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Course Number & Title: PA 644- Pharmacotherapeutics II

Course Description: A study of the general principles of pharmacology including classification, mechanisms of action and
the rational use of medications for the diagnosis, prevention and treatment of disease. The appropriate selection, dosing
and monitoring of medication is also reviewed.

Credit Hours: 4.0 Semester: Fall 2017

Contact Hours & Type: 4.0; Lecture and Seminar

Prerequisite: PA 544- Pharmacotherapeutics I
Corequisite: PA 670 Clinical Medicine II

Course Instructors: Gretchen L. Johnson, PharmD, BCPS

Office Hours: By appointment

Email: gjohnson@su.edu

General Topical Outline:

A. Musculoskeletal
B. Neurology
C. Allergy/Immunology
D. Infectious Disease
E. Hematology/Oncology
F. Emergency Medicine
G. Critical Care Medicine
H. Psychology

Specific topics and objectives will be given for each module and will be posted on the PA 644 Canvas course.

Course Objectives:
Upon satisfactory completion of this course, the student will be able to:

A. State drug and patient variables that may influence selection of appropriate drug therapy.
B. When given a drug class or a representative drug of a specific drug class, provide information including the site
of action, mechanism of action, pharmacologic effects, pharmacokinetic information, therapeutic uses,
contraindications, precautions, common and serious side effects, and potential drug interactions.
C. Understand problem based learning/life-long learning as it relates to patient care issues.
D. Apply information about drug therapy to patients with a variety of medical conditions.
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E. Describe the pathophysiology and symptoms of selected disease states.
F. Identify potential drug therapy for selected disease states.
G. Develop a plan for selecting, initiating, monitoring and adjusting drug therapy for selected disease states.
H. Incorporate patient-specific information (ex age, gender, ethnicity, renal and hepatic function, concomitant
disease and medications) into drug therapy.
I. Incorporate general drug information (ex. pharmacologic, pharmacokinetic, efficacy, toxicity) in drug choices for
a particular patient.
J. Incorporate socioeconomic information of patients into therapeutic plans.
K. Identify goals of therapy and develop a way to monitor therapy.
L. Determine parameters to identify if drug therapy is working and to monitor adverse effects.
M. Evaluate the patient’s current drug therapy regimen (ex. determine if therapy is needed and effective, if a better
alternative exists, if side effects or allergies are experienced)
N. Identify potential drug interactions in patient cases and develop a plan for adjusting, monitoring or altering drug
therapy.
O. Identify causes and develop mechanisms for the management of non-adherence to pharmacological therapy.
P. Provide patient education with respect to drug therapy (ex. indication, name, strength, administration, duration
of therapy, potential side effects, if it replaces or is an addition to current medication therapy).
Q. Verbally provided medication information using appropriate patient language.
R. Be able to write a valid prescription.

Clinical Integration Case Seminar Objectives:

A. Development of clinical reasoning skills
Upon completion of the case, the student will be able to:

1. Generate a number of hypotheses to explain the patient’s problem.
These hypotheses should refer to anatomical locations, pathophysiological (or disease) processes,
etiological mechanisms down to the organ, tissue, cellular, or molecular level as appropriate to guide
investigation into the patient’s problems.
2. Through a focused inquiry, obtain the information necessary to determine the correct hypotheses.
3. Analyze the data obtained in light of the hypotheses considered, in terms of the basic mechanisms
responsible for all symptoms and signs and laboratory findings.
4. Synthesize the significant data acquired in this inquiry/analysis process into an organized, developing
picture of the patient’s problem.
This synthesis should be in terms of pathophysiological mechanisms at the appropriate level (organ, tissue,
cellular, molecular). The organization should be in a cause and effect scenario if possible to describe the chain
of events, processes and structures involved.
5. Design appropriate interventions and justify in terms of mechanism of action of drugs.
These may include pharmacological, surgical, counseling, rehabilitative, or other referrals as pertaining
to the patient’s needs.
6. Determine what epidemiological, public health, patient care, health care, moral and ethical issues, or social
issues, might be involved in the diagnosis or treatment of the patient.

B. Development of self-directed learning skills
During the problem-solving process, the student will recognize when more knowledge is needed to better
define and understand the pathophysiological mechanisms responsible for the patient’s problem, and how
this might be managed.
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1. The most appropriate resources for obtaining this new information should be determined and
appropriately used. These might include, but are not limited to:
a. Primary library sources
b. Computer sources, including bibliographic searches
2. The accuracy, adequacy and timeliness of resources should be critiqued.
3. The new knowledge acquired should be combined with prior knowledge and applied to the patient’s
problem.

C. Depth and focus of knowledge acquired
Using the reasoning and self-directed process outlined above, the student will analyze the pathophysiology of
the patient’s problem down to the organ, tissue, cellular and subcellular level, if possible. The normal form
and function (anatomy, physiology, behavior) of the structures and processes involved should also be
understood.

D. Development of conceptual skills
The new knowledge acquired during each case study must be organized into an overall understanding of the
different organ systems. The understanding of the dynamics of disease processes as well as their
pharmacological management is imperative to the resolution of future problems in these systems. Newly
acquired knowledge should be reviewed in the light of related problems from the past to see if larger
principles can be derived.

E. Development of team skills
Each student should contribute to and support the group in its tasks with patient problems by:
1. Actively contributing to the group problem-solving process.
2. Learning from and accepting help from others in the group.
3. Teaching and helping others in the group as appropriate in the learning process.
4. Accepting constructive criticism from others in the group.
5. Providing constructive criticism to others.
6. Taking responsibility for tasks required in the group's ongoing work.

F. Development of Documentation and Communication Skills
Each student will continue to develop skills in written, oral, and interpersonal communication in areas
including but no limited to:
1. Patient charting
2. Oral presentations with other medical professionals
3. Oral and written communication with other members of the group,
4. Interactions via role playing or with standardized patients.

Assessment Standards & Criteria:

Course Requirements

Student participation in the following requirements will determine the grade earned for the course.
1. Class attendance and participation: Students are required to attend all classes, case sessions, and participate fully in
discussions. If a student is unable to attend any class, case session, or fully participate, the student must contact the
course instructor or case facilitator to discuss a plan to address missed material.
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2. Self-Directed Learning (SDL): Self-Directed Learning will be guided by the topic matrices. The student is responsible
for reading assigned areas of content and watching assigned videos related to the subject areas and worksheets
before each in-class meeting time. The textbooks and additional materials assigned by the course instructor should
be used to complete the appropriate matrices. The information in the matrices correlates with the course and
learning objectives and completion before the corresponding recitation session or teaching case session is expected.
Submission of the matrices as part of the course grade is not required but faculty will be available to give feedback
and guidance. Each individual student will be responsible for the information in the matrices and worksheets as
assigned and will be asked to discuss and integrate the information during other learning sessions, on examinations
and throughout their tenure in the Shenandoah University Physician Assistant Program.
3. Lecture (L): Lecture presentations will be used to present certain topics and material in the course. Lectures may be
delivered via in-person sessions or by using different media. Lectures may include interactive sessions or activities.
The purpose of lecture is not to supply the student with comprehensive material on a topic. Attendance is required.
4. Recitation Sessions (R): Recitation sessions will take place on specific topics indicated in the course schedule.
Completion of the topic matrices and worksheets are expected by the start of each session. These sessions serve as
time for faculty to present important information, explain important concepts, and illustrate topics. The student will
be prepared to participate in the session by answering and asking questions and participating interactively in the
discussion when appropriate. Attendance is required.
5. Teaching Cases (TC): The format of teaching cases may vary but will be primarily case-based. Participation
expectations for the student will be determined by the case facilitator, but the student will be prepared to
participate fully in an interactive discussion on the topic. The specific case topic will not be given in advance, but will
be taken from the information presented prior to the session. Attendance is required.
6. Clinical Integration Cases (CIC): The case topics will not be given in advance and some topics may only be presented
in CI Case format. Each student will be assigned to a small group with a facilitator. Attendance and full participation
is required.
7. Clinical Integration Examinations (CIE): Exams will be case-based and will cover material presented in PA 670, PA
671, PA 644, and PA 532 prior to examination. There will be three exams and the grade received on a Clinical
Integration Exam will be counted in PA 670, PA 671, PA 644, and PA 532. Although the examinations will be focused
on topics per module, they may include material covered previously in the curriculum.
8. Course Examinations: Exams may include multiple choice, matching, and short answer types of questions and may
include, but are not limited to, photographs/videos, radiographs. Exam questions will be derived from course
material and assigned reading.
9. Therapeutic Rationales (TR): Therapeutic Rationales are written assignments in this course. There will be three (3)
total and the scores will be averaged for a total of 5% of the course grade. The TR assignment will be based on a case
scenario presented in class (due dates forthcoming). The purpose of the assignment is to assess the student's ability
to choose a medical therapy for a specific scenario and to justify, based on evidence, the treatment decision.
Guidelines and grading rubric will be provided in advance.













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Methods of Evaluation

Assignment/Exam: Dates for examinations, cases, and course/reading schedule will be posted separately

69% Course Examinations: Remediation Benchmark 80%
23% Course Exam I
23% Course Exam II
23% Course Exam III

6% Therapeutic Rationales (3 Total)
6% Therapeutic Rationales

15% Clinical Integration Examinations: Remediation Benchmark 75%
5% CI Exam I
5% CI Exam II
5% CI Exam III

10% Clinical Case Seminar:

6% Deliverables
1.5% Peer Evaluation
2.5% Faculty Evaluation

Grading Scale

A = 89.5 - 100%
B = 79.5 – 89.49%
C = 69.5 – 79.49%
D = 64.5 – 69.49%
F = < 64.5%

Note: The PA Program faculty use standard rounding principles for determining course grades. For example: 89.50 and
above will be rounded to 90 and grade of A will be assigned; 89.49 will not be rounded up.

Class Policies and Procedures:

See below and also refer to the Division of Physician Assistant Student Handbook.

Academic Advising and Course Remediation

Students failing to achieve pre-determined benchmarks for each assignment or examination must make arrangements
to meet with their advisors or instructors for remediation as scheduled in Remediation Blocks in the Program Schedule.
A remediation activity will be developed specific to the type of assignment or examination and the student’s
performance.


Classroom Etiquette

The following guidelines are enforced in order to ensure an environment that is conducive to learning:
● Cell phones and pagers must be turned off during class or placed on vibration mode.

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● PowerPoint presentations and faculty lectures are considered the property of Shenandoah University and the
faculty of the Division of Physician Assistant Studies. Therefore, presentations or recordings (audio or visual) are not
to be shared outside of the PA Program.
● Students arriving late should enter the classroom through the rear door and take a seat in the back of the room in
order to minimize disruption.
● Students who are late for exams or quizzes will not be provided additional time. Students arriving late to
examinations may not be permitted to take the exam. Excessive tardiness or absence will be addressed by the
program per SU PA Student Handbook.
● The SU technology program (iMLearning) is designed to facilitate student learning. Misuse of this technology during
class time is disrespectful to the faculty and peers. Students using technology inappropriately during class periods
(e.g. social media, email, chat, shopping etc.) may be excused from class.
● Beverages are permitted if they are covered in order to minimize spills. Food is not permitted during the class
periods. Contact the instructor if this guideline presents a health concern.
● Dress: See dress code policy in SU PA Student Handbook. Please dress professionally when guest lecturers are
scheduled. If the instructor feels that your dress is inappropriate for a professional classroom environment, you will
be excused.

Exam Protocol

The section addresses exam day etiquette, exam review, and test item challenges.

Exam day etiquette:

● Exams are scheduled to begin at the assigned time. Please arrive15 minutes prior to the start time.
Additional exam time will not be allowed for late arrivals and students arriving after the first student has
finished the exam will not be permitted to sit for the examination.
● Restrict fluid intake prior to the exam and use restroom facilities prior to entering the exam area.
Distractions (i.e. flushing, doors opening & closing) can be loud and disruptive to others.
● For test security purposes students will not be allowed to leave the room prior to exam completion for any
reason (including using the restroom) after the first person has completed the exam. If this presents a
physical problem, please notify the instructor prior to taking the exam.
● Most examinations will be delivered via computer. It is the responsibility of the student to ensure all exam
software is downloaded, installed, updated, and functioning properly. It is also the student’s responsibility
to ensure their computer is fully charged and the exam is ready to load. It is recommended that you restart
your computer on the day of the exam. Quit all computer applications except for Examsoft prior to starting
the exam. No additional time will be given for students who have failed to download the exam in advance.
● Unless otherwise instructed by the course director, please bring only your computer and a writing utensil
into the exam room. No recording devices, mobile phones, or watch style mobile devices are permitted in
the examination room. All other belongings should be left in the PA Skills Lab or other available space.
Scrap paper will be provided in the examination room. All scrap paper must be returned to the exam
proctor at the end of the exam. Students may NOT leave the exam room with any scrap paper.
● Exams will be proctored by a faculty or staff member.
Exam review:
● Students will have the opportunity to review their exams during a special session after the examination as
scheduled. Reviews will be proctored by a faculty or staff member. No materials or equipment will be
permitted during the review and should be left in the PA Skills Lab or other available space. At no time will
the student be able to review their entire exam outside of the review sessions detailed above.
Exam item challenges:
● Exam item challenges must be submitted by 5pm Friday the end of exam week.
● Challenges that are accepted will be posted via grade change on Canvas after the faculty member reviews
the challenge. The decision of the instructor is final.

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● Examination challenges should focus only on requests for alternate answers to be accepted based on
alternate legitimate resources. Students may submit feedback to the instructor on confusing wording or
exam difficulty via professionally constructed email. For concerns related to exam expectations related to
course learning objectives, students are encouraged to follow up with the course instructor in a meeting in
order to identify areas of confusion.
● A minimum of two relevant sources is required on the submission of the challenge form. Sources must be
reputable scientific medical journals (E.g. JAMA, NEJM, JAAPA), medical textbooks or may include web
resources that are well referenced and specifically designed for the health care professional (E.g. Uptodate).
Lecture notes and lecturer presentations may be submitted as secondary evidence but will not be
considered on their own. Patient education literature/handouts or obscure journal references will not be
accepted. When a discrepancy between a relevant source and the text assigned to the course occurs, the
course text will be used as the default.


Academic Honor Code

Trust and respect are essential to a good learning environment. Expectations regarding academic honesty and integrity
are presented in detail in the University honor code. Please review the Shenandoah University Honor Code on the web
page for Academic Integrity under the office of Academic Affairs. Because academic integrity applies to both individual
and group assignments, but sure to discuss any question or concerns with fellow group members or faculty prior to
turning in an assignment.


Assignments involving student-generated work (individual or group work)

All work that is generated by students to be submitted must represent the work of the individual student. Cutting and
pasting text from books or resources does not constitute original work and is considered plagiarism. This pertains to but
is not limited to assignments submitted for a course grade, assignments that are used in classroom discussions, and
remediation activities. Please contact a faculty member with general questions or the course instructor for specific
assignment-related questions.

Accommodations

The Division of Physician Assistant Studies conforms to the disability policies of Shenandoah University and to federal
law. Students requesting accommodations for learning or testing must file the request through the Academic
Enrichment Center. Approvals should be transmitted to the course instructor/coordinator two weeks before the
semester in order to determine if accommodations can be made and how. It is the student’s responsibility to schedule
testing accommodations with the instructor a minimum of 72 hours in advance and to renew accommodations through
the Enrichment Center.

Campus Closure

In the event of closure of the university due to inclement weather, the course instructor will communicate with you
regarding make-up, which is required by our accrediting agencies. This may require a weekend or evening session.
Students are strongly encouraged to sign up for the SU early alert system in order receive timely notice of campus
closure. There is an emergency alert tab in Canvas. Potential options for make-up include:
1. Faculty may hold class during the scheduled time for make-up that appears with the closure notice or
within another mutually defined time through consultation with the deans/directors. Faculty should
follow their standard attendance policy.

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2. Faculty may reorganize their syllabus to absorb content and classroom work through regularly
scheduled classes.
3. Faculty may use digital means to hold class, either synchronously through teleconferencing, chatting or
discussion boards; or asynchronously through Canvas course management system, web pages or
some other means. Faculty should follow their standard attendance policy and make allowances to
complete work at a later date if students do not have access to the Internet.
4. Faculty may offer an assignment in replacement of the contact hours. These assignments could include
quizzes, papers, podcasts, research assignments, etc.
5. Examinations during campus closure may be given via ExamSoft. Students will be directed as to the
timing of the exam if different as scheduled and require students to sign an honor code form before
taking the exam. Each course instructor has the right to give exams remotely when campus is closed and
when closure is officially announced, the faculty will communicate the plan in a timely manner. All other
examinations are to be taken in person unless otherwise specified.


References & Resources: Both of the following textbooks are available on AccessPharmacy/AccessMedicine

Katzung BG, Masters SB, Trevor AJ. Basic and Clinical Pharmacology. 13th Edition. McGraw-Hill Education, LLC. 2015.
(ISBN 978-0-07-182505-4)

DiPiro JT, Talbert RL, Yee GC et al. Pharmacotherapy: a pathophysiologic approach.10th edition. McGraw-Hill Companies:
New York, NY. 2017. (ISBN 978-1-259-58748-1)

Additional resources may be assigned.

Class and Exam Schedule: The PA faculty have created a schedule in Google calendar in order to provide you with an
overview of courses and exams. It is recommended that you display this calendar on your own calendar. You can also
synch this calendar with your mobile device. Be sure that you also keep up-to-date with your course syllabi and course
specific schedules on Canvas.

Individual lecture/reading schedule: The daily schedule will be posted and shared as a GoogleDoc. It is the responsibility
of the student to check this schedule for the most up to date information.

Standards Related to Course:

B1 CURRICULUM

B1.01 The curriculum must be consistent with the mission and goals of the program.
B1.02 The curriculum must include core knowledge about established and evolving biomedical and clinical sciences and
the application of this knowledge to patient care.
B1.03 The curriculum must be of sufficient breadth and depth to prepare the student for the clinical practice of
medicine.
B1.04 The curriculum design must reflect sequencing that enables students to develop the competencies necessary for
current and evolving clinical practice.
B1.06 The curriculum must include instruction to prepare students to provide medical care to patients from diverse
populations.
B1.07 The curriculum must include instruction related to the development of problem solving and medical decision-
making skills.

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B1.09 For each didactic and clinical course, the program must define and publish instructional objectives that guide
student acquisition of required competencies.

B2 CLINICAL PREPARATORY INSTRUCTION

B2.01 While programs may require specific course(s) as prerequisites to enrollment, those prerequisites must not
substitute for more advanced applied content within the professional component of the program.
B2.02 The program curriculum must include instruction in the following areas of applied medical
sciences and their application in clinical practice:
a) anatomy,
b) physiology,
c) pathophysiology,
d) pharmacology and pharmacotherapeutics
e) the genetic and molecular mechanisms of health and disease.
B2.04 The program curriculum must include instruction in interpersonal and communication skills that result in the
effective exchange of information and collaboration with patients, their families and other health professionals.
B2.05 The program curriculum must include instruction in patient evaluation, diagnosis and management.
B2.06 The program curriculum must include instruction in the provision of clinical medical care across the life span.
B2.09 The program curriculum must include instruction in basic counseling and patient education skills.
B2.10 The program curriculum must include instruction to prepare students to search, interpret and evaluate the
medical literature, including its application to individualized patient care.


C3 STUDENT EVALUATION

C3.01 The program must conduct frequent, objective and documented evaluations of students related to learning
outcomes for both didactic and supervised clinical education components.
C3.03 The program must monitor and document the progress of each student in a manner that promptly
identifies deficiencies in knowledge or skills and establishes means for remediation.


Note: The instructor reserves the right to modify the policies in this syllabus depending upon unusual or unforeseen
circumstances. Written notifications of any changes will be made through Canvas or campus e-mail. Any modifications to
this syllabus will be done with fairness and the best interests of the student and institution in mind.

Appendix A

Learning Objectives- See learning objectives provided for individual lectures.

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