ADAM, a hands-on patient simulator for teaching principles of drug disposition and compartmental pharmacokinetics

Construction of an in vitro simulated one compartment extravascular administration model and its comparison with classic in vitro administration model in copper chloride induced HepG2 cell death

In this study, we designed an in vitro administration device based on compartment model theory and utilized it to construct an in vitro simulated one compartment extravascular administration model of copper chloride. Within the Cmax range of 3.91-1000.00 μM, the measured concentration-time curves of the simulated one compartment extravascular administration model almost coincide with the corresponding theoretical curves. The measured values of toxicokinetic parameters, including ke, T1/2, ka, T1/2a, Tmax, Cmax, CL, and AUC0-∞ are close to the corresponding theoretical values. The fitting coefficients are >0.9990. In simulated one compartment extravascular administration and classic in vitro administration, copper chloride dose-dependently induced HepG2 cell death. When Cmax/administration concentration is equal, classic in vitro administration induces a higher cell death rate than simulated one compartment extravascular administration. However, there is no significant difference in inducing cell death between the two administration models when area under the curve is equal. In conclusion, the device designed in this study can be used to in vitro simulate one compartment extravascular administration, making in vitro toxicity testing more similar to in vivo scenarios. There are differences in copper chloride induced HepG2 cell death between simulated one compartment extravascular administration and classic in vitro administration.

Teaching of drug disposition using physiologically based pharmacokinetic modeling software: GastroPlus as an educational tool

Physiologically based pharmacokinetic (PBPK) modeling requires an understanding of chemical, physiologic, and pharmacokinetic principles. Active learning with PBPK modeling software (GastroPlus) may be useful to teach these scientific principles while also teaching software operation. To examine this issue, a graduate-level course was designed using learning objectives in science, software use, and PBPK model application. These objectives were taught through hands-on PBPK modeling to answer clinically relevant questions. Students demonstrated proficient use of software, based on their responses to these questions, and showed an improved understanding of scientific principles on a pre- and post-course assessment. These outcomes support the effectiveness of simultaneous teaching of interdependent software and science.NEW & NOTEWORTHY Physiologically based pharmacokinetic (PBPK) modeling is a major growth area in drug development, regulatory submissions, and clinical applications. There is a demand for experts in this area with multidisciplinary backgrounds. In this article, we describe a course designed to teach PBPK modeling and the underlying scientific principles in parallel.

Assessing Knowledge of Pharmacokinetics in an Integrated Medical Curriculum

Pharmacokinetics is the branch of pharmacology that describes how the body processes drugs. As most physicians will prescribe drugs during their career, knowledge of pharmacokinetics is indispensable for medical students. Students, however, experience pharmacokinetics as difficult, probably due to its abstract and mathematical nature. In many medical curricula, pharmacokinetic topics are taught and examined as a part of integrated medical courses. As pharmacokinetics is a relatively small subject, unit examinations contain only few questions on the topic. The combination of a difficult subject and a few questions has raised concerns that students could perform poorly in pharmacokinetics and still pass the examinations and, hence, end up with insufficient knowledge of pharmacokinetics. In this study, we investigate this issue by contrasting students' performance on pharmacokinetics questions with their performance on the rest of the examinations (all non-pharmacokinetics questions lumped together). The results expressed as pass-fail scores showed that students failed more often on the pharmacokinetics part of the test than on the other questions, in two consecutive academic years. Despite the suboptimal knowledge in pharmacokinetics, students can still acquire their bachelor's degree. These results show that poor knowledge in pharmacokinetics could be a side effect of curricular integration. Attention should therefore be paid to provide insight into one's own performance in individual disciplines. This would avoid knowledge deficiency and incompetence in the future.

Development of a user-friendly training software for pharmacokinetic concepts and models

Although there are many commercially available training software programs for pharmacokinetics, they lack flexibility and convenience. In this study, we develop simulation software to facilitate pharmacokinetics education. General formulas for time courses of drug concentrations after single and multiple dosing were used to build source code that allows users to simulate situations tailored to their learning objectives. A mathematical relationship for a 1-compartment model was implemented in the form of differential equations. The concept of population pharmacokinetics was also taken into consideration for further applications. The source code was written using R. For the convenience of users, two types of software were developed: a web-based simulator and a standalone-type application. The application was built in the JAVA language. We used the JAVA/R Interface library and the ‘eval()’ method from JAVA for the R/JAVA interface. The final product has an input window that includes fields for parameter values, dosing regimen, and population pharmacokinetics options. When a simulation is performed, the resulting drug concentration time course is shown in the output window. The simulation results are obtained within 1 minute even if the population pharmacokinetics option is selected and many parameters are considered, and the user can therefore quickly learn a variety of situations. Such software is an excellent candidate for development as an open tool intended for wide use in Korea. Pharmacokinetics experts will be able to use this tool to teach various audiences, including undergraduates.

Interprofessional Pharmacokinetics Simulation: Pharmacy and Nursing Students' Perceptions

Interprofessional practice between pharmacists and nurses can involve pharmacokinetic dosing of medications in a hospital setting. This study describes student perceptions of an interprofessional collaboration pharmacokinetics simulation on the Interprofessional Education Collaborative (IPEC) 2016 Core Competencies. The investigators developed a simulation activity for senior undergraduate nursing and second-year pharmacy students. Nursing and pharmacy students (n = 54, 91 respectively) participated in the simulation using medium-fidelity manikins. Each case represented a pharmacokinetic dosing consult (vancomycin, tobramycin, phenytoin, theophylline, or lidocaine). Nursing students completed head-to-toe assessment and pharmacy students gathered necessary information and calculated empiric and adjusted doses. Students communicated using SBAR (Situation, Background, Assessment, and Recommendation). Students participated in debrief sessions and completed an IRB-approved online survey. Themes from survey responses revealed meaningful perceptions in all IPEC competencies as well as themes of safety, advocacy, appreciation, and areas for improvement. Students reported learning effectively from the simulation experience. Few studies relate to this type of interprofessional education experience and this study begins to explore student perceptions of interprofessional education (IPE) in a health sciences clinical context through simulation. This real-world application of nursing and pharmacy interprofessional collaboration can positively affect patient-centered outcomes and safety.

ADAM, a hands-on patient simulator for teaching principles of drug disposition and compartmental pharmacokinetics

AIMS

To design, construct and validate a pharmacokinetics simulator that offers students hands-on opportunities to participate in the design, administration and analysis of oral and intravenous dosing regimens.

METHODS

The Alberta Drug Administration Modeller (ADAM) is a mechanical patient in which peristaltic circulation of water through a network of silicone tubing and glass bottles creates a representation of the outcomes of drug absorption, distribution, metabolism and elimination. Changing peristaltic pump rates and volumes in bottles allows values for pharmacokinetic constants to be varied, thereby simulating differences in drug properties and in patient physiologies and pathologies. Following administration of methylene blue dye by oral or intravenous routes, plasma and/or urine samples are collected and drug concentrations are determined spectrophotometrically. The effectiveness of the simulator in enhancing student competence and confidence was assessed in two undergraduate laboratory classes.

RESULTS

The simulator effectively models one- and two-compartment drug behaviour in a mathematically-robust and realistic manner. Data allow calculation of numerous pharmacokinetic constants, by traditional graphing methods or with curve-fitting software. Students' competence in solving pharmacokinetic problems involving calculations and graphing improved significantly, while an increase in confidence and understanding was reported.

CONCLUSIONS

The ADAM is relatively inexpensive and straightforward to construct, and offers a realistic, hands-on pharmacokinetics learning opportunity for students that effectively complements didactic lectures.