HMM301 Principles of Pharmacology Assessment Task 3 Student Copy Trimester 1 2017 HMM301 Principles of Pharmacology Assessment Task 3 Trimester 1 2017 2 HMM301 Written Assessment. Introduction This assessment has been designed as an investigation task where students are able to develop their skills in searching for information across a broad range of media. Students are able to bring together previous skills developed in other units and hone them into a professional document. The task is set to investigate a specific condition and the drug of treatment as described below. Students should read this entire document and attend the lecture which will instruct you further on the required criteria. Purpose The art of communication in the science industry is extremely important. It is paramount to be professional and factual when reporting both to your peers, within the industry and to the public forum. The art of scientific writing removes the unnecessary and emphasises that of significant worth. Therefore, on completion of this task, students will better understand the importance of factual and succinct writing associated with reporting and publishing information in the science industry. Students will also appreciate the vast plethora of information at their disposal outside of the prescribed text. Unit Learning Outcomes (ULO’s). This assessment task will address the following Unit Learning Outcomes (ULO’s) • ULO1 - Explain the principles of pharmacology and have a basic understanding of systems pharmacology (neuropharmacology, cardiovascular, endocrine pharmacology and chemotherapy). • ULO2 - Be able to work in a team environment to complete a multidisciplinary evaluation of clinical problem in pharmacology (eg. Case study). • ULO3 - Use digital and non-digital means to search for current and relevant supporting scholarly evidence and make clear and cohesive arguments that are correctly referenced, within the discipline pharmaceutical science. • ULO4 - Present information in a clear, accurate and concise manner using various means (e.g., written report) to specialists and non-specialists within the discipline of medical science The assessment. The assessment piece will be a 1,200 word essay summary of one of the cases outlined below. 1. Case 1: Barbiturates and alcohol 2. Case 2: Addiction and clonidine 3. Case 3: Clopidogrel and thrombosis 4. Case 4: Metformin and type 2 diabetes mellitus. HMM301 Principles of Pharmacology Assessment Task 3 Trimester 1 2017 3 5. Case 5: Chloroquine and malaria. 6. Case 6: Combination Therapy and multidrug-resistant tuberculosis (MDR-TB). The questions in each case study should be used as general learning and understanding guides only, and students should feel free to use all the material available to them from library and electronic sources; as well as knowledge gained within the unit. A detailed lecture covering the protocols and requirements for the assessment will be delivered to students following the mid-trimester exam. This will provide students with the opportunity to ask questions and clarify concerns. (Detailed cases attached at the end of this document) The submitted essay must: • Have your name and student number clearly marked on the first page; as well as the campus at which you are enrolled and the title of the case which you have chosen. • Include a signed statement on the first page indicating that the work ‘to the best of the students’ knowledge is original’ and that there ‘is not conflict of interest’. • Be written in your own words. It is strongly advised that students: • Use titles (e.g. Executive summary, Pharmacodynamics, Pharmacokinetic Implications, General discussion) as used in the assessment rubric to ensure ease of marking and maximum award for each section. Format: • 1,200 words, 1.5 spacing minimum. Margins 2cm. Font must be 12pt Times New Roman. • Students are encouraged to use diagrams and figures where appropriate. o Please limit this to 2 figure and/one table maximum. o Text in figure legends will not be included in the word count. o Text in table DOES count towards the word limit Referencing style and allowances • References are to be in the Harvard referencing style. All information must be cited to the author where the information was sorted and a full reference to the text in the reference section. • Where text is quoted a reference must be indicated clearly and the text enclosed in inverted commas: as in “…..text “. HMM301 Principles of Pharmacology Assessment Task 3 Trimester 1 2017 4 • It is perfectly acceptable to reference websites however random un-reviewed websites are not acceptable references. o Websites cited as references must be peer reviewed (journal home pages or official research sites) or government registered sites (these are all peer reviewed). It is highly recommended that the main source of information used for this assignment be in the form of journal publications. o If websites are used then students need to indicate the web address in the text or as a footnote. o Where the original source is indicated in the web site: indicate this. • The majority of science publications can be found at http://www.ncbi.nlm.nih.gov/pubmed. • Text books are also an acceptable form of reference material in this unit. • Lectures are not an acceptable form of reference material however, the information within can be used when referenced back to the point of origin (textbook, journal article) and the publication author needs to be cited correctly. • You should read all published material, make notes and then reproduce the material in your own words. • All statements must be cited as to the originality of the work. Submission Format: • The finished assignment must be submitted in PDF format only (save as a PDF in Word or Pages) and uploaded through the assignment portal on Cloud Deakin. Plagiarism • It is recommended that students check through the plagiarism scanner on Turnitin before submission. • Only referencing material and small text should be detected. • Your work submitted must be your own. • All work will be scanned for PLAGARISM. Late penalties. The following marking penalties will apply if you submit an assessment task after the due date without an approved extension: • 5% will be deducted from available marks for each day up to five days. HMM301 Principles of Pharmacology Assessment Task 3 Trimester 1 2017 5 • Work that is submitted more than five days after the due date will not be marked; you will receive 0% for the task. ' • Day' means working day for paper submissions and calendar day for electronic submissions. • The Unit Chair may refuse to accept a late submission where it is unreasonable or impracticable to assess the task after the due date. • It is important that you check any assignment instructions carefully to see if late submissions are impracticable to assess and will not be marked. Due Date and Extension Requests This assessment is due for submission on Sunday 7th May before 11.59pm, 2017 Students with legitimate concerns as to meeting the submission time need to contact the unit chair as early as possible prior to submission time. Students are reminded that they require a valid medical certificate for medically significant reason for not meeting the required conditions and/or date of submission. Students are advised to submit well before the final hour of submission as delays can occur when large numbers of students attempt to upload at the same time. Assessment Cases The following cases are the bases of your assessment. You should concentrate you work on the parameters in the title for each case. Case 1: Barbiturates and alcohol. SB, a 70-year-old man, is having trouble sleeping. He recalls that his sister has been prescribed phenobarbital, a barbiturate, to control her epileptic seizures, and that barbiturates are sometimes also prescribed as sleeping pills. He decides to take “just a few” with some alcohol to help him sleep. Shortly afterward, Mr. B is rushed to the emergency department after his sister finds him minimally responsive. On examination, he is difficult to arouse and dysarthric, with an unsteady gait and impaired attention and memory. His respiratory rate is approximately six shallow breaths per minute. The patient is subsequently intubated to protect him from aspirating gastric contents. Activated charcoal is administered through a nasogastric tube to limit further absorption of phenobarbital. He also receives intravenous sodium bicarbonate to alkalinize his urine to a pH of 7.5 to facilitate renal drug excretion. Three days later, he has recovered sufficiently to return home. HMM301 Principles of Pharmacology Assessment Task 3 Trimester 1 2017 6 Case 2: Addiction and clonidine CA, a 33-year-old man, is brought to the emergency department with severe nausea, vomiting, diarrhea, muscle aches, and anxiety. Mr. A explains that he is currently shooting morphine or heroin about 3 days per week and using marijuana or cocaine “whenever.” He feels he wants to die. On examination, he has enlarged pupils, temperature is 103°F, blood pressure is 170/95 mm Hg, and heart rate is 108 beats/min. He is irritable and has abdominal cramping, hyperalgesia, and photophobia. Mr. A is given clonidine, with loperamide, ibuprofen, and promethazine as needed for diarrhea, pain, and nausea/vomiting, respectively. The severity of withdrawal does not diminish significantly until he is given sub- lingual buprenorphine/naloxone every 8 hours. Over the next week, Mr. A’s buprenorphine/naloxone is titrated to a once daily dose, with progressive diminution of withdrawal symptoms and drug craving. Mr. A is discharged to a 28-day intensive outpatient treatment program during which he continues buprenorphine/ naloxone. He agrees to attend daily mutual support self-help meetings (Alcoholics or Narcotics Anonymous), where he tells the tale of his addiction. He began diet pills in his teens for weight control and drinking as a response to physical abuse by his alcoholic father. He was prescribed Tylenol #3 for pain after minor surgery; thereafter, he started “street” pain pills and “doctor shopping” for back pain and depression, and he even had healthy teeth extracted to get opioids from the dentist. He was distraught when a close relative died, and he switched to intravenous opioids, including fentanyl patches that he ate or injected. He had three inpatient treatments, always relapsing after discharge to increasingly higher drug doses. He also tried methadone maintenance treatment for 6 months with some benefit but was unable to completely stop using “street drugs” and “never felt normal on methadone.” Mr. A continues to be abstinent from illicit opioids after 5 years on sublingual buprenorphine/ naloxone. He visits his psychiatrist monthly for psychotherapy and adheres to his treatment contract of monthly attendance at group therapy and weekly Narcotics Anonymous (NA) or Alcoholics Anonymous (AA) meetings. He consistently provides drug-free urine tests. He has been promoted at work, has negotiate Case 3: Clopidogrel and thrombosis. Mr. S, a 55-year-old man with a history of hypertension and cigarette smoking, is awakened in the middle of the night with substernal chest pressure, sweating, and shortness of breath. He calls 911 and is taken to the emergency department. An electrocardiogram shows deep T-wave inversions in leads V2 to V5. A cardiac biomarker panel shows a creatine kinase level of 800 IU/L (normal, 60–400 IU/L) with 10% MB fraction (the heart-specific isoform), suggesting myocardial infarction. He is treated with intravenous nitro-glycerine, aspirin, unfractionated heparin, and eptifibatide, but his chest pain persists. He is taken to the cardiac catheterization laboratory, where he is found to have a 90% mid- LAD (left anterior descending artery) thrombus with sluggish distal flow. He undergoes successful angioplasty and stent placement. At the time of stent placement, an oral loading dose of clopidogrel is administered. The heparin is stopped, intravenous eptifibatide is continued for 18 more hours, and he is transferred to the telemetry ward. Six hours later, Mr. S is noted to have an expanding hematoma (an area of localized hemorrhage) in his right thigh below the arterial access site. The eptifibatide is stopped and pressure is applied to the access site, and the hematoma ceases HMM301 Principles of Pharmacology Assessment Task 3 Trimester 1 2017 7 to expand. He is discharged 2 days later with prescriptions that include clopidogrel and aspirin, which are administered to prevent subacute thrombosis of the stent. Case 4: Metformin and type 2 diabetes mellitus. At her annual check-up, 55-year-old Mrs. S complains of fatigue and frequent urination (polyuria), even at night. She also reports drinking large volumes of fluids (polydipsia) to quench her thirst. Although these symptoms have been “going on for a while” and are getting worse, Mrs. S has difficulty pinpointing their exact onset. She denies other urinary symptoms such as pain on urination, blood in her urine, dribbling, and incontinence. Her past medical his- tory is remarkable for hyperlipidemia of 10 years in duration. Both of her parents died of coronary heart disease in their early 60s. On physical examination, Mrs. S is moderately obese but otherwise appears normal. Glucose is detected in her urine, but proteins and ketones are not. Her blood tests are significant for elevated glucose (240 mg/dL), elevated total cholesterol (340 mg/dL), and elevated HbA1c level (a measure of glucose covalently bound to hemoglobin; 9.2%). The physician explains to Mrs. S that she has type 2 diabetes mellitus. In this disease, the body fails to respond normally to insulin (insulin resistance) and cannot produce a sufficient amount of insulin to overcome this resistance. The physician discusses with Mrs. S the importance of decreasing her caloric intake and increasing her exercise to improve her metabolic state. The physician also prescribes metformin (a biguanide) for her diabetes. Case 5: Chloroquine and Malaria. Mr. G is a 36-year-old married software engineer who was born and raised in India. He comes to the United States and is completely well for 6 months. He then begins to experience episodes of fever, headache, and body aches. One week later, he goes to his physician, who examines a smear of Mr. G’s blood, diagnoses malaria, and prescribes chloroquine for treatment. Therapy with chloroquine resolves his symptoms completely. However, Mr. G notes recurrence of fevers and the other symptoms 3 months later and returns to his doctor’s office. HMM301 Principles of Pharmacology Assessment Task 3 Trimester 1 2017 8 Case 6: Combination Therapy and multidrug-resistant tuberculosis (MDR-TB) Mr. M is a 27-year-old man from rural Haiti who presents to a clinic with a chronic cough. He cannot afford treatment at a private clinic, so he goes to a drugstore and asks the pharmacist for appropriate medication. The pharmacist thinks that Mr. M could have tuberculosis, and he sells Mr. M a 2-week supply of isoniazid and rifampin. Mr. M takes both drugs for a couple of days, but they make him nauseated, and he decides to take just the isoniazid for 2 weeks. His symptoms resolve. Three months later, Mr. M’s cough returns. This time, he notices blood in his sputum, and he has night sweats. He takes the remainder of the 2-week supply of rifampin and experiences a brief lull in his symptoms. Within a few days, however, his cough, bloody sputum, and night sweats return. Because he does not have enough money to buy additional drugs, he travels to the nearest government hospital to seek free care and medications. The government doctor takes three sputum samples, all of which are positive for acid-fast bacilli. The doctor also sends sputum to the laboratory for culture, but since Mycobacterium tuberculosis (the causative agent of tuberculosis) is slow-growing, he also starts Mr. M on a multidrug regimen consisting of isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months, followed by isoniazid and rifampin for 4 months. Several weeks later, the culture reveals that Mr. M’s tuberculosis is not susceptible to either isoniazid or rifampin. He is now seeking a new recommendation for treatment. HMM301 Principles of Pharmacology Assessment Task 3 Trimester 1 2017 9 Marking rubric for HMM301 Assessment 3 Case study Criteria High Distinction 100-80% Distinction 79.5-70% Credit 69.5-60% Pass 59.5-50% Fail 49.5-0% Executive summary (Introduction and Background) Clear, accurate and concise description of the clinical course and treatment with use of a wide variety of published sources and discussion of disease state Pathophysiology of process and clinical course state described but minor improvements needed regarding clarity OR accuracy OR conciseness. Adequate summary of treatment regime. Some use of referenced sources from outside prescribed text. Adequate description of the pathophysiology process and disease state; but some inaccuracies AND/OR lengthy; Some description of treatment course. Brief account of the pathophysiology of the disease but requires further elaboration AND/OR clarification: no description of treatment course. Missing OR inaccurate AND/OR unclear account of the clinical course and treatment regimen. (10.00- 8.00) (7.95-7.0) (6.95-6.0) (5.950-5.0) (4.95-0) Pharmacodynamics (PD) (Description of the mechanism of drug action) Clear, accurate and concise description of all PD implications pertinent to the treatment regime. Wide use of referenced sources from outside prescribed text. Clear, accurate and concise description of all PD implications pertinent to the treatment regime but minor improvements needed regarding clarity OR accuracy OR conciseness; discussion of other off target effects. Some use of referenced sources from outside prescribed text. Adequate of account PD implications pertinent to treatment regime; but some inaccuracies AND/OR lengthy; little discussion of other off-target receptor interactions. Brief account of PD implications pertinent to treatment regime but requires further elaboration AND/OR clarification; no discussion with other off-target receptor interactions. Missing OR inaccurate AND/OR unclear account of the PD implications of treatment. (20.00-16.00) (15.9-14.0) (13.9-12.0) (12.9-10.0) (9.9-0) Pharmacokinetic (PK) Implications: Description of the mechanism of patient response (pharmacokinetics) . Clear, accurate and concise description of all PK implications pertinent to the treatment regime. Wide use of referenced sources from outside prescribed text. Clear, accurate and concise description of all PK implications pertinent to the treatment regime but minor improvements needed regarding clarity OR accuracy OR conciseness; discussion of other off target effects. Some use of referenced sources from outside prescribed text. Adequate of account PK implications pertinent to treatment regime but some inaccuracies AND/OR lengthy; little discussion of other off-target receptor interactions. Brief account of PK implications pertinent to treatment regime but requires further elaboration AND/OR clarification; no discussion with other off-target receptor interactions. Missing OR inaccurate AND/OR unclear account of the PK implications of treatment. (20.00-16.00) (15.9-14.0) (13.9-12.0) (12.9-10.0) (9.9-0) HMM301 Principles of Pharmacology Assessment Task 3 Trimester 1 2017 10 General discussion: Suggest alternative treatment course if any, as well sideeffects Comprehensive analysis and description of side effects associated with prescribed clinical course and discussion of alternative treatments with use of referenced beyond that provided or in the prescribed text. Clear, accurate and concise description of relevant side effects associated with prescription but minor improvements needed regarding clarity OR accuracy OR conciseness. Some discussion of alternate treatments. Adequate evaluation of diagnostic limitations and side effects interfering with aim of prescribed clinical course; as well as some discussion of alternative treatment. Brief account of evaluation of limitations and side effects interfering with aim of prescribed clinical course. Missing OR inaccurate evaluation of the limitations and side effects interfering with aim of prescribed clinical course. (20.00-16.00) (15.9-14.0) (13.9-12.0) (12.9-10.0) (9.9-0) Structure & Communication style Excellent structure; discipline specific language used throughout with correct spelling and grammar making it easy to comprehend Very good structure; Discipline specific language used throughout with spelling and/or grammatical errors which do not detract from the reader’s comprehension Good structure; Discipline specific language used throughout with spelling and/or grammatical errors which somewhat detracts from the reader’s comprehension All elements present but not logically structured; Generally used discipline specific language throughout with spelling and/or grammatical errors which detracts from the reader’s comprehension Lacks structure; Minimal use of discipline specific language OR major spelling and/or grammatical errors making it difficult to comprehend (20.00-16.00) (15.9-14.0) (13.9-12.0) (12.9-10.0) (9.9-0) Supporting evidence / referencing Consistent referencing style throughout with a sufficient number of high quality sources used accurately and correctly. Consistent referencing style throughout with a sufficient number of high quality sources used accurately and correctly with a few mistakes. Consistent referencing style throughout with an adequate number of high quality sources used accurately and correctly with several mistakes. Consistent referencing style throughout with mostly high quality sources used accurately and correctly with several mistakes OR too few references. Inadequate or inappropriate references cited OR major mistakes. (10.00-8.0) (7.95-7.0) (6.95-6.0) (5.95-5.0) (4.95-0) High Distinction 80-100% Distinction 70-79.5% Credit 60-69.5% Pass 50-59.5% Fail 0-49.5%