A Multidisciplinary Approach to Teaching Therapeutics, Disease, and Human Behavior MYRON

T

purpose

HE

of this

a coordinated, gram,

designed

drugs, model

and

and

accomplishing

goals of program

other health illustrates

using

expertise

the

medical of the

faculties hierarchy

ences

and

clearly cators other

the

educational

clinical

sci-

the

pharmacists, members in

of

the

diagnosis,

and

The problem that indicate

is

dence

of

a drug

the

hospital

of

pa-

setting

;1.2

or improper

including drug, wrong proper

administration wrong route

dose, wrong of administration,

compliance;

From the Biological of Southern California, Angeles, California

and Sciences School 90033.

an

1976

an

list

Section, University of Pharmacy, Los

the

and

schools,

National

been

many

followed

experiential

by

clinical

a

educais

of the Drug of Medical

ReSci-

Council,

Na-

Research of Sciences,

following

the

on Clinical Pharmacology in purpose of the Conference was problems confronting clinical and new approaches to

problems.

The

conclusions

Task Force the Student

ductory

in

pharmacological

report

recommended improvement tion of physicians in the

the

drug

That this has not been sufficient by the reportt#{176} of the Subcommittee

Academy

in

pharmacy

recently

basic

has and

tional

clinical

clini-

of quality

in basic pharmacology courses their preclinical program. In

ences,

tion,’2

medical providing

presented

on Clinical Pharmacology search Board, Division

Similar

goal and

traditionally

schools,

these

increasing

with

of

recognized

theory

to reach

medical

of drugs,5’6 or im-

of

basic

been

Medical

the

wrong

of

have

use

frequency, and

has

the curricula schools towards

information as part

tion. shown

of drugs.

need

therapeutics.

Calif.

interacproperties

a

integration

didactic

drug

in

cal application

of

Partial support of this program was provided by educational grants from Sandoz Pharmaceuticals and Meyer Laboratories, Institute of Research. January,

change pharmacy

Conference 1970. The to discuss pharmacology

drug-induced diseases resulting in a significant number of hospital admissions ;34 indiscriminate

Recently, for and

information

treatment

in

effects

and pre-

revealed by starather high incireactions

or biological

pharlnacy

pre-

Los Angeles,

significant to physicochemical

edu-

rational

for

drugs

disease. tistics

is

Ph.D.

of clinically tions,7-9 due

schools

satisfying

facing

of the

and illusion

objectives.

practitioner

out

a

The of

the

and

problems

adverse

as

pharmacy

educational

application

in and

serve

of both

vention,

tients

to

to

developing

the

the safe

of

behavior

professionals. the desirability

of physicians, health care team

paring and

in

of

knowledge

in dispelling of basic and

defined

One

pro-

human

students for

is to describe

provide

to

diseases,

pharmacy

paper

multidisciplinary

WEINER.

were

strongly

in the use of reached

educadrugs. by

the

on Prescription Drugs’1 and American Medical Associa-

both

recommending

pharmacology medical solution

inclusion teaching

curriculum to

the

of

programs as

problem.

in

introAddi-

I

WEINER

tional tion

reports’3”4

indicate

clinical

pharmacology

in

neglected

or

curricula. of the

is

College

was

cology’ mittee

for

clinical

of

Several

programs

of

a Com-

to recommend

course

pharmacology

at

to improve

therapeutics

discussed.’’8

have

However,

either

still

in the

electives

limited

students, tegration diseases,

of information

At fornia

or

to

and

these

all

not

human

veloped

that

ence, havior

combines

clinical designed

who

are

has

been

de-

in

basic

sci-

topics

human pharmacists

to provide

pharmaceutical

full

be-

patientThe ra-

services.

tionale for the integrated’9 and patientoriented20 approach to the education of health care team members at the School

has

previously

gram

been

described

sented

to

report

pharmacy

histology,

biochemistry,

and

principles

pathology, of

cokinetics,

are

before

pharmathe

third

1. Medicinal

class,

the

following

skills for evaluation of drugs therapy based on the chemical organic

medicinal

condevelop

and

drug

an

the

basic states

maximally effective other health perdevelop and

interpretation

of

skills infor-

laboratory

interactions-to

and

of

A

listing

of

dents

topics

of the existing

before

(Table

small

the

completion

of

therapeutic analgesics,

chosen

state

both

institutional lecture

stu-

study

of a gen-

agents, or

such diuretics. the

relate

drug

to

patient

and

community

the

in

reinforcing

classroom has been Journal

traditional

information. developed of

Clinical

proof

and

dis-

care

in

settings.

is supplemented

to

as

major

to examples

can

format

approach

The

(20

to accomplish

information

alternative

tory

topic.

group

of these presentations: student with specific

ease

logical gram

II, stu-

sessions, clinical pharare presented by clini-

pharmacists

The

objec-

faculty and residents. These held at appropriate times fol-

eral class of anticonvulsants, are

anti-

integra-

Specific

of each

in

cal pharmacy sessions are

objective vide the

for the

and of the copharmacy and I).

discussion

discussion case studies

lowing

of

in the example in Table and distributed to

Periodically, dents) macy

covered

program between

faculty

tives, as seen are formulated

at

pharmacist/

interfaces.

is illustrative

medical

interrela-

principles and

team

convulsants tive nature operation

prothe

communication

pharmacist/patient care

an

an underand

pharmacy-to drug therapy

understanding

health

properties

products

2. Pharmacology-to provide standing of the pharmacodynamic toxicological principles of drugs

provide

disease

to

for with

6. Professional vide

how chemistry-to

allow

for

Cases

program.

For each drug tent is presented:

2

to basic medicinal

and

presented

prephysi-

in addition

biopharmaceutics,

of

is

to

tests

pro-

students.

pharmacology,

chemistry, year

this

The

third-year

Anatomy, ology,

in

discussed.

medicine-to relating

Clinical monitoring

tionships

therapy, and to develop

qualified

centered

5.

in-

to drugs,

Southern Calia coordinated,

program

relationship

response

mation of

behavior.

the University of School of Pharmacy,

multidisciplinary

stage,

total

an and dissolu-

metabolism,

distribution, and their

which would communication

for

percentage

relating

absorption, excretion

4. Clinical information

been

programs

achieved

tion, and

provide

of bioavailability factors affecting

sonnel

teach-

developmental a small

have

the

recently

understanding physicochemical

therapeutic

Pharma-

of training.

ing are

medical

Clinical

establishment

on Education

content

in

been

one of the results Meeting of the of

the

3. Pharmacokinetics-to

instruc-

has

inadequate

Subsequently, First Annual

American

levels

that

with laborapharmaco-

to

A new provide Pharmacology

proan

TEACHING

THERAPEUTICS,

DISEASE,

TABLE Integrative Drug

Approach

class

AND

BEHAVIOR

I

to Anticonvulsant

Therapy

Programs

Topic

Anticoavulsants

Seizures

in

Presenter

man

Neurology

faculty

partment of of Medicine Center Chemistry relations

of

characteristics

Pharmacokinetics

of

considered

dents to he more practice of the graduates.

The

cor-

Pharmacological anticonvulsants

Clinical ceiving

experience

and structure-activity anticonvulsants

by

of

faculty

and

patients medication

stu-

has

the

To

develop

evaluate

drug

cluding

the

students’ literature

ability

development

2.

To

develop

confidence on

drug

language, Students no more

therapy

in

verbally

and

is presided

sons’ of

hour with over

selected by from student

by

a student

and

presiding

that

follow

the

dent

serves 1976

simple

faculty chairperassignment

collection

and

organization and publication over

each the

presentations.

as a participant

Each and

chairperson,

include

audio-taping

tion,

January,

and

in writing.

the pharmacology volunteers. The

to students,

program,

self

sessions per week. a specific category

cal review of abstracts, stracts into a program the

and

information clear

responsibilities

topics

ability

divided into small groups, 20 students per group, and

than

meet for two session deals

atti-

claims and case studies.

communicating

are

in-

of a critical

students’

in

to

objectively,

tude towards drug marketing published clinical reports and

each

critiof abof

presenta-

are

DoSchool Medical

faculty,

faculty,

USC

USC

School

Pharmacokinetics of Pharmacy

faculty,

USC

School

Clinical pharmacy of Pharmacy and Center

faculty, LAO/USC

USC

School Medical

four

speakers

per

session.

summarizing

the

Each

an abstract and a short

presentation,

is

allowed 15 minutes for his oral presentation followed by a 10- to 15-minute question-and-answer two the

different year’s

period. types program.

Students

of presentation The first

volves a literature eareh tion of clinical information the

efficacy

and/or

pharmacokinetics, and management.

session

is

slightly

modified

a discussion of controversial ing to pharmacology and sented

in a debate

Presentation

type

in-

and presentarelating to (1)

safety

clinical teractions

make during

of or

drug,

(2)

drug inThe second

(3)

to

allow

issues pharmacy

for relat-

pre-

format. of the

first

type

might

in-

elude:

1. Drugs

used

in asthma

Isoproterenol Aminophylline Isoetharine Salbutamol 2. Drugs

used

in

diabetes

mellitus

Phenformin

discussions Each

There

paper

following

goals: 1.

Chemistry Pharmacy

of

Pharmacology of Pharmacy

re-

chairman,

speaker, who must write both prior to the oral presentation

to the eventual of pharmacy

program

of

anticonvulsants

management anticonvulsant

relevant majority

Medicinal School

and

Neurology, USC and LAO/USC

Tolbutamide stu-

semester.

Chlorpropamide GI ibenclamide 3

WEINER

Presentations pro

and

of

con

the

positions,

second

1. Reserpine-breast Prophylactic

use

of

potential

the

of antiparkinsonian

to

discipline hear

harm-

The

taped

School’s

sessions

library

are

to

placed

allow

in

access

the

by

a

stu-

that

more

1.

The

student

2.

The

student

and

primidone

Given

the

3.

a. b.

should

describe

should

this tra-

learning activities, or term papers. Well-

to

the would

4.

Given vulsa.nt

5.

The student should be able tionships between phenobarbital,

6.

The and

7.

With dent a. b. c. d.

8.

hydantoin activity on

student should diphenylhydantoin, respect should State List List State

The

student

10.

of to

be

to

usefulness

(begin

student with

of the

drug, major

or

the the

chemical

sodium

in

be high

stu-

ethosuximide,

various

student

types

should

groups

of

be

(barbiturate,

treat or metrazol-induced be

structural and

able

to

to:

hydantoin,

seizures predict

formulas, primidone.

metabolic clinical

the

interaction significance ethosuximide,

general

epilepsy.

able

salts

student should 5,5’ substitution.

in

terms,

the

animals

probable metabolic

anticoninterrela-

between phenobarbital to a patient. and

primidone,

the

stu-

doses

mechanism(s)

by

which

anti-

seizures.

be able to classify mesantoin, drugs. In other words, in what

should low

treating

anticonvulsant

the

signs, symptoms, is prescribed, the

Make a reasonably accurate statement State whether the signs and symptoms State whether the signs and symptoms Recommend appropriate action relative

The

diphenyihydantoin,

in

discuss the the possible

state,

gen-

epilepsy.

diphenylhydantoin,

able

modify

should

of

show, using mephobarbital,

able to including

and Overall,

values for biological half-life, and therapeutic blood level route(s) of elimination most frequently occurring side effects at ordinary therapeutic toxicity signs and symptoms associated with over-doses.

Given a description of anticonvulsant medication a. b. c. d.

11.

should drugs

The student as anticonvulsant use

the the

experience

Program

phenobarbital,

about: form aqueous

phenobarbital, able to:

probable the major two of the probable

coavulsant 9.

to be

one

motivation, provided

enthusiasm.

Therapy

drug should effectively modify electroshock-

structure, the basis

be

an

into

statements ability to

of epilepsy the drug

their

of

structure

compare

higher evaluation

II

types

various

to

formula

student

Anticonvulsant

the able

respect

structural

Categorize the etc.) Make predictive The compound’s

a

be

with

The type Whether

for

their

the students perceived to be more appropriate than

enjoyable

erated

TABLE Objectives

allow

proindi-

defined objectives, peer teaching, and

ful?

to

evaluate

of this aspect of the past three years has

the

ditional supplemental such as laboratories

risks?

and

and

presentations.

cated program

phenothiazines justified in light

5. Marijuana-pharmacologically

4

any

Evaluation gram over

programs

receiving

from students

own

correlation

maintenance

agents in patients 4. Sulfonylureas-use

dents

with

include:

cancer

2. Methadone 3.

type,

might

able doses,

to

state abrupt

the

and student

diazepam, types of

seizure should

phenurone, diseases

pattern be able

and would

of to:

trimethadione they be of

a patient

about that patient’s compliance. may be due to the anticonvulsant (if caused by medication) require to the patient’s signs and symptoms, general

or slow

dosage

schedule

withdrawal

of

The

for

anticonvulsant

for

any

whom

medication. action. if needed. drugs

therapy).

Journal

of Clinical

Pharmacology

TEACHING

dents perceived the a unique opportunity sional

program as to develop

competence

evaluation,

in

and

viding The

education

of

operation

and

sonnel

who

suggests medical

an attempt preclinical

pharmacy

this the

pharmacy

faculty

in

format

curricula.

The

this

in

Furthermore,

evident attitude

it

will

be

inherited

this

author wishes to thank Dr. Robert C. and Mr. James K. Walker for their comments during the preparation of manuscript.

Shapiro, Jick, medical

S., H.:

Slone, Fatal inpatients.

D., drug

Lewis, G. reactions J.A.M.A.

P., and among 216:467

Report

from

the

Boston

Program: Pedat. Clin.

Collaborative problems N. Amer.

Drug and

Miller, R. R.: Drug surveillance epidemiologic methods. Amer. Pharm. 30:584 (1973). Report from the Boston Collaborative Surveillance sions due

5.

(1.

to

Program: adverse

drug

Hospital reactions.

J.

1976

Med. on

Sciences,

National

3-4,

Research

1970.

Brown, the 961

Prescription Washington, Printing

J. H. neglected

15.

U.: Clinical science. J.

Back. U.S.

Dec.,

1968. distribuAmerican Delegates

pharmacology: Med. Educ.

44:

(1969).

WHO

Alquist,

Study

H.

Group:

P.:

Rosenberg,

Report

P.:

An

17.

Chalmers, tegration perience 38:741

18.

Frankl, VT. S., and ment of an integrated cal pharmacology. (1974).

19.

McCarron, cation

20.

Sauter, R. C.: a rationale. (1974).

on

Organization Health

World

Teaching

training pharmacy and the diseased Ed. 36:16 (1972).

Amer.

Drugs: D.C.,

Office,

J.

GUn.

integrated

K.: Pharmacy of didactic and components. Amer. (1974).

J.

Ed.

Integration Amer. J.

35:396

of

Pharm.

IV. J.

12: for Drugs Pharm.

education: practical J. Pharm.

Roberts, J.: curriculum J. CUn. Pharm.

M.: An approach patient-oriented

Pharm.

and Organiza-

program

students. state. Amer.

R.

M. of

Clinical

responsibilities

clinical pharmacology. 404 (1972). 16.

Clin.

Clinical PharBoard, Division

13.

Drug admisArch.

Intern. Med. 134:219 (1974). Hoddinott, B. C., Gowdey, C. VT., Coulter, VT. K., and Parker, J. M.: Drug reactions and errors in administration on a medical ward. Can. Med. Assoc. J. 97:1001 (1967). Hynniman, C. E., Conrad, W. F., Urch, W. A., Rudthck, B. R., and Parker, P. J.:

January,

the Conference Drug Research

Government

chal19:117

utilizing Hosp.

interactions. (1974).

Resolution # 70A regarding drug tion adopted by the Student Medical Association House of at Annual Meeting, 1970.

(1972).

4.

Report of macology,

Pharmacology-Scope, Training. Geneva, tion, 1970.

Surveillance lenges. 3.

A. S.: Drug Amer. 58:965

12.

14.

(1971).

2.

1973.

Task Force on ground Papers.

References 1.

Association,

11.

Acknowledgments The Sauter critical

Drug Interactions-1973. D.C., American Pharmaceuti-

of Medical Council, Dec.

by

students.

drug distribution Amer. J. Hosp.

Nies, N.

10.

of

under dose

9.

is

cooperative and inof medical and

and traditional in four hospitals. 27:803 (1970).

errors unit

Martin, E. W.: Hazards of Medication. A Manual of Drug Interactions, Incompatibilities, Contradictions, and Adverse Effects. Philadelphia, Lippincott, 1971.

program

be attempted

medication Kentucky

8.

cal

per-

of

Evaluations Washington,

co-

of medical

participated

hoped that terdependent their

students.

of

University

7.

pro-

at improving and clinical

enthusiasm

that

pro-

BEHAVIOR

comparison

system system Pharm.

information.

multidisciplinary

represents quality of

AND A the

search, while

didactic

coordinated,

DISEASE,

offering profes-

literature

presentation

necessary

gram the

THERAPEUTICS,

InexEd.

Developin clini14:86

to the pharmacists.

edu-

(1971).

of basic sciences: Pharm. Ed. 38:735