EIGHT STAR PHARMACIST

EIGHT STAR PHARMACIST

 The concept of the “seven-star pharmacist” was introduced by WHO and adopted by FIP in 2000 in its policy statement on Good Pharmacy Education Practice to cover the roles of caregiver, decision-maker,communicator, manager, life-long learner, teacher and leader. The function of the pharmacist as a researcher has since been added and all these have been addressed in the competence standards.

1. Caregiver: 
Pharmacists must view their practice as integrated and continuous with those of the healthcare system and other health professionals.

2. Decision-maker: The appropriate, efficacious, safe and cost-effective use of resources (for example,personnel, medicines, chemicals, equipment, procedures, practices) should be the foundation of the pharmacist’swork. Achieving this goal requires the ability to evaluate, synthesise data and information and decide upon themost appropriate course of action.

3. Communicator: The pharmacist is in an ideal position to provide a link between prescriber and patient, and tocommunicate information on health and medicines to the public and other health professionals. Communication involves verbal, non-verbal, listening and writing skills.

4. Manager: Pharmacists must be able to manage resources (human, physical and financial) and information effectively; they must also be comfortable being managed by others, whether by an employer or the manager/leader of a healthcare team.

5. Life-long-learner: It is impossible to acquire in pharmacy school all the knowledge and experience needed topursue a life-long career as a pharmacist. The concepts, principles and commitment to life-long learning must begin while attending pharmacy school and must be supported throughout the pharmacist’s career. Pharmacists should learn how to keep their knowledge and skills up to date and how to put them into practice.

6. Teacher: Every pharmacist has a responsibility to assist with the education and training of future generations of pharmacists and the public. Participating as a teacher not only imparts knowledge to others, it offers an opportunity for the practitioner to gain new knowledge and to fine-tune existing skills.

7. Leader: Leadership involves compassion and empathy as well as vision and the ability to make decisions, communicate, and manage effectively. A pharmacist whose leadership role is to be recognised must have vision and the ability to lead.

8. Researcher: The pharmacist must be able to use the evidence base (e.g., scientific, pharmacy practice, healthsystem) effectively in order to advise on the rational use of medicines in the healthcare team. As a researcher,the pharmacist is able to increase the accessibility of unbiased health and medicines-related information for thepublic and other healthcare professionals.

How Innovation Differs from Invention

Invention   

This is usually defined as the discovery of a new item. Whether it is a new drug, device, or other piece of technology, it is unique and no similar one exists. Unfortunately, most invention comes from outside of the profession, with individuals using their skills to bring inventions to pharmacy practice. The invention should result in a patent submission because of its novelty and lack of prior art. 

Innovation 

This term usually comes after the invention has occurred. This can either be an improvement on a current system or a process that makes things better than their current state. Innovation could also involve taking an existing idea that was implemented at 1 site and replicating it at another. Because anything unique is often considered innovative. They are improvements of an existing service, as opposed to the creation of new technology.

 Entrepreneurship 

This term applies when someone takes a novel idea and creates a new business from it. The entrepreneur is usually the founder who gets an equity stake in the start-up company. 
The company could be based on an invention or innovation, but it has to have a commercial base to support it. Those who start and own an independent pharmacy would be considered entrepreneurs. Starting and running a business requires very different skills than inventing and innovating. 
Some might choose to turn their invention into a business, while others might allow someone else to use their invention to start a company. 

TYPES OF DOSAGE FORMS - LECTURE

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CAPSULES

CAPSULES

  Are solid dosage forms in which one or more medicinal and or inert substances are enclosed within a small shell or container generally prepared from a suitable form of gelatin.  Depending upon their formulation, the gelatin capsule shells may be hard or soft.

Characteristics:

1.  May be swallowed whole by the patient

2.  May be inserted into the rectum for drug release and absorption from the site

3.The contents may be removed from the gelatin shell and employed as a pre measured medicinal powder, the capsule shell being use to contain a dose of the medicinal substance.

Example: Theo-dur Sprinkle

4.  Elegance

5.  Ease of use

6.  Portability

7. Tasteless shell to mask the unpleasant taste/odor of the drug

8. Permits physician to prescribe the exact medication needed by the patient

9.  conveniently carried

10. readily identified

11. easily taken

12. tasteless when swallowed

13. commonly embossed or imprinted on their surface the   manufacturer’s name and product code readily identified

14. available in variety of dosage strength

15. provide flexibility to the prescriber and accurate individualized dosage for the patient

16. packaged and shipped by manufacturers at lower cost less breakage than liquid forms

17. more stable and longer shelf life

Components Of Capsules

1.  Gelatin

2.   FD & C and D & C colorant

3.  Sugar

4.  Water - 12 to 16 % but may vary depending on the storage condition

5.  Sulfur dioxide (.15%) - prevent decomposition during manufacture

6.  Opaquants/Opacifying agent - titanium dioxide

H   HARD GELATIN CAPSULES

A   Also referred to as “DFC” Dry Filled Capsule. Manufactured into two sections, the capsule body and a  shorter cap. 

A A recent innovation in capsule shell design is the Snap-Fit, Coni-Snap, and Coni Snap Supro hard gelatin capsules.

CaCapsule size

F  For human use, empty capsules ranging in size from 000 the largest to 5 the smallest.   Generally, hard gelatin capsule are used to encapsulate between 65 mg to 1 gram.


  SOFT GELATIN CAPSULES 
Also referred to as as Soft ElasticCapsule.  Are prepared from shells of gelatin from which glycerin or a polyhydric alcohol and as sorbitol has been added to render the gelatin elastic or plastic like.
Tthe gelatin is plasticized by the addition of glycerin, sorbitol or polyol.  The shell may contain preservatives to prevent from fun 

soft gelatin capsule has a seam at the point of closure of the 2 halves, and the contents can be liquid, paste or powder.

ACCORDING TO WHO ROLE OF HOSPITAL PHARMACIST

Hospital pharmacy

Hospitals and other institutions and facilities, such as outpatient clinics, drug-dependency treatment facilities, poison control centres, drug information centres, and long-term care facilities, may be operated by the government or privately. While many of the pharmacist’s activities in such facilities may be similar to those performed by community pharmacists, they differ in a number of ways. 

Additionally, the hospital or institutional pharmacist:

• has more opportunity to interact closely with the prescriber and, therefore, to promote the rational prescribing and use of drugs;

• in larger hospital and institutional pharmacies, is usually one of several pharmacists, and thus has a greater opportunity to interact with others, to specialize and to gain greater expertise;

• having access to medical records, is in a position to influence the selection of drugs and dosage regimens, to monitor patient compliance and therapeutic response to drugs, and to recognize and report adverse drug reactions;

• can more easily than the community pharmacist assess and monitor patterns of drug usage and thus recommend changes where necessary;

• serves as a member of policy-making committees, including those concerned with drug selection, the use of antibiotics, and hospital infections (Drug and Therapeutics Committee) and thereby influences the preparation and composition of an essential-drug list or formulary;

• is in a better position to educate other health professionals about the rational use of drugs;

• more easily participates in studies to determine the beneficial or adverse effects of drugs, and is involved in the analysis of drugs in body fluids;

• can control hospital manufacture and procurement of drugs to ensure the supply of high-quality products;

• takes part in the planning and implementation of clinical trials.

What are STEROID HORMONES

Steroid hormone is a steroid that acts as a hormone.

They are grouped on the basis of the receptors they bind.

vGlucocorticoids

vMineralocorticoids,

vProgesterone

vAndrogens

vEstrogens

•The natural steroid hormones are generally synthesized from cholesterol in the gonads and adrenal glands.

• These forms of hormones are lipids.

•They can pass through the cell membrane as they are fat-soluble, and then bind to steroid hormone receptors which may be nuclear or cytosolic depending on the steroid hormone, to bring about changes within the cell.

•Steroid hormones are generally carried in the blood bound to specific carrier proteins such as SHBPs and CHBPs.

•Further conversions and catabolism occurs in the liver, in other "peripheral" tissues, and in the target tissues.

•A variety of synthetic steroids and sterols have also been contrived.

•Most are steroids, but some non-steroidal molecules can interact with the steroid receptors because of a similarity of shape.

•Some synthetic steroids are weaker, and some much stronger, than the natural steroids whose receptors they activate.

Examples Of Synthetic Steroids

ØGlucocorticoids: alclometasone, prednisone,dexamethasone,

ØMineralocorticoid: fludrocortisone

ØVitamin D: dihydrotachysterol

ØAndrogens: apoptone, oxandrolone, oxabolone, testosterone, nandrolone (also known as anabolic steroids)

ØEstrogens: diethylstilbestrol (DES)

ØProgestins: danazol, norethindrone, medroxyprogesterone acetate, 17-Hydroxyprogesterone caproate.

Some steroid antagonists:

ØAndrogen: cyproterone acetate

ØProgestins: mifepristone, gestrinon

ADRs

Introduction to ADRs

Adverse drug reactions (ADRs), also known as ‘side effects’, ‘adverse
drug events’, or ‘drug misadventures’, are a frequent cause of morbidity in hospital and the community. They have a significant cost both financially and in terms of quality of life. 
Few studies of ADRs have been carried out in the community so the effect on primary care is harder to assess, but studies in the hospital environment have shown the following.

• ADRs occur in 10–20 % of patients in hospital.
• ADRs are responsible for 5 % of admissions to hospital.
• ADRs might be responsible for 1 in 1000 deaths in medical wards.
• ADRs are the most common cause of iatrogenic injury in hospital
patients.

The World Health Organization (WHO) defines an ADR as follows:
‘ a drug-related event that is noxious and unintended and occurs at doses used in
humans for prophylaxis, diagnosis or therapy of disease or for the modification
of physiological function .’

However, this definition does not take into account the following
scenarios, all of which can also cause ADRs:
• overdose (including prescribing or administration errors)
• therapeutic failure
• drug interactions
• drug withdrawal.

Pharmacists have an important role in identifying, reporting, and preventing
ADRs.

Terminology in liver disease

Hepatocellular injury
Damage to the main cells of the liver (hepatocytes)

Hepatitis
 Inflammation of the liver, a type of hepatocellular injury. Could
be caused by viruses, drugs, or other agents, or could be
idiosyncratic.

Cirrhosis
 Chronic, irreversible damage to liver cells, usually caused by
alcohol or hepatitis C. If the remaining cells cannot maintain
normal liver function (compensated disease), ascites, jaundice,
and encephalopathy can develop (decompensated disease).

Cholestasis 
Reduction in bile production or bile fl ow through the bile
ducts.

Liver failure 
Severe hepatic dysfunction where compensatory mechanisms
are no longer suffi cient to maintain homeostasis. Could be
acute and reversible, or irreversible (e.g. endstage cirrhosis).

Anaphylaxis

Symptoms and signs of anaphylaxis

Anaphylaxis is defined as an immediate systems hypersensitivity event produced

by IgE-mediated release of chemicals from mast cells and basophils.
Theoretically, prior exposure to the agent is required and the reaction is
not dose- or route-related, but in practice anaphylaxis to injected antigen
is more frequent, severe, and rapid in onset than following exposure to
oral or topical antigen.
Agents which commonly cause anaphylaxis include:
• drugs — e.g. penicillins, aspirin
• insect stings — e.g. wasp and bee venoms
• food — e.g. nuts.
Urticaria and angioedema are the most common symptoms
and absence of these suggests that the reaction may not be anaphylaxis.
Airways oedema, bronchospasm, and shock are life-threatening and
immediate emergency treatment is usually required.
The onset of symptoms following parenteral antigen (including stings) is
usually within 5–30min. With oral antigen, there is often a delay. Symptoms
usually occur within 2h, but may be immediate and life-threatening.
A late-phase reaction may also occur with recrudescence of symptoms
after apparent resolution. Recurrence is a fairly frequent phenomenon
and healthcare workers should be aware of this. Patients should not be
discharged too quickly as they may require further treatment.
End-of-needle reactions
Some patients may experience an anaphylactic-like reaction during rapid
intravenous (IV) drug administration. This is known as an end-of-needle
reaction. Initial symptoms may suggest anaphylaxis, but in fact this is a
vasopressor effect and can be distinguished from anaphylaxis as bradycardia
occurs which is rare in anaphylaxis. Skin symptoms are also rare
in end-of-needle reactions. Stopping or slowing down the infusion or
injection usually leads to resolution of symptoms,and administration at a
slower rate usually avoids a repeat event.
Signs and symptoms of anaphylaxis
F Urticaria
R Angioedema
E Dyspnoea, wheeze
Q Nausea, vomiting, diarrhoea, cramping abdominal pain
U Flush
E Upper airway oedema
N
T
R Headache
A Rhinitis
R Substernal pain
E Itch with no rash
Seizure

Biopharmaceutics

Biopharmaceutics: 

the study of how the physicochemical properties of drugs, dosage forms and routes of administeration affect the rate and extent of the drug absorption.

Thus, biopharmaceutics involves factors that influence the: 1) protection and stability of the drug within the  product; 2) the rate of drug release from the product; 3) the rate of dissolution of the drug at the absorption site; and 4) the availability of the drug at its site of action . 

nADME: is an acronym in pharmacokinetics and pharmacology for absorption, distribution, metabolism, and excretion, and describes the disposition of a pharmaceutical compound within an organism.

nPharmacokinetics: The study and characterization of the time course (kinetics) of drug absorption, distribution, metabolism and elimination (ADME).

nAbsorption: is the process of a substance entering the body.
nDistribution: is the dispersion  of substances throughout the fluids and tissues of the body.
nMetabolism: is the irreversible transformation of parent compounds into daughter metabolites.
nExcretion: is the elimination of the substances from the body.

nBioavailability: The rate and extent of drug absorption.

nBioavailable dose: The fraction of an administered dose of a particular drug that reaches the systemic circulation intact. 

nPlasma level-time curve:

nThe plasma level-time curve is generated by measuring the drug concentration in plasma samples taken at various time intervals after a drug product is administered.

nThe concentration of drug in each plasma sample is plotted against the corresponding time at which the plasma sample was removed.

nDrug Product Performance Parameters:

1- Minimum effective concentration (MEC): The minimum concentration of drug needed at the receptors to produce the desired pharmacologic effect.

2- Minimum toxic concentration (MTC): The drug concentration needed to just produce a toxic effect.

3- Onset time: The time required for the drug to reach the MEC.

4- Duration of action: The difference between the onset time and the time for the drug to decline back to the MEC.  

5- The time of peak plasma level: The time of maximum drug concentration in the plasma and is proportional to the rate of drug absorption.

6- The peak plasma level: The maximum drug concentration, usually related to the dose and the rate constants for absorption and elimination of the drug.

7- Area under the curve: It is related to the amount of drug absorbed systemically.

Pharmaceutical Aerosol

Pharmaceutical Aerosol

Definition

Pharmaceutical aerosols are dosage systems

containing one or more active ingredient which 

upon actuation emit a fine dispersion of liquid / or 

solid materials in a gaseous medium. 

Classification

Space Sprays

▫These are used o provide an airborne mist.

▫These have Particle size is less than 50 mm.

▫Contain 70-80% propellant

▫Examples are: Room disinfectants, room deodorizers, space sprays, air fresheners etc.

Surface Sprays

▫Used to carry an active ingredient to a surface.

▫Larger particle size

▫Contain usually 30-70% propellant.

▫Examples are: Dermatological aerosols, Non-pharmaceutical aerosols e.g. cologne sprays etc. 

Diet affects sleep - Study

A new study from the University of Pennsylvania's Perelman School of Medicine shows an association between what one eats’ and how one sleeps,reported BBC health. "In general, seven to eight hours of sleep each night is most likely an experience of overall better health and well being.

Question that was asked in the study, `Are there differences in the diet of those who report shorter sleep, longer sleep, or standard sleep patterns?'" said study researcher Michael A. Grandner, Ph.D., of the Center for Sleep and Circadian Neurobiology at the university.

Researchers examined the daily calories and foods consumed - down to a glass of water. They also gathered information on the amount of time the study participants slept, putting them into four categories: "very short" sleepers, who slept fewer than five hours a night;"short" sleepers, who slept five to six hours a night; "standard" sleepers, who slept seven to eight hours a night; and "long" sleepers, who slept nine or more hours a night.

And researchers did find an association between the number of calories consumed and how long the study participants slept. Those who consumed the most were more likely to be "short" sleepers.

Interestingly, "normal" sleepers were the next type to consume a lot of calories, followed by "very short" sleepers and then "long" sleepers, researchers found.

The researchers also identified different associations between sleep time and the types of nutrients the participants ate.

Overall, researchers noted that the very short, short and long sleepers consumed a less varietal diet than those who were considered normal sleepers.

The question is now whether changing eating habits can actually affect sleep, as the study only showed an association.

A new type of malaria vaccine could beat all strains

JENNIFER REIMAN, GRIFFITH UNIVERSITY

A new type of malaria vaccine that has been shown to be safe in mice is about to start trials in humans.

This promising vaccine is different to other approaches to stopping the deadly disease because we use the whole malaria parasite in it. And it is able to protect against multiple strains of the illness.

Malaria and the need for a vaccine

Malaria is a mosquito-borne disease infecting nearly 250 million people each year across 109 countries. It causes approximately one million deaths each year, mostly among African children under the age of five.

The parasite has a complex life cycle with half of it lived within the female mosquito, and the other half in the human host (first within the liver and then by infecting red blood cells).

When the parasite bursts out of infected red blood cells, it destroys the cells and causes the symptoms of malaria.

Current preventive measures against malaria include those that act on the mosquito including insecticide-treated bed nets (physical barrier) and indoor residual spraying of chemicals (insecticides) to kill mosquitoes when they land on the walls.

If you’re infected, anti-malaria drugs (artemisinin-based combination therapies) are used to kill the parasite, but not everyone has access to them.

What’s more, mosquitoes and malaria parasites are continually developing resistance to current chemicals and drugs, frustrating efforts to protect against the illness.

There is no licensed vaccine against malaria, and the most advanced experimental one in clinical trials, RTS,S is showing little protection.

Our vaccine

Researchers around the world have been working on a vaccine for malaria for over 80 years. The team I’m in has been working on the problem for over 20 years.

Based on previous results from our group showing that a vaccine containing low doses of the dead parasite protected against malaria, we decided to use the whole parasite while it is still inside the red blood cell (the second stage of malaria infection) in our vaccine.

Colleagues in North America had previously showed that treating sporozoites (the malaria parasite at the stage when it is transmitted from an infected mosquito) with a particular drug protected against infection with sporozoites of all strains.

We used this same drug to treat infected red blood cells. The drug binds to the parasite’s DNA and prevents it from multiplying.

We treated red blood cells from mice infected with malaria with the drug in a test tube, then washed away the excess drug and gave the remaining treated cells to mice. This is our vaccine.

Later, we infected the mice with malaria to see if they were protected. We found that mice given our vaccine before infection did not develop as many parasites in their blood. Some of the mice had so few parasites that we were unable to see them when we looked at the blood under a microscope.

And even though mice were immunised with only one strain of malaria and infected with a different strain, they were also protected by our vaccine. That means that our vaccine protects against all strains of malaria.

How our vaccine is different

Previous vaccines have been able to activate humoral immunity (protection mediated by antibodies). These vaccines stimulate to body to make antibodies that bind to proteins on the surface of the parasite and can prevent parasites from invading new red blood cells. Or they can make antibodies that bind to the surface of infected red blood cells and are important in their removal.

These vaccines have, for the most part, not been successful. Malaria can hide from these antibodies by making a new version of the protein that won’t be recognised by the antibodies.

People who live in malaria infected areas do eventually develop protection against malaria symptoms. But this protection doesn’t occur until they have been infected with multiple strains of malaria (and only if they don’t die from one of the infections first).

Unlike naturally acquired immunity to malaria, our vaccine works by turning on cell-mediated immunity which involves T lymphocytes (a type of white blood cell). These T lymphocytes are able to recognise all kinds of proteins including those hidden inside the malaria parasite.

The hidden proteins may be shared between the various strains of malaria and we suspect that’s why our vaccine protects not only against the strain given in the vaccine but all strains of malaria.

The next steps

The results from our studies in mice has prompted us to test our malaria vaccine in humans. Within the next few months, we will begin a human clinical trial testing the vaccine made in human red blood cells that are infected with the human malaria parasite.

If results of the study in healthy Australian volunteers is promising, the vaccine will progress onto studies in areas where malaria is present. We are very encouraged by the results so far and optimistic that our vaccine approach will aid the fight against this debilitating illness that affects so many people around the world.

Obesity can be inherited

New research from the University of Adelaide shows that the sperm of obese fathers could increase the risk of both their children and their grandchildren to inherit obesity.

In laboratory studies, researchers from the University's Robinson Institute have found that molecular signals in the sperm of obese fathers can lead to obesity and diabetes-like symptoms in two generations of offspring, even though the offspring are eating healthily.

The results of the research are published online inThe FASEB Journal.

"A father's diet changes the molecular makeup of the sperm. With obese fathers, the changes in their sperm - in their microRNA molecules - might program the embryo for obesity or metabolic disease later in life," says the lead author of the paper, Dr Tod Fullston, who is an NHMRC Peter Doherty Fellow with the University's Robinson Institute, based in Dr Michelle Lane's Gamete and Embryo Biology Group.

"For female offspring, there is an increased risk of becoming overweight or obese. What we've also found is that there is an increased chance of both male and female offspring developing metabolic disease similar to type 2 diabetes.

"This is the first report of both male and female offspring inheriting a metabolic disease due to their father's obesity," he says.

The study also extended into the second generation of progeny, which showed signs of similar metabolic disorders, including obesity, although it was not as severe as the first generation.

Dr Fullston says even if the obese father does not show any signs of diabetes, metabolic disease similar to diabetes was being seen in two generations of their descendants.

"It's been known for some time that the health of a mother before, during and after pregnancy can impact on her child's health, but the father's health during this period is often overlooked," Dr Fullston says.

"If our laboratory studies are translatable to humans, this could be a new and as yet unexplored intervention window into the epidemic of childhood obesity.

"A focus on the mother's health is extremely important, but we're seeing that the father's health is also important for conception. It's possible that by showing additional attention to diet and exercise in the father, this could have a positive impact on his future children and grandchildren."