Download Drug (active ingredient)

First Edition
Dep. No. 4345/2015
Copyright © 2015, by Raslan, Mohamed & Elmowafy, Mohammed.
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Printed in Arab Republic Of Egypt
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
1
Table of content
Chapter One:
Pharmacy
Title
Basic
Introduction
Page
to
3
Chapter Two: Sources of Drug Information
& Scientific Research
21
Chapter
Forms
41
Three:
Pharmaceutical
Dosage
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
‫ تاريخ ومدخل الصيدلة‬:‫الفصل العاشر‬
214
‫المراجع‬
238
2
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.
3
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.
4
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 nonexistent, 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 .
5
Regardless of practice setting, the pharmacy tech can
assist with workload.
Pharmacy education (governmental or private):
A) Undergraduate education:
undergraduate degrees:
There
are
two
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
6
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.
7
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.
8
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.
9
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.
10
Examples of International organizations:
1) World
(WHO):
Health
Organization
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.
11
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
12
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 policymakers.
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.
13
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;
14
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.
15
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.
16
E.g. an analgesic compound has the following
chemical structure:
HO -
O
- 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.
17
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
18
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.
19
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.
20
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
journals:
for
publication
in
the
scientific
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
journal.
then
submit
finished
article
to
a
c) Journal editors send manuscript to be reviewed
by researchers in the same field.
21
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 online.
Examples of Scientific journals:
- Journal of Pharmaceutical Sciences.
- International Journal of Pharmaceutics.
- Pharmaceutical Research.
- Journal of Pharmacy and Pharmacology.
- Journal of Drug Development
pharmacy.
&Industrial
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.
22
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 pharmacokinetics), 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
23
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.
24
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.
25
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.
26
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.
27
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.
28
29
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.
30
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,
31
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 HealthSystem 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 CDROM. Links from IPA to the indexed full text
articles are not available as of this writing.
32
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.
33
34
7) BIOSIS PREVIEWS:
It is produced by BIOSIS (Philadelphia, PA). It is
covers literature of life sciences, including preclinical
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
35
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.
36
Useful websites (up to date, 2015)
1) International organizations, associations, agencies, societies
abbreviation
Meaning
Website
CIOMS
Council for International Organizations of
Medical Science
http://www.cioms.ch/
DIA
Drug Information Association
http://www.diahome.org
EMA
European Medicines Agency
FDA
Food and Drug Administration
http://www.ema.europa.e
u/ema/
http://www.fda.gov/
HMA
Heads of Medicines Agencies
http://www.hma.eu/
ICH
International Conference on Harmonization
http://www.ICH.org/
IFAPP
International Federation of Associations of
Pharmaceutical Physicians
http://ifapp.org/Aboutifapp
ISO
International Organization for Standardization
OECD
Organization for Economic Co-Operation and
Development
http://www.iso.org/iso/ho
me.html
http://www.oecd.org/
RAPS
Regulatory
Europe
WHO
World Health Organization
http://www.who.int/
ACRP
Association of Clinical Research Professionals
www.acrpnet.org
ECPM
European Center of Pharmaceutical Medicine
http://www.ecpm.ch/
Affairs
Professionals
37
Society
www.raps.org
2) Medical websites, dictionaries, codes and other science oriented web sites:
http://www.medilexicon.com/
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.madgc.org
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;
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);
The
Cochrane
Collaboration,
an
international not-for-profit organization,
providing up-to-date information about
the effects of health care;
http://www.dimdi.de/static/de/index.html
http://www.cochrane.org
http://afen.onelook.com
Dictionary; 13,090,565 words in 1100
dictionaries indexed, including special
medical terms, glossary of oncology
terms, etc.
http://www.yourdictionary.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
38
includes both language and specialized
dictionaries (medicine, law etc.) and 96
grammars;
http://www.yourdictionary.com/
Medical
Dictionary
providing
explanations of various medical terms
and diseases.
http://www.cancer.gov/dictionary/
Dictionary of Cancer Terms; contains
more than 4,000 terms related to cancer
and medicine
http://www.merck.com/mrkshared/mmanual/
Merck Manual; searchable access to The
Merck Manual with a lot of information
such as normal laboratory values,
disease,
http://rxlist.com
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://www.rxlist.com/script/main/hp.asp
Microbiology; information on many
aspects of microbiology incl. bacterial
genera
http://www.oecd.org/
OECD, Organization for Economic Cooperation and Development
http://www.lenntech.com/periodic-chart.htm
Periodic table – chart of all chemical
elements;
http://medicine.iupui.edu/clinpharm/ddis/
P450 Drug Interactions table;
http://www.rarediseases.org
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;
39
3) Important guidelines:
– Code of Federal Regulations
http://www.gpo.gov/fdsys/browse/collect
ionCfr.action?collectionCode=CFR
– WMA Declaration of Helsinki - Ethical
Principles for Medical Research Involving
Human Subjects:
http://www.wma.net/en/30publications/1
0policies/b3 /
– Common Terminology Criteria for Adverse
Events (CTCAE):
http://ctep.cancer.gov/reporting/ctc.html
– Drug Development and Drug Interactions:
http://www.fda.gov/Drugs/Development
ApprovalProcess/DevelopmentResources
/DrugInteractionsLabeling/ucm080499.ht
m
https://www.tga.gov.au/publication/com
mon-technical-document-ctd
– Common Technical Document:
40
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
they are used as
pharmaceutical
inert
ingredients;
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).
41
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.
42
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.
43
2) According to route of administration:
Route of administration
Oral: taken by mouth
Dosage forms
Liquid and solid dosage
forms
Liquid dosage forms
Parenteral (taken by injection)
Intravenous (I.V.): into the vein.
Intramuscular (I.M.): into the
muscle.
Subcutaneous: under the skin.
Topical : applied on the skin
Semisolid dosage forms
Rectal: taken through rectum
Moulded dosage
and enemas
forms
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.
44
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.
45
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.
46
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.
47
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
5Gargle:
Aqueous
solution
frequently
containing
antiseptics
or
antibiotics, used in the
prevention or treatment of
throat Infections.
6Mouthwash:
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.
48
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.
49
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
preparations:
of
non-aqueous
1- Elixir: is clear, pleasantly,
flavored
hydroalcoholic
solution (water and ethanol)
intended for oral use. It is
used
mainly
as
flavored
vehicle.
50
solution
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, lightresistant 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.
51
4- Glycerins or glycerites
Are viscous solutions or
mixtures of medicinal
substances in not less
than 50% by weight of
glycerin (so have jellylike consistency).
5- Tinctures
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.
52
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
53
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
nongreasy 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
54
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.
55
4Poultices:
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,
56
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
57
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 badtasting 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.
58
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
vagina
tablets:
Introduced
to
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.
59
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.
60
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.
61
Suppository mould
Rectal and Vaginal suppositories:
Rectal Suppository
Vaginal Suppository
62
Urethral suppository
E. Sterile Dosage Forms:
1Parenteral
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.
2Ophthalmic
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.
63
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.
64
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.
65
- 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).
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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.
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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:
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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.
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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.
70
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.
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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.
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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.
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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.
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General differences between intravenous and
intramuscular routes:
Intravenous
Intramuscular
Drug response
Systemic effect
Systemic effect
Method of
Into the vein
Into skeletal
administration
muscle
Onset time of
Fastest route
Slower than i.v.
action
30 – 60 seconds
10 – 20 minutes
Duration of
Shorter than i.m.
Longer than i.v.
action
Bioavailability
100%
Lesser than 100%
Volume of
Large volume of Only up to 10 ml
fluids taken
fluids can be
taken
Emergency
Suitable
Not suitable
cases
Oily
Not suitable
Suitable
preparations
and emulsions
Diarrhea and
Suitable
Suitable
vomiting cases
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.
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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).
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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.
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- 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.
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Time for onset of action of various dosage forms
Time for onset of action
Seconds
Minutes
Minutes to hours
Several hours
Days
Varies
Dosage form
i.v. injections
i.m. and s.c. injections,
buccal tablets, aerosols, gases
Short-term depot injections,
solutions, suspensions,
powders, granules, capsules,
tablets, modified-release
tablets
Enteric-coated formulations
Depot injections, implants
Topical preparations
Summary of the general routes of drug administration:
Route of administration
Oral
Nasal
Buccal
Sublingual
Topical
Transdermal
Intravenous
Intramuscular
Subcutaneous
Rectal
Vaginal
Inhaled
Ocular
Otic
Application
swallowed by the mouth
Into the nose
Placed between the cheek and gum
Placed under the tongue
Applied to skin
Applied to skin to be absorbed via
skin
Injected into the vein
Injected into the muscle
Injected under the skin
Into the rectum
Into the vaginal
Into the mouth or the nose
Into the eye
Into the ear
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Flow charts summarize the routes of drug delivery
80
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
association):
Ethics
(American
pharmacists
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.
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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
competence.
your
professional
knowledge
6- Be honest and trustworthy.
7- Take responsibility for your working practices.
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and
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.
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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.
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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.
85
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.
86
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.
87
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
88
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.
89
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,
90
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
91
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.
92
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.
93
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.
94
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.
95
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
96
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).
97
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
98
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.
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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.
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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.
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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
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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.
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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)
2)
3)
4)
Hygiene (general and personal);
Nutrition (type and quality of food eaten).
Lifestyle (sporting activities, leisure etc.);
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 selfmedication: 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.
104
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 selfmedication, have recently been developed; for example:
topical and oral imidazoles for vaginal candidiasis;
topical fluorinated steroids for hay fever; acyclovir for
105
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.
106
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.
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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?
108
- 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?
109
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.
110
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?
111
This table summarizes the information required to
aid in solving problems
Clinical
Characteristics
- Age
- Sex Severity
- Ethnicity Prognoses
- Pregnancy status
- Immune status
- Kidney function
- Liver function
- Cardiac function
- Nutritional status
-Patient’s
expectations
Patient’s
Pharmacotherapy
-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
Patient’s Disease
Process
- 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?
112
Respiratory
CV
GIT
Renal/GU
- 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?
- 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?
- 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?
- 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?
113
Endocrinology
Dermatology
OB/Gyne
Vital Signs and
Pertinent Labs
- Any indications of UTI? Is urine cloudy?
Odorous? Dysuria?
- Is this drug induced?
- Is the serum blood sugar appropriate?
- Any indication of hypothyroidism?
- Was patient receiving steroids prior to
admission?
- 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?
- Could patient be pregnant?
- Is patient using any form of contraception?
- Any abnormal discharge? Bleeding? Sores?
Itching?
- 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.
114
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).
115
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.
116
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.
117
This table shows examples for certain cases and their resolutions
Assessment
Community
Acquired
Pneumonia
COPD
Exacerbation
Therapeutic
Plan
Goal(s)
Resolution of - Provide nasal O2
infection
- Add antibiotic
Prevent
&
control
episodes
of
COPD: chronic respiratory
obstructive
distress
Pulmonary
disease
Diabetes
Blood sugars <
150
Hyperlipidemia
Monitoring Plan
- Follow up with the
patient to evaluate
cough, SOB
- WBC
- Respiratory rate
Oxygen
Follow up with the
Suggest to physician patient to evaluate
inhaled
steroid SOB, Heart rate
medication
and
bronchodilator
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
Control
new
case:
cholesterol
Antihyperlipidemic
with LDL<70 drug
to help reduce - old case: replace the
cardiac risk
drug or ad another drug
- control of diet
- measurement of blood
pressure and ECG
118
Glucose tests
- Obtain fasting HDL,
LDL,
total
cholesterol,
and
triglycerides.
Peptic Ulcer
Avoidance of - new case: anti-ulcer Follow up with the
Stress
Ulcer drug
patient to evaluate GI
and PE/DVT
- old case: replace the Complaints
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
Illustrative cases study:
1) Mrs J, aged 45 years, has recently been diagnosed
with asthma, following reversibility testing with a shortacting 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.
119
Findings
1- Patient profile:
Name,
address,
city,
telephone,
birthrate, height,
weight, sex, race
(white).
Allergies: Diagnosis: asthma
osteoarthritis
and
hypertension
Other information:
smoker
Assessment
-Ineffective
therapy
for
hypertension
- Osteoarthritis
- Asthma
Resolution
- 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.
120
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
- productive of
greenish sputum
- Shortness of
breath (SOB)
- fever
Assessment
Probable
communityacquired pneumonia
(CAP)
- Hypertension
- Diabetes,
- Mild CHF
Plan
- 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
121
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
122
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
- Night cough
Shortness
of
breath (SOB)
-Frequent
exacerbations
high
blood
pressure
Assessment
Plan
- Poor asthma
control may be
aggravated
by
smoking, obesity
and
High
pressure
- smoking cessation
- Dietitian
Check
blood
pressure frequently if
still high, suggest to
physician to add
blood 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
123
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
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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
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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.
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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.
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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.
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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
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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.
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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.
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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.
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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).
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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.
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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.
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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
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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.
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� 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
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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.
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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.
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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.
141
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”
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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.
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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.
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(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.
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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).
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(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
(precipitation):
solubility
or
insolubility
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.
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- 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.
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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.
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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.
150
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.
151
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.
152
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.
153
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.
154
 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
155
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.
156
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.
157
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.
158
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.
159
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.
160
Chapter Nine: List of Pharmacy - Medical
Abbreviations &Terminology
1) List of pharmacy abbreviations:
A- Prescription Abbreviations:
Abbreviation
aa
AAA
a.c.
a.d.
ad lib.
Latin
ana
ante cibum
auris dextra
ad libitum
admov.
agit
alt. h.
a.m.m.
admove
agita
alternis horis
ad manu
medicae
ante meridiem
aqua
auris laeva,
auris sinistra
auris utraque
bis die
sumendum
bis
bis in die
-
a.m.
amp
amt
aq
a.l., a.s.
A.T.C.
a.u.
BDS/bds
bis
b.i.d./b.d.
B.M.
161
Meaning
of each
apply to affected area
before meals
right ear
use as much as one
desires; freely
apply
stir/shake
every other hour
at doctor's hand
morning, before noon
ampule
amount
water
left ear
around the clock
both ears
twice daily
twice
twice daily
bowel movement
BNF
-
bol.
bolus
B.S.
B.S.A
b.t.
BUCC
cap., caps.
c, c.
bucca
capsula
cum
cib.
cc
cibus
cum cibo
cf
comp.
cr., crm
CST
D or d
D5W
-
D5NS
-
D.A.W.
-
dc, D/C, disc
dieb. alt.
dil.
disp.
div.
dL
diebus alternis
-
162
British National
Formulary
as a large single dose
(usually intravenously)
blood sugar
body surface areas
bedtime
inside cheek
capsule
with (usually written with
a bar on top of the "c")
food
with food, (but also cubic
centimeter)
with food
compound
cream
Continue same treatment
days or doses
dextrose 5% solution
(sometimes written as
D5W)
Dextrose 5% in normal
saline (0.9%)
dispense as written (i.e.,
no generic substitution)
discontinue or discharge
every other day
dilute
dispersible or dispense
divide
deciliter
d.t.d.
DTO
D.W.
elix.
e.m.p.
emuls.
et
eod
ex aq
fl., fld.
ft.
g
gr
gtt(s)
H
h, hr
h.s.
h.s
dentur tales
doses
ex modo
prescripto
emulsum
et
ex aqua
fiat
gutta(e)
hora
hora somni
-
ID
IJ, inj
IM
injectio
-
IN
IP
IT
IU
IV
IVP
-
163
give of such doses
deodorized tincture of
opium
distilled water
elixir
as directed
emulsion
and
every other day
in water
fluid
make; let it be made
gram
grain
drop(s)
hypodermic
hour
at bedtime
hour sleep or halfstrength
intrademral
injection
intramuscular (with
respect to injections)
intranasal
intraperitoneal
intrathecal
international unit
intravenous
intravenous push
mEq
mg
mg/dL
MgSO4
mist.
mitte
mL
MS
linimentum
liquor
mane
misce
minimum
more dicto
utendus
mistura
mitte
-
MSO4
nebul
N.M.T.
noct.
non rep.
NPO
NS
1/2NS
nebula
nocte
non repetatur
nil per os
-
IVPB
kg
L.A.S.
LCD
lin
liq
lot.
MAE
mane
M.
m, min
mcg
m.d.u.
164
intravenous piggyback
kilogram
label as such
coal tar solution
liniment
solution
lotion
Moves All Extremities
in the morning
mix
a minimum
microgram
to be used as directed
milliequivalent
milligram
milligrams per deciliter
magnesium sulfate
mix
send
milliliter
morphine sulfate or
magnesium
morphine sulfate
a spray
not more than
at night
no repeats
nothing by mouth
Normal saline (0.9%)
Half normal saline
(0.45%)
N.T.E.
o_2
-
od
omne in die,
right eye
od
om
on
o.p.d.
o.s.
o.u.
oz
per
p.c.
pig. /pigm.
p.m.
p.o.
p.r. or PR
PRN, prn
pulv.
PV
q
q.a.d.
oculus dexter
omne mane
omne nocte
-oculus sinister
oculus uterque
per
post cibum
pigmentum
post meridiem
per os
per rectum
pro re nata
pulvis
per vaginam
quaque
quaque alternis
die
quaque die ante
meridiem
quaque die
quater die
sumendus
quaque die post
meridiem
q.a.m.
q.d./q.1.d.
q.d.s.
q.p.m.
165
not to exceed
both eyes, sometimes
written as o2
every day/once daily
(preferred to qd in the
UK[5])
right eye
every morning
every night
once per day
left eye
both eyes
ounce
by or through
after meals
paint
evening or afternoon
by mouth or orally
by rectum
as needed
powder
via the vagina
every, per
every other day
every day before noon
every day
four times a day
every day after noon or
every evening
q.h.
q.h.s.
q.1 h, q.1°
q.i.d.
q4PM
q.o.d.
qqh
q.s.
QWK
PR
rep., rept.
RL, R/L
s
quaque hora
quaque hora
somni
quaque 1 hora
quater in die
quater quaque
hora
quantum
sufficiat
repetatur
sine
s.a.
secundum
artem
SC, subc, subcut,
subq, SQ
s.i.d/SID
sig
SL
-
S.O.B, SOB
sol
s.o.s., si op. sit
ss
solutio
si opus sit
semis
semel in die
signa
-
166
every hour
every night at bedtime
every 1 hour; (can replace
"1" with other numbers)
four times a day
at 4pm
every other day
every four hours
a sufficient quantity
every week
rectal
repeats
Ringer's lactate
without (usually written
with a bar on top of the
"s")
according to the art
(accepted practice); use
your judgment
subcutaneous
once a day
write on label
sublingually, under the
tongue
shortness of breath
solution
if there is a need
one half or sliding scale
SSI, SSRI
-
SNRI
(antidepressant)
-
SSRI
(antidepressant)
-
sliding scale insulin or
sliding scale
regular insulin
Serotonin–nor
epinephrine reuptake
inhibitor
selective serotonin
reuptake inhibitor
(a specific class of
antidepressant)
stat
SubQ
supp
susp
syr
tab
tal., t
tbsp
t.d.s./TDS
t.i.d.
t.i.w.
top.
T.P.N.
tr, tinc., tinct.
troche
tsp
U
u.d., ut. dict.
ung.
U.S.P.
statim
suppositorium
syrupus
tabella
talus
ter die
sumendum
ter in die
trochiscus
ut dictum
unguentum
-
167
immediately
subcutaneously
suppository
suspension
syrup
tablet
such
tablespoon
three times a day
three times a day
three times a week
topical
total parenteral nutrition
tincture
lozenge
teaspoon
unit
as directed
ointment
United States
Pharmacopoeia
vag
w
w/a
wf
w/o, s
X
-
vaginally
with
while awake
with food (with meals)
without
Times
Y.O.
-
years old
B- List of measurement Abbreviations:
168
Abbreviation
TBSP
TSP
OZ
GM
KG
LB
ML
L
G
Meaning
OD
RIGHT EYE
SQ
OS
OU
LEFT EYE
IV
BOTH EYES
IC
AD
AS
AU
PO
RIGHT EAR
INJ
INTRA
CARDIAC
INJECTION
LEFT EAR
STAT
IMMEDIATELY
TABLESPOON
TEASPOON
OUNCE
GRAM
KILOGRAM
POUND
MILLILITER
LITER
GALLON
Abbreviation
SL
NG
BUCCAL
PR
PV
SUPP
TAB
CAP
IM
Meaning
SUB-LINGUAL
NASO GASTRIC
CHEEK/GUM
RECTALLY
VAGINALLY
SUPPOSITORY
TABLET
CAPSULE
INTRA
MUSCULAR
SUBCUTANEOUS
INTRAVENOUS
BOTH EARS
BY MOUTH /
ORAL
Approximate Measures:
Exact equivalents
Liquids
1 g = 15.43 grains
1 fl oz = 30 ml
1 grain = 64.8 mg
1 cup (8 fl oz) = 240 ml
1 mL = 16.23 minims
1 pint (16 fl oz) = 480 ml
1 Minim = 0.06 mL
1 quart (32 fl oz) = 960 ml
1 gallon (128 fl oz) = 3800 ml 1 oz = 28.35 g
1 lb = 453.6 g (0.4536 kg)
1 teaspoon = 5 ml
1 kg = 2.2 lb
1 tablespoon = 15 ml
1 fluid oz (fl oz) = 29.57 mL
Approximate Measures:
1 pint (pt) = 473.2 ml
Weights
1 quart (qt) = 946.4 ml
1 oz = 30 g
1 kg = 1000 g
1 lb (16 oz) = 480 g
1 g = 1000 mg
15 grains = 1 g
1 mg = 1000 mg
1 grain = 60 mg
169
Apothecary Equivalents:
Weight
1 scruple = 20 grains (gr)
Roman Numerals
60 grains = 1 dram
8 drams = 1 ounce
1 ounce = 480 grains
16 ounces = 1 pound (lb)
Apothecary Equivalents:
Volume
60 minims = 1 fluidram
8 fluidrams = 1 fluid ounce
1 fluid ounce = 480 minims
16 fluid ounces = 1 pint (pt)
I = one
V = five
X = ten
L = fifty
C = one hundred
D = five hundred
M = one thousand
C- List of pharmaceutical Abbreviations:
Abbreviation Meaning
APAP
acetaminophen
Abbrevia
tion
OC
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
170
Meaning
oral contraceptive
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)
QC
Quality Control.
HC
hydrocortisone
IQC
In process
Quality Control.
HCT
hydrocortisone or
QA
hydrochlorothiazide
(careful)
HCO3
bicarbonate
HCTZ
hydrochlorothiazide G M P
HS
half strength
GLP
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
QM
171
Quality
Assurance.
Quality
Management
Good
Manufacturing
Practice
Good Laboratory
Practice
MgSO4
magnesium sulfate
(careful)
ISO
MOM
milk of magnesia
HPLC
MTX
methotrexate
(careful)
TLC
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 antiinflammatory drug
CBER
NTG
nitroglycerin
172
International
Standard
Organization for
Quality Systems.
High
Performance
Liquid
Chromatography
Thin Layer
Chromatography
Center of
Biological
Evaluation and
Research (FDA).
2) Master List of medical Abbreviations:
Abbreviation
AAA
A-a
gradient
AAD
AAO
A&O
AAS
ABD
ABG
AC
ACLS
ACTH
ADH
ADR
ad lib
Meaning
Abbreviation
A&B
ASAP
abdominal aortic
aneurysm
alveolar to arterial
gradient
antibiotic-associated
diarrhea
alert, awake, and
oriented
alert & oriented
acute abdominal series
abdomen
arterial blood gas
before eating
advanced cardiac life
support
adrenocorticotropic
hormone
anti-diuretic hormone
ASCVD
ASD
as soon as
possible
atherosclerotic
cardiovascular disease
atrial septal defect
ARF
AS
atherosclerotic heart
disease
atrioventricular
arteriovenous
arteriovenous oxygen
acute respiratory
distress syndrome
acute renal failure
aortic stenosis
BBB
bundle branch block
BCAA
branched chain amino
acids
ASHD
AV
A-V
A-VO2
ARDS
Adverse drug reaction. |
BE
acute dystonic reaction
as much as needed
BEE
bid
AFB
antiepileptic drug
atrial fibrillation or a
febrile
acid-fast bacilli
AFP
A /G
AI
alpha-fetoprotein
albumin/globulin ratio
aortic insufficiency
BMR
BOM
BP
AED
AF
Meaning
BKA
BM
173
barium enema
basal energy
expenditure
twice a day
below the knee
amputation
bone marrow or bowel
movement
basal metabolic rate
bilateral otitis media
blood pressure
AKA
ALD
ALL
amb
AML
ANA
ANS
AOB
AODM
AP
above the knee
amputation
alcoholic liver disease
acute lymphocytic
leukemia
ambulate
acute myelogenous
leukemia
antinuclear antibody
autonomic nervous
system
alcohol on breath
adult onset diabetes
mellitus
anteroposterior or
abdominal - perineal
BRP
benign prostatic
hypertrophy
beats per minute
bright red blood per
rectum
bathroom priviledges
BS
bowel or breath sounds
BUN
blood urea nitrogen
BW
body weight
BX
biopsy
BW
body weight
BX
biopsy
BPH
BPM
BRBPR
c
C&S
CA
Ca
with
culture and sensitivity
cancer
calcium
C,D
CRCL
CRF
CRP
CSF
CAA
crystalline amino acids
CT
CABG
coronary artery bypass
graft
CVA
CAD
CAT
CBC
CBG
CC
CCU
CCV
CF
CGL
CHF
coronary artery disease
computerized axial
tomography
complete blood count
capillary blood gas
chief complaint
clean catch urine or
cardiac care unit
critical closing volume
cystic fibrosis
chronic granulocytic
leukemia
congestive heart failure
D&C
DDx
creatinine clearance
chronic renal failure
C-reactive protein
cerebrospinal fluid
computerized
tomography
cerebrovascular
accident or
costovertebral angle
CVA tenderness
central venous
pressure
chest X-ray
diet as tolerated
dispense as written
discontinue or
discharge
dilation and curettage
differential diagnosis
D5W
5% dextrose in water
DI
diabetes insipidus
CVAT
CVP
CXR
DAT
DAW
DC
174
DKA
dL
DM
DNR
DOA
disseminated
intravascular
coagulopathy
distal interphalangeal
joint
degenerative joint
disease
diabetic ketoacidosis
deciliter
diabetes mellitus
do not resuscitate
dead on arrival
DOE
dyspnea on exertion
CHO
carbohydrate
DIC
CI
cardiac index
DIP
CML
CMV
CN
CNS
CO
C/O
COLD
COPD
CP
CPAP
chronic myelogenous
leukemia
cytomegalovirus
cranial nerves
central nervous system
cardiac output
complaining of
chronic obstructive
lung disease
chronic obstructive
pulmonary disease
chest pain or cerebral
palsy
continuous positive
airway pressure
DJD
DPL
DPT
diagnostic peritoneal
lavage
diphtheria, pertussis,
tetanus
DTR
deep tendon reflexes
CPK
creatine phosphokinase
DVT
deep venous
thrombosis
CPR
cardiopulmonary
resuscitation
DX
diagnosis
E&F
EAA
essential amino acids
EBL
estimated blood loss
ECG
electrocardiogram
ECT
EFAD
EMG
electroconvulsive
therapy
essential fatty acid
deficiency
Electromyogram
ERCP
ETOH
endoscopic
retrograde cholangio
-pancreatography
ethanol
EUA
examination under
anesthesia
FBS
fasting blood sugar
FEV
forced expiratory
volume
FFP
175
fresh frozen plasma
ET
ETT
eyes, motor, verbal
response (Glasgow
coma scale)
ears, nose, and throat
extraocular muscles
erythrocyte
sedimentation rate
endotracheal
endotracheal tube
GC
gonorrhea
HEENT
head, eyes, ears,
nose, throat
GETT
general by
endotracheal tube
Hgb
hemoglobin
EMV
ENT
EOM
ESR
FRC
FTT
FU
FUO
FVC
Fx
G&H
GFR
glomerular filtration
rate
H/H
GI
gastrointestinal
HIV
HAV
Grain; 1 grain = 65mg.
Therefore Vgr =
325mg
gun shot wound
drops
glucose tolerance test
genitourinary
graded exercise
tolerance (Stress test)
headache
hepatitis B surface
antigen
hepatitis A virus
HBP
high blood pressure
gr
GSW
gt or gtt
GTT
GU
GXT
HA
HAA
HLA
functional residual
capacity
failure to thrive
follow-up
fever of unknown
origin
forced vital capacity
fracture
hendersonhasselbach equation
or hemoglobin/
hematocrit
human
immunodeficiency
virus
histocompatibility
locus antigen
HR
hepatojugular reflex
history of
head of bed
high power field
history of present
illness
heart rate
HS
at bedtime
HSM
hepatosplenomegaly
human lymphotropic
virus, type III (AIDS
agent, HIV)
HJR
HO
HOB
HPF
HPI
HTLV-III
176
HCG
HCT
HDL
human chorionic
gonadotropin
hematocrit
high density
lipoprotein
HSV
herpes simplex virus
HTN
hypertension
Hx
history
I&J&K&L
I&D
incision and drainage
KUB
I&O
ICS
intake and output
intercostal space
KVO
L
ICU
intensive care unit
LAD
ID
IDDM
infectious disease or
identification
insulin dependent
diabetes mellitus
LAE
LAHB
IG
immunoglobulin
LAP
IHSS
idiopathic hypertropic
subaortic stenosis
LBBB
IM
intramuscular
LDH
IMV
INF
IPPB
IRBBB
IRDM
IT
intermittent mandatory
ventilation
intravenous nutritional
fluid
intermittent positive
pressure breathing
incomplete right
bundle branch block
insulin resistant
diabetes mellitus
interthecal
kidneys, ureters,
bladder
keep vein open
left
left axis deviation or
left anterior
descending
left atrial enlargement
left anterior
hemiblock
left atrial pressure or
leukocyte alkaline
phosphatase
left bundle branch
block
lactate
dehydrogenase
LE
lupus erythematosus
LIH
left inguinal hernia
LLL
left lower lobe
LMP
last menstrual period
LNMP
LOC
177
last normal menstrual
period
loss of consciousness
or level of
consciousness
idiopathic
thrombocytopenic
purpura
LP
ITP
IV
intravenous
LPN
licensed practical
nurse
LUL
left upper lobe
LUQ
Left Upper Quadrant
LV
left ventricle
IVC
IVP
JODM
JVD
KOR
lumbar puncture
intravenous
cholangiogram |
inferior vena cava
intravenous pyelogram
juvenile onset diabetes
mellitus
jugular venous
distention
keep open rate
LVEDP
LVH
left ventricular end
diastolic pressure
left ventricular
hypertrophy
M&N
MAO
monoamine oxidase
MVI
multivitamin
injection
MVV
MAP
MBT
medical antishock
trousers
maternal blood type
MCH
mean cell hemoglobin
MAST
MCHC
MCV
MI
maximum voluntary
ventilation
mean arterial pressure
mean cell hemoglobin
concentration
mean cell volume
myocardial infarction
or mitral insufficiency
NAD
no active disease
NAS
ng
no added salt
nerve conduction
velocity
no evidence of
recurrent disease
nanogram
NG
nasogastric
NCV
NED
mL
milliliter
NIDDM
MLE
midline episiotomy
NKA
178
non-insulin
dependent diabetes
mellitus
no known allergies
MMEF
maximal mid
expiratory flow
NKDA
mmol
millimole
NMR
MMR
measles, mumps,
rubella
NPO
MRI
MRSA
MS
MSSA
MVA
OB
magnetic resonance
NRM
imaging
methicillin resistant
NSAID
staph aureus
multiple sclerosis or
mitral stenosis, or
NSR
morphine sulfate
methicillin-sensitive
NT
staph aureus
motor vehicle accident
O&P&Q
obstetrics
PMI
PMN
OCG
oral cholecystogram
OD
overdose or right eye
PND
OM
OOB
otitis media
out of bed
PO
POD
OOP
out of plaster
PP
OPV
oral polio vaccine
PPD
OR
operating room
PR
OS
left eye
PRBC
OU
both eyes
PRN
P
para
PS
179
no known drug
allergies
nuclear magnetic
resonance
nothing by mouth
no regular
medications
non-steroidal antiinflammatory drugs
normal sinus rhythm
nasotracheal
point of maximal
impulse
polymorphonuclear
leukocyte
(neutrophil)
paroxysmal nocturnal
dyspnea
by mouth
post-op day
postprandial or pulsus
paradoxus
purified protein
derivative
by rectum
packed red blood
cells
as needed
pulmonic stenosis
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
PAT
paroxysymal atrial
tachycardia
PTT
percutanous
transhepatic
cholangiogram
partial
thromboplastin time
PUD
P&PD
percussion and postural
drainage
peptic ulcer disease
PC
after eating
PCWP
pulmonary capillary
wedge pressure
PDA
patent ductus arteriosus q
PDR
PE
PEEP
PFT
pg
PI
PKU
physicians desk
reference
pulmonary embolus, or
physical exam or
pleural effusion
positive end expiratory
pressure
pulmonary function
tests
picogram
pulmonic insufficiency
disease
phenylketonuria
PVC
PVD
premature ventricular
contraction
peripheral vascular
disease
Every (e.g. q6h =
every 6 hours)
qd
every day
qh
every hour
q4h, q6h....
every 4 hours, every
6 hours etc.
qid
four times a day
QNS
quantity not sufficient
qod
every other day
Qs/Qt
180
shunt fraction
PMH
previous medical
history
Qt
total cardiac output
R&S
R
RA
RAD
RAE
RAP
RBBB
right
rheumatoid arthritis or
right atrium
right atrial axis
deviation
right atrial enlargement
right atrial pressure
right bundle branch
block
RVH
right ventricular
hyperthrophy
Rx
treatment
SA
SAA
without | ss = onehalf
sinoatrial
synthetic amino acid
S&E
sugar and acetone
s
RBC
red blood cell
SBE
RBP
retinol-binding protein
SBFT
RDA
recommended daily
allowance
SBS
RDW
red cell distribution
width
RIA
radioimmunoassay
SEM
RIH
right inguinal hernia
SG
RLL
right lower lobe
SGA
RLQ
right lower quadrant
SGGT
RML
right middle lobe
SGOT
RNA
ribonucleic acid
SGPT
R/O
rule out
SIADH
ROM
range of motion
sig
Subacute bacterial
endocarditic
small bowel follow
through
short bowel
syndrome
SCr
serum creatinine
181
systolic ejection
murmur
Swan-Ganz
small for gestational
age
serum gammaglutamyl
transpeptidase
serum glutamicoxaloacetic
transaminase
serum glutamicpyruvic transaminase
syndrome of
inappropriate
antidiuretic hormone
write on label
ROS
review of systems
SIMV
RPG
retrograde pyelogram
sl
RRR
regular rate and rhythm
SLE
RT
respiratory or radiation
therapy
SMO
RTA
renal tubular acidosis
SOAP
RTC
RU
RUG
return to clinic
resin uptake
retrograde urethogram
SOB
SQ
STAT
RUL
right upper lobe
SVD
RUQ
right upper quadrant
RV
residual volume
Sx
synchronous
intermittent
mandatory ventilation
sublingual
systemic lupus
erythematous
slips made out
subjective, Objective,
Assessment, Plan
shortness of breath
subcutaneous
immediately
spontaneous vaginal
delivery
Symptoms
T&U&V
T&C
type and cross
UAC
T&H
total abdominal
hysterectomy
type and hold
TB
tuberculosis
UC
TBG
ud
TKO
total binding globulin
tetanus-diphtheria
toxoid
transient ischemic
attack
total iron binding
capacity
three times a day
tetanus immune
globulin
to keep open
TLC
total lung capacity
UUN
TAH
Td
TIA
TIBC
tid
TIG
UAO
UBD
UFH
UGI
uric acid | umbilical
artery catheter
upper airway
obstruction
universal blood donor
ulcerative colitis |
umbilical cord
as directed
unfractionated
heparin
upper gastrointestinal
URQ
upper respiratory
infection
upper right quadrant
US
ultrasound
UTI
urinary tract infection
urinary urea nitrogen
URI
182
TMJ
TNTC
TO
TOPV
temporo mandibular
joint
too numerous to count
telephone order
trivalent oral polio
vaccine
total parenteral
nutrition
UVA
ultraviolet A light
VAD
VC
venous access device
vital capacity
VCT
venous clotting time
thrombin time
thrombotic
thrombocytopenic
purpura
VMA
voiding
cysourethrogram
Venereal Disease
Research Laboratory
(test for syphilis)
vanillymadelic acid
VO
verbal or voice order
TU
tuberculin units
V/Q
TUR
transurethral resection
VRE
TURBT
TUR bladder tumors
transurethral resection
of prostate
tidal volume
total vaginal
hysterectomy
VSS
tw
twice a week
VWD
Tx
UA
WBR
treatment, transplant
VZV
urinalysis
W&X&Y
whole blood
X2d
white blood cell or
XI
count
whole body radiation
XII
WD
well developed
XL
WF
white female
XM
WIA
wounded in action
XMM
TPN
TSH
TT
TTP
TURP
TV
TVH
WB
WBC
thyroid stimulating
hormone
VCUG
VDRL
VV
ventilation perfusion
vancomycin-resistant
enterococcus
vital signs stable
ventricular
tachycardia
varicose veins
VW
vessel wall
VT
183
von Willebrand's
disease
varicella zoster virus
Times 2 days.
eleven
twelve
Extended release.
Extra large.
crossmatch
Xeromammography
WID
widow, widower
XOM
WM
white male
XRT
WN
well nourished
XS
WNL
within normal limits
XULN
WO
WOP
W.P.
WPW
W-T-D
W/U
ZDV
ZE
Z-ESR
Written order | weeks
old | wide open.
without pain
whirlpool
Wolff-Parkinson-White
wet to dry
workup
zidovudine
Zollinger-Ellison
zeta erythrocyte
sedimentation rate
YF
extraocular
movements
X-ray therapy
(radiation therapy)
excessive
times upper limit of
normal
yellow fever
YLC
yo
YOB
yr
ytd
Z
Zn
ZnO
youngest living child
years old
year of birth
year
year to date
ZSB
zero stools since birth
zinc
zinc oxide
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.
184
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.
185
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.
186
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).
187
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.
188
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.
189
The most commonly used prefixes:
190
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.
191
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.
192
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.
193
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.
194
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.
195
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.
196
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.
197
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.
198
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.
199
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
200
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.
201
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.
202
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., Desoxycorrticosterone 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.
203
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).
204
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.
205
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).
206
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.
207
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).
208
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 keratincontaining 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).
209
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.
210
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, 9 th
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.
211
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 .3 rd 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
212
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).
213
‫المقدمة‬
‫الفصل العاشر‪ :‬تاريخ ومدخل الصيدلة‬
‫تاريخ الطب والصيدلة قديم قدم وجود البشر على ظهر األرض‪ ،‬ذلك‬
‫ألن الطب وثيق االرتبقا بحيقا اإلنسقان‪ ،‬كمقا أظهقر األبحقا أن‬
‫األمراض تراف وجودها مع ظهور الحيا في هذا العالم‪.‬‬
‫ودراسة تاريخ علم من العلوم عامل هام في استجالء ما غمض من‬
‫هذا العلم‪ ،‬وما أحا به من مالبسقا عاقق تقدمقه‪ ،‬أو دفعق بقه‬
‫إلى األمام‪.‬‬
‫ومن خالل هذا البحث‪ ،‬تناول حقبة هامة من تاريخ الصيدلة‪ ،‬تلقك‬
‫الحقبة التي أثرى بها العقر المسقلمون هقذا العلقم‪ ،‬وتلقك المهنقة‬
‫مما كان له األثر الكبير في التطور الذي شهدته العصور الحديثة‪.‬‬
‫ويرجع تطور هذا العلم خالل هذه المرحلة التاريخية إلى استقطا‬
‫المجتمع اإلسالمي الجديد كثيرا من العقول المستنير ‪ ،‬التي كان‬
‫تقطن في البالد المجاور ‪ ،‬ذا الحضار العريققة‪ ،‬كمقا أنقه اجتقذ‬
‫جميع العاملين في حقل العلم من سكان البالد المفتوحة ‪.‬وساعد‬
‫في ذلك ‪:‬انتشار روح التسامح الديني تجاه أهقل الكتقا ‪ ،‬وهقو مقا‬
‫يأمر به اإلسالم ‪.‬ووجود مجال للعمل والربح في جميع القبالد التقي‬
‫انتشر فيها اإلسالم‪.‬‬
‫وتشترك األدوية جميعا في الساب والالح في أمر أصيل ‪:‬هو أنها‬
‫عليهقا والتقي‬
‫تتكون كل من مكونا ماد هذه األرض التقي نعقي‬
‫منهقا كقذلك يتكقون اإلنسقان وبهقذا تكقون القاعقد العريضقة فقي‬
‫والتداوي مسألة ضبط وتنظيم‪ .‬ان تودعه جسم اإلنسان أو تزيلقه‬
‫منه ‪...‬كل شيء بسبب وكل شيء بقدر وكل شيء بأثر ‪ ...‬وهقي‬
‫معادلة ال تزال تشغل بال علماء الدواء إلى اآلن وهم يلقون الهزيمة‬
‫تلو الهزيمة من األعراض السمية التي لم تكن في الحسبان والتي‬
‫استأد بها بعض األدوية ضريبة فادحة على هيئة وفيا أو أمراض‬
‫أو تشوها خلقية لألجنة والمواليد ‪.............‬‬
‫‪214‬‬
‫فوائد دراسة تاريخ الصيدلة‬
‫‪ )1‬الكشف عن تاريخ ناحية علميقة يفخقر بهقا الشقرم عامقة ومصقر‬
‫خاصة اذ هي القطر الذي يعتبر قائدا ومعلما للنهضقة الطبيقة وعلقم‬
‫الدواء والصيدلة في العالم‪.‬‬
‫‪ )2‬تبصير العالم بما كان عليه مصر من رقي وحضار وما لعبته من‬
‫دور هام في خدمة البشرية في العلوم الطبية‪.‬‬
‫‪ )3‬دراسة حيا العقاقير المختلفة ومعرفة الخطوا التي سقار فيهقا‬
‫كل عقار القي أن وصقل القي مقا وصقل اليقه وكيقف تطقور اسقتعماله‬
‫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.‬‬
‫‪ )4‬معرفة مدي عالقة علم الصيدلة بغيرها من العلوم األخري وكيف‬
‫تداخل كالسحر والفلك والعقائد الدينية‪.‬‬
‫‪ )5‬دراسة تارخ األمراض وصناعة الدواء وأنواع المستحضرا ‪.‬‬
‫منشأة مهنة الصيدلة‬
‫العشاب‪ ،‬العطار‪ ،‬الصيدلي‬
‫‪ )1‬البققد وأن تكققون صققناعة الققدواء مالرمققة لظهققور االنسققان علققي‬
‫البسققيطة والبققد وأن االنسققان األول حققين كققان هائمققا مققع الوحققو‬
‫يبحث 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
‫العشا األول ونشقأ صقناعة العققاقير النباتيقة وأعتققد العشقابون‬
‫األول 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
‫الناس يتوارثون تلك الصنعة المقدسة اآلش السنين يحفظونهقا خلفقا‬
‫من سلف دون كتابة‪.‬‬
‫‪ )2‬وعندما تعلم االنسان األول فنون الكتابة بدأ العشابون يكتسقبون‬
‫علققومهم علققي لوحققا مققن الطققين كمققا حققد فققي بابققل بققالخط‬
‫المسماري ويكتبونهقا علقي شقرائح البقردي كمقا حقد فقي مصقر‪،‬‬
‫‪215‬‬
‫وكانقق هققذه المعلومققا المكتويققة هققي الخطققو األولققي لوضققع‬
‫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
‫بخواص بعقض العققاقير ولقو أنهقا كانق معرفقة بدائيقة‪ .‬وكقان البشقر‬
‫يعتقدون 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
‫الخفية المقدسة التي كان الكهنه يعالجون بهقا المرضقي‪ ،‬اكتسقبوا‬
‫صناعة السحر والفلقك والكيميقاء لمقا بقين هقذه جميعقا مقن عالققة‬
‫وثيقة‪.‬‬
‫‪ )3‬ظل صناعة االعشا تتطور مع الزمن ونشأ من هقذه المهنقه‬
‫صناعة العطار التي احترفهقا العطقار التقي جقاء ذكرهقا كثيقرا فقي‬
‫التوراه وظل صنعة العطار من أرقي المهن المتداولقة وكانق تعبقر‬
‫عن صناعة الصيدلة وظل كذلك حتي اآلن فقي فرنسقا حيقث ظهقر‬
‫قانون عام ‪ 1187‬يحدد بقا الشعب ومنها العطقار )‪(Apothecarie‬‬
‫‪.‬‬
‫‪ )4‬ولف الصيدلة معر وأصله هندي جاء للعقر مقن الفقرس وذلقك‬
‫من جندل أو جندن حيث قلب الجيم صادا فأصبح صندل أو صندن‬
‫وهو 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.‬‬
‫‪ )5‬أما الصيدلة فهي كلمة عربية تعني بيقع العطقر واالدويقة والعققار‬
‫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
‫)‪ (Pharmacy‬االفرنجية التي معناها الصيدلة أصقلها يونقاني ققديم‬
‫)‪(Pharmakon‬للداللة علي عقار أو دواء أو سم‪.‬‬
‫بيقة‬
‫‪ )6‬وفي عصر النهضة في مصر أيام الرومان ظهر مصطلحا‬
‫صققيدلية الرال ق مسققتعملة حتققي اآلن العقققاقير = ‪(Medicina‬‬
‫)‪ ،drugs‬دواء أو سم )‪ ، (Medicamentus‬مخزن دواء )‪. (Apotheca‬‬
‫‪216‬‬
‫ومقن أهققم اآللهقه العشققابين فقي مصققر القديمقة أوروريققو وأيققزيو‬
‫وتحو وأنوبيو وأيموحتب وحاتحور وغيرهم‪.‬‬
‫الدواء والمصريون القدماء‬
‫تعود حضار قدماء المصريين إلى أكثر مقن ‪ ٤٠٠٠‬سقنة م ‪.‬م ‪.‬كقان‬
‫الطب عندهم خليطا من السحر والشقعوذ والطالسقم وكقان لهقم‬
‫عدد من اآللهة منهم إيزيو واوريريو ‪.‬أما أشهر من مارس الطقب‬
‫عندهم فهو أمحوتب عام ‪ ٢٩٠٠‬م ‪.‬م الذي اعتبروه إلها فأقاموا لقه‬
‫والتماثيل وقدموا إليه القرابيين ومن أشهر ا لمعابد معبد »ممفيو‬
‫«‪ .‬ويعود الفضل فقي اكتشقاش مقبقر أول بيقب فقي العقالم إلقى‬
‫العالم األثري المشهور الدكتور ايمري‪.‬‬
‫كان ايمري أستاذا لآلثار القد‪ .‬في جامعة لنقدن وققد أرسقل قبقل‬
‫في أوائل هذا القرن في بعثة إلى مصر للتنقيقب فقي سققار عقن‬
‫كنور مصر الفرعونية‪ .‬باإلضقافة إلقى كقون امحوتقب أول بيقب فقي‬
‫العالم فقد كان مشهورا بعلوم الهندسقة وعمقل كحكقيم فقي بقال‬
‫الملك» روسر « صاحب الهقرم المقدرج ‪.‬ونظقرا لحكمتقه فققد اقتقرن‬
‫اسم امحوتب بآلهة الحكمة» أبيو«‪.‬‬
‫وتدل االكتشافا الهيروغليفية علقى أن حضقار ققدماء ا لمصقريين‬
‫كان من أشهر الحضارا التي اردهر فيها علوم الطب والصقيدلة‬
‫فهناك مثال سجل عظيم ولقه ‪ ٢٥٠‬ققدما وعرضقه ‪ ١٢‬بوصقة كتقب‬
‫في عهد النبقي موسقى عليقه السقالم يحتقوي علقى العديقد مقن‬
‫األدوية الشافية و رم تحضيرها وكيفية معالجة األمراض بهقا ‪.‬كمقا‬
‫أظهر الحفريا وجود آال جراحية تدل علقى تققدم فقن الجراحقة‬
‫عندهم ‪.‬وظهر مستندا تثبق أنهقم عرفقوا المئقا مقن األدويقة‬
‫النباتيقة معظمهقا معقروش لقدينا حاليقا ‪.‬ولعقل براعقة الفراعنقة فقي‬
‫التحنيط أكبر دليل على ول بقاعهم فقي معرفقة علمقي التشقريح‬
‫والكيمياء‪.‬‬
‫كمقا عرفقوا المقيئقا والمسقهال ومقدرا البقول وأققاموا مقدارس‬
‫خاصة لتعليم الطب أهمها ‪:‬مدرسة» أونو« (هليوبوليو) ومدرسقة‬
‫»سقايو للققابال « ومدرسقة» يبقة« ا لمشقهور بمكتبتهقا‬
‫العظيمة والتقي اسقتقطب العديقد مقن علمقاء العصقر مقن مختلقف‬
‫البلدان ‪.‬وكان ا لمدارس تفرض شرو ا قاسية على الطلبة أهمها‬
‫أن يكونوا من ذوي األخالم الحميد والسير المحمود وأن تكقون‬
‫‪217‬‬
‫عملية الختقان ققد أجريق علقيهم‪ .‬وكقان األ بقاء يتقاضقون رسقوما‬
‫باهظة من ا لمرضى ويقال إنه في حالة‬
‫شفاء ا لمريض كان عليه أن يحل شعر رأسه ويزنه ويقدفع‬
‫مقابل ورنه ذهبا‪.‬‬
‫أهم األدوية التي استعملوها‪:‬‬
‫لقم يكقن المقر ينمقو فقي مصقر بقل كقانوا يحضقرونه مقن الصقومال‬
‫والسعودية وقد وجد في توابي ا لمقوتى مقع أدوا التحنقيط ‪.‬ولقم‬
‫يكتف تحتمو الثالث بالنباتا المصرية بل جلب نباتا من سقوريا‬
‫ليزرعها في مصر وأرسل ا لملكة حتشبسو بعثة إلقى الصقومال‬
‫والحبشة لتحضر لها الورود ‪.‬وقد عثر على الفجل في مقابر األسر‬
‫الثانية عشر أما عصيره فكانوا يستعملونه كنقط لألذن ‪.‬وعثر كذلك‬
‫على نبا السرم ) شنوبوديوم) وجاء في البرديا أنهم استعملوا‬
‫الحنظقل والزعتقر والزعفقران والزيزفقون والثقوم والبصقل والتقرمو‬
‫والحلبة والجميقز وريق الزيتقون والسمسقم والعرعقر والخشقخا‬
‫والرمان وحبة البركقة والينسقون والكمقون والصفصقاش وحقب الهيقل‬
‫والبابونج والنعناع والقرنفل وري الخروع وغير ذلك‪ .‬وأهقتم ققدماء ا‬
‫لمصريين بصفة خاصة بشجر ري الخروع العتقادهم بفائدتها في‬
‫شفاء الصداع فكانوا يسحقون فقروع الشقجر ويمزجقون المسقحوم‬
‫مع الماء ‪.‬ويضعون كل ذلك على الرأس‪.‬‬
‫كما استعملوا شجر الخقروع لتنميقة شقعر النسقاء وذلقك بتحضقير‬
‫عجينة تتكون من الشحم وتحتوي على مسحوم شجر الخروع ثم‬
‫يفردونها على الرأس‪-‬كاستعمال خارجي‪-‬وكانوا يحصلون على ري‬
‫الخروع من عصر البذور ‪ Z‬وقد اسقتعملوه كمقرهم للجقروح يضقعونه‬
‫عليها لعد أيام فتشفيها واهتمقوا باسقتعمال مقرهم ريق الخقروع‬
‫خقالل الفتقر الصقباحية ‪.‬وققد اسقتعمل هقذه األدويقة باألشقكال‬
‫الصقيدلية المعروفقة كقا لمنققوع والمغلقي والحبيبقا والقطقرا‬
‫واللبخا والبخور والحقن الشرجية وقد حضروا منهقا أدويقة ألوجقاع‬
‫الرأس وأمراض العيون واألذن والفم واألنف والمعد واألمعاء والكبقد‬
‫والثدي والمجاري البولية واألصابع واألظافر والشقعر وكقذلك أمقراض‬
‫النساء والوالد ‪.‬‬
‫وهقم أول مقن اكتشقف أدويقة التخقدير و موانقع األلقم كمقا برعقوا‬
‫بالعمليا الجراحية كالختان والخصي وتجبير الكسور والنقب‪.‬‬
‫‪218‬‬
‫الدساتير الطبية – البرديات المصرية القديمة‬
‫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:‬‬
‫أ‪ -‬العظم‪.‬‬
‫ الطين وقد وجد كثير من صحائف الطين المكتوبقة يرجقع تاريخهقا‬‫الي االسر ‪.11‬‬
‫ج‪ -‬الطين المحروم منذ االسر ‪ 18‬بقالخط المسقماري ولوحقا تقل‬
‫العمارنة‪.‬‬
‫د‪ -‬الجلققد مخفققوظ بعققض صققحائفه بققالمتحف االيطققالي والمتحققف‬
‫المصري‪.‬‬
‫هق‪ -‬الكتان استعمل في مختلف العصور‪.‬‬
‫و‪ -‬المعادن أهمها البرونز‪.‬‬
‫ر‪ -‬الحجر وقد استعمل في الكتابة في المعابد والمقابر والتوابي ‪.‬‬
‫ح‪ -‬الخشب كالحجر‪.‬‬
‫ البردي كان هذا أهم صحفهم للكتابة وكان كشف أورام البقردي‬‫هو الحلقة األولي للكشف عن الورم فيما بعد‪.‬‬
‫وكان لقدماء المصريين لغة عالية رفيعقة (الهيروغليفيقة) لهقا نحوهقا‬
‫وصققرفها ولهققا أسققماوها وأفعالهققا وضققمائرها وصققفاتها‪ .‬ولقققد وضققع‬
‫العلماء مؤلفاتهم عن الهيروغليفية بعقد اكتشقاش حجقر رشقيد عقام‬
‫‪ 1799‬بواسطة أحد قواد حملة نابليون علي مصر وحل رمقور الكتابقة‬
‫التي عليقه العقالم الفرنسقي شقامبليون فوجقدها عبقار عقن ثالثقة‬
‫تراجم مختلفة بثال لغا مختلفة هي الهيروغليفيقة والديموتيقيقة‬
‫"كتابققة الكهنققه" واليونانيققة القديمققة المققر ملكققي واحققد صققادر أيققام‬
‫بطليمققوس الثققاني عققام ‪ 198‬م‪ .‬م‪ ،.‬وأن أجققزاء جسققم االنسققان‬
‫وجسققم الحيققوان التققي اسققتعملها الخطققا ون الهيروغليفيققون لتققدل‬
‫علي أن الفراعنة ققد أجقادوا تشقريح الحيقوان قبقل االنسقان بزمقان‬
‫بعيدا جدا وأن التشريح البشري ظهر متأخرا وذلك لتقديو الجسقم‬
‫البشري في ذلك الوق ‪ .‬أما صناعة العقاقير ومعرفة خواص النباتا‬
‫فهي أقدم بكثير من صقناعة التشقريح والجراحقة وتبعقا لقذلك تكقون‬
‫الصيدلة أقدم المهن الطبية‪.‬‬
‫‪219‬‬
‫وكان نبقا البقردي ينمقو بالقدلتا ولكنقه اآلن بحكقم الظقروش الجويقة‬
‫والطبيعية ينمو في جنقو السقودان والحبشقة‪ .‬ولققد اشقتق مقن‬
‫كلمة )‪ (Papyrus‬التي ا لق علي هذا النبقا الكلمقا األفرنجيقة‬
‫قول نبقا‬
‫الدالة علي اسم الورم هقي )‪ (Paper, Papier‬ويتفقاو‬
‫البردي الحديث بين ‪ 10 – 7‬قدم عدا القيمة المزهر والجذور وقطقر‬
‫السققام ‪5‬و‪ 1‬بوصققة والقطققاع العرضققي مققن السققام مثلققث الشققكل‬
‫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
‫يدقونها ويضغطونها ويتركوها حتي تجف بتعريضها للشمو‪ .‬وأ قول‬
‫ورقة بردي وجد هي بردية هاريو المحفوظة بالمتحف البريطاني‬
‫ويبلغ ولها ‪ 135‬قدما‪ .‬وكان هذه األورام البرية تلقف علقي شقكل‬
‫اسطواني وتربط في الوسط وكقان ققدماء المصقريين يصقنعون الحبقر‬
‫علي هيئقة أققراص جافقة بمختلقف األلقوان أهمهقا األحمقر واألسقود‬
‫تقلب بالماء عند استعمالها للكتابة‪.‬‬
‫أوراق البردى ) القراطيس(‪:‬‬
‫ورم البردى ينتمي إلى نبا من العائلة السحلبية كقان يقزرع فقي‬
‫مصر ويمتار بساقه المثلثة القطاع ‪.‬وكان أهم استعمال لهذا النبا‬
‫هو صنع القرا يو الالرمقة للكتابقة ‪.‬ويقدل علقى ذلقك اآلثقار التقي‬
‫تركها الفراعنة من الوثائ والكتابا والتماثيقل والرسقوما الققد‪.‬‬
‫والقرا يو ‪.‬وكان ورم البردى معروفا لدى اآلشوريين فقي العقرام‬
‫وكانوا يسمونه » القصب ا لمصري«‪.‬‬
‫أما اإلغري فقد استعملوا ورم البردى وكتبوا عليه خالصة علومهم‬
‫وآدابهقم‪ .‬وققد اسقتمر ورم البقردى مسقتعمال حتقى عقام ‪ ١٥٩١‬م‬
‫عندما اندثر تماما لدى ظهور الورم العادي المعروش لدينا اآلن‪.‬‬
‫ويعتمد البحث في تاريخ الطب والصقيدلة عنقد ا لمصقر يقن الققدماء‬
‫على دراسة أورام البردى الطبية المحفوظة في مختلف المتقاحف‬
‫العالمية ‪.‬كما يعتمقد ذلقك علقى الصقور والكتابقا ا لمنحوتقة علقى‬
‫جدران ا لمعابد بالخط الهيروغليفي‬
‫‪.‬‬
‫وتعتبر البرديقة مقن أققدم أشقكال الكتقا البقدائي القذي عرفقه بنقو‬
‫البشر‪ .‬وتكون البردية على شكل لفائف ويلة يصقل ولهقا أحيانقا‬
‫إلى ‪ ٢٠‬مترا أو اكثر بعقرض ‪ ٣٥ - ٣٠‬سقم تلقف مقن نهايتهقا باتجقاه‬
‫‪220‬‬
‫معاكو ‪ .‬وعند قراءتها يمسك كل رش منها بيد فتنفرد مقن جهقة‬
‫وتلف من الجهة األخرى ‪.‬وقد عرف منذ القدم باسقم »الققرا يو‬
‫«‪.‬‬
‫كان مكتبة اإلسقكندرية العظيمقة تضقم عقددا كبيقرا مقن البرديقا‬
‫بعضها من رمن الفراعنقة والقبعض اآلخقر مقن رمقن البطالسقة ‪.‬وققد‬
‫احترق ا لمكتبقة رمقن يوليقوس قيصقر فقي الققرن المقيالدي األول‬
‫فضاع اآلثار القيمقة ولقم يبق مقن البرديقا سقوى ثمقان أهمهقا‬
‫مذكور أدناه ‪:‬‬
‫‪- 1‬بردية كاهون )‪:(Kahun Papyrus‬‬
‫اكتشف هذه البردية عام ‪ .١٨٨٩‬دينقة كقاهون الفرعونيقة بقالفيوم‬
‫وتعقود إلقى األسقر الثامنقة عشقر ( ‪ ) ١٩٠٠‬م ‪.‬م ‪.‬جقزء منهقا‬
‫مخصص للطب البيطقري وتحتقوي علقى ‪ ٣٥‬وصقفة بيقة ألمقراض‬
‫النساء والوالد وتشخيص قدر اإلنسان عند ا لمرأ وجنو الطفل‪.‬‬
‫‪- 2‬بردية أدوين سميث (‪:(Smith Papyrus‬‬
‫اكتشف فقي األقصقر عقام ‪ ١٨٦١‬م ثقم درسقها ا لمقؤرخ بريسقتد ‪.‬‬
‫ولهقا ‪ ٤،٦٨‬متقرا وعرضقها ‪ ٣٣‬سقم كتبق بقالحبر األسقود والحبقر‬
‫األحمقر وتتقألف مقن ‪ ٤٦٩‬سقطرا وذكقر فيهقا ‪ ٤٨‬حالقة مقن الجقروح‬
‫والكسور واألورام والققرح وكيفيقه معالجتهقا ‪.‬وفيهقا تعويقذ لتحويقل‬
‫الكهل إلى شا وأدعية إلبعاد الرياح ا لموبوء ويعقود تاريخهقا إلقى‬
‫عام ‪ ١٧٠٠‬م ‪.‬م‪.‬‬
‫‪- 3‬بردية ايبرس (‪:(Ebers Papyrus‬‬
‫أشهر البرديا قا بة اكتشفها العالم األ? اني أيبقرس فقي األقصقر‬
‫وهي اآلن في متحف ليبزج وتحتوي على ‪ ٨١١‬وصفة بيقة ولهقا‬
‫‪ ٢٥‬مترا وعرضقها ‪ 30‬سقم ‪ Z‬وتتكقون مقن ‪ ٢٢٨٩‬سقطرا‪ .‬وفيهقا ‪١٢‬‬
‫وصفة مخصصة لألناشقيد واألدعيقة ‪.‬وتشقتمل كقذلك علقى أسقماء‬
‫األدوية الخاصة بكل عضو مقن أعضقاء الجسقم باإلضقافة إلقى وصقف‬
‫تشريحي دقي لجسم اإلنسان وتعود إلى عقام ‪ ١٥٥٠‬م ‪.‬م ‪.‬كمقا‬
‫تدل هذه البردية على مهار الفراعنة فقي تحنقيط ا لمقوتى وأنهقم‬
‫تعرفوا على وظيفة القلب واألوعية الدموية‪.‬‬
‫‪221‬‬
‫‪- ٤‬بردية هيرست ) ‪:(Hearst Papyrus‬‬
‫عثر عليها في دير البالص عام ‪ ١٩٠١‬م عرضها ‪ ١٧ ،٢‬سم وتحتوي‬
‫على‪ 273‬سطرا وعلى ‪ ٢٦٠‬وصفة بية ويعود تاريخهقا إلقى نفقو‬
‫الفتر التي تعود إليها بردية ايبرس أي حوالي ‪ ١٥٥٠‬م ‪.‬م‪.‬‬
‫‪- 5‬بردية لندن (‪:(London Papyru‬‬
‫توجد هذه البردية في متحف لندن منذ عقام ‪ ١٨٦٥‬م ويبلقغ ولهقا‬
‫‪ ٢،١‬مترا وتحتوي على ‪ ٦٣‬وصفة سحرية لمعالجقة أمقراض العيقون‬
‫والحروم وأمراض النساء‪.‬‬
‫وبدراسة هذه البرديات يمكننا أن نخرج بالنتائج اآلتية‪:‬‬
‫أوال‪ :‬هذه البرديا الطبيقة الدوائيقة عبقار عقن مسقتندا أو مراجقع‬
‫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 ‪.‬‬
‫ثانيا‪ :‬بعض هذه البرديا دوائي خالص كبردية ايبرس وبعضها دوائي‬
‫جراحقي 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.‬‬
‫رابعققا‪ :‬أن هققذه البرديققا قققد حققو مجموعققة مققن العقققاقير النباتيققة‬
‫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
‫الطبية قد أختفي من مصر بمرور الزمن وقد تكون هذه العقاقير ممقا‬
‫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
‫‪222‬‬
‫الملوك واألمراء استجال‬
‫وأقلمتها في مصر‬
‫الكثيقر مقن النباتقا‬
‫الطبيقة وغيقر الطبيقة‬
‫فضل العرب والمسلمين على الدواء والمداواة‬
‫لم يمض أكثر من قرن واحد على وفا الرسول األعظم محمد صلى‬
‫هللا عليه وسلم حتى كان ا لمسلمون قد احتلوا مساحا شاسعة‬
‫تمتد من المحيط األ لسي حتى الخليج العربقي بقل وشقمل ذلقك‬
‫الهند وتركستان ومشارش الصين شقرقا وتخقوم فرنسقا غربقا ‪.‬كمقا‬
‫دخل المسلمون صقلية وسيراالنكا وإندونيسيا‪.‬‬
‫وققد سقاعدهم ذلقك علقى الحصقول علقى جميقع مصقادر المعرفقة‬
‫والعلوم من شعو األراضي التي احتل ولذلك وفي مقتبل الققرن‬
‫التاسقع ا لمقيالدي كقان هنقاك ا لمستشقفيا العديقد بأجنحتهقا‬
‫وأ بائها وصيادلتها ‪.‬وانتهى بذلك عهد الخرافا والخزعبال وابتدأ‬
‫نهضة علمية بعد قرون عديد من الجهل والظالم ساد في أوروبا‬
‫منذ وفا جالينوس عام ‪ ٢٠١‬م حتى ظهور اإلسالم ونوره‪.‬‬
‫تمتع بغقداد بالقذا بقالمجد والغنقى والعلقم القوفير ومقا لبثق أن‬
‫امتد هذه النهضة إلى العواصم اإلسالمية األخرى تونو والقاهر‬
‫وقر بة فجلب ا لمسلمون المخ و ا والكتب العلمية من جميع‬
‫األقطار وتم ترجمتها إلى اللغة العربية بسرعة فائقة ‪.‬ومقن أوائقل‬
‫العلماء ا لمترجمين الذين شهدتهم تلك الفتر يوحنا بن ماسقويه )‬
‫‪ ٨٥٧ - ٧٧٧‬م) وحنين بن إسح ‪.‬‬
‫نخبة من علماء العرب والمسلمين في الطب والصيدلة‬
‫‪ -1‬الكندي يعقوب بن اسحق‪:‬‬
‫اهقتم بعلقوم الطقب والصقيدلة والكيميقاء والموسقيقى‪ ،‬كتقب عقد‬
‫مقاال في الغذاء واألدويقة والمسقهال والبقادرهرا ‪ ،‬وفقي عقالج‬
‫البقرص‪ ،‬وفقي النققرس‪ ،‬وفقي وجقع المعقد ‪ ،‬وفقي الحميقا وفقي‬
‫التها الطحال‪.‬‬
‫ولقد نسب القفطي للكندي" كريدين "يحتوي على وصقفا لعقالج‬
‫األمقراض‪ ،‬وشقرح لطقرم تحضقير المستحضقرا الصقيدلية مثقل‬
‫األقراص‪ ،‬والمراهم‪ ،‬واللبخا واألكحال‪.‬‬
‫‪223‬‬
‫ومن أهم كتبقه الطبيقة ‪:‬الطقب االبقرا قي‪-‬الغقذاء والقدواء المهلقك ‪-‬‬
‫األدوية الشافية من الروائح المؤذية ‪-‬كيفية إسهال األدوية وانجذا‬
‫األخال ‪-‬األدوية المركبة‪ ،‬كما ألف رسقالة فقي كيميقاء العطقور ققال‬
‫عنه أبو معشر البلخي أنه من أمهر التراجمة في اإلسالم‬
‫‪ -2‬سابور بن سهل الكوسج‪:‬‬
‫وهو صاحب األقربقاذين الكبيقر القذي كقان يعمقل بموجبقه الصقيادلة‬
‫والعطارون يشتمل هذا المؤلف على عشرين بابا ذكر فيهقا األدويقة‬
‫مرتبقة بحسقب أشقكالها الصقيدالنية وهقي‪ :‬األققراص‪ ،‬الحبقو ‪،‬‬
‫السفوفا ‪ ،‬المعاجين‪ ،‬الجوارشنا ‪ ،‬اللبخقا ‪ ،‬األشقربة‪ ،‬المربيقا ‪،‬‬
‫المطبوخقا ‪ ،‬األكحقال‪ ،‬األدهقان‪ ،‬المقراهم‪ ،‬الضقمادا ‪ ،‬الحققن‪،‬‬
‫الذرورا ‪ ،‬السعو ا ‪ ،‬أدوية الرعاش والقيء‪.‬‬
‫‪ -3‬علي بن سهل بن ربن الطبري‪:‬‬
‫كتابه فردوس الحكمقة أققدم كتقا جقامع لفنقون الطقب والصقيدلة و‬
‫قسم هذا الكتا إلى سبعة فصول في العلم الطبي والصيدلي‪:‬‬
‫ّ‬
‫في المعاني الفلسفية والطبائع والكون والفساد‪ .‬في علم الجنقين‬
‫والقوالد ووظقائف األعضقاء وتربيقة األ فقال‪ .‬فقي التغذيقة وأنواعهقا‪.‬‬
‫األمراض وأسبابها ومعالجتها‪ .‬فقي القروائح واأللقوان والمقذام‪ .‬فقي‬
‫الماد الطبية والسموم ‪:‬خصقص فيهقا خمسقة أبقوا فقي دراسقة‬
‫الماد الطبية‪ ،‬وفي األدوية المقرر والعقاقير‪ ،‬فقي الصقمغ والمقواد‬
‫الطبيعية‪ ،‬األصداش والمعادن والدخان والرماد‪ ،‬وقوى األرض والطقين‪،‬‬
‫وأخيرا "في إصقالح األدويقة وحفظهقا‪ .‬فقي البلقدان والميقاه والريقاح‬
‫والفلك والكواكب‪.‬‬
‫لقد ذكر ابن الطبري عددا "كبيرا "مقن األدويقة الهنديقة والفارسقية‪،‬‬
‫كما تكلم عن قواعد الصحة‪ ،‬باإلضافة إلى الفصد والحجامة والحجب‬
‫والتعاويذ وأنواع الدخن والغوالي" أي معاجين الطيب‪ ".‬وقد ذكر ابقن‬
‫النديم في كتابه الفهرس خمسة مؤلفا للطبري وأضاش ابن أبي‬
‫أصيبعة في كتابه بقا األ باء خمسة أخرى وهي‪:‬‬
‫الحضر ‪ ،‬كتا منافع األدويقة‬
‫تحفة الملوك‪ ،‬فردوس الحكمة‪ ،‬كنا‬
‫واأل عمة والعقاقير‪ ،‬كتا في األمثال واألد علقى مقذهبي القروم‬
‫والعر ‪ ،‬كتا عرفان الحيا ‪ ،‬كتا حف الصحة‪.‬‬
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‫‪ -4‬أبو بكر الرازي‪:‬‬
‫ينتمي أبو بكر الراري إلى الققرن الثالقث الهجقري‪ ،‬ولقد فقي مدينقة‬
‫فقي أيقام الخليفقة العباسقي‬
‫الري جنوبي هقران بفقارس ‪.‬وعقا‬
‫عضد الدولة‪ ،‬وكان مجلسقه مقن العلمقاء والحكمقاء‪ ،‬وققد استشقار‬
‫الخليفة عنقدما أراد بنقاء المستشقفى العضقدي فقي بغقداد‪ ،‬وذلقك‬
‫الختيار الموقع المالئم له ‪.‬واشتهر القراري بعلقوم الطقب والكيميقاء‪،‬‬
‫وكان يجمع بينهمقا لقدى وضقع القدواء المناسقب لكقل داء ‪.‬ويعتبقره‬
‫المؤرخون من أعظم أ باء الققرون الوسقطى‪ ،‬فققد جقاء فقي كتابقه‬
‫الفهرسق ( ‪:‬كقان القراري أوحقد دهقره‪ ،‬وققد جمقع المعرفقة بعلقوم‬
‫القدماء‪ ،‬سيّما الطب‪ .‬وقد ترك الراري عددا كبيرا من المؤلفا ‪ ،‬ضاع‬
‫قسم كبير منها ‪.‬فمن مؤلفاته المعروفه" الطب الروحاني "ثم كتا‬
‫"سر األسرار "الذي ذكر فيه المنهج المتبع في إجراء التجار فيذكر‬
‫المواد المستخدمة واألدوا ‪.‬وفي هذا الكتا الثاني يصقف القراري‬
‫ما يزيد على عشرين جهار ا‪ ،‬بعضقها مصقنوع مقن الزجقاج وبعضقها‬
‫األخر من المعدن أما كتا الحاوي فيعد من أهم ما كتب الراري في‬
‫علمقي الطقب والصقيدلة‪ ،‬وصقف فيقه األمقراض المنتشقر ‪ ،‬ودون‬
‫مشاهدته وخبراته فيها‪.‬‬
‫وقد أجمع المؤرخين على أن كتا الحاوي قد تقم انجقاره علقى يقد‬
‫تالمذته من بعده ‪ .‬وهو موسوعة تتألف من ثالثة وعشرين جزء ا‪.‬‬
‫وتتجلى في كتقا الحقاوي براعقة القراري فقي األبحقا السقريرية ‪.‬‬
‫ونظرا لضخامة هذا الكتا ولثمنه الباه فإنه كان نادر الوجود‪ ،‬ولم‬
‫يكتب منه سقوى نسقختين بالعربيقة تورعق أجزاوهمقا فقي العقالم‬
‫اإلسالمي‪ ،‬وبعض مكتبا الغر ‪ ،‬ظل الكتا الحاوي معتبقرا كأحقد‬
‫المراجع الرئيسية التي تدرس في كلية الطب بجامعة باريو حتى‬
‫عام ‪ ١٣٩٤‬م ‪.‬وقد ترجمه إلى اللغة الالتينية فرج بقن سقالم‪ ،‬القذي‬
‫أمضى فيه شطرا كبيرا من حياته‪ ،‬وانتهى منه سنة ‪ .١٢٧٩‬وأهداه‬
‫لملقك صققيلة شقارل أنجقو‪ .‬يلقي كتقا الحقاوي باألهميقة كتقا‬
‫المنصوري‪ ،‬الذي قدمه إلى أمير خراسان المنصور بن اسح ‪ ،‬وهو‬
‫يتألف من عشر مقاال تبحث في مختلف علوم الطب‪:‬‬
‫األولى ‪:‬وصف فيها العظام والعضال‬
‫مختلف أعضاء الجسم‪.‬‬
‫الثانية ‪:‬بحث فيها عن أمزجه البدن واألخال‬
‫على تشخيص األمراض‪.‬‬
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‫والدالئل التي تسقاعد‬
‫الثالثة ‪:‬تكلم فيها عن قوى األغذية واألدوية المفرد ‪.‬‬
‫الرابعقة ‪:‬تضقم البحقو‬
‫والطفل‪.‬‬
‫المتعلققة بحفق‬
‫الصقحة والعنايقة بقالجنين‬
‫الخامسقة ‪:‬معالجقة األمقراض الجلديقة مقن كلقف وحقزار وسقعفة‪،‬‬
‫باإلضافة إلى كل ما يتعل بالزينةوالخضا ‪.‬‬
‫السادسة ‪:‬تبحث في التدابير الواجب اتخاذهقا أثنقاء السقفر‪ ،‬وتغيقر‬
‫الفصول واألمكنة واألهوية‪.‬‬
‫السابعة ‪:‬وقد خصصها لمعالجة الكسقور و الجقروح والققروح ‪.‬وتكلقم‬
‫فيها عن المخاري والدجالين الذين يعالجون المرضى وهم يجهلون‬
‫أصول الصناعة‪.‬‬
‫الثامنة ‪:‬تكلم فيها عن السموم‬
‫التاسعة ‪:‬بحث فيها عن جميع األمراض التقي تصقيب اإلنسقان مقن‬
‫القرن إلى القدم‪.‬‬
‫العاشر ‪:‬ذكر فيها أنواع الحميا‬
‫و رائ‬
‫معالجتها‪.‬‬
‫ترجم كتا المنصوري من قبل جيقرار الكريمقوني‪ ،‬وتقم بعقه فقي‬
‫ميالنو ‪ ١٤٨١‬م ‪.‬وظل متداوال بين لبة الجامعا حتى نهاية القرن‬
‫السادس عشر ‪.‬ومن مؤلفا الراري المشهور ‪.‬كتا من ال يحضره‬
‫بيب ‪.‬وقد جمع فيه عددا مقن الوصقفا التقي يمكقن أن يسقتفيد‬
‫منهقا المقريض مباشقر عنقد غيقا الطبيقب ‪.‬ويعقد كتقا ( الجقدري‬
‫والحصبة ) من أجل الدراسا العلمية في الطب السريري ‪.‬وقد ذكر‬
‫فيه القراري األعقراض التقي يمكقن بوسقا تها التفريق بقين هقذين‬
‫المرضين‪ .‬والبد لنا أن نذكر كتا " ما الفارم "الذي بيّن فيقه القراري‬
‫الفوارم التشخيصية بين عدد كبير من األمراض البا نية المتشابهة‬
‫األعراض‪.‬‬
‫أما مؤلفا الراري في الكيميقاء فأشقهرها كتقا سقر األسقرار‪،‬وقد‬
‫شرح فيه خقواص بعقض المقواد الكيمائيقة ووسقائل الحصقول عليهقا‬
‫وتحض يرها وتنقيتها‪.‬وقسقمها إلقى أرواح وأجسقاد وراجقا وبقوارم‬
‫وأمالح وأحجار‪.‬‬
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‫ويعد هذا التقسيم أول ما ورد ذكره في علم الكيمياء‪ ،‬ويضم كتقا‬
‫سر األسرار بعض الوصفا الطبية‪ ،‬و ريقة تحضقيرها مقن العققاقير‬
‫النيابيقة‪ .‬وورد فقي هقذا الكتقا أيضقا ذكقر لقبعض األجهقز واآلال‬
‫واألدوا التي استعملها الراري أثناء تجاربه‪.‬‬
‫ويذكر المؤرخون أن الراري هو أول من حصل علقى الكحقول بتقطيقر‬
‫المواد السكرية المتخمر ‪،‬كما ينسب إليه اختقراع خيقو الجراحقة‪،‬‬
‫المصنوعة من أمعاء الحيوان ‪.‬واسقتعمل مقرهم الزئبق فقي مقداوا‬
‫التها الجفن‪ ،‬كمقا اسقتعمل لغسقل المثانقة الملتهبقة حقنقة مقن‬
‫الخل‪ ،‬وحقنة تتألف من أفيون مذا بماء الورد لتسكن ألمها‬
‫وعنقدما أراد عضقد الدولقة ‪ -‬الخليفقة العباسقي ‪ -‬أن تضقم إلقى‬
‫البيمارستان نخبة من األ باء المعروفين‪ ،‬أمر بأن يحضروا له قائمقة‬
‫بأسماء األ باء‪ ،‬فزاد عددهم على المائة‪ ،‬وقد اختار منهم خمسين‬
‫بيبا‪ ،‬وذلك على قدر ما وصل إلى علمه من مهارا فقي صقناعة‬
‫الطب‪ ،‬وكان الراري على رأسهم‪ ،‬ولمقا اقتصقر العقدد علقى عشقر‬
‫أ بقاء كقان القراري علقى رأس المجموعقه‪ ،‬و لقب منقه أن يقدير‬
‫المستشفى العضدي‪.‬‬
‫وامتار الراري بوفر اإلنتقاج‪ ،‬وققد سقلك فقي أبحاثقه مسقلكا علميقا‬
‫سقليما‪ ،‬فقأجرى التجقار ‪ ،‬واسقتخدم الرصقد والتتبقع‪ ،‬ممقا أعطقى‬
‫تجاربه الكيمائية قيمة خاصقة‪ ،‬حتقى أنقه بعقض علمقاء الغقر اليقوم‬
‫يعتبرونه مؤسو الكيمياء الحديثة‪ ،‬وققد بق معلوماتقه الكيمائيقة‬
‫في حقل الطب‪ ،‬واستخدم األجهز وصقنعها‪ ،‬وهقو أول مقن أدخقل‬
‫المركبا الكيماوية على الطب‪.‬‬
‫يقول ل‪.‬أ سيديو في كتابه" تاريخ العر العام "‪:‬القراري أدخقل إلقى‬
‫الصيدلة استعمال الملينا وتطبي المركبا الكيماوية على الطب‬
‫والراري هو مخترع الفتائل فكان يكثر من استعمالها لقد كان للراري‬
‫األثر الهام ليو فقط في تقدم علم الكيمياء‪ ،‬ولكن أيضا في ظهقور‬
‫علم العقاقير الكيميائية‪.‬‬
‫ويظهقر فضقله فقي الكيميقاء‪ ،‬بصقور جليقة‪ ،‬عنقدما قسقم المقواد‬
‫المعروفة في عصره إلى أربعة أقسام هي ‪:‬‬
‫المقواد المعدنيقة ‪ -‬المقواد النباتيقة ‪ -‬المقواد الحيوانيقة ‪ -‬المقواد‬
‫المشتقة‪.‬‬
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‫كما قسقم المعقدنيا إلقى أنقواع‪ ،‬بحسقب بائعهقا وحضقر بعقض‬
‫الحوامض ‪.‬وما رال الطقرم التقي اتبعهقا فقي التحضقير مسقتخدمة‬
‫حتى اليوم ‪.‬وهو أول من ذكر حقامض الكبريتيقك القذي أ لق عليقه‬
‫اسم ري الزاج أو الزاج األخضر‪.‬‬
‫واشتغل بتعين الكثافا النوعية للسقوائل‪ ،‬وصقنف لقياسقها ميزانقا‬
‫خاصا أ ل عليه اسم الميزان‪.‬‬
‫‪ -5‬علي بن العباس األهوازي المجوسي‪:‬‬
‫ولد في مدينة األهوار بالقر من جنديسقابور‪ ،‬ودرس الطقب علقى‬
‫موسقى بقن سقيار ‪.‬يعتبقر كتابقه كامقل الصقناعة الطبيقة مقن أهقم‬
‫مؤلفاته حيث بقي مرجعا لعلماء الشرم والغر على سواء‪ ،‬وظهر‬
‫فيه دوره الهام في حقل الصيدلة ‪.‬وهو يتقألف مقن جقزأين فقي كقل‬
‫منهما عشر مقاال ‪ ،‬تكلم في الجزء األول عن األمراض وأعراضقها‪،‬‬
‫أما في الجزء الثاني فقد تكلم عن رائ المداوا وتحضقير األدويقة‪.‬‬
‫ويمتقار هقذا المؤلقف بحسقن تبويقه‪ ،‬وبلغتقه السقليمة‪ ،‬وتعقابيره‬
‫الجميلة ‪.‬أ ل عليه اسم الكتا الملكي‪ ،‬وأهداه لملك بغداد عضد‬
‫الدولة البويهي‪.‬‬
‫وفي القرن الثاني عشر ققام قسقطنطين اإلفريققي‪ ،‬فقي مدرسقة‬
‫الطب بمدينة سالرنو بايطاليا‪ ،‬بترجمته إلقى الالتينيقة تحق اسقم‬
‫الكتا الملكي ونسبه لنفسه‬
‫لقد شرح قو مفعول األدوية على جسم اإلنسان‪ ،‬كمقا تكلقم عقن‬
‫عوامل الجو وفصول السنة ومهنة المريض وما لهقا مقن تقأثير علقى‬
‫البدن ‪.‬اعتبر أن سح العقاقير يساعد على استحالتها في المعد‬
‫والكبد‪ ،‬ووضع ريقة علمية لكيفية صنع األدوية المركبة‪ ،‬ويذكر في‬
‫كتابه كامل الصقناعة الطبيقة أنقه يلقزم عقالج المقريض بالغقذاء‪ ،‬فقال‬
‫يعطى شيئا من الدواء‪ ،‬وإذا أمكن عالجه بقدواء بسقيط مفقرد‪ ،‬فقال‬
‫يعالج بدواء مركب‪ ،‬وال تستعمل األدوية الغريبة‪.‬‬
‫‪ -6‬ابن سينا ‪:‬‬
‫هو أبو علي الحسين بن عبد هللا بن سقينا‪ ،‬ولقد فقي قريقة أفشقنا‬
‫بالقر من بخارى‪ ،‬إحدى مدن تركستان‪ ،‬انصقرش فقي بقاد األمقر‬
‫لحف القرآن‪ ،‬ودراسة الشريعة‪ ،‬ثم تعلم المنط والفلسفة‪ ،‬وأخيرا‬
‫تفرغ لعلوم الطب‪ ،‬فاستوعبها كما يقول ولم يتجقاور عمقره الثامنقة‬
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‫عشر ‪ .‬قربه األمير نوح بن منصور الساماني‪ ،‬ولما رأى من نبوغقه‪،‬‬
‫وفتح له مكتبته الخاصة التي كان يقضيمعظم أوقاته فيها‪.‬‬
‫يعد ابن سينا شخصية فذ وعبقرية نادر قل ما يجود بمثلها الزمن ‪.‬‬
‫ترك ما يزيد على مائة مؤلف في مختلف العلوم والفنون‪ ،‬كتب كلها‬
‫باللغة العربية‪ ،‬عدا كتا واحد تكلم فيه عن النبض ودونه بالفارسية‬
‫لقد اهقتم ابقن سقينا اهتمامقا بالغقا بدراسقة األعشقا السقتخراج‬
‫األدوية التي تستخدم لعالج المرضى‪ ،‬فنجح بذلك نجاحا باهر ا لقد‬
‫مؤرخو العلوم من قدر ابن سينا على اسقتخالص األدويقة‬
‫انده‬
‫الكيماوية من مصادرها الطبيعيقة‪ ،‬بقل إن هقذه األدويقة تمتقار كثيقرا‬
‫على األدوية التي تحضر في المختبرا الحديثة‪ .‬يقول جابر شكري‬
‫في كتابه ( الكيمياء عند العر "‪) :‬نقود أن نضقيف إلقى كيميقاء ابقن‬
‫سينا انجاراته في حقل العطاريا والعقاقير الطبية‪ ،‬واألقرباذين ‪.‬لقد‬
‫درس هذه المواد دراسة وافية مقن النقواحي العالجيقة واسقتخلص‬
‫األدوية الكيماوية من مصادرها الطبيعية استخالصقا تكقاد تكقون مقن‬
‫النقاو ‪ ،‬ما يضاهي تلك التي تجري فقي المختبقرا الحديثقة‪ ،‬وققد‬
‫خص جزءا كامال من كتا القانون فقي دراسقة واسقتعماال هقذه‬
‫العقاقير‪ ،‬وقد أصبح دراسته لها مرجعا مهما للعشابين فيمقا بعقد‬
‫إن أعمال ابن سينا في العقاقير الطبيقة‪ ،‬كانق أساسقا متينقا فقي‬
‫وضع علم العقاقير والصيدلة‪ .‬ومن دراسقته لعلقم الكيميقاء تبقين أن‬
‫معرفة األدويقة وفعاليتهقا تعتمقد علقى قريقتين الطريققة التجريبيقة‬
‫والطريقة القياسية‪.‬‬
‫لقد اهتم ابن سينا اهتماما بالغا فقي علقم األدويقة" الصقيدلة "لقذا‬
‫نجد أنه خصص الجزأين الثاني والخامو من كتب الققانون لتحضقير‬
‫األدوية المفرد والمركبة ودراسة األعشا الطبية‪ .‬ويشقمل الجقزء‬
‫الثاني علم العقاقير‪ ،‬أو األدوية المفقرد ‪ ،‬ويحتقوي عقددا كبيقرا مقن‬
‫النباتا الطبية حصل عليها من مصقادر يونانيقة‪ ،‬هنديقة ‪ ،‬فارسقية‪،‬‬
‫وصينية‪ ،‬ولكن أكثرها عربي المنشأ‪ .‬أما الجزء الخامو فقد ركّز فيه‬
‫علقى ريققة تحضقير األدويقة المركبقة مقن مصقادر نباتيقة ومعدنيقة‬
‫وحيوانية ‪.‬لذا نجد أنه جهز أكثر من ثمانمائة دواء مركب‪ ،‬بقي هذه‬
‫األدوية المركبة تتداولها األمقة ‪.‬العربيقة واإلسقالمية ثقم أوروبقا مقن‬
‫بعدهم‪.‬‬
‫يعد كتا القانون مرجعا رئيسا لطال الطقب والصقيدلة فقي القبالد‬
‫اإلسقالمية واألوروبيقة حتقى الققرن الثقامن عشقر ‪.‬وققد درس فقي‬
‫جامعتي مونبيليه ولوغان حتى عام ‪ ١٥٦٠‬م‪ ،‬وقد ترجم و بع عد‬
‫مرا أولها عام ‪ ١٤٧٢‬وأخرها عام ‪ ١٦٦٣‬م‪.‬‬
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‫‪ -7‬أبو الريحان محمد بن أحمد البيروني‪:‬‬
‫كان له مراسال مع ابن سقينا وضقعها فقي كتقا اسقماه" اآلثقار‬
‫الباقية من القرون الخالية يعتبر كتا " الصيدلة في الطب "من أهم‬
‫المراجع في علوم الصيدلة يققول عبقد العظقيم حفنقي صقابر وعبقد‬
‫الحليم منتصر وجورج شحاته قنواتي في كتا موجز تاريخ الصيدلة‬
‫" ‪:‬يعتبر كتا الصيدلة هذا ذخير علمية ومرجعقا هامقا فقي مجقال‬
‫الصيدلة‪ ،‬وينقسم هذا الكتا إلى قسمين أساسيين‪:‬‬
‫أولهمقا ‪:‬ديباجقة فقي فقن الصقيدلة‪ ،‬والفارماكولوجيقا‪ ،‬والعقالج‪ ،‬مقع‬
‫تعريفا وإيضاحا تاريخية مفيد ‪ .‬وتمثل المقدمة عمقال قيمقا‪ ،‬بقل‬
‫وتعتبقر إضقافة عظيمقة للصقيدلة‪ ،‬ولقيو فقي العهقد اإلسقالمي‬
‫المتوسط‪ ،‬بل لتاريخ الصيدلة في كل العصور‪ ،‬ولقد شرح كذلك في‬
‫هقذا القسقم المسقؤوليا والخطقوا التقدميقة التقي يجقب علقى‬
‫الصيدلي أن يقوم أو يهدش إليها‪.‬‬
‫أما القسم الثاني فقد خصصه للماد الطبية‪ ،‬فأورد فيقه كثيقرا مقن‬
‫العقاقير مرتبة حسب حروش المعجقم‪ ،‬ذاكقرا ققدرا مقن المالحظقا‬
‫األصقلية والمعلومقا ذا األهميقة الخاصقة‪ ،‬فقذكر أسقماء هقذه‬
‫العقاقير المعروفة فقي اللغقا المختلفقة واشقتقام هقذه األسقماء‬
‫و بائع هذه العقاقير‪ ،‬وموا نها‪ ،‬وتخزينها‪.‬‬
‫‪ -8‬ابن زهر‪:‬‬
‫هو أبو مروان عبد الملك بن رهر األيادي األندلسي األشبيلي‪ ،‬كان‬
‫من الشاذين في رمنه فلم يكن فيلسوفا وال فقيها وال منجمقا كمقا‬
‫كان عليه معاصروه في بلده‪ ،‬بل كقان بيبقا ال غيقر‪ ،‬مقع أنقه تعلقم‬
‫الفقه والحقديث وغيرهمقا مقن العلقوم المتداولقة فقي رمنقه‪ ،‬وصقف‬
‫نفسه بقوله ‪:‬وأما أنا فإن في نفسي مرضقا مقن أمقراض النفقوس‪،‬‬
‫من حب أعمقال الصقيدالنيين وتجربقة األدويقة‪،‬والتلطف فقي سقلب‬
‫بعض قوى األدوية‪ ،‬وتركيبها في غيرها‪ ،‬وتمييز الجقواهر وتفصقيلها‪،‬‬
‫ومحاول ذلك باليد‪.‬‬
‫ألف كتبا ومقاال متعدد ‪ ،‬أشقهرها كتابقه" التيسقير فقي المقداوا‬
‫والتدبير "ويتألف من جزأين وملح ‪ ،‬تكلم في الجزء األول عن حف‬
‫الصحة‪ ،‬واتبعه بشرح األمراض وعالجها‪ ،‬مبتدئا بعلل الرأس ومنتهيا‬
‫بذكر أمراض الصدر والبطن‪ ،‬أما الجزء الثاني فقد خصصه للكالم عن‬
‫أمراض أسفل البطن‪ ،‬وختمه بذكر الحميا ‪ ،‬واألمراض الوبائية‪.‬‬
‫‪230‬‬
‫ألف كتابا في األغذية ذكر فيه التغذية الصناعية للمريض عن ري‬
‫الفم والشرج‪ ،‬وله الجامع في األشقربة والمعجونقا ‪ ،‬ورسقالة فقي‬
‫تفضقيل العسقل علقى السقكر‪ .‬وهقو أول مقن كشقف عقن الجقر‬
‫والطفيلي الذي ينقله‪،‬كما عرش األورام السر انية‪.‬‬
‫‪ -9‬ابن رشد‪:‬‬
‫له كتا الكليا‬
‫قانون ابن سينا‪.‬‬
‫في الطب وضعه على شقكل مقوجز اقتبسقه مقن‬
‫‪ -10‬أبو جعفر أحمد بن محمد الغافقي األندلسي‪:‬‬
‫لقد نال شهر عظيمة بسبب كتابه األدوية المفرد فقد جمقع فيقه‬
‫ما يقار ألف صنف من األدوية البسيطة وصفها وصفا علميا وشرح‬
‫ريقة استعمالها‪ .‬لقد اهتم الغقافقي بجمقع وتطقوير األدويقة التقي‬
‫تعلمها من السابقين له‪ ،‬بقل أضقاش الكثيقر عقالو علقى ذلقك فققد‬
‫أعطى نصائح للطبيب والصقيدلي علقى حقد سقواء وذلقك بقولقه أن‬
‫الطبيب يجب أن يعرش تماما الدواء الذي وصفه لعليله‪ ،‬ولكقن يجقب‬
‫أن ال يتدخل في صنعه فيترك هذا للصقيدلي القذي يلزمقه أن يكقون‬
‫مطلعا على استعمال األدويقة و ريققة تحضقيرها‪ ،‬وحقاول أن يققنن‬
‫مؤهال الصيادلة‪ ،‬حيث قال يجقب أن يكقون الصقيدلي ملمقا تمامقا‬
‫بطريقة تحضير األدوية و رم استعمالها ‪.‬هذا الموققف القذي يحمقد‬
‫عليه جعله عمالقا في تحضير األدوية المفرد والمركبة‪ ،‬لذا نالحق‬
‫أن كتابه األدوية المفرد جاء على شكل موسوعة واستخدم اللغا‬
‫الشائعة آنذاك العربية والالتينية والبربرية‪.‬‬
‫‪ -11‬داود األنطاكي توفي‪:‬‬
‫من أشهر مؤلفاته تذكر داود وهقو يقدرس فقي الجامعقا‬
‫فرع الطب والصيدلة مواد العقاقير النباتية‪.‬‬
‫ذكر في مؤلفه" تذكر أولي األلبا والجامع للعجقب العجقا‬
‫من ‪ ٣٠٠٠‬من النباتا الطبية والمفردا العطارية‪.‬‬
‫والكليقا‬
‫"أكثقر‬
‫قضقى وقتقا قويال فقي وضقع ققوانين السقتعمال األدويقة المفقرد‬
‫والمركبة‪ ،‬وتعيين المقادير التي يجقب أن يتناولهقا كقل فقرد وعقرض‬
‫داود لمئقا مقن أنقواع النباتقا ‪ ،‬وعشقرا مقن أنقواع الحيوانقا ‪،‬‬
‫والمعادن‪ ،‬ما يتخذ منه عقاقير وأدوية‪ ،‬ثم ذكر عد قواعد أساسقية‬
‫‪231‬‬
‫في صناعة الدواء‪ ،‬و ريقة تحضقير العقالج‪ ،‬كمقا أورد وصقفا عامقة‬
‫وعشرا من األكحال واألدهان والسفوش والتراكيب المختلفة‪.‬‬
‫‪ -12‬كوهين العطار‪:‬‬
‫أهم مؤلفاته كتابه" منهاج الدكان ودستور األعيان "قدم فيه نصقائح‬
‫لمن أراد أن يحترش صناعة الصيدلة‪ ،‬وجمع أعمقال وتركيقب األدويقة‬
‫النافعة لألبدان ‪.‬ويشمل الكتا على خمسة وعشرين بابا‪ ،‬تتنقاول‬
‫المعقاجين والسقفوفا واألققراص واللعوققا والحبقو والمقراهم‬
‫واألدهان واألكحال واأل لية والضمادا ‪.‬‬
‫ويختص البا الرابع والعشرون بكيفية اتخاذ األدوية المفقرد ‪ ،‬وفقي‬
‫أي رمان تجنى وكيف تخزن ‪.‬وتكلم في البقا األخيقر عقن امتحقان‬
‫األدوية المفرد والمركبة ووصف حال الجيد منها قدم دراسة مفصلة‬
‫عقن أعمقار األدويقة‪ ،‬وبقرر بمقدرتقه العظيمقة علقى معرفقة األدويقة‬
‫األصلية والمغشوشة‪ ،‬وذلك بقيامه ببعض التجار المخ برية على‬
‫معظم األدوية التي كان يتعا اها‪.‬‬
‫‪ -13‬ابن البيطار‪:‬‬
‫ولد ابن البيطار في الربع األخير من القرن السادس الهجري القرن‬
‫الثقاني عشقر المقيالدي فقي مدينقة مالققة األندلسقية ‪.‬رحقل إلقى‬
‫المغر وسوريا واليونان‪ ،‬ثم عاد إلقى مصقر‪ ،‬كقان الطبيقب الحقاذم‬
‫والعشا البارع الذي عرش خصائص األعشا ‪ ،‬فاسقتطاع أن يخقرج‬
‫من دراسته للنبا واألعشا بمستحضرا ومركبا وعقاقير بية‬
‫تعد ذخير للصيدلة العالجيقة لقم يقصقر ابقن البيطقار نفسقه علقى‬
‫األدوية المفقرد التقي استخلصقها مقن األعشقا الطبيعيقة‪ ،‬ولكنقه‬
‫استخرج كثيرا من األدوية مقن الحيوانقا والمعقادن‪ ،‬معتمقدا بقذلك‬
‫على التجربة والمشاهد وصدم القول ‪.‬يقول محمد فقائز القصقري‬
‫في كتابه" مظاهر الثقافة اإلسقالمية وأثرهقا فقي الحضقار ‪":‬ومنقذ‬
‫عصر المأمون في القرن التاسع الميالدي أصبح الصيدليا تحق‬
‫إشقراش الدولقة‪ ،‬والصقيادلة يتعرضقون لفحقص مسقلكي ‪.‬وكقان أبقن‬
‫البيطار عميدا لقسم الصيدلة في القاهر وكقان مقن أشقهر علمقاء‬
‫الكيميقاء والصقيدلة وامتدحقه محمقد عبقد القرحمن مرحبقا بكتابقه‬
‫"الموجز في تاريخ العلوم عند العر "فقال" ‪:‬والح أن ابن البيطقار‬
‫كان أعظم نباتي وصيدالني ظهر في العصور الوسقطى كلهقا ‪.‬كقان‬
‫أوحد رمانه في معرفة النبا وتحقيقه واختباره ومواضع نباته ونع‬
‫أسمائه على اختالفها وتنوعها‪.‬‬
‫‪232‬‬
‫الدساتير الحديثة‬
‫سار العالم علي هذا النحو يتخبط بين هذه الدساتير الطبية الكثير‬
‫العدد حتي القرن التاسع عشر الميالدي حين ظهر عقد دسقاتير‬
‫في كثير من أقطار العالم بلغ مجموعها ‪ 26‬دستورا وهي‪:‬‬
‫الدستور البرتغالي عام ‪1876‬‬
‫الدستور البريطاني عام ‪1864‬‬
‫دستور رومانيا عام ‪1893‬‬
‫دستور شيلي عام ‪1886‬‬
‫دستور نيورالندا عام ‪1905‬‬
‫دستور المكسيك عام ‪1904‬‬
‫دستور استراليا عام ‪1906‬‬
‫دستور أسبانيا عام ‪1905‬‬
‫دستور سويسرا عام ‪1907‬‬
‫دستور الدانمارك عام ‪1907‬‬
‫دستور فرنسا عام ‪1908‬‬
‫وفي القرن العشقرين شقهد السق سقنوا بقين عقامي ‪ 1929‬و‬
‫‪ 1934‬همة ونشا ا كبيرين في مراجعة وتجديقد الدسقاتير الدوائيقة‬
‫وصدر دستور األدوية المصري عام ‪ ،1955‬كمقا صقدر دسقتور األدويقة‬
‫الدولي عام ‪.1954‬‬
‫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
‫بالصيدليا وتنظيمها‪ ،‬وصدر عقدد مقن الدسقاتير الطبيقة عقددها ‪43‬‬
‫دستورا كان أولها عام ‪ 1701‬م‪ ،‬وأخرها عام ‪ 1799‬م‪.‬‬
‫القرن التاسع عشر‬
‫نهض العلوم جميعا وبلغ الصيدلة غاية عظمتهقا وتققدم‬
‫علوم الكيمياء والصيدلة والطب والعقالج‪ .‬واكتشقف القلويقدا فقي‬
‫الثلققث األول مققن هققذا القققرن علققي يققد الصققيادلة العظقام واكتشققفوا‬
‫األفيون‪ ،‬المنوما ‪ ،‬المخدرا في الثلث الثاني‪ ،‬ثم المواد الكيماوية‬
‫العضوية في الثلث األخير‪.‬‬
‫‪233‬‬
‫القرن العشرين‬
‫تقدم البحث العلمي ونبقغ العلمقاء فقي الصقيدلة والعققاقير و فقر‬
‫علوم الطب والعالج وتم اكتشاش أهم المواد الدوائية في المضقادا‬
‫الحيوية والهرمونا والفيتامينا ومركبا السلفا وغير ذلك كثير‪.‬‬
‫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 ‪.‬‬
‫تاريخ تطور التعليم الصيدلي في مصر في العصر الحديث‬
‫تولي محمد علي علي باشا الكبيقر حكقم مصقر عقام ‪ 1805‬م القي‬
‫‪1848‬م وفي عام ‪1811‬م حدث مذبحة القلعقة وأصقبح السقيطر‬
‫كاملة لمحمد علي باشا في حكم مصقر والنهقوض بهقا فقي شقتي‬
‫المجاال مما جعله مؤسو مصر الحديثة وبالنسبة لتطقور التعلقيم‬
‫الصيدلي فيمكن تلخيصه فيما يلي‪:‬‬
‫‪ )1‬في عام ‪ 1824‬م أصدر محمد علقي مرسقوما بتعيقين كلقو بقك‬
‫المصقري القذي أنشقأ مستشقفي‬
‫رئيسا للخدما الطبية بقالجي‬
‫بقأبي رعبقل وكانق تسقع بقين‬
‫محل ثكنة قديمة من ثكنا الجي‬
‫‪ 1000 – 800‬مققريض استحضققر لهققم حققوالي ‪ 150‬صققيدليا و بيبققا‬
‫ومسقققاعدا معظمهقققم مقققن ايطاليقققا وفرنسقققا‪ ،‬وفقققي وسقققط هقققذا‬
‫المستشفي حديقة ررع فيها أكبر عدد ممكن من النباتا الطبية‪.‬‬
‫‪ )2‬أنشأ كلو بك بعد ذلك مدرسة بية لأل باء والصيادلة واأل بقاء‬
‫بمقا يلقزم مقن هقؤالء وكقان‬
‫البيطريين بأبي رعبل لمد حاجة الجي‬
‫ذلك عام ‪ ،1827‬وكان كلو بك أول ناظر لها وكان معظقم أسقاتذتها‬
‫من االوروبيون وترجم حقوالي ‪ 52‬مرجعقا بيقا مقن اللغقة الفرنسقية‬
‫الي اللغة العربية وفي عقام ‪ 1829‬نققل فقرع الصقيدلة مقن مدرسقة‬
‫الطب من أبي رعبل الي القلعة‪.‬‬
‫‪ )3‬فققي عققام ‪ 1837‬نقلق مدرسققة الطققب والمستشققفي مققن أبققي‬
‫رعبل الي القصر الذي بناه أحمقد بقن العينقي حفيقد أحقد سقال ين‬
‫مصققر ع قام ‪ 1766‬م وقققد اريل ق تكيققة بققن العينققي وأنشققأ مدرسققة‬
‫الصيدلة الحديثة وبلغ عدد الطلبة في ذلك الوق ‪ 140‬الب قب و‬
‫‪ 50‬الب صيدلة واقفل المدرسة أيام سعيد باشا (حكم مصر مقن‬
‫يوليو سنة ‪ 1854‬الي يناير سنة ‪ )1863‬ثم أعيد فتحها عام ‪ 1856‬م‬
‫وكان مد الدراسة بمدرسة الصيدلة أربعة سنوا ‪.‬‬
‫‪234‬‬
‫‪ )4‬في ‪ 12‬أكتوبر عقام ‪ 1906‬كقان أول اجتمقاع للمكتتبقين للجامعقة‬
‫المصققرية 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،‬‬
‫وأمانة الصندوم اسقند القي حسقن سقعيد بقك القذي كقان يعمقل‬
‫وكيال بالبنك األلماني الشرقي ولم يحددوا الرئيو العام‪ .‬وكقان أول‬
‫المكتتبين مصطفي بك الغمراوي من وجهاء بني سويف الذي تبقرع‬
‫بمبلغ ‪ 500‬جم وكان كل المكتتبون من الوجهاء ثم بدأ أمراء االسقر‬
‫الحاكمة يتابعون برعايتهم المادية وبجهودهم تسقهيل مهمقة اقامقة‬
‫هذه المؤسسة وكان سعيد باشا حليم أول من اهقتم بقاألمر وأخقذ‬
‫علي عاتقه رئاسة لجنة األمراء وجمع التبرعا منهم‪.‬‬
‫‪ )5‬في ‪ 30‬نوفمبر ‪ 1906‬كان االجتماع الثاني القذي أعلقن فيقه عقن‬
‫ضرور انتخا لجان فرعية متعدد لالكتتا وجمقع التبرعقا وتقوافر‬
‫بين جميع أعضاء اللجنقة فكقر اسقناد رئاسقة المشقروع ألميقر مقن‬
‫األمراء تجتمقع عليقه الكلمقة حتقي يضقمنوا انتظقام سقير االجقراءا‬
‫المتخذ للمشروع كما قرروا ايداع مقا يجكقع مقن المقال فقي البنقك‬
‫األلماني الشقرقي (البنقك الوحيقد القذي قبقل أن يعطقي فائقد ‪%4‬‬
‫سنويا)‪.‬‬
‫‪ )6‬في ‪ 19‬يناير سنة ‪ 1907‬أعلن قاسم بك أمين (الذي تقولي بقدال‬
‫مقن سققعد رغلققول الققذي تققولي ورار المعققارش) أن الخققديوي عبققاس‬
‫حلمي الثقاني (تقولي الحكقم مقن ‪1892‬م – ‪1914‬م) تفضقل بجعقل‬
‫اللجنة تح رعاية سموه وبجعل ولقي العهقد الكقريم (األميقر أحمقد‬
‫فؤاد) رئيو شرش لها وكتب قاسم أمين لألمير أحمقد فقؤاد ليتقولي‬
‫رئاسة اللجنة‪.‬‬
‫‪ )7‬فققي يققوم الجمعققة ‪ 31‬ينققاير ‪ 1908‬اجتمع ق الجمعيققة العموميققة‬
‫برئاسة قاسم بك أمين وأعلن بهذه الجلسة قبول دولة األمير أحمد‬
‫فؤاد الرئاسة‪.‬‬
‫‪ )8‬اجتمع اللجنة برئيسها الجديد (األمير أحمد فقؤاد باشقا) للمقر‬
‫األولي بسقراي دولقة األميقر أحمقد فقؤاد باشقا فقي ‪ 12‬مقارس عقام‬
‫‪ 1908‬وقد اتفقوا في هذا االجتماع علي أن أول عمل يجب البدء به‬
‫هو االرسالية والتدريو‪.‬‬
‫‪ )9‬اجتمع مجلو الجامعة في جلسة تاريخية في ‪ 5‬ديسقمبر عقام‬
‫‪ 1908‬للنظر في أمر افتتاح الجامعة‪ .‬وهنا قرر األمير أحمد فؤاد باشا‬
‫رئققيو اللجنققة أنققه سققعي الققي خققديوي مصققر وعققرض عليققه األمققر‬
‫بافتتاحها فواف وقبل أن يحضر ويخطب فيها‪ ،‬وكانق حفقل االفتتقاح‬
‫بقر جمعية شوري القوانين في صباح ‪ 21‬ديسمبر عام ‪ 1908‬وحضر‬
‫الحفققل جميققع رجققال الدولققة والوجهققاء واألعيققان ورجققال السققلك‬
‫‪235‬‬
‫العلميقة‬
‫السياسي الذين تبرعوا للجامعة وكقذلك أعضقاء الجمعيقا‬
‫في مصر‪.‬‬
‫‪ )10‬راد مصاريف الجامعة وقرر الحكومقة المصقرية مقنح الجامعقة‬
‫اعانة أوليقة ققدرها ‪1000‬جقم سقنويا وكانق القدار التقي تققيم فيهقا‬
‫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
‫بظروش مالية ضعبة واختالل في ميزانية المشروع‪.‬‬
‫‪ ) 11‬عندما أ لقع القدكتور محمقد علقوي باشقا األميقر فا مقة بنق‬
‫اسماعيل (وكان بيبا خاصا بأسرتها) علي هذه الظروش أعلن لقه‬
‫أنها علي استعداد لبذل ما لديها للمسقاعد ‪ .‬فأوقفق سقتة أفدنقة‬
‫خصصتها لباء دار جديقد للجامعقة‪ ،‬هقذا بخقالش ‪ 661‬فقدانا بمديريقة‬
‫الدقهلية وسارع الجامعة بمخابر المهندسقين لعمقل الرسقوما‬
‫الالرمة وأعلنق األميقر فا مقة أنهقا سقتتحمل جميقع تكقاليف بنقاء‬
‫الجامعة والتي كقان مققررا لهقا ‪ 26‬ألقف جنيقه فتبرعق بمجوهراتهقا‬
‫التي بيع بمبلغ ‪70000‬جم‪.‬‬
‫‪ )12‬أجر الجامعقة احتفقاال بوضقع الحجقر األساسقي لهقا فقي يقوم‬
‫األثنين المواف ‪ 3‬جمقادي األول ‪1332‬هقق ‪ 31‬مقارس ‪1914‬م فقي‬
‫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.‬‬
‫األمير فا مة بني اسماعيل سقنة (‪1332‬هقق)" واودع الحجقر بطقن‬
‫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
‫الكبير األمير فا مة وتالهقا فقي التوقيقع دولقة األميقر أحمقد فقؤاد‬
‫باشا رئيو شرش الجامعة فرئيو وأعضاء مجلو ادارتها‪.‬‬
‫‪ )13‬تعثققر الجامعققة أيققام الحققر العالميققة األولققي ونققادي الققبعض‬
‫باغالقها (‪.)1917 – 1915‬‬
‫مصققر فققي ‪ 1917‬عبققر‬
‫‪ )14‬بعققد تققولي األميققر أحمققد فققؤاد عققر‬
‫الجامعة األرمة فقد كان للرجل عالقة قديمة بالجامعة األهلية خالل‬
‫فتققر والدتهققا اذ ظققل رئيسققا لمجلققو ادارتهققا مققن ‪1913 – 1907‬‬
‫وشكل الملك فؤاد لجنة برئاسة عدلي يكن ورير المعارش للنظر في‬
‫أن تكون الجامعة حكومية‪.‬‬
‫‪ )15‬صققدر مرسققوم ملكققي فققي ‪ 11‬مققارس ‪ 1925‬بتحويققل الجامعققة‬
‫األهليققة (المصققرية) الققي جامعققة أميريققة باسققم الجامعققة المصققرية‬
‫واستغرم هذا االمر ثمقان سقنوا (‪ )1925 – 1917‬ولقم يكقن األمقر‬
‫سهال انما ساعد علي ذلك انشقاء الجامعقة األمريكيقة سقنة ‪1920‬‬
‫‪236‬‬
‫وكان الجامعة مكونة من أربع كليا هي (اآلدا والحقوم والعلقوم‬
‫والطب مع الصيدلة) يجور أن يضم اليها كليا فيما بعد (فقي ‪1928‬‬
‫ضم الهندسة والزراعة والتجار والطب البيطري)‪.‬‬
‫‪ )16‬فققي يققوم األثنققين ‪ 11‬مققايو ‪ 1925‬عقققد مجلققو ادار الجامعققة‬
‫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
‫نصيب الطب والصيدلة ناظر بريطاني واتخذ الجامعقة الجديقد مقع‬
‫نشأتها قصر الزعفرانة مقرا الدارتها‪.‬‬
‫‪ )17‬في عقام ‪ 1928‬بقدأ الجامعقة فقي انشقاء مققر دائقم لهقا فقي‬
‫موقعها الحالي الذي حصل عليه مقن الحكومقة تعويضقا عقن األرض‬
‫التي تبرع بها األمير فا مة بني الخديوي اسماعيل للجامعة‪.‬‬
‫‪ )18‬فققي ‪ 23‬مققايو عققام ‪ 1940‬صققدر القققانون رقققم ‪ 27‬بتغييققر اسققم‬
‫الجامعة المصرية الي جامعة فؤاد األول وفي ‪ 28‬سبتمبر عام ‪1953‬‬
‫صققدر مرسققوم بتعققديل اسققم الجامعققة مققن جامعققة فققؤاد األول الققي‬
‫جامعة القاهر ‪.‬‬
‫‪ )19‬حتي عام ‪ 1925‬كان مد الدراسة في مدرسة الصيدلة ثقال‬
‫سنوا يمنح الطالب بعدها دبلوم الصيدلة والعلوم الصيدلية‪.‬‬
‫‪ )20‬ابتداء مقن ‪ 1962 – 1925‬اصقبح مقد الدراسقة أربقع سقنوا‬
‫يمنح الطالب بعدها بكالوريوس في الصيدلة والعلوم الصيدلية‪.‬‬
‫‪ )21‬في عام ‪ 1955‬م صدر المرسوم بجعقل مدرسقة الصقيدلة كليقة‬
‫مستقلة وكقان أول عميقد لهقا المرحقوم أ‪.‬د ابقراهيم رجقب فهمقي‬
‫واستمر الدراسة بها أربع سنوا حتي عام ‪1962.‬‬
‫‪ )22‬مققن عققام ‪ 1964‬أصققبح الدراسققة فققي كليققة الصققيدلة خمققو‬
‫سنوا يمنح بعدها الطالب بكالوريوس في العلوم الصيدلية‪.‬‬
‫‪ )23‬حتي قيام ثور ‪ 1952‬لقم يكقن موجقود اال كليقة صقيدلة واحقد‬
‫(القاهر )‪.‬‬
‫‪237‬‬
‫المراجع‪:‬‬
‫‪ -1‬القدواء مقن فجقر التقاريخ إلقى اليقوم ‪ -‬د ‪.‬ريقاض‬
‫رمضان العلمي ‪ -‬الكوي ‪.‬‬
‫‪ -2‬القدفاع‪ ،‬علقي عبقد هللا‪ ،‬إسقهام علمقاء العقر‬
‫والمسقلمين فقي الصقيدلة‪ ،‬مؤسسقة الرسقالة‪،‬‬
‫بيرو ‪ ١٩٨٥ ،‬م‪.‬‬
‫‪ -3‬البابقا‪ ،‬محمقد رهيقر‪ ،‬تقاريخ وتشقريع وآدا‬
‫الصيدلة‪ ،‬جامعة دمش ‪ ٢٠٠١ ،‬م‪.‬‬
‫‪ -4‬الكيالي‪ ،‬ه اسح ‪ ،‬تاريخ الطب واأل باء فقي‬
‫حلقب وأ بقاء األسقنان والصقيادلة‪ ،‬ج ‪ ،١‬ورار‬
‫اإلعالم‪ ،‬دمش ‪ ١٩٩٩ ،‬م‪.‬‬
‫‪ -5‬القراري‪ ،‬أبقي بكقر محمقد بقن ركريقا‪ ،‬صقيدلية‬
‫التداوي مقن كتقا الحقاوي‪ ،‬مجربقا القراري فقي‬
‫الطقب والتقداوي‪ ،‬شقرحه محسقن عقيقل‪ ،‬دار‬
‫المحجة البيضاء‪.‬‬
‫‪238‬‬