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Title Therapeutic Aspects of Cardiovascular Pharmacy and Oncology Code PY334/5/6 Level 6 Credit rating 40 credits Pre-requisites Therapeutic Aspects of Neuroendocrinology and Pharmacokinetics. Pharmaceutical Microbiology, Immunology and Biotechnology. Type Extensive Aims Learning outcomes to understand the physiology and pathology of the cardiovascular system and the processes underlying cellular replication and differentiation and to gain a sound understanding of the mechanisms by which different pharmacological agents can modify these processes and hence manage disease. to gain an ability to predict Type 1 adverse drug reactions and an appreciation of the direction of future drug developments. to instil in students the concepts of evidence-based therapeutics and to help students integrate this knowledge with details of the patients case history, the results of simple diagnostic tests and the pharmacology and chemistry of cardiovascular and anticancer drugs, to enable them to evaluate drug therapy. to develop competency in aseptic preparation of anti-cancer agents and to continue to develop the skills necessary to communicate health and related matters. On completion of this module students should be able to: demonstrate a systematic and coherent knowledge of the cardiovascular system and oncology, to associate common symptoms with relevant pathological conditions, understand the aetiologies of various cardiovascular diseases and cancers and discuss the rationales underlying the use of pharmacological agents in their treatment. discuss the applicability of various simple diagnostic tests in the evaluation of physiological and pathological function and discuss them with reference to evaluating drug therapy. recognise the potential for drug interactions to occur on the basis of pharmacological knowledge and discriminate between them in terms of clinical importance. critically evaluate data from a variety of sources (case history, clinical trials data, diagnostic testing) and utilise this knowledge to exercise judgement to evaluate drug therapy. accept accountability for achieving personal and/or group outcomes by demonstrating competence in a variety of professional skills. recognise their professional/ethical responsibilities. ________________________________________________________________________________ MPharm student handbook 2003-04 103 Content This module normally comprises 64 hours of lectures, 40 hours of practicals/seminars/laboratory classes, 208 hours of guided study that will include case-based learning and experiential learning. Blood: overview of the structure and functions of blood. Principles of blood grouping and blood transfusions. Physiological control of plasma clotting, platelet adhesion and aggregation. Indications for haematology testing and interpretation of results; blood counts, haemoglobin, serum iron, iron binding capacity, ferritin and transferrin, platelet function, clotting parameters, anticoagulant monitoring. Characteristics of malignant tumour development, classification of cancers biochemical markers and approaches to treatment. This module will concentrate on the mechanisms of action, uses and limitations of chemotherapeutic agents in treating leukaemias and lymphomas, together with the principles underlying the choice of regimen and adjunctive treatment of side effects. Impact of National Service Framework (NSF) for cancer on patient care. Genomics of various cancers and their implications on treatment and alternative therapies to cancer chemotherapy. (Normally 25 hours) Cardiovascular physiology and pharmacology: overview of the functions of the cardiovascular system. Physiological control of the cardiac cycle, cardiac output, cardiac work, the systemic circulation, arterial blood pressure, venous pressure, transcapillary exchange mechanisms, and the integrated control of the whole system. Definitions, aetiologies, symptoms, diagnosis and introduction to the rationales of drug treatments of hypertension, coronary heart disease, chronic congestive heart failure, hyperlipidaemias and cardiac dysrhythmias. Pharmacological actions and rationales for use of calcium channel antagonists, potassium channel openers, angiotensin converting enzyme inhibitors, angiotensin receptor antagonists, alpha 2 adrenoceptor agonists, nitrates, alpha and beta adrenoceptor antagonists, inotropes, diuretics, endothelin antagonists and possible future drug developments. Recent advances in relating polymorphisms in the cardiovascular system to disease. Alternative therapies for the treatment of cardiovascular diseases. (Normally 12 hours) Treatment of the cardiovascular diseases described above will be discussed in terms of the assessment of risk/benefit ratios and the choice of drug, dose and route of administration. Pharmacological incompatibilities, drug interactions and their clinical significance. Evidence-based medicine including, protocol writing, data evaluation and outcome measures. Impact of National Service Framework (NSF) for coronary heart disease on patient care. . The scientific basis for public health and preventative medicine. Pharmaco-epidemiology and economics. Clinical audit. (Normally 9 hours) Clinical pharmacology: pharmacodynamics; the time course of drug action, volume of distribution, compartment models, biological halflife, rates and simple kinetics of absorption and elimination for cardiovascular drugs (digoxin, warfarin and amiodarone). Effects of these on serum levels and dosage regimens. Mathematical approaches, predictions and clinical applications. Adverse drug reactions to include the underlying mechanisms of pharmacogenetics, ________________________________________________________________________________ MPharm student handbook 2003-04 104 idiosyncrasy and allergy, methods of reporting such reactions. Postmarketing surveillance. (Normally 6 hours) Extended clinical pharmacy skills: pharmaceutical care including cardiac rehabilitation, criteria for patient selection. Drug utilisation reviews, economic evaluation of prescribing. Pharmacy contribution to effective prescribing in primary care. (Normally 4 hours) Pharmacist/patient interface: patients perspective on disease, general principles to be applied when responding to patients' requests for advice and information; structured history taking; symptoms heralding serious disease; clustering of symptoms; the decision whether or not to refer for immediate medical attention. Advice to patients about lifestyle (including nutrition, smoking, alcohol, stress management) and about monitoring their own therapy or physiological parameters such as blood pressure and plasma cholesterol. (Normally 8 hours) Coursework A typical coursework programme may include the following: laboratory practicals, for example the effects of drugs on the isolated heart, the effects of exercise on cardiovascular function in human volunteers), seminars, tutorials, case presentations, problem-solving exercises in therapeutics, simulated exercises in the pharmacy to include dispensing, aseptic transfer and intravenous administration of cyclotoxic drugs, counselling, responding to symptoms, professional interaction, health promotion, prescription reviews. (64 hours) Experiential learning This will include consultant/pharmacist-led ward rounds (including anticoagulation, cardiac rehabilitation and cardiac pre-admission clinics) , general practitioner surgery visits, simulated patient training, log book/portfolio, drug history taking and drug information exercise. (20 hours) Teaching and learning strategies A variety of teaching and learning strategies will be employed in the delivery of this module, including formal lectures (64 hours), seminars/practicals (40 hours), guided study (including experiential learning (20 hours), problem-based learning and resource-based independent study (208 hours)) and independent study and assessment time (78 hours). Students will also be directed to attend those research seminars held within the School which are relevant to cardiovascular system physiology and pharmacology and oncology. Learning support Anatomy and Physiology, 5th Ed, Thibodeau, G A and Patton, K T, Mosby, 2003. Pharmacology, 4th Ed, Rang, H P, Dale, M M and Ritter, J M, Churchill Livingstone, 1999. Medical Pharmacology at a Glance, Neal, M J, 3rd Ed, Blackwell Scientific Publications, 1997. Human Pharmacology - Molecular to Clinical, 3rd Ed, Brody,T M, et al, Mosby, 1998. Human Pharmacology, Gard P R, Taylor and Francis, 2000. ________________________________________________________________________________ MPharm student handbook 2003-04 105 Clinical Pharmacy and Therapeutics, Walker R and Edwards C (Ed), 3rd Edition, Churchill Livingstone, 2002. Davidson’s Principles and Practice of Medicine, Haslett, C, 19 th Edition, Churchill Livingstone, 2002. Clinical Evidence (Issue 8),Barton, S. (Ed), http://www.nelh.nhs.uk/ Drugs in Use: Clinical Case Studies for Pharmacists, Dodds, L, 2nd Ed, Pharmaceutical Press, 1996. Clinical Biostatistics: an Introduction to Evidence-Based Medicine, Dunn, G and Everitt, B, Arnold, 1995. Minor Illness or Major Disease? Responding to Symptoms in the Pharmacy, Edwards, C. and Stillman, P., 3rd Edition, Pharmaceutical Press, 2000. Pharmaceutical Practice, Winfield A J, and Aulton, M E, 2 nd Edition, Churchill Livingstone, 1998. Guided study Introduction to Cardiovascular Physiology, Levick, J R, 3rd Ed, Butterworth-Heinemann, 2000. Do you Understand the Cardiovascular System? Part 1 The Heart, Sutcliffe, M, Brighton Polytechnic, 1991. Pathophysiology of Heart Disease, Lilly L S, Lea and Febiger, 3 rd Edition, 2003. Videos The Restless Pump series, Biology, Form and Function, programme No 12, Open University Vital Poison (Horizon) - Nitric Oxide, a lethal gas, is involved in the most basic functions of our bodies Eye into the Heart (NMR) Ischaemic Heart Disease (Open University) CAL packages Coronary Circulation, Armstrong. D, Spriggs, B, Sutcliffe, M, Clewes P., Latty, M. 1995 Haemostasis, Armstrong, D., Brazil, M., Hong, A., Clewes, P., Armstrong, M., Latty, M., Pharma-CAL-ogy, 1995. Clinical Trials and Drug Development, Cunningham, M., Foster, R., Gibbs, A., George, A., Ogg, G., Padgham, C. Pharma-CAL-ogy, 2002. Alternative Therapies, Amwar, K. Jim, N., Huckbody, K. and I. Hughes. Pharma-CAL-ogy, 2002. CD-ROM The Dynamic Human, Jacobsen, C, Mosby, 1996 Interactive Pharmacology, Dale, M. M., Cunnane, T C, Purves, R and Haylett, D G, Blackwell Science, 1995 Assessment The unit of study will be assessed by means of: PY334 Coursework (10 credits): composed of the pharmacological, clinical and professional elements of the coursework. ________________________________________________________________________________ MPharm student handbook 2003-04 106 PY335 Examination (20 credits): three hours unseen examination containing MCQ and essay questions. PY336 OSCE (10 credits): a professional skills examination that will contribute up to 35% towards the final Professional Competency assessment. Brief description of module This module extends the pathophysiology, pharmacological, clinical and professional knowledge and understanding acquired in modules Respiratory and Dermatological Therapies in Pharmacy Practice and Therapeutic Aspects of Neuroendocrinology and Pharmacokinetics. Area Examination Board MPharm Biological Sciences Module authors Drs M S Yeoman, M CAllen, J G Davies and A B MacAdam Semester offered 1 and 2 Site where delivered Moulsecoomb and the Recognised Clinical Teaching Hospitals of the University Date first approved January 2003 Date of approval of this version Version number 1 Course(s) for which module is acceptable and status in that field Compulsory MPharm School home School of Pharmacy and Biomolecular Sciences External examiner Christine Bond ________________________________________________________________________________ MPharm student handbook 2003-04 107 Title Neurological and Psychiatric Pharmacy Code PY337 Level 3 Credit rating 20 credits Pre-requisites Therapeutic Aspects of Neuroendocrinology and Pharmacokinetics Type Extensive Aims To provide a sound framework of the physiology of the central nervous system upon which the students can: Learning outcomes On completion of this module the student should be able to: Content develop knowledge of disease-related pathological and/or behavioural changes in the functioning of the central nervous system. recognise the necessity for pharmacological intervention. rationalise the mechanisms by which different pharmacological agents can modify physiological and pathological processes. further develop understanding of drug dependence and substance abuse. rationalise likely future developments in respect of drug therapies and diagnostic techniques. acquire knowledge as a necessary prerequisite for applied clinical studies. demonstrate a systematic and coherent knowledge of the physiological functioning of the central nervous system, recognise the differences between neurological and psychological diseases of the brain, and critically appraise the implications of these differences with respect to diagnosis, drug treatment and future drug development. recognise the basic pathophysiological processes involved in nociception and the possible mechanisms involved in drug dependence and identify treatments for drug and substance abuse. critically evaluate data from a range of sources (case history, clinical trials data and diagnostic testing) and utilise this knowledge to exercise judgement to evaluate drug therapy for the conditions described above. discuss modern techniques available for analyses of structurefunction relationships of the central nervous system. accept accountability for achieving personal and/or group outcomes by developing a variety of professional skills. recognise his/her professional/ethical responsibilities This double module normally comprises 37 hours of theory and 28 hours of coursework supported by 75 hours of guided study. Structural and functional organisation of the central nervous system: the hierarchical and functional organisation of the brain and the ________________________________________________________________________________ MPharm student handbook 2003-04 108 spinal cord. Non invasive medical imaging for diagnostic measurements of CNS function. (Normally 3 hours) Emotions and psychopathology: pharmacology of the central nervous system: sedative/hypnotic drugs & sleep disturbances. Principles of anaesthetic practice. Pathophysiology and treatments of the different types of epilepsies. Definitions, types, incidences, symptoms and drug treatments of psychoses and affective disorders. Benefits and adverse drug reactions of drug therapies; phenothiazines, butyrophenones, thioxanthenes,‘atypical’ anti-psychotics, first and second generation anti-depressants and lithium. Consideration of the possible mechanisms of action of the above drugs in relation to the ‘amine hypothesis’ of affective disorders and the ‘dopamine- serotonin hypothesis’ of schizophrenia. Anxiety states and their treatments. Efficacy and rationale for complementary therapies for affective disorders. The genetic bases of psychiatric disorders and possible future drug developments in psychiatry. Clinical aspects of depression, anxiety and schizophrenia. Aetiologies, symptoms and treatment strategies related to anorexia nervosa and bulimia. Impact of National Service Framework (NSF) for mental health on patient care. (Normally 10 hours) Higher brain functions and neurodegeneration: degenerative neurological diseases and their treatments: Parkinson’s disease; incidence, symptoms, aetiology and consideration of the rationale of drug treatments. Benefits of treatment and adverse drug reactions. Dementia states & Alzheimer’s disease; incidence, diagnosis, symptoms, pathology, aetiology and consideration of the rationale of drug treatments (including complementary therapies) and socioeconomic consequences. Pharmacogenetics of neurodegenerative diseases. Ageing and cognition and cognitive decline and their treatment with nootropic agents. Attention deficit hyperactivity Disorder (ADHD). (Normally 9 hours) Sensory systems, pain and analgesia: definition of analgesia and consideration of the pathophysiological bases of pain. Descriptions of central nervous system pain pathways. General properties of opioid agonists and antagonists and the relationship between analgesic efficacy and clinical usage and adverse drug reactions. Possible mechanism of opioid analgesia and future drug developments including pharmacogenetics. WHO pain treatment ladder. Differences between pharmacological actions of opiate vs. non-opiate (non-steroidal anti-inflammatory, NSAID) analgesic agents. Description of common pain states. Migraine: symptomology and pharmacological treatment. (Normally 4 hours) Drug dependence and substance abuse: the neurobiology and neurochemistry of reward. Role of dopaminergic and glutamatergic pathways. Types and mechanisms of tolerance, sensitisation and dependence associated with the abuse of therapeutic and nontherapeutic substances. Basic characterisation of the drugs of abuse. Characteristics and treatments of poisoning and withdrawal. Pharmacological and clinical aspects of the treatment of substance misuse. Law: Misuse of drugs act and future changes in drug laws. Current treatments for heroin dependancy. Methadone maintenance ________________________________________________________________________________ MPharm student handbook 2003-04 109 therapy and needle exchange schemes. Future treatments for substance abuse. (Normally 11 hours) One day seminar examining the issues of substance misuse from a variety of perspectives. (Normally 8 hours) Coursework A typical coursework programme may include the following: laboratory practicals, for example pre-clinical drug development in psychiatry, seminars, tutorials, case presentations, problem-solving exercises in therapeutics, simulated exercises in the pharmacy to include extemporaneous dispensing of controlled drugs, counselling, responding to symptoms, professional interaction, health promotion, herbal and homeopathic remedies, prescription reviews. (20 hours) Teaching and learning strategies A variety of teaching and learning strategies will be employed in the delivery of this module, including formal lectures (37 hours), seminars/practicals (28 hours), guided study (including problembased learning and resource-based independent study (75 hours)) and independent study and assessment time (60 hours). Students will also be directed to attend those research seminars held within the School which are relevant to CNS disorders, addiction and the treatment of pain. Learning support Texts Anatomy and Physiology, 5th Ed, Thibodeau, G A and Patton, K T, Mosby, 2003. Pharmacology, 4th Ed, Rang, H P, Dale, M M and Ritter, J M, Churchill Livingstone, 1999. Medical Pharmacology at a Glance, Neal, M J, 3rd Ed, Blackwell Scientific Publications, 1997. Human Pharmacology - Molecular to Clinical, 3rd Ed, Brody,T M, et al, Mosby, 1998. Human Pharmacology, Gard P R, Taylor and Francis, 2000. Clinical Pharmacy and Therapeutics, Walker R and Edwards C (Ed), 3rd Edition, Churchill Livingstone, 2002. Davidson’s Principles and Practice of Medicine, Haslett, C, 19th Edition, Churchill Livingstone, 2002. Clinical Evidence (Issue 8),Barton, S. (Ed), http://www.nelh.nhs.uk/ Case Studies in Psychopharmacology: The use of drugs in psychiatry"Editors David Taylor and Carol Paton, 2002. Drugs in Use: Clinical Case Studies for Pharmacists, Dodds, L, 2nd Ed, Pharmaceutical Press, 1996. Clinical Biostatistics: an Introduction to Evidence-Based Medicine, Dunn, G and Everitt, B, Arnold, 1995. Dale and Appelbe’s Pharmacy Law and Ethics, Appelbe, GE and Wingfield J, 7th Edition, Pharmaceutical Press, 2001. Minor Illness or Major Disease? Responding to Symptoms in the Pharmacy, Edwards, C. and Stillman, P., 3rd Edition, Pharmaceutical Press, 2000. Pharmaceutical Practice, Winfield A J, and Aulton, M E, 2 nd Edition, Churchill Livingstone, 1998. ________________________________________________________________________________ MPharm student handbook 2003-04 110 Guided study Psychopharmacology: drugs, the brain and behaviour, Meyer J S, Sunderland Sinauer Associates, 2005 Brain Biochemistry and Brain Disorders, Strange, P G, Oxford University Press, 1992 Drug Treatment in Psychiatry, Silverstone, T and Turner, P, 5th Ed, Routledge, 1995 Neuropharmacology, Stone, T W, Freeman, 1995 Videos Awakening the Frozen Addicts (Parkinson's Disease), Horizon, 1993 Prisoners of the Brain (drug treatment for manic depression and schizophrenia), Infinite Voyage, 1994. CAL packages Central 5-HT transmission, Dewhurst, D, Collins, G and Bailey, B, Pharma-CAL-ogy, 1996 Central Dopaminergic Transmission, Dewhurst, D, Collins, G and Bailey, B, Pharma-CAL-ogy, 1996 Movement Disorders- Parkinsons Disease, Huckbody, K, Kelly, E, Gent, P and Hughes, I, Pharma-CAL-ogy, 2002 Schizophrenia, Dadabhai, Y, Lyon, E, Clewes, P and George, A, Pharma-CAL-ogy, 1996 Drug Dependence, Ogg, G, Benwell, M and Balfour, D, Pharma-CALogy, 1996 Central Peptidergic Transmission, Dewhurst, D, Collins, G and Bailey, B, Pharma-CAL-ogy, 1996 Alternative Therapies, Amwar, K. Jim, N., Huckbody, K. and I. Hughes. Pharma-CAL-ogy, 2002. CDRom The Dynamic Human, Jacobsen, C, Mosby, 1996 Interactive Pharmacology, Dale, M M, Cunnane, T C, Purves, R and Haylett, D G, Blackwell Science, 1995 Assessment Two hour end of module examination comprising MCQ and essay type questions (70%) and coursework (30%), the threshold for each component is 35%. The coursework assessment will include one practical dispensing assessment which will contribute 35% to the overall Professional Competency assessment, the threshold for this component is 35%. Brief description of module This module extends the pathophysiological and pharmacological knowledge and understanding acquired in modules entitled Respiratory and dermatological therapies in pharmacy practice, Therapeutic aspects of neuroendocrinology and pharmacokinetics and Therapeutics aspects of cardiovascular pharmacy and oncology. Area Examination Boards MPharm Biological Sciences Module team/authors Dr A Jackson, Dr P R Gard and Dr A MacAdam ________________________________________________________________________________ MPharm student handbook 2003-04 111 Semester offered 1&2 Site where delivered Moulsecoomb Date of first approval January 2003 Date of approval of this version Version number 1 Course(s) for which module is acceptable and status in course MPharm. (Compulsory) School home Pharmacy and Biomolecular Sciences External examiner Professor K Wilson ________________________________________________________________________________ MPharm student handbook 2003-04 112