Faculty of Medical and Health Sciences
Department of Pharmacology & Clinical Pharmacology, University of Auckland
Faculty of Medical and Health Sciences
Department of Pharmacology & Clinical Pharmacology, University of Auckland

MBChB221B - Principles of Clinical Pharmacology

Clinical Pharmacology

 

Module Coordinator

Prof Nick Holford

n.holford@auckland.ac.nz      

Module Administrator

Jeshika Raj

j.raj@auckland.ac.nz

Welcome to the Clinical Pharmacology module of the MBChB 221 course.

This Semester 2 module will build on your existing anatomy, physiology, genetics, and biochemistry knowledge. This module is designed to teach you the principles of clinical pharmacology and therapeutics that will underlie other aspects of your medical education and future medical practice.  Where we can, we will use specific clinical examples and patient scenarios to help you understand these basic principles. You should expect your learning from this module to integrate with your learning from other modules.

This module will help you achieve a set of specific learning goals.  These are expressed as  Learning Outcomes in the Phase I Year 2 Guidebook.  Please note that a Learning Outcome may be covered by the combination of several lectures, web-based clinical scenarios and tutorials.

I hope that this module is informative, challenging and interesting. Good luck with the year.

Nick Holford


Module Overview

The clinical pharmacology module is taught by a series of lectures and tutorials.

The lectures provide a structured introduction to the principles of clinical pharmacology and application to therapeutics.

The tutorials encourage students to reflect on the module content and apply principles of dose individualization.

A single coursework assignment is included as part of the module.

Lectures will be given in lecture theatre 505-011 unless you are informed otherwise.

The notes and lecture slides provided in the course manual cover key areas of interest as your lecturers see them, and guide you about the scope of what we expect you to learn. For some topics you will need to do your own reading outside of lectures and module notes. If unsure about anything please don’t hesitate to ask your lecturers for help.

If you are given reading material before any session or in this module manual, you are expected to have read and considered this prior to attending.

Recommended textbooks for this module and details of this module’s Assessment are described in the Phase I year 2 Guidebook.

Module  Timetable

 Timetable with links to all lecture and tutorial material is available at :http://clinpharmacol.fmhs.auckland.ac.nz/teaching/mbchb221b/timetable

Medicines You  Should Know About

Practicing doctors may prescribe from a large list of medicines in New Zealand. Typically, every doctor will be familiar with several hundred medicines. Clinicians at FMHS have compiled a list of medicines that they think all medical students should be aware of. A shorter list have been identified that should be familiar to year 6 medical students who may be asked to initiate a prescription. These lists are accessible on the MBChB Clinical Scenarios Medicines website.

The CP module will introduce you to medicines from these lists. As you continue in your medical training you will learn about a wider range of medicines.  You are expected to be familiar with the mechanism of action, primary indications and major adverse effects of all medicines that are referred to in the CP module.  This information will not necessarily be discussed by your teachers or appear in the course materials.

You can find a list of the medicines and poisons mentioned in the CP module in this Medicines List. Key items of information shown are:

Name: The name of the medicine (or poison) is shown here. If it is found in the New Zealand Formulary (NZF) it will show the NZF name.

Indication: A brief list of one or more main clinical indications.

Mechanism:  A brief description of the mechanism of action.

Adverse effects: A brief list of one or more main adverse effects.

The list is also available here with additional information http://clinpharmacol.fmhs.auckland.ac.nz/docs/medicines-list.xlsx

Scenario: If the medicine is mentioned in the MBChB Clinical Scenarios list the name of the medicine is shown otherwise the name is shown as missing.

NZF: If the medicine can be found in the New Zealand Formulary it will be shown as "y" otherwise "n".

Lecturer: Name of the lecturer who is responsible for the medicines information.

Mentioned: The lecture or workshope where the medicine is mentioned.

Reason: A brief reason for including this medicine on the list.


You should learn to use other online resources about medicines  to complement and integrate the materials used in the CP module (see MBChB Clinical Scenarios Medicines website for further links).

Enquiries and List of Teachers

 

The overall coordinator of the module is Professor Nick Holford (n.holford@auckland.ac.nz), who is happy to answer general questions about the module or to help you get the specific support you need. Please contact Professor Holford sooner rather than later if you have problems. However, in the first instance, please direct specific questions about the content of the module to the lecturer who gave the relevant teaching session. Email addresses are provided below and you are urged to communicate with your teachers whenever difficulties arise with module content.

 

Name

Email

Department

Prof Nick Holford

n.holford@auckland.ac.nz

Pharmacology & Clinical Pharmacology

Prof Brian Anderson

BrianA@adhb.govt.nz

Pharmacology & Clinical Pharmacology

Prof Mark McKeage

m.mckeage@auckland.ac.nz

Pharmacology & Clinical Pharmacology

Dr Stephen Jamieson

s.jamieson@auckland.ac.nz

Pharmacology & Clinical Pharmacology

Mr Liam Anderson

l.anderson@auckland.ac.nz

Pharmacology & Clinical Pharmacology

Dr Nuala Helsby

n.helsby@auckland.ac.nz

Molecular Medicine

Dr Paula Lewis

p.lewis@auckland.ac.nz

Molecular Medicine

Mrs Adele Print

a.print@auckland.ac.nz

Pharmacy

Ms Sanya Ram

sanya.ram@auckland.ac.nz

Pharmacy


Lectures and Tutorials

Lectures

Lectures are used to present the key principles of clinical pharmacology and applications to therapeutics. Lectures are used to deliver a systematic development of essential ideas so it is important to be aware of the content of earlier sessions. You are encouraged to ask questions during the lecture. The course manual includes images from the presentations so you can focus on listening to the lecturer and may only need to make brief notes.

University Principles

1. The University supports the recording of lectures, and other teaching activities as appropriate, as part of its objective to provide a high-quality learning and teaching environment that maximises the opportunity for all students to succeed. 

2. Lecture capture provides supplementary learning resources, but does not replace face-to-face delivery. 

3. Using recordings as a substitute for regular attendance at teaching sessions may negatively affect achievement and should be actively discouraged.

https://www.auckland.ac.nz/en/about/the-university/how-university-works/policy-and-administration/teaching-and-learning/lecture-capture-and-release/lecture-capture-and-release-policy-and-procedures.html

 

Tutorials

The module includes three tutorials. Each tutorial lasts for 1 hour. You will be in a group of around 30 students. You will be encouraged to work in small groups of 3 to 4.

 

What do I need to know about a medicine?

 

This tutorial encourages you to participate in learning about what you and other health professionals need to know about a medicine. You will be encouraged to suggest what you think physicians, pharmacists and patients need to know. Your tutor will guide you and indicate how and when this information will be introduced to your clinical pharmacology and therapeutics curriculum.


Loading and maintenance dose

 

You will be asked to discuss how to initiate individual dosing using the principles that were explained to you in earlier lectures in the module. You will consider several different medicines that demonstrate common principles. A simple scientific calculator is recommended so you can try calculating doses.

 

Target concentration intervention

 

This tutorial continues the idea of dose individualization with an emphasis on using information about patient response to treatment – especially measured concentrations.  A simple scientific calculator is recommended for calculations.

Coursework

A clinical pharmacology and therapeutics problem solving assignment is given to you. It involves the application of the clinical pharmacology principles, covered in lectures and tutorials, to calculate a suitable dose of a medicine. You are then asked to write a formal prescription for the medicine using the calculated dose.

20% of the marks for the Clinical Pharmacology Module of the MBChB 221B course will be based on each student submitting answers to one of the  patient cases.

In addition to providing answers to the questions about dose calculation for one of the cases, please provide an example of a prescription for the medicine you have used for dose calculation. Assume you are the patient's GP and that the medicine will be administered on a regular basis.

Dose calculation answers should show clearly the reasoning and any calculations involved using no more than 2 pages. The prescription should be on a separate page.

You are encouraged to work with others to discuss and understand this coursework assignment. However, it is important that your written assignment answers are in your words, based on your own understanding. In order to minimise inadvertent similarities, which may give the impression of copying, do not show your written work to other students or copy notes made in a discussion group. Copying the style and words from another assignment is strictly forbidden by University regulation. 

https://www.auckland.ac.nz/en/about/learning-and-teaching/policies-guidelines-and-procedures/academic-integrity-info-for-students/about-academic-integrity/turnitin-for-students.html

The assignment must be submitted no later than 3pm on Wednesday 23rd October.

Overdue assignments

In fairness to all students in the module, up to 20% of the assignment maximum mark may be deducted for each day of delay in submission. Of course, there will sometimes be compelling reasons for us to grant you an extension to the due date for an assignment.  You will need to apply for a new due date BEFORE the deadline.  In general, in order to be fair to everyone, excuses such as computer/printer malfunctions, forgetting to hand an assignment in, or technical problems preventing you sending an email cannot be considered as valid excuses for missing the deadline.

Contact: Nick Holford, n.holford@auckland.ac.nz if you need any clarification

Assignment Submission

 You are asked to submit your assignment (Dose Calculation and Prescription) to Turnitin by using the Canvas Asssignment link. Your coursework assignment is in two sections -- a Dose Calculation Section and a Prescription Section. You are asked to submit a single coursework assignment document containing both Sections.

Turnitin is an Internet-based plagiarism-prevention service, which checks the documents for unoriginal content. Visit the page for Turnitin for students:

https://www.auckland.ac.nz/en/about/learning-and-teaching/policies-guidelines-andprocedures/academic-integrity-info-for-students/about-academic-integrity/turnitin-forstudents.html

 
Before you submit an assignment to Turnitin, you must ensure that you have not plagiarised any text
in your assignment. The best way to do this is to know what plagiarism is, know how to cite and reference correctly and how to paraphrase. There are many avenues for you to approach to learn correct referencing techniques.

1. Your first port of call is your lecturer, course coordinator and/or your tutor.

2. Consult the University’s regulations, statues and guidelines.

3. The Student Learning Services (Tā te Ākonga) located in the Kate Edgar Information Commons has both hard copies and online resources outlining correct referencing and offers various workshops on referencing. Visit the website for the Student Learning (Tā te Ākonga).

http://www.library.auckland.ac.nz/student-learning

 4. For a definition of plagiarism and numerous self-help tips on correctly citing and quoting work,

paraphrasing and referencing, see:

http://www.plagiarism.org/

 5. You can find quality resources for correct referencing at:

http://www.cite.auckland.ac.nz/

 

The University of Auckland will not tolerate cheating, or assisting others to cheat, and views cheating in coursework as a serious academic offence. The work that a student submits for grading must be the student’s own work, reflecting his or her learning. Where work from other sources is used, it must be properly acknowledged and referenced. This requirement also applies to sources in the world-wide web. A student’s assessed work may be reviewed against electronic source material using computerised detection mechanisms. Upon reasonable request, students may be required to provide an electronic version of their work for computerised review.

Coursework Cases

Case One

 
John White is a 77 year old man who is known to have atrial fibrillation and congestive heart failure. He is visited at home, 365 Days Road, Orakei, Auckland 1050, by his GP. He has ankle swelling and is short of breath so his GP admits him to hospital. His drugs on admission to hospital are:

          Digoxin 0.125 mg    every night
          Enalapril 20 mg       every morning
          Frusemide 40 mg    every morning

1.       What serum digoxin concentration would you expect from his dose of digoxin if his digoxin clearance is 3.6 L/hr? (this is estimated from population parameters based on his weight and a creatinine clearance of 18 ml/min).

           NB.     F(oral) for digoxin = 0.6

2.       After arrival in hospital it is found that he was previously discharged on a dose of digoxin of 0.25 mg every day. On this dose his digoxin concentration had been reported as 2.57 mcg/L. From this data estimate what his individualised digoxin clearance was at that time.

3.       What average steady state concentration would you expect from his current dose of 0.125 mg every day based on his individualised digoxin clearance?

4.       What digoxin treatment would you recommend?

Case Two

 
Edward Smith is a 50 year old man with asthma. He lives at 2 Year Road, Orakei, Auckland 1050. He weighs 70 kg. His current treatment is:

          Inhaled Fluticasone 250 mcg       twice a day
          Inhaled Salbutamol 200 mcg        as required

He visits an Accident and Medical Clinic because of worsening asthma. He is prescribed a seven day course of oral prednisone and he is started on oral theophylline. A decision is made to give him a loading dose of oral theophylline. He is then continued on a maintenance dose of 500 mg of slow release theophylline twice a day.

He returns 4 days later complaining of nausea and difficulty sleeping. A blood sample taken (at steady state) shows a theophylline concentration of 27.8 mg/L.

Slow release theophylline (Theophylline SR) tablets are available as 175 mg and 250 mg and are usually administered twice a day.

1.       What loading dose of oral theophylline would have been given to Mr Edward Smith if the target concentration was 10 mg/L?

           F(oral) for theophylline = 1.0

2.       Based on the theophylline concentration measured on Day 4 what is his estimated theophylline clearance?

3.       What maintenance dose of theophylline SR would you prescribe if you want his target concentration to be 10 mg/L?