PHYTO-OESTROGENS A CONSENSUS REVIEW

Thanks to:Radeep.K.R

INTRODUCTION

Epidemiological studies have revealed possible etiological factors responsible for various diseases. From these population-based studies around the world, it is now apparent that many common diseases of the prosperous nations are linked to diet and can be largely prevented by diet modification. This has renewed interest in the research of non-nutrient and nutrient bioactive compounds obtained from plant sources, which possess a wide range of biological properties that contribute to different health-related benefits. These phytochemicals are becoming increasingly recognized for maintaining good health both to clinical nutritionists and lay men. The phytoestrogens are naturally occurring plant derived non-steroidal compounds and are found in many foods2. Population-based studies have revealed that consumption of a phytoestrogen-rich diet, as seen with traditional Asiatic societies, is protective against so-called "Western" diseases such as breast, prostate, and bowel cancer and cardiovascular diseases. These compounds appear to be biomarkers of a 'healthy' diet. Apart from plant source, compounds with estrogen like activity are also found in animals (ovarian steroids),microorganisms (e.g., mycoestrogens from molds)1, as well as industrially manufactured estrogenic compounds such as bisphenol A and nonylpheno!4. Drugs like diethyl stilboesterol, estradiol benzoate etc. also have estrogenic activity. Wide range of compounds with estrogenic activity may be consumed due to their introduction into the food chain. One example is pesticides and insecticides,including DOT, which contain estrogen-like compounds. These compounds and several other environmental estrogens have been-classified as xenoestrogensS. The long-term effects of xenoestrogens are not known completely, however, there is a growing concern over their potentially deleterious effects on human health's. This review is focused on classification, mechanism of action, pharmacology,and various promising uses of phytoestrogens

SOURCE OF PHYTOESTROGENS

            blackberry fruit-one of the source of phytoestrogens.

According to a study by Canadian researchers about the content of nine common phytoestrogens in a Western diet, foods with the highest relative phytoestrogen content were nuts and oilseeds, followed by soy products, cereals and breads, legumes, meat products, and other processed foods that may contain soy, vegetables, fruits, alcoholic, and nonalcoholic beverages. Flax seed and other oilseeds contained the highest total phytoestrogen content, followed by soybeans and tofu.^1J"-ⁱ The highest concentrations of isoflavones are found in soybeans and soybean products followed by legumes, whereas lignans are the primary source of phytoestrogens found in nuts and oilseeds (e.g. flax) and also found in cereals, legumes, fruits and vegetables.

Phytoestrogen content varies in different foods, and may vary significantly within the same group of foods (e.g. soy beverages, tofu) depending on processing mechanisms and type of soybean used.^ill! Legumes (in particular soybeans), whole grain cereals, and some seeds are high in phytoestrogens. A more comprehensive list of foods known to contain phytoestrogens includes: soybeans, tofu, tempeh, soy beverages, linseed (flax), sesame seeds, wheat berries, fenugreek, oais, barley, dried beans, lentils, yams, rice, alfalfa, mung beans, apples, carrots, pomegranates, ^ wheat germ, rice bran, soy linseed bread, ginseng, hops , bourbon, beer¹ ' , fennel and anise.

An epidemiological study of women in the United States found that the dietary intake of phytoestrogens in healthy post-menopausal Caucasian women is less than one milligram daily

Table 1. Foods high in phytoestrogen content.

Phytoestrogen food sources	Phytoestrogen content (µg/100g)
Flax seed	379380
Soy beans	103920
Tofu	27150.1
Soy yogurt	10275
Sesame seed	8008.1
Flax bread	7540
Multigrain bread	4798.7
Soy milk	2957.2
Hummus	993
Garlic	603.6
Mung bean sprouts	495.1
Dried apricots	444.5
Alfalfa sprouts	441.4
Dried dates	329.5
Sunflower seed	216
Chestnuts	210.2
Olive oil	180.7
Almonds	131.1
Green bean	105.8
Peanuts	34.5
Onion	32
Blueberry	17.5
Corn	9
Coffee, regular	6.3
Watermelon	2.9
Milk, cow	1.2

Table 2. Total phytoestrogen and lignan content in vegetables,

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PENICILLIN ALLERGEY

 

PENICILLIN ALLERGEY

Penicillin is an antibiotic which is taken in cases of skin rashes and other bacterial infections. It is not used in raw form; instead there are medicines in which penicillin is used as a sole ingredient. But there are seen cases where use of penicillin causes allergenic side effects. Penicillin allergy is caused when allergic reactions are seen due to the overreaction of the body’s immune system towards penicillin antibiotics.

Symptoms

The allergic symptoms of penicillin intolerance are common to most allergies. They are listed below.

• Penicillin is used as an antibiotic for curing skin rashes, but sometimes penicillin allergy can itself cause rashes on the superficial skin.
• There are hives seen as side effect allergy of penicillin consumption.
• Along with skin deformities, the eyes and nose also suffer from signs of penicillin allergy. Eyes experience itchiness and burning. They go red. Nasal irritation and runny nose are also symptoms of penicillin allergy.
• If there is oral intake of medicines inclusive of penicillin, then symptoms of its allergy could show swelling in lips and tongue.
• There are red and itchy bumps developed on the facial front as a result of penicillin intolerance.
• The occurrences are rare, but there are cases of penicillin allergy when severities like anaphylaxis are seen. This means that the person has difficulty breathing.
• Symptoms of anaphylaxis include wheezing, dizziness, unconsciousness, weakening of pulse, diarrhea, nausea, vomiting and so on.

What makes you more likely to have a severe allergic reaction to penicillin?

Severe allergic reactions to penicillin can be dangerous and life-threatening. You may be more likely to have this type of reaction if you have had:

• A positive skin test for penicillin allergy.
• Hives that appeared quickly after you took the penicillin.
• A previous anaphylactic reaction to penicillin.

If any of these apply to you, you should receive another antibiotic or undergo desensitization

Penicillin.

Penicillin.

ANTIBIOTIC CLASSIFICATION AND SIDE EFFECTS

 

Antibiotics classification

Although there are several classification schemes for antibiotics, based on bacterial spectrum (broad versus narrow) or type of activity (bactericidal vs. bacteriostatic), the most useful is based on chemical structure. Antibiotics within a structural class will generally have similar patterns of effectiveness, toxicity, and allergic potential.

The main classes of antibiotics are:

• Beta-Lactams
  • Penicillins
  • Cephalosporins
• Macrolides
• Fluoroquinolones
• Tetracyclines
• Aminoglycosides

Most commonly used types of antibiotics are: Aminoglycosides, Penicillins, Fluoroquinolones, Cephalosporins, Macrolides, and Tetracyclines. While each class is composed of multiple drugs, each drug is unique in some way.

Penicillins

The penicillins are the oldest class of antibiotics. Penicillins have a common chemical structure which they share with the cephalopsorins. Penicillins are generally bactericidal, inhibiting formation of the cell wall. Penicillins are used to treat skin infections, dental infections, ear infections, respiratory tract infections, urinary tract infections, gonorrhea.

There are four types of penicillins:

• The natural penicillins are based on the original penicillin-G structure. Penicillin-G types are effective against gram-positive strains of streptococci, staphylococci, and some gram-negative bacteria such as meningococcus.
• Penicillinase-resistant penicillins, notably methicillin and oxacillin, are active even in the presence of the bacterial enzyme that inactivates most natural penicillins.
• Aminopenicillins such as ampicillin and amoxicillin have an extended spectrum of action compared with the natural penicillins. Extended spectrum penicillins are effective against a wider range of bacteria.

Penicillins side effects

Penicillins are among the least toxic drugs known. The most common side effect of penicillin is diarrhea.

ANTIBIOTICS

 

What Are Antibiotics?

The word antibiotic comes from the Greek anti meaning 'against' and bios meaning 'life' (a bacterium is a life form).' Antibiotics are also known as antibacterials, and they are drugs used to treat infections caused by bacteria. Bacteria are tiny organisms that can sometimes cause illness to humans and animals. The singular word for bacteria is bacterium.
Such illnesses as tuberculosis, salmonella, syphilis and some forms of meningitis are caused by bacteria. Some bacteria are not harmful, while others are good for us.
Before bacteria can multiply and cause symptoms our immune system can usually destroy them. We have special white blood cells that attack harmful bacteria. Even if symptoms do occur, our immune system can usually cope and fight off the infection. There are occasions, however, when it is all too much and our bodies need some help - from antibiotics.

The first antibiotic was penicillin. Such penicillin-related antibiotics as ampicillin, amoxicillin and benzylpenicilllin are widely used today to treat a variety of infections - these antibiotics have been around for a long time. There are several different types of modern antibiotics and they are only available with a doctor's prescription in industrialized countries.

How do antibiotics work?

Although there are a number of different types of antibiotic they all work in one of two ways:

• A bactericidal antibiotic kills the bacteria. Penicillin is a bactericidal. A bactericidal usually either interferes with the formation of the bacterium's cell wall or its cell contents.
• A bacteriostatic stops bacteria from multiplying.

 

What are antibiotics for?

An antibiotic is given for the treatment of an infection caused by bacteria. They target only bacteria - they do not attack other organisms, such as fungi or viruses. If you have an infection it is important to know whether it is caused by bacteria, and not a virus or fungus. Most upper respiratory tract infections, such as the common cold and sore throats are generally caused by viruses - antibiotics do not work against viruses.

penicillin-mechanism of action

CLINICAL TRIALS

Clinical Trials

Courtesy: Wikipedia,

In medical research, clinical trials are conducted to allow safety and efficacy data to be collected for new drugs or devices. These trials can only take place once satisfactory information has been gathered on the quality of the product and its non-clinical safety, and Health Authority/Ethics Committee approval is granted in the country where the trial is taking place.

Depending on the type of product and the stage of its development, investigators enroll healthy volunteers and/or patients into small pilot studies initially, followed by larger scale studies in patients that often compare the new product with the currently prescribed treatment. As positive safety and efficacy data are gathered, the number of patients is typically increased. Clinical trials can vary in size from a single center in one country to multicenter trials in multiple countries.

Due to the sizable cost a full series of clinical trials may incur, the burden of paying for all the necessary people and services is usually borne by the sponsor who may be the pharmaceutical or biotechnology company that developed the agent under study. Since the diversity of roles may exceed resources of the sponsor, often a clinical trial is managed by an outsourced partner such as a contract research organization (CRO).

Clinical Trials : FAQ

Source: http://www.clinicaltrials.gov

What is a clinical trial?
Although there are many definitions of clinical trials, they are generally considered to be biomedical or health-related research studies in human beings that follow a pre-defined protocol. ClinicalTrials.gov includes both interventional and observational types of studies. Interventional studies are those in which the research subjects are assigned by the investigator to a treatment or other intervention, and their outcomes are measured. Observational studies are those in which individuals are observed and their outcomes are measured by the investigators.

Why participate in a clinical trial?
Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research.

Who can participate in a clinical trial?
All clinical trials have guidelines about who can participate. Using inclusion/exclusion criteria is an important principle of medical research that helps to produce reliable results. The factors that allow someone to participate in a clinical trial are called “inclusion criteria” and those that disallow someone from participating are called “exclusion criteria”. These criteria are based on such factors as age, gender, the type and stage of a disease, previous treatment history, and other medical conditions. Before joining a clinical trial, a participant must qualify for the study. Some research studies seek participants with illnesses or conditions to be studied in the clinical trial, while others need healthy participants. It is important to note that inclusion and exclusion criteria are not used to reject people personally. Instead, the criteria are used to identify appropriate participants and keep them safe. The criteria help ensure that researchers will be able to answer the questions they plan to study.

What happens during a clinical trial?
The clinical trial process depends on the kind of trial being conducted (See What are the different types of clinical trials?) The clinical trial team includes doctors and nurses as well as social workers and other health care professionals. They check the health of the participant at the beginning of the trial, give specific instructions for participating in the trial, monitor the participant carefully during the trial, and stay in touch after the trial is completed.

Some clinical trials involve more tests and doctor visits than the participant would normally have for an illness or condition. For all types of trials, the participant works with a research team. Clinical trial participation is most successful when the protocol is carefully followed and there is frequent contact with the research staff.

What is informed consent?

Drug Warnings & 'Black Box' Warnings

Drug Warnings & 'Black Box' Warnings

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Drug Warnings & 'Black Box' Warnings

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Drug Abuse Pictures Slideshow: Commonly Abused Prescription and OTC Drugs on MedicineNet.com

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Pharmacist: Career Information

Pharmacist Job Description:

Pharmacists dispense prescription drugs to patients. They provide information about those drugs and help patients understand the instructions their doctors or other health practitioners provided. They monitor their patients' health and progress to make sure their medications are working effectively and safely.

Employment Facts About Pharmacists:

Pharmacists held about 243,000 jobs in 2006. More than half worked in community pharmacies (62%). Most were salaried employees, but some were self employed. Almost a quarter worked in hospitals. The rest worked in clinics, mail order and Internet pharmacies, pharmaceutical wholesalers, physicians' offices, or for the Federal government.

Educational Requirements for Pharmacists:

To work as a pharmacist one must have a Doctor of Pharmacy degree, known as a Pharm.D. Pharmacy programs are usually four years long and must be accredited by the Accreditation Council for Pharmacy Education (ACPE). To gain admission one must have at least two years of college study with courses including math, chemistry, biology, physics, humanities and social sciences. Applicants generally have to take the Pharmacy College Admissions Test. Doctor of Pharmacy programs include coursework in pharmaceutics and pharmaceutical chemistry, pharmacology (effects of drugs on the body), toxicology and pharmacy administration.

Other Requirements for Pharmacists:

In the U.S., pharmacists must pass the North American Pharmacist Licensure Exam administered by the National Association of Boards of Pharmacy (NABP). Most states also require graduates to pass the Multistate Pharmacy Jurisprudence Exam (MPJE), a test of pharmacy law, also administered by the NABP. Other states administer another exam that tests knowledge of pharmacy law. Several states also require additional state-specific exams. All states, except California, grant license transfers from other states. Pharmacists must have scientific aptitude and good communication skills and be detail-oriented.

Advancement of Pharmacists:

Pharmacists working in independent pharmacies may become owners or part-owners after they gain experience and secure the necessary capital. Those in chain drugstores may be promoted to pharmacy supervisors or store managers, then to district or regional managers and eventually to executive positions at the headquarters. Hospital pharmacists may be promoted to supervisory positions. Those who work in the pharmaceutical industry may advance in areas including marketing, sales, research, or quality control.

Job Outlook for Pharmacists:

Employment of pharmacists is expected to grow much faster than the average for all occupations through 2016.

How Much Do Pharmacists Earn? :

Median Annual Earnings in the Industries Employing the Largest Numbers of Pharmacists (U.S., 2006)

• Department stores: $99,050
• Grocery stores: $95,000
• Pharmacies and drug stores: $94,640
• General medical and surgical hospitals: $93,640

Code of Pharmacist Ethics

APhA Code of Pharmacist Ethics

Pharmacists are health professionals who assist individuals in making the best use of medications. This Code, prepared and supported by pharmacists, is intended to state publicly the principles that form the fundamental basis of the roles and responsibilities of pharmacists. These principles, based on moral obligations and virtues, are established to guide pharmacists in relationships with patients, health professionals, and society.
I. A pharmacist respects the covenantal relationship between the patient and pharmacist.
Considering the patient-pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society. In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust.
II. A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner.
A pharmacist places concern for the well-being of the patient at the center of professional practice. In doing so, a pharmacist considers needs stated by the patient as well as those defined by health science. A pharmacist is dedicated to protecting the dignity of the patient. With a caring attitude and a compassionate spirit, a pharmacist focuses on serving the patient in a private and confidential manner.
III. A pharmacist respects the autonomy and dignity of each patient.
A pharmacist promotes the right of self-determination and recognizes individual self-worth by encouraging patients to participate in decisions about their health. A pharmacist communicates with patients in terms that are understandable. In all cases, a pharmacist respects personal and cultural differences among patients.
IV. A pharmacist acts with honesty and integrity in professional relationships.
A pharmacist has a duty to tell the truth and to act with conviction of conscience. A pharmacist avoids discriminatory practices, behavior or work conditions that impair professional judgment, and actions that compromise dedication to the best interests of patients.
V. A pharmacist maintains professional competence.
A pharmacist has a duty to maintain knowledge and abilities as new medications, devices, and technologies become available and as health information advances.

VI. A pharmacist respects the values and abilities of colleagues and other health professionals.
When appropriate, a pharmacist asks for the consultation of colleagues or other health professionals or refers the patient. A pharmacist acknowledges that colleagues and other health professionals may differ in the beliefs and values they apply tothe care of the patient.

VII. A pharmacist serves individual, community, and societal needs.
The primary obligation of a pharmacist is to individual patients. However, the obligations of a pharmacist may at times extend beyond the individual to the community and society. In these situations, the pharmacist recognizes the responsibilities that accompany these obligations and acts accordingly.
VIII. A pharmacist seeks justice in the distribution of health resources.
When health resources are allocated, a pharmacist is fair andequitable, balancing the needs of patients and society.

Pharmacy and Pharmaceutical Sciences - UCLan

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Pharmacy-A Review

Pharmacy

19th century italian pharmacy

The mortar and pestle, one of the internationally recognized symbols to represent the pharmacy profession

Typical American drug store with a soda fountain, about 1905

Drug store restoration ca. 1920 at Collingsworth County Museum and Art Center across from the courthouse in Wellington, Texas

Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs. The word derives from the Greek: φάρμακον (pharmakon), meaning "drug" or "medicine" (the earliest form of the word is the Mycenaean Greek pa-ma-ko, attested in Linear B syllabic script).

The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are the experts on drug therapy and are the primary health professionals who optimize medication use to provide patients with positive health outcomes.

An establishment in which pharmacy (in the first sense) is practiced is called a pharmacy, chemist's or (in the United States) drug store. US drug stores commonly sell not only medicines, but also miscellaneous items such as candy (sweets), cosmetics, and magazines, as well as light refreshments or groceries.

The word pharmacy is derived from its root word pharma which was a term used since the 15th–17th centuries. In addition to pharma responsibilities, the pharma offered general medical advice and a range of services that are now performed solely by other specialist practitioners, such as surgery and midwifery. The pharma (as it was referred to) often operated through a retail shop which, in addition to ingredients for medicines, sold tobacco and patent medicines. The pharmas also used many other herbs not listed.

In its investigation of herbal and chemical ingredients, the work of the pharma may be regarded as a precursor of the modern sciences of chemistry and pharmacology, prior to the formulation of the scientific method.

Disciplines

Pharmacy, tacuinum sanitatis casanatensis (XIV century)

The field of Pharmacy can generally be divided into three primary disciplines:

• Pharmaceutics
• Medicinal chemistry and Pharmacognosy
• Pharmacy practice

The boundaries between these disciplines and with other sciences, such as biochemistry, are not always clear-cut; and often, collaborative teams from various disciplines research together.

Pharmacology is sometimes considered a fourth discipline of pharmacy. Although pharmacology is essential to the study of pharmacy, it is not specific to pharmacy. Therefore it is usually considered to be a field of the broader sciences.

• Pharmacoinformatics

New disciple for systematic drug discovery and development with efficient and safety. Other specializations in pharmacy practice recognized by the Board of Pharmaceutical Specialties include: cardiovascular, infectious disease, oncology, pharmacotherapy, nuclear, nutrition, and psychiatry. The Commission for Certification in Geriatric Pharmacy certifies pharmacists in geriatric pharmacy practice. The American Board of Applied Toxicology certifies pharmacists and other medical professionals in applied toxicology.

Pharmacists

Main article: Pharmacist

Pharmacists are highly-trained and skilled healthcare professionals who perform various roles to ensure optimal health outcomes for their patients. Many pharmacists are also small-business owners, owning the pharmacy in which they practice.

Pharmacists are represented internationally by the International Pharmaceutical Federation (FIP). They are represented at the national level by professional organisations such as the Dutch Pharmacists Association (VNA) Royal Pharmaceutical Society of Great Britain (RPSGB), the Pharmacy Guild of Australia (PGA), the Pakistan Pharmacists Society (PPS) and the American Pharmacists Association (APhA).

In some cases, the representative body is also the registering body, which is responsible for the ethics of the profession. Since the Shipman Inquiry, there has been a move in the UK to separate the two roles.

History

Paleopharmacological studies attest to the use of medicinal plants in pre-history.

The earliest known compilation of medicinal substances was ARIANA the Sushruta Samhita, an Indian Ayurvedic treatise attributed to Sushruta in the 6th century BC. However, the earliest text as preserved dates to the 3rd or 4th century AD.

Many Sumerian (late 6th millennium BC - early 2nd millennium BC) cuneiform clay tablets record prescriptions for medicine.

Ancient Egyptian pharmacological knowledge was recorded in various papyri such as the Ebers Papyrus of 1550 BC, and the Edwin Smith Papyrus of the 16th century BC.

The earliest known Chinese manual on materia medica is the Shennong Bencao Jing (The Divine Farmer's Herb-Root Classic), dating back to the 1st century AD. It was compiled during the Han dynasty and was attributed to the mythical Shennong. Earlier literature included lists of prescriptions for specific ailments, exemplified by a manuscript "Recipes for 52 Ailments", found in the Mawangdui tomb, sealed in 168 BC. Further details on Chinese pharmacy can be found in the Pharmacy in China article.

Dioscorides, De Materia Medica, Byzantium, 15th century

In Ancient Greece, before, during and after the time of Hippocrates there was a group of experts in medicinal plants. Probably the most important representative of these rhizotomoi was Diocles of Carystus. The Greek physician Pedanius Dioscorides is famous for writing a five volume book in his native Greek Περί ύλης ιατρικής in the 1st century AD. The Latin translation De Materia Medica (Concerning medical substancesIslamic Golden Age. The title coined the term materia medica.

In Japan, at the end of the Asuka period (538-710) and the early Nara period (710-794), the men who fulfilled roles similar to those of modern pharmacists were highly respected. The place of pharmacists in society was expressly defined in the Taihō Code (701) and re-stated in the Yōrō Code (718). Ranked positions in the pre-Heian Imperial court were established; and this organizational structure remained largely intact until the Meiji Restoration (1868). In this highly stable hierarchy, the pharmacists—and even pharmacist assistants—were assigned status superior to all others in health-related fields such as physicians and acupuncturists. In the Imperial household, the pharmacist was even ranked above the two personal physicians of the Emperor.

There is a stone sign for a pharmacy with a tripod, a mortar, and a pestle opposite one for a doctor in the Arcadian Way in Ephesus near Kusadasi in Turkey. http://www.pbase.com/tsechien/ephesus_ has photos. The current Ephesus dates back to 400BC and was the site of the Temple of Artemis one of the seven wonders of the world, the home of Mark Anthony and Cleopatra, Mary Magdalen and where St Paul read his letter to the Ephesians.

In Baghdad the first pharmacies, or drug stores, were established in 754, under the Abbasid Caliphate during the Islamic Golden Age. By the 9th century, these pharmacies were state-regulated

The advances made in the Middle East in botany and chemistry led medicine in medieval Islam substantially to develop pharmacology. Muhammad ibn Zakarīya Rāzi (Rhazes) (865-915), for instance, acted to promote the medical uses of chemical compounds. Abu al-Qasim al-Zahrawi (Abulcasis) (936-1013) pioneered the preparation of medicines by sublimation and distillation. His Liber servitoris is of particular interest, as it provides the reader with recipes and explains how to prepare the `simples’ from which were compounded the complex drugs then generally used. Sabur Ibn Sahl (d 869), was, however, the first physician to initiate pharmacopoedia, describing a large variety of drugs and remedies for ailments. Al-Biruni (973-1050) wrote one of the most valuable Islamic works on pharmacology entitled Kitab al-Saydalah (The Book of Drugs), where he gave detailed knowledge of the properties of drugs and outlined the role of pharmacy and the functions and duties of the pharmacist. Ibn Sina (Avicenna), too, described no less than 700 preparations, their properties, mode of action and their indications. He devoted in fact a whole volume to simple drugs in The Canon of Medicine. Of great impact were also the works by al-Maridini of Baghdad and Cairo, and Ibn al-Wafid (1008–1074), both of which were printed in Latin more than fifty times, appearing as De Medicinis universalibus et particularibus by `Mesue' the younger, and the Medicamentis simplicibus by `Abenguefit'. Peter of Abano (1250–1316) translated and added a supplement to the work of al-Maridini under the title De Veneris. Al-Muwaffaq’s contributions in the field are also pioneering. Living in the 10th century, he wrote The foundations of the true properties of Remedies, amongst others describing arsenious oxide, and being acquainted with silicic acid. He made clear distinction between sodium carbonate and potassium carbonate, and drew attention to the poisonous nature of copper compounds, especially copper vitriol, and also lead compounds. He also describes the distillation of sea-water for drinking.

In Europe pharmacy-like shops began to appear during the 12th century. In 1240 emperor Frederic II issued a decree by which the physician's and the apothecary's professions were separated. the first pharmacy in Europe (still working) was opened in 1241 in Trier, Germany.

In Europe there are old pharmacies still operating in Dubrovnik, Croatia located inside the Franciscan monastery, opened in 1317 ; and one in the Town Hall Square of Tallinn, Estonia dating from at least 1422. The oldest is claimed to be set up in 1221 in the Church of Santa Maria Novella in Florence, Italy, which now houses a perfume museum. The medieval Esteve Pharmacy, located in Llívia, a Catalan enclave close to Puigcerdà, is also now a museum dating back to the 15th century, keeping albarellos from the 16th and 17th centuries, old prescription books and antique drugs.

Types of pharmacy practice areas

Pharmacists practice in a variety of areas including retail, hospitals, clinics, nursing homes, drug industry, and regulatory agencies. Pharmacists can specialize in various areas of practice including but not limited to: hematology/oncology, infectious diseases, ambulatory care, nutrition support, drug information, critical care, pediatrics, etc.

Community pharmacy

Modern pharmacy in Norway

A pharmacy (commonly the chemist in Australia, New Zealand and the UK; or drugstore in North America; retail pharmacy in industry terminology; or Apothecary, historically) is the place where most pharmacists practice the profession of pharmacy. It is the community pharmacy where the dichotomy of the profession exists—health professionals who are also retailers.

Community pharmacies usually consist of a retail storefront with a dispensary where medications are stored and dispensed. The dispensary is subject to pharmacy legislation; with requirements for storage conditions, compulsory texts, equipment, etc., specified in legislation. Where it was once the case that pharmacists stayed within the dispensary compounding/dispensing medications; there has been an increasing trend towards the use of trained pharmacy technicians while the pharmacist spends more time communicating with patients. Pharmacy Technicians are now more dependant on automation to assist them in their new role dealing with with patients prescriptions and patient safety issues.

Main article: Pharmacy automation

All pharmacies are required to have a pharmacist on-duty at all times when open. In many jurisdictions, it is also a requirement that the owner of a pharmacy must be a registered pharmacist (R.Ph.). This latter requirement has been revoked in many jurisdictions, such that many retailers (including supermarkets and mass merchandisers) now include a pharmacy as a department of their store.

Likewise, many pharmacies are now rather grocery store-like in their design. In addition to medicines and prescriptions, many now sell a diverse arrangement of additional items such as cosmetics, shampoo, office supplies, confections, snack foods, durable medical equipment, greeting cards, and provide photo processing services.

Hospital pharmacy

Main article: Hospital pharmacy

Pharmacies within hospitals differ considerably from community pharmacies. Some pharmacists in hospital pharmacies may have more complex clinical medication management issues whereas pharmacists in community pharmacies often have more complex business and customer relations issues.

Because of the complexity of medications including specific indications, effectiveness of treatment regimens, safety of medications (i.e., drug interactions) and patient compliance issues (in the hospital and at home) many pharmacists practicing in hospitals gain more education and training after pharmacy school through a pharmacy practice residency and sometimes followed by another residency in a specific area. Those pharmacists are often referred to as clinical pharmacists and they often specialize in various disciplines of pharmacy. For example, there are pharmacists who specialize 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 pharmacies can usually be found within the premises of the hospital. Hospital pharmacies usually stock a larger range of medications, including more specialized medications, than would be feasible in the community setting. Most hospital medications are unit-dose, or a single dose of medicine. Hospital pharmacists and trained pharmacy technicians compound sterile products for patients including total parenteral nutrition (TPN), and other medications given intravenously. This is a complex process that requires adequate training of personnel, quality assurance of products, and adequate facilities. Several hospital pharmacies have decided to outsource high risk preparations and some other compounding functions to companies who specialize in compounding. The high cost of medications and drug-related technology, combined with the potential impact of medications and pharmacy services on patient-care outcomes and patient safety, make it imperative that hospital pharmacies perform at the highest level possible.

Clinical pharmacy

Main article: Clinical pharmacy

Dr Sajad Issop of Airedale General Hospital explains: Clinical pharmacists provide direct patient care services that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often collaborate with physicians and other healthcare professionals to improve pharmaceutical care. Clinical pharmacists are now an integral part of the interdisciplinary approach to patient care. They work collaboratively with physicians, nurses and other healthcare personnel in various medical and surgical areas. They often participate in patient care rounds and drug product selection. In most hospitals in the United States, potentially dangerous drugs that require close monitoring are dosed and managed by clinical pharmacists.

HISTORY OF MODERN PHARMACY IN INDIA

History of Modern Pharmacy in India

GALEN-FATHER OF PHARMACY

Progress of Research

The Indian traditional systems of medicine have been Ayurveda,
Siddha and Unani. Ayurveda and
Siddha originated in India itself. Unani, the Greco-Arabic medical
system, came from West Asia. The
European colonizers brought the western system of medicine to
 the country. During the colonial period,the new system, commonly referred to as allopathy,
got firmly established. It held the sway and came to have controlling
 influence on health care. On the country attaining independence
 there was no going back.
Chronicling the medico-pharmaceutical developments
of the modern period is an attractive subject of study.
This investigator chose to explore the history of
modern pharmacy in India and related aspects of the
span covering the last several centuries, including
also the pharmaceutical progress in the independent
India. The research started in late 1980s. In the
initial years the support came from the University
Grants Commission, New Delhi, and subsequently
sponsorship continued from the Indian National
Science Academy, New Delhi.
Archival Collection
When the studies started, the investigator was very
clear in his mind as to the different aspects of the
pharmaceutical subject which would need to be
examined. He started searching for the necessary
source material from different centers within the
country and abroad. Gradually, a formidable archival
collection started taking shape. This was noted in
some western journals.1,2 At home, the investigator
was interviewed on the subject, with a particular
reference to the Collection.3 For collecting the material
from within the country the investigator has worked
at the National Library, Asiatic Society Library, Medical
College Library, School of Tropical Medicine Library,
and West Bengal Secretariat Library, at Kolkata;
NICDAP at the Central Drug Research Institute, at
Lucknow; CSIR Publications & Information Directorate
Library, National Medical Library, Central Secretariat
Library, and Parliament Library at New Delhi; and
Connemara Public Library at Chennai. Valuable material
has been uncovered through studies at the National
Archives of India, at New Delhi; Tamil Nadu Archives,
at Chennai; State Archives of West Bengal, at Kolkata;
and the Maharashtra Archives, at Mumbai. The
Pharmacy Council of India and the All India Council
for Technical Education have supplied a good deal of
material of interest. Abroad, he carried out
investigations at the British Library, British Medical
Association Library, Royal Pharmaceutical Society of
Great Britain Library, Royal College of Physicians
Library, Royal Geographic Society Library, Royal Society
Library, Wellcome Library for the History and
Understanding of Medicine, and University of London
School of Pharmacy Library at London; Harold Cohen
Library of the University of Liverpool; Philadelphia
College of Pharmacy and Science Library and College
of Physicians of Philadelphia Library at Philadelphia;
and Library of Science and Medicine, State University
of New Jersey (Rutgers) at Piscataway, NJ. From
several other libraries and archives a lot of material
has been obtained through correspondence.
The above has been really a crusade for collection of
source material. Thousands of documents and
publications which have accumulated have been
properly organized and bound. There are now available
over twelve hundred volumes. If there is available
source material on the history of modern pharmacy in
India, under one roof, it is with the investigator. The
further buildup continues and gaps are being filled.
The writing on the history of modern pharmacy in
India has continued during the last nearly two
Professor Emeritus, Pharmaceutical Sciences, Panjab University,
Chronicling the history 1135 Sector 43, Chandigarh 160 022
 of medico-pharmaceutical developments in India of the modern period is an attractive subject of study. The investigator  has
chosen to explore the history of modern pharmacy in the country. He has built a formidable archival collection.
Based on his research of the last nearly two decades, the investigator has produced four well documented and illustrated book
 monographs and forty of research articles. The areas of his historical
studies include pharmacopoeias and formularies, pharmaceutical education, pharmacy practice, pharmaceutical journalism,
 biographies of pharmaceutical luminaries, and pharmaceutical regulatory provisions.CRIPS Vol. 7 No. 3 July-September 2006 43

Review Article
decades, and there have been brought out four books
and forty papers. Brief descriptions are given next of
the work which has been carried out under the heads:
Pharmacopoeias and Formularies, Pharmaceutical
Education, Pharmacy Practice, Pharmaceutical
Journalism, Biographies of Pharmaceutical Luminaries,
and Pharmaceutical Regulatory Provisions.
Pharmacopoeias and Formularies