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Contributors
Arthur J. Winfield BPharm PhD MRPharmS
Academic and professional positions held: Senior Lecturer
and Head of Pharmacy Practice, Robert Gordon University,
Aberdeen; First Local Postgraduate Tutor for Scottish
Centre for Postqualification Pharmaceutical Education;
Academic Advisor and External Examiner for new Faculty of
Pharmacy, University of Kuwait and then became first
Chairman of Department of Pharmacy Practice, University
of Kuwait. Following retirement has been Visiting Professor,
Department of Pharmacy Practice, Faculty of Pharmacy,
Kuwait University, Kuwait
21 Routes of administration and dosage forms
26 Pharmaceutical calculations
30 Solutions
31 Suspensions
32 Emulsions
33 External preparations
34 Suppositories and pessaries
35 Powders and granules
36 Oral unit dosage forms
Appendix 2 Latin terms and abbreviations
Appendix 3 Systems of weights and measures
Judith A. Rees
Promotion
Academic and professional positions held: Senior Lecturer,
School of Pharmacy and Pharmaceutical Sciences, The
University of Manchester, Manchester; External Examiner
for Pharmacy at University of Bath, Robert Gordon
University, DeMontfort University, Aston University, Kingston
University, University of Hertfordshire, School of Pharmacy,
London, UK
2 Models of pharmacy practice within healthcare systems
13 Communication skills for the pharmacist
25 Dispensing techniques (compounding and good
practice)
28 Labelling of dispensed medicines
43 Storage of medicines and waste disposal
44 Communication skills – role of the pharmacist in giving
advice and information
Ian Smith
Academic and professional positions held: currently Boots
Teacher Practitioner, The University of Manchester,
Manchester, UK. Prior to this he held the same position in
Bradford University. He has also worked for Boots as a
Preregistration and Management Tutor in Nottingham and
as a store manager in Thirsk
24 The prescription
BPharm MSc PhD Certificate in Health
BSc(Hons) ClinDip FHEA MRPharmS
Darren Ashcroft
Reader in Medicines Usage & Safety and Director, Centre for
Innovation in Practice, School of Pharmacy and
Pharmaceutical Sciences, The University of Manchester,
Manchester, UK
9 Risk management
David R. Bethell
LPC Secretary, Wigan Branch Secretary, UK
43 Storage of medicines and waste disposal
Christine M. Bond
FHEA
Professor of Primary Care (Pharmacy), Head of Centre of
Academic Primary Care, University of Aberdeen; Consultant
in Pharmaceutical Public Health, NHS Grampian,
Aberdeen, UK
1 The role of pharmacy in healthcare
Derek G. Chapman
Lecturer, School of Pharmacy, Robert Gordon University,
Aberdeen, UK
27 Packaging
29 Production of sterile products
38 Parenteral products
Victoria Crabtree
Teaching Fellow, School of Pharmacy and Pharmaceutical
Sciences, The University of Manchester, Manchester, UK
48 Services for vulnerable patients
Parastou Donyai
PGDPRM(Open)
Lecturer, School of Pharmacy, University of Reading,
Berkshire, UK
23 Information retrieval
Ivan O. Edafiogho
Associate Professor, Department of Pharmacy Practice,
Faculty of Pharmacy, Kuwait University, Kuwait
26 Pharmaceutical calculations
K. Hannes Enlund
Professor, Department of Pharmacy Practice, Faculty of
Pharmacy, Kuwait University, Kuwait
3 Socio-behavioural aspects of health and illness
4 Socio-behavioural aspects of treatment with medicines
BPharm MSc PhD MRPharmS
BScPharm(Hons) MRPharmS MInstM
BPharm MSc MEd PhD FRPharmS FPH
BSc(Pharm) PhD MRPharmS
BPharm(Hons) MRPharmS
BPharm(Hons) PhD MRPharmS PCTLHE
BPharm MSc PhD PharmD
MSc(Pharm) DSc(Pharm)
ix
Contributors
Marthe M. Everard BSc(Pharm) MSc(Pharm)
MSc(LSHTM) MRPharmS
Technical Officer, Department of Medicines Policy and
Standards, World Health Organization, Geneva,
Switzerland
7 WHO and the essential medicines concept
Isobel J. Featherstone
MPharm MRPharmS
Locum pharmacist
13 Communication skills for the pharmacist
David Graham
BSc MSc MRPharmS
Radiopharmacist, Department of Pharmacy, Aberdeen
Royal Infirmary, Aberdeen, UK
42 Radiopharmacy
Felice S. Groundland
BSc(Pharm) MRPharmS
Boots Teacher Practitioner, School of Pharmacy, University
of Strathclyde, Glasgow, UK
14 Relationship with other members of the healthcare
team
Jason Hall
BSc MSc PhD MRPharmS PGCE MCPP
Senior Teaching Fellow, School of Pharmacy and
Pharmaceutical Sciences, The University of Manchester,
Manchester, UK
16 Access to medicines and prescribing – introduction
17 The prescribing process and evidence-based medicine
Lindsay Harper
BSc(Hons) MRPharmS DipClin
Principal Clinical Pharmacist, Salford Royal NHS
Foundation Trust, Salford Royal Hospital, Salford, UK
41 Parenteral nutrition and dialysis
Dyfrig A. Hughes
BPharm MSc PhD MRPharmS
Reader in Pharmacoeconomics, Institute of Medical and
Social Care Research, Bangor University, Bangor, UK
19 Drug evaluation and pharmacoeconomics
Janet Krska
(Health Economics) MRPharmS MCPP
BSc PhD PGCert (Tertiary Level Teaching) PGCert
Professor in Pharmacy Practice, School of Pharmacy and
Biomolecular Sciences, Liverpool John Moores University,
Liverpool, UK
11 Audit
18 Formularies
19 Drug evaluation and pharmacoeconomics
Alison Littlewood
MRPharmS MSc MCPP FHEA
Lead Pre-Registration Trainee Pharmacist Facilitator, NW
Region, School of Pharmacy and Pharmaceutical Sciences,
The University of Manchester, Manchester, UK
47 Monitoring the patient
G. Brian Lockwood
BPharm PhD MRPharmS FHEA
Senior Lecturer, School of Pharmacy and Pharmaceutical
Sciences, The University of Manchester, Manchester, UK
20 Complementary/alternative medicine
Richard C. O’Neill
LLB LLM BPharm PhD MRPharmS
Associate Head, The School of Pharmacy, University of
Hertfordshire, Hatfield, UK
12 Ethics
Karen Rice
MPharm MRPharmS
Business Developement Manager, The Cohens Group,
Lostock, Bolton, UK
45 Collection and delivery services
Peter M. Richards
BPharm MRPharmS
Prescribing Adviser, Lincolnshire Teaching Primary Care
Trust, Lincoln, UK
37 Inhaled route
R. Michael E. Richards
(Hons) DPharm(Hons) RPL(Thai)
OBE BPharm PhD DSc DPharmSci
Visiting Professor and Executive Consultant, Faculty of
Pharmacy, University of Mahasarakham, Thailand
39 Ophthalmic products
Appendix 4 Presentation skills
Paul Rutter
BPharm PhD MRPharmS
Principal Lecturer, School of Applied Sciences, University of
Wolverhampton, Wolverhampton, UK
22 Prescribing for minor ailments
Ellen Schafheutle
MSc PhD MRes MRPharmS
Research Fellow, School of Pharmacy and Pharmaceutical
Sciences, The University of Manchester, Manchester, UK
6 Types of patient charges for medicines and their impact
Jenny Scott
BSc(Pharm) PhD MRPharmS(IP) FHEA
Senior Lecturer, Department of Pharmacy and
Pharmacology, University of Bath, Bath, UK
49 Substance use and misuse
Liz Lamerton
Pharm
BSc(Hons) Pharmacy MRPharmS DipClin
Pharmacy Department, Salford Royal NHS Foundation
Trust, Salford, UK
41 Parenteral nutrition and dialysis
x
Graham J. Sewell
MIBiol CBiol
BPharm PhD MRPharmS MRSC CChem
Professor of Clinical Pharmacy, School of Pharmacy,
University of Kingston, Kingston upon Thames, UK
40 Specialized services
Contributors
Raminder Sihota BSc(Hons) MRPharmS Dip Comm Pharm
Boots Teacher Practitioner, School of Pharmacy, University
of Sunderland, Sunderland, UK
10 Continuing professional development and fitness to
practise
Megan R. Thomas
FRCPCH
BSc(Med Sci) MB ChB DRCOG MRCP
Consultant Community Paediatrician, Blenheim House
Child Development and Family Support Centre,
Blackpool, UK
Appendix 1 Medical abbreviations
Appendix 4 Presentation skills
Simon J. Tweddell
BPharm MRPharmS
Senior University Teacher, School of Pharmacy, University of
Bradford, Bradford, UK
8 Clinical governance – an overview
Roger Walker
BPharm PhD FRPharmS FFPH
Consultant in Pharmaceutical Public Health, National Public
Health Service for Wales, Temple of Peace and Health,
Cathays Park, Cardiff and Professor of Pharmacy Practice,
Welsh School of Pharmacy, Cathays Park, Cardiff, UK
5 Pharmacy and public health
Marjorie C. Weiss
MSc (Social Research Methods) DPhil MRPharmS
BSc (Pharmacy) MSc (Clinical Pharmacy)
Professor of Pharmacy Practice and Medicine Use,
Department of Pharmacy and Pharmacology, University of
Bath, Bath, UK
46 Concordance
Mary Zargarani
MPharm
Teaching Fellow, School of Pharmacy and Pharmaceutical
Sciences, The University of Manchester, Manchester, UK
15 Record keeping
xi
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Preface
It is almost 5 years since the publication of the last
edition of Pharmaceutical Practice and, as Bob Dylan
wrote, ‘The times they are a-changin’.’ Indeed, many
of the new ideas and concepts (fitness to practise and
continuing professional development, governance,
evidence-based practice, concordance, monitoring
the patient) that were emerging 5 years ago are now
fully embedded within pharmacy practice. Other
more traditionally accepted areas of practice (record
keeping, storage of medicines and waste disposal, collection and delivery services, services for vulnerable
patients) have developed and their emphasis changed
during this time period. Alongside these changes in
pharmacy practice, society itself has changed (patient
empowerment, patient choice, issues of consent and
the development of a more ethically aware public,
and the widespread availability of computers and
the Internet), and many of these changes have had an
impact on areas of pharmacy practice. Thus the content of this fourth edition of Pharmaceutical Practice
has changed to take account of all these developments.
Many new chapters have been included to cover all
these new and/or developed areas of pharmacy practice and the original chapters have been updated or
rewritten to include newer aspects of practice.
Besides the changing content of the book, one of
the original editors (AJW) remains, acting as an anchor and guide to the two newer junior editors,
and making sure the ethos of the previous editions is
maintained – that is, the reader is provided with an
up-to-date knowledge base for all aspects of good
pharmacy practice, presented wherever possible, to
encourage a professional attitude of always seeking to
provide the highest standards of pharmaceutical care.
Many new authors have been recruited for this
edition and they include full-time practising pharma-
cists, pharmacists with joint appointments with
community or hospital pharmacies, and academic
pharmacists. All these new authors have been chosen
for their experience and expertise in the subject matter. Although this book is produced in the UK, many
of the new and established authors do not hail from
these shores and so international aspects of pharmacy
practice are covered in this book.
Pharmaceutical Practice has been written to provide the reader with the traditional and pharmaceutically unique aspects of pharmacy practice, and in
addition to offer the newer concepts and methods
employed in the pursuit of quality pharmaceutical
care for patients. Hopefully this book will provide
the reader with a wide knowledge base of pharmacy
practice and the skills required for the developing
roles of a pharmacist in 2009 and beyond.
There are two companion volumes to Pharmaceu-
tical Practice: Aulton’s Pharmaceutics: The Design
and Manufacture of Medicines third edition (2007)
edited by M. E. Aulton, which provides greater detail
on the scientific principles that underpin the design
and manufacture of dosage forms and medicines;
and Clinical Pharmacy and Therapeutics fourth edition (2007), 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.
JAR
IS
AJW
xiii
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Acknowledgements
The editors would like to take this opportunity to
thank the many people who have helped to make this
fourth edition possible. Since publication of the third
edition, Professor Mike Richards has decided to ‘retire’ as an editor. It is impossible to pay sufficient
tribute to his input to previous editions. His decision
has meant that new editors were required. It has been
a pleasure working (as a new team) with both Judith
Rees and Ian Smith. They have brought a different
range of experience, which is reflected in the detailed
content of this fourth edition.
New editors also bring new contacts, so we have
been able to recruit many new authors for this edition.
We are deeply grateful to all the authors for their
willingness to contribute to this volume and for the
time and effort they have spent researching their subjects and in preparing text – and for the way they have
responded to e-mails!
Our special thanks are due to our families. Without
their continued encouragement, support and assistance, an undertaking like this would not reach completion.
Those companies, organizations and individuals
who have given permission to use or modify their
materials or who have helpfully answered queries or
provided information to our authors are thanked.
Without this type of cooperation, any textbook cannot hope to present a worthwhile overview.
Thanks are also expressed to the publishers, in
particular Ellen Green, Pauline Graham, Hannah
Kenner and Carole McMurray, for their guidance
and timely support throughout the preparation of this
fourth edition. Professional guidance is always necessary. They have provided it as required and made our
lives much easier.
Finally, we wish to thank you, our students, past
and present, in the UK and Kuwait. We know that
students do not appreciate how much their teachers
learn from them, but we do! We hope that some of
this is reflected in this book.
JAR
IS
AJW
xv
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About this book
In the initial stages of planning this fourth edition of
Pharmaceutical Practice and considering what was
needed to provide the reader with a rounded and full
knowledge of pharmacy practice, we had to take cognizance of the fact that this subject has changed rapidly in the last few years. Thus, as indicated in the
preface, this edition contains several new chapters by
new authors and, in addition, the original chapters
have been revamped and the content rewritten or
brought up to date. Because of these changes, it was
also necessary to rearrange the order of the chapters.
In so doing, we have attempted to place the chapters
into logical groupings or sections. These sections
should make it easier for the reader to appreciate
the new developments in pharmacy practice. We
hope, however, that the use of these sections does
not isolate and compartmentalize the subject matter,
especially since many topics span the range of pharmacy practice activities; thus, where appropriate, we
have indicated (cross-referenced) where the subject
matter is referred to in another part of the book. In
total there are five sections and appendices:
*
Section 1 Pharmacy practice and society
*
Section 2 Governance and good professional
pharmaceutical practice
*
Section 3 Pharmacy prescribing and selection of
medicines
*
Section 4 Dispensing and related pharmaceutical
practice activities
*
Section 5 Pharmacy services and monitoring the
medicine-taking patient
*
Appendices.
Section 1
In Section 1, the chapters address the wider aspects of
pharmacy practice, the influence of society on pharmacy practice and vice versa, the organization of pharmacy practice within societies, and the impact of
health or illness of patients and the supply of medicines within societies on pharmacy practice. These
chapters also consider international features of pharmacy practice and medicines. The book opens with a
detailed description of the development of pharmacy
practice and the role it now plays within society. This
chapter is followed by the way pharmacy practice
is organized in different countries of the world, highlighting some of the similarities and differences.
The next two chapters (3 and 4) cover the behavioural
and sociological aspects of patients and their illnesses
and treatment with drugs. An understanding of these
two chapters should underpin many of the latter
chapters, which consider self-care, patient empowerment and patient choice. The nature of public health
and the role that pharmacy can play and should play in
providing public health is the subject of Chapter 5.
While Chapters 6 and 7 have a very international
flavour, Chapter 6 considers the different methods
by which patients are charged for their medicines
and the impact it makes on the provider and patient,
and Chapter 7 considers the essential medicines concept, which is important for many countries, including ‘developed’ countries.
Section 2
The chapters in this section all consider ways of
providing good professional pharmacy practice,
whether this involves evaluating and/or setting up
‘ways of working’ or developing the individual skills
of the pharmacist. Chapter 8 sets the scene by
describing what is meant by governance, all its
component parts and how pharmacists can apply good
governance to their daily working life. The nature of
risk and how it can be managed to prevent accidents
and provide a safer environment for patients receiving
medicines is considered in Chapter 9.InChapter 10,
the need for pharmacists to demonstrate fitness to
practise and provide evidence of continuing professional development is outlined as part of governance.
Audit, as described in Chapter 11, is another aspect of
governance and a way by which pharmacists can demonstrate that they meet standards and provide good
services. Underpinning good professional practice is
an appreciation and demonstration of an ethical
stance by the pharmacist (Chapter 12), while
xvii
About this book
Chapter 13 outlines the ways in which pharmacists
can develop good communication skills to develop
their professional role. Pharmacists do not work in
isolation and Chapter 14 considers the pharmacist’s
relationship with other members of the healthcare
team as they provide good, effective and professional
services. Chapter 15 describes the very necessary record keeping that pharmacists are required to maintain as evidence of professional practice.
Section 3
The emphasis in t his section is on the development
of non -medical prescribers, including pharmacists,
and the safe and economic selection of effective
medicines. Chapters 16 and 17 provide background
and detailed information on prescribers, prescribing
and the need for an e vidence base. The development of formularies to reduce costs and help in the
selection of medicines by prescribers is discussed in
Chapter 18,whileChapter 19 develops the topic
further by considering drug evaluations and pharmacoeconomics. The increasing use by the public of
complementary and alternative medicines requires
pharmacists to develop knowledge and skills to help
with the selection of these products (Ch apter 20).
The increasingly varied routes of administering of
medicines are dealt with in Chapter 21. Prescribing
for minor ailments has always been a core role for
pharmacists and Chapter 22 describes effective
ways of assessing patients’ symptoms and condi-
tions to a rrive at a differential diagnosis and hence
become a more helpful and professional prescriber.
In order to underpin the prescribing and selection
of medicines, it is essential that the pharmacist
can access good information, especially with the
wealth of information available on the Internet:
Chapter 23 addressesthisimportanttopicand
skill.
details how to perform pharmaceutical calculations.
Packaging and labelling of dispensed products is considered in Chapters 27 and 28. Chapter 29 describes
the set-up of sterile production areas and the sterility
testing of pharmaceutical products. Then follows in
Chapters 30–36 a systematic coverage of the different
types of medicines, concentrating mainly on the extemporaneously prepared medicines that pharmacists
may have to produce. From Chapter 37, the emphasis
changes to more specialized medicines and the role
of the pharmacist in ensuring their effective use.
Chapter 37 discusses how medicines are given by
inhalation, Chapter 38 by injection and Chapter 39
deals with ophthalmic products. Chapters 40–42 describe hospital-based services including specialized
services, total parenteral nutrition, dialysis and radiopharmacy. Chapter 43 considers the storage of medicines in a pharmacy and their disposal as waste, when
required. Chapter 44 completes the dispensing process by describing the communication skills required
to provide advice to patients on their medicines.
Section 5
The chapters in this section consider the next stage
after the patient has received their medicine(s), the
pharmaceutical services provided to groups of patients
and the monitoring of patients who take medicines.
Chapter 45 outlines the provision of services to ensure
that patients receive their prescribed medicines within
the community setting. Chapter 46 considers concordance and the agreement between prescriber and
patient on how, when and why to use medicines and
whether the patient is fulfilling that agreement.
Further monitoring of the patient’s actual use of
medicines and whether they understand how to take
their medicines is followed up in Chapter 47. Chapters
48 and 49 consider how vulnerable patients and drug
misusers can be helped by pharmacists and others to
obtain and use correctly their medicines or drugs.
Section 4
Dispensing and the preparation of extemporaneous
products are at the core of traditional pharmacy practice. This section starts with Chapter 24 and the
important task of checking the information on a
prescription, and outlines a novel scheme for the clinical and legal checking of a prescription to ensure that
it is appropriate for the patient. Chapter 25 describes
dispensing techniques in general and Chapter 26
xviii
Appendices
The appendices supplement the chapters by providing information that either would not require a full
chapter or is more appropriately situated outside of
the chapters. Appendices 1 and 2 list medical and
Latin abbreviations, both of which are useful to pharmacists as part of their job, but may need to be looked
up because of their infrequent use. Appendix 3