Review of Year Y2 Medical Pharmacology Essentials (PHAR 216) • Course occurs in the fall term of Year 2. • Course Director – Sarah J. Freemantle, PhD (co-director) David Nierenberg, MD • Course has 33 curricular hours (plus the Final Exam and Narrative Assessment evaluation events) • Course was last reviewed in April 2012. The formal review is missing, however, and annual summary letters from Dr Nierenberg are substituted for this purpose. Action Plan from Prior Review From David Nierenberg's letter dated Oct 30, 2012: Overall, well organized with excellent scores and logical organization. Suggestions - Provide written notes in addition to lecture PPT Involve all students in each small group conference, not just the students presenting the cases. Have other lecturers use the “pharm card” system to help students focus on the most important information they need to know. From David Nierenberg's letter dated Oct 28, 2013: New method of student survey through Oasis, however, the overall evaluation was “good to very good”, with the overall evaluation of 3.71. The students really loved the “clinical correlations” and the use of the Pharm cards. Suggestions - Provide written notes in addition to the PPT files, which most but not all lecturers do. Get all students involved with the small groups, not just the student presenters. Also, prepare “model” answers to the cases discussed. Having all lecturers use the Pharm card system, in order to help students know the most important information about each drug. Old Course Objectives (Ilios) Course Objectives (CO) Links (GO) Sessions (CO) 1 Explain the basic concepts of drug-receptor interactions and second messenger systems how MS2,MS1 40 dose response curves can be used to define safe dosing practice. 2 Demonstrate the ability to assess pharmacodynamic and pharmacokinetic parameters using MS2,MS1 23 commonly prescribed drugs as examples. 3 Solve common pharmacokinetic calculations including loading doses and maintenance doses MS2,MS1 11 using knowledge of volume, distribution and clearance. 4 Formulate different regimens for special patient groups (e.g. pregnant women, patients with MS2,MS1, 11 compromised immune/kidney/liver function etc.) MS5,CC13,PH2 5 Recognize and anticipate common drug-drug interactions including those interactions that can MS2,MS1,CC6,CC 16 be predicted from genetic testing of metabolizing enzymes e.g. P450 isozyme testing, 10,CC1,P7,PPLD3 6 Recognize and anticipate common drug interactions with OTC medications, herbal or MS2,MS1,CC6,CC 7 nutritional supplements and specific food groups. 10,CC1,P7,PPLD3 7 Discriminate between pharmacological substances, based on generic drug name, MS2,MS1,CC6,CC 67 pharmacological classification (using class representative compounds), mechanism of action, major clinical indications and most clinically relevant adverse effects. 10,P1,P6 8 Distinguish treatments, which may become the standard of care on the horizon based on MS2,MS1,MS5,PP 2 their proximity to FDA approval e.g. Qnexa for weight loss. LD1,MS4,CC14,EI M2,PH4 GO = New Geisel Objectives Old Course Objectives (continued) Course Objectives (CO) Links (GO) Sessions (CO) 9 Recognize signs of common drug overdose, and propose how to initiate therapy where appropriate MS1,MS2,CC13, 0 when the causal agent is known or unknown. PH2 10 Integrate their knowledge from years 1 and 2 of anatomy, biochemistry, genetics, microbiology, MS1,MS2 49 physiology, and pathophysiology with the actions of drugs at all levels from the receptor to the cell, organ, circulatory systems and whole-body levels. 11 Access and evaluate different levels of biomedical literature relevant to the treatment of disease MS1,MS5 3 through experts, Internet sources, books, and other databases 12 Discuss the principals of evidence based medicine and be familiar with the current resources MS1,MS5 1 available online and through the biomedical library 13 Discuss procedures relevant to disease diagnosis and alternatives to medical therapy (e.g., MS1,MS2,MS5,C 4 percutaneous coronary intervention, arrhythmia ablation, implantable defibulator) C8,CS6,CS1,PH1 14 Discuss how to serve patients interest when evaluating brand name vs. generic drugs, and CC13,PH2,P2,PP 6 pharmaceutical advertising to patients and clinicians. LD1,PH3,CC7,EI M2,PH1,EIM5,EI M3,P5 15 Explain what is required to write a complete, unambiguous, and legal prescription and also what is MS2,CC13,PH2, 0 required to insure the patient is fully counseled about medications, their drug history is comprehensively evaluated and they have printed drug information. P2,PPLD1,PH3,C C7,EIM2,PH1 Old Course Objectives (continued) Course Objectives (CO) Links (GO) Sessions (CO) 16 Recognize signs of drug/alcohol abuse and describe potential treatment strategies. CC13,PH2,P5,PH 0 5 17 Communicate effectively with fellow students and faculty. CC8,CS6,CS1 4 18 Demonstrate team skills by participating effectively in team exercises. CC1,P7 3 19 Take responsibility for his- or her-own medical education. PPLD1 16 20 Search efficiently for and obtain recent, high quality, relevant medical information and scientific MS1,MS4 4 literature to solve problems. 21 Read critically, evaluate, and assess medical information and scientific literature about important MS1,MS4 3 neurological topics and questions. 22 Practice clinical reasoning skills in the context of a simulated patient scenario. CC6,CC7 6 23 Demonstrate skills necessary for assisting patients to understand treatment options and the need for CC12,CS4,CS7 4 care. 24 To help colleagues by contributing constructive suggestions during peer review PPLD3, 3 25 To meet professional responsibilities fully, including being punctual, present, and engaged, and being P7 6 reliable in commitment to tasks. Updated Course Objectives Geisel Competenc How # Course Objectives (CO) Sessions y Assessed Describe an overview of drug pharmacokinetic properties (e.g. absorption, distribution, metabolism, and excretion) that apply 1to all therapeutic agents 1, 3, 4, 5, 6, 8, 24 MS Exam Describe how drugs interact with receptors, cells, tissues, and organs to produce their desired and unintended 2pharamcodynamic effects 1, 5, 8 MS Exam Calculate a loading dose, maintenance dose, and half-life of a drug, using previously validated measurement of drug bioavailability, clearance, and volume of distribution 3 1,3,4,7,28 MS Exam Explain the basic concepts of drug-receptor interactions)e.g. agonists, antagonists, partial agonists, ED50, potency) 5,6 4 MS Exam Describe how drug-receptor binding can lead to a cascade of intracellular changes through second messenger systems and 5,6 beyond (e.g. cyclic AMP, cyclic GMP, etc.) 5 MS Exam Describe in detail the most common pathways in man for drug metabolism, and their pharmacogenetic importance and 8, 24 implications (e.g. ultraslow or ultrafast metabolizers) 6 MS Exam Describe the purpose, neuroanatomy, neutrotransmitters, and phsiological effects of the two branches of the autonomic 9 nervous system (sympathetic, parasympathetic) 7 MS Exam Describe in detail the most common drugs used clinically as agonists and antagonists at the various adrenergic receptors (e.g. 10, 11 beta-receptor agonists and antagonists, alpha-receptor agonists and antagonists) 8 MS Exam Describe in detail the most common drugs used clinically as agonists and antagonists at the various cholinergic receptors (e.g. 12, 13 muscarinic-receptor agonists and antagonists, nicotinic-receptor agonists and antagonists) 9 MS Exam Describe the most common adverse drug reactions for drugs presented in the course, as well as the most common drug-drug 1, 5, 6, 8, 10, 11, 12, interactions (e.g. tremor from albuterol, sedation from clonidine) 13, 15, 16, 17, 20, 21, 22, 26, 27, 29 10 Updated Course Objectives Explain how foods, herbal products, nutritional supplements, and over-the-counter drugs can cause clinically 8, 17 important interactions with commonly used therapeutic drugs 11 MS, CC Exam Describe how each class of therapeutic drugs is named in a common fashion, and also how generic and branded drugs 1 have different types of testing prior to approval, naming, and pricing strategies 12 MS, CC Exam Describe the basic and clinical pharmacology of the most common drugs used to treat hypertension and coronary 15, 16, 22 artery disease (e.g. angina, MI, etc.) 13 MS, CC Exam Describe the basic anc clinical pharmacology of the most common drugs used to treat hyperlipidemia and cardiac 21, 26 arrhythmias 14 MS, CC Exam Describe the basic and clinical pharmacology of the most common drugs used to treat congestive heart failure 27, 29 15 MS, CC Exam Describe the most common drugs used to treat respiratory conditions such as asthma, reactive airways disease, 20, 25 chronic obstructive pulmonary disease, and cough 16 MS, CC Exam While discussing clinical cases in small groups, demonstrate the ability to reason from symptoms and signs to a 14, 18, 23 diagnosis, and from a diagnosis to recommendations for treatment of that condition, including the ability to access and evaluate different current reliable sources of biomedical information 17 CC, Conf While discussing clinical cases in small groups, demonstrate the ability to communicate clearly and effectively with 14, 18, 23 students and faculty, and to participate effectively as a team member 18 CS,CT Conf By completing all assignments on time, and coming to each conference on time and well prepared, demonstrate the 14, 18, 23 ability to behave professionally, and to take responsibility for your own