Designing a Pharmacology Course for a Doctor of Physical Therapy Program

Transcription

1 Designing a Pharmacology Course for a Doctor of Physical Therapy Program Lynn Wecker, Ph.D. Distinguished Professor University of South Florida College of Medicine Department of Psychiatry & Neurosciences Department of Molecular Pharmacology & Physiology School of Physical Therapy & Rehabilitation Sciences Experimental Biology - April 2011

2 Timeline of the Discipline Year Program Degree 1917 US Army/US Office of Surgeon General - 3 month education program with focus on anatomy & exercise schools collaborated with US Army/US Office of Surgeon General - 6 month program with focus on technical skills not on essential foundations 1928 American Physiotherapy Association standards - 9 month, 1,200 hour program of instruction for graduates from a 2 year school of physical education or nursing 1936 AMA established accreditation standard - 60 college credits or graduation from a 2 year school of physical education or nursing with programs ranging from months duration Reconstruction Aide Certificate 54 programs developed 35 - Certificates 19 - B.S.

3 Year Program Degree 1960s content added in neuroanatomy, neurophysiology, psychology of disabled individuals, research, and others, a foundation for understanding pathology and treatment rationale was established B.S Case Western Reserve offered Master's program M.P.T. mid 1960s NYU, USC, Texas Woman's U & BU developed postprofessional graduate programs in several focused areas such as movement science, kinesiology, rehabilitation science, etc bachelor's degree required by APTA to enter a physical therapy program minimum knowledge and skills standards defined by APTA; preferred curricular content defined USC and Creighton U have the first 2 programs to be accredited Ph.D. D.P.T ACCREDITED PROGRAMS D.P.T.

4 "As of January 1, 2016, the DPT will be the required degree for all entry-level physical therapist education programs."

5 Evolution of Pharmacology Education for DPT Students at USF fall MPT program approved fall first class entered MPT program no formal pharmacology in curriculum; drug information provided by physical therapy faculty fall DPT program approved fall first class entered DPT program spring first pharmacology course for DPT students course given by faculty in Department of Pharmacology & Molecular Therapeutics

6 Initial Pharmacology Course for DPT Students at USF 15 weeks minute lectures and minute problem-solving sessions 7 faculty involved relatively equal distribution of lectures across topics problem-solving sessions were targeted to physical therapists exercise tolerance and cardiac drugs considerations of antispasmodics in the rehabilitation patient pain management in the rehabilitation patient exercise and chemotherapy

7 Were students learning what they needed to know to be successful in their future? Was the course meeting the standards set by APTA? Did the course cover all the material expected of the students for their licensing exam?

8 Were students learning what they needed to know to be successful in their future? predict (and avoid) possible issues that may be encountered from a person's history and use of both prescribed and over the counter drugs recognize potential problems that may occur during sessions with patients who may be using prescribed and over the counter drugs answer potential questions from patients regarding prescribed and over the counter drugs learn to evaluate the pertinent medical literature with an emphasis on evidence-based reports develop critical thought patterns work with other members of a healthcare team

9 Was the course meeting the standards set by APTA? provide matrices for core building blocks and contextual framework for content provide both terminal behavioral objectives and instructional objectives Biology/Anatomy, Cellular Histology, Physiology Exercise Physiology Exercise Biomechanics Kinesiology Neuroscience Pharmacology Pathology Behavioral Sciences Communication Social and Psychological Factors

10 Pharmacology - Primary Content pharmacokinetic principles dose-response relationships routes of administration enhancement of transdermal drug absorption absorption and distribution biotransformation and excretion factors affecting pharmacokinetics potential drug interactions pharmacodynamics

11 Pharmacology - Objectives Terminal Behavioral Objectives (after lecture, students should know ) identify factors that may alter transdermal drug absorption and describe how physical therapy interventions such as thermal agents, massage and exercise can affect drug absorption and distribution explain how altered pharmacokinetics may alter drug effects and how this may be recognized in patients receiving physical therapy Instructional Objectives describe ways a physical therapist could increase the transdermal absorption of dexamethasone explain how an anti-inflammatory steroid will reach the supraspinatus tendon following oral administration explain how the absorption and distribution of insulin are altered by exercise, thermal agents or massage applied to the injection site

12 Did the course cover all the material expected of the students for their licensing exam?

13 Pharmacology for Healthcare Professionals 2010

14 The Basics a 4 credit hour course that met twice weekly for 15 weeks topics aligned with concurrent course in Rehabilitative Medicine taught by 4 faculty 6 topic areas Principles The ANS The Cardiovascular System The Endocrine System Chemotherapeutic Agents 39 lectures, 5 small group problem-solving sessions, and 8 student group presentations

15 Problem-Solving Topics Physical Therapy Interventions and Pharmacokinetics The Autonomic Nervous System The Cardiovascular System The CNS Pain Management

16 Pharmacokinetic Problem-Solving Session. How can exercise affect the bioavailability (the fraction of a drug that reaches the systemic circulation) of drugs administered by different routes (oral, transdermal, intramuscular, subcutaneous, inhalation)? 2. How can exercise affect the volume of distribution (how a drug is dispersed throughout the body; determined by the ratio of the amount of drug administered divided by the plasma concentration) of drugs? 3. How can exercise affect the clearance (the rate at which the active form of drug is removed from the body) of drugs? 4. What pharmacokinetic effects may you expect when using heat packs? cold packs? 5. What might happen to the absorption of a drug from a subcutaneous or intramuscular injection site following massage to that area?

17 Cardiovascular Problem-Solving Session A 46-year-old man trips over a rock while training for a marathon and hurts his right wrist. His physician recommended physical therapy, and when he arrives at the clinic, you discover that he has a history of hypertension and takes both propranolol and hydrochlorothiazide. For the past 2 days he has been taking lots of aspirin for his wrist pain. He has no other illnesses, but you notice that he has cramping in his lower extremities. When you question him, he states that he just ran 8 miles to your clinic, but you notice that his clothes are dry, despite the high heat and humidity outside. You take his vitals and note a blood pressure of 90/60 mm Hg and a resting pulse of 110 bpm. His right hand exhibits mild edema with limited active and passive range of motion. Strength testing demonstrates weakness in the right hand with a right grip strength of only 25 pounds and a left grip strength of 40 pounds. The patient continues to show evidence of mild cramping, and after further questioning, the patient reports feeling weak. You are very concerned and decide to call for an ambulance. a. What is your first thought about what is going on? b. Should his medication be changed? If so, what would you recommend? (Think about how propranolol and the thiazides affect exercise performance and how they compare with other drugs for the treatment of hypertension.)

18 Student Presentation Topics What are the effects of different types of bronchodilators on exercise responses? What are the effects of beta blockers on exercise-induced cardiac responses? How do different classes of calcium channel blockers affect exercise-induced cardiac responses? Do statins affect the risk of muscle injury? How and why? How does exercise compare with drugs for the treatment of osteoporosis?

19 What potential problems may be encountered when a medicated diabetic exercises? Should fluoroquinolone antibiotics be prescribed for infections in athletes? Why or why not? Are NSAIDs beneficial for the treatment of exerciseinduced muscle injury? Why is exercise beneficial for mental health? Are anabolic steroids of benefit for increasing muscle strength? How about recovery from muscle injury?

20 Summary When designing a pharmacology course for a doctor of physical therapy program, the course should be tailored specifically to this group of students and should take into consideration: what students need to know to be successful in their future the standards set by APTA material expected of the students for their licensing exam

21 Pharmacology for Healthcare Professionals 2011 develop more problem-solving sessions decrease didactic lectures add information on special populations, viz., issues with the elderly such as ADME alterations, multiple drugs, etc. other???

22 Thanks to the students in the DPT classes I have taught for the past 4 years who taught me how to think about pharmacology from their perspective!!!!