Medication Prescribing: Making Benefit/Risk Calculations

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Department	Pharmacology
Course Number	PHAR 504
Course Title	Medication Prescribing: Making Benefit/Risk Calculations
Course Director	Travis O’Brien, PhD, MEd; Mallika Mundkur, MD, MPH
Length (Weeks)	2
When Offered	Weeks 16-17; 42-43
Prerequisites	At least one core clerkship
Availability Notes	New elective as of January 2024. Offered Weeks 16-17 (starts Oct 7, 2024) for up to 10 students and Weeks 42-43 (starts Apr 14, 2025) for up to 10 students.
Contact Name	Dr. Mundkur; Dr. O'Brien
Contact Phone	202-994-3373 (Dr. O’Brien)
Contact Fax
Contact Email	phmtjo@gwu.edu
Other Contacts	Course Directors: Dr. Mundkur (Mallika.Mundkur@fda.hhs.gov) & Dr. O'Brien (phmtjo@gwu.edu) Course faculty: April Barbour, MD, MPH, FACP (abarbour@mfa.gwu.edu); Adam Rutenberg, DO (arutenberg@mfa.gwu.edu)
Location
Limit	10 per block
Report
Evaluation	Grading: The course will be graded as Pass/Fail. In order to pass the course, the student must achieve at least a 75% on all combined assessments. The course grade will be determined from weekly components as follows: Components of course grade: Integrated Case 1 Assessment Plan 20.0% Group Participation 2.5% Presentation 2.5% Integrated Case 2 Assessment Plan 20.0% Group Participation 2.5% Presentation 2.5% Integrated Case 3 Assessment Plan 20.0% Group Participation 2.5% Presentation 2.5% Integrated Case 4 Assessment Plan 20.0% Group Participation 2.5% Presentation 2.5% TOTAL = 100% Each weekly Assessment Plan will be graded on a scale of 1 to 5 as detailed in the Integrated Case Assessment Plan Score Sheet. Group Participation will be graded as present/absent for each discussion. The presentation will be graded as detailed in the Presentation Score Sheet.
Description	Purpose and Rationale for the Course: This course is designed to further build competency in rational prescribing practices in in- and out-patient settings. Medications are universally associated with risk that may vary depending upon dosage, route, patient or other situational characteristics. Effectiveness may also vary based upon these or other factors. In adhering to the Hippocratic oath, “primum non nocere,” it is essential for physicians to be cognizant of both risk and benefit to make appropriate decisions regarding medication prescribing. Physicians should also understand uses and limitations of available tools developed to help them remain informed regarding emerging knowledge regarding drugs. To enhance learners’ assessment of risk at the patient level, the course will include identifying and managing drug-drug interactions in the polypharmacy setting. It will also integrate advanced concepts, such as comorbidities and pharmacogenetics, in rational prescribing. The course will provide students with an understanding of post-market surveillance processes and other “real world evidence” used to inform a better understanding of drug safety following approval. Students will also learn about guidelines that attempt to synthesize available evidence to provide recommendations regarding benefit versus risk. Emphasis will be placed on learners establishing a skill set in evidence interpretation and translation to medication management in preparation for graduate medical training. Target Students: MS3/MS4 students with an interest in further developing their risk:benefit skill set for prescribing. Course Description: This course is designed to further build competency in medication prescribing by helping learners conduct risk:benefit analyses for different types of patients. Although the focus of this course will primarily be adult patient populations, certain concepts will also be generalizable to the treatment of pediatric patients. This course will focus on enhancing learners’ skills in identifying and managing drug-drug interactions in the polypharmacy setting. It will also integrate advanced concepts, such as comorbidities and gene-drug interactions in rational prescribing. Emphasis will be placed on learners establishing a skill set in medication management in preparation for graduate medical training. The course will have both synchronous (i.e. in person discussions) and asynchronous content (i.e. short pre-recorded videos, case-based problems). Course Learning Objectives: By the end of this course, the student should be able to: Perform a medication reconciliation for a patient. Identify co-morbidities, drug-drug and drug-gene interactions that can increase risk for adverse drug reactions and/or treatment failure. Assess the risks and benefits of prescribing a medication. Propose an optimal treatment plan aimed at minimizing the risk of adverse drug reactions using evidence-based information.
Additional Notes	Duration: The course will be offered for 2 weeks (once in fall and spring). The class will meet synchronously in person for 2 hours on Mondays (case introductions/key concepts) and Fridays (case presentations/assessments). Tuesdays, Wednesdays and Thursdays will involve asynchronous research, meetings on cases as well as preparation for Friday presentations. In addition, each case will involve a critique of the pertinent treatment guidelines by each group of students. WEEK 1 Case 1: Pharmacologic treatment options for acute and chronic pain Session Learning Objectives: Demonstrate familiarity with evidence-based prescribing guidelines on the management of acute and chronic pain. Describe the context for the shift towards non-opioid treatment modalities for the management of pain. Create a specific pharmacologic treatment for pain that minimizes risk and maximizes benefits for the patient. Case 2: Pharmacological management in special populations Session Learning Objectives: Demonstrate the use of a risk/benefit analysis when prescribing medications for specific special populations (i.e., patients that are pregnant or breast feeding). Evaluate when to adjust medications during pregnancy or breast feeding based on pharmacological information. WEEK 2 Case 3: Management of drug-drug and drug-gene interactions Session Learning Objectives: Identify potential drug-drug and drug-gene interactions after taking a medication history. Evaluate evidence-based guidelines to manage drug-gene interactions. Case 4: Management of toxicological emergencies Session Learning Objectives: Create appropriate medication orders and patient or nursing instructions based on the presented case. Explain the thought process and the reasoning that underlies pharmacological decision making in toxicological presentations. For each case, students will use and cite external resources (to include written material, consultations, or other resources as appropriate) to assist in their decision-making. Students will demonstrate a process used to evaluate those resources and integrate the information acquired into their Assessment Plan. The deliverables for each case will include: Assessment Plan and Score Sheet for the specific case of interest Oral presentation Summary and critique of clinical guideline most applicable to case presented. This will be included as a part of the oral case presentation. Missed Sessions: Attendance is expected for all sessions. Excused absences will be considered for only emergency situations (i.e. personal illness) per instructor permission. In the event of an excused absence, a student will be required to complete the make-up assignment within one week of the date of the absence. Failure to complete the make-up assignment will result in an INCOMPLETE in the course until the assignment has been submitted and approved.