PHAR 6122

Gastrointestinal Section (2009)

Spring Semester (Second Professional Year)

(www.courses.ahc.umn.edu/pharmacy/5880)

Section Coordinator:

David R. P. Guay, Pharm.D., FASCP, FCCP, FCP

            Professor

            College of Pharmacy, University of Minnesota

            Office: WDH 7-148

            Phone:  (612) 626-5981

            Fax:  (612) 625-3927

            E-mail:  guayx001@umn.edu

            Office Hours: TBA

Duluth Facilitator:

Michael Swanoski, PharmD, FASCP

            Assistant Professor

            111 Life Sciences, Duluth

            Phone: (218) 726-6016

            Fax: (218) 726-6500

            Email: mswanosk@d.umn.edu

Topic Objectives and Readings:

Gastroesophageal Reflux Disease

Objectives:

• List the pathophysiologic basis for gastroesophageal reflux disease and esophagitis.

• Describe the therapeutic approach to gastroesophageal reflux disease and esophagitis.

Reading Assignment:

Pharmacotherapy Chapter 32 – Gastroesophageal Reflux Disease

Drug-Induced Liver Disease

Objectives:

• Describe the problems associated with the evaluation of suspected drug-induced liver disease.

• Identify risk factors for developing clinical liver damage.

• Characterize the various mechanisms proposed for drug-induced liver damage.

• Provide examples of drugs frequently implicated as causing liver damage.

Reading Assignment:

Pharmacotherapy Chapter 38 - Drug-Induced Liver Disease

Stress Ulcers

Objectives:

• Understand and describe the pathophysiology of acute stress ulcer (stress – related mucosal disease).

• List the risk factors associated with the development of acute stress ulcer lesions.

• Review the data regarding prophylactic therapy for stress ulcers and describe the deficiencies of the studies, and the benefits and risks of H2 antagonists vs. antacids vs. sucralfate vs. proton pump inhibitors vs. miscellaneous other agents.

• Develop a therapeutic plan for prophylactic therapy of acute stress ulcers, including agent, dose, route, rationale for use, goals, desired outcome, monitoring parameters, and risks.

Pathophysiology and Treatment of Peptic Ulcer Disease

Objectives:

·        Interpret and describe the pathophysiologic significance of acid production, mucosal protective mechanisms, genetic and environmental influences, non-steroidal anti-inflammatory drugs, and Helicobacter pylori infection on the development of duodenal and gastric ulcers.

·        Differentiate and describe the signs, symptoms, and clinical course of duodenal and gastric ulcers.

·        Understand and be able to discuss the pharmacology, mechanism of action, pharmacokinetics, dosage forms, adverse effects, indications, drug interactions, and formulations of:

o       Histamine H2 – receptor blockers

o       Sucralfate

o       Prostaglandins

o       Proton pump inhibitors

o       Antacids

o       Antibiotherapy of H. pylori

·        Describe the role of maintenance therapy in duodenal and gastric ulcer disease.

·        Incorporate knowledge of drug interactions of anti-ulcer medications into your memory banks.

·        Compare and contrast the various antacids pertaining to cost, side effects, composition, acid neutralizing capacity, and therapeutic indications.

Reading Assignment:

Pharmacotherapy Chapter 33 – Peptic Ulcer Disease

Constipation and Diarrhea

Objectives:

• Describe the various etiologies of constipation and diarrhea.

• Describe the rudimentary aspects of the differential diagnosis of constipation and diarrhea.

• Describe the pharmacological and nonpharmacological management of constipation and diarrhea.

Reading Assignment:

Pharmacotherapy Chapter 36 – Diarrhea, Constipation, and Irritable Bowel Syndrome

Inflammatory Bowel Disease

Objectives:

·        Understand and differentiate between the pathophysiology, clinical presentation, clinical course, prognosis, and medical and surgical treatment of ulcerative colitis and Crohn’s disease.

·        Describe the pharmacology, rationale for use, and adverse effects of sulfasalazine, metronidazole, corticosteroids, 5-aminosalicylates, 6-MP, azathioprine, miscellaneous immunosuppressants, and biologicals as applied to treatment of inflammatory bowel disease.

Reading Assignment:

Pharmacotherapy Chapter 34 – Inflammatory Bowel Disease

Viral Hepatitis

Objectives:

·        Describe the differences in incidence, transmission, clinical presentation, severity and prognosis of viral hepatitis types A, B, C, D, and E.

·        Understand the diagnostic and clinical significance of the serologic markers of viral hepatitis.

·        Describe the necessary precautions that should be taken when encountering a patient with the various forms of viral hepatitis.

·        Know the differences in indications, contraindications, dosages, and side effects of HBIG, hepatitis vaccines, interferon, ribavirin, and nucleoside antivirals including when and how they should be used clinically in the prevention and treatment of viral hepatitis.

·        Describe the prognosis, clinical presentation and drug therapy for chronic viral hepatitis.

Reading Assignment:

Pharmacotherapy Chapter 40 – Viral Hepatitis

Section Faculty (other than director)

Thomas Lackner, Pharm. D

Professor

University of Minnesota

College of Pharmacy

WDH 7-115A

308 Harvard Street SE

Minneapolis, MN 55455

General Section Information

Office Hours:

The Section Director will be available on campus in his office at times to be arranged.  The Director will be present at all lectures to answer individual and group questions and to meet with course liaisons.  If desired, the Section Director will meet with students after each lecture.  Dr. Guay can be contacted at 612-626-5981 or via email.

Textbook:

The course textbook is Pharmacotherapy: A Pathophysiologic Approach. 6^th Edition; DiPiro et al (eds)., McGraw-Hill, New York, NY, 2005.

Readings:

Textbook chapters are assigned and listed in the Topic Objectives and Readings section.  Students are strongly urged to read the assigned readings prior to class to aid in the understanding of lecture materials.  Questions from the required readings may be included in course examinations (in addition to lecture and handout material).  Supplemental readings will be made available to interested students by arrangement with the Section Director.  Such readings may be valuable for future reference.

Grading for Gastrointestinal Section:

Grading for the GI section will be based on two written exams during the semester, the oral examination, and the written comprehensive final exam during exam week at the end of the semester.  The GI section will contribute 28.5 percent to the final course grade (see table below).  Written exam format will be exclusively multiple choice.  The written and oral exams will cover materials from lectures and assigned readings.   

Overall Course Grading for PHAR 6122:

The overall PHAR 6122 course grade will be determined by the results of 5 quizzes (all within the CV section), 7 written exams (3 exclusively CV, 2 exclusively Endo, 2 exclusively GI), 1 final comprehensive and combined written exam (CV, Endo, and GI) and 1 comprehensive and combined oral exam (CV, Endo, and GI).

Exams will not be graded on a curve.  The use of electronic devices such as Palm, other PDA’s, pocket computers, programmable calculators, and other devices with electronic data bases is not permitted during quizzes, written and oral exams unless specified by the Course or Section Director.  Within each section, exams will be comprehensive and build on previous knowledge covered.  The final grade for the PHAR 6122 course will be determined according to a formula.  The overall course grade will be determined from contributions from each of the three sections.

The following is provided to guide you in the relative contributions of each section to the final grade and minimum passing grades:

*Minimum passing grade refers to the indicated evaluation tools for each section.

**The oral exam accounts for 10% of the overall course grade.  The oral exam will integrate and evaluate the application of knowledge gained from each of the three sections according to their approximate contributions to the lecture hours in the course as of the date of the oral exam (55% CV, 25% GI, and 20% Endo).

***A comprehensive integrated final exam for all three sections will contribute 20% toward the overall course grade.  Approximate contributions of each section for this exam will be 40% GI, 40% Endo, and 20% CV.

NOTE: In order to pass PHAR 6122, each student must pass the final written examination with a grade of 65% or higher.  In addition, each student must earn an overall grade of 60% or higher in each section (note: this excludes the oral and final written exams) (see * in table above).  There will be no exceptions to this rule.  Failure in one or more sections will require the student to re-take the entire course (all three sections). 

Exams will not be returned but can be reviewed outside of class time.  The Section Director reserves the right to schedule review at a time when the greatest number of students can be present.  You will have only one opportunity to review each exam (i.e. you will not be able to review it multiple times).  Grades will NOT be given out over the phone.  Consult the PHAR 6122 overall syllabus to review the percentage score/letter grade assignment correlation table.

Make up Policy:

Please note MAKE-UP EXAMINATIONS, QUIZZES, AND ASSIGNMENTS, WILL NOT BE OFFERED EXCEPT UNDER THE FOLLOWING CIRCUMSTANCES: illness, verified by a note from a licensed healthcare provider; a family emergency, verified by a note from the professional person in attendance; or a University-sponsored event, verified by a note from the leader of the sponsoring organization.  Additional circumstances will be considered at the discretion of the Course Director and/or Section Director.  If a student is unable to attend the scheduled evaluation, the relevant Section Director must be notified (by email or phone) at least 24 hours in advance of the exam time (where possible).  If you do not receive a reply to your request prior to the examination time, please do NOT assume that your request has been granted; contact the Course Director/Section Director again to confirm that your request was received and processed.  If an acceptable circumstance or adequate documentation is not provided, a grade of zero on the exam, quiz, assignment, etc. will be assigned at the discretion of the Course Director and/or Section Director.

Unless there are extenuating circumstances, the make up evaluation date will generally not be more than one week after the original evaluation date.

Workload Expectations:

The University of Minnesota defines one credit as equivalent to an average of three hours of learning effort per week (over a full semester) necessary for an average student to achieve an average grade in the course.  For example, a student taking a three credit course that meets for three hours per week should expect to spend an additional six hours per week on coursework outside the classroom.  You will get the most out of this course by actively participating in the assigned readings and pedagogical tools (quizzes, oral and written exams, review sessions, assignments, etc.).

Disability Accomodations:

Any student with a documented disability (e.g., physical, learning, psychiatric, vision, hearing, etc.) who needs to arrange reasonable accommodations must contact the Course Director.  Documentation of the need for accommodations should be received within the first week of the semester and at least 7 days before any test or exam.  It is assumed that Disability Services (TC: http://ds.umn.edu/ , 612-626-1333; Duluth: Access Center, http://d.umn.edu/access/ , 218-726-8217) has been contacted to document the disability and quantify the necessary accommodations before the beginning of the Semester.  All discussions concerning this issue will remain confidential.

Class Etiquette:

The instructors expect all students to conduct themselves in a professional manner consistent with the University of Minnesota Pharmacy Student Code of Ethical Responsibility and Professional Behavior.  Students will not engage in disruptive classroom conduct.  This refers to behavior that substantially or repeatedly interrupts either the instructor’s ability to teach or student learning.  The classroom extends to any setting where a student is engaged in work toward academic credit or satisfaction of program-based requirements or related activities.

Honor Code:

Each student is bound by the following specific provisions as part of the honor code: Academic misconduct is any unauthorized act which may give a student an unfair advantage over other students, including but not limited to: falsification, plagiarism, misuse of test materials, receiving unauthorized assistance and giving unauthorized assistance.  Specifically, each student will be required to do their own work on all quizzes (online or written), tests, and oral and written exams.

Exam Dates:

The instructors do not foresee any circumstances that would require a change in examination dates for the class as a whole.

Examination conditions will be as follows: seating arrangements (alternate seating), time allotment (see class schedule), materials to bring to exam (pen, #2 pencil), method of question presentation to test proctor (student to come to proctor at front of room), disposition of personal belongings (allowed in room, underneath chair), regrading policy (no regrading allowed).

Assumed Entry Knowledge:

In order to take the Gastrointestinal Section of PHAR 6122, the student is assumed to have a working knowledge of gastrointestinal anatomy, physiology, and pharmacology, achieved by the completion of college-level courses in physiology/pharmacology/ medicinal chemistry.  Otherwise, there are no pre-requisites for the course.

Lecture schedule:

Lectures will be in WDH 7-135 [TC students] and __ Kirby Plaza [Duluth students].  Monday and Wednesday lectures will run from 10:10AM-12:05PM and Friday lectures from 10:10-11AM.

Last Updated:04/25/2008

©2001 College of Pharmacy, University of Minnesota
Course Director: David R. P. Guay