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ONLINE CE COURSE FROM THE UNIVERSITY OF GEORGIA Learning Objectives Four easy ways to register: Phone: +1-706-542-3537 or 800-811-6640 (toll free in the USA) Fax: +1-706-583-0180 Email: [email protected] Lesson 1 — Introduction to Pharmacokinetics Upon completion of this lesson, you should be able to: • Describe the concept of tolerance. • Briefly describe the process of therapeutic drug monitoring. • Recognize organs/tissues that constitute the Central and Peripheral compartments. • Calculate a patient’s volume of distribution for a drug from the dose administered and the plasma concentration achieved from that dose. • Define elimination rate. Lesson 2 — Basic Pharmacokinetics Upon completion of this lesson, you should be able to: • Describe the concept of volume of distribution of a drug. • Describe the concept of clearance. • Describe first and zero order elimination processes. • Identify common antimicrobial agents that follow first order elimination. • Identify the general equation for calculating volume of distribution. Lesson 3 — Half-Life, Elimination Rate Constant and AUC Upon completion of this lesson, you should be able to: • Recognize the components of the natural log of plasma concentration versus time curve. • Identify the general equation for calculating a drug’s half-life. • Describe how AUC is related to drug dose and clearance. • Identify the basic equation for calculating clearance. • Identify the equation that allows one to calculate a drug’s serum concentration at any time following drug administration. Lesson 4 — Intravenous Bolus Administration, Multiple Drug Administration and Steady-State Average Concentrations 8-14/86111 Upon completion of this lesson, you should be able to: • Identify the equation that determines the non-steady state accumulation factor. • State the time period which must elapse before steady state serum concentrations of a drug are achieved. • Identify the equation for calculating a steady-state serum peak concentration. • Identify the equation for calculating a steady-state serum trough concentration. • Recognize the relationship between the dosing interval Tau and the elimination rate constant for a drug. Lesson 5 — Relationships of Pharmacokinetic Parameters and Intravenous Intermittent and Continuous Infusions Upon completion of this lesson, you should be able to: • Recognize how changes in a drug’s pharmacokinetic variables alter steady state plasma concentrations. • Identify the two factors that determine the plasma concentration of a drug administered by continuous intravenous infusion. • State the purpose for administering a loading dose of a drug. • Calculate the steady-state plasma concentration of a drug administered by continuous intravenous infusion. • Calculate the steady-state peak plasma concentration of a drug administered by intermittent intravenous infusion. • Calculate the steady-state trough plasma concentration of a drug administered by intermittent intravenous infusion. Lesson 6 — Two-Compartment Models Upon completion of this lesson, you should be able to: • Describe situation in which two compartment models ideally describe the pharmacokinetics of drugs. • Describe the Method of Residuals and its importance. • Identify the equation for calculating volume of distribution at steady state of a drug following the two compartment model. • Recognize the number of plasma concentration data points required for calculating parameters of a two compartment model. Lesson 7 — Biopharmaceutics: Absorption Upon completion of this lesson, you should be able to: • Define Biopharmaceutics. • Identify factors that may affect a drug’s oral bioavailability. • Define Ka. • Describe the components of the equation for calculating F for oral formulations of a drug. • Identify the equation for calculating total body clearance of a drug administered as a controlled-release formulation. Lesson 8 — Drug Distribution and Protein Binding Upon completion of this lesson, you should be able to: • Identify the type of body weight that should be used for calculating the volume of distribution of a drug in a given patient. • Identify the types of plasma proteins responsible for protein binding of most drugs. • Recognize the effects that renal failure can have on concentrations of plasma binding proteins. • Recognize the relationship between volume of distribution and a drug’s tissue volume, unbound plasma and tissue fractions and plasma volume. Lesson 9 — Drug Elimination Processes Upon completion of this lesson, you should be able to: • Define extraction ratio and recognize its significance. • Define “F” mathematically. • What factors determine total body elimination of a drug? • Recognize the most important routes of excretion of many drugs. • Identify the equation for calculating renal clearance of a drug. Lesson 10 — Nonlinear Processes Upon completion of this lesson, you should be able to: • Describe the concept of non-linear pharmacokinetics. • List examples of drugs that follow non-linear pharmacokinetics. • Define Vmax. • Identify the components of the Michaelis-Menten equation. • Define Km. • Calculate the t90% in a given patient situation. • Calculate Vmax in a given patient situation. Lesson 11 — Pharmacokinetic Variation and Model Independent Relationships Upon completion of this lesson, you should be able to: • Identify age related changes that may affect drug distribution and use. • State the goals of pharmacogenetics / pharmacogenomics. • Identify factors which must be considered when utilizing measured serum drug concentration data for drug dosing determinations. • Define Mean Residence Time. • Define Formation Clearance. • Describe the relationship between steady-state volume of distribution and Mean Residence Time. LESSONS 12-15 — Cases (Only Available for Participants Enrolled in Option #2) The goal of the Practice-Based Cases is to allow pharmacy practitioners with significant pharmacokinetic dosing experience the opportunity to demonstrate their proficiency. The following Cases will be explored: •Aminoglycosides •Vancomycin •Theophylline • Phenytoin and Digoxin Lesson 12 — Aminoglycosides — Case Studies Upon completion of this lesson, you should be able to: • State reasons for measuring serum peak and trough aminoglycoside levels once steady state is reached with a given dose and interval. • Identify the equation for calculating CrCl from a 24 hour urine collection. • State the equations for estimating K and V for aminoglycosides. • Select the proper equation for estimating the expected serum trough concentration which would be achieved from a dose of an aminoglycoside. • Identify reasons for dosing aminoglycosides by the extended-interval method. • Cite the Sanford Guide to Antimicrobial Therapy recommendations for calculating a dose of gentamicin or tobramycin in seriously ill patients with declining renal function. Lesson 13 — Vancomycin — Case Studies Upon completion of this lesson, you should be able to: • State recommended vancomycin steady state serum trough concentrations. • Identify the population estimate determining the volume of distribution of vancomycin in a patient. • Identify organisms for which vancomycin is commonly prescribed. • State the equation for empirically calculating a vancomycin loading dose. • Calculate a maintenance dose and dosing interval of vancomycin for a patient scenario. Lesson 14 — Theophylline — Case Studies Upon completion of this lesson, you should be able to: • Recognize the pharmacokinetic models theophylline and aminophylline follow based on serum concentrations within the therapeutic range and serum concentrations above this range. • Identify situations which may cause increased clearance of theophyllne. • Identify drugs which decrease theophylline clearance. • State the patient’s weight which should be used for calculating the Volume of distribution and Clearance for theophylline. • Identify the beneficial effects methylxanthines have in patients with asthma and/or COPD. • Recognize serum concentrations above which produce the most significant adverse effects of theophylline. Lesson 15 — Phenytoin and Digoxin — Case Studies Upon completion of this lesson, you should be able to: • Recognize the equation for estimating the volume of distribution of Phenytoin. • Identify the correct time interval for obtaining Phenytoin serum trough concentrations with oral dosing. • State the oral bioavailability of phenytoin. • Calculate an empiric loading dose for phenytoin given patient demographic information • Recognize the therapeutic range for digoxin in patients with heart failure. • State the average value for the steady state volume of distribution for digoxin. • Identify the recommended maintenance dose of digoxin for ventricular rate control. OPTION #1: Application-Based Concepts in Clinical Pharmacokinetics Web-Based Continuing Education Course Prerequisite: There are no formal prerequisites for Option #1. It is recommended that you have previous training or experience in pharmacy and that you are comfortable working with mathematics at a pre-calculus level. Technical Requirements: PC or MAC; your web browser will need Adobe® Flash Player in order to view and make use of all of the media presented in this course. Contact Hours:* 20 ACPE Number: 0014-9999-14-138-H01-P Activity Type: Application-Based Release Date: September 1, 2014 Expiration Date: August 31, 2017 OPTION #2: Practice-Based Concepts in Clinical Pharmacokinetics Online Certificate Program Prerequisite: Option #2 is primarily intended for practicing pharmacists and requires demonstration of competence in clinical pharmacokinetics in an actual patient care setting. You must be a licensed pharmacist and you must have access to patient care during the duration of the course. Technical Requirements: PC or MAC; your web browser will need Adobe® Flash Player in order to view and make use of all of the media presented in this course. Contact Hours:** 30 ACPE Number: 0014-9999-14-138-H01-P Activity Type: Practice-Based Release Date: September 1, 2014 Expiration Date: August 31, 2017 *Continuing pharmacy education credits are available only to licensed pharmacists; all others (i.e., non-pharmacists) will earn University of Georgia Continuing Education Units (CEUs). **A Certificate of Mastery is reserved for licensed pharmacists. The University of Georgia College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. For more information about the Concepts in Clinical Pharmacokinetics contact [email protected] or dial +1-706-542-3537.