Sample Essay On Aim:

Introduction:

The science of pharmacokinetics and therapeutic drug monitoring (TDM) occupy an essential part of pharmacists’ work in clinical placements. Since pharmacists are more experienced and proficient in drug monitoring and pharmacokinetic properties than other health professionals, it is their responsibility to provide effective treatment with minimum side effects and risk of toxicity. Certain drugs have a low therapeutic index and therefore require monitoring by pharmacists during patient treatment to prevent toxicity and treatment failure. This session will discuss the therapeutic drug monitoring of gentamicin in clinical practice. As gentamicin has a low therapeutic index and is associated with a high risk of toxicity and treatment failure, it is critical that every pharmacist should know how gentamicin is monitored in a hospital. This learning session targets pre-registered pharmacists in Glasgow during their hospital training. Accordingly, the pre-registered pharmacists will learn how to monitor gentamicin during their work in hospitals as they complete their training year and become officially registered pharmacists. In addition, they will understand how to monitor gentamicin in Glasgow according to local guidelines.

Objectives:
1- To give an overview of gentamicin (its pharmacological properties, pharmacokinetic properties, dosing regimens and toxicity).
2- To identify basic pharmacokinetic terms and demonstrate basic parameters required for dose calculation.
3- To explain Greater Glasgow and Clyde (GGC) guidelines for gentamicin monitoring.
4- To calculate gentamicin doses manually by using basic pharmacokinetic equations.
5- To demonstrate a real case from a clinical placement in order to illustrate how gentamicin is monitored in clinical practice.

Audience:

12 pre-registered pharmacists in Glasgow.

Pre-reading:

A basic clinical pharmacokinetics textbook (the chapter on aminoglycoside) in order to familiarise the students with the topic and to refresh their memories before the session.

Materials and equipment:

A room, 12 movable chairs to form 3 groups for the workshop segment of the session, 3 different case sheets (1 for each group to work on) and a PowerPoint presentation.

The session will be divided into 3 sections. Each section will be as follows:

1) Section 1 (50 minutes)
The first few minutes of the session will be an introduction to pharmacokinetics, explaining what it is, its benefits in clinical practice and some pharmacokinetics terms and principles. This segment will also include a definition of TDM, applications of TDM in a hospital and the role of pharmacists in TDM applications. This introductory segment on pharmacokinetics and TDM will take approximately 10 minutes. The idea behind it is to refresh the students’ memories of pharmacokinetics and TDM and to familiarise them with terms and expressions often associated with TDM (e.g. first order, second order, peak concentration) which will be used later in the session.
Thereafter will be a discussion on the pharmacological and pharmacokinetic properties of gentamicin, such as class, indication, mechanism of action and absorption. This will enable the students to understand how gentamicin produces its action, how it is moves inside body fluid and how it is eliminated from the human body. This segment will also explain the available regimens for gentamicin dosing in the UK, which will enable the students to know the advantages and disadvantages of these regimens and how to monitor each type during their future work as pharmacists. Moreover, this segment will explain the risk of toxicity and the serious side effects which may arise from inappropriate treatment with gentamicin (e.g. renal toxicity, ototoxicity, therapeutic index), teaching the students why monitoring is required for gentamicin. Finally, the basic parameters required for gentamicin dosing and monitoring (creatinine clearance, ideal body weight (IBW) etc.) will be explained to the students in detail so that they will be able to use these parameters in dose monitoring during patient interventions and will know the factors which affect these parameters and how to deal with them in practical work.
The final part of this section consists of a detailed discussion on how gentamicin is monitored in Glasgow according to the GGC guidelines. This will include an explanation of all the charts and graphs used in gentamicin monitoring in Glasgow, how the concentration is measured and recorded and the benefits and limitations of the GGC guidelines. This will be of utmost importance for the students, as they are pre-registered pharmacists in Glasgow. At the end of this section, the students will be given a 10-minute break, after which the second section will commence.
2) Section 2 (50 minutes):
This section will be divided into 2 segments. The first will be about the role of basic pharmacokinetic equations in the therapeutic drug monitoring of gentamicin. The goal of this segment is to teach the students how to dose and monitor gentamicin manually by utilising basic pharmacokinetic equations, each of which will be explained in detail. The students will learn how to use the right equation to measure and predict gentamicin doses in clinical placements. Furthermore, with these equations the students will be able to monitor individualised patients with special conditions which cannot be monitored by online guidelines (e.g. severe burns, renal failure, obesity).
In the second segment, a real case from a clinical placement involving a patient with severe septic shock will be demonstrated for the students in order to show them how gentamicin monitoring is carried out in a hospital. Septic shock patients are usually associated with acute kidney injury, and it is considered a challenge to prescribe gentamicin for patients in the intensive therapeutic unit (ITU). The students will be able to participate and share their thoughts about the case. In addition, they will be asked to do a manual calculation for this case and compare their results with the actual results obtained in the hospital.
3) Section 3 (60 minutes):
This section will be a workshop for the students. The 12 students will be divided into 3 groups, each of which will receive a case sheet to work on. The groups will be asked to calculate the dose and predict the gentamicin concentration manually using basic pharmacokinetics equations. They will also be asked to give a clinical explanation and discussion of the results. The 3 cases will be about 3 different clinical conditions: a patient with renal failure on dialysis, a patient with severe burns and a patient with ascites. These 3 conditions are considered special cases of gentamicin monitoring and dosing in which online systems and guidelines cannot be applied in the hospital. Therefore, in clinical practice these patients will require direct actions by pharmacists, that is, manual monitoring using basic pharmacokinetic equations, which is what the students will learn to do in this session. Then the cases and their solutions will be passed between the groups, and each group will be able to evaluate the results of the other groups. The idea behind this workshop is to allow the students to apply everything they have learnt theoretically to clinical practice, giving them the opportunity to recognise how monitoring is done in clinical practice for different cases. Moreover, working in groups will create enthusiasm for solving the cases and increase competitiveness in finding the right answer.