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• Undergraduate study:
• Clearing
• Courses
• Order a prospectus
• How to apply
• Information for applicants
• Why choose Kingston University
• Disability and mental health support
• Accommodation
• Undergraduate fees
• Fees, funding and payments
• Access, participation and inclusion

Endocrine, Reproductive and Inflammation

• Module code: PY6020
• Year: 2018/9
• Level: 6
• Credits: 30
• Pre-requisites: PY5040
• Co-requisites: None

Summary

This module will deal with physiology and pathology of the endocrine and reproductive systems and inflammatory processes and how they can be affected by, or cause disease. The chemistry of the drugs which affect the endocrine and reproductive systems and are used to treat inflammatory disease and their relevant structure activity relationships will be covered together with the science and use of various formulations to ensure optimal drug delivery in these areas. The module will use a series of patient centred case studies to link the scientific content and the application of pharmaceutical care to treat and manage patients, in a variety of settings from disease prevention, managing risks, disease identification, responding to symptoms in the community pharmacy, prescribing and dispensing, through to the management of hospitalised patients.

Aims

• To provide information on the physiology of the endocrine, reproductive, musculoskeletal systems and inflammatory processes and the aetiology, epidemiology, pathophysiology of selected diseases and conditions related to them.
• To provide information on the clinical presentation, complications and relevant investigations of such conditions including the symptoms and relevant important physical signs associated with them.
• To review the therapeutic strategy employed to prevent or treat diseases associated with endocrine, renal, reproductive, musculoskeletal  systems and inflammation based on recent national guidelines
• To develop skills and knowledge required for responding to symptoms, patient counselling and health promotion in relation to endocrine, reproductive, musculoskeletal and inflammatory conditions.
• To examine the pharmacological actions of drugs acting at the endocrine, reproductive, musculoskeletal systems and highlight their use in the treatment of disease.
• To review the role of chemical mediators in the inflammatory process and the action of anti-inflammatory drugs, which inhibit the function of such mediators.
• To study the science and use of various formulations to ensure optimal drug delivery in these areas, such as the use of depot injections, intra-articular injections, patches and creams for local and systemic drug administration.
• To study the chemistry and structure-activity relationships of the drugs which affect the endocrine, reproductive and musculoskeletal systems and which are used to treat inflammatory disease.

Learning outcomes

On successful completion of the module, students will be able to:

• Describe the physiology of the endocrine, renal, reproductive, musculoskeletal systems and inflammatory processes and the pathophysiology of diseases associated with them.
• Make an appropriate evaluated decision when responding to symptoms/answering queries related to inflammatory diseases, contraception use, emergency hormonal supply, etc. and to communicate this information to the patient in an effective way
• Demonstrate an advanced understanding of the role of pharmacist in detection and prevention of disease, health promotion and treatment optimisation of endocrine disease especially diabetes.
• Evaluate the therapeutic strategy used to prevent and treat conditions and associated complications in relation to endocrine, renal, reproductive and musculoskeletal  systems, indicating the rationale for use of particular drugs in relevant situations while relating the selection of therapy to treatment guidelines/evidence base, drug properties (structure and formulation) and patient factors (e.g. age, pregnancy, etc.)
• Produce a structured reflective diary and a presentation based on  placement experience

Curriculum content

• Steroid hormones and their receptors. Steroid biosynthesis (cholesterol, oestrogens, androgens)
• Control and actions of glucocorticoids. Mineralocorticoids. Adrenal corticosteroids - mechanisms of action and therapeutic uses.
• Chemistry of steroids. Steroids from natural sources
• An introduction peptides and protein hormones and neurohormones, hypothalamic-pituitary neurohormones, oxytocin, insulin structure, biosynthesis and actions, hormones of the thyroid gland
• Prostaglandins and thromboxanes. Chemistry of NSAIDs.
• Formulation, characterization and performance of dosage forms designed for nasal, transdermal drug delivery.
• Formulation, characterization and performance of injectable, insertable and implantable drug delivery devices.
• Different formulations of insulin and novel ways of drug delivery of peptides as typified by insulin
• Use of biotechnology in production of recombinant insulins.
• The role of monoclonal antibodies as therapeutic agents, their design, rationale for use and the therapeutic challenges they pose.
• Endocrine Pharmacology: Thyroid and adrenal gland pharmacology: thyroid hormones, hyper and hypothyroidism, synthesis, transport and mechanism of action of thyroid hormones. Anti-thyroid drugs: thionamides, iodide salts and iodine. Disorders of the adrenal gland and agents used in their treatment and diagnosis, Anti-diabetic agents: different therapies for type I and type II diabetes.
• Glucocorticoids and mineralocorticoids: Use of glucocorticoids as anti-inflammatory and immunosuppressive drugs. Corticosteroid therapy. Management of adverse events
• Endocrine disorders including: type I and II diabetes mellitus, disorders of the thyroid and parathyroid gland, disorders of the glucocorticoid axis, disorders of the hypothalamic-pituitary axis; calcium metabolism and impotence
• Body calcium metabolism. Hormonal control. Parathyroid hormone (PTH) control of secretion. Vitamin D₁, synthesis and actions.
• Reproduction and the human life cycle. Basic aspects of male and female reproduction, including the menstrual cycle, fertilisation, pregnancy, the placenta, lactation.
• Contraception and fertility: Menopause and hormone replacement therapy. Use of hormonal contraceptives. Drugs used in the treatment of infertility and their mechanism of action.
• Obstetrics, pregnancy, childbirth. Treatment of disorders of pregnancy and the pregnant woman.
• Mediator Pharmacology: Role of chemical mediators in the inflammatory response. Anti-histamines and treatment of allergic disease. Drugs affecting eicosanoid action including non-steroidal anti-inflammatory drugs i.e. cyclooxygenase (COX-1 and COX-2) inhibitors, 5-lipoxygenase inhibitors 5-FLAP inhibitors and leukotriene receptor antagonists. Platelet activating factor antagonists. Bradykinin antagonists. Adhesion molecule antagonists.
• Pathology, aetiology, pathophysiology, clinical features, disease progression, complications and treatment of joint disease (osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), gout and osteoporosis)
• Urinary tract disorders, urinary retention, frequency and urinary incontinence, benign prostatic hypertrophy.
• Renal disease: acute and chronic renal failure, electrolyte abnormalities, effect of renal function on drug choices and prescribing.
• Consideration of such factors as treatment guidelines/evidence base, indications, drug-drug interactions, contraindications, and adverse effects for the choice of treatment in patients with diseases of the musculoskeletal system, endocrine and reproductive system
• Patient management issues related to the treatment of patients with diseases of the musculoskeletal system, endocrine system, renal and reproductive system
• Health promotion and ability to respond to symptoms and counsel patients correctly in relation to conditions/issues of the endocrine, reproductive, contraception and musculoskeletal disorders
• Supply of tamsulosin, orlistat, emergency hormonal contraception, Chlamydia treatment in the community and good practice related to this supply
• Accurately analyse, label, dispense, and endorse multi-item prescriptions, identify potential drug interactions, and make interventions where appropriate related to above conditions/systems

Teaching and learning strategy

Lectures are used to provide underpinning knowledge while in workshops, tutorials, problem-based learning scenarios are used so that students can learn to apply knowledge to describe how the drugs discussed in the module are used in the treatment of human disease.  An underpinning principle is using the scientific learning in this module and applying it to clinical practice and patient care. Practical experiments will be lab based and will require analysis and decision making.

Breakdown of Teaching and Learning Hours

Assessment strategy

There is no end of module exam in this module, assessment is by coursework, a practical assessment and an in module assessment, in the form of an in class test.  The in class test will comprise primarily of MCQ, SBA, EMQ and SAQ style questions, along with calculation questions. The use of SBA and EMQ style questions encourage the development of clinical decision making so that effective and safe patient management can be demonstrated. This in module assessment not only provides a measure of student progress and an opportunity to provide feedback but also ensures that students maintain their learning throughout the module rather than learning purely for an end of module exam.

Team working, leadership, interpersonal skills and communication skills are developed through the public health group assignment. This assignment is a Problem Based Learning exercise where students working in groups identify health needs and design a public health campaign to meet that need. In addition to the final report, as this is group work there will be an element of peer assessment. The work not only develops the students' knowledge with regard to public health needs and how to address them but feeds forward to the synoptic OSCE at this level and also to the delivery of the campaign which is undertaken at Level 7.

The clinical case presentation, where the clinical information about a specific patient is collected while on hospital placement not only challenges the student to use their critical appraisal skills and clinical knowledge as applied to an individual patient but also develops their oral presentation skills and their ability to effectively communicate. A formative assessment of a previously prepared Patient Management Plan feeds forward to this assessment.

A range of formative assessments of short duration undertaken both in-class in practicals and workshops, and during independent study where there are also some e-learning packages will be set by the module leader and feedback given. One specific feature of these will be regular calculations mini-quizzes as part of workshops to ensure students maintain and develop this vital competence as well as feed forwarding into the synoptic calculations assessment at the end of the level. These formative assessments will provide regular and detailed feedback to students on their progress and help identify strengths and weaknesses that require addressing

The placement will be formatively assessed through a reflective diary and satisfactory completion of placement activities form part of the Academic and Professional Skills portfolio and be assessed in a placement feedback session.

Level 6 MPharm students are required to pass a synoptic OSCE style assessment and a synoptic calculations test before they can progress to Level 7. These are to assure that even at this Level the student is demonstrating the appropriate skills, knowledge, understanding and attributes to become a future pharmacist. In addition there is a synoptic exam covering the material in all four Level 6 modules, underpinned by learning from Levels 4 and 5. At level 6 the clinically themed modules have considerable cross module application and resonance to reflect the integrated nature of the course. To promote deeper learning, application and judgement as well as discourage silo learning a synoptic approach is more appropriate to assess the potential abilities of a future pharmacist. In addition it should facilitate in students the ability to focus on a patient as a whole considering not only the prime condition but also co-morbidities.

Learning in this module feeds forward into all three of these synoptic assessments. In addition the assessment modes used both formatively for calculations and summatively elsewhere in the in module assessment will prepare the students for the synoptic assessments.

Mapping of Learning Outcomes to Assessment Strategy (Indicative)

Elements of Assessment

Achieving a pass

It IS NOT a requirement that any element of assessment is passed separately in order to achieve an overall pass for the module.

Bibliography core texts

• Drugs in Use: Clinical case studies for pharmacists (4th Ed), Dodds. Pharmaceutical Press (2009). ISBN 0853697914
• Clinical Pharmacy & Therapeutics (4th Ed), Walker and Whittlesea. Churchill Livingstone (2007). ISBN 0443102856
• Pathology and therapeutics for pharmacists: A basis for clinical practice (3^rd Ed), Greene and Harris. Pharmaceutical Press, (2008). ISBN 978 0 85369 6902
• Clinical Medicine (7th ed). Kumar and Clark. Elsevier Health Sciences (2009). ISBN 0702029939
• Oxford Textbook of Clinical Pharmacology and Drug Therapy (3^rd ed). Grahame-Smith and Aronson. OUP Oxford (2002). ISBN 0192632345
• Adverse Drug Reactions (2^nd revised Ed), Lee. Pharmaceutical Press, (2006). ISBN 0853696012
• British National Formulary, Latest Edition, edited by the Joint Formulary Committee. Pharmaceutical Press. ISBN 0853697760
• Clinical Biochemistry (4^th Ed), Gaw, Murphy et al. Churchill Livingstone (2008). ISBN 0443069328
• Health promotion for pharmacists (2^nd Ed), Blenkinsopp, Panton and Anderson. Oxford University press (2000). ISBN 9780192630445
• Saunder's Pocket Essentials of Clinical Medicine (3^rd ed), Ballinger and Patchett. Saunders (W.B.) Co Ltd (2003). ISBN 070202645X
• Pharmacology (7^th ed), Rang, Dale, Ritter & Moore. Churchill Livingstone (2011). ISBN 0702034711
• Integrated Pharmacology (3^rd ed), Page, Hoffman, Curtis, Walker. Mosby (2006). ISBN: 0323040802
• Symptoms in the Pharmacy: A Guide to the Management of Common Illness (6^th Ed) Blenkinsopp, Paxton and Blenkinsopp. Blackwell Publishing (2008). ISBN 978-1405180795
• Community pharmacy; symptoms, diagnosis and treatment (2^nd Ed), Rutter. Churchill Livingstone (2008). ISBN 978-0702029950.
• Modified-Release Drug Delivery Technology (2^nd Ed). M.J. Rathbone, J. Hadgraft and M. S. Roberts. Marcel-Dekker (2008). ISBN 1420053558
• Physico-Chemical Principles of Pharmacy (5^th Ed). A.T. Florence & D. Attwood, Pharmaceutical Press (2011). ISBN 0853699844
• Pharmaceutics. The design and manufacture of medicines (3^rd Ed). M.E Aulton, Churchill Livingstone (2007). ISBN 044310108
• An Introduction to Medicinal Chemistry (4^th Ed). Patrick G.L., Oxford University Press (2009). ISBN 0199234477
• Organic Chemistry. Clayden, Greaves, Warren and Wother. Oxford University Press (2001). ISBN 0198503466
• Medicinal Chemistry - An Introduction Thomas G. John Wiley (2007). ISBN 9780470025970
• Medicinal chemistry - a molecular and biochemical approach (3^rd Ed). T. Nogrady and D. F. Weaver (2005). ISBN 0195104560
• NICE
  
• Department of Health
  
• Pharmaceutical Services Negotiating Committee
• Royal Pharmaceutical Society
  
• General Pharmaceutical Council
  

Bibliography recommended reading

• Greenspan's Basic and Clinical Endocrinology (8^th Ed) Gardner D.G. and Shoback D.M. Appleton and Lange (2007). ISBN: 0071440119
• Endocrinology: an integrated approach. Nussey SS & Whitehead SA. Taylor & Francis (2001). ISBN 1859962521
• Color Atlas of Pharmacology (3^rd Ed). Luellmann H, Mohr K, Hein L, Bieger D (2005). Georg Thieme Verlag. ISBN: 313781703x
• Applied Therapeutics: The Clinical Use of Drugs (8th revised Ed) Koda-Kimble, Young. Lippincott Williams and Wilkins, (2004). ISBN 0781748453
• Clinical Pharmacy Survival Guide, Barber and Willson. Churchill Livingstone (1999). ISBN 085369754X
• Stockley's Drug Interactions (8th ed) Stockley. Pharmaceutical Press (2007). ISBN 0853695040
• Meyler's Side Effects of Drugs (15th ed): The International Encyclopaedia of Adverse Reactions and interactions (Meyler's Side Effects of Drugs), Aronson (2006). ISBN 0444509984
• Clinical pharmacokinetics: concepts and applications (3rd ed) Rowland. Williams & Wilkins (1995). ISBN 0683074040
• Clinical pharmacy pocket companion, Wright et al, Pharmaceutical Press (2006). ISBN:9780853696490