Module PHAR2006: Pharmaceutical Care- pathology, patients and professionalism

Department: Pharmacy [Newcastle University]

PHAR2006: Pharmaceutical Care- pathology, patients and professionalism

Prerequisites

• None

Corequisites

• None

Excluded Combination of Modules

• None

Aims

• The module will lay the basis for a systematic understanding of disease pathology and how pharmacological interventions can be used to manage a single disease state. It will prepare students for advanced modules in pharmacy, taught in Levels 3 and 4, where more complex, multiple disease presentations are considered;
• The module will contribute to the wider understanding of key concepts and methods associated with drug design, development, manufacture and delivery;
• The module will aim to give students applied knowledge about patient safety and the wider role of the pharmacist in the healthcare team.

Content

• The module will examine conditions relating to the cardiovascular, respiratory, renal and gastrointestinal systems (GI) of the body. Due to the integrated nature of the program, students will navigate the content using various case studies both clinical and scientific in nature to help them to understand how the program as a whole fits together. At this level students will study diseases in isolation in the context of the patient. Students will not be expected to understand co-morbid disease states, however will be encouraged to understand the individual disease and then later in the programme develop the skills involved in dealing with co-morbid disease and therefore complex pharmaceutical interventions.
• For the purposes of the module descriptor the material has been separated to clearly demonstrate content. In actual delivery we will integrate material around individual cases as the module progresses. Throughout all areas, students will be encouraged to think about rational therapeutic decisions and how those decisions are informed by research using evidence from practice. We will use experts from practice to help illustrate these areas, in particular those areas where the evidence base is not as strong as it may be, for example in the case of intensive care medicine.
• Another common theme throughout this module will be the concept of communication and the introduction of consultation frameworks. Students will be introduced to the idea of formal modes of consultation and the importance in terms of patient safety of ensuring that communication with patients is optimised at all times.
• Cardiovascular System - The module will start by examining the aetiology, epidemiology and pathophysiology of cardiovascular disorders including: ischaemic heart disease, hypertension, heart failure, cardiac arrhythmias, ischaemic and haemorrhagic stroke. The relationship between the cardiovascular and renal system will be outlined including a discussion of acute and chronic renal failure. We will build upon material delivered at Level 1 where students were introduced to the concept of receptor theory. The clinical pharmacology of angiotensin converting enzyme (ACE) inhibitors, angiotensin-II receptor antagonists, antiarrhythmics, antiplatelets, anticoagulants, β-adrenoceptor antagonists, calcium channel blockers, diuretics (e.g. loop, thiazide and potassium sparing), nitrates and statins will be examined in detail. The therapeutic and adverse effect profile of these agents will be closely related to the structure and molecular action of the drug within the body, illustrating how this can influence a prescribing decision. This section will also examine various important aspects of pharmacokinetics including important physicochemical properties of drugs such as partition coefficient, plasma binding of drugs, drug metabolism including enzyme inhibition and induction and first-pass effect. Variation in response to drugs exhibited by individual patients will be discussed including important examples of phenotypical variation in the context of both pharmacodynamics and pharmacokinetics. Mechanisms of drug interaction will be illustrated using clinical examples and will form the basis students understanding more complex therapeutic interventions at Levels 3 and 4. In this section of the module, we will discuss the oral route as a means of drug delivery and, using examples from cardiovascular therapeutics, investigate the design and formulation of solid dosage forms, including controlled-release preparations. This will encompass a wide range of material including powder flow, particle size analysis, granulation, drying, excipients and tablet/capsule manufacture. We will examine how the individual components of the medicine are assessed in order to ensure that the final product meets the required standard, the so-called ‘quality by design’ process. This strand will outline the manufacturing process and the concept of quality assurance (QA) and good manufacturing practice (GMP). Qualitative (e.g. MS and NMR), quantitative (e.g. UV and atomic absorption) and separative (e.g. HPLC and GC) techniques – with emphasis on a particular clinical application – will then be studied. Areas of focus will include clinical chemistry with particular emphasis on cardiovascular disease (e.g. cardiac enzymes, troponins) and therapeutic drug monitoring (e.g. digoxin levels). Towards the end of this section of the module, students will be taught the clinical skills required to conduct a physical examination of the cardiovascular system, which will include a precordium examination.
• Respiratory System - The next part of the module will cover the aetiology, epidemiology and pathophysiology of respiratory system disorders including asthma and associated allergic conditions, chronic-pulmonary obstructive disease (COPD), pulmonary hypertension and cough. The role of sympathomimetics (e.g. adrenaline and salbutamol), antimuscarinics (e.g. ipratropium and tiotropium) and corticosteroids will be examined in relation to mechanism of action and clinical management of these disorders. In this part of the module we will discuss, how respiratory disorders are managed in a community pharmacy setting (such as cough); we will not differentiate in how we approach minor ailments and more serious diseases. The importance of community pharmacists being able to differentiate between major and minor disease will be highlighted at this stage using examples from research carried out by academic staff. The respiratory system as a means of drug delivery will then be discussed and the formulation, manufacture and release of drugs delivered by inhalation will be examined, including nebulisers, dry powder inhalers, pressured metered dose inhalers and the role of the spacer. We will use inhalers as a means to study how particle size is related to particle flow and how this affects the delivery of agents to the lungs. Medicines adherence will then be introduced and, using inhaler technique as an example we will show how psychological and physical barriers result in patients not using medicines correctly. The importance of the correct use of medicines and the role of the pharmacist therein will be illustrated at this stage including the wider discussion of the cost of wasted medicines to the NHS as a whole. Towards the end of this section of the module, students will be taught the clinical skills required to conduct a physical examination of the respiratory system, which will include spirometry and peak flow measurement. The important relationship between therapeutics and clinical examination will be outlined.
• Gastrointestinal System - The final part of the module will cover the aetiology, epidemiology and pathophysiology of gastrointestinal (GI) system disorders and will include: constipation, diarrhoea, emesis, nausea, peptic ulcer disease (PUD), gastro-oesophageal reflux disease (GORD), biliary disease, Crohn’s disease and ulcerative colitis. The consequences of excessive alcohol intake will be examined in terms of the pathogenesis of alcoholic liver disease but also from the viewpoint of the wider public health issue. The role of aminosalicylates, antispasmotics, antacids, antisecretory agents, rehydration therapy, antidiarrhoeals and laxatives will be examined in relation to the mechanism of action and clinical management of these disorders. Infectious diseases will be studied in Level 4 of the programme; however, as Helicobacter pylori infection plays such a crucial role in the pathogenesis of peptic ulcer disease, we will discuss it – and the associated strategies used to eliminate it – in this section of the module. We will therefore outline the antibiotic regimens used to eradicate H. pylori and explain how they can vary for each region according to levels of resistance. Liquid dosage systems, such as suspensions, emulsions, and syrups, will be discussed; chemical, physical and microbiological stability issues will also be explored in relation to these formulations. More specifically, we will examine Fick’s law of diffusion, flocculated and deflocculated systems how these things relate to formulating a drug as a suspension. We will discuss how, based on the structure of histamine, cimetidine was developed, which will lead onto rational drug design and structure activity relationships (SAR). This area will extend to include a wider discussion of the process of drug discovery and in particular the design of molecules to address specific issues within healthcare. The concept of pro-drugs will be introduced at this point and, using clinically relevant examples (e.g. omeprazole), we will discuss how this approach can be used to overcome various physiochemical barriers associated with drug development. Towards the end of this section of the module, students will be taught the clinical skills required to conduct a physical examination of the GI system. An overarching component of this module will be pharmacy law and dispensing; this will be taught throughout the module and will culminate with the clinical checking and law examinations. The pharmacy law element of the programme will focus on the analysis and interpretation of various legislation such as the Medicines Act 1968, the Misuse of Drug Act 1971 (and the associated regulations), the Poisons Act 1972 as well as any miscellaneous legislation affecting pharmacy (e.g. Data Protection Act 1998), which will then lead to application of knowledge in dispensing sessions. Students will be challenged with clinical, ethical, and legal scenarios, which require them to make a decision in the absence of a complete set of information. As the work they will be doing to support this will be in a live dispensary environment there will be a degree of uncertainty and self-management within these session. The importance of accurate numeracy skills in calculating dosage will be examined and students will be expected to reproducibly perform dosage calculations. We will also focus on communication, with students having to counsel a ‘patient’, using appropriate terminology, about the use of their medicines. The dispensing component will cover the supply of medicines in the context of hospital pharmacy including the supply of specialist intravenous products and oral chemotherapy. The importance of appropriate quality management systems within the dispensing process will be outlined using various examples from practice. The concept of root cause analysis will be examined using a range of actual dispensing errors to demonstrate the point. The module will include placement experience in a variety of healthcare settings including community and hospital pharmacy. Students will experience healthcare in other settings including general practice and community care.

Learning Outcomes

• SSK6 - systematic knowledge of the aetiology, epidemiology, pathophysiology, clinical presentation and appropriate therapeutic intervention within cardiovascular, respiratory, renal and gastrointestinal system disease states;
• SSK7 - applied understanding of physical examination and clinical monitoring of diseases of the cardiovascular, respiratory, renal and gastrointestinal systems including adverse effects of drugs used in management;
• SSK8 - understanding of pharmaceutical intervention in the context of patient care, multidisciplinary health teams and the wider National Health Service (NHS) community;
• SSK9 - systematic knowledge of law and ethics and safe, effective and accountable practice;
• SSK10 - comprehension of the design of pharmaceutical preparations and the effect of individual components of a formulation in the context of the final medicinal product;
• SSK11 - applied knowledge of the factors affecting the absorption, distribution, metabolism and excretion of pharmaceutical compounds including the management of drug interactions and poisoning;
• SSK12 - understanding of the process of drug discovery, rational design or development, quality control and regulation.

• SSS7 - the ability to perform basic physical examinations on human volunteers and simulators with regard to the cardiovascular, respiratory, renal and gastro-intestinal systems;
• SSS8 - analyse and evaluate therapeutic regimens to treat single disease states;
• SSS9 - generate, search for, analyse and evaluate experimental data and relevant primary literature;
• SSS10 - evaluate and discuss therapeutic decisions and associated adverse outcomes in an informed manner with reference to appropriate literature;
• SSS11 - the ability to apply an appropriate quality management framework to ensure the safe supply of medicines and medical devices;
• SSS12 - demonstrate the ability to use valid decision making pathways with regard to patient care;

• KS5 - the ability to apply basic theoretical frameworks at an intermediate level;
• KS6 - confidence in identifying, analysing, interpreting and solving problems creatively using appropriate knowledge and skills;
• KS7 - the ability to work as part of a multidisciplinary and multicultural team and to address the relevance and importance of ideas with open-mindedness;
• KS8 - the ability to articulate and communicate ideas, principles, theories problems and solutions verbally and in writing to specialist and non-specialist audiences;

Modes of Teaching, Learning and Assessment and how these contribute to the learning outcomes of the module

• Teaching and learning strategies include lectures, seminars, computational sessions, practical classes, interprofessional education and placements.
• Lectures will provide an introduction to those topics and will allow students to develop an understanding of the basis for the practical and seminar sessions which follow. Lectures allow for the delivery of important information, which helps to introduce fundamental concepts but also to outline cutting-edge developments within a particular field.
• Practical sessions will allow students to engage in experimental work in chemistry, pharmacology, and pharmaceutics. These sessions will provide an important basis to help students understand the practical application of theory covered in lectures. Other practical work will include interaction with patients within the University as well as using human simulators and computer-based learning packages.
• Computational sessions will involve the use of specific software around statistics, molecular modelling and dispensing. These sessions will help students to process data and to develop important skills used in research. In addition, the use of computers to visualise molecules is a vital aspect of the program in order that students can truly understand the importance of 3-dimensional molecular structure and interaction in the context of pharmacodynamics and pharmacokinetics.
• Seminars will provide an opportunity to examine an area in depth. The concept of rational prescribing and the development of sound decision-making skills will be refined in these sessions. Students will have the opportunity to discuss and debate issues at hand having already covered the theoretical aspects of an area in lectures and during self-directed directed learning. Some seminars will be problem based and will encourage students to engage in problem based learning. These sessions will encourage students to develop their knowledge and fully understand the application and integration fundamental science in modern health care.
• Interprofessional education sessions will be included in this module and will focus on the safe, legal and effective use of medicines. We expect that these sessions will develop confidence, decision-making skills, and a clear understanding of the role of the pharmacist within the wider health care team.

Teaching Methods and Learning Hours

Summative Assessment

Formative Assessment:

Two multiple choice question (MCQ) tests per term, students must complete all tests in order to successfully pass the module. Reflective portfolio related to placement experience.

■ Attendance at all activities marked with this symbol will be monitored. Students who fail to attend these activities, or to complete the summative or formative assessment specified above, will be subject to the procedures defined in the University's General Regulation V, and may be required to leave the University