Pharmaceutical Practice 5th Edition

Pharmaceutical Practice 5th Edition

In the five years since the publication of the last edition of Pharmaceutical Practice, the profession of pharmacy has once again changed and progressed. There are emerging new roles for pharmacists both within the traditional employment areas of hospital and community pharmacy, as well as other emerging roles to support the public health agenda, governance, risk management, prescribing, and pharmacoeconomic areas. As well as changes in the content of this edition of Pharmaceutical Practice, Arthur Winfield, one of the original editors, made the decision to leave the editorial team after being involved in the editing of the previous four editions – what an accomplishment! He was an extremely efficient and experienced editor, whose retirement has left a big hole in the editing team. Fortunately, the other editors, Judith Rees and Ian Smith have been joined by an enthusiastic and knowledgeable new editor, Jennie Watson. Together, this editorial team has been able to carry forward the original aims of the book, which are to provide the readers with an up-to-date knowledge base for all aspects of pharmacy practice presented whenever possible, in a way to encourage a professional attitude of always seeking to provide the highest standards of care for patients.

We have been fortunate with all our authors, who have produced up-to-the-minute information of their subject material to illustrate each of their chapters. We have recruited many new authors who have been chosen for their expertise and experience in their subject. Our authors include full-time practicing pharmacists, academics experienced in teaching pharmacy, and some pharmacists with joint appointments between hospital or community pharmacy and academic institutions.

Pharmacy continues to evolve as a profession and, while we are wary of saying that the next few years will be the most exciting ever for the profession, we certainly see great change and opportunity ahead. We have included many new chapters in this edition to reflect these newer aspects of practice, which will impact areas of future pharmacy practice.

There are two companion volumes to Pharmaceutical Practice: Aulton’s Pharmaceutics: The Design and Manufacture of Medicines, fourth edition (Churchill Livingstone 2013), edited by ME Aulton and K Taylor, which provides greater detail on the scientific principles that underpin the design and manufacture of dosage forms and medicine; and Clinical Pharmacy and Therapeutics, fifth edition (Churchill Livingstone 2012), edited by R. Walker and C. Whittlesea, which considers in greater detail, aspects of treatment with drugs and clinical practice by pharmacists. These three books complement each other and readers should realize that information cannot be compartmentalized. It is detrimental to patients to ignore any aspect of the total knowledge base – all must be integrated if optimum pharmaceutical care is to be provided.

We would encourage the readers to embrace the changes ahead, to move the profession ever further forward, to provide both the best care for your patients but also to provide you with the opportunity for job satisfaction and enjoyment.

About this Book

When we were asked by Elsevier to edit this new edition of Pharmaceutical Practice, our first task was to review the contents of the last edition. We soon realized that much had changed in pharmacy practice, in general, and that some individual chapters were rapidly becoming out of date and that newer developments in pharmacy practice were either nascent or not mentioned in the last edition. Certainly, it was evident that new developments in pharmacy practice were progressing rapidly as a result, in some cases, of changes in society, while other developments were the result of positive actions by the pharmacy profession or individual pharmacists.

Thus, it was necessary to decide which topics or chapters would be retained, and which new topics would be included in the new edition, always bearing in mind we had a limited word count and that no textbook can give total coverage of a huge subject such as pharmacy practice. What we aimed to produce was a book that would cover much of the widening topic of pharmacy practice. In order to achieve our aim, it was necessary to recruit new authors and persuade existing authors to revamp their chapters by rewriting the contents and/or bringing them up-to-date. We are very grateful to all the authors for writing the chapters in a very short timescale for completion and submission.

In view of the changes to the subject matter of some of the chapters, this has necessitated a reordering of the chapters into a logical sequence. We have also arranged the book into sections and in each section, we have grouped together chapters with the related subject matter. These sections are not meant to isolate or compartmentalize the topics and indeed, we have cross-referenced, where appropriate, to the similar subject material in another chapter or section. Not surprisingly, some topics underpin the development of other topics found in a separate chapter. Indeed, the ethos of the book was that no chapter stands totally alone. All chapters link in with one another, in the same way, that pharmacists, whatever their role, need knowledge and skills that will be used by them in their role and by other pharmacists working in different roles. The book consists of seven sections and four appendices: SECTION 1: An introduction to the pharmacy and its place in society

In Section 1, the chapters address the wider aspects of pharmacy practice, the development of pharmacy and the emerging subject of pharmacy practice, as well as the influences of society on pharmacy practice and vice versa. The book opens with a detailed description of the development of pharmacy practice and the role it now plays within society and health care. The next two chapters cover the behavioral and sociological aspects of patients and their illnesses and treatment with drugs. An understanding of these two chapters will underpin later chapters, which consider patient choice, patient empowerment, and self-care.SECTION 2: Protecting the public

The chapters in this section all consider the ways in which the pharmacy profession and the legal system have a duty to protect the public. The first chapter in this section describes the ways in which medicines are controlled by the legal system in order to protect the public and patients from freely accessing and using medicines that could be harmful to them. The second chapter in this section (Ch. 5) considers the ways healthcare professionals are regulated, again to protect the public from unscrupulous people. In order to maintain the standards of knowledge and skills of healthcare professionals, Chapter 6 focuses on continuing professional development (CPD) and revalidation. Chapters 7 and 8 together describe ethics and ethical dilemmas. Both these chapters underpin professional behavior and are aimed at protecting the public. Clinical governance, which is considered in Chapter 9, describes the ways of providing quality in pharmacy services and health care, while Chapter 10 outlines the ways in which errors occur and the ways to manage risk and thus protect the public. Standard operating procedures described in Chapter 11 and audit in Chapter 12, are other ways of protecting the public by standardizing procedures used by professionals and then checking (auditing) that procedures actually do what they are meant to do. Public health considered in Chapter 13 aims to protect the public by promoting health by the efforts of healthcare professionals and informed choice by the public.SECTION 3: Delivering professional pharmacy practice

Chapter 14 starts off this section on delivering professional services, by describing the structure and organization of pharmacy, which supports this delivery. Chapter 15 considers the other members of the healthcare team and the importance of good management skills between pharmacists and their team. Chapters 16, 17, 18, and 19 describe the skills and understanding required by pharmacists to undertake the delivery of professional services. All pharmacy professions need to develop and maintain their skills to retrieve information (Ch. 16), communicate with their team and patients as well as other healthcare professionals (Ch. 17), and to perform pharmaceutical calculations (Ch. 19). Chapter 18 describes concordance and emphasizes that pharmacists should gain an understanding of patients and their ability to choose if, and how they take their medicines.SECTION 4: Access to medicines and their selection

Section 4 considers access to medicines and their selection. In this section, the ways of obtaining medicines are described and the restraints on both their access and selection. Chapter 20 outlines the prescribing process and emphasizes the need for good prescribing to be based on sound evidence. Evidence-based medicine is a theme running through all the chapters in this section. Prescribing for minor ailments (Ch. 21) is based on a logical and rational approach to diagnose before considering whether a medicine needs to be prescribed or not. Chapters 22 and 23 consider how drugs are evaluated and whether they are valued for money. This approach is then used to develop formularies to guide prescribers in their selection of effective and economical medicines. The impact of patient charges on the access to medicines is discussed in Chapter 23 and how to effectively provide advice and information in the selection of medicines is considered in Chapter 25. Nowadays, many people are moving away from conventional medicine and considering and using complementary and alternative medicines. Chapter 24 provides the background and use of these medicines. Chapters 26 and 27 consider prescriptions, both the funding and requirements for medicines supply via a prescription. Lastly, the access and selection of veterinary medicines are considered in Chapter 28.SECTION 5: Medicines and their preparation This section initially considers the many routes by which medicines are administered to patients and the dosage forms, which allow these methods of administration (Ch. 29). This is followed by a description of the dispensing techniques used to prepare extemporaneous preparations (Ch. 30). Chapters 33 to 39 each describe the methods of preparation and the use of necessary excipients to produce a different type of formulation. These methods, although only suitable for extemporaneously prepared products, are the basis of methods used in the pharmaceutical industry to produce the many medicines available commercially. Chapters 31 and 32 describe how to appropriately label and pack an extemporaneously produced medicine.SECTION 6: Specialized pharmacy products and services

Section 6 considers specialized pharmacy products and services provided by pharmacists. Chapters include an in-depth description of the production of sterile products (Ch. 40), followed by the types of parenteral products available and how they are prepared and packaged (Ch. 41). Chapter 42 considers in-depth ophthalmic products, the types used, and their formulation including necessary excipients. Besides ophthalmic medicinal products, the chapter considers the types of products specially formulated for contact lenses and their users. Inhaled products are considered in Chapter 43, the different types of manufactured inhaled products, their specially designed packaging and how to explain to the patient how to use them. Parenteral nutrition and dialysis are two services provided in hospitals and often transferred into the community in which pharmacists are heav-ily involved in the preparation of the formulations and their use by patients (Ch. 44). Radiopharmacy is another specialized area in which pharmacists are involved in the production, packaging and use of radiopharmaceuticals. These specialized methods and underpinning theories are described and explained in Chapter 45. Chapter 46 centers on the range, risks and benefits of medicines, which are aseptically compounded in the hospital or specialized units by pharmacists. These pharmaceutical services include cytotoxic reconstitution and centralized intravenous additive services. Appliances dispensed by pharmacists including trusses and stoma products are described and explained in Chapter 47.SECTION 7: Pharmacy services

This section looks at some services which have increased in prominence in recent years. These include an acknowledgment that pharmacy pro-vides public health interventions on a daily basis to an increasing number of the public. These pharmacy interventions are described in Chapter 48. Services to vulnerable people (Ch. 49) in the pharmacy setting have increased due, in some respects, to an increased number of government policies but mainly because pharmacists are well placed to access vulnerable people, when they require medicines. For many years, pharmacists have come into professional contact on a frequent basis with patients who misuse illegal drugs and substances. Chapter 50 describes the role of the pharmacist and the range of pharmaceutical interventions in operation for illegal drug and substance users. Monitoring the patient after they have received a medicine is the subject of Chapter 51. In this chapter, the methods of reporting adverse drug reactions are described as well as the role of pharmacists in medicine use reviews of patients.APPENDICES

Appendix 1 lists the abbreviations used throughout this book. This is followed, in Appendix 2, by a list of medical abbreviations that pharmacists may encounter during their careers. Latin terms and abbreviations frequently used in prescription writing are covered in Appendix 3 and Appendix 4 lists key references, including websites, and guidance to further reading for the chapters.

In producing this textbook, we have tried to cover as many aspects of pharmacy practice that is possible within the word count and realizing that subject matter should not be too brief an over-view, but should have some substance. Clearly, each chapter is not a totally comprehensive description of the subject matter and readers requiring more information are directed to Appendix 4 for additional reading and then to Chapter 16 to practice their information retrieval skills.

Finally, we acknowledge that changes will take place in pharmacy practice between the writing and publishing of this text and this means that by the time the book appears in print, it will inevitably be out of date in places. This process of obsolescence will continue with time. Therefore, the readers are encouraged to keep up-to-date (your own CPD, see Ch. 6) by reading current pharmaceutical and medical journals and literature.


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