Unit I: Cellular response to injury:

•         Causes of cell injury.

•         Mechanism of cell injury.

•         Morphological alteration in cell injury.

•         Necrosis (pathological cell’s death): Coagulative, Gaseous necrosis, liquifactive, fat, Zenker’s necrosis.

•         Apoptosis.

•         Gangrene

•         Steatosis (fatty change)

•         Cholesterol and cholesterol esters

Extracellular depositions:

•         Pathological calcification

•         Amyloidois

Acute inflammation:

•         Definition

•         local signs and symptoms, systemic effects

•         outcomes of acute inflammation

•         types of acute inflammation

•         abscess, furuncle, carbuncle,

•         serous inflammation, fibrinous inflammation

•         chemical mediators and regulators of inflammation

•         Definition

•         Cells of chronic inflammation,

•         Types of chronic inflammation, granuloma,

•         Healing and repair

•         Healing of wounds: (Primary and secondary types, Factors affecting wound healing)

•         Edema: definition, types, pathogenesis.

•         Embolism: definition, types.

•         Infarction: definition, types.

•         Hemorrhage and shock: mechanism and types.

•         Congestion: active and passive.

·         Aplasia -Hypoplasia. – Hyperplasia. – Atrophy. – Hypertrophy.

·         Hematoma. – Metaplasia.- Anaplasia.

·         Neoplasia (tumors): Definition, classification, differences between benign and malignant tumors, types of benign and malignant tumors, malignancies of hematopoietic cells. (Leukemia) and lymphomas.

·         Introduction to the immune system.

·         Cells and other elements involved in the immune response (T,B …cells)

·         Hypersensitivity reactions; types (I, II,III, IV).

·         Transplant pathology.

·         Auto-immune diseases: Types, etiology, pathogenesis, clinical features, pathology and prognosis of selected major illness (SLE, Scleroderma).

·         Acquired immune deficiency syndromes.

·         Tuberculosis: incidence, pathogenesis, primary complex secondary TB and features of pulmonary TB.

·         Gonorrhea:

Unit X: Protozoal and Helminithic diseases:

·         Amoebiasis, Leishmaniasis, Hydatid disease.

·         Bilharzisis: Geographical distribution, types, and complications.

Unit XI: Cardiovascular system:

·         Atherosclerosis- pathogenesis, risk factors, complications.

·         Hypertension.

·         Ischemic heart disease (IHD)- types of angina pectoris, rheumatic heart disease.

·         Iinfective endocarditis.

·         Tonsillitis, bronchitis, bronchial asthma, pneumonia- bronchiectasis-

·         Bronchogenic carcinoma.

·         Gastritis-Peptic Ulcer, Ulcerative colitis, Crohn’s disease, Zollinger- Ellison syndrome, Pancreatitis

·         Cholecystitis- Hepatitis- Cirrhosis- complications.

·         Glomerulonephritis: definition, types.

·         Drug-nephritic syndrome-induced tubule- cystitis – interstitial nephritis pyelonephritis.

·         Thyroid: hypethyroidism, hypothyroidism goiter, pyelonephritis-diabetes mellitus, types, complications

·         Adrenal glands.

·         Classification of anaemias- Iron deficiency anemia – Vitamin B12 and folate deficiency anaemia- aplastic anaemia- thrombocytopenia- leucopenia.

·         Structure of the genom and its disorders, selected definitions, mutationof genes, mendelian disorders, Normal karyo type, cytogenetic disorders, role of moleuclar diagnostics.

·         Fibrinous pericarditis, Diphtheria lf larynx, Brain abscess, acute appendicitis

·         Infarction of spleen, CVC liver, Cerebral hemorrhage.

·         Adenoma thyroid, Fibroadenoma Breast (Carcinoma stomach, Carcinoma Ureter).

·         Lipoma (Leiomyoma Uterus, Metastasis Lung, Malignant Melanoma skin).

·         Miliary Tuberculosis, lung (Tuberculosis lymphadenitis, Gumma liver- Bilharzial Hepatic fibrosis- Tuberculosis small intestine- Hydatid cyst liver, Amebic liver abscess).

·         Acute bacterial endocarditis (recent infection heat, Atheresclerosis, Lobar pneumonia, Bronchogenic carcinoma.

·         Crohn’s disease, Ulcerative colitis-Micro-nodular cirrhosis- Macro-nodular cirrhosis- Chronic cholecystitis- Chronic gastric ulcer.

·         Acute pyelonephritis, Acute cystitis, Goiter.

·         Introduction.

·         The scope of pharmacy & activities of the pharmacist: The procedure for procurement & warehousing of drugs and pharmaceuticals in the hospitals

·         Different methods of drug distribution systems in hospitals.

·         The procedure for Distribution of Narcotic and other controlled substances

·         Hospital pharmacist’s participation in continuing education programme.

·         Inventory control, methods and types of inventory control.

·         Outlines of Good Storage Practice (GSP).

Unite IV: Hospital and it organization:

·         The hospital and its requirements.

·         Functions of hospitals.

·         The hospital pharmacy department.

·         The pharmacy and therapeutic committee.

·         Primary source of information.

·         Secondary source of information.

·         Tertiary source of information.

·         Services offered by DIC.

·         The hospital formulary.

·         Fluid and electrolyte therapy.

·         Parenteral nutrition.

·         Introduction.

·         importance of radiopharmaceuticals, frequently used radio

·         pharmaceuticals in the hospital.

·         Radio-pharmaceutical quality control.

·         Test for pyrogens on water for injection.

·         Evaluation of the plastic transfusion bottles used for large volume parenterals.

·         Operation of the sterilization equipment (Autoclave).

·         Test for hydrolytic resistance of glass containers used for parenterals.

·         Evaluation of prescription form.

·         Preparation and sterilization of normal saline IP.

·         Preparation and sterilization of dextrose injection IP.

·         Study of drug profile of radiopharmaceuticals.

·         Study of poisons information service.

·         Study of drug information service.

•         Definition of clinical pharmacy.

•         Define and understand the role of the patient care process in providing care.

•          Describe the components of comprehensive patient history taking.

•         Apply a process to assess a patient for drug-related problems.

•         Outline the components of patients’ comprehensive care plans.

•         Develop appropriate documentation of patient care.

•         Describe the role of patient assessment in pharmacy practice.

•         Describe the steps of symptoms assessment.

•         Physical Assessment skills for Pharmacists

•         List available comprehensive guides to physical assessment.

•         Describe the role of the pharmacist in the intensive care unit (ICU) and in the care of critically ill patients

•         Describe the steps of critical care assessment, including collecting patient history, assessing the history of present illness, and conducting a review of systems Apply knowledge of routes of administration, intravenous compatibility, and pharmacokinetic.

•         Changes in the critically ill to ensure effective and safe medication delivery to the patient.

(Vancomycin, Aminoglycosides, digoxin, theophylline, carbamazepine)

•         Describe the goals of therapy and management strategy for menopause.

•         Assess women for menopausal symptoms and who may be considering hormone therapy.

•         Describe the goals of therapy and the therapeutic options for women seeking hormonal contraceptives.

•            Assess women who are seeking combined hormonal contraception.

•         Recognize challenges related to patient assessment that are unique to pediatrics and neonatology.

•         Describe the required components of a complete pharmacy assessment that are unique to pediatrics and neonatology.

•         Gain a basic understanding of the differences in pediatric assessment as it relates to vital signs and common laboratory parameters

•         Describe the process of comprehensive geriatric assessment.

•         Identify the domains of comprehensive geriatric assessment.

•         Describe practical tools that pharmacists cause in their assessment of older adults.

Diabetes Mellitus:

•         Describe the diagnostic criteria and tests for diabetes.

•         Describe glycemic control targets for different populations with diabetes.

•         Describe treatment options for patients with diabetes.

•         Apply various tests to assess glycemic control.

•         Describe hypoglycemia, its symptoms and its treatment, and how to avoid it.

Dyslipidemia:

•         Understanding the pathophysiology and it is classifications and Major Risk Factors

•         Identify appropriate standards for the diagnosis of dyslipidemia and determine risk and prognosis for developing cardiovascular disease.

•         Outline the management and treatment lines of hyperlipidemia

•         Understanding approach of assessing a patient with hypertension.

•         To outline the various methods of diagnosis and monitoring for those with hypertension.

•         To outline appropriate follow-up and monitoring parameters for patients with hypertension.

•         Complications of Hypertension

•         General Management of hypertension and Special patient groups

•         Resistant hypertension, hypertensive urgencies, and emergencies

•         To define heart failure (HF)

•         To review the diagnosis of HF including common signs and symptoms, risk factors and common diagnostic tests

•         To highlight goals of therapy in patients with HF

•         To outline a general approach to a patient with HF including initial assessment and ongoing evaluation and monitoring

•         To provide an approach to pharmacotherapy in HF including parameters for initiation and titration of therapy.

•         Pathophysiology of disease.

•         Clinical presentation and diagnosis.

•         Modifiable and non-modifiable Risk factors

•         Clinical syndromes

•         Medical management and prevention

•         Evaluation of therapeutic outcomes.

•         clinical manifestations of venous thromboembolism

•         pulmonary embolism

•         management of bleeding and excessive anticoagulation

•         general approach to the treatment

•         of venous thromboembolism. treatment of venous

•         thromboembolism in special populations.

•         clinical presentation and diagnosis of hit & pharmacologic treatment options

•         Pathophysiology and classification

•         Etiology and Risk factors.

•         Clinical presentation (including diagnostic considerations.

•         General approach to treatment.

•         general information regarding safety and efficacy

•         Use available parameters to measure and monitor target lipid goals for patients under treatment for dyslipidemia.  Review recommendation of pivotal clinical trials).

Asthma:

•         Describe the epidemiology, risk factors, clinical presentation, and diagnosis of asthma.

•         Describe the goals of therapy and management strategies for asthma.

•         Conduct an initial assessment of patients newly diagnosed with asthma.

•         Describe the role of inhaled medications and optimal inhalation device use in asthma management.

•         Conduct a follow-up assessment of patients with asthma.

•         Non-specific & specific immunity.

•         Cells involved in the immune response

•         Types of immunoglobulin & mechanism of antibody production.

•         Hypersensitivity reactions.

•         Serological tests.

Epilepsy:

•         Describe the epidemiology, etiology, risk factors, and pathophysiology of epilepsy.

•         Describe the classification of different seizure types.

•         Conduct initial assessment of patients newly diagnosed with epilepsy.

•         Apply the general principles of antiepileptic drug therapy in the follow-up

•         assessment of patients with epilepsy.

Depression:

•         Describe the disease burden, epidemiology, diagnosis, prognosis, and management of major depressive disorder and other depressive disorders.

•         Conduct initial assessment of patients who present with new diagnosis of depression or who are suspected of having depression but have not been formally diagnosed.

•         Outline monitoring parameters and follow-up plans for patients using pharmacological therapy to manage their depression.

•         Provide guidance to patients on how to manage partial/non-response or adverse effects of medications.

Osteoporosis:

•         Assess fracture risk in patients using bone mineal density and risk factors.

•         Identify potential complications from osteoporosis drug therapy.

•         Assess appropriate monitoring parameters in osteoporosis including lab work and imaging.

Rheumatoid Arthritis:

•         Describe the epidemiology, etiology, clinical presentation, and diagnosis of rheumatoid arthritis.

•         Describe the goals of therapy and the management strategy for rheumatoid arthritis.

•         Conduct an initial assessment of a patient newly diagnosed with rheumatoid arthritis.

•          Conduct a follow-up assessment of a patient on disease-modifying ant

rheumatic drug therapy, considering the regimen’s effectiveness and safety and the patient’s ability to adhere

•         Describe the core elements of approach to infectious disease assessment.

•         Describe the use of empiric, definitive, and prophylactic antimicrobial therapies.

•         Describe the use of an antibiogram.

•         Describe the approach to interpretation of culture results.

•         Pathophysiology of CNS infections

•          Most common pathogens & risk factors

•          Antibiotic selection issues

•         Appropriate empirical antimicrobial regimens

•          Prevention strategies

•          Adjunctive therapy Components of monitoring plan

•         Pathophysiology, Type of cancer and risk factors

•         Diagnosis and staging of tumor cancer

•         Clinical presentation and Complications of Malignancy

•         Oncology management. Combination chemotherapy, Adjuvant chemotherapy, Neoadjuvant chemotherapy.

•         Complication of cancer chemotherapy.

•         Types and symptoms

•         Risk factors and diagnostic methods,

•          Management of therapy,

Chronic Non-cancer pain:

•         To identify key features of chronic non-cancer pain as a pathological form of pain

•         To review assessment strategies that allow the clinical pharmacist to assess pain and evidence of reduced coping in chronic pain Patients.

•         To link pain and coping assessments to pharmacotherapy optimization and management

•         Describe the classification of anemia.

•         Complete a patient assessment and interpret laboratory findings to determine the most likely cause of anemia.

•         Apply a monitoring and follow-up plan for patients initiated on treatment for anemia.

the fundamental goal of the clinical pharmacy clerkship is to provide a structured, practical and closely supervised professional experience that enables the students to better assume their future role as a competent clinical pharmacist. This goal includes the development of professional judgment, pharmaceutical care practice competencies and technical skills.

At the completion of clerkship, the students should be able to demonstrate competencies in the following areas;

1.               To obtain accurate medication histories & gather other relevant patient’s data.

2.               To learn medical terminologies commonly used by health care professionals in the patient care areas.

3.               To learn interpretation of common clinical laboratory tests.

4.               To perform effective drug regimen reviews and identify actual and potential medication – related problems.

5.               To develop a pharmaceutical care plan for the patient.

6.               To recommend a therapeutic drug monitoring plan, including drug concentration monitoring and indicators of efficacy and toxicity.

7.               To assess drug therapy regimen in a patient with alter renal or hepatic function.

8.               To demonstrate an awareness of the assessment skills in areas necessary to monitor medication outcomes.

9.               Communicate effectively with health care professionals and others both orally and in

10.         To perform complete and accurate patient counseling and enhance patient education and compliance.

11.         To provide drug information to health care professionals and patients and to demonstrate competencies in the following areas:

•         Indication – specific prescribing practice

•         Appropriate drug dosage selection

•         Appropriate dosage – form selection

•         Drug use in pregnancy

•         Drug use in pediatrics

•         Drug use in geriatrics

•         Dosage adjustment in renal impairment

•         Dosage adjustment in hepatic impairment

•         Management of drug interactions

•         Detection & management of adverse reaction & drug induced diseases.

12.         To demonstrate professional attitude, motivation and ethics.

13.         To demonstrate the fundamental knowledge of pharmacotherapeutics in the areas necessary to provide the service.

14.         To provide the student opportunities to engage in scholarly activities (i.e, special projects, presentations, research activities).

•         Introduction to Pharmaceutical care

•         Pharmaceutical care and the scope of Pharmacy Practice

•         Essential components of pharmaceutical care

Drug related problems:

•         The response of the profession of pharmacy to drug related problems.

•         Exploration of the drug process.

•     Clinical skills and Pharmacist’s role in pharmaceutical care.

•         The pharmacist’s functions.

•         Functions related to the individual patient.

•         Functions related to the community.

•     Data collection (Patient data, patient past medical history, patient family history, patient social history, patient history of present illness, physical finding, laboratory and test results.

•     Pharmaceutical car as the model of Pharmacy Practice

•         The CORE pharmacotherapy plan

•         The CORE pharmacotherapy problems.

•         The FARM progress note

•         The pharmacist’s responsibility and role in drug product selection

•         Factors affecting drug-product selection

•         Patient acceptance consideration.

•         Patient age consideration

•       Environmental consideration

•         Patient compliance

•     Biopharmaceutical consideration

•         Concept of optimized drug products and controlled release delivery systems (CR-DDS)

•         Definitions

•         Optimized controlled release (CR) products

•         Advantages of sustained /controlled drug therapy

•         Categories of non-immediate delivery systems

•         Types of CR-DDS (examples)

•         The goal of drug supply

•    The drug supply process

·         The dimensions of drug supply

Responding to symptoms in Pharmacy Practice:

The Communication Process”

•         The goal of effective communications

•         The scope of medication-counseling sessions: (In organized health care setting, In the community setting).

•         Patient assessment and consultation self-medication: (Importance of communication skills, Provision of pharmaceutical care through Patient-Pharmacist communication process).

OTC criteria according to international stranded

Label requirements for non-prescription medicine

Non-prescription medication as a primary therapy and related conditions:

•         Antidiarrheal and other gastrointestinal products

•         Laxative products

•         Antacids and other gastrointestinal reflux disease products).

•         Internal analgesics (management of headache, pain and fever)

•         Menstrual products

•         Acne Products

•         Others

•         Diabetes care products and monitoring kits

•         Pregnancy testing and ovulation prediction testing kits

•         Fecal occult blood kits

•         Home blood pressure and temperature monitoring

•         Organization, functions, Policies of the pharmacy and therapeutic committee in including drugs into formulary, inpatient and outpatient prescription, automatic stop order, and emergency drug list preparation.