Module PHAR3006: Applied Pharmaceutical Interventions - design, delivery and decisions

Department: Pharmacy [Newcastle University]

PHAR3006: Applied Pharmaceutical Interventions - design, delivery and decisions

Prerequisites

• None

Corequisites

• None

Excluded Combination of Modules

• None

Aims

• The module will give students a systematic understanding evidence-based decision making for semi-complex clinical cases (i.e. those involving more than one disease state). It will prepare students for Level 4, where critical appraisal around complex clinical cases will be considered;
• Students will develop detailed knowledge around advanced drug discovery, formulation and delivery techniques including in silico screening methods.
• The module will develop the ability to formulate and justify professional decisions where ethical, legal and clinical issues are considered.

Content

• This module will examine conditions relating to the central nervous system (CNS), musculoskeletal, endocrine and genito-urinary systems of the body. As with other modules in the programme, they will be navigated using clinical case scenarios. For the purposes of this module outline material has been separated to demonstrate content. In actual delivery material will be integrated.
• Musculoskeletal System The module will start by examining the aetiology, epidemiology and pathophysiology of musculoskeletal disorders and will include: rheumatoid arthritis (RA), osteoarthritis (OA), gout and connective tissue disorders. The role of non-steroid anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs) and muscle relaxants will be examined in relation to mechanism of action and clinical management of these disorders. The use of DMARDs in disease management will allow aspects of patient safety to be discussed and the role of the pharmacist therein. We will include specific examples where system failure has resulted in the harm or death of patients (e.g. the Cambridgeshire methotrexate incident). Towards the end of this section of the module, students will be taught the clinical skills required to conduct a physical examination of the musculoskeletal system.
• Pain - The next part of the module will cover the epidemiology, aetiology and pathophysiology of pain and will include: acute, chronic, neuropathic pain. Pain assessment techniques will be also included. The role of NSAIDs, non-opioid and opioid analgesics, anaesthetics and adjunctive agents (e.g. gabapentin) will be examined in relation to mechanism of action and clinical management of these disorders. In addition, given the toxicity of analgesics in overdose (e.g. paracetamol), we will discuss poisoning and the strategies used to manage patients who have taken an overdose. Natural products as sources of drugs will also be re-visited using opioid analgesics as examples and, building on knowledge gained from Level 2, how advanced hyphenated analytical techniques (e.g. LC-MS,LC-NMR) are used for structure elucidation of such complex compounds. We will also discuss, using appropriate clinical examples (e.g. lidocaine gel / fentanyl patch), the formulation, manufacture and release of agents used in topical drug delivery.
• Central Nervous System - The next part of the module will cover the aetiology, epidemiology and pathophysiology of CNS disorders and will include: depression, anxiety, psychosis, substance misuse, Parkinson’s disease and dementia. The role of anxiolytics, antidepressants, hypnotics, neuroleptics, mood stabilisers, anti-epileptic drugs and anti-Parkinson’s drugs will be examined in relation to mechanism of action and clinical management of these disorders. Building on knowledge in Level 2, were we covered structure activity relationships (SAR) and rational drug design, we will, using molecular modelling techniques, explore quantitative structure activity relationships (QSAR) and how these techniques are used in modern day drug design. In this section the module we will examine the formulation of depot treatments used to manage various CNS disorders e.g schizophrenia. The structure of these agents will be discussed in the context of their formulation and the challenges that present for the manufacture of such medicinal products. The laws and legislation around CNS disorders will also be introduced at this stage. The Mental Health Act 2007 and the Equality Act 2010 will be discussed and how these things relate to, and have an impact on, patient care. Ethical dilemmas and critical decision-making will also be introduced at this stage where we encourage students to enter ethical debate using various scenarios related to CNS disorders. Towards the end of this section of the module, students will be taught the clinical skills required to conduct a physical CNS examination, which will include a cranial nerve examination. The clinical skills sessions will, at this point, also have special emphasis on communication and consultation skills and examine relevant frameworks in relation to patient communication / consultation.
• Endocrine - The next part of the module will cover the aetiology, epidemiology and pathophysiology of endocrine disorders and will include: diabetes, thyroid disorders, and abnormalities associated with adrenocorticol, hypothalamic, pituitary and sex hormones. The role of insulin, biguanides, sulfonylureas and other associated treatments will be examined in detail. The use of hormones will be examined in relation to mechanism of action and clinical management of a range of disorders. As complications of diabetes are important causes of morbidity and, in some cases, mortality, we will discuss this and the role of the pharmacist in the wider context of public health. As insulin is the mainstay treatment for many patients with diabetes, we will, in detail, examine why insulin is delivered parenterally, how insulin is manufactured (both from a chemical and biotechnological standpoint) and the development of novel delivery techniques (e.g. insulin nasal spray) to overcome challenges associated with parenteral drug delivery. In this section, we will also discuss, using appropriate clinical examples (e.g. insulin and total parenteral nutrition [TPN]), the formulation, manufacture and release of agents used in parenteral drug delivery. Towards the end of this section, students will be taught the clinical skills required to conduct an assessment with a patient who has diabetes and all of the potential complications therein.
• Genito-urinary - The final part of the module will cover the aetiology, epidemiology and pathophysiology of genito-urinary disorders and will include: sexually transmitted diseases (STIs), major gynaecological problems, issues around men’s health, and issues around fertility and pregnancy. This part of the module will also consider contraception and important public health implications, such as teenage pregnancy rates and the extended role of the community pharmacist in relation to such interventions, such as supplying emergency hormonal contraception (EHC). Building on knowledge from Level 2, numeracy – with particular emphasis on patient factors – will be taught throughout the module and will include examples such as phenytoin kinetics, opioid conversion dose calculations and estimating glomerular filtration rates (GFR) (e.g. for a patient with diabetes). Students will be expected to pass a summative numeracy test that assesses knowledge of these issues. Communication and consultation will form an overarching part of this module and, building on knowledge and skills from Level 2, particular emphasis will be placed on responding to the needs to the patient. This may include having a consultation with a patient who is unable to take medication due to physical (e.g osteoarthritis) or psychological barriers (e.g dementia). The complex nature of relationships with patients of this type will be discussed as will be the importance of clear communication with patients, representatives and carers.

Learning Outcomes

• SSK13 - systematic knowledge of the aetiology, epidemiology, pathophysiology, clinical presentation and appropriate therapeutic intervention of central nervous, musculoskeletal, endocrine and genitourinary system disease states.
• SSK14 - applied understanding of physical examination and clinical monitoring of diseases of the central nervous, musculoskeletal, endocrine and genitourinary systems including adverse effects of drugs used in management;
• SSK15 - systematic understanding of the management of multiple treatment strategies for patients exhibiting co-morbid disease states;
• SSK16 - conceptual understanding that enables the student to critically evaluate current research and advanced scholarship in modern drug delivery and future drug development;

• SSS13 - the ability to perform basic physical examinations on human volunteers and simulators with regard to the central nervous, endocrine and musculoskeletal systems;
• SSS14 - capacity to analyse and evaluate therapeutic regimens used to treat co-morbid disease;
• SSS15 - the ability to formulate and justify judgements in the absence of complete data and communicate their conclusions to patients, the public and professional colleagues;

• KS9 - the ability to distinguish and differentiate conceptual/theoretical models, and critically assess and evaluate their comparative strengths and weaknesses, detect false logic or reasoning, identify implicit values, define terms adequately and generalise appropriately;
• KS10 - demonstrate self-direction and originality in tackling and solving problems, and act autonomously in planning and implementing tasks at a professional or equivalent level;

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, problem-based learning, practical classes, interprofessional education and placements. There will be an increased focus on students developing as independent learners building upon the work done to support this aim earlier in the programme.
• Lectures will provide an introduction to 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 outline cutting-edge developments within a particular field.
• Practical sessions will allow students to engage in experimental work in chemistry and pharmaceutics. These sessions will involve students engaging with advanced practical techniques in analytical and synthetic chemistry and in pharmaceutics. We will create links to practical application of microbiology via practical classes which investigate aseptic preparation of products. This level will continue to include interaction with patients, both real volunteer as well as using human simulators and computer-based learning packages. The clinical skills sessions will involve students examining each other and stimulator to develop an understanding of the diagnostic process.
• 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 and directed learning. Some seminars will be problem-based and will encourage students to engage in problem based learning. These problem-based sessions will serve to integrate the material students have covered so far they will involve laboratory work combined with clinical decision-making.
• Interprofessional education sessions will be included in this module and will continue to focus on the safe, legal and effective use of medicines. As students have completed their study of the law relating to pharmacy the sessions will take a more problem-based orientation. Students will be able to work with colleagues studying cognate subjects making decisions together to ensure safe management of the cases they will be given.
• Placements will continue at this level and students will be exposed to a full range of practical experiences including hospital and community pharmacy but encompassing the full scope of healthcare. We will ensure that students experience various social care settings at this level the influence of socio-economic class in terms of health and access to healthcare services is significant and we will provide placements to demonstrate why this is so.

Teaching Methods and Learning Hours

Summative Assessment

Formative Assessment:

Oral presentations of PBL sessions throughout the year. Reflective portfolio related to placements

■ 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