Errors versus Mistakes............................................................ 184
Not Enough Help..................................................................... 185
Community Pharmacy Services........................................................ 186
Traditional Services...................................................................... 186

xvi

Contents

Prescription Services............................................................... 186
Over-the-Counter Drugs.......................................................... 186
Newer Services............................................................................. 187
Types of New Services............................................................ 187
Are Patients Using These New Pharmacy Services?............... 188
Examples of How New Services Are Offered......................... 188
Payment for Community Pharmacy Care.................................... 188
Mail-Order Pharmacies..................................................................... 189
Community Pharmacist Satisfaction................................................. 190
Positions for Pharmacists in Community Pharmacy......................... 190
Pharmacy Interns.......................................................................... 190
Community Pharmacy Residents................................................. 191
Staff Pharmacists.......................................................................... 191
Store-Level and District Managers............................................... 191
Corporate Management................................................................ 191
Pharmacy Ownership................................................................... 191
Future of Community Pharmacy Practice........................................ 192
Implementing Change in Community Pharmacy Practice............... 192
Summary........................................................................................... 192
Discussion Questions and Exercises................................................. 193
Challenges......................................................................................... 193
Web Sites of Interest.......................................................................... 194
References......................................................................................... 194
Chapter 9 Health System Pharmacy.................................................................. 199

Introduction....................................................................................... 199
Learning Objectives.......................................................................... 199
Health Systems.................................................................................. 199
Hospitals............................................................................................200
How Hospitals Started..................................................................200
Modern Hospitals.........................................................................200
Types of Hospitals........................................................................200
Hospital Ownership................................................................. 201
Hospital Size............................................................................ 201
Hospital Type........................................................................... 201
Hospital Statistics.................................................................... 201
Hospital Accreditation.................................................................. 201
Internal Organization...................................................................202
Medical Staff Structure...........................................................202
Administrative Structure.........................................................202
Patients.............................................................................................. 203
Health Care Team.............................................................................. 203
Pharmacy Department......................................................................204
Mission of Pharmacy....................................................................204
Control of Drugs......................................................................204


Contents

xvii

Overseeing the Drug Use Process...........................................205
Ensuring Rational Drug Use....................................................208
Pharmaceutical Care.................................................................... 210
Clinical Pharmacy versus Pharmaceutical Care............................... 212

Focusing on Patients Needing the Most Help.............................. 212
Avoiding Medication Misadventures............................................ 213
Medication Errors......................................................................... 213
Practice Models................................................................................. 214
Education and Training..................................................................... 214
Pharmacy Staff.................................................................................. 215
Pharmacists.................................................................................. 215
Pharmacy Managers................................................................ 215
Pharmacy Supervisors............................................................. 216
Staff Pharmacists and Clinical Pharmacists........................... 216
Pharmacy Supportive Personnel.............................................. 217
Accreditation..................................................................................... 217
2015 Initiative.................................................................................... 218
Checking on Progress........................................................................ 218
Job Satisfaction.................................................................................. 218
Summary........................................................................................... 219
Discussion Questions and Exercises................................................. 219
Challenges......................................................................................... 219
Web Sites of Interest.......................................................................... 220
References......................................................................................... 220

Chapter 10 Managed Care Pharmacy.................................................................. 223
Introduction....................................................................................... 223
Learning Objectives.......................................................................... 223
What Is Managed Care?....................................................................224
Health Maintenance Organizations................................................... 226
Preferred Provider Organizations..................................................... 228
Point-of-Service Plans....................................................................... 228
Standards........................................................................................... 229
Accreditation..................................................................................... 229

Impact of Managed Care................................................................... 229
Good Things/Bad Things............................................................. 229
Criticisms of Managed Care......................................................... 230
Pharmacy Benefits Managers............................................................ 231
Impact of Managed Care on Pharmacy............................................. 232
Impact on Community Pharmacy................................................ 232
Impact on Pharmacy in Organized Health Care Settings............ 232
Pharmacy and Therapeutics Committee and the MCO
Formulary..................................................................................... 233
Medication Therapy Management.................................................... 234


xviii

Contents

Quality Assessment and Assurance.................................................. 234
Selecting a Target......................................................................... 235
Developing Measurement Criteria................................................ 235
Monitoring Drug Use................................................................... 235
Comparing the Actual Drug Use versus the Ideal........................ 236
Reporting Results......................................................................... 236
Communicating Results............................................................... 236
Adjusting Criteria and Performing the Review Again................. 236
Education of Providers and Members............................................... 237
Member Education....................................................................... 237
Provider Education....................................................................... 237
Ambulatory Clinics...................................................................... 238
Health Outcomes............................................................................... 238
Pharmacoeconomic Studies......................................................... 239

Patient Satisfaction.......................................................................240
Quality of Life.............................................................................. 241
Delivering Pharmaceutical Service and Care................................... 241
Information Systems..................................................................... 241
Prescription Networks.................................................................. 242
Prescription Benefit Design.......................................................... 242
Partnerships.................................................................................. 243
Continuity of Care........................................................................ 243
Disease State Management...........................................................244
Reducing Medication Errors........................................................ 245
Being a Pharmacist in Managed Care............................................... 245
Ethics................................................................................................. 245
Opportunities.....................................................................................246
Summary...........................................................................................246
Discussion Questions and Exercises.................................................246
Challenges......................................................................................... 247
Web Sites of Interest.......................................................................... 247
References......................................................................................... 247
Chapter 11 Home Health and Hospice Care Pharmacy....................................... 251
Introduction....................................................................................... 251
Learning Objectives.......................................................................... 251
Background....................................................................................... 251
Statistics............................................................................................ 252
Home Care Agencies......................................................................... 252
Home Infusions............................................................................ 253
Providing Home Care........................................................................ 253
Patient Eligibility.......................................................................... 254
Standard Treatment...................................................................... 254
Home Care Patients...................................................................... 254
Accreditation................................................................................ 254

Contents

xix

Home Health Care Pharmacy Services............................................. 255
Total Parenteral and Enteral Nutrition......................................... 255
Pharmaceutical Care.................................................................... 255
Home Medical Equipment............................................................ 256
Opportunities................................................................................ 256
The Pharmacist’s Role in Home Health Care................................... 256
Pharmacist Functions................................................................... 256
Competency in Home Care.......................................................... 257
The Pharmacist’s Role in Hospice Care............................................ 257
Career Opportunities......................................................................... 257
Rewards and Satisfaction.................................................................. 258
Success Stories............................................................................. 258
Summary........................................................................................... 258
Discussion Questions and Exercises................................................. 259
Challenges......................................................................................... 259
Web Sites of Interest..........................................................................260
References.........................................................................................260

Chapter 12 Long-Term Care Pharmacy............................................................... 263
Introduction....................................................................................... 263
Learning Objectives.......................................................................... 263
The Aging Population....................................................................... 263
The Elderly...................................................................................264
Goals of Long-Term Care.............................................................264

Diseases........................................................................................264
Drug Therapy in the Elderly.........................................................264
Comorbidity.................................................................................. 265
Physiological Changes.................................................................. 265
Enhanced Effects..........................................................................266
Medication-Related Problems......................................................266
Polypharmacy...............................................................................266
Long-Term Care Facilities................................................................. 267
Nursing Homes............................................................................. 267
Assisted Living............................................................................. 267
Continuing Care Retirement Community.................................... 267
Statistics........................................................................................ 268
Quality of Care............................................................................. 268
Financing Long-Term Care.......................................................... 269
Consultant Pharmacy Practice.......................................................... 269
Settings......................................................................................... 269
Federal Laws................................................................................ 269
Managed Care.............................................................................. 270
Standards of Practice.................................................................... 270
Accreditation................................................................................ 270


xx

Contents

Services........................................................................................ 270
Provider Services..................................................................... 270
Consultant Services................................................................. 271
Drug Safety................................................................................... 277

Growth in Long-Term Care............................................................... 277
Growth in Consultant Pharmacy Practice......................................... 277
Certification....................................................................................... 278
Rewards and Satisfaction.................................................................. 278
Future of Consultant Pharmacy Practice.......................................... 278
Summary........................................................................................... 278
Discussion Questions and Exercises................................................. 279
Challenges......................................................................................... 279
Web Sites of Interest.......................................................................... 279
References.........................................................................................280
Chapter 13 Government Pharmacy...................................................................... 283
Introduction....................................................................................... 283
Learning Objectives.......................................................................... 283
U.S. Public Health Service................................................................ 283
Centers for Disease Control and Prevention.....................................284
Food and Drug Administration....................................................284
Indian Health Service................................................................... 285
National Institutes of Health......................................................... 285
Federal Bureau of Prisons............................................................ 286
Environmental Protection Agency (EPA).................................... 286
Agency for Toxic Substances and Disease
Registry (ATSDR)................................................................. 286
Agency for Healthcare Research and Quality (AHRQ)............... 287
Centers for Medicare and Medicaid Services (CMS).................. 287
Substance Abuse and Mental Health Services
Administration (SAMHSA).......................................................... 287
Other Areas.................................................................................. 287
Commissioned Corps................................................................... 287
Department of Defense..................................................................... 288
U.S. Army..................................................................................... 289

U.S. Navy...................................................................................... 289
U.S. Air Force............................................................................... 290
Opportunities with the DOD........................................................ 290
Department of Veterans Affairs........................................................ 290
Consolidated Mail Outpatient Pharmacy System........................ 291
Ambulatory Pharmaceutical Care................................................ 291
Independent Prescribing Privileges......................................... 292
A Focus on Patient Outcomes...................................................... 292
Pharmacist Career Ladder Program............................................. 293
Satisfaction................................................................................... 293


Contents

xxi

Federal Hospitals............................................................................... 293
Drug Enforcement Administration (DEA)........................................ 293
Working for State Government......................................................... 294
Rewards and Satisfaction.................................................................. 294
Summary........................................................................................... 294
Discussion Questions and Exercises................................................. 295
Challenges......................................................................................... 295
Web Sites of Interest.......................................................................... 296
References......................................................................................... 296

Chapter 14 Drug Information and Poison Control.............................................. 299
Introduction....................................................................................... 299
Learning Objectives.......................................................................... 299
Drug Information..............................................................................300

Brief History.................................................................................300
Drug Information Centers............................................................300
Functions.................................................................................. 301
Answering Drug Information Questions................................. 301
Drug Evaluations..................................................................... 303
Education................................................................................. 303
Key Resources..............................................................................304
Drug Information in the Pharmaceutical Industry.......................304
Marketing.....................................................................................304
Value.............................................................................................304
Drug Information Pharmacists..................................................... 305
Rewards and Satisfaction.............................................................. 305
Future of Drug Information.......................................................... 305
Poison Information............................................................................306
Brief History.................................................................................306
Poison Control Centers Today......................................................306
Statistics........................................................................................307
Resources......................................................................................307
Cost-Effectiveness........................................................................307
Answering Poison Questions........................................................307
Staffing.........................................................................................308
Disaster Planning and Terrorism..................................................308
The Poison Information Pharmacist.............................................308
Rewards and Satisfaction..............................................................309
Future of Poison Information.......................................................309
Summary...........................................................................................309
Discussion Questions and Exercises.................................................309
Challenges......................................................................................... 310
Web Sites of Interest.......................................................................... 310
References......................................................................................... 310

xxii

Contents

Chapter 15 Pharmacy Academia......................................................................... 313
Introduction....................................................................................... 313
Learning Objectives.......................................................................... 313
A Brief History.................................................................................. 314
Schools and Colleges of Pharmacy................................................... 315
Statistics........................................................................................ 315
Accreditation................................................................................ 315
Structure....................................................................................... 315
Pharmacy Students............................................................................ 316
Supply of Pharmacists....................................................................... 316
Pharmacy Faculty.............................................................................. 318
Rank............................................................................................. 318
Tenure........................................................................................... 318
Faculty Responsibilities................................................................ 319
Scholarship of Teaching............................................................... 320
Undergraduate Teaching............................................................... 321
External Doctor of Pharmacy Degree.......................................... 324
Graduate Education...................................................................... 324
Delivery Strategies....................................................................... 325
Assessment and Evaluation.......................................................... 326
The Scholarship of Research........................................................ 327
Service.......................................................................................... 328
Faculty Evaluation............................................................................. 328
Job Satisfaction.................................................................................. 329

Preparation for an Academic Career................................................. 329
Summary........................................................................................... 329
Discussion Questions and Exercises................................................. 329
Challenges......................................................................................... 330
Web Sites of Interest.......................................................................... 330
References......................................................................................... 331
Chapter 16 Pharmacy Organizations................................................................... 333
Introduction....................................................................................... 333
Learning Objectives.......................................................................... 333
A Brief History.................................................................................. 333
The Role of Pharmacy Organizations............................................... 335
The Importance of Membership....................................................... 335
Pharmacy Organizations................................................................... 335
Pharmacy Practitioner Organizations.......................................... 336
American College of Apothecaries (ACA).............................. 336
American College of Clinical Pharmacy (ACCP)................... 336
Academy of Managed Care Pharmacy (AMCP)..................... 336
American Pharmacists Association (APhA)........................... 337
American Society of Consultant Pharmacists (ASCP)............ 337


Contents

xxiii

American Society of Health-System Pharmacists (ASHP)..... 337
International Academy of Compounding
Pharmacists (IACP)................................................................. 337
National Community Pharmacists Association (NCPA)......... 338
National Pharmaceutical Association (NPhA)........................ 338

Joint Commission of Pharmacy Practitioners (JCPP)............. 338
National Alliance of State Pharmacy
Associations (NASPA)...................................................... 339
Educational Organizations........................................................... 339
Accreditation Council for Pharmaceutical Education
(ACPE)..................................................................................... 339
American Association of Colleges of Pharmacy (AACP)....... 339
American Foundation for Pharmaceutical
Education (AFPE)................................................................ 339
Special Interest Organizations.....................................................340
American Association of Homeopathic Pharmacists
(AAHP)....................................................................................340
American Association of Pharmaceutical
Scientists (AAPS).................................................................340
American College of Veterinary Pharmacists (ACVP)...........340
American Institute of the History of Pharmacy (AIHP).........340
American Society for Automation on Pharmacy (ASAP)....... 341
American Society of Pharmacognosy (ASP)........................... 341
American Society for Clinical Pharmacology and
Therapeutics (ASCPT)............................................................ 341
American Society for Parenteral and Enteral Nutrition
(ASPEN).................................................................................. 341
American Society for Pharmacy Law (ASPL)......................... 342
Association of Clinical Research Professionals (ACRP)........ 342
Christian Pharmacists Fellowship International (CPFI)......... 342
Food and Drug Law Institute (FDLI)...................................... 342
International Society for Pharmaceutical Engineering
(ISPE)...................................................................................... 342
International Society for Pharmacoepidemiology (ISPE)....... 343
International Society for Pharmacoeconomics and

Outcomes Research (ISPOR).................................................. 343
Parenteral Drug Association (PDA)........................................ 343
Pediatric Pharmacy Advocacy Group (PPAG)........................ 343
Society of Veterinary Hospital Pharmacists (SVHP)..............344
Pharmacy Technician Organizations............................................344
American Association of Pharmacy Technicians (AAPT).....344
National Pharmacy Technician Association (NPTA)..............344
Pharmacy Technician Certification Board (PTCB).................344
Pharmacy Technician Educators Council (PTEC).................. 345
Pharmacy Trade Organizations.................................................... 345
Chain Drug Marketing Association (CDMA)......................... 345


xxiv

Contents

Food Marketing Institute (FMI).............................................. 345
Generic Pharmaceutical Association (GPhA)......................... 345
Healthcare Distribution Management Association (HDMA).. 346
National Pharmaceutical Council (NPC)................................346
National Association of Chain Drug Stores (NACDS)...........346
Pharmaceutical Care Management Association (PCMA).......346
Pharmaceutical Research and Manufacturers of America
(PhRMA)................................................................................. 347
Other Organizations..................................................................... 347
Board of Pharmacy Specialties (BPS)..................................... 347
Commission for Certification in Geriatric Pharmacy
(CCGP).................................................................................... 347
International Pharmaceutical Federation (FIP)....................... 347

National Association of Boards of Pharmacy (NABP)...........348
United States Pharmacopeia (USP).........................................348
Should Pharmacy Organizations Change?........................................348
Summary........................................................................................... 349
Discussion Questions and Exercises................................................. 349
Challenges......................................................................................... 350
Web Sites of Interest.......................................................................... 350
References......................................................................................... 350
Chapter 17 How Drugs Are Discovered, Tested, and Approved......................... 351
Introduction....................................................................................... 351
Learning Objectives.......................................................................... 351
A Brief History of Drug Discovery and Development...................... 352
How New Drugs Are Discovered...................................................... 352
Drug Discovery................................................................................. 353
Plant Poisons................................................................................. 353
Inorganic Chemicals..................................................................... 353
Drugs from Animal Sources (Biologics)...................................... 354
Drugs from the Seas..................................................................... 354
Screening for New Natural Drug Products.................................. 354
Synthetic Substitutes.................................................................... 354
Biotechnology............................................................................... 355
New Methods of Drug Design.......................................................... 355
The Drug Researcher........................................................................ 355
Pharmaceutical Chemistry........................................................... 355
Clinical Pharmacology................................................................. 355
Biopharmaceutics and Clinical Pharmacokinetics....................... 356
Clinical Toxicology...................................................................... 356
Pharmaceutics............................................................................... 356
Drug Testing...................................................................................... 356
Animal Testing............................................................................. 356

Testing in Humans........................................................................ 357