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THE PHARMACY TECHNICIAN

CHAPTER 1PHARMACY AND HEALTH CARE

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ORIGINS

◆ in earliest times, medicine was based in magic and religion

• 4000 BC - Sumerians believed demons were the cause of illness - studied the stars and intestines of animals for clues to the supernatural causes of man’s condition and fate

• in many cultures, physicians were priests - viewed as gods or demi-gods

Imhotep (born 3000 BC) - first physician known by name (priest and advisor) - after his death “Egyptian god of medicine”

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◆ the supernatural approach to treating illness gave way to a more scientific approach - observation and experiments◆ 400 BC - Greek physician Hippocrates - promoted idea

of diagnosing illness based on careful observation of the patient’s condition (natural causes were examined scientifically - wrote the Hippocratic Oath

◆ besides looking to the supernatural, ancient man looked to the natural world for medical answers◆ Sumerians used 250 natural medicines derived from

plants to treat / relieve illness◆ Chinese Emperor Shen Nung - “trial and error testing” of

natural material to determine which were beneficial / poisonous - 365 “herbs” used in health treatments -herbal medicine major component of modern Chinese medicine

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nature’s medicine…

◆ quinine - made from the bark of the Cinchona tree (Peruvian) - prevents malaria

called “Jesuit’s powder” - Spanish priests sent it to Europe from the the New World

◆ cocaine - made from coca leaves - shown to be the first effective local anesthetic (Carl Koller - Veinnese surgeon)

because of its harmful properties when abused, man-made substitute was developed - Novocain® (procaine)

Indians of the Andes (before Spanish exploration) chewed coca leaves for medicinal effects which included increased endurance

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◆ salicylic acid (aspirin like) - bark of the white willow (Mediterranean)

ancient Greek physicians, Hippocrates and Dioscorideswrote about the pain relieving ability of white willow bark (salicylic acid) due to difficulties ingesting salicylic acid, acetylsalicylic acid(aspirin) was developed - most widely used drug in the world

◆ throughout the ages, people have used drugs to treat illness and other physical conditions - historically natural

syntheitc drugs: combining simpler chemicals into complex compounds, creating a chemical not found in nature

• advantages in cost, effect and availability

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pharmacology - the study of drugs - their properties, uses, application and effects

pharmacognosy - the study of physical , chemical, biochemical and biological properties of drugs as well as the search for new drugs from natural sources

materia medica - pharmacology as well as the drugs in use

pharmacopeia - an authoritative listing of drugs and issues related to their use (side effects)

pharmaceutical - relating to a drug product

panacea - a cure-all

antitoxin - a substance that acts against a toxin in the body; also a vaccine containing antitoxins used to fight disease

antibiotic - a substance which harms / kills microorganisms like bacteria or fungi

hormones - chemicals produced by the body that regulate body functions and processes

human genome - the complete set of genetic material contained in a human cell

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Medicine through the ages - a timeline…

◆ 4000 BC - Sumerians ◆ 3000 BC - Chinese Emperor Shen Nung / Egyptian Imhotep◆ 1500 BC - Papyrus Ebers - most compete record of

Egyptian medicine and pharmacology (1100 page scroll -800 prescriptions from 700 drugs derived from plants)

◆ 600 BC - Aesculaplus (Greek god of Medicine) -established centers where medicine was practiced

◆ 500 BC - Alcmaeon (Greek student of Pythagorus) saw diseases as a result of a loss of the body’s natural equilibrium

◆ 400 BC - Hippocrates influence - approach to medicine that is grounded in scientific reasoning and close observation of the patient - Hippocratic oath (conduct for physicians)

Medicine through the ages - a timeline…

◆ 77 BC - Dioscorides (Greek physician) - wrote the De Materia Medica - 5 books describing 600 plants (white willow bark) and their healing properties - influenced Westerns pharmaceutics for over 1600 year

◆ 162 AD - Greek physician Galen - believed their were four “humors” which needed to be in balance for good health -believed in the vigorous application of scientific approach to medicine - emphasis on education, observation and logic formed the cornerstone for Western medicine

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Medicine through the ages - a timeline…

◆ 1500 AD - Paraceisus - rejected Galen’s philosophy of “humors” - established the use of chemistry to create medicinal drugs (addictive drug laudanum - abused for 300 years)

◆ 1630 AD - quinine

◆ 1721 - Dr Zabdiel Boylston (Boston) - small pox epidemic - administered a smallpox vaccine (249 inoculated / 6 died vs5980 / 844 died)

◆ 1796 - Edward Jenner - successful vaccine for smallpox -used cowpox disease (mild)

Medicine through the ages - a timeline…

◆ 1785 - William Withering (British physician) - foxgloveplant contained digitalis (treating heart disease) -established dosage

◆ 1803 - Frederic Serturner (German pharmacist) - extracts morphine from opium

◆ 1846 - first publicized operation using general anesthesia(ether)

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Medicine through the ages - a timeline…

◆ 1864 - Louis Pasteur’s “germ theory” - microorganisms cause food spoilage - heat is used to kill them

◆ 1884 - Carl Koller - cocaine is the active ingredient in coca leaves - first local anesthetic

◆ 1890 - effective antitoxins are developed for diphtheriaand tetanus

◆ 1899 - acetylsalicylic acid (aspirin) developed

◆ 1921 - Frederick Banting / Charles Best (Toronto, Canada) - extract of insulin lowers blood sugar

◆ 1922 - biochemist James Collip develops pure extract of insulin - first human trial - changes outlook for diabetics

Medicine through the ages - a timeline…

◆ 1928 - Alexander Flemming - discovers a fungus that produces a chemical that kills bacteria - penicillin - first antibiotic

◆ 1943 - Russell Marker - creates hormone progesterone -first reliable birth control drug

◆ 1953 - James Watson and Francis Crick - identified the structure of DNA

◆ 1955 - Dr Jonas Salk - developed a refined injectable polio vaccine

◆ 1957 - Albert Sabin - develops an oral polio vaccine (live attenuated)

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Medicine through the ages - a timeline…

◆ 1960 - birth control pill introduced◆ 1981 - first documented cases of AIDS◆ 1987 - AZT approved by the FDA◆ 1988 - Human Genome Project◆ 1989 - Amgen, a biotechnology company produces Epogen

(anemia treatment for dialysis patients) - cellular and molecular biology

◆ 1996 - highly active anti-retroviral therapy (HAART) - slows HIV progress

The 20th Century

◆ the average life span in the US has increased dramatically ◆ 1900’s - life expectancy early 50’s◆ 2000’s - life expectancy over 77

◆ growth of hospitals, advances in treatment of disease, improved medical technology, better understanding ofnutrition and health, rapid increase in pharmaceuticals and vaccines

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◆ with the increase in the availability with pharmaceuticals -regulation increased

◆ in the US - Food and Drug Administration (FDA) - major factor in the nation’s public health and safety◆ before a drug can be marketed, must show through

testing that it is safe and effective for intended use -monitors adverse effects

◆ the discovery of new drugs requires major investment of capital, time, research, and development

PHARMACY TODAY

◆ a "prescription" drug is one that has been “prescribed” by a physician or other licensed prescriber to treat a patient

◆ the pharmacist has consistently been rated as one of the most highly trusted and ethical professionals in the US (Gallop 2005)

◆ nurses◆ pharmacists◆ medical doctors◆ high school teachers◆ police officers

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♦ pharmacist – Doctor of Pharmacy degree (PharmD), state licensing and continuing education to maintain license

• 3/5 work in community pharmacies• 1/4 work in hospitals

Pharmacy settings• community pharmacies• hospitals• mail order operations (growing)• long-term care facilities• managed care (Aetna, BlueCross BlueShield)• home care

Economic trends• 1970 – 2000 cost of health care in the US rose 1500%• increasing efforts by gov’t, industry and consumers to control the cost of health care

• managed care – 3rd party payers• formularies – list of drugs approved for use (substitute generic for brand)• therapeutic substitution – chemically different drug that performs a similar function is substituted (less expensive)

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Computers in Pharmacy (increased productivity and efficiency)

♦ computerized pharmacy management systems put customer profiles, product, inventory, pricing and essential info within easy access♦ automate labeling, inventory management, stock reordering and billing