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Pharm D Year 4 Syllabus

This page gives the complete syllabus for Year 4 of the Pharm D course, exactly as prescribed by the Pharmacy Council of India (PCI) in the Pharm.D. Regulations 2008. Every subject of the year is listed below with its full syllabus: scope and objectives and the detailed syllabus and lecture wise schedule for theory subjects, and the full practical content for practical subjects. In this year the practical column of the course table is hospital posting for the clinical subjects.

Subjects in this year

4.1 Pharmacotherapeutics-III (Theory)

Scope: This course is designed to impart knowledge and skills necessary for contribution to quality use of medicines. Chapters dealt cover briefly pathophysiology and mostly therapeutics of various diseases. This will enable the student to understand the pathophysiology of common diseases and their management.

Objectives: At completion of this subject it is expected that students will be able to understand -

a. the pathophysiology of selected disease states and the rationale for drug therapy; b. the therapeutic approach to management of these diseases; c. the controversies in drug therapy; d. the importance of preparation of individualised therapeutic plans based on diagnosis; e. needs to identify the patientspecific parameters relevant in initiating drug therapy, and monitoring therapy (including alternatives, timecourse of clinical and laboratory indices of therapeutic response and adverse effects); f. describe the pathophysiology of selected disease states and explain the rationale for drug therapy; g. to summarize the therapeutic approach to management of these diseases including reference to the latest available evidence; h. to discuss the controversies in drug therapy; i. to discuss the preparation of individualised therapeutic plans based on diagnosis; and j. identify the patientspecific parameters relevant in initiating drug therapy, and monitoring therapy (including alternatives, timecourse of clinical and laboratory indices of therapeutic response and adverse effects).

Detailed Syllabus and Lecture Wise Schedule

Etiopathogenesis and pharmacotherapy of diseases associated with following systems/ diseases: Title of the topic

1. Gastrointestinal system: Peptic ulcer disease, Gastro Esophageal Reflux Disease, Inflammatory bowel disease, Liver disorders - Alcoholic liver disease, Viral hepatitis including jaundice, and Drug induced liver disorders.
2. Haematological system: Anaemias, Venous thromboembolism, Drug induced blood disorders.
3. Nervous system: Epilepsy, Parkinsonism, Stroke, Alzheimer's disease,
4. Psychiatry disorders: Schizophrenia, Affective disorders, Anxiety disorders, Sleep disorders, Obsessive Compulsive disorders
5. Pain management including Pain pathways, neuralgias, headaches.
6. Evidence Based Medicine

4.1 Pharmacotherapeutics-III (Practical)

Practicals: Hospital postings for a period of at least 50 hours is required to understand the principles and practice involved in ward round participation and clinical discussion on selection of drug therapy. Students are required to maintain a record of 15 cases observed in the ward and the same should be submitted at the end of the course for evaluation. Each student should present at least two medical cases they have observed and followed in the wards.

Assignments: Students are required to submit written assignments on the topics given to them. Topics allotted should cover recent developments in drug therapy of various diseases. A minimum of THREE assignments [1500 - 2000 words] should be submitted for evaluation.

Format of the assignment: 1. Minimum & Maximum number of pages 2. Reference(s) shall be included at the end. 3. Assignment can be a combined presentation at the end of the academic year 4. It shall be computer draft copy 5. Name and signature of the student 6. Time allocated for presentation may be 8+2 Min.

4.2 Hospital Pharmacy (Theory)

Scope: In the changing scenario of pharmacy practice in India, for successful practice of Hospital Pharmacy, the students are required to learn various skills like drug distribution, drug dispensing, manufacturing of parenteral preparations, drug information, patient counselling, and therapeutic drug monitoring for improved patient care.

Objectives: Upon completion of the course, the student shall be able to -

a. know various drug distribution methods; b. know the professional practice management skills in hospital pharmacies; c. provide unbiased drug information to the doctors; d. know the manufacturing practices of various formulations in hospital set up; e. appreciate the practice based research methods; and f. appreciate the stores management and inventory control.

Lecture Wise Programme

Topics

1. Hospital - its Organisation and functions
2. Hospital pharmacy - Organisation and management a) Organizational structure - Staff, Infrastructure & work load statistics b) Management of materials and finance c) Roles & responsibilities of hospital pharmacist
3. The Budget - Preparation and implementation
4. Hospital drug policy a) Pharmacy and Therapeutic committee (PTC) b) Hospital formulary c) Hospital committees - Infection committee - Research and ethical committee d) developing therapeutic guidelines e) Hospital pharmacy communication - Newsletter
5. Hospital pharmacy services a) Procurement & warehousing of drugs and Pharmaceuticals b) Inventory control Definition, various methods of Inventory Control - ABC, VED, EOQ, Lead time, safety stock c) Drug distribution in the hospital i) Individual prescription method ii) Floor stock method iii) Unit dose drug distribution method d) Distribution of Narcotic and other controlled substances e) Central sterile supply services - Role of pharmacist
6. Manufacture of Pharmaceutical preparations a) Sterile formulations - large and small volume parenterals b) Manufacture of Ointments, Liquids, and creams c) Manufacturing of Tablets, granules, capsules, and powders d) Total parenteral nutrition
7. Continuing professional development programs. Education and training
8. Radio Pharmaceuticals - Handling and packaging
9. Professional Relations and practices of hospital pharmacist

4.2 Hospital Pharmacy (Practical)

1. Assessment of drug interactions in the given prescriptions
2. Manufacture of parenteral formulations, powders.
3. Drug information queries.
4. Inventory control

List of Assignments:

1. Design and Management of Hospital pharmacy department for a 300 bedded hospital.
2. Pharmacy and Therapeutics committee - Organization, functions, and limitations.
3. Development of a hospital formulary for 300 bedded teaching hospital
4. Preparation of ABC analysis of drugs sold in one month from the pharmacy.
5. Different phases of clinical trials with elements to be evaluated.
6. Various sources of drug information and systematic approach to provide unbiased drug information.
7. Evaluation of prescriptions generated in hospital for drug interactions and find out the suitable management.

4.3 Clinical Pharmacy (Theory)

Objectives of the Subject: Upon completion of the subject student shall be able to (Know, do, appreciate) -

a. monitor drug therapy of patient through medication chart review and clinical review; b. obtain medication history interview and counsel the patients; c. identify and resolve drug related problems; d. detect, assess and monitor adverse drug reaction; e. interpret selected laboratory results (as monitoring parameters in therapeutics) of specific disease states; and f. retrieve, analyse, interpret and formulate drug or medicine information.

Detailed Syllabus and Lecture Wise Schedule

Title of the topic

1. Definitions, development and scope of clinical pharmacy
2. Introduction to daily activities of a clinical pharmacist a. Drug therapy monitoring (medication chart review, clinical review, pharmacist interventions) b. Ward round participation c. Adverse drug reaction management d. Drug information and poisons information e. Medication history f. Patient counseling g. Drug utilisation evaluation (DUE) and review (DUR) h. Quality assurance of clinical pharmacy services
3. Patient data analysis. The patient's case history, its structure and use in evaluation of drug therapy & Understanding common medical abbreviations and terminologies used in clinical practices.
4. Clinical laboratory tests used in the evaluation of disease states, and interpretation of test results a. Haematological, Liver function, Renal function, thyroid function tests b. Tests associated with cardiac disorders c. Fluid and electrolyte balance d. Microbiological culture sensitivity tests e. Pulmonary Function Tests
5. Drug & Poison information a. Introduction to drug information resources available b. Systematic approach in answering DI queries c. Critical evaluation of drug information and literature d. Preparation of written and verbal reports e. Establishing a Drug Information Centre f. Poisons information - organization & information resources
6. Pharmacovigilance a. Scope, definition and aims of pharmacovigilance b. Adverse drug reactions - Classification, mechanism, predisposing factors, causality assessment [different scales used] c. Reporting, evaluation, monitoring, preventing & management of ADRs d. Role of pharmacist in management of ADR.
7. Communication skills, including patient counselling techniques, medication history interview, presentation of cases.
8. Pharmaceutical care concepts
9. Critical evaluation of biomedical literature
10. Medication errors

4.3 Clinical Pharmacy (Practical)

Students are expected to perform 15 practicals in the following areas covering the topics dealt in theory class.

a. Answering drug information questions (4 Nos) b. Patient medication counselling (4 Nos) c. Case studies related to laboratory investigations (4 Nos) d. Patient medication history interview (3 Nos)

Assignment: Students are expected to submit THREE written assignments (1500 - 2000 words) on the topics given to them covering the following areas dealt in theory class.

Drug information, Patient medication history interview, Patient medication counselling, Critical appraisal of recently published articles in the biomedical literature which deals with a drug or therapeutic issue.

Format of the assignment: 1. Minimum & Maximum number of pages. 2. Reference(s) shall be included at the end. 3. Assignment can be a combined presentation at the end of the academic year. 4. It shall be computer draft copy. 5. Name and signature of the student. 6. Time allocated for presentation may be 8+2 Min.

4.4 Biostatistics & Research Methodology (Theory)

Detailed Syllabus and Lecture Wise Schedule

1. Research Methodology

a) Types of clinical study designs: Case studies, observational studies, interventional studies, b) Designing the methodology c) Sample size determination and Power of a study: Determination of sample size for simple comparative experiments, determination of sample size to obtain a confidence interval of specified width, power of a study d) Report writing and presentation of data

2. Biostatistics

2.1 a) Introduction b) Types of data distribution c) Measures describing the central tendency distributions - average, median, mode d) Measurement of the spread of data - range, variation of mean, standard deviation, variance, coefficient of variation, standard error of mean.

2.2 Data graphics: Construction and labeling of graphs, histogram, piecharts, scatter plots, semilogarthimic plots

2.3 Basics of testing hypothesis

a) Null hypothesis, level of significance, power of test, P value, statistical estimation of confidence intervals. b) Level of significance (Parametric data) - students t test (paired and unpaired), chi Square test, Analysis of Variance (oneway and twoway) c) Level of significance (Nonparametric data) - Sign test, Wilcoxan's signed rank test, Wilcoxan rank sum test, Mann Whitney U test, Kruskal-Wall is test (one way ANOVA) d) Linear regression and correlation - Introduction, Pearsonn's and Spearmann's correlation and correlation coefficient. e) Introduction to statistical software: SPSS, Epi Info, SAS.

2.4 Statistical methods in epidemiology: Incidence and prevalence, relative risk, attributable risk

3. Computer applications in pharmacy

Computer System in Hospital Pharmacy: Patterns of Computer use in Hospital Pharmacy - Patient record database management, Medication order entry - Drug labels and list - Intravenous solution and admixture, patient medication profiles, Inventory control, Management report & Statistics.

Computer In Community Pharmacy: Computerizing the Prescription Dispensing process - Use of Computers for Pharmaceutical Care in community pharmacy - Accounting and General ledger system

Drug Information Retrieval & Storage : Introduction - Advantages of Computerized Literature Retrieval - Use of Computerized Retrieval

4.5 Biopharmaceutics & Pharmacokinetics (Theory)

1. Biopharmaceutics

2. Introduction to Biopharmaceutics a. Absorption of drugs from gastrointestinal tract. b. Drug Distribution. c. Drug Elimination.

3. Pharmacokinetics

4. Introduction to Pharmacokinetics. a. Mathematical model b. Drug levels in blood. c. Pharmacokinetic model d. Compartment models e. Pharmacokinetic study.

5. One compartment open model. a. Intravenous Injection (Bolus) b. Intravenous infusion.
6. Multicompartment models. a. Two compartment open model. b. IV bolus, IV infusion and oral administration
7. Multiple - Dosage Regimens. a. Repititive Intravenous injections - One Compartment Open Model b. Repititive Extravascular dosing - One Compartment Open model c. Multiple Dose Regimen - Two Compartment Open Model
8. Nonlinear Pharmacokinetics. a. Introduction b. Factors causing Nonlinearity. c. Michaelismenton method of estimating parameters.
9. Noncompartmental Pharmacokinetics. a. Statistical Moment Theory. b. MRT for various compartment models. c. Physiological Pharmacokinetic model.
10. Bioavailability and Bioequivalence. a. Introduction. b. Bioavailability study protocol. c. Methods of Assessment of Bioavailability

4.5 Biopharmaceutics & Pharmacokinetics (Practical)

1. Improvement of dissolution characteristics of slightly soluble drugs by some methods.
2. Comparison of dissolution studies of two different marketed products of same drug.
3. Influence of polymorphism on solubility and dissolution.
4. Protein binding studies of a highly protein bound drug and poorly protein bound drug.
5. Extent of plasmaprotein binding studies on the same drug (i.e. highly and poorly protein bound drug) at different concentrations in respect of constant time.
6. Bioavailability studies of some commonly used drugs on animal/human model.
7. Calculation of Ka, Ke, t1/2, Cmax, AUC, AUMC, MRT etc. from blood profile data.
8. Calculation of bioavailability from urinary excretion data for two drugs.
9. Calculation of AUC and bioequivalence from the given data for two drugs.
10. In vitro absorption studies.
11. Bioequivalency studies on the different drugs marketed. (eg) Tetracycline, Sulphamethoxzole, Trimethoprim, Aspirin etc., on animals and human volunteers.
12. Absorption studies in animal inverted intestine using various drugs.
13. Effect on contact time on the plasma protein binding of drugs.
14. Studying metabolic pathways for different drugs based on elimination kinetics data.
15. Calculation of elimination halflife for different drugs by using urinary elimination data and blood level data.
16. Determination of renal clearance.

4.6 Clinical Toxicology (Theory)

1. General principles involved in the management of poisoning
2. Antidotes and the clinical applications.
3. Supportive care in clinical Toxicology.
4. Gut Decontamination.
5. Elimination Enhancement.
6. Toxicokinetics.
7. Clinical symptoms and management of acute poisoning with the following agents - a) Pesticide poisoning: organophosphorous compounds, carbamates, organochlorines, pyrethroids. b) Opiates overdose. c) Antidepressants d) Barbiturates and benzodiazepines. e) Alcohol: ethanol, methanol. f) Paracetamol and salicylates. g) Nonsteroidal antiinflammatory drugs. h) Hydrocarbons: Petroleum products and PEG. i) Caustics: inorganic acids and alkali. j) Radiation poisoning
8. Clinical symptoms and management of chronic poisoning with the following agents - Heavy metals: Arsenic, lead, mercury, iron, copper
9. Venomous snake bites: Families of venomous snakes, clinical effects of venoms, general management as first aid, early manifestations, complications and snake bite injuries.
10. Plants poisoning. Mushrooms, Mycotoxins.
11. Food poisonings
12. Envenomations - Arthropod bites and stings.

Substance abuse: Signs and symptoms of substance abuse and treatment of dependence a) CNS stimulants : amphetamine b) Opioids c) CNS depressants d) Hallucinogens: LSD e) Cannabis group f) Tobacco

Source: Pharmacy Council of India, New Delhi, Pharm.D. Regulations 2008 (published in the Gazette of India, No.19, Part III, Section 4, New Delhi, 10th May, 2008), Appendix-A (see regulation 8), Pharm.D. Syllabus. Syllabus text above is reproduced from the PCI syllabus.