PHRM 250 Course Overview and Guidelines

Course Information

• Course name: PHARMACOTHERAPEUTICS FOR HEALTH PROFESSIONALS
• Course code: PHRM 250
• Instructor: Amy Warren MN, RN
• Instructor experience: Rural acute, continuing care, ER experience
• Years teaching at Portage: 10 years
• Instructor contact: College email (and use your own) during business hours

Course Format

• This week: Traditional lecture
• Lecture videos: Available before next week's class in your College email and on Moodle
• Next week's class: Flipped classroom format (watch videos beforehand and participate in case studies, group discussions, interactive games etc.)
• Format for rest of semester: Flipped classroom format

Course Overview

• Units: 10 units divided by medications affecting particular body systems
• Unit 1.1: Drug Legislation in Canada
• Unit 1.2: General Principles of Pharmacology
• Unit 2.1: Peripheral Nervous System
• Unit 2.2: Central Nervous System
• Unit 3.1: Drugs Used to Manage Pain
• Unit 4.1: Diuretics
• Unit 4.2: Fluids and Electrolytes
• Unit 5.1: Drugs Affecting the Cardiovascular System
• Unit 6.1: Drugs Affecting the Endocrine System
• Unit 7.1: Drugs Affecting the Respiratory System
• Unit 8.1: Drugs Affecting the Gastrointestinal System
• Unit 9.1: Anti-Inflammatory and Anti-Infective Drugs
• Unit 9.2: Immunologic Drugs
• Unit 10.1: Drugs Affecting Other Body Systems

Learning Guide

• Use PHRM 250 Learning Guide
• Includes: All readings, learning outcomes, tips for success, additional resources, necessary information for group assignment
• Group assignment instructions: At the end of the learning guide document (part 1 = 10%, part 2 =15%)
• Check learning guide for answers first before emailing the instructor

Assessment Values

• Midterm #1: On-site 1.5-hour exam, units 1-4 (20%)
• Midterm #2: On-site 1.5-hour exam, units 5-8 (20%)
• Group assignment: See the learning guide for instructions (25%)
• Final Exam: On-site 3-hour exam, units 1-10 (35%)
• Total: 100%

Exam Blueprint

• Knowledge/Comprehension: 35%
• Application: 35%
• Critical Thinking: 30%
• Professional, Ethical, & Legal Practice: 15-25% (recommended 20%)
• Foundations of Practice: 60-70% (recommended 65%)
• Collaborative Practice: 10-20% (recommended 15%)

Assessment Due Dates

• Midterm #1: February 4th @ 1200
• Midterm #2: March 18th @ 1200
• Part 1 of Group Assignment: February 25th @ 0900
• Part 2 of Group Assignment: March 4th @ 0900
• Course calendar on Moodle site and College email

Assignment Overview

• Groups: Same as NURS 152 assignment groups
• Part 1: Interview of a person on a specific medication (short 2-page paper, pre-approved medication by instructor, no two groups have same medication, interviewee cannot be an LPN student)
• Part 2: Research paper comparing interview results to textbook and drug guide (3 pages)
• Full details in PHRM 250 Learning Guide

Medication Information

• Drug Definitions:
• Drug: Chemical agent that produces physiological response in the body
• Effects: Desirable (therapeutic) and undesirable (adverse)
• Canadian Drug Legislation: Frameworks to provide safe administration of medications
• Canadian Food & Drug Act: Regulates food, drugs, cosmetics, and medical devices, protects from contamination, and ensures compliance with prescribed standards. Drug labels regulated
• Schedules:
• Schedule A: Diseases that drug treatments are not promoted for
• Schedule C: Radiopharmaceuticals, must detail where and how drug was manufactured
• Schedule D: Allergenic substances, vaccines, and blood derivatives, details of manufacturer required
• Schedule F: List of prescription drugs
• Schedule G: Includes regulations for prescription based drugs impacting the central nervous system and labeling
• Schedule J: Highly restricted drugs, no recognized medical use

Drug Categories

• Prescription Drugs: Require a prescription from a professional
• Over-the-Counter (OTC) Drugs: Legally available without prescription
• Natural Health Products (NHPs): Vitamins, minerals, herbal remedies, homeopathic medicines

Medication Approval Process

• Preclinical trial: Lab research on human and microbial cells, tested on animals (3-5 years)
• Clinical Phases:
  • Healthy volunteers (informed consent)
  • Individuals with the disorder (small group)
  • Individuals with the disorder (large group)
  • Double-blind studies with placebo
  • Post-marketing studies by drug companies

Pharmacodynamics

• Therapeutic effect: Onset, Peak, Duration, Half-life
• Mechanism of action
• Receptor Interactions
• Enzyme Interactions
• Types of drug action: Local (topical), Systemic
• Medication interactions: Additive, Synergistic, Antagonistic
• Types of Drug Therapy: Palliative, Acute, Supportive, Maintenance, Supplemental, Prophylactic, Empirical
• Secondary effects: Adverse effects (severe negative response, medication discontinued), side effects, predictable, unpredictable, over/under-react, carcinogenic, idiosyncratic effects
• Additional Effects of medications: Toxicity (acute, chronic), Therapeutic Index (difference between therapeutic and toxic levels), Prolonged intake, Accumulation, Antidotes, Lethal Effects, Allergic reactions (unintentional and unpredictable responses, release of antibodies, medication allergies, anaphylaxis, etc.)
• Considerations in dosing: Tolerance, dependence (physical and psychological)

###Pharmacokinetics

• Absorption: The length of time required to produce a response; Routes: Enteral (GI tract, oral, sublingual, buccal, rectal), Topical (eyes, ears, skin, nose, lungs, vagina), Parenteral (Intravenous, Intramuscular, Subcutaneous, Intradermal, Intrathecal, Intraarticular)
• Factors affecting absorption: Route of administration, GI motility, Food-drug interactions, Drug-drug interactions, Empty stomach (absorption), Bioavailability of drug, Status of absorptive surface, Health of tissue, blood flow, surface area, pH, drug solubility (lipid), first pass effects
• Distribution: Transport of drugs; Rate & extent varies in clients, body physiology (fat & water content), Blood flow to organs, Lipid solubility, drug-protein binding (drug-protein complexes)
• Areas of rapid distribution: heart, liver, kidneys, brain; Areas of slow distribution: muscle, skin, fat
• Metabolism: Biological transformation of drugs to an active form; water soluble, excretion in urine
• Sites of metabolism: Liver, Kidneys, Lungs, Plasma, Intestinal Mucosa, Exocrine Glands
• Excretion: Elimination of drugs from the body; Ways/sites: Kidneys, Liver, Bowel, Lungs, Exocrine glands (mammary, sweat, salivary)

Half-Life (T1/2)

• Measures the rate at which drugs are removed from the body, required to eliminate 50% of the drug. Affects dosing considerations: Amount, Frequency. Difficulty excreting a drug increases risk for toxicity
• Example: 1200 furosemide 40 mg, different t values, drug elimination percentages and times.

Drug Information Sources

• Canadian Formulary (CF)
• Compendium of Pharmaceuticals and Specialties (CPS)
• Drug handbooks/guides (Course material)
• Each medication has an 8-digit identification number (DIN)

Drugs & Special Populations

• Pediatric patients: Immature organs, stomach lacks acid (bacteria-killing), high body water, lower protein levels, immature blood-brain barrier, impaired metabolism, and excretion
• Older Adults: Degenerating organ systems, multiple/serious illnesses, unreliable compliance (polypharmacy), taking multiple drugs concurrently increases drug interactions & side effects; changes in pharmacokinetics (lower dose, reduced frequency, slower absorption, reduced blood flow, gastric acidity, increased body fat, decreased H2O intake, ↓ albumin (↑ free drug), ↓ cardiac output, ↓ liver enzyme production, ↓ liver mass, ↓ blood flow to organs) and excretion (↓ renal function, ↓ GI motility)

Drug Related Information (Additional)

• PCEA General Guidelines
• Drug specific examples: Morphine, Fentanyl, Hydromorphone, Sufentanil, Methadone

Specific Drug Related Questions (if there are any)