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What is a
pharmacist?
A pharmacist is
someone who is registered with the Royal Pharmaceutical Society of Great
Britain. In order to be registered, they must have spent at least
four years studying drugs and medicines and obtained a degree in
pharmacy at an approved university. They will also have spent at
least a year working under the supervision of an experienced pharmacist,
usually in a hospital or community pharmacy (chemist's shop).
Before anyone can
call themselves a pharmacist, pharmaceutical chemist, Member of the
Royal Pharmaceutical Society, or Fellow of the Royal Pharmaceutical
Society, he or she must be a registered pharmacist. It is illegal
for anyone to call themselves a pharmacist or even suggest by inference
that they are a pharmacist if they are not registered with the Royal
Pharmaceutical Society.
During their
training pharmacists study all aspects of drug treatment, including:
- the effects of
drugs on the mind and the body
- the manufacture
of drugs and medicines
- the law
relating to drugs and medicines.
They are not
medical doctors, although, like anyone else, pharmacists may study for a
PhD which allows them to use the title Doctor (Dr).
Are there
different sorts of pharmacists?
Once someone is
registered as a pharmacist, they are legally allowed to deal with drugs
and medicines and could potentially work in a number of different areas:
Community
pharmacies:
The majority of pharmacists work in a community pharmacy
- either in their own business or as an employee in someone else's
business (which could be part of a large chain of chemists). Hospitals
or NHS trusts: Pharmacists may specialise in different areas of
practice, depending on the particular specialism of the hospital.
Some large GP practices may employ their own pharmacist, while some GP's
in rural areas do their own dispensing, so that patients need not visit
a pharmacist at all. The pharmaceutical industry: Where
pharmacists may work in one of several areas - for example researching
new drugs for one of the pharmaceutical (drug) companies. University
departments Health Authorities Veterinary pharmacy: Working
with the drugs and medicines used in the treatment of animals.
What does a
pharmacist do?
This depends on
the type of pharmacist. All pharmacists are trained as experts in
drugs and medicines, but pharmacists working in a community pharmacy
will develop a different range of skills from those working solely in
specialist areas e.g. within a Mental Health Trust. Indeed, many
community pharmacists have only a limited understanding of psychiatry
and psychotropic medication (drugs which have an influence on the
function of the brain).
The supply of
drugs and medicines:
When you take your
prescription to a pharmacist they will first check that what the doctor
has prescribed is reasonable. This means checking that the dose
and frequency is usual for the drug concerned. If your doctor has
prescribed more than one drug, the pharmacist will also make sure that
there should be no problems when the drugs are given together. (see
‘Is it safe…’ page 5)
If there is
anything unusual about your prescription, the pharmacist will contact
your doctor to discuss and confirm the details. However, given the vast
range of doses that can be used for some medicines, the pharmacist may
decide to check with you whether you have had the drugs before. This
helps him or her to decide if it is appropriate to discuss your
prescription with the doctor. Usually, a pharmacist will not make
changes to your prescription without first confirming it with the
doctor.
Advice on
treatment
Some hospitals and
community trusts employ specialist pharmacists to work in mental health.
These pharmacists often work as part of a multi-disciplinary team and
have a direct involvement in your drug treatment. They will make
recommendations on the types of drugs and doses which may be most
appropriate for you. They should also be able to discuss any
questions or concerns you may have about any aspect of treatment with
drugs or medicines.
Why can I buy
some drugs from a pharmacy, but not others?
The law covering
the supply of medicines (The Medicines Act) specifies those medicines
which can be supplied only on prescription from a doctor (or dentist),
and those which can be obtained from a pharmacist. It also states
which medicines you can buy from the newsagent or supermarket. All
drugs used in mental health must be prescribed by a doctor before a
pharmacist can supply them. Even if you are in hospital or at a day
centre, only a doctor can authorise the supply of your medication.
If you are away
from home and find you have run out of your medication, you can contact
a pharmacist who may be able to give you an emergency supply of your
usual medication.
Where do I find
a pharmacist?
This depends on why
you need a pharmacist. If you have been given a prescription by
your GP, you may take it to any pharmacy in the country. However, it is
probably best to get to know your local pharmacist and take your
prescription there - particularly if you use medication regularly.
(If you are not sure where to go, look in Yellow Pages or telephone your
local Community Health Council. Talking Pages on (0800) 600900 can also
give details of local chemists with ‘out-of-hours’ services). Some
High Street pharmacies hold computerised records of patients' or
customers' long-term prescriptions (some do not).
If you have a
prescription from your hospital, outpatient clinic or day centre, you
will usually have to take this to the pharmacy at the hospital or NHS
Community Trust where it was issued. In some cases you will find
your drugs and medicines are delivered from the pharmacy and handed to
you by your nurse or keyworker.
If there are
specialist pharmacists working in your mental health team, you may be
given a booklet or leaflet describing how they can be contacted; if not,
ask your doctor, nurse or keyworker if you can arrange to see a
pharmacist.
What can I ask
a pharmacist?
Anything you like
about your medication. However, many drugs can be used for more
than one condition, so unless your pharmacist has already been involved
in your treatment, it will be impossible for them to know why you
have been given a particular medication. For example, a drug like
carbamazepine (Tegretol) could have been prescribed to manage epilepsy
or fits, but could equally have been given to control mood swings in
someone who does not have epilepsy but has bipolar disorder, a totally
unrelated condition. In this instance, it would be impossible for
a pharmacist to tell you why you have been given a particular
drug just by looking at the prescription.
Apart from this,
the pharmacist should be able to answer any other questions you may have
about your drug treatment. Where a specialist pharmacist has been
involved in your treatment, naturally you can expect them to explain all
about the drug and why you have been given it.
What are the
most important questions I should ask?
What does the drug
do?
The pharmacist
will be able to tell you which different parts of the body the drug
affects, and what this means for you taking the drug. In the field
of mental health in particular, there is still a great deal of
uncertainty about exactly how some of the drugs used produce their
effects; but this should not stop the pharmacist explaining what the
drug does in general terms. If you already know why you have been
given a particular drug, tell the pharmacist; this will make it easier
for them to explain the relevant points.
None of the drugs
available at the moment actually cures mental health problems; they all
aim to reduce, relieve or suppress the symptoms.
Are there any side
effects? What are they?
All drugs produce
side effects. Once a drug is taken, it does not magically know
where in the body (or brain) to act. The drug passes into the
blood stream and is carried throughout the body. Therefore, there
is a likelihood that the drug may affect more than one system in the
body. If it does, and it produces an unwanted effect, this is
called a "side effect". Sometimes people use the term
"adverse effect" to describe the negative side effects of a
drug.
Given the
complexity of drugs as well as of the mind and body, some drugs have the
potential to cause many side effects. Some of them may affect the
majority of people who take the drug, while others may be very rare -
affecting only 1 in 1000 people or fewer. Some may be very minor effects
- others so severe that the drug must be stopped immediately. If
you have only a short time to speak to the pharmacist, you might want to
ask which side effects are common and if there are any serious side
effects.
Even simple
questions like this one can sometimes be difficult to answer.
Drowsiness, for example, is a common side effect of many drugs used in
mental health, but is it serious? Clearly that depends on the
severity of the drowsiness. Neuroleptic malignant syndrome,
however, is a potentially life-threatening side effect of anti-psychotic
drugs (also referred to as neuroleptics and, misleadingly, as major
tranquillisers). Reports vary, but the syndrome may occur in about
1% of people taking anti-psychotics. Is 1 in 100 common?
How long will I
have to take the medication for?
This depends on
the type of medication you have been given and why it has been
prescribed for you.
Will I get
addicted?
Again, this
depends on the type of medication you are taking and also on how one
defines addiction.
Will the
medication stop working or become less effective if I keep taking it for
a long time?
This does happen
with some drugs, but generally speaking all the drugs commonly used in
mental health are unlikely to become less effective as you continue to
take them. The exception being benzodiazepines or sleeping tablets.
I am not ill at
the moment, so do I need to take my medication?
None of the
available drugs cures mental distress. Unfortunately, for many
people the symptoms are only controlled while they continue taking the
drug. If drug treatment is stopped prematurely there may be a risk
of symptoms returning.
Is it safe to take
my usual medication with …X (another medication)?
When two or more
drugs are taken together, they can interact in a number of ways. So, if
you usually take medication and are prescribed another it would be wise
to check that it is safe to take the two together. Some drugs can
interfere with your usual medication by preventing it from working as
well as it should. Other drugs can affect the way the body deals
with your usual medication. For instance, some drugs can speed up
the rate at which your medication passes through the body - causing it
to work less efficiently. Others still can slow down the process
of removal - making your medication more effective, but perhaps also
increasing the side effects experienced. Some drugs produce the
same side effects, which can also cause problems. For example, if
your medication makes you feel sleepy and you take another drug that has
the same side effect, you may end up feeling extremely sleepy.
There are hundreds
of interactions, with more being discovered all the time. Most
interactions are not dangerous but a very few can be - so it always pays
to ask.
I use the
contraceptive pill. Will this medication make it less effective?
Some drugs can
interact with oral contraceptives (the pill). So you may need to use a
different method of contraception while taking that particular
medication.
I am pregnant/
breastfeeding. Will this medication affect my baby?
Drugs taken during
pregnancy and when breastfeeding may affect the developing baby or
newborn infant. To minimise any risk of harm, it is best to completely
avoid taking medication at this time. Medication should only be
prescribed if the benefits to you, the mother, outweigh the potential
risk of harm to the baby. Your pharmacist should be willing to discuss
the pros and cons of drug treatment during pregnancy or breastfeeding
with you.
Why do drugs
have more than one name?
When a drug is
first produced, it is given a chemical name, which is the approved name
for that particular drug. When a drug company manufactures the
drug in a form which can be given to a patient, they are allowed to give
it any name they like (a brand name). For example, the drug
chlorpromazine is given the brand name Largactil when it is manufactured
as a tablet by one particular drug company. In practical terms
especially when a drug is used a lot and has been on the market for a
long time, the two names are interchangeable. If more than one
drug company make the same drug, it will be given a different brand name
by each drug company that supplies it. If your GP prescribes a
particular brand of drug, the pharmacist must supply you with that
specific brand. In hospitals or Community Trusts this is not the
case; they may give you a different brand of the same drug.
Do I need to be
taking medication before I can discuss it with a pharmacist?
No. The
pharmacist will be able to explain and discuss drug treatment with you,
even if you are not taking it. Prior to starting long-term
treatment, with a drug such as lithium for example, it may be helpful to
arrange to see a pharmacist to discuss it. Some people may be
worried about the effects taking (or not taking) medication might have
on a relative or friend. Again, it is fine to discuss this with a
pharmacist. In both cases speaking to a pharmacist who specialises in
mental health would be particularly helpful.
Do I need an
appointment to see the pharmacist?
This depends on
how long you need to spend with the pharmacist. You can walk into
any community pharmacy and ask to speak to the pharmacist. If they
are not already dealing with someone else, they might be able to spend
some time answering your questions. However, if the pharmacist is busy
they may suggest that you call back at a quieter time in order to spend
longer with you. Some pharmacists have a quiet area set aside where you
can talk in some privacy.
Specialist
pharmacists in hospitals or community trusts may have specific times
when they are available to discuss medication; others are available
throughout normal working hours. There are no fixed rules and the
availability of pharmacists depends on local arrangements. You
should always be able to call in to a pharmacy or telephone a pharmacist
for advice or information about your medication. If you are not
sure where to contact a pharmacist, telephone the Hospital or Community
Trust.
Can I ask the
pharmacist to speak to local user groups or self-help groups?
Yes. Most
pharmacists, particularly those employed as specialists, will be quite
happy to arrange to speak about drugs or to come along and answer any
questions group members may have about medication.
Do pharmacists
have a Code of Ethics?
Yes. It is
published by the Royal Pharmaceutical Society.
The code of ethics
lays down the fundamental duties of all pharmacists. There are
nine principles in all, which form the basis of the code. It
reminds pharmacists that their prime concern must be the welfare of the
patient, as well as ensuring that all pharmacists act in an appropriate
and professional manner. Other parts of the code include ensuring
that the pharmacist's knowledge remains up-to-date, and that they are
always in a position to maintain their independent professional
judgement. Finally, as with other health professionals, a
pharmacist must respect the confidentiality of any information acquired
in the course of professional practice, and never disclose this
information to others without the patient's consent.
Every registered
pharmacy is visited regularly by an Inspectorate from the Royal
Pharmaceutical Society. Any pharmacist who is found to have breached the
code of ethics could have their name removed from the register and would
therefore be unable to practise.
What if I want
to make a complaint?
Any complaint
about a pharmacist?s work or professional conduct can be made in writing
or by telephone to the Professional Standards Directorate at the Royal
Pharmaceutical Society (see Helpful Organisations page 8), who will
carry out an investigation or refer complainant to other official bodies
as appropriate.
Where else can
I find out about my drugs and medicines?
Some people have
very limited access to pharmacies and pharmacists. For example, only 21%
of rural parishes have a pharmacy (be that independent or part of the
GP’s surgery)1
- so there is a great need for other sources of information. Obviously,
doctors, nurses and keyworkers should be able to answer queries about
drug treatment. Here are some other alternatives:
A wide variety of
books and information leaflets about drugs and medicines are also
available in bookshops and libraries. The British National Formulary
lists the drugs available in the UK, together with their side effects
and usual dose ranges. However, this book is primarily aimed at
health professionals and it can be difficult to follow all the
terminology. Also, it is not a textbook so some of the information
may be difficult to place in context. The BMA Guide to Medicines and
Drugs is an excellent book, which describes many commonly used medicines
in a format that is practical and relatively easy to understand; it does
not, however, deal with drugs used in mental health.
Note: You
should always check the publication dates of this type of information
and make sure you are looking at the most up-to-date information
available.
Organisations like
Mind, NSF, and SANE produce booklets and leaflets and the Royal College
of Psychiatrists has also produced a series of fact sheets. The United
Kingdom Psychiatric Pharmacy Group represents all pharmacists with a
special interest in mental health and has more than 400 members. It
exists essentially to help ensure that those suffering mental health
problems are treated appropriately and safely, and with direct reference
to their needs. The UKPPG organises training and postgraduate education
in the use of psychotropic drugs and helps to maintain standards of
practice across the UK. It also produces information on medicines and
oversees the drugs’ helpline at the Maudsley hospital. Individual
hospitals and Community Trusts also produce information leaflets about
medication. European regulations require all drug companies to include
an information leaflet about their drugs to be supplied by the
pharmacist when the drug is dispensed. This leaflet must include
information about the common uses of the drug as well as about side
effects and special conditions where the drug should not be used.
Note: If
you do spend time looking up information about your medication in books
and leaflets, it is probably still sensible to discuss this with a
pharmacist, who will be able to help you to put the information into
context.
Helpful
Organisations
Details of
specialist pharmacists or community mental health trusts can be found in
the local telephone directory.
Royal
Pharmaceutical Society of Great Britain
1 Lambeth High Street
London
SE1 7JN
For further
information about the advantages and/or adverse effects of different
drugs, contact Mindinfoline on (020) 8522 1728 or (0845) 7660163
if calling from outside London. (Open 9.15 a.m.– 4.45 p.m. on
weekdays) Or contact the United Kingdom Psychiatric Pharmacy Group on
(020) 7919 2999 (Open 11.00 a.m. – 5.00 p.m. on weekdays).
Further reading
Available from
Mind Publications on (020) 8221 9666:
Making Sense of
Treatments and Drugs:
- Anti-depressants
- Major
Tranquillisers
- Minor
Tranquillisers
- Lithium
Mind
Publications also stocks a range of books on drugs and treatments,
including The Complete
Guide to Psychiatric Drugs – A Layman’s Guide by Ron Lacey,
which explains the benefits, adverse effects and hazards of the complete
range of psychiatric drugs.
Further
information on several types of anti-depressant and major tranquilliser,
tardive dyskinesia and taking lithium during pregnancy is also available
from Mind’s Information Unit.
Contact Mind at:
15-19 Broadway, London E15 4BQ
website www.mind.org.uk
Based on original
work by Peter Pratt, Chief Pharmacist at Community Health Sheffield.
Mind Information
Unit
Updated August
1999.
[1]
1997 survey of rural services, Rural Development Commission
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