Syllabus - CHALLENGES IN VETERINARY THERAPEUTICS - VM 8784

  1. CATALOGUE DESCRIPTION
  2. Course Description. VM8784 has three main areas of particular emphasis: 1)Therapeutic decision making with special attention paid to sources of therapeutic information and government regulation of veterinary drug therapy; 2) Effects of disease processes on drug disposition and; 3) Clinical pharmacology of anti-infective and anti-inflammatory drugs. The course will consider principles of therapeutic decision making with emphasis on selection among drugs that are potentially effective, the risks and benefits of each. In addition, we will consider means for monitoring the course of therapy in individual patients, and the economic impact of therapeutic decisions. (2H, 2C)
  3. OBJECTIVES
  4. In general, it is logical to look to expert opinion as the basis for selecting appropriate treatment for veterinary patients. A list of therapeutic (pharmaceutical) preferences for a particular disorder is often referred to as the "drugs of choice." Drugs of choice offered by experts are a logical starting point for selecting drug therapy. However, this approach lacks flexibility and insight that may be required when the patient is NOT "typical" or when patient characteristics are recognized as specific contraindications. Furthermore, drugs of choice lists may be dated and do not provide information that will assist you in determining the proper role of new therapeutic agents that may become available after their publication.

    Having successfully completed this course, the student will be able to:


  5. PREREQUISITES AND COREQUISITES
  6. Third-year standing in the DVM curriculum.
  7. TEXTS AND SPECIAL TEACHING AIDS
  8. Required texts

    None

    Recommended texts

    USPDI
    Textbook used in VM 8274 (Fundamentals of Veterinary Pharmacology)
    Current Veterinary Therapy (Various - species appropriate to student interests)
    Veterinary Drug Handbook - Plumb

    Other materials

    Complete set of lecture notes (printed and web based)
    http://www.fda.gov/cvm
    http://cpharm.vetmed.vt.edu/vm8784/default.htm
  9. COURSE DETAILS
    1. Introduction:
    2. Course leader: Wilcke Credits: 2 Semester: 6 Core, track, or elective: core Contacts: Lectures: 23 Labs: 4 (1/2 hour each)
    3. Schedule:
    4. Lectures

      1. Clinical evidence and therapeutics (Introduction to therapeutic decision making) - Therapeutic challenges and constraints, types and sources of therapeutic evidence, cost benefit analysis.
      2. External influences on veterinary therapeutics - Animal drug regulation by the food and drug administration with special emphasis on understanding the Animal Drug Use Clarification Act (AMDUCA - Extra-label drug use, Labeling, Records, Withdrawal periods for food animal, prohibitions), animal drug label interpretation, Freedom of Information evidence summaries, the Animal Drug Availability Act (Changes in efficacy evidence, Veterinary Feed Directive Drugs, Flexible labeling, Drugs for "Minor Species"), the Drug Enforcement Administration, State pharmacy laws, the veterinary pharmaceutical industry.
      3. Pharmacokinetics in patient care - dehydration, organ failure - A detailed consideration of the effects of dehydration and organ failure as they affect drug disposition in veterinary patients. Relationships between these important physiologic and pathologic changes and the principles of drug absorption, distribution and elimination. Leads to an ability to anticipate unusual in responses to usual doses of therapeutic agents in clinical patients and to modify therapy accordingly.
      4. Pharmacokinetics in patient care - absorption, blood flow alterations, pharmaceutical factors - A detailed consideration of relationships between physiologic, pathologic and pharmaceutical factors and the principles of drug absorption, distribution and elimination. Leads to an ability to anticipate unusual responses to usual doses of therapeutic agents in clinical patient and to modify therapy accordingly.
      5. Therapeutic concentration monitoring - Principles of dose adjustment in clinical patients based on therapeutic drug concentration monitoring for aminoglycosides, phenobarbital, digoxin, and theophylline.
      6. Antimicrobial principles - spectrum, mechanisms of action, resistance mechanisms. - An examination of the activity, mechanisms of action, mechanisms of resistance of antimicrobials.
      7. Susceptibility of bacteria isolates - An examination of susceptibility of isolates and bacterial populations from both an laboratory result and epidemiologic perspective and the effect susceptibility and resistance have on proper selection of therapeutic agents.
      8. Susceptibility tests - laboratory options - An examination of the meaning of and application of MICs, Breakpoints, Kirby-Baur tests to the selection of antimicrobial agents for treatment of clinical infections.
      9. Dosing considerations - An examination of factors affecting dosage (dose and interval)and duration of therapy including effects of host defenses as well as concentration/activity profiles.
      10. Clinical pharmacology of beta lactams - An examination of the clinical pharmacology and activity profiles of the penicillins and cephalosporins.
      11. Clinical pharmacology of aminoglycosides and fluoroquinolones - An examination of the clinical pharmacology and activity profiles of aminoglycosides and fluoroquinolones.
      12. Clinical pharmacology of macrolides and lincosamides - An examination of the clinical pharmacology and activity profiles of the macrolide and lincosamide antimicrobials.
      13. Clinical pharmacology of tetracyclines and chloramphenicol - An examination of the clinical pharmacology and activity profiles of tetracyclines, chloramphenicol and florfenicol.
      14. Clinical pharmacology of miscellaneous antibacterial agents and antifungals - An examination of the clinical pharmacology and activity profiles of miscellaneous antimicrobials and antifungals.
      15. Antimicrobial Therapeutics I - bacteremia, soft tissue infections and abscesses.
      16. Antimicrobial Therapeutics II - urinary and reproductive system infections.
      17. Antimicrobial Therapeutics III - respiratory and infections of skin and intracellular infections.
      18. Selected Antimicrobial Cases I
      19. Principles of antimicrobial prophylaxis - General principles of and techniques applied to prevention of infections.
      20. Preventing patient infections - surgery, immunosuppression, dentistry, and urinary catheterization.
      21. Selected Antimicrobial Cases II
      22. Clinical pharmacology of glucocorticoids - General principles including influence of mechanisms, adverse effects, dosing and dose forms on glucocorticoid therapeutics.
      23. Glucocorticoid therapeutics - An examination of replacement therapy, therapy for inflammatory disease, therapy for immune disease, and alternate day therapy
      24. Clinical Pharmacology of NSAIDS - An examination of the similarities and differences among non-steroidal antiinflammatory drugs based on mechanisms of action, pharmacokinetics, drug interactions.

      Labs

      1. Veterinary Drug Labels (determining whether a particular use of a pharmaceutical is extra-label)
      2. Veterinary Drug Labels (Label pharmacokinetics)
      3. Veterinary Drug Labels (Label microbiology)
      4. Target: Empirical drug selection based on historical susceptibility information.

      Exams

      2 x 60 minute online (Scholar) exams. Question format is not pre-determined. May include any combination of multiple choice, short answer, essay.

      Final

      The final examination will be posted through Scholar.
    5. Clothing, special equipment
    6. Refer to Student Handbook.
    7. Grading Policies and Standards
    8. Refer to Student Handbook.
      Grades will be calculated from 2 in-class exams account for 2/5 of total grade (1/5 each), quizzes for 4 labs account for 1/5 of the total grade and the final exam for the remaining 2/5 of the total grade. Grading scale employed is that stated in the Student Handbook.
    9. Attendance Policy
    10. Refer to Student Handbook.
    11. Disabilities, Professionalism, Academic Misconduct, Honor Code, Drop/Add Policy
    12. Refer to Student Handbook