IES INSTITUTE OF PHARMACY
(IES CAMPUS, KALKHEDA, RATIBAD MAIN ROAD,BHOPAL 462044
CONTACT NO - 9229251422)
Practice School Report
PHARMACIST: PHARMACY AND PRESCRIPTION
DRUGS
SUBMITTED BY:-
MD SALMAN REZA
PHARMACIST: PHARMACY AND PRESCRIPTION
DRUGS
INTRODUCTION
A pharmacist, also known as a chemist or a druggist (North
Americanand, archaically, Commonwealth English), is a health professional
who
dealswiththecomposition,properties,interactions,properuseanddistributionof
[Link]
clinical advice to the public, as well as primary health care services, with
[Link]
drugs, the pharmacist understands how they should be used to
achievemaximumbenefit,minimalsideeffectsandtoavoiddruginteractions.
Pharmacists undergo university or graduate-level education to
understandthe biochemical mechanisms and actions of drugs, drug uses,
therapeuticroles, side effects, potential drug interactions, and monitoring
[Link] is mated to anatomy, physiology, and pathophysiology.
Pharmacistsinterpretandcommunicate thisspecializedknowledgeto
patients,physicians,andotherhealthcareproviders.
Amongotherlicensingrequirements,differentcountriesrequirepharmaciststo
hold either a Bachelor of Pharmacy, Master of Pharmacy, or Doctor
ofPharmacydegree.
Themostcommonpharmacistpositionsarethatofacommunityphar
macist(alsoreferredtoasaretailpharmacist,first-line
pharmacist or dispensing chemist), or a hospital pharmacist, where
theyinstruct and counsel on the proper use and adverse effects of
medicallyprescribeddrugsandmedicines.
In most countries, the profession is subject to professional
[Link] on the legal scope of practice, pharmacists may
contribute toprescribing (also referred to as "pharmacist prescriber") and
administeringcertainmedications(e.g.,immunizations)[Link]
macistsmay also practice in a variety of other settings, including
industry,wholesaling, research, academia, formulary management, military,
andgovernment.
WORKING
Historically,thefundamentalroleof pharmacistsasahealthcarepractitionerwas to
check and distribute drugs to doctors for medication that had beenprescribed
to patients. In more modern times, pharmacists advise
patientsandhealthcareprovidersontheselection,dosages,interactions,andside
effects of medications, and act as a learned intermediary between
aprescriber and a patient. Pharmacists monitor the health and progress
[Link]
ce compounding; however, many medicines are now produced
bypharmaceuticalcompaniesinastandarddosageanddrugdeliveryform.
In some jurisdictions, pharmacists have prescriptive authority to
eitherindependently prescribe under their own authority or in
collaboration withaprimarycare physicianthrough
anagreeduponprotocolcalled
acollaborativepracticeagreement.
Increased numbers of drug therapies, aging but more knowledgeable
anddemanding populations, and deficiencies in other areas of the health
caresystemseemtobe
drivingincreaseddemandfortheclinicalcounselingskillsofthe pharmacist.
Oneofthemostimportantrolesthatpharmacistsarecurrentlytakingonisoneof
pharmaceuticalcare.
Pharmaceutical care involves taking direct responsibility for patients
andtheir disease states, medications, and management of each to
improveoutcomes. Pharmaceutical care has many benefits that may include
but arenot limited to: decreased medication errors; increased patient
compliance inmedication regimen; better chronic disease state
management, includinghypertension and other cardiovascular disease risk
factors; strongpharmacist–patient relationship; and decreased long-term
costs of medicalcare.
Pharmacists are often the first point-of-contact for patients with
healthinquiries. Thus pharmacists have a significant role in assessing
medicationmanagementinpatients,andin
[Link],butare notlimited to:
• Clinical medication management, including reviewing and monitoring
ofmedicationregimens
• Assessmentofpatientswithundiagnosedordiagnosedconditions,andascer
tainingclinical medicationmanagementneeds
• Specialized monitoring of disease states, such as dosing
drugsinkidney andliver failure
• Compoundingmedicines
• Providingpharmaceuticalinformation
• Providingpatientswithhealthmonitoringandadvice,includingadviceandtr
eatment ofcommonailmentsand diseasestates
• Supervisingpharmacytechnicians andotherstaff
• Oversightofdispensingmedicinesonprescription
• Provision of and counseling about non-prescription or over-the-
counterdrugs
• Education and counseling for patients and other health care providers
onoptimaluseofmedicines(e.g.,properuse,avoidanceofovermedication)
• Referralstootherhealthprofessionalsifnecessary
• Pharmacokineticevaluation
• Promotingpublichealthbyadministeringimmunizations
• Constructingdrugformularies
• Designingclinicaltrialsfordrugdevelopment
• Workingwithfederal,state,orlocalregulatoryagenciestodevelopsafedrugp
olicies
• Ensuringcorrectnessofallmedicationlabelsincludingauxiliarylabels
• Memberofinter professionalcareteamforcriticalcarepatients
• Symptomassessmentleadingtomedicationprovisionandlifestyleadvicefor
community-based health concerns (e.g. head colds, or
smokingcessation)
• Stageddosingsupply([Link])
EducationandCredentialing
HospitalPharmacy Industrial
PharmacistTheroleofpharmacyeducation,pharmacistlicensing,andcontin
uing
educationvaryfromcountrytocountryandbetweenregions/localitieswithincount
ries. In most countries, pharmacists must obtain a university degree ata
pharmacy school or related institution, and/or satisfy other
national/[Link],studentsmustfirstco
mplete
pre-professional (undergraduate) coursework, followed by about four
yearsofprofessionalacademicstudiestoobtainadegreeinpharmacy(such
asDoctorateofPharmacy).
In the European Union, pharmacists are required to hold a Masters
ofPharmacy, which allows them to practice in any other E.U. country,
pendingprofessional examinations and language tests in the country in
which theywantto practice.
Pharmacistsareeducated
inpharmacology,pharmacognosy,chemistry,organic
chemistry, biochemistry, pharmaceutical chemistry, microbiology,
pharmacypractice (including drug interactions, medicine monitoring,
medicationmanagement),pharmaceutics,pharmacylaw,
pathophysiology, physiology, anatomy, pharmacokinetics,
pharmacodynamics, drug delivery, pharmaceutical care, nephrology,
hepatology, andcompoundingof medications.
Additionalcurriculummaycoverdiagnosiswithemphasisonlaboratorytests,disea
sestatemanagement,therapeuticsandprescribing(selectingthemostappropriat
e medicationfor agivenpatient).
Upongraduation,pharmacistsarelicensed,eithernationallyorregionally,todispens
emedication ofvarioustypesintheareastheyhavetrainedfor.
Somemayundergofurtherspecializedtraining,[Link]
cialtiesinclude:
• Academicpharmacist
• Clinicalpharmacyspecialist
• Communitypharmacist
• Compoundingpharmacist
• Consultantpharmacist
• Druginformationpharmacist
• Homehealthpharmacist
• Hospitalpharmacist
• Industrialpharmacist
• Informaticspharmacist
• Managedcarepharmacist
• Militarypharmacist
• Nuclearpharmacist
• Oncologypharmacist
• Regulatory-affairspharmacist
• Veterinarypharmacist
• Pharmacistclinicalpathologist
• Pharmacistclinicaltoxicologist
PHARMACYANDPRESCRIPTIONDRUGS
Prescription drugs are a key component in the healthcare. Pharmacies
andpharmacists,inparticular,playacriticalrole in dispensingthesemedications,
educating patients, and ensuring patient safety. However, ruralcommunity
pharmacies face many challenges to stay open, including low-
volumepurchasing,slimprofitmargins,unfavorableinsurancepractices,andalimit
edpharmacyworkforce.
When a pharmacy is not available nearby, timely access to
pharmaceuticalservicescanbecompromisedduetolackoftransportationoptions,
extremeweather conditions, or the patient being too sick to travel the long
distancetothe nearestpharmacy.
While the development of telepharmacy and online mail order
pharmaciesmight suggest that geographical limits to access are no longer
a concern,many rural residents do not have the equipment, technical
skills, and/ortelecommunications accessibility that these services require.
In addition,telepharmacy is not currently allowed by regulation or statute
in
[Link]
ndmuch-neededroleinthe healthofruralpeople.
EffectiveExamples
PharmacistsforPatientSafetyNetwork
• Need: Pharmacists in rural Nebraska are often isolated and find
itdifficulttocommunicatewithothersaboutsafetyconcerns.
• Intervention: The Pharmacists for Patient Safety Network was
acommunication network in which pharmacists identified
safetyconcernsandsharedsolutions.
• Results: After one year of implementation, 30 of the 38
participatingpharmacies reported that the network encouraged new
safetypracticesandreinforcedexistingsafetystrategies.
MidcoastMainePrescriptionOpioidReductionProgram
• Need: Reduction in the number of emergency department
dentalpatientsabusingopioidprescriptionsinruralsoutheasternMain
e.
• Intervention:Usingaone-
pageopioidprescriptionguideline,opioidprescribingandemergencyroom
visits fordentalpaindecreased.
• Results: The rate of opioid prescription dropped nearly 20%
afterimplementation, and in comparing the 12-month period
before andafter implementation, dental pain emergency
department visitsdecreasedfrom26to 21per1,000.
ProjectLazarus
Need:Toreduceoverdose-
relateddeathsamongprescriptionopioidusersinruralWilkesCounty,
NorthCarolina
• Intervention: Education and tools are provided for
prescribers,patientsandcommunitymemberstolessendrugsupplyandde
mand,andto reduceharminprescriptionopioiduse
• Results: Opioid overdose death rates have decreased in
WilkesCounty
PromisingExamples
TheHealthWagon
• Need: Healthcare access in Central Appalachia for the
medicallyunderserved challenged by social and economic
determinants ofhealth, including transportation barriers, food
insecurity, poverty, andlackof healthinsurance.
• Intervention: Three mobile clinics and 2 stationary clinics
providefreehealthcareforpeoplein16countiesinVirginia,Kentucky,and
Tennessee.
• Results: By leveraging technology and meeting patients where
theyare, Health Wagon provided comprehensive healthcare services
—including specialty care — to 5,500 patients during 16,000
visitencountersin2020.
IntegratedChronicPainTreatmentandTrainingProject
• Need:ToreduceprescriptionopioidmisuseandoverdosesinNorthCaroli
na.
• Intervention: The ICPTTP standardizes and streamlines chronic
painmanagementinprimary careclinics.
• Results: The ICPTTP reduced patients' average morphine
equivalentdailydose,and29%ofpatients
successfullytaperedoffchronicopioidtherapy.
PhysicalandBehavioralHealthIntegratedCareProject
• Need:Toprovideunifiedandseamlessaccesstoprimarycaretoadultpatient
s in Pennsylvania's rural Clearfield and Jefferson counties
whohavebeendiagnosedwith Seriousand PersistentMentalIllness.
• Intervention: A "one-stop shop" of healthcare services addressed
thephysical and behavioral health and medication needs of adults in
theregion.
• Results: Results indicated better behavioral and physical
healthoutcomes for participants as well as increased adherence
tomedications.
TheRuralVirtualInfusionProgram
• Need: Allow rural cancer patients in a region inclusive of 26
countiesin Iowa, Minnesota, and South Dakota to have access to
tertiary-levelchemotherapyregimensinrural infusioncenters.
• Intervention: With telehealth-based oversight from a tertiary
careoncology team, 3 rural infusion teams were trained to
coordinatecancer treatment plans and administer complex
chemotherapyregimens.
• Results: Almost 130 patients were transitioned to
receivechemotherapy in a rural infusion center, translating to over
1,000infusionvisitsandsavingpatients/familiesnearly65,000tripmiles
,1,800travelhours and$71,000.
OtherProjectExamples
MobileHealthUnitsforOpioidUseDisorderTreatment
Need: To bring medication-assisted treatment to rural and
underservedareasinColorado.
• Intervention: Six mobile health units travel to 32 counties and
offerservicesliketelehealthsessions,counseling,naloxone,andreferralsto
wraparoundservices.
• Results:Theunitstraveledmorethan100,000milesfromJanuary2020t
o January 2021.
SouthwestHealthSystemAntibioticStewardshipProgram
• Need:Impactpatientcareandsafetyissuesrelatedtoantibioticuseinsout
hwestColorado.
• Intervention:Pharmacy-
ledantibioticstewardshipprogramforinpatient,outpatient,andlong
-term caresettings.
Results: With antibiotic use guidelines, refined infection diagnostics,
andfirst-
choiceantibioticselections,allcaresettingsnowseedecreaseddaysoftreatmenta
nddecreasedresistance patterns.
EffectiveExamples
VermontHub-and-SpokeModelofCareforOpioidUseDisorder
• Need:Increaseaccesstomedication-
assistedtreatmentforopioidusedisorderinruralVermont.
• Intervention:Statewidehub-and-spoketreatmentaccesssystem.
• Results:Increasedtreatmentcapacityandcarecoordination.
PromisingExamples
IntegratedChronicPainTreatmentandTrainingProject
• Need:Toreduce
prescriptionopioidmisuseandoverdosesinNorthCarolina.
• Intervention: The ICPTTP standardizes and streamlines chronic
painmanagementinprimary careclinics.
• Results: The ICPTTP reduced patients' average morphine
equivalentdailydose,and29%ofpatientssuccessfullytaperedoffchronicop
ioidtherapy.
OtherProjectExamples
MaineGeneralHarmReductionProgram
• Need: ToreducedeathsfromopioidoverdosesinruralMaine.
• Intervention:TheMaineGeneralHarmReductionProgramprovidescom
munity education/training for healthcare staff, first
responders,community agency staff, and community members in
rural KennebecandSomersetcounties.
• Results:MaineGeneralcontinuestotrainproviders,providestigmaasses
sments,anddistribute Narcankits.
MorrisonCountyAccountableCommunityforHealth
• Need: To combat prescription drug misuse in rural Morrison
County,Minnesota.
• Intervention: The Morrison County ACH brings together primary
care,social services, law enforcement, and other partners to make sure
thatpatientsreceive treatmentandsupport.
• Results: One pharmacy saw a 40% reduction in the number
ofprescribedopioids,andtheACHwasabletotaper684patientsoffopioi
dscompletely.
OpioidOverdosePreventionOutreachProgram
Need: To reduce opioid use disorder and overdose deaths in
Maryland'sEasternShorecounties.
• Intervention: An outreach program educates healthcare
providers,EMS staff, and laypeople on the risks of opioids,
prevention andtreatmentoptions, andNarcantraining.
• Results: Program coordinators have presented information to
988peopleinMaryland'sEasternShorecountiesandcertified609peoplein
Narcantraining.
NewHorizonsSubstanceUseRecoveryNetwork
Need: In northern Michigan, a need for an integrated approach to
delivermedication-
assistedtreatmentforestablishedpatientsofFederallyQualifiedHealthCenters
withopioid usedisorder.
• Intervention: Collaboration between one FQHC across 3 sites, a
localwaivered prescriber group, and a behavioral health
organizationcreatedanintegratedtreatmentapproachforopioidusedisord
er.
• Results: Increased access to medication-assisted treatment
andcomprehensive substance use disorder services leading to
increasedretentionintreatmentandincreasedengagementinstablereco
veryfromopioidandalcoholuse disorders.
OtherProjectExamples
ProjectVISION
• Need:ToreduceopioiduseandincreasequalityoflifeinRutland,Vermo
nt.
• Intervention:ProjectVISIONworkstoreduceopioidusethroughcom
munityengagement.
• Results: Since 2012, Project VISION has collected and disposed
of550poundsofunusedmedications,reducedtheftsbyover32%,andhada
50%improvementonaneighborhoodqualityof lifesurvey.
