HistoryofCasesinPharmaceutics

Bookofpharmaceuticscaseswas collectedbyAACPTeachersof PharmaceuticsSectioninthemid 1990s

WendyDuncanHewitt(editor)

ClinicalCasesinPharmaceutics
RobinH.Bogner.,R.Ph.,Ph.D. UniversityofConnecticut

BloomsTaxonomy
Synthesis Evaluation Analysis Application Comprehension Knowledge PreP1 P2P3P4

BloomsTaxonomy
Synthesis Evaluation Analysis Application Comprehension Knowledge PreP1 P2P3P4

BloomsTaxonomy
Cases
Synthesis Evaluation Analysis Application

BloomsTaxonomy
Cases
Synthesis Evaluation Analysis Application

RealClinical Problem

RealClinical Problem

Vignette
Comprehension Knowledge PreP1 P2P3P4 Comprehension Knowledge PreP1

Vignette

P2P3P4

BloomsTaxonomy
Cases
Synthesis Evaluation Analysis Application Vignette

Contrast
RealClinicalProblem Collectedfrompractice Complex Openendedanswer Opentodisagreement Studentsaskthekey questionstobeanswered togenerateasolution Onlylimitedinformationis providedalongwithsome extraneousinformation Uncomfortableforstudents Concocted Simple Oneanswer Notopentointerpretation Studentsareasked questionstoleadthemto therightanswer Allnecessaryinformationis provided

RealClinical Problem

Vignette
Comprehension Knowledge PreP1 P2P3P4

Comfortableforstudents

Whatmakesapharmaceutics case?
Aproblemthatrequirestheapplicationof pharmacokinetics biopharmaceutics physicalpharmacy tosolveaproblemrelatedtoapatients therapeuticoutcome,suchas choiceofproductorpreparation administrationofproductorpreparation qualityofproductorpreparation

Whatmakesagood pharmaceutics case?

RealProblem
Collectedfrompractice Complex Openendedanswer Opentodisagreement Studentsaskthekey questionstobeanswered togenerateasolution Onlylimitedinformationis providedalongwithsome extraneousinformation Uncomfortablefor students

3ExamplesofPharmaceutics Cases
P2studentscompoundasuspensionwhichis assayedbyGeneralChemistrystudents Labbasedcase Interprofessionalinteraction P3studentsinasmallelectiveclasseachfind theirowncaseandsolve theclinicalproblem. P4academicrotationstudentsdevelopcases foruseinacasebasedintegratedcourse.

P2/GenChemJointLab Goalsdescribedtostudents
P2students:prepare2bottlesofcalaminelotion CalamineTopicalSuspension,USP GenChemstudents:assaythepreparationsforiron Both:prepareareportoffindingswithexplanations foranydeviationsfromexpected Both:contributetoansweringanopenended question

P2/GenChemJointLab MyGoals
Provideapharmacyrelatedactivityforprepharmacy students Obtainfeedbacktopharmacystudentsonthequality oftheirproduct Givestudentstheopportunitytoworkonopenended problemtopreparethemforrealcases Utilizepreparationsfrompharmacystudentsrather thandisposingofthem Provideopportunitiesforseniorclassmembersto mentorprepharmacystudents

P2/GenChemJointLab Delivery
Allonlineinteractionof5studentgroupscomposed ofP2andgeneralchemistrystudents

Challenges
Coordinationofdeliveringpreparationstogeneral chemistry Coordinationofgroups Motivationofgroups Conflictresolutionwithingroups TIME

P2/GenChemJointLab Outcomes
Notatrueclinicalcase,butitinvolvedmeasuringof qualityofcompoundedpreparation Fociofcomplaining Compiledresultsarenotavailableyet.

P3/AdvancedCompounding Goalsdescribedtostudents
Withaprescriber,identifythreepatientswith therapeuticproblemsthatyouthinkcanbebestsolved bycompoundinganewpreparation Workwiththeinstructor,otherstudentsandthe prescribertodevelopthecompound Prepareareportonthebackgroundincluding biopharmaceutis,pharmacokinetics,stability, administrationandpatientconsultationforyournew compound

P3/AdvancedCompounding MyGoals
Providestudentswithanauthenticcompounding experience Integrateknowledgeofpharmaceuticswiththatof othercourses(therapeutics,patientcommunications, sociology,ethics,etc)tosolveaproblemforthepatient inhis/herenvironment Buildthemarketforcompoundingintheregion Learnnewcompoundingstrategiesfromstudents

P3/AdvancedCompounding Delivery
15studentsallworkingondifferentprojectsoverthe courseofasemesterwith4labsdevotedtoindividual projects.Midtermisinterimreport.Final.

Challenges
Studentsunderestimatethedifficultiesinfindinga prescribertoworkwiththem Interactingwitheachstudentonaseparateproject takes: TIME

P3/AdvancedCompounding Outcomes
Studentshaveagreatsenseofaccomplishmentin puttingtogethertheiraccumulatedknowledge, literaturesupport,andcreativitytoprepareanew compound. Studentsreportasenseofconfidencegoinginto clinicalrotations. Intellectualsatisfactionfortheinstructor.

P4/AcademicRotationCaseWriting Goalsdescribedtostudents
Identifythreepatientproblemsthatrequiresignificant pharmaceuticsknowledgetofindasolution Workwiththeinstructortodevelopatleastoneofthe threepatientproblemstofindasetofsolutions

P4/AcademicRotationCaseWriting MyGoals
Solidifypharmaceuticsbackgroundofseniorstudents Identifyanyweaknesses/misconceptionsandaddress them Tapthestudents experienceforrealworld pharmaceuticscasesforthenewcurriculum Learnnewandrelevantexamplestouseinclassand keepmeuptodate

P4/AcademicRotationCaseWriting Delivery
2studentspermonthworktogethertoidentify possiblecases,withtwiceweeklyfeedbackfromthe instructor.

Challenges
Studentsarefocusedonthediseasestateratherthan thepatient Feedbacktostudentstodevelopgoodcasestake: TIME

P4/AcademicRotationCaseWriting Outcomes TwoCases

MThasnewlydiagnosedosteoporosis APhasbeenhavingbreakthroughseizures

MT is a 58 year old Caucasian female who sees her favorite pharmacist behind the counter at the pharmacy in the grocery store. She is scheduled for a follow up visit with her primary care physician tomorrow, but she is inquisitive about her new diagnosis. CC: I found out that I have osteoporosis and I cant swallow very well. I am going to the doctors tomorrow, and I would like to know what my options for treatment are? PMH: Esophageal Cancer (1998)-Received chemotherapy & radiation-in remission Hypothyroidism Hypertension Osteoporosis All/Intolerances: NKDA Meds::Levothyroxine 125 mcg daily ; Lisinopril 10 mg daily Supplemental Information: MT had chemotherapy and radiation for throat cancer in 1998 and her epiglottis was removed. She is now unable to swallow solids, but has taught herself to swallow liquids, small amounts of soft food, and even very small pills. Also, MT does not produce saliva. She reports trouble tolerating intranasal medications.

1. Define osteoporosis. 2. What are all the available medication options and their available dosage forms for treating osteoporosis? (Drug class, brand and generic name, dosage form, dose and frequency of administration, cost per month, appropriateness for this patient) 3. RuleouttheoptionsthatarenotpossibleforMT.Takeintoaccounttablet size/shapeandthepossibilityofsplittingorcrushingtablets. 4. 5. 6. WhichoptionsareappropriateforMT?Explainwhy. ArethereanydruginteractionsthatMTshouldbemadeawareof? CostisanissueforMT.Whatarethemostaffordableoptions?

AP is a 34-year-old male that presented to the ambulatory care clinic . He had recently undergone a Roux-en-Y gastric bypass (5 weeks ago), is feeling well and has no complaints. His wife is with him today and claims that AP has been exhibiting seizure symptoms at home including staring off, blanked face, and periods of fast blinking. PMH: Absence seizures x 20 years Obesity x 15 years Hypertension x 6 years SH: Lives at home with wife and 3-year-old son Denies alcohol use, illicit drug use and tobacco Medications: Depakote Delayed-Release: 3000mg/day (1500mg BID) Lisinopril 20mg/day The clinic physician wants the pharmacists advice on adjusting APs medication.

7. 6monthslaterMTisstartedonNexium(esomeprazole)forgastrointestinalreflux disease(GERD).IsthisanappropriateoptionforMT?Shouldhermedicationregimen bechanged? 8. 1yearlateritwasdiscoveredthatshehasanirondeficiencyanemia.Shewas startedonferroussulfate.Anythereanycounselingpointsyou canmakeMTaware of?

RouxenYGastricBypass: Mostcommongastricbypassprocedure. Thissurgeryisthegoldstandard ofweightlosssurgeries. Whatitentails: Creationofasmall,(1530mL/12tbsp)thumbsized pouchfromtheupperstomach. Thesmallbowelisdividedabout45 cm(18in)belowthe lowerstomachoutlet,andisrearrangedintoaY configuration,toenableoutflowoffoodfromthesmall upperstomachpouchtothelowerduodenum Thissurgerybypassestheentireduodenum.

FinalThoughts
Pharmaceuticscaseshelpstudentsintegrate physicalpharmacy,biopharmaceutics,and pharmacokineticsintotheirclinicalproblem solving. Calciumsupplementationandgastricbypass providerichlinesofdiscussion.Others? Byintegratingotherknowledgeareasintothe pharmaceuticscase,wecanmakeitrelevant. Havehighexpectationsforstudents.Manyof themwillsurpriseyou!

Acknowledgements
MelissaDavis,PharmD(Classof2008) DeannaJoubert,PharmD(Classof2008) TysonMiller,PhD(DeptofChemistry) ChristineCardillo,PhDcandidate(Chemistry) Countlessotherstudentsandcolleagues