First Edition Dep. No. 4345/2015 Copyright © 2015, by Raslan, Mohamed & Elmowafy, Mohammed.

All rights reserved. This book is protected by copyright. No part of

this book may be reproduced or transmitted in any form or by any

means, electronic or mechanical including photocopy, recording, or

any information storage and retrieval system, without permission in

writing from the Publisher. To request permission please contact

Maktabet Aleman (16 Montasser street extension, Elmansoura,

Dakahleyia, Egypt). Printed in Arab Republic Of Egypt

1

Preface

This book is designed for early undergraduate pharmacy

students. It helps the pharmacists to get the pharmacy skills and

attitudes to become a member of health care teams getting the

benefits which they can provide through their professional input.

It also examines the challenges which pharmacists face and the

unlimited opportunities available to them to assume leading roles

in patient-focused and public health efforts.

This book was divided into ten chapters. Chapter 1

presents basic introduction to pharmacy which includes important

information about departments of pharmacy colleges and sciences

which the pharmacist will study and official organizations.

Chapter 2 exhibits sources of drug information and scientific

research in which the pharmacist knows how to acquire scientific

information. It also directs to how to perform scientific research.

Chapter 3 gives short description about available pharmaceutical

dosage forms, uses and routes of administration. Chapter 4 deals

pharmacy ethics. It also presents different functionalities of

pharmacist. Chapter 5 is concerning with modern pharmacy

practice and different roles of pharmacist. Chapter 6 depicts

pharmaceutical care and related cases. Chapter 7 exhibits

prescription types and the pharmacist should deal with. Chapter 8

contains different types of incompatibilities which may face the

pharmacist during prescription compounding and how to correct.

Chapter 9 defines most of important terms and explains their

scientific meanings. Chapter 10 exhibits Arabic brief description

about historical pharmacy overview.

Pharmaceutics is one of the fundamental bases of

pharmacy. Few, if any, other disciplines study the subject. In our

view, Knowledge of the pharmacy basics which we have put

down in this book is very important if pharmacists are to continue

to know about drugs and formulations and to contribute

something special to healthcare. We hope that this book will help

in preparing pharmacists and other healthcare interesting

practitioners.

Mohamed Raslan

Mohammed Elmowafy

2

Table of content

Title Page

Chapter One: Basic Introduction to

Pharmacy

3

Chapter Two: Sources of Drug Information

& Scientific Research

21

Chapter Three: Pharmaceutical Dosage

Forms

41

Chapter Four: Functions of Pharmacists

81

Chapter Five: Modern pharmacy practice

92

Chapter Six: Pharmaceutical Care

108

Chapter Seven: The prescription

126

Chapter Eight: Drug Incompatibilities

144

Chapter Nine: List of Pharmacy - Medical

Abbreviations &Terminology

161

List of English References

211

الفصل العاشر: تاريخ ومدخل الصيدلة

214

المراجع

238

3

Chapter One: Basic Introduction to Pharmacy

Modern Pharmacy orientation helps the pharmacists

to get the pharmacy skills and attitudes to become a

member of health care teams getting the benefits which

they can provide through their professional input. It also

examines the challenges which pharmacists face and the

unlimited opportunities available to them to assume

leading roles in patient-focused and public health

efforts.

Pharmacy:

The word pharmacy is derived from

the Greek word pharmakon,

meaning medicine or drug.

Pharmacy has been defined as the

art and science of preparing and

dispensing medicines and providing

of drugs and related information to

the public.

Pharmacy practice:

The traditional roles of the

profession of pharmacy focused on

drug services.

Pharmacy practice now focuses on

patient care services. The new

approach has been given the name

pharmaceutical care.

4

The most generally accepted definition of this new

approach is:

(Pharmaceutical care is the responsible provision of

drug therapy for the purpose of achieving definite

outcomes that improve a patient’s quality of life).

Pharmacist:

A pharmacist is one who is educated and licensed to

dispense drugs and provide drug information – He is an

expert on drugs.

The role of the pharmacist has changed over the past

two decades. The pharmacist is no longer just a supplier

of medicines, but also a team member involved in the

provision of health care whether in the hospital, the

community pharmacy, the laboratory, the industry or in

academic institutions. Pharmacist participates now other

healthcare professionals in patient care to promote

health prevent diseases.

The modern pharmacist:

The modern pharmacist is a seven-star pharmacist (this

concept was introduced by World Health Organization).

He has the following skills or functions which help him

to be an effective member in heath care team members:

1) Caregiver: The Pharmacist provides caring services

of the highest quality. The Pharmacist uses the

appropriate, efficacious, safe and cost-effective of

resources (e.g., personnel, medicines, chemicals,

equipment, procedures, and practices) and plays a role in

setting medicines policy.

5

2) Decision-maker: The pharmacist has the ability to

evaluate, synthesize data and information and decide the

most appropriate decision.

3) Communicator: The pharmacist provides a link

between prescriber and patient, and to communicate

information on health and medicines to the public.

4) Manager: The Pharmacist manages resources

(human, physical and financial) and information

effectively. The pharmacist also is comfortable being

managed by others, whether by an employer or the

manager/leader of a health care team.

5) Life-long-learner: As the pharmacy school does not

introduce all the knowledge and experience to pursue a

life-long career as a pharmacist, the pharmacist learns

skills and keeps them up to date throughout the

pharmacist’s career.

6) Teacher: The pharmacist assists with the education

and training of future generations of pharmacists and the

public.

7) Leader: In patient caring situations or in areas where

other health care providers are in short supply or non-

existent, the pharmacist has the vision and the ability to

lead.

Pharmacy technician: is an individual working in a

pharmacy that, under the supervision of a licensed

pharmacist, assists in pharmacy activities that do not

require the professional judgment of a pharmacist .

6

Regardless of practice setting, the pharmacy tech can

assist with workload.

Pharmacy education (governmental or private):

A) Undergraduate education: There are two

undergraduate degrees:

1) Bachelor degree in pharmaceutical science

(B.Pharm.):

It is an undergraduate academic degree in the field of

pharmacy requires as minimum 5 academic years. The

degree is the basic prerequisite for registration to

practice as a pharmacist in Egypt and some countries.

Areas of Undergraduate study include:

Pharmacognosy, organic chemistry, analytical

chemistry, pharmaceutical chemistry, biochemistry,

pharmaceutics, industrial pharmacy, clinical pharmacy,

microbiology, Pharmacology and toxicology.

2) The Doctor of Pharmacy degree (PharmD degree):

- It is a professional degree providing advanced

education in clinical pharmacy practice that prepares the

graduate to be a clinical pharmacist. It requires 6

academic years to complete the degree requirements.

- In USA, it is a first professional degree, and a

prerequisite for licensing to exercise the profession of

Pharmacist.

- In Egypt, The PharmD degree program at Helwan

University is a full-time 6-years course of study. In

7

Tanta and Alexandria Universities, PharmD degree

program is separated after the bachelor degree taken in

two years; the first year is theoretical bases and the

second year is the practical part (clinical rounds).

B) Postgraduate education:

A) Diplomas in: cosmetics; hospital pharmacy; clinical

pharmacy; drug design; quality control; medicinal

plants; biochemistry; pharmacology; microbiology; and

organic chemistry.

B) Master degree in pharmaceutical science (M.Sc.):

This requires a minimum of two years beside a one year

of general courses. The candidate fulfills his degree by

writing a thesis (both theoretical and practical) in the

specialized field.

C) Doctor in philosophy in pharmaceutical science

(Ph.D.): This requires a minimum standard of five years

during which the candidate should defend his thesis

(both theoretical and practical) in the specialized field.

Departments of faculty of pharmacy:

1) Clinical pharmacy: is a health science

discipline in which pharmacists provide patient

care that optimizes medication therapy and

promotes health, wellness, and disease prevention.

The mission of clinical pharmacy is to help people

get the best outcomes from medication therapies to

achieve a healthier society.

8

2) Pharmacology and toxicology:

Pharmacology (pharmakon, "drug" and logia "study of)

is the science of drugs including their composition, uses,

and effects. It involves examining the interactions of

chemical substances with living systems, with a view to

understanding the properties of drugs and their actions,

including the interaction s between drug molecules and

drug receptors and how these interactions elicit an

effect. Toxicology is the science of study the nature,

effects, and detection of poisons and the treatment of

poisoning.

3) Pharmacognosy: is the science that deals with the

study of drugs derived from natural sources. It involves

cultivation, collection, transportation, quality control

and preservation of plants. Photochemistry is the

science deals with studying of active ingredients,

pharmacological action, clinical effectiveness, quality

control of herbs and their products.

4) Organic Chemistry: is the science that deals with

the study of the structure, nomenclature, properties and

reactions of organic compounds and organic materials.

5) Analytical chemistry: is the science that deals with

the study of the separation, identification, and

quantification of the chemical components of natural

and artificial materials.

6) Pharmaceutical Chemistry (Medicinal chemistry): is the science that deals with design, development and

synthesis of raw materials, chemical agents and

analytical reagents, used in drug industry and final

products.

9

7) Biochemistry: is the science which enables the study

of living organisms not only on the cellular level but

also as to molecular and chemical composition. It

involves studying of the chemical compounds, reactions,

etc, occurring in living organisms and the processes that

occur in their metabolism and catabolism.

8) Microbiology: is the science of study microscopic

organisms. It deals with microscopic or ultramicroscopic

structure, actions of viable microorganisms (as bacteria,

virus, fungi and parasites), Infections, sterilization,

antimicrobials and immunology. Public health is the

science deals with all measures needed to protect the

health of community, which extends to infection

problems of pollution, wastes …etc.

9) Pharmaceutical technology: It includes:

a) Pharmaceutics: is the science of preparing medicines

or the science of dosage form design. It involves

studying of Physico-chemical characters of raw

materials (preformulation), formulation, quality control,

process validation and quality assurance of all

pharmaceutical drug delivery system.

Biopharmaceutics is the science dealing with

relationship between physicochemical properties of the

drug, dosage form, route of administration as related to

the bioavailability of the drug.

b) Industrial pharmacy: is the science of

manufacturing, development, marketing and distribution

of drug products including quality assurance of these

activities.

10

New trends in pharmacy education and research:

1) Pharmacogenomics: is the study of the role of

genetics in drug response.

2) Pharmacoepidemiology: is the study of the patterns

of drug effects, use and side effects in defined

populations.

3) Pharmacoeconomic: is study that evaluates the cost

and effects of a pharmaceutical product.

4) Molecular biology: is the study of the molecular

mechanisms by which genetic information encoded in

DNA is able to result in the biological process.

5) Pharmacovigilance: is the science relating to the

detection, assessment, monitoring, and prevention of

adverse effects with pharmaceutical products.

Pharmacy organizations:

A) International Organizations:

The role of international organizations:

1) Development of protocols and methodologies

(inter-country studies involving patient and

treatment outcomes).

2) Development and testing of guidelines.

3) Dissemination of materials.

4) Exchange of information and experiences.

5) Operational research for evaluation of changing

self-medication practices.

11

Examples of International organizations:

1) World Health Organization

(WHO):

It is the organization responsible for the

international public health. It aims to

improve people’s health outcomes and

increase healthy life. Its current priorities include:

a) Communicable diseases (that spreads from person to

person), in particular, HIV/AIDS, Ebola, malaria and

tuberculosis.

b) The mitigation of the effects of non-communicable

diseases (chronic diseases).

c) Sexual and reproductive health.

d) Development and aging.

e) Nutrition, food security and healthy eating.

f) Occupational health and substance abuse.

g) Drive the development of reporting, publications, and

networking.

2) Food and drug administration (FDA):

It is the organization responsible for

protecting the public health by

assuring the safety, efficacy, and

security of human and veterinary

drugs, biological products (vaccines,

blood and biologics), medical devices,

food, cosmetics, tobacco products and

radiation emitting products. The FDA

also provides accurate, science-based

health information to the public.

12

FDA's roles in drug services:

1) Emergency preparedness: Bioterrorism, drug

preparedness and natural disaster response.

2) Drug approvals and databases: Drug-related

databases from FDA; information on drug approvals.

3) Drug Safety and availability: Medication guides,

drug shortages, drug safety communications and other

safety announcements.

4) Development & approval process (Drugs):

Conducting clinical trials, types of drug applications,

forms and submissions requirements, labeling initiatives,

drug and biologic approval reports.

5) Science & research (Drugs): Research by FDA staff

to evaluate and enhance the safety of drug products.

FDA's roles in food services:

1) Recalls, outbreaks & emergencies: Food recalls,

safety alerts and advisories, outbreak investigations, and

keeping food safe in emergencies.

2) Food borne illness & contaminants: Preventing

food borne illness and info on pathogens, chemicals,

pesticides, natural toxins, and metals.

3) Ingredients, packaging & labeling: Information

about ingredients, additives, contact substances, GRAS,

allergens, and nutrition labeling.

4) Dietary supplements: Using dietary supplements

and FDA's role in regulating supplement products and

dietary ingredients.

5) Food defense: FDA's role in helping reduce the risk

of malicious, criminal, or terrorist actions on the food

supply.

6) Science & research (Food): Biotechnology,

laboratory methods and publications, research strategic

13

plan, and research areas such as risk assessment and

consumer behavior.

3) United Nation Division of Narcotic Drug

(UNDND):

It is the organization responsible for regulations

concerning the use and abuse of narcotic drugs.

B) National Organizations:

The role of national organizations:

1) Adaptation of self-medication protocols, reference

materials and training activities to meet local

needs.

2) Implementation of training and support activities

for organization members.

3) Participation in curriculum development for

training of pharmacists.

4) Encouraging members to participate in teaching in

academic and practice settings.

5) Providing input for self-care and self-medication

policies established by governments and policy-

makers.

6) Collaboration with pharmacy students and recent

graduates regarding research aspects of self-care

and self-medication.

Examples for national Egyptian organizations:

1) Syndicate of the pharmacists:

Responsible for pharmacy profession

in Egypt.

14

2) Egyptian Pharmaceutical Society:

The main function of this society is educational. It issues

a scientific journal in pharmacy, hold conferences for

pharmacists every two years and responsible for

continuing education.

3) Egyptian Society of Hospital Pharmacists:

concerns with all aspects of hospital and clinical

pharmacists.

4) National Pharmacopeial Committee: Responsible

for reviewing & updating the Egyptian pharmacopoeia.

Examples for national USA organizations:

1) American Pharmacists Association (APhA):

The APhA is the national professional organization of

pharmacists representing pharmacy practitioners, and

pharmaceutical scientists and students. Since its

founding in 1852, the APhA has been a leader in the

professional and scientific advancement of pharmacy.

2) American Society of Health-System Pharmacists

(ASHP):

The ASHP is the professional association of pharmacists

who practice in organized healthcare settings. The

mission of the ASHP is to enable pharmacists to provide

high-quality pharmaceutical services that foster the

efficacy, safety, and cost-effectiveness of drug use;

contribute to programs and services that emphasize the

health needs of the public and the prevention of disease;

15

and promote pharmacy as an essential component of the

healthcare team.

3) American Society of Consultant Pharmacists

(ASCP):

The ASCP promotes the development and advancement

of pharmaceutical care activities directed at elderly

patients, particularly those in long-term care institutions.

4) American Association of Pharmaceutical Scientists

(AAPS):

The AAPS serves an advocacy role for the

pharmaceutical sciences, promotes the economic

viability of the pharmaceutical sciences and its

scientists, and represents scientific interests within

academia, industry, government, and other research

institutions.

5) American College of Clinical Pharmacists

(ACCP(:

The ACCP is a professional and scientific society that

provides leadership, education, advocacy, and resources,

enabling clinical pharmacists to achieve excellence in

practice and research.

16

Basic introduction to drug:

A drug (active ingredient) is defined as an agent

that has a pharmacological effect, used to prevent,

treat, cure, diagnose, or mitigate human diseases.

Origin: New drugs may be discovered from

natural sources (plant or animal) or synthesized in

the laboratory. After the isolation and structural

identification of naturally derived drugs, organic

chemists may recreate them by total synthesis in

the laboratory or, more importantly, use the natural

chemical as the starting material in the creation of

slightly different chemical structures through

molecular manipulation. The new structures,

termed semisynthetic drugs, may have a slightly or

different pharmacologic activity from that of the

starting substance, depending on the nature and

extent of chemical alteration.

Nomenclature: Every drug has three names:

1) Chemical name: It is based on the compound's

chemical structure. The chemical name is useful

to chemists, but is too confusing for most other

people.

2) Generic name: It is a name that listed in the

official compendia. An example of a generic name

is acetaminophen.

3) Brand name: It is a name given to the generic

entity by the company that manufactures it. The

brand name is proprietary, and no one but the

company who registered it as a Trademark

(denoted by the symbol ®) can use it.

17

E.g. an analgesic compound has the following

chemical structure:

O

HO - - NH – C – CH3

Chemical name is: N-acetyl-Para-aminophenol.

Generic name:

In British pharmacopoeia (B.P.1998); it is named

Paracetamol.

In United States pharmacopoeia (USP XXII) it is

named acetaminophen.

Trade name:

The drug has many names according to the

manufacture:

Abimol (Glaxo), Paramol (Misr), Pyral (Kahira)

and Cetal (Eipico).

Features of an ideal drug:

1) Produces the specifically desired effect,

2) Can be administered by the most desired route

(generally orally) at minimal dosage and dosing

frequency.

3) Have optimal onset and duration of activity.

4) Exhibits no side effect.

6) Following its desired effect would be eliminated

from the body efficiently, completely, and without

residual effect.

6) Easily produced at low cost.

7) Pharmaceutically elegant, and physically and

chemically stable in various conditions of use and

storage.

18

Uses of drug:

1) Most drugs are used to cure a disease or

condition. For example, antibiotics are given to

cure an infection.

2) Drugs are also given to treat a medical

condition. For example, anti-depressants are given

to treat depression.

3) Drugs are also given to relieve symptoms of an

illness. For example, analgesics are given to

reduce pain.

4) Drugs are given to prevent diseases. For

example, the Flu Vaccine helps to prevent the

person from complications of having the flu.

Drug effects: A drug may have several types of effects

on the human body:

1) Desired Effect (Therapeutic effect): This means

that the drug is doing what it is supposed to.

2) Side Effects: are the symptoms that result from a

normal dose of a drug. For example, some blood

pressure drugs, because of the way that they act on the

heart, can cause the person to feel tired. Other drugs can

cause side effects such as dry mouth, stomach upset or

headache.

3) An adverse effect may be related to an increased

dosage of a drug or when a drug accumulates in the

body, causing toxicity. For example, some seizure

medications and some psychiatric medications require

monitoring for adverse physical symptoms and

monitoring through blood tests to make sure that the

level of drug in the body is not toxic. Severe allergic

19

reactions to drugs can occur, sometimes called

“anaphylactic reactions” or “anaphylaxis,” and can be

life-threatening.

4) Tolerance: This occurs when, over time or with

repeated dosages, the individual's response to the drug is

decreased. Tolerance is good when it means that the

body has adapted to the minor side effects of the drugs.

Tolerance can be a problem if it makes the drug less

effective so that a higher dose of the drug is needed.

5) Dependence: This occurs when an individual

develops a physical or psychological need for a drug.

For example: People who take laxatives for a long time

can become physically dependent on the laxatives in

order to have a bowel movement because the body loses

the ability to work without it.

6) Interactions: This occurs between drugs or between

drugs and food.

7) No Apparent Effect: This occurs when the drug is

not working because the individual's symptoms have not

improved.

8) Paradoxical Effect: This occurs when the drugs

work in an opposite way. For example: Benadryl

usually causes a person to become tired or drowsy. An

example of a paradoxical effect to Benadryl might be

that the individual becomes hyperactive or agitated.

20

Drug combinations:

a) Synergistic combination: When certain drugs are

prescribed together, the combined action produced is

greater than the summation of the individual effect such

as aspirin and phenacetine. Sometimes two or more

drugs of the same therapeutic effect may be given

together and in such a case each drug must be given in a

reduced dose while the total dose is similar to that of any

individual. The combined drugs must not be

contraindicated or interacted with each other.

b) Antagonist combination: in which two or more

drugs are given together can reduce or cancel out the

effect of one or more medications.

21

Chapter Two: Sources of Drug Information &

Scientific Research

Sources of drug information:

1) Primary literatures: are original materials

which are presented by the author or authors

without interpretation, condensation, or evaluation

by a second party.

For examples, journals, Thesis and Conference

proceedings.

Scientific journals: is the channel through which

scientific research is reported, evaluated and

published.

Procedure for publication in the scientific

journals:

a) As researchers finish a study, they write:

1) Abstract (summary).

2) Introduction.

3) Description of methodology used and results.

4) Discussion of what the results mean.

5) List of references.

b) Authors then submit finished article to a

journal.

c) Journal editors send manuscript to be reviewed

by researchers in the same field.

22

d) Manuscript that meets criteria of good research

is accepted for publication & is published in

journal.

e) Lately scientific journals have been produced in

electronic form & in print.

f) Authors can also submit their manuscript on-

line.

Examples of Scientific journals:

- Journal of Pharmaceutical Sciences.

- International Journal of Pharmaceutics.

- Pharmaceutical Research.

- Journal of Pharmacy and Pharmacology.

- Journal of Drug Development &Industrial

pharmacy.

2) Secondary literatures: are derived from 1ry

sources which has been modified, selected,

rearranged or discussed usually by someone other

than the original author. For examples;

a) Review article: summarize the research has

been published. They are found in scholarly

journals and in special book collections with titles

that begin Annual Review of …., Progress in ….

or something similar. Review articles in both

journals and books can be found by using online or

print indexes.

b) Abstracts: are summaries of a scientific article,

text, document, etc.

23

3) Special information sources: are derived from

either or both the primary or second sources. For

examples; Pharmacopoeias, Formularies, Drug

compendia and textbooks.

a) Textbooks: are those books that have been

known by author (s) names who first wrote them.

For example: Remington (The Science & Practice

of pharmacy).

b) Pharmacopoeia: is derived from Greek word

(Pharmakon) means drug and (Poiea) means to

make. It is a book contains official standards for

purity, strength, quality and analysis of drugs. It is

a legal book issued or authorized by governments

or international agencies. In the US the national

pharmacopeia has been published by private

organizations. For example: United States

pharmacopeia (USP.), British Pharmacopoeia

(B.P.) and European Pharmacopoeia (E.P.).

c) Formulary: In the past, formularies were recipe

books for making drugs, but now they are usually

lists of drugs approved for use by a special

hospital, health plan, or government. For

example: British National Formulary (BNF) and

Egyptian national formulary (ENF).

d) US Drug Compendia: For concise information

on the therapeutic use of drugs (including dosage,

contraindications, adverse effects and pharmaco-

kinetics), there are a variety of drug compendia,

probably the best known one is Physicians’ Desk

Reference (PDR). Most developed countries have

at least one drug compendium with information

24

about the drugs available there. For example: the

CPS: Compendium of Pharmaceutical Specialties

(Canada).

Martindale: is one of the permanent international

drug compendia. It is a compendium of

therapeutic and other information on drugs and

medicines from around the world. Martindale also

includes lists of products and manufacturers,

making it an invaluable reference for identifying

foreign drugs.

Scientific research:

Definition: performing a methodical study in order to

prove a hypothesis or answer a specific question.

The scientific method: is a tool that helps scientists

and the rest of us to solve problems and determine

answers to questions in a logical format.

Steps of the Scientific method:

1) Identify a Problem/Question. Develop a question

or problem that can be solved through experimentation.

2) Research the problem: Make research on your topic

of interest.

3) Formulate a Hypothesis: Predict a possible answer

to the problem or question.

4) Conduct an experiment: Design an experiment to

answer hypothesis question. The experiment should

enable retesting for verification of results.

25

5) Collect and Analyze Results: using tables, graphs,

and photographs, confirm the results by retesting and

analyze results for assessment their validity i.e. support

or refuse your hypothesis.

6) Conclusion: Include a statement that accepts or

rejects the hypothesis. Make recommendations for

further study and possible improvements to the

procedure.

7) Communicate the Results: Be prepared to present

the project to an audience. Expect questions from the

audience.

26

For example:

1) Identify a problem you're faced with the problem

of not being able to read because your pen torch doesn't

work, and you're not happy about it.

2) Research the problem you think back to the last

time your pen torch didn't work, and you remember that

it was because of worn-out batteries.

3) Formulate a hypothesis You guess that worn-out

batteries are the reason your pen torch isn't working.

4) Conduct an experiment now, so you get some

new batteries from the drawer next to your bed and

replace the ones in your pen torch.

5) Collect results Oh! Your pen torch works.

6) Conclusion Accepted hypothesis.

Research ethics:

The term “research ethics” is defined as follows:

“Research ethics involves the application of

fundamental ethical principles to a variety of topics

involving scientific research.

Ethics principles in the scientific research:

1) Principle of honesty: reported data, methods, and

procedures, results and publication status must be

truthful and accurate i.e. without fabrication,

falsification or plagiarism of data.

2) Principle of objectivity: researchers are obligated to

avoid or to minimize errors in all scientific actions:

experimental design, results interpretation, grants

writing, action as expert or referee, etc.

27

3) Principle of integrity: “keep your promises and

agreements; act with sincerity; strive for consistency of

thought and action”.

4) Principle of carefulness: decisions dealing with the

researcher’s work and that of others have to be assessed

completely, carefully, and fairly; results should be

validated through replication.

5) Principle of openness: methods, data, results and

their interpretations should be presented and published,

thus submitted to criticism.

6) Principle of responsibility: researchers are obligated

to make efforts to ensure that their research does not

duplicate research carried out by other researchers, thus

to give evidence of their professional responsibility. All

authors bear full responsibility for the research process

and the result publication; a special social responsibility

(promotion of social good and other moral duties to

society) and proper respect in conducting research on

human subjects and animals are rested with the

researchers.

28

Sources of Scientific search:

a) Online databases: - It is the first choice for locating pharmaceutical

literature because of their convenience.

- For clinical literature, the databases of choice are

MEDLINE, EMBASE, evidence-based medicine

databases, The Iowa Drug Information Service (IDIS),

and international pharmaceutical abstracts.

- For drug development, Chemical abstracts and

BIOSIS previews are the most comprehensive.

- Each of these is available in print, through the World

Wide Web (''The web'').

1) MEDLINE:

It is produced by the US National Library of

Medicine (Bethesda, MD). It coverage of 4600

highly regarded clinical journals makes it the

preeminent biomedical database. It is subsidized

by US government which one search engine,

PubMed, available at no cost all over the world.

The resulting low or no cost to its users means that

it is the first choice for those seeking medical

information. Its coverage is strongest in clinical &

therapeutic topic. PubMed (http://pubmed.gov),

the MEDLINE search engine provided free to the

world over the internet by the National Library of

Medicine.

29

30

2) EMBASE:

It is another highly regarded medical database

produced & provided by Elsevier, (Amsterdam). It

is stronger in drug information & in areas of

biological science related to human medicine.

EMBASE covers European literature in much

more depth than does MEDLINE. EMBASE is

available through online vendors such as Dialog

and Ovid and through the web. A recent product

EMBASE.com includes not only EMBASE but

also unique MEDLINE records.

31

3) Evidence-Based Medicine (EBM) databases: In both PubMed and Ovid, MEDLINE searchers

can be limited to randomized controlled trials

(RCT's). However, strong proponents of EMB feel

that only RCT's that meet vigorous standards of

methodology should be used. They prefer

'systematic reviews': reviews in which all RCT's

on a particular topic are collected and analyzed, a

meta-analysis is performed (if possible) and that

evidence is then used to come to a clinical

decision. The Cochrane library, the best known

such collection, is a volunteer effort begun in

Great Britain. International team donate their time

to identify all published and nonpublished RCT's

on a particular topic and then to prepare a

systematic review with implications for practice.

Abstracts systematic reviews are available free on

the internet. The reviews themselves may be

purchased from Cochrane library organization or

searched through subscription to Ovid, Dialogue,

32

and other vendors. A major drawback for

Cochrane library is the amount of time it takes for

volunteers to complete their projects.

4) Iowa Drug Information System (IDIS):

It is produced by the college of pharmacy of

university of Iowa. It allows the user to search for

drug therapy articles selected from 200 clinical

journals and to access the full text one the article.

Access is provided on the web, by CD-ROM, or on

microfiche. This product is useful for drug

information centers that may not otherwise be able

to access a large collection of scientific journals.

5) International Pharmaceutical Abstracts

(IPA):

It is produced by the American Society of Health-

System Pharmacists (ASHP) and covers 850

pharmacy periodicals. It is a small database but it

covers publications not indexed in other databases

as; pharmacy trade magazines, state pharmacy

journal and abstracts of pharmacy-related

associations IPA is the best to use to find large

number of articles on articles on pharmacy

administration, drug laws & legislation and

Pharmacy ethics. Ovid, Dialogue, and the

American Society of Health-System Pharmacists

make IPA available through the web and on CD-

ROM. Links from IPA to the indexed full text

articles are not available as of this writing.

33

6) Chemical Abstracts:

It is produced by the American Chemical Society's

Chemical Abstracts (CAS). It is the world’s largest

scientific database contains 14 million abstracts. It

is most important database in drug development.

Vendors of Chemical Abstracts include Ovid,

Dialogue and STN. Some subsets of the database

are available on CD-ROM. There are a links from

a Chemical Abstracts search to full text articles

available one the web, but to access them the

searcher must subscribe to the journal that contains

the article.

34

35

7) BIOSIS PREVIEWS:

It is produced by BIOSIS (Philadelphia, PA). It is

covers literature of life sciences, including pre-

clinical toxicity & carcinogenicity studies.

Vendors include, BIOSIS, Ovid, Dialogue and

STN. Ovid provides links to full text article.

8) Electronic mail and discussion groups: Electronic mail (e-mail) is very commonly used.

E-mail allows the pharmacist to communicate

quickly with patient, physicians & colleagues

around the world several e-mail discussion groups

or mailing lists have developed for the

pharmacists. These forums allow groups

pharmacists with common interests or specialties

to share information and idea. The mailing list’s

software allows a user to subscribe to a discussion

36

group and post messages to a central address.

These messages are then automatically distributed

to all of the subscribers to the list. Mailing lists

exist for students, members of professional

organization & individuals interested in specific

topics such as natural products & toxicology.

9) The World Wide Web (WWW):

WWW is the fastest growing component of the

internet. Information is presented in pages that

contain hyperlinks, electronic links to other web

pages. Every web page has an individual URL

(uniform resource locator), which is the page’s

address for retrieval. The pages are retrieved and

displayed by browser software such as Netscape

Navigator and Microsoft Internet Explorer

10) Search engines & search directories:

They allow users to search for web sites, e-mail

address & message in public mailing list archives.

They are useful when the searcher does not know

the title of a particular web site. The most search

engines employ natural language searching-users

simply ask their questions in a search box:" what

are the adverse effects of smoking?”

• Yahoo (http//www.yahoo.com/)

• Google (http//www.google.com/)

b) Printed index.

c) Bibliography:

There are thousands of scientific journals

published worldwide. They are not very long ago,

researcher needed; standard bibliography, printed

indexes & abstracts. They are found only in

library.

37

Useful websites (up to date, 2015)

1) International organizations, associations, agencies, societies

Website Meaning abbreviation http://www.cioms.ch/

Council for International Organizations of

Medical Science

CIOMS

http://www.diahome.org

Drug Information Association

DIA

http://www.ema.europa.e

u/ema/

European Medicines Agency

EMA

http://www.fda.gov/

Food and Drug Administration

FDA

http://www.hma.eu/

Heads of Medicines Agencies

HMA

http://www.ICH.org/

International Conference on Harmonization

ICH

http://ifapp.org/About-

ifapp

International Federation of Associations of

Pharmaceutical Physicians

IFAPP

http://www.iso.org/iso/ho

me.html

International Organization for Standardization

ISO

http://www.oecd.org/ Organization for Economic Co-Operation and

Development

OECD

www.raps.org

Regulatory Affairs Professionals Society

Europe

RAPS

http://www.who.int/

World Health Organization

WHO

www.acrpnet.org

Association of Clinical Research Professionals ACRP

http://www.ecpm.ch/

European Center of Pharmaceutical Medicine

ECPM

38

2) Medical websites, dictionaries, codes and other science oriented web sites:

MediLexicon contains medical searches,

news and resources for medical,

pharmaceutical and healthcare

professionals. The following medical

searches, medical dictionary listings, and

resources are available for use within this

website.

http://www.medilexicon.com/

Autoimmune diseases; website

maintained by a group of leading genetic

researchers who have joined efforts to

identify and understand the genes that

autoimmune diseases have in common;

http://www.madgc.org

Classification of diseases (ICD); website

of DIMDI (Deutsches Institute fur

Medizinische Documentation und

Information) with access to the

International Classification of Diseases

ICD-10 (in German) and all older

versions of the ICD (downloadable);

http://www.dimdi.de/static/de/index.html

The Cochrane Collaboration, an

international not-for-profit organization,

providing up-to-date information about

the effects of health care;

http://www.cochrane.org

Dictionary; 13,090,565 words in 1100

dictionaries indexed, including special

medical terms, glossary of oncology

terms, etc.

http://afen.onelook.com

Dictionary with definitions, thesaurus

entries, spelling, pronunciation, and

etymology results; one can browse the

English dictionary alphabetically or by

related terms to find meanings and

synonyms. In addition, Your Dictionary

provides resources to find the best

dictionary and translation sites for

French, Spanish, Italian, German and

hundreds of other languages; about every

language on the world can be found here,

from Bengali to Lithuanian; the site

http://www.yourdictionary.com

39

includes both language and specialized

dictionaries (medicine, law etc.) and 96

grammars;

Medical Dictionary providing

explanations of various medical terms

and diseases.

http://www.yourdictionary.com/

Dictionary of Cancer Terms; contains

more than 4,000 terms related to cancer

and medicine

http://www.cancer.gov/dictionary/

Merck Manual; searchable access to The

Merck Manual with a lot of information

such as normal laboratory values,

disease,

http://www.merck.com/mrkshared/mmanual/

Medicinal products; a very complete

searchable cross-index of almost 5,000

US prescription products, OTCs and

nurtraceuticals; permits fuzzy search for

generic or brand name drug but also for

NDC code search and medical

abbreviations.

http://rxlist.com

Microbiology; information on many

aspects of microbiology incl. bacterial

genera

http://www.rxlist.com/script/main/hp.asp

OECD, Organization for Economic Co-

operation and Development

http://www.oecd.org/

Periodic table – chart of all chemical

elements;

http://www.lenntech.com/periodic-chart.htm

P450 Drug Interactions table;

http://medicine.iupui.edu/clinpharm/ddis/

Website of the National Organization for

Rare Disorders (NORD) with

information on 1,150 diseases that can be

accessed in a free or subscription

version;

http://www.rarediseases.org

40

3) Important guidelines:

http://www.gpo.gov/fdsys/browse/collect

ionCfr.action?collectionCode=CFR

– Code of Federal Regulations

http://www.wma.net/en/30publications/1

0policies/b3 / – WMA Declaration of Helsinki - Ethical

Principles for Medical Research Involving

Human Subjects:

http://ctep.cancer.gov/reporting/ctc.html

– Common Terminology Criteria for Adverse

Events (CTCAE):

http://www.fda.gov/Drugs/Development

ApprovalProcess/DevelopmentResources

/DrugInteractionsLabeling/ucm080499.ht

m

– Drug Development and Drug Interactions:

https://www.tga.gov.au/publication/com

mon-technical-document-ctd – Common Technical Document:

41

Chapter Three: Pharmaceutical Dosage Forms

Dosage form is the mean by which drug is

delivered to the site of action within body. It

determines the physical form of the final

pharmaceutical preparation.

Conversion of a drug into Medicine:

Drug + Excipients (additives) Dosage form

Packaging and Labeling in the manufacture

Pharmaceutical product provided to the

patient Medicine.

Excipients: are pharmaceutical inert ingredients;

they are used as

1) Corrective: to qualify the drug as coloring,

sweating, flavoring, disintegrating, lubricating,

stabilizing, agents, etc.

2) Vehicle (diluent, bulking agent): to bulk up

(dilute) the drug to the dosage form. It is may be;

- Solid solid dosage forms (e.g. tablets and

capsules).

-Liquid liquid dosage forms (e.g. solutions,

suspensions and emulsions).

- Ointment, gelling and emulsion bases

Semisolid dosage forms (e.g. ointments, gels and

creams).

- Fatty bases as cocoa-butter or gelatoglycerin

bases Moulded dosage forms (e.g.

suppositories).

42

The need for dosage forms:

1) Protection from the destructive influences of

atmospheric oxygen or humidity and gastric juice.

2) Masking the bitter, salty, or offensive taste or

odor of a drug substance.

3) To provide for placement of drugs directly in

the bloodstream (injections) and into one of the

body’s orifices (rectal or vaginal suppositories).

4) To provide topical applications (ointments,

creams, transdermal patches, and ophthalmic, ear,

and nasal preparations).

5) To provide liquid dose forms (solutions,

suspensions, emulsions and colloids)

6) To control the drug action providing either fast,

intermediate, and or sustained drug actions.

Pharmaceutical preparation (PP): is a packed

and labeled dosage form. There are two major

types of PP according the origin:

1) Manufactured in large scales by pharmaceutical

industry.

2) Compounded individually by compounding

pharmacists.

Medicine: When PP is dispensed to patient, it is

called medicine.

Classification of Medicines: There are two broad legal

classifications of medicines:

1) Prescription medicines: Are those that you can get

only by prescription.

2) Nonprescription or over-the-counter (OTC)

medicines: Are those that you can typically get at the

pharmacy without a prescription or medication order.

43

Classification of dosage forms (DF):

1) According to physical form:

A. Liquid Dosage Forms:

1. Solutions.

2. Suspensions.

3. Emulsions.

B. Semisolid Dosage Forms:

1. Creams.

2. Ointments.

3. Gels.

4. Pastes.

C. Solid Dosage Forms:

1. Tablets (Different types and shapes).

2. Capsules (Hard and Soft).

3. Powder and granules.

D. Moulded Solid Dosage Forms:

1. Suppositories.

2. Pessaries.

E. Sterile Dosage Forms:

1. Injectables.

2. Ophthalmics.

3. Inhalations.

4. Otic preparations.

44

2) According to route of administration:

Route of administration Dosage forms

Oral: taken by mouth Liquid and solid dosage

forms

Parenteral (taken by injection)

Intravenous (I.V.): into the vein.

Intramuscular (I.M.): into the

muscle.

Subcutaneous: under the skin.

Liquid dosage forms

Topical : applied on the skin Semisolid dosage forms

Rectal: taken through rectum Moulded dosage forms

and enemas

A) Liquid dosage forms:

1) Suspensions: are liquid preparations for oral

use containing one or more active ingredients

suspended in a suitable solvent. It may be oral,

topical, Otic, or ophthalmic.

45

2) Emulsions: are two phase-system (2 immiscible

liquids) in which one liquid is dispersed

throughout the other liquid in the form of small

particles using an emulsifying agent.

3) Solutions: are homogenous clear liquid

preparations for oral use containing one or more

active ingredients dissolved in a suitable solvent or

mixture of miscible solvents.

46

Classification of solutions:

A) According to route of administration: Oral,

topical, otic, vaginal, rectal, parenteral, nasal and ocular

solutions.

B) According to the solvent used:

1) Aqueous solutions the solvent used is water

E.g. aromatic water, syrup, douche, gargle, mouthwash,

otic drop, eye drop, spray and Injectable solution.

2) Non aqueous solutions the solvent used is:

alcohol – propylene glycol –glycerin – oils e.g.

Elixir, spirit, tincture, glycerite, collodion, liniment and

oleo vitamin.

Examples of aqueous solution preparations:

1- Aromatic water: a clear, saturated aqueous

solution of one or more volatile oils or other

aromatic or volatile substances. It is used mainly

as flavored vehicle.

47

2- Syrup: a concentrated aqueous solution of a

sugar, usually sucrose. It may be medicated

(contains drug) or non-medicated (used as

sweetened vehicle).

3- Douche: Aqueous solution intended for

cleansing of the vagina. It is introduced into vagina

by using bulb syringe.

48

4- Enema: Aqueous solution (rectal injection) that

is introduced into the rectum for either; local

purposes (evacuation enema), e.g., to cleanse the

bowel, systemic purposes (retention enema), e.g.,

nutritive, sedative and antiemetic enemas and

diagnostic purposes (diagnostic enema).

Evacuation enema Retention enema

5- Gargle: Aqueous

solution frequently

containing antiseptics or

antibiotics, used in the

prevention or treatment of

throat Infections.

6- Mouthwash: Aqueous

solution similar to gargle but

are used for oral hygiene (e.g.

to reduce plaque or bad

breath). It can be also used to

treat infections of the mouth

e.g. gingivitis.

49

7- Spray: Aqueous solution of drug (s) that breaks

up into small droplets by means of atomizer nozzle

or valve, applied topically or to the

nasopharyngeal tract (the nose and throat). Spray

may contain antibiotics, antihistamines and

vasoconstrictors.

8-Nasal drop: Solution of drugs designed to be

applied to the nasal mucosa in a small volume. It

formulated to be buffered and isotonic with the

nasal secretions (to minimize the damage of the

nasal cilia).Examples for sprays: Nasal sprays,

anti-burns sprays, antibiotic sprays, skin protectant

sprays, antiseptic sprays, local anesthetic sprays,

antifungal sprays, deodorant sprays, etc.

50

9- Ear drop: Solution of drugs

designed to exert a local effect in

the ear, to soften wax, to treat

local inflammation and infections,

to relief pain.

Examples of non-aqueous solution

preparations:

1- Elixir: is clear, pleasantly,

flavored hydroalcoholic

solution (water and ethanol)

intended for oral use. It is

used mainly as flavored

vehicle.

51

2- Spirit: is alcoholic or hydroalcoholic solution

of volatile substances. Some spirits serve as

flavoring agents while others have medicinal

value. Spirits should be stored in tight, light-

resistant containers and in a cool place, to prevent

evaporation of alcohol & volatile drugs.

3- Linctuses: are viscous, liquid oral preparations

that are usually prescribed for the relief of cough.

They usually contain a high proportion of syrup

and glycerol which have a demulcent effect on the

membranes of the throat. The dose volume is small

(5ml) and, to prolong the demulcent action, they

should be taken undiluted.

52

4- Glycerins or glycerites 5- Tinctures

Are viscous solutions or

mixtures of medicinal

substances in not less

than 50% by weight of

glycerin (so have jelly-

like consistency).

Alcoholic or

hydroalcoholic solutions of

either pure chemical

substances or of plant

extractions (prepared by

extraction of active

constituents from crude

drugs).Most chemical

tinctures are applied

topically, e.g., iodine

tincture.

6- Oleo vitamins: are non

aqueous solutions of the

indicated fat soluble vitamins

(usually vitamins A and D) in

fish liver oil or edible

vegetable oil.

53

7- Collodion: Highly volatile non aqueous

solution composed of pyroxylin (nito cellulose)

dissolved in a 3:1 mixture of ether and ethanol.

When applied to the skin with a fine camel's hair

brush or glass applicator, the solvent rapidly

evaporates, leaving a thin film of pyroxylin

providing a protective coating on the skin or holds

the edges of incised wound together. When

collodion is medicated, it leaves a thin layer of

medication.

- Salicylic acid collodion is a 10 % solution of

salicylic acid in flexible collodion and used as

Keratolytic in the removal of corns and warts.

B. Semisolid Dosage Forms:

They are include; creams, ointments, gels and

pastes. They are administered topically, nasally,

rectally, vaginally and via ophthalmic route except

pastes which are administered only topically.

1- Creams: are semisolid preparations prepared by

dispersion of the active ingredient (s) in the

suitable emulsion bases (oil in water or water in oil

54

emulsion bases). They are applied topically to the

skin, eye and vagina.

2- Ointments: are semisolid greasy

preparations prepared by levitation

of the active ingredient (s) with the

suitable ointment bases (for

example, Vaseline). They are

applied topically to the skin, eye

and nose.

3- Gels (sometimes called Jellies):

are semisolid transparent non-

greasy preparations prepared by

dispersion of liquid phase within

natural or polymeric a 3D cross

linked matrix called gelling agent

(for example, natural gum and

cellulose derivatives). They are

applied topically to the skin and the

mucous membrane of the mouse.

4- Pastes: are stiff and sticky

semisolid preparations prepared by

levitation of high concentration (> 2

55

5%) of the active ingredient (s) with the suitable

bases (mostly oleaginous bases, i.e., hydrocarbon

bases). They are applied topically to the skin.

Common topical dosage forms:

1- Lotions: are liquid p reparations

(solutions, suspensions and emulsions)

for external application without friction.

They are either dabbed on the skin or

applied on a suitable dressing and used

generally to provide cooling, soothing

and protective action.

2- Liniments: are liquid preparations

(alcoholic or oily solutions or

emulsions). Liniments are of a similar

viscosity to lotions (being significantly

less viscous than an ointment or cream)

but unlike a lotion a liniment is applied

with friction (counter-irritant relieve

pain). Some are applied on a warm

dressing or with a brush (analgesic and

soothing types).

3- Paints: are either topical

liquid paints contains a volatile

solvent that evaporates quickly

to leave dry resinous films of

medicament or throat paints

which are liquid viscous paints

due to a high content of

glycerol designed to prolong

contact of the medicament.

56

4- Poultices: are paste-like

preparations used externally to

reduce pain and inflammation.

After heating, the preparation is

spread thickly on a dressing and

applied to the affected area.

5- Transdermal patch or skin

patch: is a medicated adhesive

patch that is placed on the skin

to deliver a specific dose of

medication through the skin and

into the bloodstream. An

advantage of a transdermal drug

delivery route over other types

such as oral, topical, etc is that it

provides a controlled release of

the medicament into the patient.

6- Plasters: solid or semisolid

adhesive masses spread across a

suitable backing material and

intended for external application to a

part of the body for protection or for

the medicinal benefit of added

agents.

C. Solid dosage forms:

1- Tablets: are solid dosage forms prepared by the

compression (using tablet machine) or molding the

active ingredients with the aid of suitable

excipients. They may vary in size, weight and

shape (round, oval, triangular, etc.), hardness,

57

thickness depending on their use and method of

manufacture. They release the drug fast,

intermediate, or sustained depending on the

excipients used.

Tablet shapes

Tablet mould

Tablet machine

58

Tablet excipients:

1) Binders, glidants (flow aids) and lubricants to

ensure efficient tableting.

2) Disintegrants to ensure that the tablet breaks up

in the digestive tract.

3) Sweeteners or flavors to mask the taste of bad-

tasting active ingredients.

4) Pigments to make uncoated tablets visually

attractive.

Types of tablets: The majority of tablets are

used by swallowing, other tablets are:

Buccal tablets: intended to be placed between the

gum and the cheek to be absorbed through

Sublingual tablets: Intended to be placed under

the tongue to be absorbed through oral mucosa.

59

Effervescent tablets: intended to be dissolved in

water before use. They are prepared by

compressing granular effervescent salts that

release gas when in contact with water.

Chewable tablets: Intended to be chewed.

Vaginal tablets: Introduced to

vagina

2- Capsules: are solid dosage forms in which the

drugs and or/ excipients are enclosed within a

small shell, mostly from gelatin. Gelatin shells

may be hard or soft depending on their

composition.

Types of capsules:

a) Hard gelatin capsules are used

usually to encapsulate the solid

medicaments and consist of body

and cap which fits together after

filling. The empty capsule shell is

made from a mixture of gelatin,

sugar and water.

60

b) Soft gelatin capsules are used

usually to encapsulate liquids and

suspensions and consist of one piece

which sealed after filling. The empty

capsule shell is made from a mixture

of gelatin, glycerin to render the

gelatin elastic, preservative, colorant

and opaquant.

3- Powders: are mixtures of dry finely

divided drugs and or excipients intended

to be use internally or externally.

4- Granules: are dry aggregates of

irregular shape (may be prepared

spherical) of fine powder particles

contain one or more drugs with or

without other excipients. Granules are

often supplied in single-dose sachets.

Granules can be compressed then into

small round tablets and enclose with hard gelatin

capsule.

5- Lozenges: are solid preparations

intended to dissolve slowly in the

mouse to exert local or systemic effects.

They contain mainly of sugar and gum

(giving strength and cohesiveness to the

lozenge and facilitating slow release of

the medicament).

6- Pastilles: are solid medicated

preparations intended to dissolve in

the mouth. They are softer than

lozenges and their bases are glycerol,

gelatin, or acacia and sugar.

61

7- Pills are small, rounds, oral

dosage forms contain one or more

drugs incorporated with inert

excipients.

8- Dental Cones: a tablet form intended to be placed in

the empty socket following a tooth extraction, for

preventing the local multiplication of pathogenic

bacteria associated with tooth extractions. The cones

may contain an antibiotic or antiseptic.

D. Moulded Solid Dosage Forms:

Suppositories: Solid dosage forms intended for

insertion into body orifices where they melt,

soften, or dissolve. They vary in shapes and

weights and used either rectally with fingers (rectal

suppositories), vaginally (pessaries) with the aid of

an appliance or inserted into the male of female

urethra (urethral suppositories or bougies).

Suppositories exert either local or systemic actions

and it is an effective dosage form for patients with

vomiting or for pediatrics.

62

Suppository mould

Rectal and Vaginal suppositories:

Rectal Suppository Vaginal Suppository

63

Urethral suppository

E. Sterile Dosage Forms:

1- Parenteral preparations

(injections): Sterile, buffered,

isotonic preparations (solutions,

suspensions, emulsions, or dry

powder combined with solvent just

prior to use), applied parenterally

through intravenous, intramuscular,

subcutaneous, intrademral, etc.,

routes of administration.

2- Ophthalmic preparations

(ophthalmics): Sterile, buffered,

isotonic liquid preparations

(solutions or suspensions) or

ointments, applied topically to the

eye. They are used to treat many

cases such as; inflammation to eye

or eyelid, infections (bacterial,

fungal and viral), glaucoma, dry

eye, etc.

3 Nasal preparations: Sterile, buffered, isotonic

aqueous solutions that contains antibiotics and

anti-decongestants, administered by the nasal route

either as nose drops or sprays. They are used to

treat rhinitis of the common cold and sinusitis but

usually for short periods (not longer than 3-5 days)

because prolonged use may lead to chronic edema

of nasal mucosa.

64

4- Otic preparations: Sterile, buffered, isotonic

liquid preparations (solutions or suspensions) or

ointments, applied topically to the ear. It is used to

treat excessive cerumen, infection and relief the

pain and inflammation of ear.

65

5- Inhalation:

- Powders or sterile solutions of drugs or certain

gases such as oxygen administered by the nasal or

oral respiratory route for local or systemic effects.

Inhalations can be taken as follow:

- Inhalation aerosols: Is either metered dose

inhalers that aerosols the powdered drug as fine

particles to the respiratory tract by the aid of

mechanical inhaled a device, or aerosol sprays

which aerosol the solution of drug the form of mist

by the aid of valve or atomizer.

- A special device is called a nebulizer can be used

for inhalation of sterile solutions.

- Volatile liquid drugs can be inhaled by the simple

method illustrated below.

- Anesthetic gases or gases like O2 can be inhaled

directly by inhalation masks.

66

- An inhalation aerosol contains a liquid under

pressure and when the container's valve is opened,

the liquid is forced out of a small hole and emerges

as mist.

6- Irrigations: Sterile solutions intended to bathe

or flush open wounds or body cavities.

7- Implants: Sterile small solid masses prepared by

molding or compression of pure drug (s) with or without

excipients for implantation in the body by injection or

incision for where they continuously release their

medication over prolonged periods (months or years).

67

Biological products (biologicals): are any viruses,

therapeutic serum, toxin, antitoxin or analogous

products which are employed to develop a type of

immunity (the natural resistance to disease).

Biological products are of two categories:

1) Biologicals for active

immunity: This type based on

introducing of antigenic

substances as bacterial, viral and

cancer vaccines.

2) Biologicals for passive immunity: This type

based on introducing of immunoglobulin from

human or animal source. Immunoglobulins are

glycoprotein that functions as antibodies.

Immunoglobulins are produced as a response to

the detection of antigens in the body. There are

different types of Immunoglobulins which vary in

their structures and responses to antigens, they are:

IgG, IgM, IgA, IgD and IgE.

68

Routes of drug administration:

They are the ways of getting drugs into the body. Most

of drugs can be taken through number of routes.

The choice of the proper route is dependent on many

factors, for examples:

1) Physiochemical properties of the drugs (state of

matter, stability, PH, solubility, polarity, ionization,

irritancy, etc.)

2) Ease of administration:

- Pediatrics can't take oral medications and so for

examples, liquid dosage forms or chewable tablets are

satisfactory.

- Unconscious patients can't take any oral medications

and so I.V. injection for example, is satisfactory.

- Nauseous or vomiting patients can't take an oral

medication and so injections or suppositories for

examples, are satisfactory.

3) Onset time of action: Is the time required after

administration of a drug for the response to be observed.

The fastest onset time is by I.V. and inhalations routes.

4) Duration of action: describes how long the drug

effect will last.

5) Type of response required:

a) Local action: Drug is applied directly to the area that

needs treatment and do not usually enter the

bloodstream in significant quantities. For example:

69

antibiotic ointment is applied to a scrape on the skin, the

ointment stays on the surface of the skin, where the

medication effect is needed.

b) Systemic action: Drug ends up in the bloodstream

and act on a specific organ or system within the body.

For example: anti-depressant drugs are taken orally to

be circulated through the bloodstream and work by

increasing the amount of certain chemicals in the brain.

Bioavailability: is the fraction of the administered drug

reaching the systemic circulation as intact drug.

Bioavailability is highly dependent on both the route of

administration and the drug formulation.

6) Condition of patient: age and disease.

7) Quantity of dose required: large doses can be taken

via injections while small doses can be taken orally.

8) First pass metabolism of drugs: is extending to

which a drug is metabolized by liver before reaching

systemic circulation. Some routes of administration

avoid the liver metabolism.

70

Classification of routes of drug administration:

1) Enteral routes: oral, sublingual, buccal and rectal.

2) Parenteral routes: injectables and inhalations.

3) Topical routes.

1) Enteral routes:

A) Oral route (PO):

It is the most common route.

Medicines are taken by

swallowing and exert

systemic effect. Solid and

liquid dosage forms can be

taken by this route.

71

Advantages:

1. Convenient: orally administered drugs are easy to

be taken, self administered and pain free.

2. Cheap: orally administered drugs don’t need to be

sterilized.

3. Variety: Solid and liquid dosage forms can be

given by oral route.

4. Absorption: takes place along the whole length of

the GIT.

5. The most suitable route for GIT infections and

parasites.

Disadvantages:

1. Slower onset (not suitable in case of emergency).

2. Not suitable for unconscious patients.

3. Unpleasant taste of some drugs.

4. Can cause nausea, vomiting and irritation of

gastric mucosa.

5. Low solubility of some drugs, first pass effect and

first destruction of drugs by gastric acid or

digestive juices decrease bioavailability.

B. Sublingual route: sublingual

tablets are placed under the tongue,

absorbed by sublingual mucosa and

exert systemic effects.

Advantages:

1. Rapid absorption suitable in emergency, e.g.,

Nitroglycerin, as a softer sublingual tablet [2 min

disintegration time], may be used for the rapid

relief of angina.

2. Avoid first pass effect higher bioavailability.

72

3. Drug stability pH in mouth relatively neutral

(cf. stomach - acidic). Thus a drug may be more

stable.

Disadvantages:

1. Unpleasant taste of some drugs.

2. Irritation to oral mucosa.

3. Few drugs are absorbed by this route. It is usually

more suitable for drugs with small doses.

4. Short duration.

C. buccal administration: buccal tablets

are placed between gums and inner lining

of the cheek, absorbed by buccal mucosa

and exert systemic effect, e.g., Nicotine

gum.

Advantages and disadvantages: similar to sublingual

route.

D. Rectal route: Suppositories or enemas are inserted or

introduced in the rectum and either absorbed by rectal

mucosa exerting systemic effect or acting locally.

Advantages:

1. Suitable in nauseous, vomiting and unconscious

patients.

2. Suitable for pediatrics and geriatrics.

3. Avoid first pass effect.

Disadvantages:

1. Not suitable in case of diarrhea.

2. Incomplete absorption.

3. May cause an irritation to rectal mucosa.

73

2. Parenteral routes (Derived from the Greek words

Para, meaning outside and enteron, meaning the

intestine).

A. Injections:

1) Intravenous (I.V.): drugs may be

given into a peripheral vein over 1

to 2 minutes or longer by infusion.

Advantages of I.V. route:

a. Rapid a quick response (fastest onset time of

action).

b. Total dose the whole dose is delivered to the blood

stream giving 100% bioavailability.

c. Larger doses may be given by IV infusion over an

extended time.

d. Veins relatively insensitive to irritation by irritant

drugs at higher concentration in dosage forms.

Disadvantages of I.V. route:

a. Suitable vein it may be difficult to find a suitable

vein. There may be some tissue damage at the site of

injection. b. May be toxic because of the rapid response;

toxicity can be a problem with rapid drug

administrations. For drugs where this is a particular

problem the dose should be given as an infusion,

monitoring for toxicity.

c. Requires trained personnel.

d. Expensive sterility, pyrogen testing and larger

volume of solvent means greater cost for preparation,

transport and storage.

e. Painful, expensive, embolism and danger of infection.

74

2. Intramuscular (I.M.):

Advantages of I.M. route: a. Larger volume can be given by IM as compared with

subcutaneous route of administration.

b. Are easier to be administered as compared with I.V.

injections.

c. A depot or sustained release effect is possible with IM

injections, e.g. procaine penicillin.

Disadvantages of I.M. route:

a. Trained personnel required for injections.

b. The site of injection will influence the absorption;

generally the deltoid muscle provides faster and more

complete absorption.

c. Absorption is sometimes erratic, especially for poorly

soluble drugs, e.g. diazepam, phenytoin.

d. The solvent maybe absorbed faster than the drug

causing precipitation of the drug at the site of injection.

e. Irritating drug may be painful.

75

General differences between intravenous and

intramuscular routes:

Intravenous Intramuscular

Drug response Systemic effect Systemic effect

Method of

administration

Into the vein Into skeletal

muscle

Onset time of

action

Fastest route

30 – 60 seconds

Slower than i.v.

10 – 20 minutes

Duration of

action

Shorter than i.m. Longer than i.v.

Bioavailability 100% Lesser than 100%

Volume of

fluids taken

Large volume of

fluids can be

taken

Only up to 10 ml

Emergency

cases

Suitable Not suitable

Oily

preparations

and emulsions

Not suitable Suitable

Diarrhea and

vomiting cases

Suitable Suitable

GIT irritation No No

Nutrition Provide nutrition Don't provide

nutrition

3. Subcutaneous route: fluids are taken under the skin

by angel 45 exerting systemic effect. It is commonly

used for insulin injection.

Advantages:

a. Longer duration time (prolonged action) as compared

with i.v. and i.m. routes of administration.

b. Suitable for depot preparations.

c. Large volume of fluids may be administered.

76

d. Can be self administered i.e. can be given by patient,

e.g. in the case of insulin.

Disadvantages:

a. Slow onset.

b. Not suitable for irritant drugs.

c. Maximum of 2 ml injection thus often small doses can

be taken.

d. Can be painful.

4. Intrademral route: fluids are taken under the skin by

angel 10-15 exerting local or systemic effects. This route

is used for administration of local anesthetics and

vaccines. Diagnostic tests such as sensitivity test are

done through this route.

5. Intraarticular: fluids are injected in the joint for

treatment of arthritis.

Disadvantages:

a. Painful and may cause damage to cartilage.

b. More skill is required.

6. Intrathecal into the spinal cord.

7. Intracardiac into the heart.

8. Intraperitoneal into peritoneum (rapid absorption

and large volume can be injected).

B. Inhalation route: Anesthetic gases, volatile liquids

and aerosols are taken by this route, absorbed via nasal

mucosa or alveolar membrane exerting local (e.g.

bronchodilators) or systemic effects (e.g. general

anesthesia).

77

C. Topical or transdermal route: The dosage forms

are applied to the mucous membranes of;

1) Skin e.g., creams, ointments, paints, lotions, gels,

sprays and pastes, transdermal patches.

2) Eye (ocular route) e.g., drops and ointments, gels

and creams.

3) Ear (otic route) e.g., drops and ointments.

4) Nose (nasal route) e.g., drops and gels.

5) Vagina e.g., douches.

78

- Drugs introduced topically exerting either local effects

or systemic effects if the drug absorbed via skin.

Absorption of drugs through the skin to achieve

systemic effect is commonly known as transdermal drug

delivery.

79

Time for onset of action of various dosage forms

Time for onset of action Dosage form

Seconds i.v. injections

Minutes i.m. and s.c. injections,

buccal tablets, aerosols, gases

Minutes to hours Short-term depot injections,

solutions, suspensions,

powders, granules, capsules,

tablets, modified-release

tablets

Several hours Enteric-coated formulations

Days Depot injections, implants

Varies Topical preparations

Summary of the general routes of drug administration:

Route of administration Application

Oral swallowed by the mouth

Nasal Into the nose

Buccal Placed between the cheek and gum

Sublingual Placed under the tongue

Topical Applied to skin

Transdermal Applied to skin to be absorbed via

skin

Intravenous Injected into the vein

Intramuscular Injected into the muscle

Subcutaneous Injected under the skin

Rectal Into the rectum

Vaginal Into the vaginal

Inhaled Into the mouth or the nose

Ocular Into the eye

Otic Into the ear

80

Flow charts summarize the routes of drug delivery

81

Chapter Four: Functions of pharmacists

Code of Ethics for Pharmacists:

Code of ethics is simply: principles of professional

conduct are written to guide pharmacist in relationship

with patients, fellow practitioners, other health

professionals, and the public.

a) Code of Ethics (American pharmacists

association):

1- A pharmacist respects the covenantal relationship

between the patient and pharmacist.

2- A Pharmacist promotes the good every patient in a

caring, compassionate, and confidential manner.

3- A Pharmacist respects the autonomy and dignity of

each patient.

4- A pharmacists acts with honesty and integrity in

professional relationship.

5- A pharmacist maintains professional competence.

6- A pharmacist respects the values and abilities of

colleagues and other health professionals.

7- A pharmacist serves individual, community and

societal needs.

8- A pharmacist seeks justice in the distribution of

health resources.

82

B) Code of Ethics (Royal Pharmaceutical Society of

Great Britain):

1- Make the care of patients your first concern.

2- Exercise your professional judgment in the interests

of Patients and the public.

3- Show respect for others.

4- Encourage patients to participate in decisions about

their care.

5- Develop your professional knowledge and

competence.

6- Be honest and trustworthy.

7- Take responsibility for your working practices.

83

The function of pharmacist (druggist):

1) Community pharmacist: It is the most accessible

health professionals to the public. The main activities

are:

a) Patient services:

1) Processing of prescriptions.

2) Patient counseling at the time of dispersion

prescription and non-prescription drugs: Help the

patient to understand the proper use medication,

dose, interactions, side effects and storage of the

medication.

3) Assist in the patient's choice of nonprescription

drugs or in the decision to consult a physician.

4) The connecting link between physician and

patient.

5) Prepare and compound special dosage forms.

6) Train other health care workers: training provided

by pharmacist aims to optimize drug therapy by

promoting rational use and storage of drugs and

reducing methods of reducing use.

b) Drug services:

1) All activities include drug synthesis, analysis,

stability, quality control, bioavailability,

production, distribution.

2) All scientific names and complete data about

them.

C) Run a business:

1) Hires and supervises employees.

2) Deals with insurance companies.

3) Maintains inventory.

84

2) Hospital pharmacist:

Hospital pharmacist works in a hospital pharmacy

service, primarily within the public sector.

Hospital pharmacist is an expert in medicines and

performs all the activities of community pharmacist but

with increase focusing on patient (hospital pharmacy is

an intermediate between community and clinical

pharmacists). Hospital pharmacist differs from

community pharmacist in:

a) Close interaction with physicians and other health

care professionals and having access to medical

records, thus gain greater expertise.

b) Selection of drugs and dosage regimens.

c) Monitoring patient compliance, response to drug

therapy and report adverse drug reactions.

d) Promote rational prescribing and use of drugs as

he is so close to the prescriber.

e) Serves as a member of policy-making

committees, including those concerned with drug

selection, the use of antibiotics, and hospital

infections.

f) Can control hospital manufacture and

procurement of drugs to ensure the supply of

high-quality products.

g) Participates in the planning and implementation of

clinical trials.

h) Participates in the analysis of drug in the body to

determine the beneficial or adverse effects of

drugs.

85

Hospital pharmacist education: (B.Pharm.) degree and

he can gain more education in; Helwan, Ein Shams and

Tanta universities, to get PharmD degree that requires 2

academic years, the first year is a diploma in clinical

pharmacy to be a clinical pharmacist and the second

year is training in hospital to be a pharmacy doctor.

Hospital pharmacist can gain fellowship to be more

specializing in various disciplines of pharmacy, for

example, in hematology/oncology, HIV/AIDS,

infectious disease, critical care, emergency medicine,

toxicology, nuclear pharmacy, pain management,

psychiatry, anti-coagulation clinics, herbal medicine,

neurology/epilepsy management, pediatrics, neonatal

pharmacists and more. Hospital pharmacist can gain

also a master in hospital pharmacy.

The missions of the hospital pharmacist can be

summarized as follow:

1) Purchase, manufacture, storing of all medicines used

in a hospital.

2) Dispense and compound medicines: They can

compound sterile products for patients including total

parenteral nutrition (TPN) and cytotoxic drugs.

3) Drug services:

a) Quality testing of all medicines used in a hospital.

b) Promoting rational use of drugs

c) Participates in the analysis of drug in the body to

determine the beneficial or adverse effects of

drugs

- Goal: Ensuring the supply of highly effective

medicines to optimize the therapeutic outcomes (goals)

of the therapy.

86

4) Patient services:

a) Patient counseling.

b) Provide drug information to the patient.

c) Ensuring Ensures right dose, right route, right

time, and right drug with the right information.

d) Monitoring patient compliance, response to drug

therapy and report adverse drug reactions.

e) Selecting drugs and dosage regiments (after

calling the prescriber).

- Goal: patient care

N.B., There is balance for the hospital pharmacist is

between the buying/storing/compounding/dispensing

and the increased focus on the patient in all activities.

3) Clinical pharmacist:

Clinical pharmacy is a health science discipline in

which pharmacists provide patient care that optimizes

medication therapy and promotes health, wellness, and

disease prevention. The practice of clinical pharmacy

embraces the philosophy of pharmaceutical care.

Clinical pharmacy also has an obligation to contribute to

the generation of new knowledge that advances health

and quality of life.

Goals: a) Optimizing therapy for achieving therapeutic

goals.

b) Minimizing the risk of treatment-induced adverse

events.

c) Trying to provide the best treatment alternative

for the greatest number of patients to minimize

the expenditures.

d) Prevention of diseases.

87

e) Encourage self care and self medication.

f) Promote human health and quality of life.

g) Pharmaceutical care of patient as an effective

member of a cooperative health.

Education: PharmD degree or a diploma in clinical

pharmacy after getting B.Pharm. degree.

Clinical Pharmacist performs all the activities of

hospital and community pharmacists, in addition to the

recent roles in: a) Health promotion.

b) Self care and self medication practices.

c) Pharmaceutical care of patients.

d) Social and behavioral skills to manage work

issues: include those competencies that are

required to manage problems and interpersonal

issues that arise in the course of professional

practice.

1) Apply of communication skills: the ability of

pharmacists to communicate effectively with other

pharmacists and health professionals, staff, patients,

careers and members of the public individually or in

groups.

2) Participate in negotiations: the ability of

pharmacists to work through situations arising in daily

practice where potentially divergent views or

circumstances present the need for pharmacists to

exercise professional judgment in order to reach a

position that is mutually acceptable to the parties

concerned.

88

3) Address problems: the ability of pharmacists to

recognize and resolve problems that arise in the

workplace, to assess whether an effective solution has

been found, and identify what further action is required.

4) Manage conflict: the pharmacist’s capacity to

manage or resolve situations of conflict that arise in

professional practice. This includes conflict situations

that arise between staff or between staff and another

health professional, a patient or another client of the

service.

5) Apply assertiveness skills: the ability of pharmacists

to support or maintain a position that is consistent with

sound pharmacy practice and their duty of care to

patients through the application of assertiveness skills.

The missions of the clinical pharmacist can be

summarized as follow:

a) Pharmaceutical caring which enables the clinical

pharmacist in Participating in therapeutic decision

making.

b) Following up individual patients to verify they are

achieving the intended benefits.

c) Promote rational drug use.

d) Dispense medicines: Assess, evaluate and supply

the prescribed medicines.

e) Prepare pharmaceutical products. By encouraging,

assisting and providing the means for patients and

other members of the community, individually

and collectively, to take responsibility for their

own health.

f) Provide medicines and health information and

education to other health professionals, patients

and members of the general public

89

g) Apply organizational skills in the practice of

pharmacy: that relate to the way in which

pharmacists apply management and

organizational skills to contribute to the effective

and efficient delivery of pharmacy services.

4) Nuclear pharmacist:

Main activities: Procures, stores, compounds, dispenses,

and provides information about radioactive

pharmaceuticals used for diagnostic and therapeutic

purposes. Nuclear pharmacists undergo additional

training specific to handling radioactive materials and

unlike in community and hospital pharmacies, nuclear

pharmacists typically do not interact directly with

patients.

5) Governmental pharmacist: works in the Egyptian

management of pharmacy as pharmacy inspector.

Main activities:

a) Registration- approval- quality control of

medicines, cosmetics and medical devices.

b) Providing the license to the community

pharmacies or drug manufactories.

c) Application of the pharmacy laws.

d) Inspection for the performance of manufacturers

and pharmacies.

6) Academic pharmacist: engages in undergraduate

and postgraduate continuing education, pharmaceutical

practice and research in pharmacy colleges.

90

7) Industrial pharmacist: The main activities are:

a) Research and development.

b) Formulation and manufacture.

c) Quality control and quality assurance.

d) Provide detailed information on medicines to the

health professional members.

e) Patent application and drug registration.

f) Clinical trials and post-marketing monitoring.

g) Sales and marketing.

h) Management.

8) Compounding pharmacist: specializes in

compounding. Compounding is the practice of preparing

drugs in new forms. For example, if a drug manufacturer

only provides a drug as a tablet, a compounding

pharmacist might make medicated syrup that contains

the drug. Another form of compounding is by mixing

different strengths (g, mg, mcg) of capsules or tablets to

yield the desired amount of medication indicated by the

physician. This form of compounding is found at

community or hospital pharmacies.

The role of pharmacist in compounding formulations:

a) Determines appropriate formulation:

1) The pharmacist selects correct formulations for

specified products.

2) Interprets common terminology & abbreviations, e.g.

ingredients, instructions, dose forms, quantities.

3) Identifies trade, generic & common names of

ingredients.

4) Identifies problem formulations, e.g. incorrect

proportions, drug instability, vehicle instabilities,

91

inaccuracies, precipitations, syringe

compatibilities/incompatibilities.

5) Modifies formulations to ensure product is stable &

suitable for intended use.

6) Follows manufactures’ guidelines, or appropriate

reference source, for dilution of solutions, suspensions

& ointments.

7) Explains the limits of modifications that can be made

to formulations, e.g. addition of electrolytes to TPNs,

additions to creams.

b) Compounds pharmaceutical products applying

suitable compounding techniques and principles:

1) Calculates quantities of ingredients & end product to

100% accuracy, and documents this.

2) Produces clear labels for end products, including full

patient instructions, expiry dates, storage information

and any supplementary advisory labels.

3) Obtains correct form & strength of ingredients needed

for product.

4) Checks each ingredient to ensure it is fit to use, e.g.

checks expiry date, signs of degradation, stored correctly

(temperature & protection from light & moisture),

stability if packaging already opened.

5) Checks ingredient is pharmaceutical grade.

6) Ensures equipment and work area are appropriate,

clean & tidy e.g. ointment slab cleaned; positive

pressure areas maintained in sterile unit.

7) Ensures personnel are appropriately prepared for

aseptic production, e.g. handwashing, appropriate

clothing

8) Uses appropriate compounding technique to prepare

product.

9) Weighs or measures correct quantity of ingredients

92

10) Follows professional conventions & formulation

principles when compounding.

11) Uses aseptic, no-touch technique for sterile

preparations.

c) Examines final product for particulate contamination

and homogeneity.

d) Complies with rules of schedule or formulary,

relevant for the product

e) Packs each compounded product in container suitable

for type, quantity, intended use & storage requirements

of product, e.g. protected from light & moisture,

container suited to product & use, bottle with dropper

dispenser for ear drops.

f) Attaches labels securely, without obscuring relevant

information, e.g. graduations on syringes, poison bottle

ribs.

g) Ensures optimal storage of ingredients and

compounded products: Complies with optimal storage

conditions regarding: temperature, light, moisture, type

of container, transport of product

h) Cleans and maintains compounding equipment.

i) Completes documentation and records.

8) Military Pharmacist: serves as none commissioned

or commissioned officers in the armed forces, and he

has the following activities:

a) Manufacture of generic products.

b) Distribute drugs to different areas and hospitals in

army.

c) They dispense drugs to personnel working in the

army.

d) Preparation of products to purify water during

emergency.

93

9) Veterinary pharmacist: Aware with medications

that fulfill the pharmaceutical needs of animals -

veterinary pharmacy is often kept separate from regular

pharmacies.

10) Internet pharmacist (is not involved in Egypt):

are those who deal with people online. Since about the

year 2000, a growing number of Internet pharmacies

have been established worldwide. Many of these

pharmacies are similar to community pharmacies. The

primary difference is the method by which the

medications are requested and received. Some customers

consider this to be more convenient and private method

rather than traveling to a community drugstore where

another customer might overhear about the drugs that

they take. Internet pharmacies (also known as online

pharmacies) are also recommended to some patients by

their physicians if they are homebound.

While most Internet pharmacies sell prescription drugs

and require a valid prescription, some Internet

pharmacies sell prescription drugs without requiring a

prescription. Many customers order drugs from such

pharmacies to avoid the "inconvenience" of visiting a

doctor or to obtain medications which their doctors were

unwilling to prescribe.

94

Chapter Five: Modern Pharmacy Practice

The practice of pharmacy has been defined as follow:

The “Practice of Pharmacy” means:

1) The interpretation of the prescription orders.

2) The compounding, labeling and dispensing of

drugs.

3) The product and device selection.

4) The responsibility for patient monitoring and

intervention.

5) Drug and drug related research.

6) The provision of cognitive services related to the

use of medications and devices.

The number of medicines on the market has increased

dramatically over the last few decades. The mission of

pharmacy practice has been focusing on two main

goals or challenges:

a) Drug services:

1) Ensuring that all medications are of good quality and

proven safety and efficacy.

2) Ensuring that all medications are used rationally.

Rational use of medicine:

This requires that patients receive medications

appropriate to their clinical needs, in doses that meet

their own individual requirements for an adequate period

of time, and at the lowest cost to them and their

community.

95

Irrational use of medicine:

For those people who do receive medicines, more than

half of all prescriptions are incorrect and more than half

of the people involved fail to take them correctly. In

addition, there is growing concern at the increase in the

global spread of antimicrobial resistance, a major public

health problem.

b) Patient services:

1) Pharmacists have a vital role to communicate the

correct information to patients are as important as

providing the medicine itself.

2) Pharmacists also have a vital role to make to care

patients through managing drug therapy and concurrent

non-prescription or alternative therapies.

These challenges – both to drug and patient services,

have made dramatic changes in the practice of

pharmacy.

New dimensions of pharmacy practice:

Over the past, there has been a trend for pharmacy

practice to move away from its original focus on

medicine supply towards a more inclusive focus on

patient care. The role of the pharmacist has evolved

from that of a compounder and supplier of

pharmaceutical products towards a provider of patient

care.

96

A vision for pharmacy practice has been articulated in

the Joint Commission of Pharmacy Practitioners’ (JCPP)

Future Vision for Pharmacy Practice 2015, which states

that:

“Pharmacists will be the healthcare professionals

responsible for providing patient care that ensures

optimal medication therapy outcomes.”

The modern activities of pharmacist in; pharmaceutical

care, self care, self medication, health promotion in

addition to traditional roles in processing of

prescriptions and preparing of products; are key

components of an accessible health care system ensures

the efficacy, safety and quality of medicines.

Organizational skills in the practice of pharmacy:

Goal: Optimize pharmacists’ ability to deal with

contingencies in the workplace as well as routine work.

A) Competency1: Plan and manage work time:

This covers the ability of pharmacists to manage work

activities and contingencies within available time to

complete tasks according to established deadlines or

targets.

In order to deliver completed tasks on time pharmacists

are required to consider the nature and demands of the

tasks as well as the potential or actual problems that will

need to be addressed. They have to assess whether there

is a need for any additional guidance and support and a

source for that support/guidance has to be identified. In

planning and managing their time pharmacists have to

97

deal effectively with contingencies that arise in the

workplace as well as routine work commitments.

B) Competency 2: Manage own work contribution:

This covers the way in which pharmacists apply

themselves to ensure their contribution in the workplace

is consistent with their role and appropriate for

furthering the activities of the pharmacy service (and a

wider organization where relevant).

It addresses the way in which pharmacists manage and

organize their own work. Self management is part of the

responsibility pharmacists accept as independent

professionals. Regardless of the work environment in

which they practice, or the number of other pharmacists

and support personnel in the environment, pharmacists

must take responsibility for managing their own work

and professional duties through the application of

organizational and management skills.

C) Competency 3: Supervise staff:

This covers the ability of pharmacists to accept

responsibility for supervising the work of others and to

provide the required support and advice for those staff to

successfully undertake assigned tasks.

D) Competency 4: Work in partnership with others:

This concerned with how pharmacists work with others

both within and outside their workplace to undertake

work activities. It also encompasses the way in which

pharmacists assist others to progress the work of the

pharmacy service (and the wider organisation where

relevant).

98

E) Competency 5: Plan and manage pharmacy

resources:

It addresses the role pharmacists have in establishing an

appropriate structure and human resource capability for

delivering the range of pharmacy services provided and

for ensuring personnel are appropriately deployed and

supported. It also covers the responsibilities pharmacists

have in relation to acquiring and managing the necessary

equipment and products for the range of services

offered.

There is significant diversity in the organizational

structures in which pharmacists work. This is matched

by an equal diversity in the staffing and materials

needed to deliver services.

Whatever the environment in which they work,

pharmacists will be required to contribute to the efficient

and effective management of equipment and products.

Some pharmacists, usually those holding senior

positions in an organisation, will be required to accept

management responsibilities for organizational

resources and will be expected to demonstrate leadership

in supporting and developing the human resource

capability of the organisation.

This competency should also be applied in

circumstances where pharmacists have management

responsibility for resource management and planning

across the entire service or a significant part of it. These

pharmacists are expected to have a heightened

awareness of work process and performance and

knowledge and understanding of industrial issues

relevant to human resources management. They may

99

also be expected to pursue contracting arrangements for

required equipment and/or products for the mutual

benefit of the service and its clients.

F) Competency 6: Plan and manage pharmacy

services and the work environment:

This covers the involvement of pharmacists in managing

and planning pharmacy services and in maintaining a

safe and secure workplace. It addresses the

responsibilities they have to ensure delivery of efficient,

high quality professional services to patients and other

clients of the service.

Pharmacists will be involved to varying degrees in the

ongoing management and future planning of pharmacy

services depending, in part, on the size and type of the

organisation in which they work and their seniority

within the organisation. A focus on maintaining and

improving service quality is important for all health

service providers. In larger organisations pharmacists

may be exposed to quite formal quality assurance and

improvement programs with a supporting policy and

documentation framework. However, even in small

organisations measuring service quality, planning for

improvement and checking that improvement has been

achieved (and deleterious effects avoided) is an essential

part of a pharmacist’s professional responsibilities.

Whatever the size of the organisation, all pharmacists

are obligated to consider and contribute to workplace

safety and security and may also be responsible for

ensuring supervised staff give due consideration to

understanding and addressing these issues.

100

This Competency should be applied in circumstances

where pharmacists are extensively, if not exclusively,

involved in management and planning activities. These

pharmacists will usually be responsible for establishing

the policy framework in which others work to deliver

pharmacy services and for budget and service planning.

They will demonstrate highly developed self

management, team building and leadership skills. They

will also have a key role in providing the leadership

needed to overcome barriers to others making an

efficient and effective contribution.

101

Recent areas for pharmacists:

A) The role of pharmacist in providing health-related

information

Pharmacists are a trusted source of information and

advice on health and medicines. The pharmacist

should:

1) Use reference sources to compile medicines and

healthcare information.

2) Provide information about medicines use and health

care:

a) Explains the pharmacology and therapeutic use of

common medicines.

b) Provides health care information to individuals and

groups.

3) Communicates effectively with other health

professionals and patients.

B) The role of pharmacist in promotion of public

health:

The mission of public health can be summarized in 4

pints: optimizing public health service delivery,

protecting the community against environmental

hazards, assisting and reinforcing the community

healthcare provider system and assist individuals

(consumers) to achieve optimal health status through

promoting medical self-help principles.

The pharmacist are the most accessible and highly

trusted health care professionals, the pharmacist sees the

patient at the time of a prescription refill, which can be

an opportune time to discuss public health issues.

102

Pharmacists also can use this time to identify early signs

and symptoms of diseases.

Pharmacist can actively involve in; family planning,

pregnancy and infant care, immunizations, transmission

of sexual diseases, control of toxin agents, occupational

health and safety, control of accidental injuries,

reduction in the spread of communicable and infectious

diseases, fluoridation of community water supplies,

tobacco cessation, reduction of drug/alcoholism use and

abuse, improved nutrition and fitness.

The following sections illustrate examples of areas of

health care where a pharmacist can have a positive

role on health outcomes of their communities:

1) Communicable disease control:

a) Pharmacists can promote for example, safer sexual

practices.

b) Pharmacists can prevent transmission of blood borne

infections e.g. HIV by encouraging the once-only use of

sterile needles and syringes.

2) Maternal and child health:

a) Pharmacists can remain up to date immunization

schedules and advice parents who have infants or young

children

b) Pharmacist should understand the normal course of

pregnancy and infancy.

c) Pharmacist should encourage breast feeding, where

possible.

d) Pharmacist should be at vanguard of family planning

e) Pharmacist should be able to discuss various

contraceptive methods

103

3) Nutrition:

a) Pharmacist should be aware of normal nutritional

requirement and the problem of malnutrition or poor

nutrition.

b) Pharmacist should advising patient about basic food

needs and helping to correct improper food habits

4) Oral health: Pharmacists should be able to cover oral

structure and diseases, prevention of caries and OTC

dental drugs

5) Intelligent roles: Pharmacists can play a role in:

a) Controlling food and water borne diseases.

b) Tobacco cessation, reduction of drug/alcoholism use

and abuse.

c) Public health research programs.

d) Blood pressure screening and monitoring programs.

e) Control and prevention of poisoning. Pharmacists

should be a ware of dangerous arising from industrial

toxins.

f) Control of accidental injuries.

104

Self care and self medication:

Self- Care: is what people do for themselves to

establish and maintain health, prevent and deal with

illness. It is a broad concept encompassing:

1) Hygiene (general and personal);

2) Nutrition (type and quality of food eaten).

3) Lifestyle (sporting activities, leisure etc.);

4) Environmental factors (living conditions, social

habits, etc.);

5) Socioeconomic factors (income level, cultural

beliefs, etc.);

6) Self-medication.

Self-Medication: is the selection and use of medicines

by individuals to treat recognized illnesses or symptoms.

Responsible self-medication requires that:

1) Medicines used are of proven safety, quality and

efficacy.

2) Medicines used are those indicated for conditions

that are self-recognizable and for some chronic or

recurrent conditions (following initial medical

diagnosis).

The increasing importance of self-care and self-

medication: The increase in self-care is due to a number

of factors:

Socioeconomic factors: Improved educational levels

resulting in growing demand for direct participation in

health care decisions.

105

Lifestyle: Awareness has increased of maintaining

health and preventing illness.

Accessibility: Consumers prefer the convenience of

readily available of medicinal products to long waiting

times at clinics or at other health facilities.

Management of acute, chronic and recurrent

illnesses: It is now recognized that certain medically

diagnosed conditions may be appropriately controlled by

self-medication or no medication at all.

Public health and environmental factors: Good

hygiene practices and appropriate nutrition, safe water

and sanitation have contributed to the capacity of

individuals to establish and maintain their health, and

prevent illness.

Demographic and epidemiological factors:

Demographic transition towards a more elderly and

epidemiological factors arising from changing disease

patterns are requiring changes in health policy. This in

turn means increasing individuals' capacity for self-care.

Health sector reforms: Worldwide, self-medication is

being promoted as a means of reducing the health care

burden on the public budget.

Availability of new products: New, more effective

products, which are considered suitable for self-

medication, have recently been developed; for example:

topical and oral imidazoles for vaginal candidiasis;

topical fluorinated steroids for hay fever; acyclovir for

106

cold sores; H2 blockers for prevention of heartburn;

H1agonists for asthma.

The role of pharmacist in self care and self

medication:

As a Communicator:

1- The pharmacist should initiate dialogue with the

patient (and patient's physician, when necessary) to

obtain detailed medication and disease history.

2- The pharmacist must provide the medical advice

about the disease and medicine.

3- The pharmacist must be prepared and adequately

equipped to perform a proper screening for specific

conditions and diseases, without interfering with the

prescriber's authority;

4- The pharmacist must help the patient to take the

appropriate self medication.

As a Quality Drug Supplier: The pharmacist must

ensure the proper source, quality, storage, and expiration

date of medicines.

As a Trainer and Supervisor: The pharmacist must

promote and participate in the training and supervising

the work of non-pharmaceutical staff.

As a Collaborator: The pharmacist develops a

relationship with; other health care professionals,

national health associations, pharmaceutical industries,

government, patients, and the general public.

107

As a Health promoter: As a member of the health -

care team, the pharmacist must:

1- Participate in health screening to identify health

problems in the community.

2- Participate in health promotion and disease

prevention.

3- Provides a medical advice to the patients and the

general public.

Evaluation of performance relating to self-care and

self-medication needs:

Several indicators can be used to evaluate the

performance of pharmacists in response to self-care and

self-medication needs. One of the most important

indicators is:

Outcome indicators:

1) Customer satisfaction regarding the purchase and

use of the product acquired, including the

intervention of and advice provided by the

pharmacist;

2) comprehension of information delivered by the

pharmacist;

3) Health outcomes;

4) Increased patient knowledge of the practice of

self-care and responsible self-medication.

108

Chapter Six: Pharmaceutical Care

Pharmaceutical care: a process through which a

pharmacist cooperates with a patient and other health

care professionals in designing, implementing, and

monitoring a therapeutic plan that will produce specific

therapeutic outcomes for the patient.

- Pharmacist + patient+ other professionals +ve

therapeutic outcomes.

Goals:

1) Identifying actual and potential drug-related

problems.

2) Resolving actual drug-related problems.

3) Preventing potential drug-related problems.

Steps:

1) Establish a comprehensive patient-specific

database: Includes at minimum, the following

information:

a) Description of the Patient: Age, sex, ethnicity,

height, weight, race.

Familiarize yourself with the patient:

- How old is the patient?

- Are they male or female?

- What is the patient's chief complaint?

- What is the house staff's differential diagnosis?

- When was the patient's last admission and was he/she

admitted for a related problem?

109

- Social history: smoke? Family support?

- Quick review of medication list for drug related issues

to address in the patient interview.

b) History of the present illness/past medical History:

- Have the present medical problems been treated with

drugs previously? What was the outcome?

- Is there anything in the history to suggest a

contraindication to drug therapy or anything that would

affect the drug's action or effectiveness?

c) Medication History:

- What medications, routes of administration, doses and

duration of treatment are presently being taken?

- Have the medications produced the desired therapeutic

outcomes? Can these medications be contributing to

some or all of the present medical problems?

- What organ systems (functions) are these medications

affecting?

- Is there a history of success or failure with past drug

therapy?

- Have past drugs adversely affected an organ system or

function?

- What is the immunization history?

d) Allergies/adverse drug reactions:

- Have any allergic reactions occurred in the past? What

is the nature and significance of past allergic reactions?

- Do potential allergies exist (drug, food, etc)?

- Is there evidence that the patient could not tolerate a

medication in the past?

- Has the patient experienced side effects from any drugs

before? If so, what drugs and what reactions? What was

the treatment, if any? What was the outcome?

110

e) Smoking/alcohol/drug abuse history:

f) Compliance History:

- Do past therapeutic failures suggest a lack of

adherence to drug regimens?

- What social history, living conditions and/or physical

limitations might affect patient compliance?

- How reliable is the source of information?

- Is the patient responsible for his/her own drug taking.

If not, who is?

- What is the patient's understanding of the instructions

for taking the medication?

g) Physical Examination:

- What abnormal signs and symptoms are being

manifested that could affect drug therapy (e.g. abnormal

renal or hepatic function), or that will form the basis for

outcome monitoring?

2) Identification of real or potential drug related

problems: Most drug-related problems are the result of:

a) Untreated Indication(s): patient has active disease

process for which no pharmacotherapy has been

prescribed.

b) Improper Drug Selection: patient is receiving the

wrong drug or dosage form.

c) Subtherapeutic Dosage: patient is receiving too little

of the correct drug.

d) Over dosage: patient taking or receiving too much

of the correct drug.

e) Adverse Drug Reaction (ADR): patient’s medical

problem is the result of an adverse effect.

111

f) Drug Interactions: patient’s medical problem is the

result of a drug-drug, drug-food, and drug disease or

drug-lab interaction.

g) Failure to receive Drugs: patient is not taking or

receiving the drug prescribed.

h) Drug Use without Indication: patient is taking or

receiving a drug for which there is no valid medical

indication.

Each drug already being administered and each new

drug should be evaluated by asking questions such as:

- Is the use of this drug justified?

- Is there therapeutic duplication?

- Is this the drug of choice for this patient?

- What therapeutic alternatives are there?

- Is this therapy cost-effective?

- Has the dosage been adjusted for patient-specific

changes? (I.e. renal or liver impairment, age, weight,

etc)

- What side effects are possible and are any of these

more likely to occur in this patient?

- Is the patient currently experiencing any of these?

- Are there any clinically significant interactions possible?

112

This table summarizes the information required to

aid in solving problems

Clinical

Characteristics

Patient’s

Pharmacotherapy

Patient’s Disease

Process

- Age

- Sex Severity

- Ethnicity Prognoses

- Pregnancy status

- Immune status

- Kidney function

- Liver function

- Cardiac function

- Nutritional status

-Patient’s

expectations

-Present

Pharmacotherapy

- Past Pharmacotherapy

- Drug Allergies

- Toxicity profile of

drug (s)

- Adverse drug

reactions assoc. with

the drug(s)

-Route and technique

for drug administration

- Present Medical

Problems

- Severity

- prognoses

- Impairments

- Disabilities

- Patient perception

of

- disease process

This table summarizes the questions that can be used

for evaluation the body systems

CNS

- Is the patient in pain? Chronic or acute? Have

patient describe location, quality, and severity of

pain.

- What makes pain better or worse? Does patient's

pain affect sleep? Mood? Functional ability?

Activity tolerance?

Is patient receiving regular analgesics?

- Is the patient sleeping ok? Receiving adequate

hypnotics?

- Is the patient alert? Is the patient drowsy, dizzy,

confused, or disoriented?

- Is the patient having any problems with visual

acuity?

- Is the patient having any seizures? Is the seizure

a result of abrupt drug withdrawal because the

patient ran out of med or med not restarted in

hospital?

- Is this drug induced?

113

Respiratory - Is the patient breathing okay?

- Is there a need for B-agonist therapy? Does

breathing limit patient's activity?

- Is the schedule for a B-agonist appropriate?

Excessive?

- Is this drug induced?

CV - Is the blood pressure adequate? Excessive?

- Is fluid intake adequate? Excessive?

- Is there a contraindication of subcutaneous

heparin?

- Is there an indication of therapeutic

anticoagulation?

- Is there an indication for antiplatelet therapy?

- Is this drug induced?

GIT - Can drugs be administered orally?

- Is patient swallowing okay?

- Is patient pocketing meds?

- Is patient nauseous?

- Is patient vomiting?

- Does patient have mouth ulcers?

- Is patient having abdominal pain?

- Is there NG suction which is interfering with GI

absorption?

- Is there an ileus? Is there potential for drug

induced ileus?

- Is gastric emptying adequate?

- Is the patient having diarrhea? Constipation?

- Is patient having fecal incontinence? Does

patient have hemorrhoids? Rectal bleeding?

- Is treatment necessary or will non-drug

measures sufficed?

- Is the patient being adequately fed? Recent

weight changes?

- Are liver tests normal?

- Is this drug induced?

Renal/GU - Is urine output adequate?

- Is serum creatinine rising? What is the estimated

creatinine clearance?

- Are all drugs dosed appropriately for renal

function?

- Is the patient continent? Incontinent?

- Does patient have foley catheter inserted? Date

foley inserted?

114

- Any indications of UTI? Is urine cloudy?

Odorous? Dysuria?

- Is this drug induced?

Endocrinology - Is the serum blood sugar appropriate?

- Any indication of hypothyroidism?

- Was patient receiving steroids prior to

admission?

Dermatology - Any sign of skin breakdown on sacrum or

buttock?

- Does patient have circulatory problems?

- Is patient immobile?

- Does patient have impaired sensation?

- Any sign of rash? Itching? Lesions? Abnormal

bruising?

Jaundice? Edema?

- Is this drug induced?

OB/Gyne - Could patient be pregnant?

- Is patient using any form of contraception?

- Any abnormal discharge? Bleeding? Sores?

Itching?

Vital Signs and

Pertinent Labs

- Is the temperature normal? WBC normal?

- BP? HR?

- Platelets?

- Hemoglobin?

- Liver tests?

- Electrolytes within normal range?

- Is this drug induced?

3) Determination of desired therapeutic outcomes

(goals):

I.e. what is the desired outcome for the primary problem

in this patient?

Outcome: Cure of disease, elimination or reduction of

symptoms, arresting or slowing of disease process,

preventing a disease or symptoms.

115

Most therapeutic goals relate to:

a) Approach normal physiology (i.e., normalize

blood pressure).

b) Slow progression of disease (i.e., slow progression of

cancer).

c) Alleviate symptoms (i.e., optimize pain control).

d) Prevent adverse effects.

e) Control medication costs.

f) Educate the patient about his or her medication.

4) Development of the pharmacy care plan:

The pharmaceutical care plan is implemented with the

agreement of the patient and in cooperation with other

members of the health care team.

5) Specify monitoring parameters with end points

and frequency.

Monitoring parameter: is the information do you need

to evaluate that the drug therapy is producing the desired

outcome.

End point: achievement of therapeutic outcome. If

outcomes are not achieved, the care plan should be

reviewed.

6) Documentation:

a) SOAP note:

In the SOAP note format, the subjective (S) and

objective (O) data are recorded and then assessed (A) to

formulate a plan (P).

116

Subjective data include patient symptoms, information

obtained about patient. Much of the subjective

information is obtained by speaking with the patient.

Objective data include the physical examination and

other relevant information includes laboratory values,

serum drug concentrations (along with the target

therapeutic range for each level), and the results of other

diagnostic tests (e.g., ECG, x-rays, culture and

sensitivity tests).

The assessment (A) outlines what the pharmacist thinks

the patient’s problem is, based upon the subjective and

objective information acquired.

Plan (P): the action proposed to resolve the drug related

problem.

b) FARM note:

Findings (F): include Demographic data, symptoms of

disease, and physical examination data (i.e. subjective

and objective data).

Assessment (A): includes the pharmacist evaluation to

the situation (i.e., the nature, extent, type, and clinical

significance of the problem).

Resolution (R): include the action proposed to resolve

the drug related problem.

Monitoring (M): Follow up of the patient using

monitoring parameters which assess the efficacy of

resolution. For example, rather than stating monitor for

GI complaints, the recommendation may be to question

the patient about the presence of dyspepsia, diarrhea, or

constipation. The frequency, duration (the time of

monitoring), and target endpoint for each monitoring

parameter should be identified.

117

For example, in the case of a patient with dyslipidemia:

- Goal: LDL of <100.

- Monitoring parameters: obtain fasting HDL, LDL, total

cholesterol, and triglycerides.

- Duration: after 3 months of treatment.

118

This table shows examples for certain cases and their resolutions

Assessment Therapeutic

Goal(s)

Plan Monitoring Plan

Community

Acquired

Pneumonia

Resolution of

infection

- Provide nasal O2 - Add antibiotic

- Follow up with the

patient to evaluate

cough, SOB

- WBC

- Respiratory rate

COPD

Exacerbation

COPD: chronic

obstructive

Pulmonary

disease

Prevent &

control

episodes of

respiratory

distress

Oxygen

Suggest to physician

inhaled steroid

medication and

bronchodilator

Follow up with the

patient to evaluate

SOB, Heart rate

Diabetes

Blood sugars <

150

- New case:

Antidiabetic drug

- Old case: replace the

drug or ad another drug

- If the patient takes

insulin, adjust the dose

- Control of diet and

drinks

- practice exercise

Glucose tests

Hyperlipidemia

Control

cholesterol

with LDL<70

to help reduce

cardiac risk

- new case:

Antihyperlipidemic

drug

- old case: replace the

drug or ad another drug

- control of diet

- measurement of blood

pressure and ECG

- Obtain fasting HDL,

LDL, total

cholesterol, and

triglycerides.

119

Illustrative cases study:

1) Mrs J, aged 45 years, has recently been diagnosed

with asthma, following reversibility testing with a short-

acting bronchodilator. Her relevant medical history

includes osteoarthritis and hypertension. Her blood

pressure was recently measured as 170/ 110 mmHg. Mrs

J smokes 30 cigarettes a day and does no physical

exercise. Previous drug therapy of bendroflumethiazide

2.5 mg in the morning was ineffective for hypertension.

Her current drug therapy is as follows:

Paracetamol 500 mg 2 as required up to 8 in 24 hours

Propranolol 40 mg three times daily

Salbutamol metered dose inhaler (MDI) 2 puffs as

required, MDI = metered-dose Inhaler.

Budesonide turbo (dry powder inhaler) 200 mcg twice

daily

On the basis of your information, use the FARM

format to document the problem.

Peptic Ulcer

Avoidance of

Stress Ulcer

and PE/DVT

- new case: anti-ulcer

drug

- old case: replace the

drug or ad another drug

- Smoking and caffeine

drinks cessation

- Control of diet

- Test for H.pylori

- Stop analgesics and

other medicines cause

gastric irritation

- getting away of

stresses

Follow up with the

patient to evaluate GI

Complaints

120

Findings Assessment Resolution

1- Patient profile:

Name, address,

city, telephone,

birthrate, height,

weight, sex, race

(white).

Allergies: -

Diagnosis: asthma

osteoarthritis and

hypertension

Other information: smoker

-Ineffective

therapy for

hypertension

- Osteoarthritis

- Asthma

- Smoking cessation

- Stop Propranolol,

ineffective and causes

bronchconstriction

- Suggest to physician

to add new

antihypertensive drug

- Lifestyle changes to

reduce blood pressure

include; reduced

alcohol intake,

reduced weight if

obese, reduced salt

intake and regular

physical exercise

- Suggest to physician

to add calcium

supplements

Monitoring: Follow up with the patient to evaluate blood

pressure

2) Margaret Jones is a 62 year old woman seen on

rounds Monday morning. She was admitted the previous

evening with complaints of shortness of breath, fever,

and cough productive of greenish sputum. She has a

history of type 2 diabetes, mild CHF, and is S/P MI. At

home, she is maintained on metformin 500 mg po BID,

glyburide 10 mg po q AM, digoxin 0.125 mg po q AM,

warfarin 5 mg po q AM, aspirin 80 mg po q AM,

furosemide 80 mg po BID, and metoprolol XL100 mg

po q AM. The physical exam on admission revealed the

following findings:

VS: BP 168/88.

Chest: Crackles and rales on the left; e-to-a changes and

increased tactile fremitus over the left lower and middle lung

fields.

121

Sputum Gram stains: Gram-positive cocci in pairs.

CHF = congestive heart failure;

MI = myocardial infarction;

Po = oral;

q = every, per;

BID = twice daily.

On the basis of your information, use the SOAP

format to document the problem.

Patient profile:

Name (Margaret Jones), address, city, telephone, birthrate,

height, weight, sex, race (white).

Allergies:

Diagnosis: Probable community-acquired pneumonia (CAP)

Other information: diabetes, mild CHF, and is S/P MI

Subjective and

Objective

Assessment Plan

- productive of

greenish sputum

- Shortness of

breath (SOB)

- fever

- Probable

community-

acquired pneumonia

(CAP)

- Hypertension

- Diabetes,

- Mild CHF

- Provide nasal O2 if

appropriate for SOB

- Add antibiotic and

Mucolytic

- suggest to physician

to replace

metoprolol, causes

vasoconstriction

Monitoring (evaluation): Follow up with the patient to evaluate

cough, SOB, number of exacerbations, blood pressure, blood

glucose

122

3) Mrs Hedda Poplar is a 55-year-old white woman who

presents at the pharmacy with new prescriptions for

TheoDur and albuterol MDI. She was admitted the

previous evening with complaints of shortness of breath,

coughs at night and frequent exacerbations. Mrs Hedda

Poplar overweight and smokes cigarettes. Her blood

pressure was recently measured as 168/88. She had a

history of allergy to aspirin caused bronchospasm.

HRQOL = health-related quality of life; HRQOL is a

broad multidimensional concept that usually includes

self-reported measures of physical and mental health.

MDI = metered-dose Inhaler;

PCP = pharmaceutical care plan;

PEFM = peak expiratory flow meter;

PEFR =peak expiratory flow rate;

SOB = shortness of breath.

BP = Blood pressure

On the basis of your information, use the SOAP

format to document the problem

123

Patient profile

Name (Hedda Poplar), address, city, telephone, birthrate,

height, weight, sex, race (white).

Allergies: Aspirin (bronchospasm)

Diagnosis: asthma

Other information: smoker, obese

Subjective and

Objective

Assessment Plan

- Night cough

- Shortness of

breath (SOB)

-Frequent

exacerbations

- high blood

pressure

- Poor asthma

control may be

aggravated by

smoking, obesity

and

- High blood

pressure

- smoking cessation

- Dietitian

- Check blood

pressure frequently if

still high, suggest to

physician to add

antihypertensive drug

-Lifestyle changes to

reduce blood

pressure include;

reduced alcohol

intake, reduced

weight if obese,

reduced salt intake

and regular physical

exercise.

- Suggest to

physician to add

inhaled corticosteroid

Monitoring (evaluation): Follow up with the patient to evaluate

cough, SOB, number of exacerbations, blood pressure

124

Study cases

1) Mr Thomson, a 32 year old asthmatic who is well

known to you comes into your pharmacy. He is known

to have a best peak flow of 640 L/min. He tells you that

over the last few weeks he has been wakening up once

or twice a week coughing, and he is using his salbutamol

inhaler a couple of times a day. He has recorded his

morning and night-time peak flows these have averaged

580 L/min and 540L/min respectively. He has recently

changed his job and is now working in the open air

rather than in an office. His PMR shows that he has been

maintained on salbutamol MDI, 2 puffs as required

beclometasone 100 MDI, 2 puffs twice a day (recently

changed to non CFC (Clenil Modulite) for the last four

years. He also buys antihistamine tablets from you

during the summer. His prescription today is for a

Seretide® MDI 50, 2 puffs twice a day.

- Based on the information available construct a care

plan for Mr Thomson. He is under pharmacist care

for his asthma. Include in the plan the immediate

management of the patient and the monitoring you

would carry out to ensure that the patient is

benefiting from your plan.

2) You are asked to dispense a prescription for Angela,

age 10 years, for salbutamol MDI, 2 puffs when required

Seretide® 50 Evohaler, 2 puffs twice daily Angela has

been a patient of your pharmacy since she was a small

child and has suffered from eczema and hay fever since

she was 3 years old. Two years ago she was diagnosed

with asthma and her GP has commenced this

prescription. You know that she has been referred to the

local hospital to see the respiratory pediatrician as her

125

asthma was not controlled on Seretide 50, 2 puffs twice

a day. She saw the hospital pediatric respiratory

consultant last week.

-Construct a care plan for this child. In the care plan

you should include prescribing, monitoring and

follow-up for Angela. Indicate when you would

expect to see her gain and how often she should

attend for follow-up. What other health-care

professionals would you involve in the care of this

patient?

3) Mrs White, a 35 year old woman who is 28 weeks

pregnant, comes in to your pharmacy on a Saturday

afternoon with a repeat prescription for a terbutaline

turbohaler. She last received a prescription for

terbutaline 10 days ago and on that occasion received 2

turbohalers. From your PMR you note that at the same

time she was also prescribed: Symbicort®

100/Turbohaler 2 doses twice daily. On questioning Mrs

White regarding her symptoms she says her asthma is

usually worse at this time of year. She has used her last

two terbutaline turbohalers and that although you

dispensed the Symbicort® she has not been using these

for the last six months as she was concerned about the

effect that the corticosteroids may have on her unborn

child. She has been using up all the terbutaline inhalers

that she had at home and is now wheezy. Mrs White is

breathless.

What is the immediate care that Mrs White

requires? How can this be delivered? Construct a

care plan for Mrs White to deal with her

breathlessness. Include in this recommendations for

prescribing and monitoring

126

Chapter Seven: the prescription

Definition:

A prescription is a written order from a registered

physician, dentist or veterinarian or surgeon or any other

person licensed by law to prescribe medicine containing

instructions for preparing and dispensing. The

pharmacist may accept the prescription by telephone in

case of emergency.

Requirements of prescription: The prescription

should:

1) Be written in ink.

2) Not have over-writing.

3) Be legible.

4) Have only official weight and measure

abbreviations.

5) Contain drug generic name as far as possible.

6) Not have drug abbreviations (should have full

name).

Parts of prescription:

1- Superscription:

This part is consisting of name, qualification and

the address of the physician. It should also contain date,

name, age and address of patient. Rx symbol is a

characteristic symbol of prescription superscription

which originated from Latin verb “recipe” meaning "you

take". Some historians believe this symbol originated

from the sign of Jupiter, employed by the ancients in

requesting aid in healing. It directs the pharmacist to

take the prescribed drugs in their given quantities to

prepare the medication.

127

Information of physician is essential especially in

narcotic prescriptions to ascertain the prescriber and

avoid drug abuse.

The date is essential for:

a) Judging the interval between issue of prescription

and that of dispensing it.

b) Identifying the date of prescribing the medicine to

evaluate the case improvement in physician

reports.

2- The inscription:

This is the body or principal (medical) part of the

prescription order. It contains the names and quantities

of the prescribed ingredients. Today, the majority of

prescriptions contain the dosage forms supplied by

industrial manufacturers directly without needing of

compounding.

3- The subscription:

This part of the prescription consists of directions

to the pharmacist for preparing the prescription into a

suitable dosage form to be used by the patient. The

subscription serves merely to designate the dosage form

(as tablets, capsules, etc) and the number of dosage units

to be supplied.

4- Transcription:

The prescriber indicates the directions for the

patient's use of the medication in the portion of the

prescription called the Signature. The word usually

abbreviated "Signa" or "Sig" meaning write or let to be

written.

128

The directions are transcribed by the pharmacist

onto the label of the container of dispensed medication.

These directions frequently include the best time to take

the medication, the importance of adhering to the

prescribed dosage schedule, the permitted use of the

medication with respect to food, drink and other

medications the patient may be taking as well as

information about the drug itself.

5- Signature:

The name of the prescriber may be given as an

official signature.

TYPES OF PRESCRIPTIONS

1- Simple Prescription:

It is the prescription which contains the active

ingredients to treat a definite disease.

2- Compound Prescription:

It is the prescription which mainly contains four

parts and the pharmacist is responsible for compounding

it in the pharmacy. The parts are:

a) The base or basis is the main active constituents.

The base is responsible for the main pharmacological

effects while the other ingredients may have or not.

b) The adjuvant is that substance that assists the bases

and improves its activity.

c) The corrective is that substance added to qualify the

action of the basis and the adjuvant. Correctives are used

to make other drug less irritating or to serve as flavoring

agent, e.g., mask the odor and taste.

129

d) The vehicle is added to dilute the active constituents

to a reasonable dose so that the patient can take the dose

by household measures. In mixtures, the vehicle is some

material that is usually devoid of therapeutic activity and

simply acts as a diluent. It may be distilled water;

aromatic water, infusion or decoction. It forms the

medium which the substances are dissolved or

suspended. Sometimes it may have an auxiliary medical

action. In some cases the vehicle may has a preservative

or sweetening effect e.g. chloroform water. It has a

flavoring effect such as peppermint water, anise water...

etc.

3- Narcotic Prescription

It is that prescription which contains a narcotic

substance or contains other habit forming drugs. It must

include, in addition to the contents of the simple

prescription; (a) the address of the patient, (b) The

130

narcotic registry number of the prescriber if he requires

it in his clinic, hospital or maternity.

Such proscription should be:

(a) Written by ink or typewriter,

(b) The quantities of the narcotic substance must be

written in words and numbers,

(c) The prescription should be stored in a special file

which must be opened all times for inspection by the

proper authorities.

131

Handling the Prescription

I. Receiving the prescription:

1. The pharmacist, personally, must receive the

prescription from the patient or the person who

represents the prescription for the patient.

2. The pharmacist can serve this capacity in more

dignified and more efficient manner than any other one

in the pharmacy.

3. It is the duty of the pharmacist to instill the out most

confidence in the individual presenting the prescription.

4. If the patient's name does not appear in the

prescription, the pharmacist should obtain this

information and if the prescription is intended for a

child, the age of the patient for whom the medicine is

intended should be recorded in the prescription.

5. Some of the large pharmacies use claim check system

to prevent mistakes in the identity of the prescriptions.

The check book consists of three sections each bearing

the same number, one part is given to the customer, the

second part is attached to the prescription and the third

part to the final container.

6. Careful examination of the prescription should be

attempted only behind the counter. In this way if there is

any doubt concerning reading of the prescription

ingredients or directions or if it appears that an error has

been made in writing it, there is an opportunity to

examine it more closely and if necessary to consult other

pharmacists or the prescriber without arousing fear or

doubt on the part of the customer.

132

II. Reading and checking the prescription:

a) Legibility of the prescription:

1. The prescription order should be read completely and

carefully: there should be no doubt as to the ingredients

or quantities prescribed.

2. The pharmacist should determine the compatibility of

the newly prescribed medicament with other drugs being

taken by the patient. Most prescription computer

software programs identify possible drug interactions.

3. Should the probability or likelihood of a drug

interaction exist, the pharmacist should consult with the

prescriber to determine therapeutic alternatives.

4. The same would apply when a medication is

prescribed for a patient with a known drug allergy or

sensitivity to the drug prescribed or to other drugs of the

same chemical class.

5. If something is illegible or if it appears that an error

has been made, the pharmacist should consult another

prescriber.

6. A pharmacist should never guess at the meaning of an

indistinct word or unrecognized abbreviation.

7. Abbreviations must be translated with caution. Thus

“Merc. Chloride” may be referred to mercurous chloride

a laxative or mercuric chloride an antiseptic, a substance

which is highly poisonous if taken internally. Also

“Barium Sulph.” may refer to barium sulphate or

poisonous barium sulphide used externally.

8. Legibility is a problem requiring alertness and critical

judgment on part of pharmacist.

b) Dosage:

1. The amount and frequency of a dose of each drug in a

prescription should be checked carefully by the

pharmacist before he proceeds to fill the prescription.

133

2. It should be known that, in the event of injuries or

fatalities from prescriptions containing over doses, the

pharmacist can be held criminally liable.

Factors affecting dosage and calculations:

They are those factors which the pharmacist should take

into consideration in judging the danger or the safety of

a dose of medicine which are:

1) Age, weight and body surface area (B.S.A.):

Age is important because infants, children and old

people require smaller dose than that of adults. There are

a number of methods for calculating the fractional part

of the average adult dose which an infant or child can

take safely.

“Fried's Rule" which has been recommended for

calculating doses for infants based on the assumption,

that an adult dose of a drug can be tolerated safely by a

child when he reaches the age of 150 months. Therefore:

Infant's dose = Age in months × adult dose/150

Two other formulas which are based on age of the

patient and which have been used for calculating doses

for children are Dr. Young's Rule and Dr. Cowling's

Rule

Dr. Young's Rule: child dose = Age in years × adult

dose/ (Age in years+12)

Dr. Cowling's Rule is based on age in year at next

birthday (present age + 1).

134

Dr. Cowling's Rule: child dose = (Age in years +1)×

adult dose/ 24

Dr. Clark's Rule assumes the average weight of an

adult to be 150 pounds therefore:

Child dose or infant dose = (weight of child in pounds)

× adult dose/ 150

As a general rule, a naturally heavy individual can

withstand larger doses of medicines than a person of less

weight. Many physiological factors including; blood

volume, oxygen consumption, glomerular filtration as

well as requirements for electrolytes fluids and calories

are more closely related to B.S.A. than they are to body

weight, and the use of B.S.A. in calculation of pediatric

dosage as a fraction of the usual adult dose is preferable

to calculations on the basis of weight. The following

formula can be used to calculate pediatric doses from the

usual adult close.

Child dose or infant dose = (B.S.A. in meters square of

child) × adult dose/ (B.S.A. in meters square of adult;

1.7)

The formula is based on the 100 percent adult dose for

an individual weighing about 140 lb (about 54 kg) and

having B.S.A. about 1.7 m2. The body surface area of an

individual can be estimated from his height and weight

by certain monographs.

135

Geriatric patients may lack ability to metabolize and

excrete certain drugs because of impaired organ

function. Hence dosage of certain drugs for these

patients must be carefully considered. Old people of 70‐ 80 years old require 3/4 adult's dose. Those above 80

years old require half adult's dose.

136

2) Sex:

In general women require smaller doses than men. This

is due to smaller size and body weight of females

generally contains a higher percentage of fats than

males. Also some physiological factors make females

more sensitive to medicine.

3) Therapeutic purpose: The dose of the drug varies according to the therapeutic

effect e.g. quinine is given in small dose as a bitter

stomachic while the drug is given in its full dose for the

treatment or malaria. Also prophylactic doses are much

smaller than therapeutic doses.

4) Frequency of administration:

If the drug has a fleeting action there should be little

concern about the short intervals of time between doses.

On the other hand, many potent drugs when given

frequently for a sufficient length of time may get

accumulated in the body with frequent development of

pronounced toxic symptoms. This usually occurs with

drugs which are slowly excreted and especially if they

cannot be destroyed or detoxicated by the tissues, e.g. of

cumulative drugs digitalis, arsenic, thyroid. Frequency

of administration is often determined by the type of drug

action. Quick acting and rapidly eliminated drugs

(noncumulative) may be given more frequently than

those which are slowly eliminated and have prolonged

action (cumulative drugs).

5) Synergistic drugs:

When certain drugs are prescribed together, the

combined action produced is greater than the summation

of the individual effect such as aspirin and phenacetine,

this is called synergism. Sometimes, two or more

137

sulphonamides may be given together to reduce the

formation of crystaluria as the constituents of

sulphonamides can coexist in solution in water and urine

without affecting the solubility of each other. In such a

case each sulpha drug must be given in a reduced dose

and the total dose is similar to sulpha drug when given

alone (0.5 gm), for example:

Rx

Sulphadiazine 0.167 gm

Sulphamerazine 0.167 gm

Sulphamethacine 0.167 gm

Fiat: tab Mitte: xx

Sig. m.d.s

6) Time of administration:

Time at which the drug to be given may influence the

magnitude of its dose. For instance, sedatives are given

in their full therapeutic dose during day. When

ephedrine is used for bronchial asthma, its evening dose

should be reduced because it causes insomnia. If we are

obliged to give large doses at night it must be

accompanied by hypnotics.

7) Route of administration:

�Comparison of the oral doses of drug with parenteral

doses or rectal dose of the same drug shows that there is

no valid rule can be established for predicting parenteral

or rectal dose of a drug from the oral dose.

� Drugs which are absorbed completely from the

gastrointestinal tract will probably have equal parenteral

and oral doses, where as drugs which are poorly

absorbed by oral route will have smaller doses

parenterally than orally.

138

� Sometimes drugs, which are poorly absorbed, can be

given by oral and all parenteral routes (subcutaneous,

intramuscular and intravenous). In such a case a

subcutaneous injection dose is 3/4 oral dose,

intramuscular dose is about I/2 and intravenous is about

1/3 the oral dose. Rectal doses are somewhat larger than

oral dose.

� The pharmacist must know the range of safe and

effective dose for the prescribed route. Since many

drugs cannot be administered safely by all parenteral

routes, the pharmacist should also make certain that the

prescribed route of administration is safe for the

particular drug.

8) Pharmaceutical dosage form (vehicle and degree of

subdivision):

The vehicle of a prescription or the degree of

subdivision of a solid drug in a particular dosage form

affects the safety and the therapeutic efficacy of the

prescription. If polyethylene glycol is used as the base

for an ointment containing benzoic and salicylic acid,

the concentration of the acids should be only half what

they would be if a hydrocarbon ointment base were

employed, because the acid are more active in the

polyethylene glycol base than they are in the

hydrocarbon base.

The degree of subdivision of an active drug also may

affect its therapeutic activity and potential toxicity.

Again using an ointment as an example, if polysorbate

80 (tween 80) is mixed with coal tar prior to

incorporation of coal tar into the ointment base, a lower

concentration of coal tar must be prescribed. This is due

139

to the fact that the subdivision of coal tar with

polysorbate 80 results in a more pronounced action on

the skin.

9) There are many factors concerning the safety of a

given dose which the physician alone has the

opportunity of knowing:

1) A nervous person usually requires a greater quantity

of sedative than a normal person,

2) A phlegmatic person usually requires a quantity of

stimulant that seems abnormally large,

3) A patient may have developed a tolerance for certain

drugs and consequently needs abnormally large doses

for the desired effect,

4) There may be an unusually large amount of pain

accompanying the condition and abnormally large doses

of narcotic may be required.

5) These are some of the characteristics pertaining to the

patient which only the physician knows. When he writes

the prescription, he could underline the drug and the

quantity to direct the pharmacist’s attention to the fact

that he is aware of the unusual dose he has called for.

III. Compounding the prescription

Compounding the prescription is the most important

phase in handling the prescription; all other phases are

worthless unless the proper drug in suitable form is

dispensed. Accuracy is an essential quality which must

be stressed on continuously. The intimate precision of

any prescription will depend on the summation of the

following factors:

a) Proper weighing and volumetric equipment.

b) Proper technique of weighing and measuring.

c) Proper arithmetic operations.

140

d) Knowledge of physical and chemical properties of

chemicals and drugs involved.

e) Knowledge of and technique in handling various

dosage forms.

f) Proper devices of measuring prescription dosage.

� Prescriptions should be filled one at a time with

undivided attention. Attempting to fill two or more

prescriptions at the same time is an invitation to the

most serious mistake of all that is dispensing the wrong

drug.

� Two unlabelled containers on the counter likewise

suggest the possibility of reversal during labeling.

� When interruptions occur during the compounding

procedure, it is best to stop until the interruption is over.

� Some pharmacists prefer to type the label first; others

prefer to type the label after the prescription has been

compounded. It is advantageous to type the label first

and check it for accuracy before attaching it to the final

container.

� The label on the stock bottle should be read at least

three times: once when the bottle is taken from the shelf,

again, when the contents are removed during

compounding, and finally, when the bottle is returned to

the shelf.

� The type of product and general order of mixing must

be definitely in mind before beginning the compounding

procedure.

To start in a haphazard manner or mix the ingredients in

the order specified on the prescription without

considering all ingredients and all factors often result in

an unsatisfactory preparation.

141

IV. Finishing the Prescription: Includes:

a) Selecting the container,

b) Preparing the label, and

c) Checking the product.

Importance of careful finishing: Although the accuracy

with which the ingredients are compounded is,

doubtless, of greatest importance to the patient. The

manner with which the prescription is finished is the

usual criterion by which the quality of the prescription is

judged. Even though a pharmacist exercises the most

scrupulous care in filling a prescription, he may fail to

receive proper credit in the eyes of the patient if the

prescription is dispensed in a cheap or unsuitable

container or if there is careless labeling or other

suggestions of sloppy work.

The completed prescription represents the highest skill

of the medical and pharmaceutical profession, and it

should be dispensed in packages that convey an idea of

its value to the patient.

Choice of the container:

Selections of containers for prescription medication

should receive special care and attention. In making a

selection, the pharmacist should choose the container

that:

a) Protects the efficacy of the medication during the time

of its use.

b) Allow convenient and proper use of medication.

c) It is the most suitable type for the particular dosage

form and the quantity dispensed.

d) Represents through its appearance the care employed

in preparing the medicine.

142

Containers are available in a variety of size, shape,

colors and compositions. It may be oval prescription

bottles, round vials, dropper bottles, ointment jars, sifter

top boxes. Most containers are colorless or colored

either amber or green glass or plastic. The choice of the

container is based, first of all, on the type of the

preparation to be dispensed e.g. liquids of low viscosity

are dispensed in oval prescription bottles, liquids of high

viscosity in wide mouth bottles, ointments in wide

mouth jars, dropper bottles are used for dispensing

ophthalmic, oral, nasal or otic preparations.

The chosen container should be approximately the same

volume as the dispensed medication. The container must

be capable of preserving the medicine at least for the

period which it should be used.

Choice of the label

� It is important to remember that patient judge

prescription medication by the finished product

presented to him.

� If the label and the container are not neat and

professional in appearance, the patient may conclude

that the prescription medication was compounded in a

careless manner. This may result in loss of confidence in

the pharmacy.

� Since the label is an important factor in the

appearance of the finished prescription, it is important to

use label of high quality.

� The size of the label should be proportionate to the

size of the container.

� Special directions or cautions are often indicated on

the container by attaching a small printed, auxiliary label

containing such phrases "for external use only", "Shake

well before using", "Store in a refrigerator”

143

Checking the product

� After the prescription has been prepared and labeled,

it should be carefully checked before it is allowed to

leave the prescription department.

� A good system of checking is necessary to ensure

accuracy, quality and safety of prescription. It is

preferable to have the finished prescription checked by a

pharmacist other than the compounder.

� The contents of the container should be examined for

color, odor and other evidence of correctness and

quality.

� If only one pharmacist is on duty, the compounder

must serve as his own checker. The procedure is the

same, but a greater degree of alertness is required

because a mistake in more likely to be repeated.

V. Delivering the prescription

� Since the first impression is given by the exterior of

package, care should be taken to wrap the prescription

so that it will have a neat and dignified appearance.

� Wrapping paper should be of good quality and plain

white in color.

� The wrapping is usually secured by sticking tape.

� A prescription is delivered directly to the customer,

because there will be an excellent opportunity for the

pharmacist to make sure that the customer fully

understands how the medication is to be used.

� Attention should be called to any special precautions

that must be observed such as protection from light or

storage in a refrigerator, color change and expiration

date.

� A special warning should be given if the drugs is

expected to color the urine prevent alarming the patient.

144

Chapter Eight: Drug Incompatibilities

Incompatibility is defined as undesirable change taking

place in physical, chemical or therapeutic properties of

medicament when two or more than two ingredients are

mixed together.

Types of incompatibilities:

(A) Therapeutic incompatibilities: arise from mixing

drugs or doses which lead to modification of therapeutic

effect. It is the responsibility of physician. However, the

pharmacy should be aware and inform the prescriber

before compounding.

(B) Physical incompatibilities: are those in which the

physical properties of the ingredients process a mixture

unacceptable in appearance as immiscibility problems or

inaccuracy of dosage. Addition of water to oil without

any additives produces such problems. Eutectic mixtures

are also another example to physical incompatibility.

(C) Chemical incompatibilities: are those in which two

or more compounds react with each others to give a new

compound which may be toxic or inactive.

145

(A) Therapeutic incompatibilities: Occurs when the

drugs give different action, which may be intended or

unintended by the physician.

a) Intentional therapeutic incompatibilities:

If one drug has some desirable effects, and some

undesirable effects, it may be prescribed with drugs

which oppose the unwanted actions but don’t interfere

with desired effects. This happens as in prescribing

morphine as analgesic, physician may use atropine to

prevent an excessive depressant effect of morphine on

respiratory system.

b) Unintentional therapeutic incompatibilities: May be

classified as follow (causes):

1- Dosage error:

Causes: Overdose administration or too frequent

administration result dosage error.

Rx Atropine Sulphate 0.006 g.

Phenobarbital 0.360 g.

Ft. caps i mitte Xll

Sig. caps i t.d.s.

Problem: This represents 12 times the dose of atropine

and Phenobarbital, the physician no doubt intended that

the prescription be divided into 12 dose but wrote the

wrong directions.

146

Correction: It is necessary to call the prescriber and

request permission to correct the directions. (Atropine

sulphate 0.0005g, Phenobarbital 0.03g)

2- Additive and synergistic combinations:

Additive effect: occurs when two or more drugs having

the same effect are combined and the result is the sum of

the individual effects relative to the doses used. This

additive effect may be beneficial or harmful to the

client. For example; aspirin and acetaminophen when

taken together, the patient will gain the total effect of

both pain-killing drugs.

Synergistic effect: occurs when two or more drugs are

used together to yield a combined effect that has an

outcome greater than the sum of the single drugs active

components alone. For example; amphetamine with

ephedrine, both of the drugs are sympathetic stimulants

and this formulation will produce overdose effect.

Hence, the dose of individual drug should be reduced.

3-Antagonistic combinations: Prescribing two or more

antagonistic drugs resulting in no therapeutic effect,

where the drug actions cancel each other (e.g. Protamine

administered as an antidote to anticoagulant action of

heparin; caffeine (stimulant) with alprazolam (sedative)).

4-Drug drug interaction:

For example, Ketoconazole (antifungal) is interacted

with ranitidine (H2-blocker).

147

(B) Physical or pharmaceutical incompatibilities:

Main causes: Interaction between two or more

substances which lead to change in color, odor, taste,

viscosity and morphology.

Subsequent effects:

a) Immediate: When incompatibility occurs

immediately upon mixing as effervescence and

immediate precipitation.

b) Delayed: When incompatibility occurs at any time

later.

Types:

a) Intentional physical incompatibilities: This happens

as in prescribing tincture myrrh which is used as gargle

and precipitates by dilution with water. This precipitate

has more therapeutic effect than the soluble form in

treatment of tonsillitis.

b) Unintentional physical incompatibilities: May be

classified as follow:

1) Incomplete solubility or insolubility

(precipitation):

When two or more substances are combined, they may

not give a homogenous product owing to insolubility

and formation of precipitate occurs.

Examples:

- Silicones are immiscible with water.

- Gums are insoluble in alcohol.

148

- Resins are insoluble in water.

- Boric acid is precipitated from saturated solution of

tragacanth.

This type of physical incompatibility may be corrected

by one of the following solutions:

a) Addition of cosolvent.

b) Complex formation.

c) Reduction of particle size.

d) Changing pH.

Rx

Terpin hydrate 3.0

Simple syrup ad 120

Problem: The terpin hydrate is insoluble in syrup.

Correction:

a) Half of syrup may be substituted by alcohol.

b) Terpin may be suspended in other viscous vehicle

that retards precipitation and the bottle is labeled by

"shake the bottle".

Rx

Sulfamethoxazole 4.0 g

Trimethoprim 0.8 g

Purified water to 100 ml

Problem: Sulfamethoxazole and trimethoprim are

indiffusible in water.

149

Correction:

The drugs may be suspended in viscous vehicle that

retards precipitation by adding Na-carboxy

methylcellulose or other suspending agent.

Rx Ephedrine sulphate

Menthol

Liquid paraffin

Ephedrine sulphate is salt and soluble in water but

insoluble in paraffin.

Correction: paraffin is substituted by purified water.

Rx

Magnesium carbonate 3.75g

Sodium bicarbonate 7.50 g

Citric acid 7.50 g

Distilled water to 250ml

Problem: There is insufficient citric acid to neutralize

and solubilizing both of the carbonates. If citric acid is

reacted first with the sodium bicarbonate, some

magnesium carbonate will be insoluble and a suspension

will result.

Correction: by changing the order of mixing, not by

adding another substance(s). Magnesium carbonate is

firstly neutralized by mixing with citric acid then

sodium bicarbonate is added in the reaction mixture,

the solution is obtained.

150

2) Separation of immiscible liquids: When two or

more liquid substances are separating upon mixing

together.

For examples,

- Oils are separating upon mixing with water.

- Ethyl nitrate floats on the surface upon mixing with

potassium citrate.

Factors contributing immiscibility:

1. Incomplete mixing

2. Addition of surfactant with:

Unsuitable concentration

False time of addition

Unsuitable for the type of emulsion

3. Presence of microorganisms

Some bacteria grow on constituents of mixture i.e.

gelatin Arabic gum

Others produce enzymes which oxidize the

surfactant

4. Temperature

Storage must be in room temperature to prevent

separation

Rx

Castor oil 15ml

Distilled water 30ml

Ft. Solution

Problem: Oil and water do not mix.

Correction: Emulsification by adding suitable surface

active agent with appropriate concentration.

151

Rx

Chloral hydrate 15g

Sodium bromide 11.25g

Elixir aromatic q.a. ad 60ml

Problem: Chloral hydrate will be salted out by the

bromide in such prescriptions. Administration of

separated layer as one dose will produce toxicity.

Correction: Clear solution will be obtained upon

addition of more than 50% alcohol.

3) Liquefaction of solids (Eutaxia):

Definition;

Liquefaction of solid ingredients when mixed together in

dry state and conversion into liquid state takes place.

Causes:

a) Formation of eutectic mixture:

The term eutectic mixture is applied when 2 powders are

mixed together in certain ratios to give the lowest

melting point and converted to liquid e.g. a mixture of

45% camphor and 55% salol.

Eutectic mixture is a mixture of two powders of lower

melting point than individual powders.

152

Rx Thymol 250mg

Menthol 2mg

Camphor 2mg

Problem: Eutectic mixture.

Correction: Add equal quantity of starch, triturate

separately and mix at the end.

Rx Aminopyrine 300mg

Acetyl salicylic acid 200mg

Codiene 1.3g

Problem: Eutectic mixture (aminopyrine and acetyl

salicylic acid).

Correction: Add adsorbent such as light magnesium

oxide, magnesium carbonate and kaolin.

b) Liberation of water of hydration:

When hydrated crystals are mixed with dry crystals,

liquefaction occurs because crystalline water diffuses to

dry crystals.

4) Incorrect formulation:

Prescription itself may contain false formulation. A

physician may prescribe an alkaloidal salt to be

dissolved in liquid petrolatum, or an alkaloid to be

dissolved in water.

153

C) Chemical incompatibilities:

It exists when the ingredients of a prescription undergo a

chemical reaction whereby their original composition is

altered or it may be the result of:

1) Oxidation.

2) Hydrolysis.

3) Polymerization.

4) Isomerization.

5) Decarboxylation.

6) Absorption of CO2.

7) Combination reactions.

8) Formation of insoluble complexes.

The occurrence of these reactions is sometimes,

manifested by change of color, evolution of gas or by

precipitation.

1) Oxidation:

Oxidation is defined as loss of electrons or gain of

oxygen.

Auto-oxidation is a reaction with oxygen of air which

occurs spontaneously without other factors.

Pre-oxidants are substances catalyze oxidation process

i.e. metals, some impurities.

Factors lead to oxidation:

a. Presence of oxygen.

b. Light: it can cause photo-chemical reactions:

chemical reaction occur in presence of light.

c. Temperature: elevated temperature accelerates

oxidation reaction.

154

d. PH: each drug has its ideal pH for stability. Any

change in pH affects drug stability and may

accelerate oxidation reaction.

e. Pharmaceutical dosage form: oxidation reaction

occur in solutions faster than in solid dosage

forms.

f. Presence of pre-oxidants as metals and

peroxides.

g. Type of solvent used: oxidation reaction occurs

faster in aqueous solution than others.

h. Presence of unsaturated bonds: as double and

triple bonds (oils) which undergo easier than

saturated bonds (margarine) for oxidation.

Protection of drugs from oxidation:

a. Addition of Antioxidants: Vitamin E, vitamin C

and inorganic sulfur compounds; thiosulfate and

polysulfide.

b. Addition of chemicals which form complexes

with metals i.e. EDTA, Benzalkonium chloride.

c. Protection from light:

Using of dark container

Storage in dark places

Packaging with substances which absorbed

light i.e. Oxybenzene

d. Choice of suitable pharmaceutical dosage

forms which reduce the possibility of oxidation

process (solid dosage forms are better than

solutions)

e. Maintenance of pH by using buffer solution.

f. Choice of suitable solvent (rather than water).

g. Storage in low temperature.

h. Protection from air by:

Using good closed containers.

155

Replacement of oxygen by nitrogen.

2) Hydrolysis:

A chemical reaction in which water is used to break

down a compound; this is achieved by breaking a

covalent bond in the compound by inserting a water

molecule across the bond.

Types of hydrolysis:

a) Ionic hydrolysis:

- In which the compound is broken into ions by water.

- The covalent bond between ions of compound is

broken down.

- It is reversible Ex: Codeine phosphate Codeine +

Phosphate

- This type takes place spontaneously

- Most affected are weak bases and salts.

b) Molecular hydrolysis:

- In which the molecule itself is broken down.

- It is a slow process and irreversible.

- It must be avoided.

- Acetylsalicylic acid Salicylic acid + Acetic

acid

- So there is no solution as dosage forms for Aspirin

156

Factors contributing hydrolysis:

a. Presence of water.

b. pH (as atropine: optimal pH=3.1-4.5).

c. High temperature (Problem by autoclave i.e.

procaine).

Protection from hydrolysis

a. Protection from moisture by:

Packaging with substances impermeable for

moisture.

Addition of substances that absorb water

(CaCO3).

b. Using of solvent rather than water.

c. Maintenance of pH by using buffer system.

d. Formation of complexes: which protect the drug

from the effect of water?

e. Using of surfactants (micelle formation).

f. Reducing of solubility of substance (i.e. Suspension

instead of solution).

3) Polymerization:

In polymerization, small repeating units called

monomers are bonded to form a long chain polymer.

4) Isomerization: It means conversion of drug to its

isomer

- Isomers have either identical molecular formulas or a

different arrangement of atoms.

157

5) Decarboxylation: It is the removal of carboxylic

group.

6) CO2 – absorption: When some pharmaceutical

dosage forms contain CO2, precipitate is formed:

Ca (OH)2 + CO2 CaCO3

7) Combination: It takes place when the pharmaceutical

dosage form contains substances with different charges

such as surfactants with positive and negative charges.

8) Formation of insoluble complexes:

For example; tetracycline can form insoluble complex

with divalent cations as calcium.

Chemical incompatibilities may be classified into the

following types:

1) Formation of a precipitate:

Cause: Interaction between two substances to produce

an insoluble product.

Rx

Sodium salicylate 10g

Potassium iodide 2g

Potassium bicarbonate 4g

Water to 100ml

Problem: Sodium salicylate reacts with potassium

bicarbonate to form sodium bicarbonate (in excess)

which precipitates. Solution is also darkened due to

presence of salicylate in basic media.

158

Correction:

Refer back the prescription to prescriber to

dispense potassium bicarbonate separately.

Mix tragacanth powder with one of reacting

substances to one portion of vehicle and the

other portion with the other reacting

substances and mix both.

2) Effervescence (evolution of gas):

Cause: Prescriptions containing carbonates or

bicarbonates and acids such as citric, acetic and tartaric

acid usually effervesce on mixing. This incompatibility

can be overcome by allowing the reaction to complete in

an opened mouthed container.

3) Color change:

Cause: The color change is usually evidenced by a

chemical reaction.

For examples:

a) A laxative phenolphthalein is colorless in acid media

but purple in alkaline media.

b) A salicylate mixture acquires a reddish color or

pinkish color on keeping.

The color changes in such cases are of no significant

from the therapeutic point of view but it has a

physiological effect on the patient.

159

4) Production of poisonous substances:

Cause: Prescriptions containing substances which upon

chemical reaction a more toxic substance is formed.

For example; potassium iodide and calomel in presence

of moisture react to form toxic mercuric salt.

5) Gelatinization:

Solution may form gel upon combining with certain

substance.

For example; acacia solution is gelatinized by ferric salts

as acacia contains carboxylic group which may react

with trivalent ferric ion to form polymer chain.

4- Cementation

In some cases, prescriptions contain substances which

may produce cement like mass. This occurs when

compounds form hydrates polymerize or convert to new

crystal form.

160

Intentional incompatibilities:

1) Therapeutic intentional incompatibilities:

In many cases antagonistic combinations are intentional.

For example, one drug has some desirable effects and

some undesirable effects; it may be prescribed with

drugs which oppose the unwanted actions without

interfering with desired effects.

Thus, in prescribing morphine as analgesic, a physician

may use atropine to prevent an excessive depressant

effect of morphine on the respiratory center.

2) Chemical intentional incompatibilities:

Black wash contains glycerin, calomel and lime water.

Mercurous chloride with lime water gives a black

precipitate (HgO & Hg) which is desired in treatment of

syphilitic ulcers.

3) Physical intentional incompatibilities: Tincture

myrrh with water which is used as a gargle.

161

Chapter Nine: List of Pharmacy - Medical

Abbreviations &Terminology

1) List of pharmacy abbreviations:

A- Prescription Abbreviations:

Abbreviation Latin Meaning

aa ana of each

AAA - apply to affected area

a.c. ante cibum before meals

a.d. auris dextra right ear

ad lib. ad libitum use as much as one

desires; freely

admov. admove apply

agit agita stir/shake

alt. h. alternis horis every other hour

a.m.m. ad manu

medicae

at doctor's hand

a.m. ante meridiem morning, before noon

amp - ampule

amt - amount

aq aqua water

a.l., a.s. auris laeva,

auris sinistra

left ear

A.T.C. - around the clock

a.u. auris utraque both ears

BDS/bds bis die

sumendum

twice daily

bis bis twice

b.i.d./b.d. bis in die twice daily

B.M. - bowel movement

162

BNF - British National

Formulary

bol. bolus as a large single dose

(usually intravenously)

B.S. - blood sugar

B.S.A - body surface areas

b.t. - bedtime

BUCC bucca inside cheek

cap., caps. capsula capsule

c, c. cum with (usually written with

a bar on top of the "c")

cib. cibus food

cc cum cibo with food, (but also cubic

centimeter)

cf - with food

comp. - compound

cr., crm - cream

CST - Continue same treatment

D or d - days or doses

D5W - dextrose 5% solution

(sometimes written as

D5W)

D5NS - Dextrose 5% in normal

saline (0.9%)

D.A.W. - dispense as written (i.e.,

no generic substitution)

dc, D/C, disc - discontinue or discharge

dieb. alt. diebus alternis every other day

dil. - dilute

disp. - dispersible or dispense

div. - divide

dL - deciliter

163

d.t.d. dentur tales

doses

give of such doses

DTO - deodorized tincture of

opium

D.W. - distilled water

elix. - elixir

e.m.p. ex modo

prescripto

as directed

emuls. emulsum emulsion

et et and

eod every other day

ex aq ex aqua in water

fl., fld. fluid

ft. fiat make; let it be made

g - gram

gr - grain

gtt(s) gutta(e) drop(s)

H - hypodermic

h, hr hora hour

h.s. hora somni at bedtime

h.s - hour sleep or half-

strength

ID - intrademral

IJ, inj injectio injection

IM - intramuscular (with

respect to injections)

IN - intranasal

IP - intraperitoneal

IT - intrathecal

IU - international unit

IV - intravenous

IVP - intravenous push

164

IVPB - intravenous piggyback

kg - kilogram

L.A.S. - label as such

LCD - coal tar solution

lin linimentum liniment

liq liquor solution

lot. - lotion

MAE - Moves All Extremities

mane mane in the morning

M. misce mix

m, min minimum a minimum

mcg - microgram

m.d.u. more dicto

utendus

to be used as directed

mEq - milliequivalent

mg - milligram

mg/dL - milligrams per deciliter

MgSO4 - magnesium sulfate

mist. mistura mix

mitte mitte send

mL - milliliter

MS - morphine sulfate or

magnesium

MSO4 - morphine sulfate

nebul nebula a spray

N.M.T. - not more than

noct. nocte at night

non rep. non repetatur no repeats

NPO nil per os nothing by mouth

NS - Normal saline (0.9%)

1/2NS - Half normal saline

(0.45%)

165

N.T.E. - not to exceed

o_2 - both eyes, sometimes

written as o2

od omne in die,

right eye

every day/once daily

(preferred to qd in the

UK[5])

od oculus dexter right eye

om omne mane every morning

on omne nocte every night

o.p.d. -- once per day

o.s. oculus sinister left eye

o.u. oculus uterque both eyes

oz - ounce

per per by or through

p.c. post cibum after meals

pig. /pigm. pigmentum paint

p.m. post meridiem evening or afternoon

p.o. per os by mouth or orally

p.r. or PR per rectum by rectum

PRN, prn pro re nata as needed

pulv. pulvis powder

PV per vaginam via the vagina

q quaque every, per

q.a.d. quaque alternis

die

every other day

q.a.m. quaque die ante

meridiem

every day before noon

q.d./q.1.d. quaque die every day

q.d.s. quater die

sumendus

four times a day

q.p.m. quaque die post

meridiem

every day after noon or

every evening

166

q.h. quaque hora every hour

q.h.s. quaque hora

somni

every night at bedtime

q.1 h, q.1° quaque 1 hora every 1 hour; (can replace

"1" with other numbers)

q.i.d. quater in die four times a day

q4PM - at 4pm

q.o.d. - every other day

qqh quater quaque

hora

every four hours

q.s. quantum

sufficiat

a sufficient quantity

QWK - every week

PR - rectal

rep., rept. repetatur repeats

RL, R/L Ringer's lactate

s sine without (usually written

with a bar on top of the

"s")

s.a. secundum

artem

according to the art

(accepted practice); use

your judgment

SC, subc, subcut,

subq, SQ

- subcutaneous

s.i.d/SID semel in die once a day

sig signa write on label

SL - sublingually, under the

tongue

S.O.B, SOB - shortness of breath

sol solutio solution

s.o.s., si op. sit si opus sit if there is a need

ss semis one half or sliding scale

167

SSI, SSRI - sliding scale insulin or

sliding scale

regular insulin

SNRI

(antidepressant)

- Serotonin–nor

epinephrine reuptake

inhibitor

SSRI

(antidepressant)

- selective serotonin

reuptake inhibitor

(a specific class of

antidepressant)

stat statim immediately

SubQ subcutaneously

supp suppositorium suppository

susp - suspension

syr syrupus syrup

tab tabella tablet

tal., t talus such

tbsp - tablespoon

t.d.s./TDS ter die

sumendum

three times a day

t.i.d. ter in die three times a day

t.i.w. - three times a week

top. - topical

T.P.N. - total parenteral nutrition

tr, tinc., tinct. - tincture

troche trochiscus lozenge

tsp - teaspoon

U - unit

u.d., ut. dict. ut dictum as directed

ung. unguentum ointment

U.S.P. - United States

Pharmacopoeia

168

vag - vaginally

w - with

w/a - while awake

wf - with food (with meals)

w/o, s - without

X - Times

Y.O. - years old

B- List of measurement Abbreviations:

169

Abbreviation Meaning Abbreviation Meaning

TBSP TABLESPOON SL SUB-LINGUAL

TSP TEASPOON NG NASO GASTRIC

OZ OUNCE BUCCAL CHEEK/GUM

GM GRAM PR RECTALLY

KG KILOGRAM PV VAGINALLY

LB POUND SUPP SUPPOSITORY

ML MILLILITER TAB TABLET

L LITER CAP CAPSULE

G GALLON IM

INTRA

MUSCULAR

OD RIGHT EYE SQ SUB-

CUTANEOUS

OS LEFT EYE IV INTRAVENOUS

OU BOTH EYES IC INTRA

CARDIAC

AD RIGHT EAR INJ INJECTION

AS LEFT EAR STAT IMMEDIATELY

AU BOTH EARS

PO BY MOUTH /

ORAL

Approximate Measures:

Liquids

Exact equivalents

1 g = 15.43 grains

1 grain = 64.8 mg

1 mL = 16.23 minims

1 Minim = 0.06 mL

1 oz = 28.35 g

1 lb = 453.6 g (0.4536 kg)

1 kg = 2.2 lb

1 fluid oz (fl oz) = 29.57 mL

1 pint (pt) = 473.2 ml

1 quart (qt) = 946.4 ml

1 kg = 1000 g

1 g = 1000 mg

1 mg = 1000 mg

Roman Numerals

1 fl oz = 30 ml

1 cup (8 fl oz) = 240 ml

1 pint (16 fl oz) = 480 ml

1 quart (32 fl oz) = 960 ml

1 gallon (128 fl oz) = 3800 ml

1 teaspoon = 5 ml

1 tablespoon = 15 ml Approximate Measures:

Weights

1 oz = 30 g

1 lb (16 oz) = 480 g

15 grains = 1 g

1 grain = 60 mg Apothecary Equivalents:

Weight 1 scruple = 20 grains (gr)

170

C- List of pharmaceutical Abbreviations:

Abbreviation Meaning Abbrevia

tion

Meaning

APAP acetaminophen

OC

oral contraceptive

ASA aspirin

ORS

oral rehydration

solution

BC

Birth control. PB

Phenobarbital

Ca,Ca++

calcium

PCN

penicillin

CHF

congestive heart

failure

PNV

prenatal vitamin

Cl

chloride, chlorine

SR

slow release or

sustained release

CR

controlled release

TAC

triamcinolone

doxy

doxycycline

TCN

tetracycline

EC

enteric coated

TR

time release

60 grains = 1 dram

8 drams = 1 ounce

1 ounce = 480 grains

16 ounces = 1 pound (lb)

I = one

V = five

X = ten

L = fifty

C = one hundred

D = five hundred

M = one thousand

Apothecary Equivalents:

Volume 60 minims = 1 fluidram

8 fluidrams = 1 fluid ounce

1 fluid ounce = 480 minims

16 fluid ounces = 1 pint (pt)

171

EC,ASA

enteric coated

aspirin

XL

extended release

ER

extended release

XR

extended release

EtOH

(ethyl) alcohol

Zn, Zn++

zinc

Fe,FE++

iron

ZnSO4

zinc sulfate

FeSO4

ferrous sulfate

(iron)

Q C Quality Control.

HC

hydrocortisone

I Q C In process

Quality Control.

HCT

hydrocortisone or

hydrochlorothiazide

(careful)

Q A Quality

Assurance.

HCO3

bicarbonate

Q M Quality

Management

HCTZ

hydrochlorothiazide

G M P Good

Manufacturing

Practice

HS

half strength

G L P Good Laboratory

Practice

INH

ionized

GSP Good Storage

Practice.

K,K+

potassium

GPP Good Pharmacy

Practice

LA

long acting (time

released)

GCP Good Clinical

Practice.

Mg,Mg++

Magnesium

R & D Research and

Development

172

MgSO4

magnesium sulfate

(careful)

ISO International

Standard

Organization for

Quality Systems.

MOM

milk of magnesia

HPLC High

Performance

Liquid

Chromatography

MTX

methotrexate

(careful)

TLC Thin Layer

Chromatography

MVI

multivitamin

GC Gas

Chromatography.

Na,Na+

sodium

PTC Pharmacy and

Therapeutic

Committee.

NaCl,0.9%

Normal saline

GATT General

Agreement of

Trade and

Traffic.

NS,NSS

normal saline

CDER Center of Drug

Evaluation and

Research (FDA).

NSAID

non-steroidal anti-

inflammatory drug

CBER Center of

Biological

Evaluation and

Research (FDA).

NTG

nitroglycerin

173

2) Master List of medical Abbreviations:

Abbreviation Meaning Abbreviation Meaning

A&B

AAA abdominal aortic

aneurysm ASAP as soon as

possible

A-a

gradient

alveolar to arterial

gradient ASCVD atherosclerotic

cardiovascular disease

AAD antibiotic-associated

diarrhea ASD atrial septal defect

AAO alert, awake, and

oriented ASHD atherosclerotic heart

disease

A&O alert & oriented AV atrioventricular

AAS acute abdominal series A-V arteriovenous

ABD abdomen A-VO2 arteriovenous oxygen

ABG arterial blood gas ARDS acute respiratory

distress syndrome

AC before eating ARF acute renal failure

ACLS advanced cardiac life

support AS aortic stenosis

ACTH adrenocorticotropic

hormone BBB bundle branch block

ADH anti-diuretic hormone BCAA

branched chain amino

acids

ADR Adverse drug reaction. |

acute dystonic reaction BE barium enema

ad lib as much as needed BEE

basal energy

expenditure

AED antiepileptic drug bid twice a day

AF atrial fibrillation or a

febrile BKA

below the knee

amputation

AFB acid-fast bacilli BM

bone marrow or bowel

movement

AFP alpha-fetoprotein BMR basal metabolic rate

A /G albumin/globulin ratio BOM bilateral otitis media

AI aortic insufficiency BP

blood pressure

174

AKA above the knee

amputation BPH

benign prostatic

hypertrophy

ALD alcoholic liver disease BPM beats per minute

ALL acute lymphocytic

leukemia BRBPR

bright red blood per

rectum

amb ambulate BRP bathroom priviledges

AML acute myelogenous

leukemia BS bowel or breath sounds

ANA antinuclear antibody BUN blood urea nitrogen

ANS autonomic nervous

system BW body weight

AOB alcohol on breath BX biopsy

AODM adult onset diabetes

mellitus BW body weight

AP anteroposterior or

abdominal - perineal BX biopsy

C,D

c with CRCL creatinine clearance

C&S culture and sensitivity CRF chronic renal failure

CA cancer CRP C-reactive protein

Ca calcium CSF cerebrospinal fluid

CAA crystalline amino acids CT computerized

tomography

CABG coronary artery bypass

graft CVA

cerebrovascular

accident or

costovertebral angle

CAD coronary artery disease CVAT CVA tenderness

CAT computerized axial

tomography CVP

central venous

pressure

CBC complete blood count CXR chest X-ray

CBG capillary blood gas DAT diet as tolerated

CC chief complaint DAW dispense as written

CCU clean catch urine or

cardiac care unit DC

discontinue or

discharge

CCV critical closing volume D&C dilation and curettage

CF cystic fibrosis DDx differential diagnosis

CGL chronic granulocytic

leukemia D5W 5% dextrose in water

CHF congestive heart failure DI diabetes insipidus

175

CHO carbohydrate DIC

disseminated

intravascular

coagulopathy

CI cardiac index DIP distal interphalangeal

joint

CML chronic myelogenous

leukemia DJD

degenerative joint

disease

CMV cytomegalovirus DKA diabetic ketoacidosis

CN cranial nerves dL deciliter

CNS central nervous system DM diabetes mellitus

CO cardiac output DNR do not resuscitate

C/O complaining of DOA dead on arrival

COLD chronic obstructive

lung disease DOE dyspnea on exertion

COPD chronic obstructive

pulmonary disease DPL

diagnostic peritoneal

lavage

CP chest pain or cerebral

palsy DPT

diphtheria, pertussis,

tetanus

CPAP continuous positive

airway pressure DTR deep tendon reflexes

CPK creatine phosphokinase DVT deep venous

thrombosis

CPR cardiopulmonary

resuscitation DX diagnosis

E&F

EAA essential amino acids ERCP

endoscopic

retrograde cholangio

-pancreatography

EBL estimated blood loss ETOH

ethanol

ECG electrocardiogram EUA examination under

anesthesia

ECT electroconvulsive

therapy FBS fasting blood sugar

EFAD essential fatty acid

deficiency FEV

forced expiratory

volume

EMG Electromyogram

FFP fresh frozen plasma

176

EMV

eyes, motor, verbal

response (Glasgow

coma scale) FRC

functional residual

capacity

ENT ears, nose, and throat FTT failure to thrive

EOM extraocular muscles FU follow-up

ESR erythrocyte

sedimentation rate FUO

fever of unknown

origin

ET endotracheal FVC forced vital capacity

ETT endotracheal tube Fx fracture

G&H

GC gonorrhea HEENT head, eyes, ears,

nose, throat

GETT general by

endotracheal tube Hgb hemoglobin

GFR glomerular filtration

rate H/H

henderson-

hasselbach equation

or hemoglobin/

hematocrit

GI gastrointestinal HIV

human

immunodeficiency

virus

gr

Grain; 1 grain = 65mg.

Therefore Vgr =

325mg HLA

histocompatibility

locus antigen

GSW gun shot wound HJR hepatojugular reflex

gt or gtt drops HO history of

GTT glucose tolerance test HOB head of bed

GU genitourinary HPF high power field

GXT graded exercise

tolerance (Stress test) HPI

history of present

illness

HA headache HR heart rate

HAA hepatitis B surface

antigen HS at bedtime

HAV hepatitis A virus HSM hepatosplenomegaly

HBP high blood pressure HTLV-III

human lymphotropic

virus, type III (AIDS

agent, HIV)

177

HCG human chorionic

gonadotropin HSV herpes simplex virus

HCT hematocrit HTN hypertension

HDL high density

lipoprotein Hx history

I&J&K&L

I&D incision and drainage KUB kidneys, ureters,

bladder

I&O intake and output KVO keep vein open

ICS intercostal space L left

ICU intensive care unit LAD

left axis deviation or

left anterior

descending

ID infectious disease or

identification LAE left atrial enlargement

IDDM insulin dependent

diabetes mellitus LAHB

left anterior

hemiblock

IG immunoglobulin LAP

left atrial pressure or

leukocyte alkaline

phosphatase

IHSS idiopathic hypertropic

subaortic stenosis LBBB

left bundle branch

block

IM intramuscular LDH

lactate

dehydrogenase

IMV intermittent mandatory

ventilation LE lupus erythematosus

INF intravenous nutritional

fluid LIH left inguinal hernia

IPPB intermittent positive

pressure breathing LLL left lower lobe

IRBBB incomplete right

bundle branch block LMP last menstrual period

IRDM insulin resistant

diabetes mellitus LNMP

last normal menstrual

period

IT interthecal LOC

loss of consciousness

or level of

consciousness

178

ITP

idiopathic

thrombocytopenic

purpura

LP

lumbar puncture

IV intravenous LPN licensed practical

nurse

IVC

intravenous

cholangiogram |

inferior vena cava LUL left upper lobe

IVP intravenous pyelogram LUQ Left Upper Quadrant

JODM juvenile onset diabetes

mellitus LV left ventricle

JVD jugular venous

distention LVEDP

left ventricular end

diastolic pressure

KOR keep open rate LVH left ventricular

hypertrophy

M&N

MAO monoamine oxidase MVI multivitamin

injection

MAP mean arterial pressure

MVV

maximum voluntary

ventilation

MAST medical antishock

trousers NAD no active disease

MBT maternal blood type NAS no added salt

MCH mean cell hemoglobin NCV nerve conduction

velocity

MCHC mean cell hemoglobin

concentration NED

no evidence of

recurrent disease

MCV mean cell volume ng nanogram

MI myocardial infarction

or mitral insufficiency NG nasogastric

mL milliliter NIDDM

non-insulin

dependent diabetes

mellitus

MLE midline episiotomy NKA no known allergies

179

MMEF maximal mid

expiratory flow NKDA

no known drug

allergies

mmol millimole NMR nuclear magnetic

resonance

MMR measles, mumps,

rubella

NPO

nothing by mouth

MRI magnetic resonance

imaging NRM

no regular

medications

MRSA methicillin resistant

staph aureus NSAID

non-steroidal anti-

inflammatory drugs

MS

multiple sclerosis or

mitral stenosis, or

morphine sulfate NSR normal sinus rhythm

MSSA methicillin-sensitive

staph aureus NT nasotracheal

MVA motor vehicle accident

O&P&Q

OB obstetrics PMI point of maximal

impulse

OCG oral cholecystogram

PMN

polymorphonuclear

leukocyte

(neutrophil)

OD overdose or right eye PND paroxysmal nocturnal

dyspnea

OM otitis media PO by mouth

OOB out of bed POD post-op day

OOP out of plaster PP postprandial or pulsus

paradoxus

OPV oral polio vaccine PPD purified protein

derivative

OR operating room PR by rectum

OS left eye PRBC packed red blood

cells

OU both eyes PRN as needed

P para PS pulmonic stenosis

180

PA posteroanterior PT prothrombin time, or

physical therapy

PAC premature atrial

contraction Pt patient

PAO2 alveolar oxygen PTCA

percutaneous

transluminal coronary

angioplasty

PaO2 peripheral arterial

oxygen content PTH parathyroid hormone

PAP pulmonary artery

pressure PTHC

percutanous

transhepatic

cholangiogram

PAT paroxysymal atrial

tachycardia PTT

partial

thromboplastin time

P&PD percussion and postural

drainage

PUD

peptic ulcer disease

PC after eating PVC premature ventricular

contraction

PCWP pulmonary capillary

wedge pressure

PVD

peripheral vascular

disease

PDA patent ductus arteriosus q Every (e.g. q6h =

every 6 hours)

PDR physicians desk

reference qd every day

PE

pulmonary embolus, or

physical exam or

pleural effusion qh every hour

PEEP positive end expiratory

pressure q4h, q6h....

every 4 hours, every

6 hours etc.

PFT pulmonary function

tests qid four times a day

pg picogram QNS quantity not sufficient

PI pulmonic insufficiency

disease qod every other day

PKU phenylketonuria Qs/Qt shunt fraction

181

PMH previous medical

history Qt total cardiac output

R&S

R right RVH right ventricular

hyperthrophy

RA rheumatoid arthritis or

right atrium Rx treatment

RAD right atrial axis

deviation s

without | ss = one-

half

RAE right atrial enlargement SA sinoatrial

RAP right atrial pressure SAA synthetic amino acid

RBBB right bundle branch

block S&E sugar and acetone

RBC red blood cell SBE Subacute bacterial

endocarditic

RBP retinol-binding protein SBFT small bowel follow

through

RDA recommended daily

allowance SBS

short bowel

syndrome

RDW red cell distribution

width

SCr

serum creatinine

RIA radioimmunoassay SEM systolic ejection

murmur

RIH right inguinal hernia SG Swan-Ganz

RLL right lower lobe SGA small for gestational

age

RLQ right lower quadrant SGGT

serum gamma-

glutamyl

transpeptidase

RML right middle lobe SGOT

serum glutamic-

oxaloacetic

transaminase

RNA ribonucleic acid SGPT serum glutamic-

pyruvic transaminase

R/O rule out SIADH

syndrome of

inappropriate

antidiuretic hormone

ROM range of motion sig write on label

182

ROS review of systems SIMV

synchronous

intermittent

mandatory ventilation

RPG retrograde pyelogram sl sublingual

RRR regular rate and rhythm SLE systemic lupus

erythematous

RT respiratory or radiation

therapy SMO slips made out

RTA renal tubular acidosis SOAP subjective, Objective,

Assessment, Plan

RTC return to clinic SOB shortness of breath

RU resin uptake SQ subcutaneous

RUG retrograde urethogram STAT immediately

RUL right upper lobe SVD spontaneous vaginal

delivery

RUQ right upper quadrant Sx

Symptoms

RV residual volume

T&U&V

T&C type and cross UAC uric acid | umbilical

artery catheter

TAH total abdominal

hysterectomy UAO

upper airway

obstruction

T&H type and hold UBD universal blood donor

TB tuberculosis UC ulcerative colitis |

umbilical cord

TBG total binding globulin ud as directed

Td tetanus-diphtheria

toxoid UFH

unfractionated

heparin

TIA transient ischemic

attack UGI upper gastrointestinal

TIBC total iron binding

capacity URI

upper respiratory

infection

tid three times a day URQ upper right quadrant

TIG tetanus immune

globulin US ultrasound

TKO to keep open UTI urinary tract infection

TLC total lung capacity UUN urinary urea nitrogen

183

TMJ temporo mandibular

joint UVA ultraviolet A light

TNTC too numerous to count VAD venous access device

TO telephone order VC vital capacity

TOPV trivalent oral polio

vaccine VCT venous clotting time

TPN total parenteral

nutrition VCUG

voiding

cysourethrogram

TSH thyroid stimulating

hormone VDRL

Venereal Disease

Research Laboratory

(test for syphilis)

TT thrombin time VMA vanillymadelic acid

TTP

thrombotic

thrombocytopenic

purpura VO verbal or voice order

TU tuberculin units V/Q ventilation -

perfusion

TUR transurethral resection VRE vancomycin-resistant

enterococcus

TURBT TUR bladder tumors VSS vital signs stable

TURP transurethral resection

of prostate VT

ventricular

tachycardia

TV tidal volume VV varicose veins

TVH total vaginal

hysterectomy VW vessel wall

tw twice a week VWD von Willebrand's

disease

Tx treatment, transplant VZV varicella zoster virus

UA urinalysis

W&X&Y

WB whole blood X2d Times 2 days.

WBC white blood cell or

count XI eleven

WBR whole body radiation XII twelve

WD well developed XL Extended release.

Extra large.

WF white female XM crossmatch

WIA wounded in action XMM Xeromammography

184

WID widow, widower XOM extraocular

movements

WM white male XRT X-ray therapy

(radiation therapy)

WN well nourished XS excessive

WNL within normal limits XULN times upper limit of

normal

WO Written order | weeks

old | wide open. YF yellow fever

WOP without pain YLC youngest living child

W.P. whirlpool yo years old

WPW Wolff-Parkinson-White YOB year of birth

W-T-D wet to dry yr year

W/U workup ytd year to date

Z

ZDV zidovudine Zn zinc

ZE Zollinger-Ellison ZnO zinc oxide

Z-ESR zeta erythrocyte

sedimentation rate ZSB zero stools since birth

List of Pharmacy and medical terminology:

A) Pharmaceutical terminology:

Pharmacy: Derived from the Greek work pharmakon meaning

medicine or drug.

Dosage Form: The physical form in which a drug is administered

to or used by a patient.

Dosage Regimen: Is the systematized dosage schedule.

Drug Product: A dosage form containing one or more active

therapeutic ingredients along with other substances included

during the manufacturing process.

Dosage from Design: The conversion of a drug into a medicine.

Dose: Amount of drug which is taken each time. It should be safe

and effective.

Loading Dose (Initial Dose): The dose size used in initiating

therapy so as to yield therapeutic concentration which will result

in clinical effectiveness.

185

Maintenance Dose: The dose size required to maintain the

clinical effectiveness or therapeutic concentration according to the

dosage regimen.

Chemical Name: Name used by the organic chemist to indicate

the chemical structure of the drug.

Generic Name: The nonproprietary name, the name assigned to

the compound during early investigative stages.

Official Name: The name given to the drug in the pharmacopeia.

Brand Name: Trade name of the drug.

The LADME-System: Deals with the complex dynamic

processes of liberation of an active ingredient from the dosage

form, its absorption into systemic circulation, its distribution and

metabolism in the body and the excretion of the drug from the

body.

Intravascular Administration: Refers to all routes of

administration where the drug is directly introduced into the blood

stream, i.e., intra- venous, intra-arterial, and intracardial.

Extravascular Administration: Refers to all routes of

administration except those where the drug is directly introduced

into the blood stream.

Extravascular routes are: I.M., S.C., Oral, Rectal, I.P., Topical,

etc.,

Available Quantity: Is that quantity which is capable of

producing desired result and can be utilized.

Disintegration: The process that a solid drug product

disintegrates into small particles.

Dissolution: The process in which amount of active ingredient in

a solid dosage form dissolves under standardized conditions of

liquid/solid interface, temperature and media composition.

Bioavailability: The bioavailability of a drug is defined as its rate

and extent of absorption.

Absolute Bioavailability: The bioavailability of a drug product

as compared by I.V. administration.

Relative Bioavailability: The bioavailability of a drug product as

compared to a recognized standard of the same dosage form.

Comparative Bioavailability: The bioavailability of a drug

product as compared to a recognized standard of different dosage

form.

186

Bioequivalence: Comparable bioavailability indicates that two or

more similar dosage forms reach, the general circulation at the

same relative rate and relative extent.

Therapeutic Equivalence: comparable clinical effectiveness and

safety.

Bioinequivalence: Statistically significant difference in

bioavailability.

Therapeutic Inequivalence: Clinical important difference

in bioavailability.

Inactive Ingredient: Any component other than an active

ingredient.

Manufacture: All operations of purchase of materials and

products, production, quality control, release, storage, shipment of

finished products, and the related controls.

Raw materials: All substances, active or inactive whether any

appear in the finished product or not, that are employed in the

processing of drugs.

Processing: That part of production cycle which starting from

weighting and compounding of raw materials to the bulk product.

Packaging Material: Any material, including printed material,

employed in the packaging of a pharmaceutical product,

excluding any outer packaging used for transportation or

shipment.

Packaging: All operations including filling and labeling, that a

bulk product has to undergo to a finished product.

Procedures: Description of the operations to be carried out, the

precautions to be taken and measures to be applied directly or

indirectly related to the manufacture of a medicinal product.

Intermediate Product: Partly processed materials that must

undergo further manufacturing steps before it become a bulk

product.

Finished Product: A product that undergone all stages of

production, including packaging in its final container and

labeling.

Released or passed: The status of materials or products which

are allowed to be used for processing, packaging or distribution.

Production: All operations involved in the preparation of a

pharmaceutical product, from receipt of materials, through

processing and packaging, to completion of the finished product.

187

Batch or Lot: A quantity of any drug product during a given

cycle of manufacture, that is uniform in character and quality.

Batch Number (Lot Number): A distinctive combination of

numbers and / or letters, which identifies a batch from which the

complete history of the manufacture processing, packing, holding

and distribution of a batch or lot of drug product or other material

can be determined

Quarantine : The status of materials or products that is set apart

while other effective means while a decision is awaited on their

release, rejection, or reprocessing

Validation: The documented act of proving that any procedure,

process, equipment, material, activity, or system actually leads to

expected results.

Specification: A document described in detail the requirements

with which the products or materials used or obtained during

manufacturing have to conform. Specifications serve as a basis for

quality evaluation.

SOP: Standard operating procedure for each process.

Sanitation: Hygiene control on manufacturing processes,

including personnel, premises, equipment, and material handling

(from starting materials to finished product).

Identity: The product must comply with the information given on

the product label.

Purity: extend to which a raw material or a drug in dosage form

is free from undesirable or adulterating chemical, biological, or

chemical entities.

Strength/ potency: The concentration of drug substance or its

potency.

Bioavailability: The rate and extends of absorption of a drug

from a dosage form as determined by its concentration time curve

in systemic circulation, or by its excretion in urine.

Stability: The ability of dosage form, in a specific container

closure system, to remain within the defined physical, chemical,

microbiological, therapeutic, and toxicological specifications till

the end of the stated dating, under defined storage conditions.

Stability indicating Assay: The assay which is sensitive and

selective to determine quantitatively the active ingredient in the

presence of its decomposition products.

Shelf-storage Stability: The stability of the drug product at

ambient room temperature (15-30°C).

188

Accelerated stability: The stability of the drug product at two or

more elevated temperatures.

Expiration Date: The date placed on the immediate container

label of a product that designated the date through which the

product is expected to remain within specifications. Kinetically it

is the time at which 90% of the material remains.

Shelf-life: The length of time a product can be stored without

deterioration occurring.

Degradation, deterioration = becoming degraded (oxidation,

hydrolysis).

Overage: The excess quantity of drug that must be added to the

preparation to maintain at least 90% of the labeled amount during

the expected shelf-life of the drug.

Storage: The term used to describe safe keeping of staring

materials, packaging materials, components received, semi

finished, in-process and finished products awaiting dispatch. The

term also applied for safe keeping of materials and drug products

in drug stores, pharmacies, hospitals.

Storage Conditions: The conditions specified for storing the

product e.g. temperature, humidity, container ....etc.

Storage Temperatures: The actual storage temperature

(numerical) used during stability studies.

Stability studies: Carried out under stress conditions e.g high

temperature.

Cold Place: The temperature does not exceed 8°. It includes:

i. Refrigerator: The temperature is thermostatically controlled

between 2° and 8°.

ii. Freezer: The temperature is thermostatically controlled to not

higher than -10°.

Cold Place: The temperature is between 8°and 15°.

Warm Place: Any temperature between 30° and 40°.

Room Temperature: The temperature i.; between 15° and 30°.

Ambient Temperature: The temperature of surrounding

atmosphere.

Excessive Heat: Any temperature above 40°.

Cell culture: The result from the in-vitro growth of cells isolated

from multicellular organisms.

Clean room or clean area: A room or area with defined

environmental control of particulate and microbial contamination.

189

Contaminant: The action of confining a biological agent or

other entity within a defined space.

Cross contamination: Contamination of a material or of a

product with another material or product.

Contraindication: Any condition which renders a

particular line of treatment improper or undesirable. E.g.:

Tetracycline –pregnant, children. Side effect: A consequence other than that for which an

agent is used, especially an adverse effect on another organ

system.

Solubility: The concentration of solute in saturated

solution at specified temperature.

Solubilizing agent: an agent improves solubility.

Deliquescence: The condition of becoming moist or

liquefied as a result of absorption on water from the air.

Hygroscopic = readily absorbing moisture.

B) Medical terminology:

Medical terminology is the language used by physicians and other

members of health team.

The word building system: the medical words consists of three

parts

1) The word root,

2) The prefix and

3) The suffix.

190

The most commonly used prefixes:

191

Examples for medical terms:

1) The clinical description of disease:

Etiology: studying the cause of the disease and its predisposing

factors such as tumor, allergy, and infection….etc.

Pathogenesis: the study of disease development from the start of

the condition till the establishment of the disease.

Pathology: the science that deal with the cause and nature of the

disease by microscopic and naked-eye examination.

Symptoms: the feelings noticed by the patient due to the

disturbances caused by the disease.

Signs: the features of the disease or deformation. It is observed by

the physician, relatives or the patient himself.

Diagnosis: the name of the disease is reached through knowledge

of its sign and symptoms and through clinical investigation.

Investigations: The methods used to reach the definitive

diagnosis such as laboratory tests which include: biochemical,

bacteriological, histological, haematological and radiological.

Clinical examinations: Examination of the patient by using the

physician, skills, his hands, stethoscope, blood pressure apparatus

or other aids to know the physical signs of the disease.

Anatomy: The science that deal with the body systems regarding

structure and relations.

192

Prognosis: the prediction of the progress, and termination of a

disease.

Complications: Undesirable events in the progress of the disease

such as bleeding from stomach ulcer.

Prophylaxis: Protection from a disease.

Prophylactic: Protective against a disease.

Syndrome: Set of signs and symptoms running together.

Disease: A state of ill-health resulting from structural changes

associated with functional alteration.

Relapsing: Repeated recurrence of disease for several times.

Logist: Specialist in type of study in health and disease.

Surgeon: Physician who uses instruments to remove or repair a

diseased tissue or organ.

Acute: The severe signs and symptoms of the disease that occur

in short duration.

Chronic: The signs and symptoms of mild nature start slowly and

gradually and maintained for a long time.

Subacute: The severity and duration of the signs and symptoms

are between acute and chronic.

Indications: The use of drugs in the diagnosis, prevention or

treatment of specific disease.

Contra-indications: The disease in which the use of a drug will

be harmful or will aggravate the condition.

Inflammation: Cellular, lymphatic and vascular reactions against

an irritant in order to localize and remove the irritant.

Repair: A replacement of a damage tissue by a new one.

Regeneration: The division and reproduction of the cells.

Degeneration: A metabolic and morphological changes resulting

from irritation not severe enough to kill cells.

Necrosis: A local death of a mass of tissue which occurs either

directly or follows severe degeneration.

Thrombosis: The formation of compact body (from blood

elements) inside a blood vessel or the heart.

Embolism: Insoluble body which circulates in the blood until it

occludes a small vessel.

Thrombo-embolism: The movement of a thrombus from its site

and production of embolism.

Edema: Accumulation of excess fluid in tissue spaces, pulmonary

alveoli or inside the cells.

193

Ischemia: A decrease of blood supply to an organ due to

occlusion of its artery.

Infarction: An area of necrosis caused by sudden occlusion of the

arterial supply by thrombosis or embolism.

Haemorrhage: The escape of blood outside the blood vessels or

the heart.

Shock: An acute circulatory failure i.e. hypotension and tissue

hypoxia.

Bacterial infection: The invasion of the body by pathogenic

bacteria and development of pathological changes.

Toxaemia: The presence of toxins in the circulating blood.

Septicemia: The presence of a large number of multiplying

bacteria and their toxins in the blood due to low body resistance.

Immunity: The ability of the body to overcome infection by the

microorganism by producing antibodies.

Diabetes mellitus: Metabolic disease due to decrease or complete

loss of insulin leading to increase in the blood glucose level

(hyperglycemia).

2) Disturbances of growth:

Aplasia: Complete failure of organ development.

Hypoplasia: Failure of an organ to reach its full sized

development.

Hyperplasia: Increase in size and weight of an organ.

Neoplasia: New growth formed by unlimited multiplication of

the cells in an organ (tumor).

Atrophy: A decrease in size and weight of tissue or organ after

reaching a full development.

Hypertrophy: Abnormal increase in the size and weight of an

organ.

Benign tumors: Slowly growing tissue growth localized at the

site of origin and cells resemble the tissue of origin.

Malignant (evil nature) tumors: Rapidly growing growth,

infiltrating between surrounding cells without localization.

Metastasis: Spread of malignant tumors away from site of origin

through blood or lymphatic vessels.

Carcinoma: A malignant tumor from epithelial origin.

Sarcoma: A malignant tumor from mesenchymal tissue in

younger age. It spread faster than carcinoma.

Embryoma: A malignant tumor from fetal tissues in early life.

194

Adenoma: Benign epithelial tumor of glandular origin (endocrine

or mucous).

Lipoma: Benign mesenchymal tumor from fatty tissue.

Fibroma: Benign mesenchymal tumor from fibrous tissue.

Osteoma: Benign mesenchymal tumor from bone.

Melanoma: Benign or malignant tumor from cells between

epidermis and dermis.

3) The Central Nervous System (CNS):

Somatic N.S.: The voluntary part of the CNS. Soma= body.

Autonomic N.S.: The involuntary part of the CNS.

Parasympathetic: A division of the autonomic N.S. that

originates from cranial nerves or sacral plexus.

Sympathetic: The other division of the ANS that originates from

thoracic spinal segments.

Synapse: Contact site between nerve end and other cell.

Afferent: Sensory nerve supply from an organ to the CNS.

Efferent: Motor nerve supply from CNS to an organ.

Meninges: Cells that cover the brain and spinal cord.

Paraplegia: Paralysis of the lower limbs.

Quadriplegia: Paralysis of all four limbs.

Hemiplegia: Paralysis of one side of the body.

Tinnitus: Noise in the ears.

Deafness: Hearing loss with poor speech discrimination.

Ophthalmology: Science of the eye.

Ophthalmologist: Physician specialized in diagnosis and

treatment of eye diseases.

Optician: A person who deals with eye glasses, contact lenses

and optical instruments.

Conjunctiva: A protective coating covers the eye when closed.

Iris: The front part of the eye. The opening of the iris is the pupil.

Lens: Lies behind the pupil opining of the iris and supported by

ciliary's muscles.

Retina: The most inner layer of the eye.

Vitreous humour: Fills the inner eye and prevents the eye from

collapse.

Aqueous humour: Watery fluid fills the chamber of the eye

behind the cornea and in front of the lens.

Glaucoma: Increased the intra-ocular pressure which can lead to

damage of optic nerve and blindness.

195

Cataract: Lens opacity or cloudiness the lens.

Mydriasis: Abnormal dilatation of the pupil.

Miosis: Abnormal contraction of the pupil.

Exophthalmus: Protrusion of the eye ball.

Photophobia: Eye pain with bright light.

Syncope: Loss of consciousness due to temporarily insufficient

flow of blood to the brain.

Insomnia: Inability to sleep.

Hypnosis: Sleep.

Analgesia: Without feeling of pain.

Anesthesia: Loss of feeling of all sensation.

General anesthetics: Drugs which produce anesthesia.

Local anesthetics: Drugs which produce local or topical

anesthesia

Pre-anesthetic medications: Drugs used before anesthesia to

facilitate the induction and maintenance of anesthesia.

Hypnotics Drugs: which inducing sleep.

Analgesics: Drugs used to prevent or abolish pain.

Antipyretics: Drugs that lower high body temperature.

Antidepressants: Drugs used to control depression.

Antiepileptics: Drugs used to control epilepsy.

Muscle relaxants: Drugs that reduce tension in the muscles.

4) Cardiovascular system (CVS):

Card- = heart

Myo- = muscle

Myocardium = Heart muscle.

Pericardium: Sac around the heart.

Endocardium: Endothelial lining of the heart.

Atrium: The upper chamber of the heart, the right A. receives

blood from systemic veins; the left A. receives blood from

pulmonary veins.

Ventricle: One of the two lower chambers of the heart with thick

muscular walls.

Aorta: The main artery arises from the left ventricle.

Aortic valve: Between the left ventricle and the aorta.

Tricuspid valve: Between the right atrium and the right ventricle.

Mitral valve: Between the left atrium and the left ventricle.

Pulmonary artery: Conveys the blood from the heart to the lung.

196

Pulmonary vein: Carrying oxygenated blood from the lungs to

the left atrium.

Coronary: The vessels that supply heart muscle with blood.

Systole: Contraction of the heart muscle.

Diastole: Relaxation of the heart muscle.

Cardiac output: Blood volume pumped from the heart/min.

Hypertension: High blood pressure more than 160/95 mmHg.

Hypotension: Low blood pressure less than 100/50 mmHg.

Haematoma: Blood collection in internal organs or S.C. tissues.

Electrocardiograph (ECG): Electrical tracing of the changes in

action potential from the heart during cardiac cycle.

Myocarditis: Inflammation of the myocardium.

Valve stenosis: Narrowing of the cardiac valve.

Antiarrhythmic drugs: Drugs used to treat myocardial

arrhythmia.

Antianginal drugs: Drugs used to treat angina pectoris.

Hyperlipidemia: Increased blood lipids such as cholesterol and

triglycerides.

5) The respiratory system:

Rhin- = nose

Thorac- = chest

Pulm- = lung

Pneum- = air

Respire- = to keep on breathing

Ventilation: Passage of air to bronchi.

Alveolus: Air-sac o f the lung.

Inspiration: Passage of air into the lungs.

Expiration: Passage of air outside the lungs.

Asphyxia: Failure of breathing.

Apnoea: No breathing either voluntary or pathological.

Dyspnoea: Difficult or uncomfortable breathing.

Hyperventilation: Increased rate and volume of breathing with

increasing in carbon dioxide elimination.

Anoxia: No oxygen delivery to tissues.

Hypoxia: Decreased tissue oxygenation.

Sputum: The mucoid bronchial secretions.

Rhinitis: Inflammation of the mucous membrane of the nose with

discharge and obstruction.

Pharyngitis: Inflammation of pharynx with fever& disphagia.

197

Bronchial asthma: Reversible and temporarily airway

obstruction.

Bronchitis: Inflammation of the trachea and bronchial tree.

Pneumonia: Acute infection of the alveolar spaces of the lung.

Emphysema: Distended alveoli with atrophy in the adjacent

alveolar wall forming large air sacs with diminution of the

alveolar surface area.

Decongestant: A drug used (locally or systemically) to treat

congestion of mucus membrane in the lung.

Expectorant: A drug which modifies secretion with easy

expulsion from the bronchial tree.

Antitussive: A drug used to inhibit cough reflex by depressing

cough center in the medulla.

Mucolytic: A drug that dissolves thick sputum to be easily

expectorated.

6) The gastrointestinal tract (GIT), the digestive system:

Pepsia- = Digest

Phagia- = Eating

Hepatic = Liver

Chole- = Bile

Gastro-= Stomach

Absorption: The passage of digested food from the intestinal

lumen to the blood.

Excretion: Elimination of waste materials from the body.

Abdomen: The place that contains the GIT and the urinary tract.

Cholecyst- = Gall bladder

Toothache = Tooth pain

Gingivitis = Inflammation of the gum.

Xerostomiaxero- = dry = dry mouth

Stomatitis: Inflammation of the mouth.

Glossitis: Inflammation of the tongue.

Anorexia: Loss of appetite.

Hyperorexia (Bulimia): Increased appetite.

Dysphagia: Difficult, painful swallowing.

Polyphagiapoly: To eat frequently.

Nausea = try to vomit.

Gastric reflux: Reflux of gastric contents into the oesophagus.

Flatulence: Bloating and distension of the intestine with gas.

Dyspepsia = indigestion.

198

Gastritis: Inflammation of the gastric mucosa.

Peptic ulcer: Ulceration of the mucous membrane and the

muscularis mucosa of stomach or duodenum and occurring in

areas bathed by acid and pepsin.

Appendicitis: Inflammation of the appendix which my leads to

peritonitis.

Peritonitis: Acute inflammation of visceral and parietal

peritoneum.

Pancreatitis: Inflammation of the pancreas.

Diarrhea: An increase in the volume, fluidity of the stools or in

the frequency of the bowel movement.

Constipation: Difficult defecation or infrequent passage of feces.

Hepatomegaly: Hepatitis Inflammation of the liver.

Cirrhosis: Disorganization of the liver by widespread of fibrosis

and reddish yellow color.

Fatty liver: Accumulation of triglycerides in the liver in visible

amounts.

Endoscopy = seeing inside e.g. gastroscopy

Biopsy: A piece of the mucosa taken by endoscopy for

histopathological examination.

Anorexiogenic drug: A drug that depress appetite, used for

obesity.

Carminative: A drug expels gases from the stomach or colon.

Antacid: A drug taken orally to increase the pH of the stomach

by neutralizing the free acid (HCL).

Antiemetic: A drug that inhibits the mechanisms of vomiting.

Laxative (Purgative): A drug taken to evacuate the bowel

contents.

Antispasmodic: A drug decreases colic or smooth muscle spasm.

Antidiarrheal: A drug used to treat diarrhea.

Anthelmintic: A drug used to eradicate intestinal parasites.

Enema: Rectal injection of fluid to evacuate the colon.

7) Urinary System:

Nephr- = Ren- = Kidney

Uria = Urine.

Urologist = Surgeon of the urinary tract.

Nephrologist = Specialist in the urinary syst.

Nephron = Functional unit of the kidney.

Dysuria = Painful urination.

199

Oliguria = Low urine volume < 100 ml/d.

Polyuria = High urine volume > 2500 ml/d.

Glycosuria = Presence of glucose in urine.

Ketonuria = Presence of ketone bodies in urine.

Nephrectomy: Surgical removal of the kidney.

Diuretic: A drug that increases urine formation.

Saluretic: A drug that increases sodium ion excretion.

Catheterization: Introduction of rubber tube or metal cannula

into the urethra to the bladder to withdraw the urine in treatment

of urinary retention.

8) Hematological Disorders:

Haemopoiesis: Haem-= blood Poiesis= formation.

Erythrocyte: Erythr-= red -cyte= cell.

Leukocyte: Leuk-= white = White blood cells.

Thrombocyte: The cell that initiate blood thrombosis.

Plasma: The blood without its cells.

Serum: Plasma without fibrinogen and prothrombin.

Haematocrit (Hct): The % of the cellular volume in the blood.

Haemoglobin (Hb): Respiratory pigment in the red cell.

Aemia= blood.

Anemia: The Hb or the RBCs production is impaired.

Sickle cell: An oblong cell with blunt ends (sickle-shaped).

Thalassaemia: Chronic familial hemolytic anemia

(Mediterranean anemia).

Hyperkalaemia: An increase in serum potassium level.

Hypocalcaemia: A decrease in serum calcium level < 8.8/100 ml.

Antineoplastic (cytotoxic) drugs: Drugs that inhibits rapid cell

division and used for treatment of malignant diseases.

Anticoagulant: A drug that inhibits the blood coagulation.

Fibrinolytic: A drug that dissolves fibrin network of the clot.

9) Endocrinology:

Endocrine gland: The gland that release its hormone directly into

the blood and not through a duct.

Hormone: A substance produced by an endocrine gland.

Hypophysis = the pituitary gland.

Trophic = Development.

Acromegaly: An increase in the size of the hands, feet and face.

Dwarfism: A disorder characterized by growth retardation.

200

Polydipsia: An excessive thirst.

Thyrotoxicosis (hyperthyroidism): An increased secretion of

thyroid gland T3, T4.

Obesity: A condition in which excess fat has accumulated in the

body.

Hyperglycemia: An abnormally high blood glucose level.

Hypoglycemia: An abnormally low blood glucose level.

Adrenal: Towards the kidney.

Suprarenal: Above the kidney.

10) Nutritional and Metabolic Disorders:

Metabolism: All processes by which the body acquires and uses

nutrients and energy required for growth, maturation and life.

Anabolism: The constructive processes by which nutritive

substances are transformed into complex living matter.

Catabolism: The processes by which complex substances are

reduced to simpler one.

Low fat diet: A diet consists largely of easily digested high

carbohydrate food. It is used in gall bladder disease and

malabsorption syndromes.

Low-salt diet: A mild to low salt diet, indicated in hypertension,

edema, renal and liver diseases, in toxemia of pregnancy and

steroid therapy.

Phenylketonuria: An inborn error in the metabolism

characterized by absence of phenylalanine hydroxylase and

increase in plasma phenylalanine with mental retardation.

11) Infectious and Parasitic Diseases:

Fever: An elevation in body temperature above normal (normal

range 37-37.2 0C).

Pyrogen: A substance released from leukocytes following contact

with inflammatory stimuli leads to fever.

Contagious= Infectious.

Endemicen: A disease which is restricted to a group of people in

a specific location.

Epidemic: A disease which has a wide-spread distribution in

different location.

Pandemic: A disease with a worldwide distribution.

Mutation: To change

Measles: A highly contagious acute viral disease

201

Chickenpox: An acute viral disease with mild symptoms

characterized by macules, papules, vesicles and crusting.

Smallpox: A highly contagious acute viral disease with severe

symptoms characterized by a cutaneous eruption resulting in

permanent pits and scars.

Poliomyelitis (Infantile paralysis): An acute viral infection, the

virus invades the gray matter of the spinal cord which contains the

anterior horn motor cell groups.

Mumps: An acute contagious viral disease affecting children

between 5-15 years. Fever, headache, vomiting and painful

enlargement of salivary glands are the main symptoms.

Typhoid fever: A generalized infection caused by salmonella

typhi, characterized by fever, bradycardia, rose-colored eruption,

distention and splenomegally.

Tetanus (Lock Jaw): An acute infectious disease. It is caused by

an endotoxine secreted by clostridium tetani. Stiff neck, difficulty

in opening the jaw, fixed smile and elevated eyebrows are main

symptoms.

Leprosy: A chronic infectious disease caused by Myco-bacterium

leprae characterized by skin, mucous membrane and peripheral

nerve lesions.

Anthrax: A highly infectious disease of animals transmitted to

man by contact. It is characterized by cutaneous or pulmonary

lesions.

12) Immunology:

Antigen: A substance capable of combing with specific antibody

and also eliciting immune response.

Antibody: A molecule that reacts with antigen and produced by

plasma cells.

Mast cell: A cell containing granules which release active agents

such as heparin and histamine.

Allergen: An antigen responsible for hypersensitivity reactions

such as asthma.

Macrophage: A cell characterized by a capacity to phagocytose

both foreign and endogenous substances.

T-cell: A lymphocyte altered by passage through the thymus

gland and becomes responsible for cellular immunity.

Helper cell: A T cell that is able to augment antibody production

by plasma cells.

202

Complement: A complex series of 11 enzymatic proteins acting

as 9 functioning components C1 through C9. When activated,

they participate in some immunological responses e.g.

phagocytosis.

Immunoglobulin: A protein produced by plasma cells that

having antibody activity. E.g. IgA, IgD, IgE, IgG & IgM.

Autoimmune disease: A disease resulting from an immune

response against an auto-antigen with injury to tissues, e.g.

hemolytic anemia, rheumatoid arthritis and systemic lupus

erythematosus.

Transplantation: The transfer of living tissues or cells from one

individual to another to maintain the functional integrity of the

transplanted tissue in the recipient e.g. heart.

Immuno-suppressives: Agents that control the rejection reaction

and all immunologic reactions.

Immunization: The administration of antigens, antibodies,

sensitized T-cells or transfer factor in order to induce reactivity

against antigenic substances.

13) Miscellaneous (Enzymes, hormones and drugs actions):

Acidifier, Systemic: A drug that lowers internal body pH, useful

in restoring normal body pH (pH 7.4 for blood) in patients with

systemic alkalosis.

Acidifier, Urinary: A drug that lowers the pH of the renal filtrate

and urine.

Alkalizer, Systemic: A drug that raises internal body pH useful

in restoring normal pH (pH 7.4 for blood) in patients with

systemic acidosis. (Sodium Bicarbonate).

Adrenergic: A drug that activates organs innervated by the

sympathetic branch of the autonomic nervous system; a

(Epinephrine) sympathomimetic drug.

Anti-adrenergic: A drug that prevents response to sympathetic

nerve impulses and to adrenergic drugs e.g., Propranolol

Hydrochloride.

Cholinergic: A drug that activates organs innervated by the

parasympathetic branch of the autonomic nervous system; a

parasympathomimetic drug.

203

Aaticholinergic: A drug that prevents response to

parasympathetic nerve impulse and to cholinergic drugs e.g.,

Atropine Sulfate.

Adrenocortical Steroid, Salt-regulating: An adrenal cortex

hormone or analog that regulates sodium/potassium electrolyte

balance in the body; a mineralocorticoid e.g., Desoxy-

corrticosterone Acetate.

Mineralocorticoid: A salt-regulating adrenocortical steroid

useful in regulating sodium/potassium electrolyte balance

(Desoxycorticosterone Acetate).

Androgen: A hormone that stimulates and maintains mal

reproductive function and sex characteristics (Testosterone

Propionate).

Estrogen: A hormone that stimulates and maintains female

reproductive organs and sex characteristics, and functions in both

the proliferative and secretory phases of the uterine cycle (Ethinyl

Estradiol).

Progestin: A hormone that stimulates the secretory phase of the

uterine cycle.

Contraceptive, Oral: Orally effective drug that prevents

conception. All currently available oral contraceptives are for use

by females.

Oxytoxic: A drug that stimulates motility, useful in obstetrics to

initiate labor or to control postpartum hemorrhage.

Gonad-stimulating principle: A hormone or other drug that

stimulates function of the ovaries or tests (gonads).

Hormone, Adrenocorticotropic: The pituitary hormone that

stimulates the adrenal cortex to produce glucocorticoids.

Hormone, Posterior pituitary, Antidiuretic: The pituitary

hormone that promotes water reabsorption from the distal and

collecting renal tubules, useful in treating Antidiuretic hormone

deficiency.

Hormone, Thyroid: The thyroid gland hormone that stimulates

mature metabolic function maintains normal basal metabolic rate.

Enzyme, Proteolytic: An enzyme that hydrolyzes proteins, useful

in eye surgery to facilitate lens removal useful topically to digest

necrotic material, etc. (Chemotropism, ophthalmic and systemic

use; Trypsin, topical and systemic use).

Proteolytic: An enzyme that hydrolyzes protein, useful in

digesting: necrotic and other proteinaceous material.

204

Immunizing Agent, Active: An antigen that induces production

of antibodies against a pathogenic microorganism, used to provide

permanent but delayed protection against infection with the

microorganism.

Immunizing Agent, Passive: A biological product containing

antibodies against a pathologic microorganism, used to provide

immediate but temporary protection against infection with the

microorganism (Tetanus Antitoxin).

Anti-anemic: A drug that stimulates production of erthrocytes in

normal number, size and hemoglobin content.

Anticholesteremic: A drug that lowers plasma cholesterol level.

Antihyperlipidemic: A drug that lowers plasma cholesterol and

lipid level.

Coagulant, Clotting Factor: A blood derivative that replaces a

deficient factor necessary for coagulation (Fibrinogen).

Anticoagulant, Systemic: A systemically acting drug that slows

clotting of circulating blood, e.g., Warfarin Sodium.

Anticoagulant, for Storage of Whole Blood: A drug that when

added to collect blood prevents clotting.

Antihemophilic: A drug that replaces the blood clotting factors

absent in the hereditary disease hemophilia.

Antihypertensive: A drug that lowers arterial blood pressure,

especially the elevated diastolic pressure of hypertensive patients.

Antineoplastic: A drug that is selectively toxic to the rapidly

multiplying cells of malignant tumors.

Blood Volume Supporter: An intravenous drug containing

solutes that are retained in the vascular system to supplement

osmotic activity of plasma and so to expand plasma volume.

(Plasma Protein Fraction, Human).

Diuretic: A drug that promotes renal excretion of electrolytes and

water, useful in treating generalized edema (Furosemide).

Hematopoietic: A vitamin that stimulates formation of blood

cells, useful in treating vitamin deficiency anemia

(Cyanocobalamin).

Hematinic: A drug that promotes hemoglobin formation by

supplying iron needed for incorporation (Ferrous Sulfate).

Hemostatic, local: A drug applied to a bleeding surface to

promote the clotting process or to serve as a matrix for the clot

(Thrombin, clot promoter).

205

Hemostatic, Systemic: A drug that inhibits systemic dissolution

of clots (fibrinolysis), useful in treating hyperfibrinolysis.

Metal Complexing Agent: A drug that binds tightly, removing

them from ionic solution, useful in treating poisoning with the

metal (Edetate calcium Disodium complexing agent for lead).

Systemically Acting Drug: A drug administered absorption into

systemic circulation, from which the drug diffuses into all tissues

including the site of therapeutic action.

Anti-anginal: A coronary vasodilator useful in preventing or

treating attacks of angina pectoris (Nitroglycerine Tablets).

Anti-arrhythmic; A cardiac depressant useful in suppressing

cardiac rhythm irregularities (Procainamide Hydrochloride).

Cardiac Depressant, Antiarrhythmic: A drug that depresses

myocardial function, useful in treating cardiac arrhythmias.

Cardiotonic: A drug that increases myocardial contractile force,

useful in treating myocardial inadequacies such as congestive

heart failure (Digitoxin).

Antitussive: A drug that suppresses coughing (Codeine

Phosphate).

Bronchodilator: A drug that expands bronchiolar airways, useful

in treating asthma and related conditions.

Expectorant: A drug that increases respiratory tract secretion,

lowering its viscosity and promoting its removal.

Mucolytic: A drug that hydrolyses mucoproteins, useful in

reducing the viscosity of pulmonary mucous (Acetulcysteine).

Anticonvulsant: An antiepileptic drug or a drug that arrests

convulsions by inducing general anesthesia.

Antidepressant: A central acting drug that selectively induces

mood elevation, useful in treating mental depration.

Anti-epileptic: An anticonvulsant drug that selectively

suppresses epileptic seizures without inducing loss of

consciousness.

Antiparkinsonian: A drug that reduces the neurologic

disturbance and symptoms present in the disease

Parkinsonism (shaking palsy) (Levodopa).

Centrally Acting Drug: A drug that produces its therapeutic

effect by action on the central nervous system, usually designated

by type of therapeutic action.

Hypnotic: A central nervous system depressant that with suitable

dosage induces sleep.

206

Narcotic: A drug that induces its pharmacologic action by

reacting with central nervous system receptors that respond to

morphine or a drug legally classified as a narcotic with regard to

prescribing regulations.

Relaxant, Skeletal Muscle: A drug that inhibits contracting of

voluntary muscles, usually by interfering with innervations.

Relaxant, Smooth Muscle: A drug that inhibits contraction of

involuntary (visceral) muscles usually by action on their

contractile elements.

Sedative: A central nervous system depressant which, in suitable

dosage, induces mild relaxation and reduces emotional tension.

Stimulant, Central: A drug that increases the general functional

state of the central nervous system, sometimes used in convulsive

therapy of mental disorders, or as antidote for barbiturate over

dosage.

Stimulant, Respiratory: A drug that selectively stimulates

respiration, either by peripheral initiation of respiratory reflexes,

or by selective central nervous system stimulation.

Antidiabetic: A drug that replaces insulin or stimulates secretion

of insulin, useful in treating diabetes mellitus, e.g., Insulin Zink

Suspension.

Antihypoglycemic: A drug that elevates plasma glucose level,

useful in treating hypoglycemia, including that induced by over

dosage with antidiabetic drugs.

Analgesic: A drug that selectively suppresses pain perception e.g.

Aspirin.

Anti-arthritic: An anti-inflammatory drug useful in treating

rheumatoid arthritis and other types of joint inflammation.

Anti-inflammatory: A drug that inhibit the physiologic response

to cell damage (inflammation

Adrenocortical Steroid, Anti-inflammatory: An adrenal cortex

hormone or analog that regulates organic metabolism and inhibits

inflammatory response; a glucocorticoid (Hydrocortisone).

Antipyretic: A drug that lowers body temperature in the presence

of fever.

Antirheumatic: A drug that alleviates inflammatory symptoms of

arthritis and related rheumatic diseases.

Glucocorticoid: An anti-inflammatory adrenocortical steroid

useful in suppressing the inflammatory process (Betamethasone).

207

Suppressant: A drug that inhibits the progress of a disease but

dose not cure it (Colchicine, suppressant for gout).

Anesthetic, General: A drug that eliminates pain perception by

inducing unconsciousness.

Anesthetic, Local: A drug that eliminates pain perception in a

limited body area by local action on sensory nerves.

Abrasive: An agent that rubs off an external layer, such as dental

plaque.

Dental Caries Prophylactic: A drug applied to the teeth to

reduce the incidence of cavities (Stannous Fluoride).

Dentin Desensitizer: A drug applied to the teeth to reduce the

sensitivity of exposed subenamel material (dentin).

Digestive Aid: A drag that promotes digestion, usually by

supplementing a naturally occurring digestive enzyme

(Pancreatin).

Anorexic: A drug that suppresses appetite, e.g. (Phenmetrazine

Hydrochloride).

Antacid: A drug that neutralizes excess gastric acid locally, e.g.,

Aluminum Hydroxide Gel.

Anthelmintic: A drug that kills or inhibits pathogenic nematodes

and cestodes; causative agents of intestinal worm infestations,

e.g., Piperazine Citrate.

Anti-amebic: A drug that kills or inhibits the pathogenic

protozoan Entamoeba histolytica, causative agent of intestinal and

extra intestinal amebasis.

Antidote, General Purpose: A drug that prevents or minimizes

the effects of an ingested poison (or drug overdose) by adsorption

of the toxic material while in the gastrointestinal tract, e.g.,

Activated Charcoal.

Antidote, Specific: A drug that terminates or minimizes the

systemic effects of a poison (or drug overdose) by a mechanism

of action that is specific for the particular poison, e.g.,

Dimercaprol, specific antidote for arsenic mercury and gold

poisoning; Naloxone Hydrochloride, specific antidote for narcotic

analgesic over dosage).

Anti-emetic: A drug that prevents vomiting.

Emetic: A drug that induces vomiting useful in removing

unabsorbed accidentally ingested poisons.

Antiflatulent: A drug that reduces gastrointestinal gas, e.g.,

Simethicone.

208

Cathartic: A drug that strongly promotes defecation.

Choleretic: A drug that increases secretion of bile by the liver,

e.g.., Dehydrocholic Acid.

Fecal Softener: A drug that promotes defecation by softening the

feces, e.g., Dioctyl Calcium Sulfosuccinate).

Antibacterial: A drug that kills or inhibits pathogenic bacteria.

Antifilarial: A drug that kills or inhibits pathogenic filarial

worms, causative agents of infections such as loaiasis.

Antifungal, Systemic: A systemically active drug that kills or

inhibits pathogenic fungi that causes systemic, gastrointestinal or

topical infections, e.g., Griseoulvin.

Antifungal, Topical: A topically active drug that kills or inhibits

pathogenic fungi that causes topical infections.

Anti-infective, Topical (or Local): A drug that kills or inhibits a

variety of pathogenic microorganisms and is suitable for

sterilizing the skin or wounds.

Antimalarial: A drug that kills or inhibits pathogenic protozoa

that causes malaria, e.g., Chloroquine Phosphate.

Antiprotozoal: A drug that kills or inhibits pathogenic protozoa,

such as Giardia lamblia, e.g., Quinacrine Hydrochloride

antiprotozoal for giardiasis.

Antischistosomal: A drug that kills or inhibits pathogenic flukes

of the genus Schistosoma, causative agents of schistosomiasis.

Antitrichomonal: A drug that kills or inhibits pathogenic

protozoa of the genus Trichomonas, causatuive agents of

infections such as trichomonal vaginitis, e.g., Metronidazole.

Antiviral, Ophthalmic: A topically acting drug that kills or

inhibits viral infections of the eye.

Antiviral, Prophylactic: A drug useful in preventing (rather than

treating) viral infections.

Disinfectant: An agent that destroys microorganisms on contact

and suitable for sterilizing inanimate objects.

Leprostatic: A drug that kills or inhibits the pathogenic

bacterium Mycobacterium leprae, causative agent leprosy, e.g.,

Dapsone.

Parasiticide: A drug that kills or inhibits invertebrate parasites,

especially those that infest the skin or hair follicles.

Anti-eczematic: A topical drug that aids in control of chronic

exudative skin lesions.

Antipruritic: A drug that prevents or inhibits itching (pruritus).

209

Antipsoriatic: A drug that suppresses the lesions or otherwise

alleviates the symptoms of the skin disease psoriasis.

Antiseborrheic: A drug that aids in the control of seborrheic

dermatitis

Astringent: A mild protein precipitant suitable for topical

application to toughen and shrink tissues.

Caustic: A topical drug that destroys tissues on contact, useful in

removing abnormal skin lesions.

Pigmenting Agent: A drug that promotes skin darkening by

increasing melanin synthesis. It is used to promote repigmentation

or increase tolerance to solar exposure.

Depigmenting Agent: A topical drug that inhibits formation of

skin pigment (melanin), useful in lightening localized areas

darkened skin (Hydroquinone).

Detergent: An emulsifying agent used as a cleanser, as for the

skin.

Emollient: A topical drug, especially an oil or fat, used to soften

the skin (Cold Cream).

Ion-Exchange Resin: An ion-containing solid resin which when

perfused with an ion-containing solution, gives up its ions in

exchange for those in solution.

Irritant, Local: A drug that reacts weakly and nonspecifically

with biological tissue, used topically to induce a mild

inflammatory response.

Keratolytic: A topical drug that softens the superficial keratin-

containing layer the skin and promotes its desquamation

(Salicylic Acid).

Pediculicide: An insecticide suitable for eradicating louse

infestations of humans (Pediculosis).

Protectant: A topical drug that serves as a Physical barrier to the

environment.

Repellant, Arthropod: An agent applied to the skin or clothing

toward off insects and other members of the phylum arthropoda.

Scabicide: An insecticide suitable for topical use on human to

eradicate the itch mite Sarcoptes scabiei (scabies).

Sun Screening Agent: A skin protectant that absorbs light energy

at the wavelengths that cause sunburn, e.g., Aminobenzoic Acid.

Antihypocalcemic: A drug that elevates plasma calcium level,

useful in treating plasma hypocalcemia, especially that associated

with hypoparathvroidism (Parathyroid Injection).

210

Antirachitic: A drug with vitamin D activity, useful in

preventing or treating vitamin D deficiency and its symptoms

such as rickets.

Antiscorbutic: A drug with vitamin C activity, useful in

preventing or treating vitamin C deficiency and its symptoms

such as scurvy (Ascorbic Acid).

Prothrombagenic: A drug with vitamin K activity, useful in

treating vitamin K deficiency (or over dosage with vitamin K

antagonist) and associated symptoms such as

hypoprothrombinemia.

Diagnostic Aid: A drug used to determine the functional state of

a body organ.

Absorbent: A drug that takes up chemicals into the drug

substance, useful in reducing the free availability of toxic

chemicals.

Adsorbent: A drug that binds chemicals to the drug surface,

useful in reducing the free availability of toxic chemicals, (kaolin

gastrointestinal adsorbent).

Potentiator: An adjunctive drug that enhances the action of a

primary-drug.

211

List of English References;

1- Gennaro, Lippincott, Remington: the science and

practice of pharmacy. 20th edition, (2000).

2- L. Michael Posey, Pharmacy: An Introduction to the

Profession. 2nd ed. Washington, DC. America

Pharmacists Association, (2009).

3- Aulton, M.E., Pharmaceutics: The science of dosage

form design. Churchill living stone, a medical division

of Harcourt Brace and Company limited. (1998).

4- Appleton and Lange, (2015) Drug information: A

guide for Pharmacists. Malone P.M. (Ed), 3rd Edition,

5- Lieberman, H.A., Lachman, Scwartz, J.B.,

Pharmaceutical Dosage Forms, Marcel Dekker Inc.,

New York and Basel, (1990).

6- Allen, N.G. Popovich, H.C. Ansel, Ansel’s

Pharmaceutical Dosage Forms and Drug Delivery

Systems. Pitman Publishing Corporation, New York, 9th

Edition, (2011).

7- Helms R., Quan D.J., Herfindal E.T., (Ed)., Textbook

of therapeutics, drugs and disease management. ,

Williams and Wilkins.

8- Hospital pharmacy. Martin Stephen. Pharmaceutical

press.

212

9- Clinical Pharmacy and Therapeutics, (Walker,

Clinical Pharmacy and Therapeutics) by Roger Walker.

10- Clinical Skills for Pharmacists - A Patient-Focused

Approach (3rd edition).

11- Manageing pharmacy practice, principles, stratigics

and systems. Andrew Peterson.

12- Introduction to Health Care Management by Sharon

B. Buchbinder and Nancy H. Shanks.

13- Medical terminology simplified .3rd Ed. Davis

company,

14- Medical Terminology by Marjorie C. Willis.

15- Anonymous. American heritage dictionary of the

English language, 4th ed. Boston: Houghton Mifflin,

2007.

16- Anonymous. Dorland’s illustrated medical

dictionary, 31st ed. Philadelphia: Saunders, 2007.

17- American Pharmacists Association and National

Association of Chain Drug Stores Foundation.

Medication therapy management in community practice:

Core elements of an MTM service. April 29, 2005 [cited

2009 June 20]. Available from:

http://www.pharmacist.com/AM/Template.cfm?Section

=Home2&Template=/CM/ContentDisplay.cfm&Content

ID=16857

213

18- Council on Credentialing in Pharmacy.

Credentialing in pharmacy. July 2006 [cited 2009 July].

Available at:

http://www.pharmacycredentialing.org/ccp/Files/CCPW

hitePaper2006.pdf

19- Indian Health Service. IHS National clinical

pharmacy specialist (NCPS).Available at:

http://www.usphs.gov/corpslinks/pharmacy/clinpharm/c

ertifications/index.html

20- Ried LD, Wang F, Young H, and Awiphan R.

Patients’ satisfaction and their perception of the

pharmacist. J Am Pharm Assoc 1999; 39(6):835–42;

quiz 882–84 [cited 2009 June 20]. Summary available

from:

http://www.ahrq.gov/research/mar00/0300RA17.htm#he

ad3.

21- Documentation Guidelines for Evaluation and

Management Services. Washington, DC, Health Care

Financing Administration, December 2000.

22- World Health Organization (1996) Good pharmacy

practice (GPP) in community and hospital pharmacy

practice. Geneva: WHO (unpublished WHO document

WHO/PHARM/DAP 96.1).

23- World Health Organization (1997) Report of a

WHO consultative group on the role of the pharmacist:

preparing the future pharmacist. Geneva, WHO

(unpublished document WHO/PHARM/97/599).

214

: تاريخ ومدخل الصيدلةعاشرالفصل ال

المقدمة

ذلك األرض، ظهر على البشر وجود قدم قديم والصيدلة الطب تاريخ أن األبحقا أظهقر كمقا اإلنسقان، بحيقا االرتبقا وثيق الطب ألن

.العالم هذا في الحيا ظهور مع وجودها تراف األمراض

من غمض ما الءاستج في هام عامل العلوم من علم تاريخ ودراسة بقه دفعق أو تقدمقه، عاقق مالبسقا من به أحا وما العلم، هذا .األمام إلى

تلقك الصيدلة، تاريخ من هامة حقبة تناول البحث، هذا خالل ومن

المهنقة وتلقك العلقم، هقذا المسقلمون العقر بها أثرى التي الحقبة .حديثةال العصور شهدته الذي التطور في الكبير األثر له كان مما

استقطا إلى التاريخية المرحلة هذه خالل العلم هذا تطور ويرجع

كان التي المستنير ، العقول من كثيرا الجديد اإلسالمي المجتمع اجتقذ أنقه كمقا العريققة، الحضار ذا المجاور ، البالد في تقطن وساعد .المفتوحة البالد سكان من العلم حقل في العاملين جميع مقا وهقو الكتقا ، أهقل تجاه الديني التسامح روح انتشار :ذلك في التقي القبالد جميع في والربح للعمل مجال ووجود .اإلسالم به يأمر .اإلسالم فيها انتشر

أنها هو :أصيل أمر في والالح الساب في جميعا األدوية وتشترك والتقي عليهقا نعقي التقي األرض هذه ماد مكونا من كل تتكون فقي العريضقة القاعقد تكقون وبهقذا اإلنسقان يتكقون ككقذل منهقا

تزيلقه أو اإلنسان جسم تودعه ان . وتنظيم ضبط مسألة والتداوي وهقي ...بأثر شيء وكل بقدر شيء وكل بسبب شيء كل ...منه

الهزيمة يلقون وهم اآلن إلى الدواء علماء بال تشغل تزال ال معادلة والتي الحسبان في تكن لم التي السمية األعراض من الهزيمة تلو

أمراض أو وفيا هيئة على فادحة ضريبة األدوية بعض بها استأد ............. والمواليد لألجنة خلقية تشوها أو

215

فوائد دراسة تاريخ الصيدلة ( الكشف عن تاريخ ناحية علميقة يفخقر بهقا الشقرم عامقة ومصقر 1

ما للنهضقة الطبيقة وعلقم خاصة اذ هي القطر الذي يعتبر قائدا ومعل الدواء والصيدلة في العالم.

( تبصير العالم بما كان عليه مصر من رقي وحضار وما لعبته من 2 دور هام في خدمة البشرية في العلوم الطبية.

( دراسة حيا العقاقير المختلفة ومعرفة الخطوا التي سقار فيهقا 3ر اسقتعماله كل عقار القي أن وصقل القي مقا وصقل اليقه وكيقف تطقو

واستخالص مواده الفعالة وبقذلك يكقون عنقدنا سقجل كامقل لجميقع أنواع العقاقير وتطورهقا و ريققة البحقث فيهقا وققد يهقدينا هقذا القي الكشف عن نقواح جديقد فقي دراسقة بعقض العققاقير أو القي أفقام واسعة أخري في محقيط السقيطر مثقل الكشقف عقن الفيتامينقا

وغيرها.قة علم الصيدلة بغيرها من العلوم األخري وكيف ( معرفة مدي عال4

تداخل كالسحر والفلك والعقائد الدينية. ( دراسة تارخ األمراض وصناعة الدواء وأنواع المستحضرا .5

منشأة مهنة الصيدلة

العشاب، العطار، الصيدلي ( البققد وأن تكققون صققناعة الققدواء مالرمققة لظهققور االنسققان علققي 1

االنسققان األول حققين كققان هائمققا مققع الوحققو البسققيطة والبققد وأنيبحث عن الغذاء بين النباتا والحيوان الحق بعقض خقواص مقا كقان يصادفه أو يستعمله بتأثيره عليه، فأحب ما كان منها سائغا وأعرض عن ما فض منها وكان تأثيره عنيفا غير مرغو فيه، ومقن هنقا نشقأ

تيقة وأعتققد العشقابون العشا األول ونشقأ صقناعة العققاقير النبااألول في بالد الشرم أن هذه المهنة مقدسة أنشأها اآللهه القذين علموا االنسان ما لم يعلم مقن الخقواص السقائبة للمقاء واالعشقا والنباتققا والزيققو ، ومققن هنققا وخققالل اآلش السققنين نشققأ عقيققد مقدسة عن صناعة الطب والدواء علقي مقر العصقور المتتاليقة وظقل

يتوارثون تلك الصنعة المقدسة اآلش السنين يحفظونهقا خلفقا الناس من سلف دون كتابة.

( وعندما تعلم االنسان األول فنون الكتابة بدأ العشابون يكتسقبون 2

علققومهم علققي لوحققا مققن الطققين كمققا حققد فققي بابققل بققالخط المسماري ويكتبونهقا علقي شقرائح البقردي كمقا حقد فقي مصقر،

216

المكتويققة هققي الخطققو األولققي لوضققع وكانقق هققذه المعلومققا المجموعا النباتية الشرقية التي كان في الغالب تحوي الوصفا التي امتزج فيها السحر بالدواء، ورغم هذا فقد ثب علي مر العصور أن هذه النباتا القديمة وهؤالء العشابون كقانوا علقي معرفقة حققه

يقة. وكقان البشقر بخواص بعقض العققاقير ولقو أنهقا كانق معرفقة بدائيعتقدون أن االعشقا الطبيقة مقا هقي اال رسقاال عقن اآللهقه وأن بعض العقاقير النباتية الشافية كان تحوي بعض ما في روح اآللهقه، ومن اآللهه انتقل تلك المعلوما عن كثير من العقاقير الي الكهنه بحكم وظائفهم الدينية، ومع مضي القزمن، وفقي ظقل تلقك االسقرار

فية المقدسة التي كان الكهنه يعالجون بهقا المرضقي، اكتسقبوا الخصناعة السحر والفلقك والكيميقاء لمقا بقين هقذه جميعقا مقن عالققة

وثيقة. ( ظل صناعة االعشا تتطور مع الزمن ونشأ من هقذه المهنقه 3

صناعة العطار التي احترفهقا العطقار التقي جقاء ذكرهقا كثيقرا فقي طار من أرقي المهن المتداولقة وكانق تعبقر التوراه وظل صنعة الع

عن صناعة الصيدلة وظل كذلك حتي اآلن فقي فرنسقا حيقث ظهقر (Apothecarie)يحدد بقا الشعب ومنها العطقار 1187قانون عام

. ( ولف الصيدلة معر وأصله هندي جاء للعقر مقن الفقرس وذلقك 4

دل أو صندن من جندل أو جندن حيث قلب الجيم صادا فأصبح صنوهو خشقب الصقندل ذا الرائحقة الذكيقة المعقروش القذي يجلقب مقن الهند ويؤيد ذلك البيروني حيث ذكر أن الصيدالني والصيدناني معر مققن جنققدالني أو جنققدناني ونقققل العققر هققذا االسققم المعققر مققن

مزاولي العطر الي مزاولة األدوية. طقر واالدويقة والعققار ( أما الصيدلة فهي كلمة عربية تعني بيقع الع5

هو النبا الذي يعقر االبل في الصحراء أي يسمها ومنها ا ل لف عقار علي النبا السام وعممه العقر علقي النباتقا ذا الفائقد الطبية، وأقرابقارين لفظقة فارسقية تعنقي فقن تركيقب القدواء وكلمقة

(Pharmacy) االفرنجية التي معناها الصيدلة أصقلها يونقاني ققديم (Pharmakon).للداللة علي عقار أو دواء أو سم

( وفي عصر النهضة في مصر أيام الرومان ظهر مصطلحا بيقة 6

= Medicina) صققيدلية الرالقق مسققتعملة حتققي اآلن العقققاقير drugs) دواء أو سم ، (Medicamentus) مخزن دواء ، (Apotheca).

217

روريققو وأيققزيو ومقن أهققم اآللهقه العشققابين فقي مصققر القديمقة أو وأيموحتب وحاتحور وغيرهم. وتحو وأنوبيو

القدماء والمصريون الدواء

كقان .م .م سقنة ٤٠٠٠ مقن أكثر إلى المصريين قدماء حضار تعود لهقم وكقان والطالسقم والشقعوذ السحر من خليطا عندهم الطب الطقب مارس من أشهر أما .واوريريو إيزيو منهم اآللهة من عدد

لقه فأقاموا إلها اعتبروه الذي م .م ٢٩٠٠ عام أمحوتب فهو عندهم ممفيو «معبد لمعابد ا أشهر ومن القرابيين إليه وقدموا والتماثيل

إلقى العقالم فقي بيقب أول مقبقر اكتشقاش فقي الفضل ويعود ». .ايمري الدكتور المشهور األثري العالم

قبقل سقلأر وققد لنقدن جامعة في . القد لآلثار أستاذا ايمري كان عقن سققار فقي للتنقيقب مصر إلى بعثة في القرن هذا أوائل في فقي بيقب أول امحوتقب كقون إلقى باإلضقافة .الفرعونية مصر كنور بقال فقي كحكقيم وعمقل الهندسقة بعلوم مشهورا كان فقد العالم اقتقرن فققد لحكمتقه ونظقرا .المقدرج الهقرم صاحب » روسر« الملك ». يوأب« الحكمة بآلهة امحوتب اسم

لمصقريين ا ققدماء حضقار أن علقى الهيروغليفية االكتشافا وتدل والصقيدلة الطب علوم فيها اردهر التي الحضارا أشهر من كان كتقب بوصقة ١٢ وعرضقه ققدما ٢٥٠ ولقه عظيم سجل مثال فهناك مقن العديقد علقى يحتقوي السقالم عليقه موسقى النبقي عهد في

كمقا .بهقا األمراض معالجة يفيةوك تحضيرها و رم الشافية األدوية الجراحقة فقن تققدم علقى تدل جراحية آال وجود الحفريا أظهر األدويقة مقن المئقا عرفقوا أنهقم تثبق مستندا وظهر .عندهم فقي الفراعنقة براعقة ولعقل .حاليقا لقدينا معقروش معظمهقا النباتيقة التشقريح علمقي معرفقة فقي بقاعهم ول على دليل أكبر التحنيط .يمياءوالك

مقدارس وأققاموا البقول ومقدرا والمسقهال المقيئقا عرفقوا كمقا ومدرسقة (هليوبوليو)» أونو« مدرسة :أهمها الطب لتعليم خاصة

بمكتبتهقا لمشقهور ا» يبقة« ومدرسقة » للققابال سقايو« مختلقف مقن العصقر علمقاء مقن العديقد اسقتقطب والتقي العظيمة أهمها الطلبة على قاسية اشرو تفرض لمدارس ا وكان .البلدان تكقون وأن المحمود والسير الحميد األخالم ذوي من يكونوا أن

218

رسقوما يتقاضقون األ بقاء وكقان .علقيهم أجريق ققد الختقان عملية حالة في إنه ويقال لمرضى ا من باهظة

ويقدفع ويزنه رأسه شعر يحل أن عليه كان لمريض ا شفاء .ذهبا ورنه مقابل

:استعملوها التي األدوية أهم

الصقومال مقن يحضقرونه كقانوا بقل مصقر فقي ينمقو المقر يكقن لقم ولقم .التحنقيط أدوا مقع لمقوتى ا توابي في وجد وقد والسعودية

سقوريا من نباتا جلب بل المصرية بالنباتا الثالث تحتمو يكتف الصقومال إلقى بعثة حتشبسو لملكة ا وأرسل مصر في ليزرعها األسر مقابر في الفجل على عثر وقد .الورود لها لتحضر والحبشة كذلك وعثر .لألذن كنقط يستعملونه فكانوا عصيره أما عشر الثانية استعملوا أنهم البرديا في وجاء (شنوبوديوم( السرم نبا على

والتقرمو والبصقل والثقوم والزيزفقون والزعفقران والزعتقر الحنظقل والخشقخا والعرعقر سمسقموال الزيتقون وريق والجميقز والحلبة الهيقل وحقب والصفصقاش والكمقون والينسقون البركقة وحبة والرمان ا ققدماء وأهقتم .ذلك وغير الخروع وري والقرنفل والنعناع والبابونج في بفائدتها العتقادهم الخروع ري بشجر خاصة بصفة لمصريينالمسقحوم ويمزجقون الشقجر فقروع يسحقون فكانوا الصداع شفاء .الرأس على ذلك كل ويضعون .الماءمع

بتحضقير وذلقك النسقاء شقعر لتنميقة الخقروع شجر استعملوا كما

ثم الخروع شجر مسحوم على وتحتوي الشحم من تتكون عجينة ري على يحصلون وكانوا-خارجي كاستعمال-الرأس على يفردونها يضقعونه للجقروح كمقرهم اسقتعملوه وقد Z البذور عصر من الخروع الخقروع ريق مقرهم باسقتعمال واهتمقوا فتشفيها أيام لعد هاعلي

باألشقكال األدويقة هقذه اسقتعمل وققد .الصقباحية الفتقر خقالل والقطقرا والحبيبقا والمغلقي لمنققوع كقا المعروفقة الصقيدلية ألوجقاع أدويقة منهقا حضروا وقد الشرجية والحقن والبخور واللبخا والكبقد واألمعاء والمعد واألنف والفم واألذن العيون وأمراض الرأس أمقراض وكقذلك والشقعر واألظافر واألصابع البولية اريلمجوا والثدي .والوالد النساء

برعقوا كمقا األلقم نقعموا و التخقدير أدويقة اكتشقف مقن أول وهقم

.والنقب الكسور وتجبير والخصي كالختان الجراحية بالعمليا

219

رية القديمةالبرديات المص –الدساتير الطبية

كشف الكتابة وأوراق البردي عند المصريين

لقد كان قدماء المصريين أول من اخترع الكتابة للتعبير عن أفكقارهم ولهم الفضل األول علي العالم أجمع في الكشف عن ريقة خطيقة للتفققاهم وتققدوينها علققي مققواد مختلفققة وأهققم هققذه المققواد حسققب

الترتيب التاريخي هي: العظم. -أالطين وقد وجد كثير من صحائف الطين المكتوبقة يرجقع تاريخهقا -

.11الي االسر بقالخط المسقماري ولوحقا تقل 18الطين المحروم منذ االسر -ج

العمارنة.الجلققد مخفققوظ بعققض صققحائفه بققالمتحف االيطققالي والمتحققف -د

المصري. الكتان استعمل في مختلف العصور. -هق ونز.المعادن أهمها البر -و الحجر وقد استعمل في الكتابة في المعابد والمقابر والتوابي . -ر الخشب كالحجر. -حالبردي كان هذا أهم صحفهم للكتابة وكان كشف أورام البقردي -

هو الحلقة األولي للكشف عن الورم فيما بعد.

وكان لقدماء المصريين لغة عالية رفيعقة )الهيروغليفيقة( لهقا نحوهقا هققا أسققماوها وأفعالهققا وضققمائرها وصققفاتها. ولقققد وضققع وصققرفها ول

العلماء مؤلفاتهم عن الهيروغليفية بعقد اكتشقاش حجقر رشقيد عقام بواسطة أحد قواد حملة نابليون علي مصر وحل رمقور الكتابقة 1799

التي عليقه العقالم الفرنسقي شقامبليون فوجقدها عبقار عقن ثالثقة يروغليفيقة والديموتيقيقة تراجم مختلفة بثال لغا مختلفة هي اله

"كتابققة الكهنققه" واليونانيققة القديمققة المققر ملكققي واحققد صققادر أيققام م. م.، وأن أجققزاء جسققم االنسققان 198بطليمققوس الثققاني عققام

وجسققم الحيققوان التققي اسققتعملها الخطققا ون الهيروغليفيققون لتققدل علي أن الفراعنة ققد أجقادوا تشقريح الحيقوان قبقل االنسقان بزمقان

وأن التشريح البشري ظهر متأخرا وذلك لتقديو الجسقم بعيدا جداالبشري في ذلك الوق . أما صناعة العقاقير ومعرفة خواص النباتا فهي أقدم بكثير من صقناعة التشقريح والجراحقة وتبعقا لقذلك تكقون

الصيدلة أقدم المهن الطبية.

220

وكان نبقا البقردي ينمقو بالقدلتا ولكنقه اآلن بحكقم الظقروش الجويقة الطبيعية ينمو في جنقو السقودان والحبشقة. ولققد اشقتق مقن و

التي ا لق علي هذا النبقا الكلمقا األفرنجيقة (Papyrus)كلمة ويتفقاو قول نبقا (Paper, Papier)الدالة علي اسم الورم هقي

قدم عدا القيمة المزهر والجذور وقطقر 10 – 7البردي الحديث بين رضققي مققن السققام مثلققث الشققكل بوصققة والقطققاع الع 1و5السققام

ويتكون من قشر ولب داخلي هو القذي اسقتعمل لصقناعة البقردي بأن تش السام الي شرائح ويلقة دقيققة وكانق هقذه الشقرائح توضع بجوار بعضها في وضع ولي ثقم توضقع فوقهقا شقرائح أخقري في وضع عرضي وتنقدي بمقاء النيقل وتوضقع بينهقا مقاد الصققة ثقم

ها ويتركوها حتي تجف بتعريضها للشمو. وأ قول يدقونها ويضغطونورقة بردي وجد هي بردية هاريو المحفوظة بالمتحف البريطاني

قدما. وكان هذه األورام البرية تلقف علقي شقكل 135ويبلغ ولها اسطواني وتربط في الوسط وكقان ققدماء المصقريين يصقنعون الحبقر

ألحمقر واألسقود علي هيئقة أققراص جافقة بمختلقف األلقوان أهمهقا ا تقلب بالماء عند استعمالها للكتابة.

:)القراطيس( البردى أوراق

فقي يقزرع كقان السحلبية العائلة من نبا إلى ينتمي البردى ورم النبا لهذا استعمال أهم وكان .القطاع المثلثة بساقه ويمتار مصر التقي اآلثقار ذلقك علقى ويقدل .للكتابقة الالرمقة القرا يو صنع هو . الققد والرسقوما والتماثيقل والكتابا الوثائ من الفراعنة ركهات

العقرام فقي اآلشوريين لدى معروفا البردى ورم وكان .والقرا يو ». لمصري ا القصب« يسمونه وكانوا علومهم خالصة عليه وكتبوا البردى ورم استعملوا فقد اإلغري أما

م ١٥٩١ عقام ىحتق مسقتعمال البقردى ورم اسقتمر وققد .وآدابهقم .اآلن لدينا المعروش العادي الورم ظهور لدى تماما اندثر عندما

الققدماء يقن لمصقر ا عنقد والصقيدلة الطب تاريخ في البحث ويعتمد المتقاحف مختلف في المحفوظة الطبية البردى أورام دراسة على

علقى لمنحوتقة ا والكتابقا الصقور علقى ذلقك يعتمقد كما .العالمية الهيروغليفي بالخط عابدلم ا جدران

. بنقو عرفقه القذي البقدائي الكتقا أشقكال أققدم مقن البرديقة وتعتبر أحيانقا ولهقا يصقل ويلة لفائف شكل على البردية وتكون .البشر باتجقاه نهايتهقا مقن تلقف سقم ٣٥ - ٣٠ بعقرض اكثر أو مترا ٢٠ إلى

221

جهقة مقن فتنفرد بيد منها رش كل سكيم قراءتها وعند .معاكو الققرا يو« باسقم القدم منذ عرف وقد .األخرى الجهة من وتلف

.«

البرديقا مقن كبيقرا عقددا تضقم العظيمقة اإلسقكندرية مكتبة كان وققد .البطالسقة رمقن مقن اآلخقر والقبعض الفراعنقة رمن من بعضها األول المقيالدي الققرن فقي قيصقر يوليقوس رمقن لمكتبقة ا احترق أهمهقا ثمقان سقوى البرديقا مقن يبق ولقم القيمقة اآلثار فضاع : أدناه مذكور

(Kahun Papyrus): كاهون بردية - 1

بقالفيوم الفرعونيقة كقاهون دينقة. ١٨٨٩ عام البردية هذه اكتشف منهقا جقزء .م .م ( ١٩٠٠ ) عشقر الثامنقة األسقر إلقى وتعقود ألمقراض بيقة وصقفة ٣٥ علقى وتحتقوي البيطقري للطب مخصص .الطفل وجنو لمرأ ا عند اإلنسان قدر وتشخيص د والوال النساء

:Smith Papyrus)) سميث أدوين بردية -2

.بريسقتد لمقؤرخ ا درسقها ثقم م ١٨٦١ عقام األقصقر فقي اكتشف والحبقر األسقود بقالحبر كتبق سقم ٣٣ وعرضقها متقرا ٤،٦٨ ولهقا الجقروح مقن حالقة ٤٨ فيهقا وذكقر سقطرا ٤٦٩ مقن وتتقألف األحمقر لتحويقل تعويقذ وفيهقا .معالجتهقا وكيفيقه والققرح واألورام والكسور إلقى تاريخهقا ويعقود لموبوء ا الرياح إلبعاد وأدعية شا إلى الكهل .م .م ١٧٠٠ عام Ebers Papyrus): ) ايبرس بردية -3

األقصقر فقي أيبقرس اني? األ العالم اكتشفها قا بة البرديا أشهر ولهقا بيقة وصفة ٨١١ على وتحتوي ليبزج متحف في اآلن وهي ١٢ وفيهقا .سقطرا ٢٢٨٩ مقن وتتكقون Z سقم 30 وعرضقها مترا ٢٥

أسقماء علقى كقذلك وتشقتمل .واألدعيقة لألناشقيد مخصصة وصفة وصقف إلقى باإلضقافة الجسقم أعضقاء مقن عضو بكل الخاصة األدوية

كمقا .م .م ١٥٥٠ عقام إلى وتعود اإلنسان لجسم دقي تشريحي وأنهقم لمقوتى ا تحنقيط فقي الفراعنة مهار ىعل البردية هذه تدل .الدموية واألوعية القلب وظيفة على تعرفوا

222

( Hearst Papyrus): هيرست بردية -٤ وتحتوي سم ١٧ ٢، عرضها م ١٩٠١ عام البالص دير في عليها عثر نفقو إلقى تاريخهقا ويعود بية وصفة ٢٦٠ وعلى سطرا 273على .م .م ١٥٥٠ حوالي أي ايبرس يةبرد إليها تعود التي الفتر London Papyru): ) لندن بردية -5

ولهقا ويبلقغ م ١٨٦٥ عقام منذ لندن متحف في البردية هذه توجد العيقون أمقراض لمعالجقة سحرية وصفة ٦٣ على وتحتوي مترا ٢،١

.النساء وأمراض والحروم

وبدراسة هذه البرديات يمكننا أن نخرج بالنتائج اآلتية: ال: هذه البرديا الطبيقة الدوائيقة عبقار عقن مسقتندا أو مراجقع أو

دوائية بية شبه رسمية منقولقة عقن مراجقع أخقري سقابقة أو ققد تكون منقولة مع بعض التعديل ويمكن اعتبار هقذه البرديقا دسقاتير

األدوية في تلك العصور أو كما نسميها نحن اآلن فارماكوبيا .

ا دوائي خالص كبردية ايبرس وبعضها دوائي ثانيا: بعض هذه البرديجراحقي كبرديققة أدويققن سققميث وبعضقها عالجققي وسققحري كبرديققة

برلين.

ثالثا: بعض هذه البرديا رتب ترتيبا دقيقا اذ تذكر البرديقة فقي كقل وصفة نوع المرض، ريقة الفحص، التشخيص، وصف العالج، ريقة

تحضير الدواء، ريقة تعا ي الدواء. بعققا: أن هققذه البرديققا قققد حققو مجموعققة مققن العقققاقير النباتيققة را

والحيوانية والمعدنية وأن نسبة العقاقير النباتية فيها مرتفعة حوالي خمو أسداس.

خامسققا: أن الكثيققر مققن العقققاقير النباتيققة التققي ذكققر يحتققاج الققي دراسة دقيقة لتحقيقه ومعرفة أسمه وأصله اذ أن كثيرا من النباتا

طبية قد أختفي من مصر بمرور الزمن وقد تكون هذه العقاقير ممقا ال استجلبه المصريون من األقطار اآلخري.

سادسا: تجد في بعض البرديا بعقض العققاقير غيقر المصقرية اذ أن المصريين القدامي لن يكتفوا بما نب فقي أرضقهم بقل حقاول بعقض

223

لطبيقة وغيقر الطبيقة الملوك واألمراء استجال الكثيقر مقن النباتقا ا وأقلمتها في مصر

والمداواة الدواء على والمسلمين العرب فضل

صلى محمد األعظم الرسول وفا على واحد قرن من أكثر يمض لم شاسعة مساحا احتلوا قد لمسلمون ا كان حتى وسلم عليه هللا ذلقك وشقمل بقل العربقي الخليج حتى األ لسي المحيط من تمتد كمقا .غربقا فرنسقا وتخقوم شقرقا الصين ومشارش نوتركستا الهند .وإندونيسيا وسيراالنكا صقلية المسلمون دخل

المعرفقة مصقادر جميقع علقى الحصقول علقى ذلقك سقاعدهم وققد

الققرن مقتبل وفي ولذلك احتل التي األراضي شعو من والعلوم بأجنحتهقا العديقد لمستشقفيا ا هنقاك كقان لمقيالدي ا التاسقع وابتدأ والخزعبال الخرافا عهد بذلك وانتهى .وصيادلتها وأ بائها أوروبا في ساد والظالم الجهل من عديد قرون بعد علمية نهضة .ونوره اإلسالم ظهور حتى م ٢٠١ عام جالينوس وفا منذ

أن لبثق ومقا القوفير والعلقم والغنقى دلمجبقا بالقذا بغقداد تمتع والقاهر تونو األخرى سالميةاإل العواصم إلى النهضة هذه امتد جميع من العلمية والكتب و ا لمخا لمسلمون ا فجلب وقر بة أوائقل ومقن .فائقة بسرعة العربية اللغة إلى ترجمتها وتم األقطار ( ماسقويه بن يوحنا الفتر تلك شهدتهم الذين لمترجمين ا العلماء .إسح بن وحنين (م ٨٥٧ - ٧٧٧

والصيدلة الطب في والمسلمين العرب علماء من نخبة :اسحق بن يعقوب الكندي -1

عقد كتقب والموسقيقى، والكيميقاء والصقيدلة الطقب بعلقوم اهقتم عقالج وفقي والبقادرهرا ، والمسقهال واألدويقة الغذاء في مقاال وفقي الحميقا وفقي المعقد ، وجقع وفقي النققرس، وفقي البقرص، .الطحال التها

لعقالج وصقفا على يحتوي "كريدين" للكندي القفطي نسب ولقد

مثقل الصقيدلية المستحضقرا تحضقير لطقرم وشقرح األمقراض، .واألكحال واللبخا والمراهم، األقراص،

224

-المهلقك والقدواء الغقذاء-االبقرا قي الطقب :الطبيقة كتبقه أهم ومن

وانجذا األدوية إسهال كيفية -المؤذية الروائح من الشافية األدوية ققال العطقور كيميقاء فقي رسقالة ألف كما المركبة، ويةاألد -األخال اإلسالم في التراجمة أمهر من أنه البلخي معشر أبو عنه

:الكوسج سهل بن سابور -2

الصقيادلة بموجبقه يعمقل كقان القذي الكبيقر األقربقاذين صاحب وهو األدويقة فيهقا ذكر بابا عشرين على المؤلف هذا يشتمل والعطارون الحبقو ، األققراص، :وهقي الصقيدالنية شقكالهاأ بحسقب مرتبقة

المربيقا ، األشقربة، اللبخقا ، الجوارشنا ، المعاجين، السفوفا ، الحققن، الضقمادا ، المقراهم، األدهقان، األكحقال، المطبوخقا ، .والقيء الرعاش أدوية السعو ا ، الذرورا ،

:الطبري ربن بن سهل بن علي -3

و والصقيدلة الطقب لفنقون جقامع كتقا أققدم الحكمقة فردوس كتابه :والصيدلي الطبي العلم في فصول سبعة إلى الكتا هذا قّسم الجنقين علم في .والفساد والكون والطبائع الفلسفية المعاني في

.وأنواعهقا التغذيقة فقي .األ فقال وتربيقة األعضقاء ووظقائف والقوالد فقي .موالمقذا واأللقوان القروائح فقي .ومعالجتها وأسبابها األمراض دراسقة فقي أبقوا خمسقة فيهقا خصقص :والسموم الطبية الماد والمقواد الصقمغ فقي والعقاقير، المقرر األدوية وفي الطبية، الماد

والطقين، األرض وقوى والرماد، والدخان والمعادن األصداش الطبيعية، والريقاح والميقاه البلقدان فقي .وحفظهقا األدويقة إصقالح في "وأخيرا .اكبوالكو والفلك

والفارسقية، الهنديقة األدويقة مقن "كبيرا "عددا الطبري ابن ذكر لقد والحجب والحجامة الفصد إلى باإلضافة الصحة، قواعد عن تكلم كما

ابقن ذكر وقد ."الطيب معاجين أي" والغوالي الدخن وأنواع والتعاويذ أبي ابن وأضاش للطبري مؤلفا خمسة الفهرس كتابه في النديم : وهي أخرى خمسة األ باء بقا كتابه في أصيبعة

األدويقة منافع كتا الحضر ، كنا الحكمة، فردوس الملوك، تحفة

القروم مقذهبي علقى واألد األمثال في كتا والعقاقير، واأل عمة .الصحة حف كتا الحيا ، عرفان كتا والعر ،

225

:الرازي بكر أبو -4

مدينقة فقي ولقد الهجقري، ثالقثال الققرن إلى الراري بكر أبو ينتمي العباسقي الخليفقة أيقام فقي وعقا .بفقارس هقران جنوبي الري استشقار وققد والحكمقاء، العلمقاء مقن مجلسقه وكان الدولة، عضد

وذلقك بغقداد، فقي العضقدي المستشقفى بنقاء أراد عنقدما الخليفة والكيميقاء، الطقب بعلقوم القراري واشتهر .له المالئم الموقع الختيار ويعتبقره .داء لكقل المناسقب القدواء وضقع لقدى بينهمقا يجمع وكان

كتابقه فقي جقاء فققد الوسقطى، الققرون أ باء أعظم من المؤرخون بعلقوم المعرفقة جمقع وققد دهقره، أوحقد القراري كقان) :الفهرسق ضاع المؤلفا ، من كبيرا عددا الراري ترك وقد .الطب سيّما القدماء، كتا ثم "الروحاني الطب" هلمعروفا مؤلفاته فمن .منها كبير قسم

فيذكر التجار إجراء في المتبع المنهج فيه ذكر الذي "األسرار سر" القراري يصقف الثاني الكتا هذا وفي .واألدوا المستخدمة المواد وبعضقها الزجقاج مقن مصقنوع بعضقها ا ، جهار عشرين على يزيد ما

في الراري كتب ما أهم من فيعد الحاوي كتا أما المعدن من األخر ودون المنتشقر ، األمقراض فيقه وصقف والصقيدلة، الطقب علمقي

.فيها وخبراته مشاهدته يقد علقى انجقاره تقم قد الحاوي كتا أن على المؤرخين أجمع وقد

.ا جزء وعشرين ثالثة من تتألف موسوعة وهو . بعده من تالمذته

.سقريريةال األبحقا فقي القراري براعقة الحقاوي كتقا في وتتجلى ولم الوجود، نادر كان فإنه الباه ولثمنه الكتا هذا لضخامة ونظرا العقالم فقي أجزاوهمقا تورعق بالعربيقة نسقختين سقوى منه يكتب

كأحقد معتبقرا الحاوي الكتا ظل الغر ، مكتبا وبعض اإلسالمي، حتى باريو بجامعة الطب كلية في تدرس التي الرئيسية المراجع القذي سقالم، بقن فرج الالتينية اللغة إلى ترجمه قدو .م ١٣٩٤ عام

وأهداه. ١٢٧٩ سنة منه وانتهى حياته، من كبيرا شطرا فيه أمضى كتقا باألهميقة الحقاوي كتقا يلقي .أنجقو شقارل صققيلة لملقك

وهو اسح ، بن المنصور خراسان أمير إلى قدمه الذي المنصوري، :لطبا علوم مختلف في تبحث مقاال عشر من يتألف

.الجسم أعضاء مختلف والعضال العظام فيها وصف :األولى

تسقاعد التي والدالئل واألخال البدن أمزجه عن فيها بحث :الثانية .األمراض تشخيص على

226

.المفرد واألدوية األغذية قوى عن فيها تكلم :الثالثة

بقالجنين والعنايقة الصقحة بحفق المتعلققة البحقو تضقم :الرابعقة .لوالطف

وسقعفة، وحقزار كلقف مقن الجلديقة األمقراض معالجقة :الخامسقة .بالزينةوالخضا يتعل ما كل إلى باإلضافة

وتغيقر السقفر، أثنقاء اتخاذهقا الواجب التدابير في تبحث :السادسة .واألهوية واألمكنة الفصول

وتكلقم .والققروح الجقروح و الكسقور لمعالجة خصصها وقد :السابعة يجهلون وهم المرضى يعالجون الذين والدجالين ري المخا عن فيها .الصناعة أصول

السموم عن فيها تكلم :الثامنة

مقن اإلنسقان تصقيب التقي األمراض جميع عن فيها بحث :التاسعة .القدم إلى القرن

. معالجتها و رائ الحميا أنواع فيها ذكر :العاشر

فقي بعقه وتقم ي،الكريمقون جيقرار قبل من المنصوري كتا ترجم القرن هايةن حتى الجامعا لبة بين متداوال وظل .م ١٤٨١ ميالنو

يحضره ال من كتا .المشهور الراري مؤلفا ومن .عشر السادس يسقتفيد أن يمكقن التقي الوصقفا مقن عددا فيه جمع وقد . بيب الجقدري) كتقا ويعقد .الطبيقب غيقا عنقد مباشقر المقريض منهقا

ذكر وقد .السريري الطب في العلمية الدراسا أجل من ( والحصبة هقذين بقين التفريق بوسقا تها يمكقن التقي األعقراض القراري فيه

القراري فيقه بيّن الذي "الفارم ما" كتا نذكر أن لنا والبد .المرضين المتشابهة البا نية األمراض من كبير عدد بين التشخيصية الفوارم .األعراض

األسقرار،وقد سقر كتقا فأشقهرها الكيميقاء يف الراري مؤلفا أما

عليهقا الحصقول ووسقائل الكيمائيقة المقواد بعقض خقواص فيه شرح وبقوارم وراجقا وأجسقاد أرواح إلقى وقسقمها.وتنقيتها يرها وتحض .وأحجار وأمالح

227

كتقا ويضم الكيمياء، علم في ذكره ورد ما أول التقسيم هذا ويعد العققاقير مقن تحضقيرها و ريقة الطبية، الوصفا بعض األسرار سر

واآلال األجهقز لقبعض ذكقر أيضقا الكتقا هقذا فقي وورد .النيابيقة .تجاربه أثناء الراري استعملها التي واألدوا

بتقطيقر الكحقول علقى حصل من أول هو الراري أن المؤرخون ويذكر الجراحقة، خيقو اختقراع إليه ينسب المتخمر ،كما السكرية المواد

مقداوا فقي الزئبق مقرهم واسقتعمل .الحيوان أمعاء من ةالمصنوع مقن حقنقة الملتهبقة المثانقة لغسقل اسقتعمل كمقا الجفن، التها ألمها لتسكن الورد بماء مذا أفيون من تتألف وحقنة الخل،

إلقى تضقم أن - العباسقي الخليفقة - الدولقة عضقد أراد وعنقدما قائمقة له يحضروا بأن رأم المعروفين، األ باء من نخبة البيمارستان

خمسين منهم اختار وقد المائة، على عددهم فزاد األ باء، بأسماء صقناعة فقي ا مهار من علمه إلى وصل ما قدر على وذلك بيبا ، عشقر علقى العقدد اقتصقر ولمقا رأسهم، على الراري وكان الطب، يقدير أن منقه و لقب ،المجموعقه رأس علقى القراري كقان أ بقاء

.لعضديا المستشفى

علميقا مسقلكا أبحاثقه فقي سقلك وققد اإلنتقاج، بوفر الراري وامتار أعطقى ممقا والتتبقع، الرصقد واسقتخدم التجقار ، فقأجرى سقليما ، اليقوم الغقر علمقاء بعقض أنقه حتقى خاصقة، قيمة الكيمائية تجاربه الكيمائيقة معلوماتقه بق وققد الحديثة، الكيمياء مؤسو يعتبرونه أدخقل مقن أول وهقو وصقنعها، األجهز ستخدموا الطب، حقل في

.الطب على الكيماوية المركبا

إلقى أدخقل القراري ":العام العر تاريخ" كتابه في سيديو أ.ل يقول الطب على الكيماوية المركبا وتطبي الملينا استعمال الصيدلة للراري كان لقد استعمالها من يكثر فكان الفتائل مخترع هو والراري

ظهقور في أيضا ولكن الكيمياء، علم تقدم في فقط ليو الهام ثراأل .الكيميائية العقاقير علم

المقواد قسقم عنقدما جليقة، بصقور الكيميقاء، فقي فضقله ويظهقر هي : أقسام أربعة إلى عصره في المعروفة

المقواد - الحيوانيقة المقواد - النباتيقة المقواد - المعدنيقة المقواد

.المشتقة

228

بعقض وحضقر بائعهقا بحسقب أنقواع، إلقى لمعقدنيا ا قسقم كما مسقتخدمة التحضقير فقي اتبعهقا التقي الطقرم رال وما .الحوامض عليقه أ لق القذي الكبريتيقك حقامض ذكر من أول وهو .اليوم حتى .األخضر الزاج أو الزاج ري اسم

ميزانقا لقياسقها وصقنف للسقوائل، النوعية الكثافا بتعين واشتغل .الميزان اسم عليه أ ل خاصا

:المجوسي األهوازي العباس بن علي -5 علقى الطقب ودرس جنديسقابور، من بالقر األهوار مدينة في ولد

أهقم مقن الطبيقة الصقناعة كامقل كتابقه يعتبقر .سقيار بقن موسقى وظهر سواء، على والغر الشرم لعلماء مرجعا بقي حيث مؤلفاته كقل فقي جقزأين مقن يتقألف ووه .الصيدلة حقل في الهام دوره فيه

وأعراضقها، األمراض عن األول الجزء في تكلم مقاال ، عشر منهما .األدويقة وتحضقير المداوا رائ عن تكلم فقد الثاني الجزء في أما

وتعقابيره السقليمة، وبلغتقه تبويقه، بحسقن المؤلقف هقذا ويمتقار عضد بغداد لملك وأهداه الملكي، الكتا اسم عليه أ ل .الجميلة .البويهي الدولة

مدرسقة فقي اإلفريققي، قسقطنطين ققام عشر الثاني القرن وفي اسقم تحق الالتينيقة إلقى بترجمته بايطاليا، سالرنو بمدينة الطب لنفسه ونسبه الملكي الكتا

عقن تكلقم كمقا اإلنسان، جسم على األدوية مفعول قو شرح لقد

علقى تقأثير مقن هقال وما المريض ومهنة السنة وفصول الجو عوامل المعد في استحالتها على يساعد العقاقير سح أن اعتبر .البدن في ويذكر المركبة، األدوية صنع لكيفية علمية ريقة ووضع والكبد، فقال بالغقذاء، المقريض عقالج يلقزم أنقه الطبيقة الصقناعة كامل كتابه فقال مفقرد، بسقيط بقدواء عالجه أمكن وإذا الدواء، من شيئا يعطى .الغريبة األدوية تستعمل وال مركب، بدواء يعالج

: سينا ابن -6 أفشقنا قريقة فقي ولقد سقينا، بن هللا عبد بن الحسين علي أبو هو

األمقر بقاد فقي انصقرش تركستان، مدن إحدى بخارى، من بالقر وأخيرا والفلسفة، المنط تعلم ثم الشريعة، ودراسة القرآن، لحف الثامنقة عمقره يتجقاور ولم يقول كما توعبهافاس الطب، لعلوم تفرغ

229

نبوغقه، من رأى ولما الساماني، منصور بن نوح األمير قربه .عشر .فيها أوقاته يقضيمعظم كان التي الخاصة مكتبته له وفتح .الزمن بمثلها يجود ما قل نادر وعبقرية فذ شخصية سينا ابن يعد كلها كتب والفنون، مالعلو مختلف في مؤلف مائة على يزيد ما ترك بالفارسية ودونه النبض عن فيه تكلم واحد كتا عدا العربية، باللغة السقتخراج األعشقا بدراسقة بالغقا اهتمامقا سقينا ابقن اهقتم لقد

لقد ا باهر نجاحا بذلك فنجح المرضى، لعالج تستخدم التي األدوية دويقةاأل اسقتخالص على سينا ابن قدر من العلوم مؤرخو انده كثيقرا تمتقار األدويقة هقذه إن بقل الطبيعيقة، مصادرها من الكيماوية شكري جابر يقول .الحديثة المختبرا في تحضر التي األدوية على ابقن كيميقاء إلقى نضقيف أن نقود": (العر عند الكيمياء ) كتابه في لقد .واألقرباذين الطبية، والعقاقير العطاريا حقل في انجاراته سينا واسقتخلص العالجيقة النقواحي مقن وافية دراسة المواد هذه درس مقن تكقون تكقاد استخالصقا الطبيعية مصادرها من الكيماوية األدوية وققد الحديثقة، المختبقرا فقي تجري التي تلك يضاهي ما النقاو ، هقذه واسقتعماال دراسقة فقي القانون كتا من كامال جزءا خص

بعقد فيمقا للعشابين مهما مرجعا هال دراسته أصبح وقد العقاقير، فقي متينقا أساسقا كانق الطبيقة، العقاقير في سينا ابن أعمال إن أن تبقين الكيميقاء لعلقم دراسقته ومن .والصيدلة العقاقير علم وضع التجريبيقة الطريققة قريقتين علقى تعتمقد وفعاليتهقا األدويقة معرفة

.القياسية والطريقة لقذا "الصقيدلة" األدويقة علقم فقي بالغا ماما اهت سينا ابن اهتم لقد لتحضقير الققانون كتب من والخامو الثاني الجزأين خصص أنه نجد

الجقزء ويشقمل .الطبية األعشا ودراسة والمركبة المفرد األدوية مقن كبيقرا عقددا ويحتقوي المفقرد ، األدوية أو العقاقير، علم الثاني فارسقية، ، هنديقة يونانيقة، رمصقاد من عليها حصل الطبية النباتا فيه ركّز فقد الخامو الجزء أما .المنشأ عربي أكثرها ولكن وصينية، ومعدنيقة نباتيقة مصقادر مقن المركبقة األدويقة تحضقير ريققة علقى

هذه بقي مركب، دواء ثمانمائة من أكثر جهز أنه نجد لذا .وحيوانية مقن أوروبقا ثقم ميةواإلسقال العربيقة .األمقة تتداولها المركبة األدوية .بعدهم

القبالد فقي والصقيدلة الطقب لطال رئيسا مرجعا القانون كتا يعد

فقي درس وققد .عشقر الثقامن الققرن حتقى واألوروبيقة اإلسقالمية عد و بع ترجم وقد م، ١٥٦٠ عام حتى ولوغان مونبيليه جامعتي .م ١٦٦٣ عام وأخرها ١٤٧٢ عام أولها مرا

230

:البيروني أحمد بن محمد الريحان أبو -7

اآلثقار" اسقماه كتقا فقي وضقعها سقينا ابن مع مراسال له كان أهم من "الطب في الصيدلة" كتا يعتبر الخالية القرون من الباقية وعبقد صقابر حفنقي العظقيم عبقد يققول الصيدلة علوم في المراجع الصيدلة تاريخ موجز كتا في قنواتي شحاته وجورج منتصر الحليم

مجقال فقي هامقا ومرجعقا علمية ذخير هذا الصيدلة كتا تبريع" : :أساسيين قسمين إلى الكتا هذا وينقسم الصيدلة،

مقع والعقالج، والفارماكولوجيقا، الصقيدلة، فقن فقي ديباجقة :أولهمقا بقل قيمقا ، عمقال المقدمة وتمثل .مفيد تاريخية وإيضاحا تعريفا اإلسقالمي العهقد فقي ولقيو للصقيدلة، عظيمقة إضقافة وتعتبقر

في كذلك شرح ولقد العصور، كل في الصيدلة لتاريخ بل المتوسط، علقى يجقب التقي التقدميقة والخطقوا المسقؤوليا القسقم هقذا

.إليها يهدش أو يقوم أن الصيدلي مقن كثيقرا فيقه فأورد الطبية، للماد خصصه فقد الثاني القسم أما

المالحظقا مقن ققدرا را ذاكق المعجقم، حروش حسب مرتبة العقاقير هقذه أسقماء فقذكر الخاصقة، األهميقة ذا والمعلومقا األصقلية األسقماء هقذه واشقتقام المختلفقة اللغقا فقي المعروفة العقاقير .وتخزينها وموا نها، العقاقير، هذه و بائع

:زهر ابن -8 كان األشبيلي، األندلسي األيادي رهر بن الملك عبد مروان أبو هو كمقا منجمقا وال فقيها وال فيلسوفا يكن فلم رمنه في شاذينال من تعلقم أنقه مقع غيقر، ال بيبقا كقان بل بلده، في معاصروه عليه كان وصقف رمنقه، فقي المتداولقة العلقوم مقن وغيرهمقا والحقديث الفقه النفقوس، أمقراض مقن مرضقا نفسي في فإن أنا وأما :بقوله نفسه سقلب فقي األدويقة،والتلطف بقةوتجر الصقيدالنيين أعمقال حب من وتفصقيلها، الجقواهر وتمييز غيرها، في وتركيبها األدوية، قوى بعض

.باليد ذلك ومحاول المقداوا فقي التيسقير" كتابقه أشقهرها متعدد ، ومقاال كتبا ألف

حف عن األول الجزء في تكلم وملح ، جزأين من ويتألف "والتدبير ومنتهيا الرأس بعلل مبتدئا جها،وعال األمراض بشرح واتبعه الصحة، عن للكالم خصصه فقد الثاني الجزء أما والبطن، الصدر أمراض بذكر .الوبائية واألمراض الحميا ، بذكر وختمه البطن، أسفل أمراض

231

ري عن للمريض الصناعية التغذية فيه ذكر األغذية في كتابا ألف فقي ورسقالة نقا ،والمعجو األشقربة في الجامع وله والشرج، الفم

الجقر عقن كشقف مقن أول وهقو .السقكر علقى العسقل تفضقيل .السر انية األورام عرش ينقله،كما الذي والطفيلي

:رشد ابن -9 مقن اقتبسقه مقوجز شقكل على وضعه الطب في الكليا كتا له

.سينا ابن قانون

:األندلسي الغافقي محمد بن أحمد جعفر أبو -10

فيقه جمقع فقد المفرد األدوية كتابه بسبب ةعظيم شهر نال لقد وشرح علميا وصفا وصفها البسيطة األدوية من صنف ألف يقار ما

التقي األدويقة وتطقوير بجمقع الغقافقي اهتم لقد .استعمالها ريقة فققد ذلقك علقى عقالو الكثيقر أضقاش بقل له، السابقين من تعلمها أن بقولقه ذلقكو سقواء حقد علقى والصقيدلي للطبيب نصائح أعطى يجقب ولكقن لعليله، وصفه الذي الدواء تماما يعرش أن يجب الطبيب

يكقون أن يلزمقه القذي للصقيدلي هذا فيترك صنعه في يتدخل ال أن يققنن أن وحقاول تحضقيرها، و ريققة األدويقة استعمال على مطلعا تمامقا ملمقا الصقيدلي يكقون أن يجقب قال حيث الصيادلة، مؤهال يحمقد القذي الموققف هذا .استعمالها و رم األدوية رتحضي بطريقة نالحق لذا والمركبة، المفرد األدوية تحضير في عمالقا جعله عليه اللغا واستخدم موسوعة شكل على جاء المفرد األدوية كتابه أن

.والبربرية والالتينية العربية آنذاك الشائعة

:توفي األنطاكي داود -11

والكليقا الجامعقا فقي يقدرس وهقو داود تذكر مؤلفاته أشهر من .النباتية العقاقير مواد والصيدلة الطب فرع

أكثقر "العجقا للعجقب والجامع األلبا أولي تذكر " مؤلفه في ذكر .العطارية والمفردا الطبية النباتا من ٣٠٠٠ من

المفقرد األدويقة السقتعمال ققوانين وضقع فقي قويال وقتقا قضقى وعقرض فقرد كقل يتناولهقا أن يجقب التي المقادير وتعيين ،والمركبة الحيوانقا ، أنقواع مقن وعشقرا النباتقا ، أنقواع مقن لمئقا داود

أساسقية قواعد عد ذكر ثم وأدوية، عقاقير منه يتخذ ما والمعادن،

232

عامقة وصقفا أورد كمقا العقالج، تحضقير و ريقة الدواء، صناعة في .المختلفة والتراكيب لسفوشوا واألدهان األكحال من وعشرا

:العطار كوهين -12

نصقائح فيه قدم "األعيان ودستور الدكان منهاج" كتابه مؤلفاته أهم األدويقة وتركيقب أعمقال وجمع الصيدلة، صناعة يحترش أن أراد لمن

تتنقاول بابا ، وعشرين خمسة على الكتا ويشمل .لألبدان النافعة والمقراهم والحبقو اللعوققا و واألققراص والسقفوفا المعقاجين .والضمادا واأل لية واألكحال واألدهان

وفقي المفقرد ، األدوية اتخاذ بكيفية والعشرون الرابع البا ويختص

امتحقان عقن األخيقر البقا في وتكلم .تخزن وكيف تجنى رمان أي مفصلة دراسة قدم منها الجيد حال ووصف والمركبة المفرد األدوية األدويقة معرفقة علقى العظيمقة بمقدرتقه وبقرر دويقة،األ أعمقار عقن

على برية المخ التجار ببعض بقيامه وذلك والمغشوشة، األصلية .يتعا اها كان التي األدوية معظم

:البيطار ابن -13

القرن الهجري السادس القرن من األخير الربع في البيطار ابن ولد

إلقى رحقل .ندلسقيةاأل مالققة مدينقة فقي المقيالدي عشقر الثقاني الحقاذم الطبيقب كقان مصقر، إلقى عاد ثم واليونان، وسوريا المغر يخقرج أن فاسقتطاع األعشا ، خصائص عرش الذي البارع والعشا

بية وعقاقير ومركبا بمستحضرا واألعشا للنبا دراسته من علقى نفسقه البيطقار ابقن يقصقر لقم العالجيقة للصيدلة ذخير تعد

ولكنقه الطبيعيقة، األعشقا مقن استخلصقها التقي د المفقر األدوية بقذلك معتمقدا والمعقادن، الحيوانقا مقن األدوية من كثيرا استخرج القصقري فقائز محمد يقول .القول وصدم والمشاهد التجربة على ومنقذ :"الحضقار فقي وأثرهقا اإلسقالمية الثقافة مظاهر" كتابه في تحق الصيدليا أصبح الميالدي التاسع القرن في المأمون عصر

أبقن وكقان .مسقلكي لفحقص يتعرضقون والصقيادلة الدولقة، إشقراش علمقاء أشقهر مقن وكقان القاهر في الصيدلة لقسم عميدا البيطار بكتابقه مرحبقا القرحمن عبقد محمقد وامتدحقه والصقيدلة الكيميقاء

البيطقار ابن أن والح " :فقال "العر عند العلوم تاريخ في الموجز" كقان .كلهقا الوسقطى العصور في ظهر وصيدالني نباتي عظمأ كان ونع نباته ومواضع واختباره وتحقيقه النبا معرفة في رمانه أوحد

.وتنوعها اختالفها على أسمائه

233

الدساتير الحديثة

سار العالم علي هذا النحو يتخبط بين هذه الدساتير الطبية الكثير دي حين ظهر عقد دسقاتير العدد حتي القرن التاسع عشر الميال دستورا وهي: 26في كثير من أقطار العالم بلغ مجموعها

1876الدستور البرتغالي عام 1864الدستور البريطاني عام 1893دستور رومانيا عام 1886دستور شيلي عام

1905دستور نيورالندا عام 1904دستور المكسيك عام 1906اليا عام دستور استر 1905دستور أسبانيا عام 1907دستور سويسرا عام 1907دستور الدانمارك عام 1908دستور فرنسا عام

و 1929وفي القرن العشقرين شقهد السق سقنوا بقين عقامي

همة ونشا ا كبيرين في مراجعة وتجديقد الدسقاتير الدوائيقة 1934، كمقا صقدر دسقتور األدويقة 1955وصدر دستور األدوية المصري عام

.1954عام الدولي

الصيدلة الحديثة

القرن الثامن عشر

ارتق الصيدلة، واخترع الصيادلة األدوية المختلفقة لعقالج األمقراض. وفي هذا القرن اعترش بالصيادلة ضمن العائلة الطبية بعد نقزاع حقاد مققع األ بققاء فققي انجلتققرا وسققبق المانيققا جميققع الققبالد األوروبيققة

43عقدد مقن الدسقاتير الطبيقة عقددها بالصيدليا وتنظيمها، وصدر م. 1799م، وأخرها عام 1701دستورا كان أولها عام

القرن التاسع عشر

نهض العلوم جميعا وبلغ الصيدلة غاية عظمتهقا وتققدم

علوم الكيمياء والصيدلة والطب والعقالج. واكتشقف القلويقدا فقي ام واكتشققفوا الثلققث األول مققن هققذا القققرن علققي يققد الصققيادلة العظقق

األفيون، المنوما ، المخدرا في الثلث الثاني، ثم المواد الكيماوية العضوية في الثلث األخير.

234

القرن العشرين

تقدم البحث العلمي ونبقغ العلمقاء فقي الصقيدلة والعققاقير و فقر علوم الطب والعالج وتم اكتشاش أهم المواد الدوائية في المضقادا

نا والفيتامينا ومركبا السلفا وغير ذلك كثير.الحيوية والهرمو

القرن الواحد والعشرين

أهم ما يميز هذا القرن هو االهتمام بالتكنولوجيا الحيوية والهندسقة الوراثية، وقد أنتج عد أدوية هامقة عقن ريق الهندسقة الوراثيقة

منها االنسولين وبعض الهرمونا واللقاحا .

الصيدلي في مصر في العصر الحديث تاريخ تطور التعليم

م القي 1805تولي محمد علي علي باشا الكبيقر حكقم مصقر عقام م حدث مذبحة القلعقة وأصقبح السقيطر 1811م وفي عام 1848

كاملة لمحمد علي باشا في حكم مصقر والنهقوض بهقا فقي شقتي المجاال مما جعله مؤسو مصر الحديثة وبالنسبة لتطقور التعلقيم

فيمكن تلخيصه فيما يلي:الصيدلي م أصدر محمد علقي مرسقوما بتعيقين كلقو بقك 1824( في عام 1

رئيسا للخدما الطبية بقالجي المصقري القذي أنشقأ مستشقفي محل ثكنة قديمة من ثكنا الجي بقأبي رعبقل وكانق تسقع بقين

صققيدليا و بيبققا 150مققريض استحضققر لهققم حققوالي 1000 – 800يقققا وفرنسقققا، وفقققي وسقققط هقققذا ومسقققاعدا معظمهقققم مقققن ايطال

المستشفي حديقة ررع فيها أكبر عدد ممكن من النباتا الطبية.( أنشأ كلو بك بعد ذلك مدرسة بية لأل باء والصيادلة واأل بقاء 2

البيطريين بأبي رعبل لمد حاجة الجي بمقا يلقزم مقن هقؤالء وكقان تها ، وكان كلو بك أول ناظر لها وكان معظقم أسقاتذ1827ذلك عام

مرجعقا بيقا مقن اللغقة الفرنسقية 52من االوروبيون وترجم حقوالي نققل فقرع الصقيدلة مقن مدرسقة 1829الي اللغة العربية وفي عقام

الطب من أبي رعبل الي القلعة.نقلقق مدرسققة الطققب والمستشققفي مققن أبققي 1837( فققي عققام 3

رعبل الي القصر الذي بناه أحمقد بقن العينقي حفيقد أحقد سقال ين م وقققد اريلقق تكيققة بققن العينققي وأنشققأ مدرسققة 1766ام مصققر عقق

الب قب و 140الصيدلة الحديثة وبلغ عدد الطلبة في ذلك الوق الب صيدلة واقفل المدرسة أيام سعيد باشا )حكم مصر مقن 50

م 1856( ثم أعيد فتحها عام 1863الي يناير سنة 1854يوليو سنة ربعة سنوا .وكان مد الدراسة بمدرسة الصيدلة أ

235

كقان أول اجتمقاع للمكتتبقين للجامعقة 1906أكتوبر عقام 12( في 4المصققرية فققي منققزل سققعد رغلققول بققك المستشققار فققي محكمققة االستئناش األهلية وتقم انتخقا اللجقة التحضقيرية مثقل فيهقا سقعد رغلول بك وكيال للرئيو العقام، وقاسقم أمقين بقك سقكرتيرا للجنقة،

ي حسقن سقعيد بقك القذي كقان يعمقل وأمانة الصندوم اسقند القوكيال بالبنك األلماني الشرقي ولم يحددوا الرئيو العام. وكقان أول المكتتبين مصطفي بك الغمراوي من وجهاء بني سويف الذي تبقرع

جم وكان كل المكتتبون من الوجهاء ثم بدأ أمراء االسقر 500بمبلغ مهمقة اقامقة الحاكمة يتابعون برعايتهم المادية وبجهودهم تسقهيل

هذه المؤسسة وكان سعيد باشا حليم أول من اهقتم بقاألمر وأخقذ علي عاتقه رئاسة لجنة األمراء وجمع التبرعا منهم.

كان االجتماع الثاني القذي أعلقن فيقه عقن 1906نوفمبر 30( في 5ضرور انتخا لجان فرعية متعدد لالكتتا وجمقع التبرعقا وتقوافر

ة فكقر اسقناد رئاسقة المشقروع ألميقر مقن بين جميع أعضاء اللجنقاألمراء تجتمقع عليقه الكلمقة حتقي يضقمنوا انتظقام سقير االجقراءا المتخذ للمشروع كما قرروا ايداع مقا يجكقع مقن المقال فقي البنقك

%4األلماني الشقرقي )البنقك الوحيقد القذي قبقل أن يعطقي فائقد سنويا(.

ن )الذي تقولي بقدال أعلن قاسم بك أمي 1907يناير سنة 19( في 6مقن سققعد رغلققول الققذي تققولي ورار المعققارش( أن الخققديوي عبققاس

م( تفضقل بجعقل 1914 –م 1892حلمي الثقاني )تقولي الحكقم مقن اللجنة تح رعاية سموه وبجعل ولقي العهقد الكقريم )األميقر أحمقد فؤاد( رئيو شرش لها وكتب قاسم أمين لألمير أحمقد فقؤاد ليتقولي

رئاسة اللجنة.اجتمعقق الجمعيققة العموميققة 1908ينققاير 31فققي يققوم الجمعققة (7

برئاسة قاسم بك أمين وأعلن بهذه الجلسة قبول دولة األمير أحمد فؤاد الرئاسة.

( اجتمع اللجنة برئيسها الجديد )األمير أحمد فقؤاد باشقا( للمقر 8مقارس عقام 12األولي بسقراي دولقة األميقر أحمقد فقؤاد باشقا فقي

قوا في هذا االجتماع علي أن أول عمل يجب البدء به وقد اتف 1908 هو االرسالية والتدريو.

ديسقمبر عقام 5( اجتمع مجلو الجامعة في جلسة تاريخية في 9للنظر في أمر افتتاح الجامعة. وهنا قرر األمير أحمد فؤاد باشا 1908

رئققيو اللجنققة أنققه سققعي الققي خققديوي مصققر وعققرض عليققه األمققر وقبل أن يحضر ويخطب فيها، وكانق حفقل االفتتقاح بافتتاحها فواف

وحضر 1908ديسمبر عام 21بقر جمعية شوري القوانين في صباح الحفققل جميققع رجققال الدولققة والوجهققاء واألعيققان ورجققال السققلك

236

السياسي الذين تبرعوا للجامعة وكقذلك أعضقاء الجمعيقا العلميقة في مصر.

المصقرية مقنح الجامعقة ( راد مصاريف الجامعة وقرر الحكومقة10جقم سقنويا وكانق القدار التقي تققيم فيهقا 1000اعانة أوليقة ققدرها

الجامعة ليس ملكا لها )مقر الجامعة األمريكيقة اآلن( وال تصقلح أن تكون مققرا ثابتقا لهقا كمقا كقان صقاحبها جنقاكليو غيقر راغقب فقي استغاللها علي سبيل االيجار وكان الجامعة فقي ذلقك الوقق تمقر

ظروش مالية ضعبة واختالل في ميزانية المشروع.ب( عندما أ لقع القدكتور محمقد علقوي باشقا األميقر فا مقة بنق 11

اسماعيل )وكان بيبا خاصا بأسرتها( علي هذه الظروش أعلن لقه أنها علي استعداد لبذل ما لديها للمسقاعد . فأوقفق سقتة أفدنقة

فقدانا بمديريقة 661 خصصتها لباء دار جديقد للجامعقة، هقذا بخقالشالدقهلية وسارع الجامعة بمخابر المهندسقين لعمقل الرسقوما الالرمة وأعلنق األميقر فا مقة أنهقا سقتتحمل جميقع تكقاليف بنقاء

ألقف جنيقه فتبرعق بمجوهراتهقا 26الجامعة والتي كقان مققررا لهقا جم.70000التي بيع بمبلغ

اسقي لهقا فقي يقوم ( أجر الجامعقة احتفقاال بوضقع الحجقر األس12م فقي 1914مقارس 31هقق 1332جمقادي األول 3األثنين المواف

الرابعققة والنصققف بعققد الظهققر وذلققك فققي األرض التققي وهبتهققا دولققة األمير فا مة وحضر االحتفال سمو الخديوي عباس حلمي الثاني. وقققد كتققب علققي حجققر األسققاس هققذه العبققار "الجامعققة المصققرية.

هقق(" واودع الحجقر بطقن 1332اسماعيل سقنة )األمير فا مة بني األرض ومعه أصناش العملة المصرية المتداولة ومجموعة من الجرائد التي صدر يوم االحتفال ونسخة مقن محضقر وضقع حجقر األسقاس الققذي تققوج بتوقيققع الخققديوي وصققاحبة الدولققة والعصققمة المحسققنة

أحمقد فقؤاد الكبير األمير فا مة وتالهقا فقي التوقيقع دولقة األميقر باشا رئيو شرش الجامعة فرئيو وأعضاء مجلو ادارتها.

( تعثققر الجامعققة أيققام الحققر العالميققة األولققي ونققادي الققبعض 13 (.1917 – 1915باغالقها )

عبققر 1917( بعققد تققولي األميققر أحمققد فققؤاد عققر مصققر فققي 14الجامعة األرمة فقد كان للرجل عالقة قديمة بالجامعة األهلية خالل

1913 – 1907تققر والدتهققا اذ ظققل رئيسققا لمجلققو ادارتهققا مققن فوشكل الملك فؤاد لجنة برئاسة عدلي يكن ورير المعارش للنظر في

أن تكون الجامعة حكومية.بتحويققل الجامعققة 1925مققارس 11( صققدر مرسققوم ملكققي فققي 15

األهليققة )المصققرية( الققي جامعققة أميريققة باسققم الجامعققة المصققرية ( ولقم يكقن األمقر 1925 – 1917مر ثمقان سقنوا )واستغرم هذا اال

1920سهال انما ساعد علي ذلك انشقاء الجامعقة األمريكيقة سقنة

237

وكان الجامعة مكونة من أربع كليا هي )اآلدا والحقوم والعلقوم 1928والطب مع الصيدلة( يجور أن يضم اليها كليا فيما بعد )فقي

البيطري(. ضم الهندسة والزراعة والتجار والطبعقققد مجلققو ادار الجامعققة 1925مققايو 11( فققي يققوم األثنققين 16

المصرية في ثوبها األميري أولي جلساته وانعققد اللجنقة برئاسقة علي مقاهر باشقا وريقر المعقارش وبحضقور أحمقد لطفقي السقيد أول مدير للجامعقة واختيقر نظقار الكليقا األربقع مقن األجانقب وكقان مقن

ناظر بريطاني واتخذ الجامعقة الجديقد مقع نصيب الطب والصيدلة نشأتها قصر الزعفرانة مقرا الدارتها.

بقدأ الجامعقة فقي انشقاء مققر دائقم لهقا فقي 1928( في عقام 17موقعها الحالي الذي حصل عليه مقن الحكومقة تعويضقا عقن األرض التي تبرع بها األمير فا مة بني الخديوي اسماعيل للجامعة.

بتغييققر اسققم 27صققدر القققانون رقققم 1940يو عققام مققا 23( فققي 18 1953سبتمبر عام 28الجامعة المصرية الي جامعة فؤاد األول وفي

صققدر مرسققوم بتعققديل اسققم الجامعققة مققن جامعققة فققؤاد األول الققي جامعة القاهر .

كان مد الدراسة في مدرسة الصيدلة ثقال 1925( حتي عام 19 الصيدلة والعلوم الصيدلية.سنوا يمنح الطالب بعدها دبلوم

اصقبح مقد الدراسقة أربقع سقنوا 1962 – 1925( ابتداء مقن 20 يمنح الطالب بعدها بكالوريوس في الصيدلة والعلوم الصيدلية.

م صدر المرسوم بجعقل مدرسقة الصقيدلة كليقة 1955( في عام 21مستقلة وكقان أول عميقد لهقا المرحقوم أ.د ابقراهيم رجقب فهمقي

.1962لدراسة بها أربع سنوا حتي عام واستمر اأصققبح الدراسققة فققي كليققة الصققيدلة خمققو 1964( مققن عققام 22

سنوا يمنح بعدها الطالب بكالوريوس في العلوم الصيدلية.لقم يكقن موجقود اال كليقة صقيدلة واحقد 1952( حتي قيام ثور 23

)القاهر (.

238

:المراجع ريقاض .د - اليقوم ىإلق التقاريخ فجقر مقن القدواء -1

.الكوي - العلمي رمضان العقر علمقاء إسقهام هللا، عبقد علقي القدفاع، -2

الرسقالة، مؤسسقة الصقيدلة، فقي والمسقلمين .م ١٩٨٥ بيرو ،

وآدا وتشقريع تقاريخ رهيقر، محمقد البابقا، -3

.م ٢٠٠١ دمش ، جامعة الصيدلة، فقي واأل باء الطب تاريخ اسح ، ه الكيالي، -4 ورار ،١ ج والصقيادلة، األسقنان وأ بقاء بحلق

.م ١٩٩٩ دمش ، اإلعالم، صقيدلية ركريقا، بقن محمقد بكقر أبقي القراري، -5

فقي القراري مجربقا الحقاوي، كتقا مقن التداوي دار عقيقل، محسقن شقرحه والتقداوي، الطقب .البيضاء المحجة