Course:PHAR501/Pulmonary

From UBC Wiki
Pulmonary Therapeutics
Wiki.png
PHAR 501
Section:
Instructor: Dr. James McCormack
Email: james.mccormack@ubc.ca
Office: PHRM 3519
Office Hours:
Class Schedule: 1300-1700h, 30AUG12
Classroom: Pharm.D. Seminar Room
Important Course Pages
Syllabus
Lecture Notes
Assignments
Course Discussion


Pulmonary Therapeutics

Updated Aug/Sept 2012

Instructor

James McCormack, B.Sc., B.Sc.(Pharm), Pharm.D.
james.mccormack@ubc.ca
phone 604-603-7898

Section Objectives

The overall objective of this section is to have the Pharm. D. student design an effective, safe and cost-effective therapeutic plan for the treatment of patients with respiratory disease. The approach to the patient should follow the pharmacist’s workup of drug therapy.

This therapeutic plan should include:

  1. establishing achievable short term and long term goals of therapy
  2. choosing appropriate empiric drug therapy for the treatment of asthma (acute/chronic/adult/pediatric), bronchitis, and emphysema
  3. appropriate dosage recommendations based on patient variables such as age, weight, severity of disease, and organ function
  4. measuring the effectiveness of drug therapy by monitoring patient symptoms and objective pulmonary tests
  5. minimizing the risk of toxicity by understanding the toxicities of drug therapy and knowing what to do should they occur
  6. determining cost considerations of various type of therapy for pulmonary disease
  7. counselling patients on the appropriate use of inhalers
  8. understanding the clinically important drug/drug and drug/food interactions and what to do should they occur
  9. explaining the differences and similarities between drugs/products in the same therapeutic class and differentiating between these agents in the treatment of acute versus chronic asthma/COPD
  • beta agonists(inhaled, oral, and parenteral)
  • corticosteroids(inhaled, oral, and parenteral)
  • leukotriene antagonists
  • ipratropium, tiotropium
  • cromolyn, ketotifen
  • theophyllines and related salts (including different product formulations)
  • methotrexate, gold

Overall Schedule

JM handout

Tuesday September 4 - 1000 – 1200 – Evaluation of a patient with Asthma/COPD
Thursday September 6 - 1000 – 1200 – Acute asthma
Friday September 7 - 0800 – 1100 - Chronic asthma
Monday September 10 – 0800 - 1000 - Acid-Base – Sean Spina
Tuesday September 11 – 1000 - 1200 – Smoking Cessation – Sean Spina
Thursday September 13 – 1000 -1200 – COPD/Pulmonary Therapeutic Beliefs
Friday September 14 - 0800 – 1100 –Pediatric Asthma – Roxane Carr

Pre-readings and Pre-reading Objectives

** FOR YOUR REFERENCE - NOT TO BE READ FROM BEGINNING TO END
TUESDAY
A) Evaluation and assessment of asthma
 Pre-Readings

  1. Li JT, O’Connell. Clinical evaluation of asthma. Ann Allergy Asthma Immunol 1996;76:1-14
  2. Aaron SD et al. Overdiagnosis of asthma in obese and nonobese adults. CMAJ 2008;179:1121-31

Specific Pre-reading Objectives

  • For reference 1, review Table 1 and be able to discuss clinical features one needs to consider when obtaining a comprehensive history in a patient with asthma
  • Discuss the 4 limitations of the clinical evaluation of asthma

B) Drug-induced pulmonary disorders
 Pre-Readings

  1. **Ozkan M et al. Drug-induced lung disease. Clev Clin J Med. 2002

Specific Pre-reading Objectives

  • None – this is just for reference purposes

C) Pulmonary function tests, lung exam/breath sounds
Pre-Readings

  1. Examination of the Chest and Lungs – you can find this at http://medinfo.ufl.edu/year1/bcs/clist/chest.html
  2. Breath Sounds – you can find this at http://jan.ucc.nau.edu/~daa/heartlung/breathsounds/contents.html Review the breath sounds, adventitious sounds and voice transmission tabs of this website

Specific Pre-reading Objectives

List the physical exam parameters obtained through inspection, palpation, percussion, and auscultation that would likely be found in patients with asthma, bronchitis, emphysema, and pneumonia.
Be able to distinguish between wheezes and crackles during auscultation

D) Tests of Pulmonary Function
 Pre-readings

  1. Diagnosis and monitoring. Applied Therapeutics 2005:23-5,6,8 and 9
  2. Tests of pulmonary function
  3. McGrath AM, Gardner DM, McCormack J. Is home peak expiratory flow monitoring effective for controlling asthma symptoms? J Clin Pharm Ther 2001; 26:311-317
  4. Acid-Base Made Simple

Specific Pre-reading Objectives

Define and identify from a spirogram the various lung volumes (RV, ERV, TV, IRV) and capacities(TLC, VC, FRC, IC)
Define and identify FEV1, PEFR, FEF25%-75%
Describe when and how to use a peak flow meter in the treatment of pulmonary disorders

THURSDAY
E) X-ray
Pre-readings

  1. Dick E. Chest X-ray made easy. BMJ

Specific Pre-reading Objectives

List and describe 5 pieces of information that can be obtained from a chest X-ray

F) Therapeutics of acute asthma (LIKELY FOR THURSDAY), chronic asthma (LIKELY FOR THE FOLLOWING FRIDAY), COPD (LIKELY FOR THE FOLLOWING THURSDAY)
 Pre-readings

  1. Fanta CH. Asthma. N Engl J Med 2009;360:1002-14
  2. **Expert Panel Report-3 2007 Guidelines for the diagnosis and management of asthma. National Institute of Health
  3. **Bateman ED et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 2008;31:143-78
  4. **O’Donnell DE et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease – 2007 update Can Respir J 2007;14(Suppl B):5B-32B
  5. **Witt TJ et al. Management of Stable Chronic Obstructive Pulmonary Disease: A Systematic Review for a Clinical Practice Guideline. Ann Intern Med. 2007;147:639-53
  6. **Puhan MA et al. Inhaled drugs to reduce exacerbations in patients with chronic obstructive pulmonary disease: a network meta-analysis. BMC Medicine 2009;7:2
  7. LISTEN TO - Therapeutics Education Collaboration Podcast – Smoking cessation Episode 13; COPD - 26,27,39, ASTHMA - 104, 105, 124 IF YOU HAVE TIME – YOU WILL NEED A PREMIUM SUBSCRIPTION – email me once you have signed up on the site (therapeuticseducation.org) and I’ll give you a free one
  8. Inhaler technique MDI, spacers, diskus, turbuhaler, diskhaler – you can find this at http://www.asthma.ca/adults/treatment/howToUse.php

Specific Pre-reading Objectives

See overall section objectives – bottom line, please come prepared to discuss the selection and monitoring for drugs used in asthma and COPD
Retrieved from "https://wiki.ubc.ca/index.php?title=Course:PHAR501/Pulmonary&oldid=189266"