Undergraduates

ECTS Value
5 Credits

Clinical Pharmacology and Therapeutics

The aim of this module is to develop the knowledge, skills and attitudes required for safe prescribing in the common medical conditions and emergencies likely to be encountered by a medical practitioner in day-to- day practice. The knowledge acquired in pharmacology in the second medical year is built upon and placed in its broader clinical context thereby facilitating the development of the critical thinking and decision-making skills necessary to ensure each student can write safe, effective and cost effective prescriptions for their patients.

Concepts relating to the broader context of healthcare are introduced in this module though studies in Pharmacoeconomics. This content is delivered through large group lectures and small group tutorials. The skills to incorporate concepts of opportunity cost and cost to the patient –issues that are becoming increasingly relevant to individual practitioners on a day to day basis – are developed through these modules.

The course comprises some 49 hours of lectures and 6 clinical therapeutics tutorials. A small number of students have their clinical medical attachment to the Department of Therapeutics at St. James’s Hospital. Through the use of hospital staff – intern, senior house officer and registrars based on the Hospital wards, students have contact with real patients and the participation of the Clinical Pharmacists fosters inter-professional liaison.

Clinical therapeutics tutorials
These are in the format of problem based learning with smaller groups of students asked to review and discuss prescribing on patient medication prescription charts. Students are given an outline of the patient’s condition and are asked to comment on therapy, monitoring of beneficial and toxic effects, dose adjustments depending on the patient’s clinical conditions and issues of drug interactions etc. These tutorials are facilitated by both clinicians and clinical pharmacists, thereby fostering an understanding of the benefit of good interdisciplinary relationships in the hospitals setting from an early point in clinical education.

Principles and Practice of Clinical Pharmacology [9 lectures]

• Introductions to Clinical Pharmacology and Therapeutics
• Management of Drug Overdose and Poisoning
• Prescribing at extremes of age
• Therapeutic Drug Monitoring /ADR/Interactions
• Clinical Response to Drugs
• Cancer Chemotherapy (2 lectures)
• Medication Safety/Prescribing Information
• Prescribing safely in the hospital

Cardiovascular Medicine [7 lectures]

• Management of CVS risk
• Management of hypertension
• Antiplatelets and anticoagulants
• Novel Oral Anticoagulants
• Management of Cardiac Arrhythmias and Cardiac Arrest
• Management of Heart Failure including Acute Pulmonary Oedema
• Management of Ischaemic Heart Disease/AMI

RespiRatory Medicine [1 lecture]

• Management of Asthma, COAD

Gastroenterology [3 lectures]

• Management of Common Gastrointestinal Tract Conditions, Peptic Ulcer disease, H.pylori infection
• Management of Liver Disease; Prescribing in and drug induced disease
• Management of Inflammatory Bowel Disease and Treatment of Gallstone/Pancreatic Disease

CNS: Neurology, Psychiatry and Anaesthesiology [9 lectures]

• Anxiety and OCD
• Depression & dementia
• Psychosis
• Parkinson’s Disease
• Pain syndromes and migraine
• Neuromuscular/Demyelinating disorders
• Anaesthesia, Peri-anaesthetic Drugs and ICU Therapy
• Drug addiction and Substance Abuse
• Epilepsy and vertigo

Rheumatology and Bone Disease [2 lectures]

• Management of Rheumatoid Arthritis, Osteoarthritis and Gout
• Bone Disease and Management of Osteoporosis

Endocrinology [3 lectures]

• Endocrine I: Drug therapy in Pituitary, Hypothalamic and Adrenal Disorders
• Endocrine II: Drug therapy of thyroid disease
• Management of hyperthyroidism and hypothyroidism
• Endocrine III: Management of diabetes mellitus

Nephrology and Genitourinary [1 lecture]

• Management of Renal Disease and Drugs and the Kidney

Reproductive Endocrinology [1 lecture]

• Clinical use of Sex hormones, contraception and HRT

Special Senses and Skin [2 lectures]

• Treatment of common Ophthalmological & ENT Disorders
• Management of common dermatological conditions

Immunology and Hypersenstivity [1 lecture]

• Management of Allergic/Hypersensitivity Conditions

Treatment of Infectious Diseases [4 lectures]
(Note: Other areas covered by Clinical Microbiology)

• Antifungals/antivirals
• HIV/STI
• Antimicrobials I
• Antibiotics II

Pharmacology – Evidence Based Medicine [5 lectures]

• Pharmaceutical Medicine, Drug development and Assessment
• Clinical trial interpretation
• Prescribing Cost Effectively, Pharmaeconomics and HTA
• NMIC/Role of Clinical Pharmacy/Herbals
• Clinical Trials, Study Design and Simple Statistics

PRACTICAL PRESCRIBING
There will be 6 practical prescribing tutorials:

• Kardex 1: Respiratory prescribing
• Kardex 2: Cardiovascular prescribing
• Kardex 3: Insulin prescribing
• Kardex 4: Gastrointestinal prescribing
• Kardex 5: Pharmacoeconomics in prescribing
• Kardex 6: Endocrinology prescribing

The form of assessment in this module reflects the acquisition of not only knowledge but also skills and attitudes throughout the year.
There is an interim multiple choice assessment at the end of Term 1 and at the end of the Third Year there is an assessment comprising a written exam and a practical prescribing exam.

The practical prescribing exam consists of a problem based discussion based on a patient Kardex and this exam is marked by cliniciams and pharmacists, reflecting the real-world dynamics of hospital prescribing.

Recommended Text Books

Each student should have a pharmacology text book to supplement lecture material. Suggested text:

• Basic and Clinical Pharmacology (13th Edition), 2015, Bertram Katzung (Author), Anthony Trevor (Author), LANGE Basic Science

Reference Texts

• The British National Formulary (2015). British Medical Association and the Pharmaceutical Society of Great Britain (also www.bnf.org)

• Goodman & Gilman’s. The Pharmacological Basis of Therapeutics (12th Edition). 2011. Ed. L. Brunton, BA Chabner. McGraw-Hill’s.
• Martindale (38th Edition), Pharmaceutical Press 2014.The Complete Drug Reference.

Journals

• Drug and Therapeutic Bulletins
• National Medicines Information Centre Bulletin (www.stjames.ie)
• Leading Articles and Reviews – Lancet, New England Journal of Medicine and British Medical Journal

Electronic Source

• Cochrane Library via Trinity site or www.hrb.ie

On successful completion of this course, students should be able to display the following attributes:

• Knowledge
• Broad knowledge of pharmacological treatment of a wide range of conditions covered in the lecture course
• Broad knowledge of pharmacological treatment of common medical emergencies

• Skills
• Ability to prescribe safely, effectively and cost effectively
• Develop an understanding of practicalities of prescribing in hospital setting

• Attitudes
• Appreciation of how to critically appraise information in relation to drug therapy especially in peer- reviewed journals
• Thorough understand on the issues surrounding prescribing safety and on-going opportunities at all levels of prescriber for quality improvement

The teaching techniques employed include formal lectures as well as small group tutorials designed to expose the students to the more practical aspects of prescribing using drug prescribing charts used for inpatient prescribing (Kardex) as a template.

Summative

Student progress is evaluated by continuous assessment (Semester 1) and a major examination in Semester 2 (based on both terms work) and final assessment in May.

• Semester 1 Assessment 20% (50 MCQs)

• Semester 2 Assessment 60%

This examination comprises 50 MCQs (10%), 10 obligatory Short Answer Questions (25%) and two essay questions (25%) and

• Oral Therapeutic Examination 20%

In this exam all students receive a medication prescription chart (Drug Kardex) for comments. At the practical prescribing examination, each student is usually examined by two examiners, one of whom is an experienced clinician.

A supplemental examination using the same format (MCQ, SAQ, Essays, Practical) will be held in August/September.

Formative

Informal assessments are used to ‘check in’ with students to find out what they are learning and what they don’t understand; do not contribute towards a final grade: are done during the medication prescribing tutorials.

Audits seeking student feedback are conducted at the end of term.