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Hospital Pharmacy



Hospital Pharmacy

Description: Hospital Pharmacy
Hospital pharmacies can usually be found within the premises of the hospital. Hospital pharmacies usually stock a larger range of medications.
For over 45 years Hospital Pharmacy has been practitioner focused and dedicated to the promotion of safe medication practice and the prevention of medication errors.
Hospital Pharmacy features peer-reviewed clinical information applicable to pharmacists in hospitals and organized health systems, managed care practice, nursing homes, pharmacy schools, long term care, and other settings where state-of-the-art practice information is required.
Hospital pharmacists and trained pharmacy technicians compound sterile products for patients including total parenteral nutrition (TPN), and other medications given intravenously e.g. neonatal antibiotics and chemotherapy. This is a complex process that requires adequate training of personnel, quality assurance of products, and adequate facilitie.
All large acute hospitals have an on-site pharmacy department which has the key purpose of ensuring
that patients can receive the right medicine at the right time by an efficient and economical system.
Today most pharmacists would agree that they have a wider responsibility in ensuring that they apply
pharmaceutical expertise to help maximise drug efficacy and minimise drug toxicity. This concern
of pharmacists for the outcome of treatment in an individual patient, which has developed in the UK
over the last thirty years, characterises the practice of clinical pharmacy and has led to the concept of pharmaceutical care as the description of the role of the pharmacist in patient care.

Hospital Pharmacist
Hospital pharmacists are experts in the field of medicines. They are responsible for the purchase, manufacture, dispensing, quality testing and supply of all the medicines used in the hospital. They work closely with medical and nursing staff to ensure patients receive the most appropriate treatment, and provide help and advice to patients in all aspects of their medicines.
They advise on the selection of medicines and the dose and route of administration for individual patients. They provide information about potential side effects and ensure that new treatments are compatible with existing medication. In addition, they monitor the effects of treatment to ensure that it is safe and effective.
As the medicines expert in the healthcare team, you are able to provide advice about the effects that a medicine or combination of medicines may produce. You will give advice on dosage, suggest the most appropriate form of medication – such as tablet, injection, ointment, inhaler – and discuss with the medical staff the potential problems patients may experience with their medicines.
You will be expected to provide specialist advice on medicines for patients with conditions such as heart failure, kidney or liver disease, and for pregnant or breast-feeding women who should not take some medicines. As well as working on the wards with patients, there are several roles that are undertaken within the pharmacy itself. Main role in the dispensary is to “professionally check” all prescriptions to ensure that the dispensed medicines are appropriate and safe for the individual patient.
In the medicines information department, pharmacists use a range of reference sources, including electronic databases and the Internet, to provide detailed information
to healthcare professionals and patients about all aspects of medicines usage. New drugs are evaluated and compared to existing treatments before the hospital decides whether to purchase them.
Pharmacists are also involved in the manufacture of medicines when ready-made preparations are not available. For example, certain cancer treatments and intravenous feeding solutions need to be tailor made under sterile conditions for individual patients. .
Many pharmacists combine their professional role with some form of managerial responsibility, and also often will be involved in monitoring and reporting on expenditure from the budget for medicine usage within the hospital.

Community Pharmacist
Community pharmacists, working from high street, local and rural pharmacies, use their detailed knowledge to ensure that medicines ordered on doctors’ prescriptions or bought over the counter are correctly and safely supplied, with appropriate patient counseling on use and potential side effects.
They provide a convenient source of treatment and advice on minor ailments for the general public.
Community pharmacists are part of the healthcare team. They are concerned with the sale and supply of medicines, and the provision of advice about medicines, symptoms and general health matters. They dispense medicines, counsel patients on their proper use, clarify dosages are correct, and check new treatments are compatible with other medicines the patient may be taking.
Community pharmacists also advise on a variety of healthcare issues e.g. stopping smoking, healthy eating and family planning. The work may involve supplying free literature, supporting promotional health campaigns or performing screening tests, like blood pressure or cholesterol measurements. Every community pharmacy in Britain must be under "the direct supervision" of a pharmacist. Strict legal and ethical obligations are in place to ensure the control and safe use of medicines within the community.
Community pharmacists' work may also take them out of the pharmacy to advise on the proper handling of medicines in residential or nursing homes. They may visit house-bound patients to discuss their medicines or deliver fresh supplies. Some community pharmacists also work in GP practices on a sessional basis to advise on appropriate prescribing and review the medicines particular patients are taking.

Primary Care Pharmacist
The role of the primary care pharmacist has emerged over the last five to ten years. The work may include medicines management, prescribing advice, GP practice based work, professional development adviser and pharmacy clinical governance co-ordination. They may also work in GP practices as practice pharmacists.
The type of work carried out will vary depending on the specific role that the pharmacist has.
In a primary care trust (or local health board in Wales and Scotland) the pharmacist may have a lead role for all issues related to medicines management and prescribing. This may include ensuring evidence based prescribing practice, formulary development, financial management of prescribing allocations or budgets.


Clinical Trials

Description: A clinical trial is a research study in human volunteers to answer specific health questions. Carefully conducted clinical trials are the safest and fastest way to find treatments that work in people, and new ways to improve health.
Types of Clinical Trials
Treatment trials test experimental treatments, new combinations of drugs, or new approaches to surgery or radiation therapy.

Prevention trials look for better ways to prevent disease in people who have never had the disease or to prevent a disease from returning. These approaches may include medicines, vaccines, vitamins, minerals, or lifestyle changes.

Diagnostic trials are conducted to find better tests or procedures for diagnosing a particular disease or condition.

Screening trials test the best way to detect certain diseases or health conditions.

Quality of Life trials (or Supportive Care trials) explore ways to improve comfort and the quality of life for individuals with a chronic illness.

1 - Many clinical trials are done to see if a new drug or device is safe and effective for people to use.
2 - Clinical trials are also done for other reasons. Some compare existing treatments to determine which is better.
3 - The current, approved treatments are called the "standard treatments." Sometimes clinical trials are used to study different ways to use the standard treatments so they will be more effective, easier to use, and/or decrease side effects
4 - Sometimes, studies are done to learn how to best use the treatment in a different population, such as children, in whom the treatment was not previously tested.
5 - For most trials, researchers, doctors, and other health professionals administer the clinical trials according to strict rules set by the Food and Drug Administration (FDA). FDA sets the rules to make sure that people who agree to be in studies are treated as safely as possible.

Potential Benefits
Participating in well-designed and well-executed clinical trials is one approach for eligible patients/volunteers to:
- Get actively involved in their health care.
- Gain access to potentially new research treatments
- Have access to expert medical care for the condition being studied, since investigators are often specialists in the disease area being studied.
- Help others by contributing to medical research.

Possible Risks
There are generally known and unknown risks associated with clinical trials, such as:
- There may be unpleasant, serious, or even life-threatening side effects resulting from the treatment.
- The treatment may not be effective for the participant.
- The protocol may require more of the participant's time and attention than a standard treatment. (Participants may need to visit the study site on a regular basis, be subjected to additional tests, get more treatments than are normally necessary, stay in the hospital and/or follow)

All clinical trials have guidelines about who can participate.
- Inclusion/exclusion criteria is an important principle of medical research that helps to produce reliable results.
Inclusion Criteria
- The factors that allow someone to participate in a clinical trial are called "inclusion criteria"
Exclusion Criteria
- Those that disallow someone from participating are called "exclusion criteria".
- These criteria are based on such factors as age, gender, the type and stage of a disease, previous treatment history, and other medical conditions. Before joining a clinical trial, a participant must qualify for the study.

Informed Consent
Informed consent is the process of learning the key facts about a clinical trial before deciding whether or not to participate. Then the research team provides an informed consent document that includes details about the study, such as its purpose, duration, required procedures, and key contacts. Risks and potential benefits are explained in the informed consent document. The participant then decides whether or not to sign the document. Informed consent is not a contract, and the participant may withdraw from the trial at any time.

A protocol is a study plan on which all clinical trials are based. The plan is carefully designed to safeguard the health of the participants as well as answer specific research questions. A protocol describes what types of people may participate in the trial; the schedule of tests, procedures, medications, and dosages; and the length of the study. While in a clinical trial, participants following a protocol are seen regularly by the research staff to monitor their health and to determine the safety and effectiveness of their treatment.

Control Group
A control is the standard by which experimental observations are evaluated. In many clinical trials, one group of patients will be given an experimental drug or treatment, while the control group is given either a standard treatment for the illness.

SAFE Clinical Trials
The FDA works to protect participants in clinical trials and to ensure that people have reliable information as they decide whether to join a clinical trial. The federal government has regulations and guidelines for clinical research to protect participants from unreasonable risks.

Safety of the Participant
The ethical and legal codes that govern medical practice also apply to clinical trials. In addition, most clinical research is federally regulated with built in safeguards to protect the participants. The trial follows a carefully controlled protocol, a study plan which details what researchers will do in the study. As a clinical trial progresses, researchers report the results of the trial at scientific meetings, to medical journals, and to various government agencies. Individual participants' names will remain secret and will not be mentioned in these reports.

Phases of Clinical Trials
Clinical trials are conducted in phases. The trials at each phase have a different purpose and help scientists answer different questions:
- In Phase I trials, researchers test an experimental drug or treatment in a small group of people (20-80) for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
- In Phase II trials, the experimental study drug or treatment is given to a larger group of people (100-300) to see if it is effective and to further evaluate its safety.
- In Phase III trials, the experimental study drug or treatment is given to large groups of people (1,000-3,000) to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the experimental drug or treatment to be used safely.
- In Phase IV trials, post marketing studies delineate additional information including the drug's risks, benefits, and optimal use.

Expanded Access
Expanded access is a means by which manufacturers make investigational new drugs available, under certain circumstances, to treat a patient(s) with a serious disease or condition who cannot participate in a controlled clinical trial.

Sponsors OF Clinical Trials
Clinical trials are sponsored or funded by a variety of organizations or individuals such as physicians, medical institutions, foundations, voluntary groups, and pharmaceutical companies, in addition to federal agencies such as the National Institutes of Health (NIH), the Department of Defense (DOD), and the Department of Veteran's Affairs (VA). Trials can take place in a variety of locations, such as hospitals, universities, doctors' offices, or community clinics.

A placebo is an inactive pill, liquid, or powder that has no treatment value. In clinical trials, experimental treatments are often compared with placebos to assess the experimental treatment's effectiveness. In some studies, the participants in the control group will receive a placebo instead of an active drug or experimental treatment.

People SHOULD think before joining a Clinical Trial
People should learn as much as possible about the clinical trials that interest them. They should also feel comfortable discussing their questions and concerns with members of the health care team. Prospective participants should understand what happens during the trial, the type of health care they will receive, and any costs to them - which may or may not include the cost of the product, costs associated with administering the product, etc.
Anyone considering a clinical trial should also know that there are benefits and risks associated with participating.

Role of the FDA in approving New Drugs & Medical Treatments
The Food and Drug Administration's job is to make sure medical treatments are safe and effective for people to use. However, FDA does not develop new therapies, or conduct the clinical trials to demonstrate safety and effectiveness. FDA staff members meet with researchers, and perform inspections of clinical trial study sites to protect the rights of participants and to verify the quality and integrity of the data.


Clinical Pharmacy

Description: Clinical Pharmacy is a commonly used term in pharmacy practice and in pharmacy literature. It is a health specialty, which describes the activities and services of the clinical pharmacist to develop and promote the rational and appropriate use of medicinal products and devices.
Clinical Pharmacy includes all the services performed by pharmacists practising in hospitals, community pharmacies, nursing homes, home-based care services, clinics and any other setting where medicines are prescribed and used.

Focus of Clinical Pharmacy

- The discipline of pharmacy embraces the knowledge on synthesis, chemistry and preparation of drugs
- Clinical pharmacy is more oriented to the analysis of population needs with regards to medicines, ways of administration, patterns of use and drugs effects on the patients.
The focus of attention moves from the drug to the single patient or population receiving drugs.

Goal of Clinical Pharmacy

The overall goal of clinical pharmacy activities is to promote the correct and appropriate use of medicinal products and devices. These activities aim at:
- Maximising the clinical effect of medicines, i.e., using the most effective treatment for each type of patient
- Minimising the risk of treatment-induced adverse events, i.e., monitoring the therapy course and the patient's compliance with therapy
- Minimising the expenditures for pharmacological treatments born by the national health systems and by the patients, i.e., trying to provide the best treatment alternative for the greatest number of patients.

Level of Action of Clinical Pharmacists
Clinical pharmacy activities may influence the correct use of medicines at three different levels: before, during and after the prescription is written.
1. Before the prescription
- Clinical trials
- Formularies
- Drug information
- Clinical pharmacists have the potential to implement and influence drug-related policies, i.e., making decisions on which drugs deserve to be marketed, which drugs should be included in national and local formularies, which prescribing policies and treatment guidelines should be implemented.
- Clinical pharmacists are also actively involved in clinical trials at different levels: participating in ethical committees; study monitoring; dispensation and preparation of investigational drugs.
2. During the prescription
- Counselling activity
- Clinical pharmacists can influence the attitudes and priorities of prescribers in their choice of correct treatments.
- The clinical pharmacist monitors, detects and prevents harmful drug interaction, adverse reactions ad medication errors through evaluation of prescriptions' profiles.
- The clinical pharmacist pays special attention to the dosage of drugs which need therapeutic monitoring.
- Community pharmacists can also make prescription decisions directly, when over the counter drugs are counselled.
3. After the prescription
- Counselling
- Preparation of personalised formulation
- Drug use evaluation
- Outcome research
- Pharmacoeconomic studies
- After the prescription is written, clinical pharmacists play a key role in communicating and counselling patients.
- Pharmacists can improve patients' awareness of their treatments, monitor treatment response, check and improve patients' compliance with their medications.
- As members of a multidisciplinary team, clinical pharmacists also provide integrated care from 'hospital to community' and vice versa, assuring a continuity of information on risks and benefits of drug therapy.

Direct Patients Care
Clinical Pharmacy, patients are provided with direct care services optimizing the use of medication for health promotionand disease prevention. Clinical Pharmacy initially began in hospitals and clinics but now, clinical pharmacists administercare for patients in whatever health care setting. The clinical pharmacist's work is in collaboration with physicians, nurses and other healthcare personnel in various medical and surgical areas, making their profession an integral part of patient care
Clinical Pharmacy Care is direct health care and consultation provided by clinically trained pharmacists to patients and consumers about prescription and nonprescription drugs, and related products. Clinical Pharmacy Residents post-PharmD professionals training in general pharmacy practice and/or specialty areas, such as oncology and pediatrics. In the system ofhealth care, clinical pharmacists are experts in the therapeutic use of medications.


The Formulary

Description: 1. The Formulary is a listing of drugs, dosage forms, package sizes, and drug strengths stocked by the Hospital and ACC Pharmacies. It is published as a quick reference to assist the physician and nursing staffs.
The Formulary is divided into four general sections:
Therapeutic Index,
Drug Monographs,
General Reference Section.
2. The Therapeutic Index is a listing by pharmacological or therapeutic category of those drugs which are carried in one or more dosage forms, by the Pharmacy. The listing is alphabetical by generic name under each category. From the Therapeutic Index, the physician can determine if the desired drug is stocked in any form. If it is, she/he will then refer to the Drug Monographs Section for complete information.
3. The Drug Monographs Section is a straight alphabetical listing of both trade names and generic names. The trade name will be cross referenced to the generic name under which the complete information will be found. Each Complete monograph will contain the following information:
- Official, non-proprietary, or generic name.
- Trade Name: Common trade or proprietary names which refer to the generic drug. The listing of a trade name does not necessarily mean that it is stocked as such by the Pharmacy.
- Category: The American Hospital Formulary Service Reference System of Therapeutic Classification which relates to the information in the Therapeutic Section of the Formulary.
- Dosage Form: This lists all the dosage forms which are available in the Pharmacy.
4. The General Reference Section contains information and aids that are used in patient care. It contains dosing formula conversion tables for weight, measures and temperature, as well as guidelines for use of certain drugs as adopted by the P&T Committee.
• A hospital formulary is a comprehensive list of every drug and therapeutic agent stocked by the pharmacy of that hospital.
• A formulary includes a list of the drugs; monographs with information on each drug, such as uses, dosages and warnings; and a general reference section with information that might be helpful in treating patients.
• The purpose of the formulary is to prevent unnecessary spending to stock medications that differ only slightly from one another.
Who Decides
• A committee of the medical staff and pharmacists decides what drugs are included in the formulary. This committee typically meets once monthly.
Adding New Drugs
• A physician can request the addition of a drug. The drug is compared with similar agents present on the formulary in terms of effectiveness, side effects and cost.
Off-Formulary Drugs
If a necessary drug is not included on the formulary, it can be ordered from a neighboring hospital or pharmacy.

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