These directions are designed to provide an outline to the features of the learning resources in this module.  The learners are notified that pop-up questions (H5P.com format) are overlaid over most content videos.  And PDF versions of the slides are available.

This animated video (4:03) briefly describes the goals and philosophy of the "Approach to Pharmacology" series, starting with this learning module.  The instructor could use this video to introduce the resources or provide a video introduction customized to how he/she will use the resources with their students.  The use of an animated video hopefully allows a brief introduction to the creators of the resources without reducing the ownership that an instructor might take in choosing which resources to use (and in which order) and the refinement of interactive components of the course including detailed questions in a project or requests of students to provide multimedia updates.

Video (4:56) This video might be used as an option for students starting to learn about veterinary drug therapy. In large part, the point for describing the utility of a digital formulary is to begin to train the learner to "ask the right questions," and to avoid memorizing content that can be most easily (and safely) searched within a formulary.  The example formulary highlighted is a veterinary drug formulary that is one of the most complete and popular formulary used in North America and available at https://plumbsveterinarydrugs.com .    In a live offering of these learning resources, this formulary was highlighted because access was provided as part of course registration.  The instructor could replace or leave out this section completely.

Understanding the appropriate evidence for therapeutic efficacy and safety requires the understanding of the placebo effect, which has relevance even with veterinary patients.  The link is to a TED Ed lesson devised by an author of this module.

Additionally, particularly for learners that are new to the topic of drug development, they should be encouraged to explore the TED Ed playlist and post a brief update on one of the videos for other members of their cohort or class.

2 part video

Part 1: 17:02

Part 2: 18:59

These videos are designed to provide a construct whereby the student can collect and structure data about a specific drug and connect this information to the treatment of clinical problems. The acronym of "PACMAN" is introduced as a mnemonic to keep track of this information.  It should be emphasized to the student that the practice of evidence-based medicine is often not obvious or explicit, but is important for the future clinician to gain practice. 

Video 38:57

Extensive description of how one might apply evidence-based therapy to a specific case of a dog with flea allergies.  The discussion addresses a variety of possible therapeutic solutions and how critical clinical thinking needs to be applied to adapt "best practice" based upon the literature to the circumstances of the animal owner and the animal's health scenario.

This 5 minute video from TED Ed addresses fundamental questions about the differences of metabolic rates in animal species of different sizes.   This video might a good introduction to, in particular, comparative pharmacology, which is quite driven by species-differences in drug metabolism that often correlate with general metabolic rates of the organisms.

This 9 minutes video focuses on the process of drug metabolism and excretion (collectively known as elimination). 

Video Duration: 14:13

Video addressing the various dosage routes and the principles underlying absorption from these sites (if not intravenous). In the videos are embedded pop-up questions that are designed to assess immediate understanding by the student.  They can choose "Video Review" to return to the beginning of the section relating to the question, allowing them to try again, or they can proceed. 

This 17 minute video presents the topic of pharmacokinetics in visual terms, using simulations from the program STELLA which model a one-compartment model.  A brief excursion into the significance of 2 compartment models is included.   The key PK terms of Vd, eliminate rate constant k,el, halflife, bioavailability, Clearance and dosing interval are demonstrated.  General behaviors of the one-compartment model with first-order elimination are emphasized.

It is recommended to focus on the clinical relevance of a one-compartment model, and provide a brief list of key pharmacokinetic formulae (see attached to student side) for their use.

This video of 17:33 uses the basic concepts of pharmacokinetics to explain how a loading and maintenance dosage is derived.

Again, have the student refer to the summary of key pharmacokinetic formulae.

Video: 16:38

Therapeutic Drug Monitoring is one of the few places students may see the principles of pharmacokinetics play out in an individual clinical case.  The focus is again on using the one-compartmental model to appreciate the need to achieve steady-state before sampling.  The next 2 videos provide an opportunity to see practical examples of TDM.   A suggestion for interactivity might be to have students view the case examples, pausing before the answer to the case problems are revealed, and have them undertake the calculation and post as an update with their analysis and discussion before proceeding to viewing the explanations.

Video 10:04

This is actually the second part of the "Principles" video and it emphasizes the use of therapeutic drug monitoring (TDM) in an animal with renal failure requiring adjustment of aminoglycoside dosing,  as well as another case showing adjustment of phenobarbital dosage following self-induction of hepatic metabolism, resulting in loss of efficacy.

Video: 17:21

The 2 cases discussed involve a dog treated with phenobarbital on a dosage regimen that initially is adequate, but becomes inadequate after some weeks due to the self-induction of phenobarbital's metabolism. Therapeutic. drug monitoring and the principles of pharmacokinetics allow not only a quantitative determination of how to adjust the dosage.  There are several steps in this first case that involve calculations and might be a case to encourage students to pause, do the calculations, and then proceed to see the explanation.  They also might be encouraged to watch the video and post an update with their calculations. 

The second case shows the opposite scenario, when a drug interaction leads to accumulation of drug (in this case, cyclosporine) that is caused by the antimicrobial azithromycin.  Again, TDM allows adjustment of the dosage following calculations.  A general principle is that, when measured at steady-state, drug concentrations can be adjusted upward or downward in proportion to a properly timed drug monitoring sample or samples.

This animated video (6:08) overviews briefly the ways that receptors act through cellular signal transduction.  It should also be emphasized to the learner that drugs can act in non-receptor dependent ways....drugs like an osmotic diuretic pulling water into the renal luminal space, or drugs that don't exert all of their effects via specific protein targets like gas anesthetics.

This unit could be placed after the discussion of drug agonists and antagonist but should be reviewed before discussion of receptor phenomena as the the prior understanding of signal transduction is important to understanding the various perturbations of signal transduction. 

Video (12:39)

Full and partial agonists are discussed using semi-logarithmic log(dose or concentration) vs. Effect (Response) plots.  The receptor binding terms KD are compared with the effect terms EC50 and Bmax with Emax, making the point that the non-linear relationship between [Drug] and Effect is established by the non-linear binding of a drug to the receptor.

Video 13:40

The focus is on drugs that operate against a specific receptor/signal transduction pathway. Competitive and non-competitive antagonists alter receptor activation, agonist/antagonists work in a mixed fashion, and inverse agonists slow a signal transduction system below its intrinsic basal rate.

Receptor theory is again used to explain the pharmacodynamics.

Video 14:43

This unit fundamentally addresses the idea that receptor/signal transduction systems are not inert but can adapt to activation or inactivation, and that there are clinical consequences.  

PROJECT:

Release the introductory video (duration: 11:08), which ends with the key content questions in the Herd Health Case Analysis. To emphasize a literature and media review, the learner should prepare a brief literature review, which can start with the relevant paper provided in the video, and then address the key questions.  A suggested Case Analysis Peer Review rubric for the project is attached.

Case Analysis Peer Review Rubric

SUGGESTED DIRECTIONS FOR STUDENTS in left panel.

Using the critical clinical thinking questions on the last slide, prepare a ~500 word explanation reviewing the literature or other multimedia resources you find, while addressing the 3 critical clinical thinking questions in this case:

1. After completing a literature review like you did, describe key steps you would take to investigate the mortality in the cattle cases

2. Using your understanding of pharmacokinetics, the precedent case in pigs, suggest molecular mechanisms and organ perturbations that might lead to toxicity in the cattle cases that would be more severe than in the literature case in pigs.

3. What was a major difference in the long-term impact of the toxicosis for the producer between the swine and cattle case?

4. Finally, briefly reflect on 2 learning issues you had in addressing this case, and describe where you found information to help you address them.

Video Dureation: 8:31

This video could be released after some discussion in the community or at completion of the suggested project. Either way, it provides key points of consideration that the learner might want to have included in their case analysis.