University of Minnesota College of Pharmacy

Phar 6122 Pharmacotherapy II: (Cardiology)

Robert J. Straka, Pharm.D. Course Director

Spring 2006

Phar 6122: Pathophysiology and Pharmacotherapy of Cardiovascular Disorders Spring 2006 Revised 01/13/06 Table of Contents and Reading Assignments January 18 t h

Orientation and Course Overview

Dr. Straka

Course Table of Contents and Readings Assignments .............................................................. 1 Course Information (6122 overview of all three sections) ........................................................ 8 Phar 6122 Course Schedule..................................................................................................... 14 Cardiovascular Section Information........................................................................................ 17 Advice for Exam Taking ......................................................................................................... 21 Helpful Abbreviations ............................................................................................................. 22 Introduction to Phar6122......................................................................................................... 24 Objectives................................................................................................................................ 25 Cardiac Anatomy Lecture........................................................................................................ 26 Suggested American Heart Association. 2006 Heart and Stroke Statistical Update. (http://www.americanheart.org/downloadable/heart/1136308648540Statupdate2006.pdf)

January 18 t h

Hypertension I

Dr. Straka

Objectives................................................................................................................................ 29 Hypertension Lecture .......................................................................................................... TBA Required DiPiro 6th ed. (2005), Chapter 13: Hypertension……….pp 185-217 Suggested Barkis GL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (The JNC 7 Report). JAMA. 2003;289:25602572. (http://www.nhlbi.nih.gov/guidelines/hypertension/index.htm) (http://www.courses.ahc.umn.edu/pharmacy/5822/JNC_7_Complete_Version_2003.pdf)

January 20 t h

Hypertension II

Dr. Straka

Objectives................................................................................................................................ 29 Hypertension Lecture .............................................................................................................. 30-56

January 23 r d

Hypertension III

Dr. Straka

Objectives................................................................................................................................ 29 Hypertension Lecture .......................................................................................................... TBA

January 23 r d

Hypertension IV

Dr. Straka

Objectives................................................................................................................................ 29 Hypertension Lecture .......................................................................................................... TBA

Page 1

January 25 t h

Hyperlipidemia: Drug Pathophysiology

Dr. Straka

Objectives................................................................................................................................ 57 Hyperlipidemia Lecture....................................................................................................... TBA Quiz 1 Take quiz online through WebCT Vista (http://vista.umn.edu) for the cardiovascular topic of hypertension. Required Executive Summary of the Third Report of the National Cholesterol Education Program Expert Panel on Detection Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001: 285(19) 2486-2496. Web access to ATP III guidelines: (http://www.nhlbi.nih.gov/guidelines/cholesterol/atp_iii.htm) Suggested DiPiro 6th ed. (2005), Chapter 21: Hyperlipidemia……………pp 429-452

January 25 t h

Hyperlipidemia: Drug Therapy I

Dr. Straka

Objectives................................................................................................................................ 57 Hyperlipidemia Lecture....................................................................................................... TBA

January 27 t h

Hyperlipidemia: Drug Therapy II

Dr. Straka

Objectives................................................................................................................................ 57

Hyperlipidemia Lecture ...........................................................................................TBA January30 t h

Hyperlipidemia: Drug Therapay III

Dr. Straka

Objectives................................................................................................................................ 57 Hyperlipidemia Lecture....................................................................................................... TBA

Appendix A: Web Exercise Due Submit exercise with a stapled PDF abstract printout to cardiovascular TA at end of class on 1/30/06

January 30 t h

Review and Case Studies for Hypertension and Hyperlipidemia

Dr. Straka

Objectives............................................................................................................................ TBA Quiz 2 Take quiz online through WebCT Vista (http://vista.umn.edu) for the cardiovascular topic of dysipidemia.

February 1 s t Coronary Syndromes: Chronic Stable Angina (SA), Dr. Straka Unstable Angina (UA or non-STEMI), and Myocardial Infarction (MI or STEMI) with Pathophysiology Overview Objectives of Ischemic Heart Disease ..................................................................................... 58 Ischemic Heart Disease Lecture .......................................................................................... TBA Table of Contents 1/13/06

Page 2

Objectives of Acute Coronary Syndromes .............................................................................. 58 Acute Coronary Syndromes Lecture ................................................................................... TBA Required DiPiro 6th ed. (2005), Chapter 15: Ischemic Heart Disease…………….pp 261-290 Suggested 1) ACC/AHA 2002 Guideline Update for the Management of Patients with Chronic Stable AnginaFull Text. See the AHA website: (http://www.americanheart.org/presenter.jhtml?identifier=3006769) 2) ACC/AHA Guideline Update 2002 for the Management of Patients With Unstable Angina and Non--ST-Segment Elevation Myocardial Infarction. Access to the summary article at the AHA website: (http://circ.ahajournals.org/cgi/content/full/106/14/1893) 3) AHA/ACC 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infraction. Access to the guideline at the AHA website: (http://circ.ahajournals.org/cgi/reprint/110/9/e82)

February 1 s t

Pharmacotherapy of Chronic Stable Angina (SA) Part I

Dr. Straka

Objectives................................................................................................................................ 58 Ischemic Heart Disease and Chronic Stable Angina Lecture .............................................. TBA

February 3 r d

Cardiovascular Exam #1

Dr. Straka

Examination covers CV material from 1/18 to 1/30

February 6 t h

Pharmacotherapy of Chronic Stable Angina (SA) Part II

Dr. Straka

Objectives................................................................................................................................ 58 Ischemic Heart Disease and Stable Angina Lecture............................................................ TBA

February 6 t h

Pharmacotherapy of UA/non-STEMI

Dr. Gulseth

Objectives................................................................................................................................ 59 Unstable Angina/non-STEMI Lecture ................................................................................ TBA Required DiPiro 6th ed. (2005), Chapter 11: Cardiovascular Testing………………………..pp 149-170 DiPiro 6th ed. (2005), Chapter 16: Acute Coronary Syndromes……………….…..pp 291-319

February 8 t h

Pharmacotherapy of STEMI

Dr. Gulseth

Objectives................................................................................................................................ 59 STEMI Lecture.................................................................................................................... TBA

February 8 t h

Antithrombotic Therapy in CV: Part I

Dr. Gulseth

Objectives................................................................................................................................ 59 Antithrombotic Therapy Lecture......................................................................................... TBA Table of Contents 1/13/06

Page 3

Suggested 1) CHEST: Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy 2004. Access CV website (http://www.courses.ahc.umn.edu/pharmacy/5822/CHESTACCP2004.html) 2) Guide to Anticoagulant Therapy: Heparin (AHA 2001 Scientific Statement). Access the AHA website (http://circ.ahajournals.org/cgi/content/full/103/24/2994) 3) AHA/ACC Foundation Guide to Warfarin Therapy (AHA 2003 Scientific Statement). Access the AHA website (http://circ.ahajournals.org/cgi/content/full/107/12/1692)

February 10 t h

Antithrombotic Therapy in CV: Part II

Dr. Gulseth

Objectives................................................................................................................................ 59 Antithrombotic Therapy Lecture......................................................................................... TBA

February 13 t h

Review and Case Studies for Ischemic Heart Disease

Dr. Straka

Objectives............................................................................................................................ TBA Quiz 3 Take quiz online through WebCT Vista (http://vista.umn.edu) for the cardiovascular topics of ACS and Antithrombotic therapy.

February 15 t h

Introduction to Arrhythmias: Cardiac Conduction System and Rhythm Recognition

Dr. Straka

Objectives................................................................................................................................ 60 Cardiac Conduction System and Rhythm Recognition ....................................................... TBA Required DiPiro 6th ed. (2005), Chapter 17: Arrhythmias…………………………….pp 321-356 ACLS Algorithms (will be provided)

February 15 t h

Guideline for the Management of Supraventricular Arrhythmias

Dr. Straka

Objectives................................................................................................................................ 60 Supraventicular Arrhythmia Lecture ................................................................................... TBA Suggested ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias (AHA 2003 Guideline). Access the AHA website: (http://www.americanheart.org/downloadable/heart/1062186010820SVAFullTextGLfinal.pdf)

February 17 t h

Cardiovascular Exam #2

Dr. Straka

Examination covers CV material from 1/18 to 2/13

February 20 t h

Therapy of Supraventricular Arrhythmias

Dr. Ujhelyi

Objectives................................................................................................................................ 60 Supraventicular Arrhythmia Lecture ................................................................................... TBA Table of Contents 1/13/06

Page 4

February 20 t h

Therapy of Ventricular Arrhythmias

Dr. Ujhelyi

Objectives................................................................................................................................ 60 Supraventicular Arrhythmia Pharmacotherapy Lecture ...................................................... TBA Quiz 4 Take quiz online through WebCT Vista (http://vista.umn.edu) for the cardiovascular topic of Antiarrhythmia therapy.

February 22 n d

ACLS Antiarrhythmic Drug Therapy

Dr. Chapman

Objectives................................................................................................................................ 60 Therapy of Ventricular Arrhythmias Lecture...................................................................... TBA

February 22 n d ACLS:Bradyarrhythmias and Tachyarrhythmias Dr. Chapman Objectives................................................................................................................................ 60 ACLS Antiarrhythmic Drug Therapy Lecture..................................................................... TBA Algorithms for Cardiac Care ............................................................................................... TBA Required DiPiro 6th ed. (2005), Chapter 12: Cardiopulmonary Resuscitation ………pp 171-183

February 24th

Overview Pharmacotherapy of Chronic Heart Failure (CHF) I Dr. Straka

Objectives................................................................................................................................ 61 Chronic Heart Failure Lecture............................................................................................. TBA Required DiPiro 6th ed. (2005), Chapter 14: Heart Failure………………..pp 219-260

February 27th

Pharmacotherapy of Chronic Heart Failure (CHF) II

Dr. Parra

Objectives................................................................................................................................ 61 Chronic Heart Failure Lecture............................................................................................. TBA Suggested AHA/ACC 2005 Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. Access guideline at the AHA website (http://circ.ahajournals.org/cgi/reprint/112/12/e154)

February 27th

Pharmacotherapy of Chronic Heart Failure (CHF) III

Dr. Parra

Objectives................................................................................................................................ 61 Chronic Heart Failure Lecture............................................................................................. TBA

March 1st

Treatment of the Patient with Acute Heart Failure I

Dr. Chapman

Objectives................................................................................................................................ 62 Acute Heart Failure Lecture ................................................................................................ TBA

Appendix A: Web Exercise Due Submit 2 page review with a stapled PDF article printout to cardiovascular TA at end of class on 3/1/06 Table of Contents 1/13/06

Page 5

March 1st

Treatment of the Patient with Acute Heart Failure II

Dr. Chapman

Objectives................................................................................................................................ 62 Acute Heart Failure Lecture ................................................................................................ TBA

March 3rd

Chronic Heart Failure Case

Dr. Straka

Objectives............................................................................................................................ TBA

March 6th

Heart Failure Case Discussions

Dr. Straka

Objectives............................................................................................................................ TBA Quiz 5 Take quiz online through WebCT Vista (http://vista.umn.edu) for the cardiovascular topic of Heart Failure therapy.

March 8th

Cardiovascular Advanced Topics I: Lipids (Dr. Straka) TBA

Dr. Straka

Objectives............................................................................................................................ TBA

March 8th

Pathophysiology and Drug Therapy of PE/DVT

Dr. Gulseth

Objectives................................................................................................................................ 63 PE/DVT Lecture.................................................................................................................. TBA Required DiPiro 6th ed. (2005), Chapter 19: Venous Thromboembolism……………pp 373-413 Suggested CHEST: Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy 2004. Access CV website (http://www.courses.ahc.umn.edu/pharmacy/5822/CHESTACCP2004.html) Quiz 6 Take quiz online through WebCT Vista (http://vista.umn.edu) for the cardiovascular topics of Acute-HF/PE/DVT therapy.

March 10th

Cardiovascular Exam #3

Dr. Straka

Examination covers CV material from 1/18 to 3/8

April 21st

CV/GI/Endo Oral Exam

Twin Cities Prep Room ...................................................................................................... IERC Twin Cities Exam Rooms................................................................................................... IERC Duluth Prep Room............................................................................................................... TBA Duluth Exam Rooms ........................................................................................................... TBA

Table of Contents 1/13/06

Page 6

All

April 28th

Pharmacy Day

No Class

May 8th-13th

Phar 6122 Comprehensive Final Written Exam 3 hours

Exam Room......................................................................................................................... TBA Comprehensive Examination covers Cardiovascular/GI/Endocrine material from 1/18 to 5/5

Appendix A: Web Exercise Exam Room............................................................................................................................. 65 Submit exercise with a stapled PDF abstract printout to cardiovascular TA at end of class on 1/30/06

Table of Contents 1/13/06

Page 7

Phar 6122: Pharmacotherapy II (5 Credits) Pathophysiology and Pharmacotherapy of Cardiovascular Disorders Pathophysiology and Pharmacotherapy of Endocrine Disorders Pathophysiology and Pharmacotherapy of Gastrointestinal Disorders Spring 2006 Course Outline 1/13/06 Overall Course Director: Robert J. Straka, Pharm.D., F.C.C.P. Associate Professor, Clinical Pharmacist University of Minnesota 7-109 Weaver-Densford Hall Phone (612) 624-5663 Fax (612) 625-3927 E-mail: [email protected] Web Page: http://www.courses.ahc.umn.edu/pharmacy/5822/homepage1.html Cardiovascular Section: Course (6122) and Section (Cardiovascular) Director: Robert J. Straka, Pharm.D., F.C.C.P. Associate Professor University of Minnesota, WDH 7-109 Phone (612) 624-5663 Digital pager (651) 629-0163 Fax (612) 625-3927 E-mail: [email protected]

Course Faculty, continued: Michael Gulseth, Pharm.D., BCPS Department of Pharmacy Practice and Pharmaceutical Sciences Assistant Professor 2530 Peace Dr. Duluth, MN 55811 U of MN-Duluth Campus Phone: 218-726-6012 Fax: 218-726-6500 Email: [email protected]

R. Todd Burkhardt, Pharm.D. Teaching Assistant: Research Fellow, Cardiovascular Pharmacotherapy 7-189 WDH 308 Harvard St. SE. Minneapolis, MN 55455 Phone: 612-624-6489 Fax: 612-625-3927 Email: [email protected]

Scott Chapman, Pharm.D. Assistant Professor, College of Pharmacy Clinical Specialist, Critical Care and Cardiology Department of Pharmacy North Memorial Medical Center 3300 Oakdale Avenue N. Robinnsdale, MN 55422 Phone :763-520-3961 Email : [email protected]

David Parra, Pharm.D, BCPS Adjunct Assistant Professor, University of Minnesota, ECP Dept. and Clinical Pharmacy Specialist in Cardiology Department of Cardiology Veterans Affairs Medical Center 7305 N. Military Trail West Palm Beach, FL 33410-6400 Email: [email protected]

Michael R. Ujhelyi, Pharm.D. Senior Principal Scientist Cardiac Rhythm Management Research Medtronic Inc. Phone: (763) 514-3674 E-mail: [email protected]

Page 8

Endocrine Section: Section Director: Thomas E. Lackner, Pharm.D., CGP, FASCP Professor College of Pharmacy, University of Minnesota Phone: (612) 626-4135 Fax: (612) 625-3927 E-mail: [email protected]

Teaching Assistant: Ying-Chi “Alice” Lin, M.S. ECP Graduate Student 7-192 WDH Phone: (612) 624-9683 Email: [email protected] Gastrointestinal Section: Section Director: David Guay, Pharm.D., FCP, FASCP, FCCP, CGP Professor College of Pharmacy, University of Minnesota Phone: (612) 626-5981 Fax: (612) 626-6095 E-mail: [email protected]

Course Faculty, continued: Sarah M. Westberg, Pharm.D., BCPS Department of Pharmacy Practice and Pharmaceutical Sciences Assistant Professor 356 Kirby Plaza 1208 Kirby Drive Duluth, MN 55812 Phone: 218-726-6005 Email: [email protected] Teaching Assistant: Varun Goel ECP Graduate Student 7-101 WDH Phone: (612) 624-6932 Email: [email protected] Course Faculty, continued: Randy Seifert Pharm.D. Department of Pharmacy Practice and Pharmaceutical Sciences Professor 366 Kirby Plaza 1208 Kirby Drive Duluth, MN 55812 Phone: (218) 726-6032 Email: [email protected]

Teaching Assistant: Manisha Lamba ECP Graduate Student Phone: (612) 626-2593 Email: [email protected] All sections Duluth campus: Teaching Assistant Adam Pavek Pharm.D. Student Duluth, MN 55812 Phone: (218) 343-3637 E-mail: [email protected] Learning Objectives: I. Cardiovascular Course Objectives: At the conclusion of the section, learners should be able to… 1. 2. 3. 4.

Demonstrate a clear understanding of the basic pathophysiology associated with common cardiovascular diseases and syndromes. Contrast and compare available pharmacotherapeutic options to manage patients with one or more common cardiovascular disorders. Apply their knowledge of pharmacotherapy to design, initiate, modify and evaluate pharmacotherapeutic plans for specific patients with such conditions. Be able to counsel patients receiving cardiovascular medications on their appropriate use.

In order to consider this course a success you must be able to answer the following questions regarding the common medications used in a patient with cardiovascular disease: 1. Is this the optimal drug? 2. Is this the optimal dose? 3. What will I monitor for efficacy? 4. What will I monitor for toxicity? 5. Are there any significant drug interactions or adverse effects associated with this drug? 6. What are the alternatives and their benefits/risks/cost etc? 7. What is the overall goal of my therapeutic plan? 8. What is the evidence supporting the choice of drug therapy in my plan?

Page 9

II.

Endocrine Course

Objectives: At the conclusion of the section, learners should be able to… 1. 2. 3. 4.

III.

Demonstrate a clear understanding of the basic pathophysiology associated with common Endocrine conditions. Contrast and compare available pharmacotherapeutic options to manage patients with one or more common Endocrine disorders. Apply their knowledge of pharmacotherapy to design, initiate, modify and evaluate pharmacotherapeutic plans for specific patients with such conditions. Be able to counsel patients receiving agents commonly used to manage their Endocrine conditions. Gastrointestinal Course

Objectives: At the conclusion of the section, learners should be able to… 1. 2. 3. 4.

Demonstrate a clear understanding of the basic pathophysiology associated with common Gastrointestinal conditions. Contrast and compare available pharmacotherapeutic options to manage patients with one or more common Gastrointestinal disorders. Apply their knowledge of pharmacotherapy to design, initiate, modify and evaluate pharmacotherapeutic plans for specific patients with such conditions. Be able to counsel patients receiving agents commonly used to manage their Gastrointestinal conditions.

Required Texts The required readings for the course will be outlined in the final syllabus and include chapters from "Pharmacotherapy: A Pathophysiologic Approach", 6th edition, DiPiro et al (eds)., McGraw-Hill, New York, NY and selected cases from “Student’s Guide For Pharmacotherapy”, 6th Edition, 2005, Ed. Schwinghammer TL (McGraw Hill). Textbook chapters are assigned and listed in the Objectives and Readings sections. Students are strongly urged to read the assigned readings prior to class to aid in the understanding of lecture material. 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 arrangements with the course directors. Such readings may be valuable for future reference.

Additional References and Course Web Addresses for lecture material may be found at the following: Cardiovascular Section: http://www.courses.ahc.umn.edu/pharmacy/5822/homepage1.html GI Section: http://www.courses.ahc.umn.edu/pharmacy/5880/ Endocrine Section: No website. In addition to the required readings, the Table of Contents provides a listing of suggested readings designed to supplement and enhance the student’s understanding of the course content. 1. 2.

Lexi-Complete™ available at: http://www.lexi.com/web/index.jsp . This PDA reference is a portable source for general information and drug dosing. Goodman and Gilman’s. The Pharmacologic Basis of Therapeutics, 10th Ed., McGraw-Hill, New York, NY, 2001. This is a good source for information on basic pharmacology.

Other Good Sources of Information Students are encouraged to utilize new and progressive methods of obtaining the latest and most up to date information. Specifically, there are numerous sources of information available on the Internet. As always, information on the Internet or sources other than material covered in the lectures and required readings should be viewed as supplementary material and not a primary source. The accuracy of information you may find on the Internet can rarely be ensured and should be viewed as supplementary to what is presented in class.

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Prerequisites: All students will have completed Anatomy and Physiology (Phar 6061), Medicinal Agents I (Phar 6154), Pharmacokinetics (Phar 6163), Pharmacology I (Phar 5101) and Pharmacotherapy I (Phar 6121), The student is responsible for this material to the extent that basic information taught in such classes will be built upon in this course. Thus, students are encouraged to review basic cardiovascular, endocrine, and gastrointestinal anatomy and physiology and specifically encouraged to review the section of Goodman and Gilman’s Pharmacological Basis of Therapeutics relevant to the classes of drugs covered. Instructors may briefly review this material but are not required to do so. Student Evaluation and Grading Phar 6122 Overall Course Grade: The overall 6122 course grade will be determined by the results of 5 quizzes (all within the CV pharmacotherapy 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 also covering CV, Endo, and GI sections. 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 course or section director. Within each section, exams will be comprehensive and build on previous knowledge covered in each section. The final grade for the Phar6122 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 evaluation tools. Contribution (evaluation tool)

Point (%) contribution from each section and evaluation tool

CV section (3 exams, 5 quizzes) GI Section (two exams) Endo Section (two exams)

38 (9+9)=18 (7+7)=14 38+18+14=

CV + GI +Endo Oral exam (CV, Endo, and GI**) CV + GI + Endo + Oral exam 6122 Final Written Exam (CV, Endo, and GI)*** Final Grade

70 10 70+10=

80 20 80+20

100

Minimum Passing Grade > 60%* > 60%* > 60%*

> 65% > 60%

*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 at the time of the oral exam (55% cardiovascular, 25% GI, and 20% endocrinology). ***A comprehensive 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% endocrine and 20% CV. NOTE: In order to pass this course (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 for the indicated evaluation tools (see * in table above). (There will be no exceptions to this rule). Failure will require the student to re-take the entire course (all three sections). The exams will be returned and reviewed at some point either during or outside of class time. This will be your only chance to comprehensively review your exam. If you have extenuating circumstances, you may schedule an appointment with the section director (or the TAs , at the section director’s discretion) to review any of your exams. Grades will NOT be given out over the telephone. For Pharmacotherapy II (Phar 6122), there will be no make-up quizzes. We will, however, drop the lowest quiz score and provide one additional optional mechanism to discount one other quiz grade. (see optional writing assignment below)

Page 11

Letter Grade assignments appearing on your transcripts are as follows. Common rounding rules will be applied to the final grade (as per Microsoft Excel® where 0.5 and higher values are rounded up). A AB+ B BC+ C CD+ D F

≥ 93% 90-92% 87-89% 83-86% 80-82% 77-79% 73-76% 70-72% 67-69% 60-66% < 60%

Make up Policy: Please note MAKE-UP EXAMINATIONS, QUIZZES AND OTHER ASSIGNMENTS WILL NOT BE OFFERED EXCEPT UNDER THE FOLLOWING CIRCUMSTANCES: illness, verified by a note from a licensed professional; 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 or section director. If a student is unable to attend the scheduled exam, the relevant section director must be notified (by email and 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 us again to confirm your request was received and processed. If an acceptable circumstance or adequate documentation is not provided, a grade of zero, on the exam, quiz etc. will be assigned by the course or section director. Unless there are extenuating circumstances, students must contact the section or course director within 24 hours of the missed scheduled exam, quiz or other assignment in order to be considered for a make up assessment. Unless there are extenuating circumstances, the make up exam date is generally not more than one week after the original exam 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 a week should expect to spend an additional six hours a week on coursework outside the classroom. You will get the most out of this course by actively participating in the assigned readings, pedagogical tools (quizzes, oral and written exams, review sessions, assignments etc.). Disability Accommodations: Any student with a documented disability (eg. physical, learning, psychiatric, vision, hearing, etc.) who needs to arrange reasonable accommodations must contact the course directors as well as each section director for the course. Documentation of the need for accommodations should be received within the first week of the course and at least 7 days before any exam or test. It is assumed that Disability Services (TC: http://ds.umn.edu/, 612-626-1333, Duluth: Access Center, http://www.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 (on line or written), tests, oral and written exams.

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Exam Dates: The instructors do not foresee any circumstances that would require a change in examination dates for the class as a whole. Course/Instructor Evaluation: Students will be given class-time to complete a written course evaluation to be completed near the conclusion of each section of this course. Section Director Office Hours: Dr. Straka will be available by appointment at the University (WDH 7-109). Students are encouraged to seek additional help early if needed. To facilitate this, Dr. Straka will have an ITV room booked every Wednesday from 0900-10:00 (Room 7-115F) for a walk in visit at any time throughout the cycle for the CV section. Other course faculty will be available on an appointment basis. Call (612) 624-5663 or email [email protected] for appointments with the course director and call the numbers listed for appointments with other course faculty (see Course Faculty listing). The TAs will have office hours posted on the CV website (http://www.courses.ahc.umn.edu/pharmacy/5822/CV_TA.html). Dr. Lackner (Section Director for Endocrinology) is available by appointment to meet with students on campus on Tuesdays and Fridays. Office hours can be scheduled with Dr. Lackner by appointment (612) 626-4135 or email [email protected]. Dr. Lackner is also available after lectures to answer individual and group questions and to meet with course liaisons. Dr. Guay (Section Director for Gastroenterology) is available to meet with students on campus by appointment Monday through Friday. Office hours can be scheduled with Dr. Guay on an appointment basis (call (612) 626-5981 or email [email protected]). Dr. Guay will be present at all lectures to answer individual and group questions and to meet with course liaisons. If desired, Dr. Guay will meet with students after each lecture.

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Phar 6122: Pharmacotherapy II

Pathophysiology and Pharmacotherapy of Cardiovascular Disorders Pathophysiology and Pharmacotherapy of Endocrine Disorders Pathophysiology and Pharmacotherapy of Gastrointestinal Disorders Spring 2006 5 Credits COURSE SCHEDULE Last updated: 12/19/2005 All lectures will be held from 10:10-12:05am Monday and Wednesday, as well as 10:10-11:00am Friday in room 7-135 WDH, unless otherwise indicated. Bolded Lecturer denotes the provider of the lecture versus faculty colleague in attendance at alternate campus. University of Minnesota-Twin Cities calendar: http://www1.umn.edu/usenate/calendars/05-06tc.html University of Minnesota Duluth calendar: http://www1.umn.edu/usenate/calendars/05-06dul.html

LECTURE DATE

CV

Wednesday, Jan. 18

1 2 3 4 5 6 7 8 9 10

Friday, Jan. 20 Monday, Jan. 23 Wednesday, Jan. 25 Friday, Jan. 27 Monday, Jan. 30

Wednesday, Feb. 1

11 12

Friday, Feb. 3 Monday, Feb. 6

13 14 15

Wednesday, Feb. 8 Friday, Feb. 10 Monday, Feb. 13 Wednesday, Feb. 15

Friday, Feb. 17 Monday, Feb. 20 Wednesday, Feb. 22

16 17 18 19 20 21 22 23 24 25 26 27

EN

GI

LECTURE TOPIC Orientation and Course Overview Hypertension I Hypertension II Hypertension III Hypertension IV Hyperlipidemia-Drug Pathophysiology / Hyperlipidemia-Drug Therapy I Q1 Hyperlipidemia-Drug Therapy II Hyperlipidemia-Drug Therapy III Review and Case Studies for HTN and Hyperlipidemia/Q2 Coronary Syndromes: Chronic Stable Angina (SA), Unstable Angina (UA or non-STEMI) & Myocardial Infarction (MI or STEMI)—Pathophysiology Pharmacotherapy of Chronic Stable Angina (SA) Part 1 CV Exam #1 Pharmacotherapy of Chronic Stable Angina (SA) Part 2 Pharmacotherapy of non-STEMI/UA Pharmacotherapy of STEMI Antithrombotic Therapy in CV part 1 Antithrombotic Therapy in CV Part 2 Ischemic Heart Disease Case Discussions and Review / Q3 Introduction to Arrhythmias Guidelines for the Management of Supraventricular Arrhythmias CV Exam #2 Therapy of Supraventricular Arrhythmias Therapy of Ventricular Arrhythmias / Q4 ACLS Antiarrhythmic Drug Therapy ACLS: Bradyarrhythmias/ Tachyarrhythmias, Sections 1&2

Page 14

LECTURER LECTURER Twin Cities Dr. Straka

Duluth Dr. Gulseth

Dr. Straka Dr. Straka

Dr. Gulseth Dr. Gulseth

Dr. Straka

Dr. Gulseth

Dr. Straka Dr. Straka

Dr. Gulseth Dr. Gulseth

Dr. Straka

Dr. Gulseth

Dr. Straka Dr. Straka Dr. Straka

Dr. Gulseth Dr. Gulseth Dr. Gulseth

Dr. Straka

Dr. Gulseth

Dr. Straka Dr. Straka Dr. Straka Dr. Straka

Dr. Gulseth Dr. Gulseth Dr. Gulseth Dr. Gulseth

Dr. Straka Dr. Ujhelyi

Dr. Gulseth Dr. Gulseth

Dr. Chapman

Dr. Gulseth

LECTURE DATE

CV

Dr. Gulseth

Dr. Gulseth Dr. Gulseth

Dr. Straka Dr. Straka

Dr. Gulseth Dr. Gulseth

37

CV Advanced Topics (Lipids, TBA) Pathophysiology & Drug Therapy of PE/DVT / Q6

38

CV Exam #3

Dr. Straka/ Burkhardt

Dr. Gulseth

Dr. Lackner

Dr. Westberg

Dr. Guay

Dr. Westberg

Dr. Guay

Dr. Westberg

Dr. Sheridan

Dr. Westberg

Endocrine: Hormonal Contraception

Dr. Joseph

Dr. Westberg

Endocrine Exam #1 Endocrine: Diabetes Mellitus

Dr. Lackner Dr. Harris

Dr. Westberg Dr. Westberg

Endocrine: Diabetes Mellitus Course Evaluation Endocrine: Menopause/HRT Endocrine Exam #2 Endocrine: Case Study Gastrointestinal: Pathophysiology of PUD Gastrointestinal: Treatment of PUD Gastrointestinal: Treatment of PUD Gastrointestinal: Gastroesophageal reflux disease Gastrointestinal: Drug-induced Hepatic disease Gastrointestinal: Diarrhea & Constipation ORAL EXAM DAY Gastrointestinal: Diarrhea & Constipation Gastrointestinal: Inflammatory Bowel Disease (IBD) Gastrointestinal: Exam #1

Dr. Harris

Dr. Westberg

Dr. Lackner Dr. Lackner

Dr. Westberg Dr. Westberg

Dr. Guay

Dr. Seifert

Dr. Guay Dr. Lackner

Dr. Seifert Dr. Seifert

Dr. Guay

Dr. Seifert

29 30 31 32 33 34 35 36

Friday, Mar. 10 Monday, Mar. 13 Tuesday, Mar. 14 Wednesday, Mar. 15 Thursday, Mar. 16 Friday, Mar. 17 Monday, Mar. 20

Wednesday, Mar. 22 Friday, Mar. 24 Monday, Mar. 27 Wednesday, Mar. 29 Friday, Mar. 31 Monday, Apr. 3 Wednesday, Apr. 5 Friday, Apr. 7 Monday, Apr. 10 Wednesday, Apr. 12 Friday, Apr. 14 Monday, Apr. 17 Wednesday, Apr. 19

Overview of Pharmacotherapy of Chronic Heart Failure (CHF)-I Pharmacotherapy of CHF-II Pharmacotherapy of CHF-III Treatment of the Patient with Acute HF-I Treatment of the Patient with Acute HF-II Chronic HF Cases Heart Failure Case Discussion Q5

SPRING BREAK SPRING BREAK SPRING BREAK SPRING BREAK SPRING BREAK Endocrine: Orientation & Thyroid Disorders Endocrine: Thyroid Disorders Endocrine: Drugs in Pregnancy and Lactation Endocrine: Drug-Induced Sexual Dysfunction Endocrine: Adrenal Therapeutics

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1 2 3 4 5 6 7

Friday, Apr. 21 Monday, Apr. 24

Wednesday, Apr. 26

LECTURER LECTURER

Dr. Parra Dr. Parra Dr. Chapman Dr. Chapman Dr. Straka Dr. Straka

Monday, Feb. 27

Wednesday, Mar. 8

LECTURE TOPIC

Duluth Dr. Gulseth

28

Friday, Mar. 3 Monday, Mar. 6

GI

Twin Cities Dr. Straka

Friday, Feb. 24

Wednesday, Mar. 1

EN

8 9 10

Page 15

Dr. Guay Dr. Guay

Dr. Gulseth

Dr. Seifert Dr. Seifert

Dr. Guay Dr. Guay

Dr. Seifert

LECTURE DATE Friday, Apr. 28 Monday, May 1

Wednesday, May 3 Friday, May 5 May 8-13 (Monday – Saturday) Final Exam Week

CV

EN

GI

LECTURE TOPIC

LECTURER LECTURER Twin Cities

11 12 13 14 15

PHARMACY DAY!!! Gastrointestinal: IBD Gastrointestinal: Viral Hepatitis Gastrointestinal: Viral Hepatitis Review Gastrointestinal: GI Exam #2 Phar 6122 Comprehensive Final Written Exam 3 hours

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Dr. Guay

Duluth Dr. Seifert Dr. Seifert

Dr. Guay

Dr. Seifert

Dr. Guay All

Dr. Seifert Dr. Seifert

Phar 6122: Pharmacotherapy II Cardiovascular Section Course Information Spring 2006 Course Overview and Goals What is the importance of this class and what is expected of the student who completes this course? Cardiovascular pharmacotherapy is one of the most exciting areas of medical care. Each one of us will have some degree of personal experience with cardiovascular disease in our lifetime. New and innovative approaches for treating cardiovascular diseases are constantly being evaluated. As a pharmacist, you can have a major impact on the care of patients with cardiovascular disease through your development of an understanding of the appropriate use of drugs for such patients. The objectives of this course should provide the basis for a pharmacist to care for a patient with common cardiovascular diseases. Required texts (see Course Outline) Other Good Sources of Information Students are encouraged to utilize new and progressive methods of obtaining the latest and most up to date information. Specifically, there are numerous sources of information available on the Internet. As always, information on the Internet or sources other than material covered in the lectures and required readings should be viewed as supplementary material and not a primary source. However, the accuracy of information you may find on the Internet cannot always be verified. The following sources of information may be useful in further exploring areas of interest or in obtaining information that may be useful in completing group projects. Below are several Web sites that provide excellent information or will at least guide you in the right direction. 1.Homepage for Phar 6122: Pathophysiology and Pharmacotherapy of Cardiovascular Disorders. (http://www.courses.ahc.umn.edu/pharmacy/5822/homepage1.html) This site contains general course information, course-related news and announcements, and other interesting links. 2. Theheart.org (http://www.theheart.org/index.cfm) outstanding source of new info re: to Cardiovascular Pharmacotherapy. You may register for free and receive updates via email on news or just search the site as needed. 3.Pharmacy Web Page (http://www.pharmweb.net/) This site provides information for pharmaceutical and other health-related organizations, including a schedule of future conferences and discussion groups. 4.Medicine Online (http://www.mol.net/medj.htm) or (http://www.mol.net/) Here you will have access to information such as the table of contents of the most recent publications of many medical journals. 5.Pharminfonet (http://www.pharminfo.com)This site is a source for several types of pharmaceutical information, and within this site is the cardiovascular disease resources at (http://www.pharminfo.com/disease/cardio/card_rsc.html). 6.Virtual Hospital (http://www.vh.org/)This is the University of Iowa’s virtual hospital. Here you can find examples of cardiovascular-related cases. 7. OnHealth (http://onhealth.com/ch1/condctr/cardio/item,14121.asp) This site is geared towards general public but it provides nicely detailed information about prevention, diagnosis and

Course Info. Revised: 01/12/06

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treatment of cardiovascular diseases. It is very useful for description of variety of cardiac procedures. 8. American Heart Association (http://www.americanheart.org/) This site is very useful for accessing various Guidelines to manage patients with heart disease, retrieve updated official statistics re: Cardiovascular disease, obtain official AHA statements on selected topics of CV importance etc. 9. Lexi.com (http://www.lexi.com/web/index.jsp) 10. Micromedex (http://www.biomed.lib.umn.edu/micromedex/index.html) This site can be used to search for summaries and detailed monographs of drugs, alternative medicine, toxicological management, reproductive risks, and acute/emergency care. Student Evaluation and Grading Phar 6122 Overall Course Grade: The overall 6122 course grade will be determined by the results of 5 quizzes (all within the CV pharmacotherapy 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 also covering CV, Endo, and GI sections. 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 course or section director. Within each section, exams will be comprehensive and build on previous knowledge covered in each section. The final grade for the Phar6122 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 evaluation tools. Contribution (evaluation tool)

CV section (3 exams, 5 quizzes) GI Section (two exams) Endo Section (two exams)

Point (%) contribution from each section and evaluation tool 38 (9+9)=18 (7+7)=14 CV + GI +Endo 38+18+14=

Oral exam (CV, Endo, and GI**) CV + GI + Endo + Oral exam 6122 Final Written Exam (CV, Endo, and GI)*** Final Grade

70 10 70+10=

80 20 80+20

100

Minimum Passing Grade > 60%* > 60%* > 60%*

> 65% > 60%

*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 at the time of the oral exam (55% cardiovascular, 25% GI, and 20% endocrinology). ***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% endocrine and 20% CV.

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NOTE: In order to pass this course (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 for the indicated evaluation tools (see * in table above). (There will be no exceptions to this rule). Failure will require the student to re-take the entire course (all three sections). The exams will be returned and reviewed at some point either during or outside of class time. This will be your only chance to comprehensively review your exam. If you have extenuating circumstances, you may schedule an appointment with the section director (or the TAs , at the section director’s discretion) to review any of your exams. Grades will NOT be given out over the telephone. Make up Policy: Please note MAKE-UP EXAMINATIONS, QUIZZES AND OTHER ASSIGNMENTS WILL NOT BE OFFERED EXCEPT UNDER THE FOLLOWING CIRCUMSTANCES: illness, verified by a note from a licensed professional; 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 or section director. If a student is unable to attend the scheduled exam, the relevant section director must be notified (by email and 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 us again to confirm your request was received and processed. If an acceptable circumstance or adequate documentation is not provided, a grade of zero, on the exam, quiz etc. will be assigned by the course or section director. Unless there are extenuating circumstances, students must contact the section or course director within 24 hours of the missed scheduled exam, quiz or other assignment in order to be considered for a make up assessment. Unless there are extenuating circumstances, the make up exam date is generally not more than one week after the original exam date. Letter Grade assignments appearing on your transcripts are as follows. Common rounding rules will be applied to the final grade (as per Microsoft Excel® where 0.5 and higher values are rounded up). A AB+ B BC+ C CD+ D F

≥ 93% 90-92% 87-89% 83-86% 80-82% 77-79% 73-76% 70-72% 67-69% 60-66% < 60%

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6122 Cardiovascular Section Grade Distributions The grade for the CV section will be determined by the results of best 5 out of 6 quizzes*** and three written examinations. The oral and a final examination will contribute to the 6122 course grade as described above. The CV section will contribute to the oral exam in proportion to the lecture hours devoted to the CV section with in 6122. Evaluation tools 5 out of 6 Quizzes δ Exams (one, two and three) CV section (less oral and course final exam) Oral Exam Final Exam

Minimum passing grade 1. 6 points/quiz (8/5 points x 5 quizzes) 10+10+10=30

8 points 30 points 30+8=

10% of entire course 20% of entire course

38 points

> 60%

10 points 20 points

> 65%

δ The top 5 quizzes out of 6 will count towards the final CV grade for this course. Additionally, students may also substitute one quiz grade with an optional journal article review, outlined below. ***Optional Journal Article Review Since only 5 out of 6 quizzes will contribute to the CV section grade, students are allowed to drop their lowest score from a quiz. There will be no make-up opportunities for missed quizzes, however in addition to being able to drop their lowest quiz score, students have an option to submit a critical review of a recent journal article. This optional journal article review can be used to replace one quiz. The journal article review is designed to allow you to explore recent (the article must be published AFTER November 01, 2005) cardiovascular pharmacotherapeutic research of your choice. Pick one original research article from New England Journal of Medicine, Journal of the American College of Cardiology, Archives of Internal Medicine, Circulation, Journal of the American Medical Association, or Hypertension and provide a 2-page (single spaced, 12 pt font, 1 inch margins) review of the article. The article must present original research in the field of cardiology. If you are unsure of the significance of a published research article, it is highly recommend bringing the article to the cardiovascular course director for determining the selected article’s importance. Your review should be more than a summary of the article. The review should critically evaluate the objectives of the study, methods (including sampling strategies), data analysis, results, applicability of the results to the clinical setting, validity of the conclusions, potential for bias, and how the original research contributes to or refutes conclusions based from the CV suggested readings. A copy of the journal article should be attached to the review. Your review will be graded on a scale of 1-10. This optional assignment is due no later than March 1st. Course Instructor Evaluation Students will be given class time to complete a written course evaluation to be completed near the conclusion of the course (see Course Schedule). An interim assessment may also be made at approximately the midpoint of the CV section or the course.

Course Info. Revised: 01/12/06

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Advice for Optimal Exam Taking in Phar 6122--Cardiology section Robert Straka, Pharm.D. Spring 2006 The following are some suggestions and helpful hints for successfully writing an exam or a quiz in Dr. Straka's course. You are free to use this information any way you like. Our intent is to show you ways that you can minimize unnecessary loss of points on tests. • Write a complete order: When asked to recommend drug therapy for a patient always write a complete order including drug, dose, route and schedule. You will only be given full credit for a complete order. • Convince us of your understanding of the subject: When we give the oral exam it is easy for us to determine the depth of your knowledge by just asking a few more questions. However, on a written exam we can only go by your written response on the paper. It is up to you to explain your reasoning such that we have little doubt that you understand the concept. • Understand the meaning of the term "Significant Statements": This point directly correlates to the previous suggestion of convincing us of your understanding. Here are examples of poor and acceptable significant statements concerning the description of the MOA of warfarin: - Warfarin is an anticoagulant and as such inhibits the formation of clots. (Poor answer) - Warfarin is an antithrombotic agent which inhibits the formation of the vitamin K dependent clotting factors II, VII, IX and X, and thus results in the patient having an anticoagulated state. (acceptable answer) • Be specific but brief: This is a skill which most students are just beginning to develop. It may seem contradictory to other suggestions above which state that you need to "convince us of your understanding of a subject", but then we ask you to be brief. However the suggestion here is to not write unnecessary statements which lack relevance. Think of what you want to say and then write it. It may not always be a very short response, but most times when only the pertinent points are mentioned, it should be concise. • Examples given at the end of a question DO NOT count as answers: It is often difficult to fully describe what type of answer we are searching for. Often an example helps. Sometimes the example will be an actual answer to the question and in these cases we are not giving away points. We will attempt to state that "3 answers other then the example" are needed, but in cases where we don't, it is assumed you realize that the examples don't count and should not be used as your answers. • Units: When answering a question with a lab value, a measurement, a monitoring parameter, or anything else requiring units, always include units or critical values (cut-off etc.) in your answer. You will lose points if units are left out of your answer. • Only answer what is asked of you: This is a major point that many students have trouble understanding. The bottom line is that you should only give the number of answers which are asked for because only that many will be graded. eg - The question asks for three independent risk factors for calculating goal LDL-C according to NCEP ATP III . Student A

Student B

Student C

1. Smoking 2. Hypertension - >140/90 mm Hg 3. Low HDL-C (140/90 mm Hg Low HDL-C ( 240 mg/dL EtOH Abuse Obesity Smoking Hypertension - >140/90 mm Hg Low HDL-C (