Leslie Dan Faculty of Pharmacy University of Toronto Course Outline and Syllabus (2017 2018) Course Instructor: Dr. Reina Course Number: PHM143H1 Course Title: Pathobiology and Pathology Course Description: This course is designed to introduce pharmacy students to the physiological and biochemical mechanisms which lead to pathological states, and includes the laboratory investigation and follow-up associated with specific diseases. Required: Yes Elective: No 1. Course Learning Objectives: Upon completion of this course, students will be able to have: Knowledge/Skills/Attitudes/Values Intermediate Level: The students will acquire a working knowledge of the basic mechanisms of disease, including the pathophysiology and biochemical changes that occur in specific disease states, and how diagnostic investigations (i.e., laboratory) can confirm the presence of these disease states. Students are expected to integrate knowledge from several sources, such that they can explain and interpret the disease state process present in specific cases to other health care professionals as well as to patients. 2. Rationale for Inclusion in the Curriculum: Knowledge of the pathophysiology, clinical biochemistry, and other laboratory tests relating to diseases students will eventually encounter as practicing pharmacists is necessary to understand the rationale for pharmacotherapeutic intervention. 3. Pre-requisites: Physiology, Anatomy, Molecular Biochemistry, Immunology 4. Statement of agreement from course coordinators of courses for which your course is a pre-requisite: N.A. 5. Co-requisites (for the current and subsequent year): Physiology, Anatomy, Molecular Biochemistry, Immunology 6. Statement of agreement from course coordinators of courses for which your course is a co-requisite: N.A. 1
7. Course Contact Hours and Teaching Methodologies: Didactic (lecture) Large group problem-based or case-based learning Large Group Size Laboratory or Simulation Tutorial/Seminar/Workshop/Small Group Small Group Size Experiential On-line Other (please specify)* * Other specific information: Total course contact hours 34 hours 0 persons 3 hours 0 persons 37 hours 8. Estimation and description of student's out-of-class preparation time required: Students will be expected to obtain and read over the notes prior to the lectures. Additional time may be required after the lecture to annotate/complete the notes with material derived from the lecture. 9. Course Coordinator and Teaching Assistant: Dr. Reina Tel. #: 416-978-8511 Email: r.bendayan@utoronto.ca Camille Alam E-mail: camille.alam@mail.utoronto.ca 10. Course Instructors (including contact information): Course instructors are numerous and are contacted for their participation. 11. Required Resources/Textbooks/Readings: Course notes are available online at Blackboard. 12. Recommended Resources/Textbooks/Readings: Kumar, V., Abbas, A. K., Aster, J. C. (2014). Robbins and Cotran Pathologic Basis of Disease, 9 th ed. Elsevier Saunders. Burtis, C. A., Ashwood, E. R., Bruns, D. E. (2015). Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 7 th ed. Philadelphia, PA: Saunders. 13. Topic Outline/Schedule: Week 1 No Class Week 2 Introduction (1 hr): Orientation to the course with an emphasis on the purpose/content, format, and the evaluation methods used. Outline the topics to be covered and lectures to be offered by invited clinicians. 2
Mechanisms of Cell Death (1 hr): Describe the different forms of cell death and the outcomes associated with them. Summarize the various degrees of damage associated with cell death and the diagnostic methods used to evaluate the consequences of cell death. Genetic Disorders (1 hr): Describe the rationale for prenatal screening. Review the factors that lead to neural tube defects and its consequences, the biochemistry and management of PKU, and the potential of gene therapy. Week 3 Week 4 Week 5 Week 6 Week 7 Introduction to Carcinogenesis (2 hr): Discuss the molecular basis of carcinogenesis. Describe the epidemiology, pathogenesis, diagnosis, and clinical presentation of cancers and potential genetic causes for these conditions. Vitamin D and Calcium Disorders (2 hr): Describe the role of calcium in healthy individuals. Describe how calcium uptake and loss is regulated during a patient s life and how diagnostic tests can be used to monitor bone density and loss. Alcoholic Liver Disease (1 hr): Describe the spectrum of liver toxicities observed in patients, their causality (alcohol induced hepatic toxicity) and prevention, using specific examples and cases. Electrolyte Disorders (2 hrs): Discuss the consequences of volume depletion and abnormal sodium/ potassium levels. Interpretation of laboratory tests will be used to allow the students to determine the underlying cause of disorders. Acid/Base Disorders (1 hr): Compare and contrast the underlying basis for respiratory and metabolic acidosis and alkalosis. Integrate the interpretation of laboratory test results and how appropriate interventions can be used to correct these imbalances. Neurophysiology - Epilepsy, Alzheimer s & Parkinson s Disease (3 hrs): Overview of brain structure and function. Describe the epidemiology, disease progression, diagnosis, biochemical causes, and potential treatment for neurological disorders. Describe the causes of epilepsy and seizures, including triggering factors, diagnosis, pathogenesis, and clinical representation. Compare and contrast the causes and symptoms of Alzheimer s, Parkinson's, and cerebrovascular diseases. Tutorial - Midterm Review (1 hr): Describe the format of the exam, provide suggestions for effective exam preparation, and discuss relevant case studies. Gastrointestinal Pathology (2 hrs): Overview of Peptic Ulcer Disease, Inflammatory Bowel Disease, and Ulcerative Colitis. Describe the epidemiology of GI bleeding, ulcers, and inflammatory bowel diseases including the etiology, pathology, diagnosis, clinical presentation, and complications. Describe the factors that lead to GERD, its symptomatology, and complications. Midterm Exam Week 8 Reading Week! Week 9 Disorders of the Cardiovascular System (3 hrs): Compare and contrast the pathogenesis that leads to angina, atherosclerosis (i.e., plaque development molecular biology), myocardial infarction, and congestive heart failure. Review the development of the human heart and describe common 3
congenital defects that may result. Summarize the integration and interpretation of diagnostic tests within these conditions. Week 10 Hepatic Pathology - Liver and Biliary Tract Liver Disease (2 hrs): Describe the normal function of the liver. Summarize the purpose and types of liver function tests. Compare and contrast various mechanisms of damage, which lead to cirrhosis or portal hypertension. Respiratory Pathology - Asthma (1 hr): Describe the prevalence, pathogenesis, clinical presentation, causes, and complications of asthma. Week 11 Ophthalmology (2 hrs): Describe the structure and function of the eye. Describe common diseases of the eye and their causes. Summarize the diagnosis and symptomatology of these conditions, and discuss the use of dilating agents, anti-bacterial agents, anti-viral agents, steroids, NSAIDS, and anti- VEGF as treatment options. Respiratory Pathology - Chronic Obstructive Pulmonary Disease (1 hr): Describe the prevalence, pathogenesis, clinical presentation, causes, and complications of COPD. Week 12 Diabetes Mellitus (2 hrs): Summarize the process of glucose homeostasis and how defects can produce hyper or hypo glycaemia or diabetes. Describe diagnostic tests used to monitor glucose levels in diabetic patients. Renal Physiology (1 hr): Describe the anatomy and physiology of the kidney. Review the various qualitative and quantitative tests used to evaluate kidney function. Week 13 Renal Pathology Acute and Chronic Dysfunction (2 hrs): Contrast the etiology, pathogenesis, and clinical presentation and biochemical characteristics of acute and chronic renal failure. Describe the basis of clinical investigation in renal disease. Drug-Induced Renal Toxicity (1 hr): Discuss the mechanisms involved in drug-induced renal injury. Identify which classes of drugs frequently induce renal toxicity and describe the mechanisms whereby this occurs. Week 14 Renal Dysfunction - Clinical Investigation and Biochemical Tests (2 hrs): Integrate diagnostic test results with impaired renal function and renal disorders. Discuss several cases illustrating the pathogenesis, clinical presentation, and laboratory data of acute and chronic renal insufficiency. Renal Dysfunction and Drug-Induced Renal Toxicity: (1 hr): Discuss several cases illustrating the pathogenesis, clinical presentation, and laboratory data of acute and chronic renal insufficiency. Discuss relevant case studies of drug-induced renal toxicity. Tutorial - Exam review (2 hrs): Describe the format of the exam, provide suggestions for effective exam preparation, and review relevant case studies. Week 15 Renal Dysfunction and Drug-Induced Renal Toxicity: (2 hrs): Discuss several cases illustrating the pathogenesis, clinical presentation, and laboratory data of acute and chronic renal insufficiency. Discuss relevant case studies of drug-induced renal toxicity. 4
14. Assessment Methodologies Used: Learning Objective Addressed Assessment 1: Students are expected to answer factual questions and be able to apply concepts learned during the lectures. Assessment 2: Students are expected to answer factual questions and be able to apply concepts learned during the lectures. Assessment Method Used Assessment 1: MCQs Assessment 2: MCQs When Administered Assessment 1: Week 6 Assessment 2: Final Exam Period Percentage of Course Grade Assessment 1: 40% Assessment 2: 60% For Group Work (maximum 10% of course grade) indicate how marks within groups are allocated: Individualized or Same for all Group Members Assessment 1:N.A. Assessment 2: N.A. Remediation Opportunities? Assessment 1: N.A. Assessment 2: N.A. Expectation for pass grades for all Pharmacy courses is 60%. 15. Policy and procedure regarding make-up assignments/examinations/laboratories: In the case of a missed examination, midterm or final exam, the regulations and policies established by the Faculty of Pharmacy will be applied. When an examination is missed, the student must file with the Faculty Registrar, a petition for consideration in respect to the missed examination. This petition, along with supporting documentation, must be filed within seven calendar days of the missed examination. For examinations missed during the regularly scheduled examination period (December and April), petitions must be submitted by the end of the examination period. In the case of a missed examination and when a reason deemed valid by the Faculty is presented, the student will be given a make-up examination (written or oral at the instructor s discretion). 16. Policy and procedure regarding supplemental assignments/examinations/laboratories: Provided they have an overall GPA 1.7, students who fail the course will be permitted to write a supplemental examination covering all course material worth 100% of their grade. 17. Policy and procedure regarding course exemptions/prior learning assessment and recognition: N.A. 5
Lecture Schedule (2017-2018) Wk. Date Time (hrs.) Topic Lecturer PB Room 1 WED Jan 3 2 MON Jan 8 WED Jan 10 3 MON Jan 15 WED Jan 17 FRI Jan 19 (Makeup) 4 MON Jan 22 WED Jan 24 5 MON Jan 29 WED Jan 31 6 MON Feb 5 WED Feb 7 No Class Introduction Mechanisms of Cell Death Genetic Disorders Dr. I. Crandall Dr. C. Parra- Carcinogenesis Herran No Class Vitamin D & Calcium Disorders Vieth HS610 No Class Interprofessional Education Alcoholic Liver Disease Dr. B. Bartle Electrolyte Disorders Dr. M. Schreiber Acid Base Disorders Dr. M. Schreiber Cardiovascular Disorder Dr. J. Butany Cardiovascular Disorder Dr. J. Butany WED Feb 7 1pm-2pm Midterm Exam Review TA & MS 2158 MON Feb 12 7 WED Feb 14 8 MON Feb 19 WED Feb 21 9 MON Feb 26 WED Feb 28 10 MON Mar 5 WED Mar 7 11 MON Mar 12 WED Mar 14 12 MON Mar 19 4pm 6pm 8:45am 10:45am 11am 12pm Gastrointestinal Pathology Dr. M. Cino Midterm Exam EX 200 No Class Family Day &Reading Week Hepatic Pathology Dr. B. Hoffman No Class Neurophysiology Dr. I. Lecker Respiratory Pathology: Asthma Dr. C. Chan Ophthalmology Dr. A. Rai Respiratory Pathology: COPD Dr. C. Chan Diabetes Mellitus Dr. B. Hoffman 6
7 WED Mar 21 13 MON Mar 26 Renal Physiology & Pathology: Acute and chronic dysfunction Renal Physiology & Pathology: Acute and chronic dysfunction WED Mar 28 14 MON Apr 2 Case Studies: Clinical investigation/ biochemical Tests Drug-induced renal toxicity WED Apr 4 Case Studies: Renal Dysfunction and Druginduced renal toxicity FRI Apr 6 11am-1pm Final Exam Review TA & 15 MON Apr 9 Case Studies: Renal Dysfunction and Druginduced renal toxicity Apr 12-30 Final Exam Period 7