What do pharmacy students need to know about biochemistry?

PharmacyEducation20(1)324-335ISSN1477-2701online©2020FIP

KevinRKearney1iiiiI,MelanyPPuglisi2IIII,EstherPBlack3***,PramodBMahajan4

Whatdopharmacystudentsneedtoknowaboutbiochemistry?

PharmacyEducation(2020)20(1)324-335https://doi.org/10.46542/pe.2020.201.324335

AbstractObjective:Thegoalofthisstudywastodeterminewhatstudentsneedtoknowaboutbiochemistryinordertopracticepharmacy. Methods:Withreferencetoalistoflearning objectives, educators interviewed students during their advanced clinicalrotations, asking if they hadused each item in practice. Each itemwasthen ratedaccording tothenumberandstrengthofaffirmativeresponses. Theratingswereusedtoidentifytheelementsofbiochemistrymoststronglyrecognisedasrelevanttoclinicalpractice. Results: All of the learning objectives received affirmative responses,indicating thateachwasrecalledorusedby somerespondent(s).Themosthighly ratedobjectives indicate aspects of biochemistrymost closely related to clinical practice.Conclusion: The results provide guidance to educators for designing biochemistrycourses, highlighting recognisable connections between biochemistry and clinicalpractice,andareaswhererelevancemayneedtobemadeclearerorre-evaluated.

RESEARCHARTICLE

IntroductionIn recent years, pharmacy practice has changed toaccommodate an expanding healthcare system andclinicalexpectationsofthosepharmacists.Assuch,manycollegesandschoolsofpharmacyhavere-envisionedtheircurricula to prepare students for the growing role of apharmacist in a healthcare team (Romanelli, 2018).Biochemistryhas longbeen accepted as the foundationforpharmacology,therapeuticsandothercontentinthepharmacycurriculum,andtherefore,directlyorindirectly,for theactualpracticeofpharmacy(Lewis,1947;Bauer,1947;Woster,2003;Broedel-Zauggetal., 2008;Harrold&McFalls,2010;Rose,2011;VanWinkleetal.,2013;Goyaletal.,2014;Osheroffetal.,2015;Dirks-Nayloretal.,2015;Georgievet al., 2016; Sánchez-Pozo, 2017; Grykaet al.2017; Niederhofferet al., 2017;Okubo et al.,2017).Assuch, biochemistry is typically taught early in the

pharmacycurriculum,oritisaprerequisiteforentryintosomeprofessionalpharmacyprogrammes.Becauseofitsfoundational role, educators need to structurebiochemistry course(s) so that they cover all of thecompetenciesrequiredofpharmacists,asthoroughlyandconciselyas possible. Further,the Accreditation Councilfor PharmacyEducation (ACPE), in the Standards 2016,underscore that pharmacists must ‘employ evidence-based practice’ and be able to ‘apply foundationalsciences to theprovisionof patient-centred care’ (ACPE,2016).

Whilepharmacyeducatorsunderstand thatbiochemistryis an important area of the foundational sciences forpharmacy students, an agreement on necessarycompetenciesrelatedtopracticeisrarelydiscussedintheliterature.A2007-2008study,forexample,reportedthattwo-thirds of a sample of administrators agreed that a

KeywordsAssessmentBiochemistryCourseDesign

CorrespondenceKevinRKearneyMCPHSUniversity19FosterStreetWorcesterMassachusettsUSAkevin.kearney@mcphs.edu

324

1MCPHSUniversity,Massachusetts,USA.2ChicagoStateUniversity,Chicago,Illinois,USA.3UniversityofKentucky,Lexington,Kentucky,USA.4DesMoines,Iowa,USA.

https://orcid.org/0000-0002-2342-8101

https://orcid.org/0000-0002-2823-9932

https://orcid.org/0000-0003-2350-7536

https://doi.org/10.46542/pe.2020.201.324335

https://doi.org/10.46542/pe.2020.201.324335

mailto:[email protected]

mailto:[email protected]

Kulvinder Rennie

Kearney,Puglisi,Black,&MahajanPharmacystudents’knowledgeofbiochemistry?

PharmacyEducation20(1)324-335 325

course in biochemistryshouldberequiredfor admissionto the professional pharmacy curriculum. The reportindicatedthatarelativelysmallnumberofschoolsactuallydorequirebiochemistryforadmission, butmanyschoolsincludebiochemistryintheir curricularather thanhavingit as aprerequisite for admission (Broedel-Zaugget al.,2008).AwhitepaperpreparedbytheBiologicalSciencesSection of the American Association of Colleges ofPharmacy(AACP)includedasectiononthe‘BiochemistryCoreKnowledgeandSkills’(competencies)thatpharmacyschoolgraduatesneedtopossess(PersonalCommunication,Dr. Arbi Nazarian, Chair, Committee of Sections, AACP,2014).Further,atthe2015ConferenceoftheAssociationof BiochemistryCourseDirectors (ABCD; since renamedtheAssociationofBiochemistryEducators[ABE]), apanelof pharmacy educators presented and discussed aproposed list of biochemistry learning objectives forpharmacyeducation(Osheroffetal., 2015), alignedwiththe AACP Biological SciencesSection ‘BiochemistryCoreKnowledge and Skills’ competencies. In this report, theauthors will refer to this as the AACP/ABE list. The listincluded131 learningobjectives.Most recently,Dasandcolleagues speculated that the growing healthcareenterprisewillleanheavilyonpharmacistsformedicationmanagement services, requiring both basic and clinicalscience knowledge, and sought to improve therelationship of pharmaceutical sciences to the clinicalarena by providing students with case-based practiceactivitiesthatfocusonthetenetsofmedicinal chemistry(Dasetal.,2018).

Biochemistry educators have the knowledge, skills andexperiencenecessarytodevelop courses in theirareaofexpertise. However, feedback from practitioners,includingstudentpharmacistsengagedinclinicaltraining,may be helpful in the design of courses to allow forrelevance without unnecessarily expanding content.Advanced pharmacy students are able to, for example,reflectonwhichelementsofbiochemistrytheyutiliseintheir clinical practice. The authors reasoned this as onewayof verifying the relevance of biochemistry for thepractice of pharmacy. Such reflections can also helpeducators fine-tune their courses, highlightingareas onwhich they should focus, and providing first-handfeedbackwhichmaybeused toexplaintherelevanceofbiochemistry in providing evidence-based, patient-centredcaretotheirstudents.

Thegoalofthepresentstudywastogatherfeedbackfromadvanced pharmacy students about what biochemistryknowledge and understanding they are using in theirclinical practice. This feedbackwill enable educators tobetter understand what concepts of biochemistry

pharmacy students use and need to know in order tofunction as high-level pharmacy practitioners and willallowfor re-toolingofthe learningobjectivesassociatedwiththecoursesthatpresentthefundamentalaspectsofbiochemistry.

MethodsSince2015,agroup of biochemistryeducators in sevenschools of pharmacy have conducted interviews withadvanced students (students doing their AdvancedProfessional Practice Experience [APPE] rotations) todeterminewhat information, from the AACP/ABElist oflearning objectives, these students have used in theirclinical practice education. The original study groupincluded educators from 17 institutions and all wereinvited toconductinterviews,butonlysevenactuallydidso.Theinstitutionswheretheinterviewswereconductedwere:MCPHSUniversity,SchoolofPharmacy,Worcester,MA;St.LouisCollegeofPharmacy(STLCOP),St.Louis,MO;University of Kentucky (UK), College of Pharmacy,Lexington,KY;ChicagoStateUniversity(CSU),CollegeofPharmacy, Chicago, IL; Samford University (SU),McWhorter School ofPharmacy,Birmingham,AL;DrakeUniversity(DU)CollegeofPharmacyandHealthSciences,DesMoines,IA;PresbyterianCollegeSchoolofPharmacy(PCSP),Clinton,South Carolina. Approval for conductingthisstudywassoughtandobtainedfromtheInstitutionalReviewBoardsoftheseinstitutions.

Overthecourseof twoacademicyears(2015-2017),theeducators interviewed 70 APPE students.A preliminaryreport onthisproject,basedonthefirst 32 interviews(apilotstudy),waspresentedatthe2017ConferenceoftheAssociationofBiochemistryEducators(Niederhofferetal.,2017).

Students who agreed to participate in the study wereinterviewed individually, orally, and in-person. Eachinterviewee received,reviewed, and signedan InformedConsent document, indicating her/his willingness toparticipate in the study. This document explained thepurposeof the study,thatparticipation inthestudywasvoluntary,how the interview would be conducted,andtheconfidentialnatureofthestudy.Eachintervieweewasassigned a participant ID number, and all remainingdocuments included that number, but no participantname. Participants completed a registration form,including demographic information, and informationabouttheireducationalbackground.

For each interview, the interviewer went through theAACP/ABElist,askingtheinterviewee,withregardtoeach



learningobjective,tociteaclinicalsituationduringAPPErotations wherein she/he had used that piece ofknowledge/information. The interview questions werepre-formulatedsothateachstudentwasaskedthesamequestions.Each interviewer recordedand tooknotes onthe interviews, and entered notes summarising eachparticipant’scommentsabouteachlearningobjectiveinaspreadsheet. After all of the interviews had beenconducted,theinterviewers’spreadsheetsweresubmittedto the study co-directors, who merged all reportedcommentsintoamasterspreadsheet.

In accordwith best practices for conducting qualitativeresearch (Patton, 1999; Merriam, 2009; Patton, 2015;O’Sullivan,2017;O’Sullivan,2018),thestudyco-directorsanalysedthecollecteddataasfollows.

Sinceintervieweeswereaskedto citeaclinical situationduringAPPErotationswhereinshe/hehadusedthatpieceof knowledge/information, the initial analysis involvedcategorising each response as either affirmative (if aclinical applicationwascited) or negative(for anyotherresponse). Upon further review of the responses,however, it becameclear that amorenuanced analysiswascalled for.Based ona reviewofall ofthe recordedresponses, a rating system was therefore devised,assigninganumberofpointstoeachresponse,asfollows:

• 3pointsiftheintervieweecitedaclinicalapplication(e.g.,adiseasestate,suchasdiabetes)oraspecificrotationduringwhichthetopicwasrelevant

• 2 points if the interviewee/interviewer indicatedclearly that the topic was important (usingwordssuchas‘Yes‘or‘Good’,orelaboratingonthetopictoillustrate understanding) but did not explicitlyindicateaclinicalapplication

• 1 point if the interviewee/interviewer indicatedsomeconnectiontothetopic,usingaword suchas‘Weak’or‘Basic’,butnoclinicalapplication

• 0pointsiftherewasanegativeresponse(No)ornoresponse at all (blank), or if the comment hadnothingtodowiththespecificlearningobjective

For each ofthe131items,oneof thestudyco-directorsratedeachresponse.Thenumbersof3,2,1,and0ratingsforeachitemwerethentabulated.

When categorising or rating qualitative responses, it ispossiblethataratermaybebiased-forexample,tendingto rate responses relativelyhigh in order to make theclinical relevance of items appear strong. In order toestablish the credibility and validity of ratings, it isthereforeimportanttotestforraterbiasbyhavingtwoormoreraterscategoriseresponses.

Additionally, if the definitions of the categories ofresponses arenot clear andunambiguous, it ispossiblethatdifferentobserverswillrateresponsesdifferently.Inordertodemonstratethevalidityoftheratingsystemitisimportant to demonstrate that independent raters willcategoriseresponsessimilarly.

Asawayofestablishingthevalidity ofratings,bycheckingfor bias and making sure that independent raterscategoriseresponsessimilarly, Merriam(2009)andPatton(1999;2015)suggest‘analysttriangulation’,havingtwoormore persons independently analysedata and comparetheir results. To dothis for thepresent study,the studydirector initiallyrated all responses,andthen two oftheco-authors,without seeing theinitial ratings,each ratedall70reportedresponsestotwo-thirdsoftheitems.Withthissystem,everyitemwasratedbytheprimaryraterandone or two independent secondary raters. To assessinter-rater agreement,Cohen’skappa(Cohen,1960)wascalculatedforeachsecondary-primaryraterpair.

ResultsSeventyAPPEstudents fromseven collegesofpharmacyin the United States of America (USA) (Table I), wereinterviewed for this study. Participants included 20students fromMCPHSUniversity,15 fromCSU,14 fromDU, 11 fromUK,5 from PCSP, 4 from SU,and 1 fromSTLCOP.Themajority of the participants (78.6%,n=55)attendedfour-yeardegreeprogrammesatCSU,UK,PCSPand SU, or a three-year accelerated programme atMCPHS,whiletheremainingstudentswereenrolledinthesix-yeardegreeprogrammesatDUandSTLCOP.WiththeexceptionofonestudentenrolledinSTLCOP, allstudentscompletedbiochemistryintheirfirstyearofthepharmacycurriculum. Students attending MCPHS, CSU and UKcompletedatwo-semesterbiochemistrycoursesequence,while studentsfromPCSP,DU and SU completed aonesemestercourse.

The majority of the participants were female (65.7%;n=46).Moststudentparticipantsfellwithintheagerangesof 21-27 (n=51). The most diversity was observed instudents from CSU, DU and MCPHS (Table I). A slightmajority of the participants (n=37, 52.9%) obtained aB.A./B.S.prior toenteringpharmacyschool,while31.4%participants reportedcompleting somecollege(n=22).Alittle more than 50% of students (n=36) reportedcompleting a separate biochemistry course prior toentering the Pharm.D. programme (Table I). An equalnumber of participants reported receiving an A or B(44.3%,n=31)whiletheremainingreportedearningaCintheirpharmacybiochemistrycourses(TableI).



TableI:DemographicinformationofstudentparticipantsVariablesVariables Total

N=70(%)

ChicagoStateUniversity

N=15(%)

DrakeUniversity

N=14(%)

MCPHSUniversity

N=20(%)

PresbyterianCollegeSchoolofPharmacyN=5(%)

SamfordUniversity

N=4(%)

St.LouisCollegeofPharmacy

N=1(%)

UniversityofKentucky

N=11(%)GenderGender

Female 65.7 73.3 64.3 65 80 25 100 63.4

Male 32.3 26.7 35.7 35 20 75 0 36.4AgeinyearsAgeinyears

21-24 31.4 6.6 78.6 20 20 50 36.425-27 41.4 26.7 14.3 45 80 25 100 63.628-34 22.9 60 7.1 3035orolder 4.3 6.6 5 25

Race/EthnicityRace/EthnicityWhite 57.1 20 78.6 30 100 100 100 90.9AfricanAmerican 14.3 33.3 7.1 20Asian/PacificIslander 27.1 40 14.3 50 0.9Hispanic/Latino 1.4 6.6

HighestLevelofEducationHighestLevelofEducationHighestLevelofEducationHighestLevelofEducationSomeCollege 31.4 20 100 60 27.3AssociatesDegree 5.7 6.6 0.9BA/BS 52.9 66.7 90 100 51.6MA/MS 4.3 10Pharm.D. 5.7 6.6 40 0.9

CompletedBiochemistryCoursePriortoEnteringPharmacySchoolCompletedBiochemistryCoursePriortoEnteringPharmacySchoolCompletedBiochemistryCoursePriortoEnteringPharmacySchoolCompletedBiochemistryCoursePriortoEnteringPharmacySchoolCompletedBiochemistryCoursePriortoEnteringPharmacySchoolCompletedBiochemistryCoursePriortoEnteringPharmacySchoolCompletedBiochemistryCoursePriortoEnteringPharmacySchoolCompletedBiochemistryCoursePriortoEnteringPharmacySchoolCompletedBiochemistryCoursePriortoEnteringPharmacySchoolCompletedBiochemistryCoursePriortoEnteringPharmacySchoolYes 51.4 53.3 28.6 65 25 50 100 65No 48.6 46.7 71.4 35 75 50 35

GradeReceivedGradeReceivedA 44.3 26.7 78.6 25 40 25 100 35B 44.3 66.7 21.4 50 20 75 65C 11.4 6.7 25 40

TableII:NumberofrotationsrequiredforeachprogrammeInstitution NumberofRotations

MCPHSUniversity 6

ChicagoStateUniversity 7

UniversityofKentucky 7

SamfordUniversity 8

St.LouisCollegeofPharmacy 8

DrakeUniversity 9

PresbyterianCollegeSchoolofPharmacy 9

TheAPPErotationrequirementforgraduationvariedfromsixtoninemodulesattheuniversitiesparticipatinginthestudy(Table II).The length of therotationsvaried fromfourtosixweeks.Onaverage,participantscompletedsix(SD±1.4)rotationspriortoparticipatingin thestudy.Themajority of the participants had completed the corerotations in Ambulatory care (n=58), Community

Pharmacy (n=59), Hospital/Institutional (n=62) andMedicine (n=52) (Table III).Amongthe electives,CriticalCare and Infectious Disease were reported mostfrequentlybystudentparticipants(TableIII).

Table III: Completed rotations reported by studentparticipantsRotationRotation TotalN=70(%)

RequiredRequired

AmbulatoryCare 82.9

CommunityPharmacy 84.3

Hospital/Institutional 88.6Medicine 74.3

ElectiveElective

CriticalCare 41.4

InfectiousDisease 22.9

Oncology 14.3

Pediatrics 10.0Psychology 12.9



The compiled ratings of the learningobjectives can befoundinAppendixA.TableIVshowsasampleofreportedcomments, to illustrate ratings assigned to thosecomments.

TableV:Numberofitemsreceivingspecifiednumberofratingsof3

No.ofratingsof3 No.ofitems

0-9 58

10-19 35

20-29 21

30-39 13

40-49 250+ 2

Howto read thetable: Seventy [70] interviewees commentedoneachofthe 131items. The studydirectorrated each of the comments oneach item on a scaleof0-3.Example:35ofthe131itemsreceived10-19ratingsof3.

Highlights of the ratings are as follows: the number ofrespondentsindicatingthattheyhadusedagivenpieceofinformation in a clinical situation (a rating of 3) rangedfrom0to52.Thedescriptionsoftheratingscanbefoundin the Methods section above, and that a rating of 3indicated that the interviewee had cited a clinicalapplication e.g., a disease state, such as diabetes or aspecific rotation during which the topic was relevant.TableVshowsthenumberofitemsreceivingratingsof3.

TableVI:MosthighlyratedlearningobjectivesLearningObjective(s) L.O.Number(s)

(AppendixA)

Vitamins,cofactors,andtheirroleinmetabolism

120,121

Hemoglobinanditsroleintransport 26

pH,pKa,andthedissociationconstant,Kd 1

Carbohydratemetabolism,itsregulation,andtheconnectiontodiseasestatessuchasdiabetes

60,65,68,74,118

Enzymeinhibition,andtheconnectiontodrugsthatareinhibitors 40,41

Lipidsandtheirmetabolism,includingcholesterol;theroleofHMG-CoAreductase,andtheactionofstatins;lipoproteins;ketonebodies

16,18,93,94,95,98

DNAandDNAprocesses,andantibacterialandanticancerdrugsthataffecttheseprocesses 57,58

Pharmacogenomics 131

Check for inter-rater agreement: as detailed in theMethods section above, after one of the studyco-directors(the‘primaryrater’)hadratedeachresponseto the 131 items, each of two of the co-authors (the‘secondaryraters’),without seeingthoseratings,did thesame for approximatelytwo-thirdsof theitems, so thateveryitemwasratedbytwoindependentobservers.Theirratingswerethen compared to theprimaryratings,and

TableIV:Examplesofreportedcommentstoillustrateratings

Rating Illustrativecomments3-iftheintervieweecitedaclinicalapplication(e.g.,adiseasestate,suchasdiabetes)oraspecificrotationduringwhichthetopicwasrelevant.

pH/pKa(LO1):“Yes,relatedtoexcretion.ChargeasfunctionofpH.Transport.Solubility.Esp.duringInstitutionalrotation.”

Hemoglobin(LO26):“Veryimportant,esp.forICUrotation:patientbloodO2level,Hct,etc.”

Carbohydratemetabolism(LO68):“Yes,fordiabeticpatients-especiallyresponsetoinsulinandglucagon(alsowithregardtobetablockers)”

Vitamins(LO121):“PatientstakingOrlistatatmayhavetosupplelementA,D,E,K.TalkedaboutScurvy.AnemiapatientsmayhaveBvitamindeficiencies.”

2-iftheinterviewee/interviewerindicatedclearlythatthetopicwasimportant(usingwordssuchasYesorGood,orelaboratingonthetopictoillustrateunderstanding)butdidnotexplicitlyindicateaclinicalapplication.

pH/pKa(LO1):“Can'tgiveaclinicalexperiencethatcanthinkofinheadthathavehadtousetowardsAPPErotation.Haveusedinotherclassesdowntheroad.pKaorpHofadrug-forlikecalculations(introducedinbiochemandreinforcedinanotherclass.”

Acid-Base(LO2):“Henderson-HasselbalchusedinpKclass,notinrotation.”

Stereochemistryofmonosaccharides(LO6):“SomedrugshaveS&Rconfig.:someactive,somenot.”

Glycosidicbondbetweenmonisaccharides(8/10-20):“Stereochemistry-inmedchem,notinpractice”

1-iftheinterviewee/interviewerindicatedsomeconnectiontothetopic,usingawordsuchasWeakorBasic,butnoclinicalapplication.

Weakinteractions(LO4):“Notspecifically,butmaybeonabroadleveltheconceptofhydrophobicityetc.”

Regulationofcarbohydratemetabolism(66/116):“Biochem/MedChemlecture”

Ureacycle(80/143-45):“getwasteoutofthebody,protectpH”

ATP:ADPratioandregulation(109/234-45):“Feedbackmechanism”



Cohen’s kappa (κ) was calculated for each primary-secondarypair (Cohen,1960).Thevaluesofκforthetwopairswere0.87and0.81.Thereisnogeneralagreementastowhatmagnitudeofκreflectsadequateagreement,but Landis & Koch (1977) suggested guidelines thatauthorsoften reference: κvaluesof 0.41-0.60represent‘moderate agreement’, values of 0.61-0.80 represent‘substantialagreement’,andvaluesof0.81-1.00represent‘almostperfectagreement’(Woster,2003).

Among the learning objectives that were most highlyrated(AppendixA),with thehighestnumber of3ratingswerethoserelatedtothefollowingtopics:

• vitamins,cofactors,andtheirroleinmetabolism(L.O.#120,121)

• haemoglobinanditsroleintransport(L.O.#26)

• pH,pKa,andthedissociationconstant,Kd(L.O.#1)

• carbohydrate metabolism, its regulation, and theconnection to disease statessuch asdiabetes (L.O.#60,65,68,74,118)

• enzymeinhibition,and theconnection to drugsthatareinhibitors(L.O.#40,41)

• lipidsandtheirmetabolism,includingcholesterol;theroleofHMG-CoAreductase,andtheactionofstatins;lipoproteins;ketonebodies(L.O.#16,18,93,94,95,98)

• DNA and DNA processes, and antibacterial andanticancer drugs that affect these processes (L.O.#57,58)

• pharmacogenomics(L.O.#131)

Interviewees indicated that they had used informationrelated to the above topics during their APPE rotations(ratingof 3)or that theyunderstood the importance ofthetopic(ratingof2).

DiscussionsandConclusionTheresultsofthisstudyindicatethatalloftheaspectsofbiochemistrycoveredbythe131learningobjectiveswererecalled by students, and many were recognised asrelevantduringthestudents’APPErotations.

Onemight expectthat inaperfectlyaligned curriculum,everythingtaught indidactic coursewouldbe applied inexperientialeducation.Thismight leadtoanexpectationthat students interviewed for this study would reportusingalmosteveryoneof the131 biochemistrylearningobjectives during their APPE rotations. The authorssubmit,however,thattherearemanypossiblereasonsto

explainwhynoteverystudentreportedusingeverypieceofinformationinaclinicalsetting:

Inorderforastudenttoindicatethatshe/hehadused,ina clinical setting,a specific piece of information from abiochemistry course two or more years earlier, thestudent would have to have almost perfect memory -remembering all patient cases from all rotations, andremembering and understanding everything that wastaught in the biochemistry course. If a student did notrecallallofthis,that studentwouldnot rememberallofthepiecesofbiochemistryinformation that she/hedrewoninclinicalsituations.Becauseofthisimperfectrecall, itis likelythat studentsdrew on biochemistryinformationmoreoften thantheyremembered.For this reason,theauthorssubmitthattherelativenumberofacknowledgedconnectionsprobablyindicatestherelativeimportanceoftheitems(learningobjectives)toclinicalpractice, butthatthe number of actual connections is probably muchgreaterthanthenumberofrememberedconnection.

Studentswereinterviewedatdifferenttimesduringtheirfinal year in pharmacyschool, duringwhich theywouldcomplete a total of six-nine rotations. Students whoparticipatedinthestudyhadnotyetcompletedalloftheirrotationsatthetimeoftheir interviews,so theyhadnotyet had clinical experiences related to some of thebiochemistrytheyhadlearned.Forexample, 17%hadnotyet completed the required Ambulatory Care rotation,16% had not yet completed the required CommunityPharmacy rotation, 11% had not yet completed therequiredHospital/Institutional rotation,and26%hadnotyetcompletedtherequiredMedicinerotation(TableIII).

Some studentsmaynot consciouslyrecognise that theyare applying biochemistry in their APPE rotations. Thiscouldbebecauseasignificantamountoftimehadpassedsincetheyhadtakenabiochemistrycourse,becausetheyhad forgotten the biochemical underpinnings of othersubjects they had studied (e.g., pharmacology), orbecause of a host of other reasons. It could be thatbiochemistry,or abiochemicalwayof thinking,couldbeembeddedintheirthinkingatasubconsciouslevel.

Someof thelearningobjectivesmaybesogranular thatinterviewees replied that they never applied theobjectives during their clinical experiences,even thoughtherewasimportantgeneralinformationintheobjectives.For example,studentsmayneverhavehadto ‘applytheHenderson-Hasselbalch equation to solvepH problems’,buttheymayhavehadtounderstandhowpHcanaffectthechargeonmolecules,suchasvariousdrugs.

It wasclear fromcommentsmadeby interviewees thatdifferent preceptors emphasised different topics, and


PharmacyEducation20(1)324-335

differentsitesoffereddifferentlearningopportunities.Forexample, one preceptor might highlight amino acids aspart of Total Parenteral Nutrition,while another mightnot.Thiscertainlyaccounts for someof thevariabilityinresponsesaboutclinicalapplicationofbiochemistry.

Beyond these possible reasons for low ratings, it isneverthelessimportanttoincludesomebiochemistryinacourseevenifnoteverystudentabsolutelyneedstoknowit inorder to successfullycomplete everyAPPErotation.Whether or not students realise it, theyneed to knowsomeparts of biochemistryasprerequisites for coursesthey will take subsequently (e.g., medicinal chemistry),andtheymayneedtoknowsomethingsthattheywillnotapplyin their APPE rotationsbutwhich theymayapplyoverthecourseoftheirprofessionalpractice,suchasthegrowingfieldofpharmacogenomics(Weitzeletal.,2016).

Thereliabilityoftheratingsinthisstudyisimportant. Thiswas assessed by comparing the ratings, carried outindependently, of the primary study director and twoco-directors. The fact that independent assessors ratedthe responses very similarly (kappas of 0.87 and 0.81)suggests that the ratingrubricswereclear, and that theratingswerenotsubstantiallyaffectedbyraterbias.

Whilethelowratingsforsomelearningobjectivesmaybeconcerning, lack of high ratings for every item isunderstandable, especially in view of the limitationsdiscussed above. Instead of focusing on absolutenumbers,the authors submit that what is important tofocuson is therelative ratings ofthe items.Specifically,theresultsofthisstudyprovideguidancetoeducatorsastheydesign biochemistrycourses inpharmacycurricula.Relativelyhighly-rated learningobjectivesappeartohavehighclinicalrelevance,andbiochemistryeducatorswoulddowelltohighlightthisintheir teaching.When teachingmaterial related to objectives with lower ratings,educatorsmayneedtoprovideextrainformationtomaketheir practicerelevance clear. In somecases, though, itmay be that these objectives are less important forpharmacy students,or that theyaremore specific thantheyneedtobe.Theauthorssubmitthatarevisedlistoflearning objectives should include less-specific (andtherefore less limiting) items, highlighting broader butcriticallyimportant information. Thecriteriafor includingitemsshouldbethattheyareessentialforprogressingtosubsequent courses in the curriculum,and essential forpharmacists to competently practice their profession,upon graduation and licensure, and over their entirecareer.

The focus of the present study was on pharmacyeducation in theUSA.The referenced competenciesand

330

learningobjectiveswerefromsub-groupsof,respectively,the AACP and the ABE, both of which are primarilyUSA-based organisations. This means that the study ismost relevant for USA-based educators, but thecompetenciesandlearningobjectivesareprobablysimilarfor educators world-wide. Having said that, it wouldcertainlybeworthwhiletocarryoutsimilarstudiesinthefuture about teaching biochemistry in pharmacyprogrammesincountriesotherthantheUSA.

Theapproachofthepresentstudycouldalsobeextendedto the teaching of biochemistry to students in otherhealthcareprofessions(e.g.,medicine,physicianassistant,dentistry). The ABE includes educators from schools ofmedicine and dentistry and may be interested in suchstudies. Comparative analysesof such results would bevaluablefor further improvingbasic sciencescurriculainpharmacyaswellasotherhealthcareprofessions.Finally,it would be interesting to explore the effectiveness ofvarious methods for teaching biochemistry (and othersubjects), someofwhich havebeen necessitatedbytheCOVID-19pandemic.

ThisstudymayalsoinspirefacultyinundergraduateAlliedHealth Sciences’ courses to conduct similar studies fortheir students. For example, theymaywish to explorewhat organic or analytical chemistry students need toknow in order to succeed in other courses in apharmaceuticalsciencescurriculum.

Asnoted in the Introduction,educators generallyagreeabouttheimportanceofbiochemistryintheeducationofpharmacists,andbiochemistrycompetencies havebeenproposed(Nazarianetal.,2014).Whatthepresentstudyadds to the literature ispractice-based evidence of therelevance and importance of specific elements ofbiochemistry that underlie the practice of pharmacy. Inaddition to providing course-design guidance toeducators,thisalsohighlightstheadvantageofincludingbiochemistryinthepharmacycurriculum,ratherthanjustas a prerequisite for admission, because pharmacyeducators can make explicit connections betweenbiochemistryandthepracticeofpharmacy.

AcknowledgementsTheauthorsthankthefollowingcolleagueswhoconductedinterviewsattheir institutions:PaulJuang(Pharm.D.), St.Louis College of Pharmacy; Danielle Cruthirds (Ph.D.),SamfordUniversity,McWhorterSchoolofPharmacy;andDavid Eagerton (Ph.D.), Presbyterian College School ofPharmacy (now at Campbell University, College ofPharmacyandHealthSciences).



ReferencesACPE [Accreditation Council for Pharmacy Education]. (2016).Standards2016Accreditation StandardsAndKey Elements ForTheProfessional ProgramInPharmacy Leadingtothe DoctorofPharmacy Degree: Chicago, IL2015. Available at: https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf

Bauer, C.W. (1947). Biochemistry in the pharmacy curriculum.AmericanJournalofPharmacyEducation,11(1),125-131

Broedel-Zaugg,K.,Buring,S.M.,Shankar,N.Soltis,R.,Stamatakis,M.K., Zaiken, K., & Bradberry, J.C. (2008). Academic pharmacyadministrators'perceptionsofcore requirements for entry intoprofessionalpharmacyprograms.AmericanJournalofPharmacyEducation,72(3),52.https://doi.org/10.5688/aj720352

CohenJ.A. (1960). Coefficient ofagreement for nominal scales.Educational and Psychological Measurement, 20(1), 37-46.https://doi.org/10.1177/001316446002000104

Das,J.,Fernandez,J., Shah,D.,Williams, L.&Zagaar,M.(2018).Case-based studies in teaching medicinal chemistry in PharmDcurriculum: Perspectives of students, faculty, and pharmacistsfrom academia. Currents in Pharmacy Teaching and Learning,10(1),85-89.https://doi.org/10.1016/j.cptl.2017.09.004

Dirks-Naylor, A.J., Wright, N.J.D., & Alston, G.L. (2015).Development and Assessment of a Horizontally IntegratedBiological Sciences Course Sequence for Pharmacy Education.AmericanJournalofPharmacyEducation,79(6),89. https://doi.org/10.5688/ajpe79689

Georgiev,A.M.,Krajnović,D.,Manojlović,J.,Ignjatović,S.,&MajkićSingh, N. (2016). Seventy Years of Biochemical Subjects'Development in Pharmacy Curricula: Experience from Serbia.JournalofMedicalBiochemistry,35(1), 69-79.https://doi.org/10.1515/jomb-2015-0018

Goyal,R.K.,Bhise,S.B.,Srinivasan,B.P.,Rao,C.M,Sen,T.,&Koneri,R.(2014).CurriculumforpharmacologyinpharmacyinstitutionsinIndia:Opportunities and challenges. Indian Journal of Pharmacology,46(3),241-245.https://doi.org/10.4103/0253-7613.132149

Gryka,R.,Kiersma,M.E.,Frame,T.R.,Cailor,S.M.,&Chen,A.MH.(2017). Comparison of student confidence and perceptions ofbiochemistry concepts using a team-based learning versustraditional lecture-basedformat.Currents inPharmacyTeachingandLearning,9(2),302-310.https://doi.org/10.1016/j.cptl.2016.11.020

Harrold, M.W., & McFalls, M.A. (2010). A Pharmacy PracticeLaboratory Exercise to Apply Biochemistry Concepts. AmericanJournal of Pharmacy Education, 74(8), 144. https://doi.org/10.5688/aj7408144

Landis,J.R.,&Koch,G.G. (1977). Themeasurementofobserveragreement for categorical data. Biometrics, 33(1), 159-174.https://doi.org/10.2307/2529310

Lewis, H.B. (1947). Biochemistry in the pharmacy curriculum;optional or required subject. American Journal of PharmacyEducation,11(1),119-125Merriam,S.B.(2009).QualitativeResearch:AGuidetoDesignandImplementation.2nded,Jossey-Bass,SanFrancisco,CaliforniaNazarian, A., Bloom, T.J., Oliveira, M., Zavod, R., Harrold, M.,Mobley, C., & White, C. (2014). Roles of the PharmaceuticalSciencesinPharmacyEducationandPractice-AWhite Paperbythe Biological Sciences Section of the American Association ofCollegesofPharmacy

331

Niederhoffer, E.C., Cline, S.D., Osheroff, N., Simmons, J.M.,Diekman,A.B.,Franklin,D.S.,etal.(2017).TeachingBiochemistryandGeneticstoStudentsofDentistry,Medicine,andPharmacy6thInternationalConference oftheAssociationofBiochemistryEducators (ABE) Clearwater Beach, FL, USA, May 7-1.MedicalScience Education, 27(4), 855-859. https://doi.org/10.1007/s40670-017-0441-1Okubo,M.,Takahashi,Y.,Yamashita,J.,Takahashi,H.,Miyata,O.,Suzuki,T.,& Ishii, I.(2017).InPracticalTraining,aQuestionnaireSurvey and Analysis to Pharmacy Students of the UtilizationSituationofthe CourseContentsofPharmacySchool.YakugakuZasshi,137(6),745-755.https://doi.org/10.1248/yakushi.16-00256Osheroff,N.,Niederhoffer,E.C.,Sabina,R.L.,Cline,S.D.,Wimmer,M.J., Franklin, D.S., Diekman, A.B., et al. (2015). TeachingBiochemistrytoStudentsofMedicine,Pharmacy&Dentistry:5thInternational Conference of the Association of BiochemistryCourse Directors (ABCD) Santa Fe, NM, USA, May 3-7, 2015.Medical Science Education, 25(4), 473-477. https://doi.org/10.1007/s40670-015-0160-4

O'Sullivan, T.A., Sy, E., & Bacci, J. (2017). A qualitative studydesigned to build an experiential education curriculum forpractice-ready community pharmacy-boundstudents. AmericanJournal of Pharmacy Education, 81(10), 6055. https://doi.org/10.5688/ajpe6055O'Sullivan,T.A.,&Sy, E. (2018).Aqualitativestudy identifying keycomponents to standardize across inpatient general medicineadvanced pharmacy practice experiences. American Journal ofPharmacyEducation,82(2),6215.https://doi.org/10.5688/ajpe6215Patton, M.Q. (1999). Enhancing the quality and credibility ofqualitative analysis. Health Services Research, 34(5 part 2),1189-1208Patton, M.Q. (2015). Qualitative Research and EvaluationMethods.4thed,SagePublications,ThousandOaks,CA.Romanelli,F.(2018).ToBoldlyGo.AmericanJournalofPharmacyEducation,82(4),7085.https://doi.org/10.5688/ajpe7085

Rose,T.M.(2011).Aboardgame toassistpharmacystudentsinlearning metabolic pathways. American Journal of PharmacyEducation,75(9),183.https://doi.org/10.5688/ajpe759183

Sánchez-Pozo, A. (2017). A Comparison of Competences forHealthcareProfessionsinEurope.Pharmacy(Basel),5(1),8pii:E8.https://doi.org/10.3390/pharmacy5010008

VanWinkle,L.J.,Cornell,S.,Fjortoft,N.,Bjork,B.C.,Chandar,N.,Green, J.M., La Salle, S., Viselli, S.M.,Burdick, P.,& Lynch, S.M.(2013).Criticalthinkingandreflectionexercisesinabiochemistrycourse to improve prospective health professions students'attitudes toward physician-pharmacist collaboration. AmericanJournal of Pharmacy Education, 77(8), 169. https://doi.org/10.5688/ajpe778169

Weitzel,K.W.,Aquilante,C.L.,Johnson,S.,Kisor,D.F.,&Empey,P.E.(2016). Educational strategies to enable expansion ofpharmacogenomics-based care. American Journal ofHealth-SystemPharmacy,73(23), 1986-1998. https://doi.org/10.2146/ajhp160104

Woster, P.M. (2003). Maintaining Basic Science ContentThroughout The PharmD Curriculum. American Journal ofPharmacyEducation,67(3),99.https://doi.org/10.5688/aj670399

https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf




https://doi.org/10.5688/aj720352


https://doi.org/10.1177/001316446002000104

https://doi.org/10.1177/001316446002000104

https://doi.org/10.1016/j.cptl.2017.09.004


https://doi.org/10.5688/ajpe79689




https://doi.org/10.1515/jomb-2015-0018




https://doi.org/10.4103/0253-7613.132149

https://doi.org/10.4103/0253-7613.132149



https://doi.org/10.5688/aj7408144

https://doi.org/10.5688/aj7408144

https://doi.org/10.5688/aj7408144

https://doi.org/10.5688/aj7408144

https://doi.org/10.2307/2529310

https://doi.org/10.2307/2529310

https://doi.org/10.1007/s40670-017-0441-1

https://doi.org/10.1007/s40670-017-0441-1

https://doi.org/10.1007/s40670-017-0441-1

https://doi.org/10.1007/s40670-017-0441-1

https://doi.org/10.1248/yakushi.16-00256

https://doi.org/10.1248/yakushi.16-00256

https://doi.org/10.1007/s40670-015-0160-4

https://doi.org/10.1007/s40670-015-0160-4

https://doi.org/10.1007/s40670-015-0160-4

https://doi.org/10.1007/s40670-015-0160-4











https://doi.org/10.3390/pharmacy5010008

https://doi.org/10.3390/pharmacy5010008





https://doi.org/10.2146/ajhp160104








AppendixA

Competencies(BiologicalSciencesSectionofAACP)

LONo. LearningObjectives(AssociationofBiochemistryCourseDirectors)

No.ofratingsNo.ofratingsNo.ofratingsNo.ofratings

Competencies(BiologicalSciencesSectionofAACP)

LONo. LearningObjectives(AssociationofBiochemistryCourseDirectors)

0 1 2 3 Basics 1 DefineandexplainpH,pK,andthedissociationconstantKd. 8 2 28 32

Basics2 ApplytheHenderson-HasselbalchequationtosolvepHproblems 39 4 20 7

Basics

3 DefineandexplainGibbsfreeenergy(ΔG),standardfreeenergy(ΔG˚°),andtheequilibriumconstant(Keq)asitappliestobiochemicalreactions. 62 5 2 1

Basics

4 DefineandexplaintherolesofVanderWaalsforces,charge-chargeinteractions,hydrogenbonds,andhydrophobicinteractionsinproteinandmacromoleculararchitectureandindicatehowtheseforcesdifferfromcovalentbonds.

28 10 16 16

1Structureoftheessentialbiologicalbuildingblocks:StudentPharmacistshouldbeabletodescribethefunctionalgroupsandelementsthatcharacterizeaminoacids,carbohydrate,nucleotidesandlipidsandevaluatetheirphysicalandchemicalproperties.

5 Describethegeneralstructureofmonosaccharides,andclassificationbysizeandtypeofcarbonylfunctionalgroup. 32 1 15 22

Structureoftheessentialbiologicalbuildingblocks:StudentPharmacistshouldbeabletodescribethefunctionalgroupsandelementsthatcharacterizeaminoacids,carbohydrate,nucleotidesandlipidsandevaluatetheirphysicalandchemicalproperties.

6 Describethestereochemistryofmonosaccharidesandwhatismeantbystereoisomer,enantiomer,diastereomerandepimer. 27 6 26 11


7 Describethecyclicstructureofmonosaccharidesandthedefinitionofα-andβ-anomers. 58 4 7 1


8 Describeaglycosidicbond,andhowaglycosidicbondbetweensugarmoleculesisidentified. 46 2 20 2


9 Describethestructuraldifferencesbetweenstarchandglycogen. 45 3 8 14

Structureoftheessentialbiologicalbuildingblocks:StudentPharmacistshouldbeabletodescribethefunctionalgroupsandelementsthatcharacterizeaminoacids,carbohydrate,nucleotidesandlipidsandevaluatetheirphysicalandchemicalproperties. 10 Demonstratethatyouknowthestructuresofthe20aminoacidsthatcommonlyoccurinproteinsand

classifythemaccordingtochirality,polarity,andcharge. 44 9 6 11


11 Knowthe3lettercodesidentifyingthe20standardaminoacidsandselenocysteine. 43 2 3 22


12 DeterminethechargeonanaminoacidatagivenpH. 56 3 3 8


13 Explainwhatismeantbytheisoelectricpoint(pI)ofanaminoacid. 59 1 8 2


14 Namethemajorpurineandpyrimidinebasesandidentifyaminoacidandone-carbonmetabolitesthatcontributetothesynthesisoftheseringstructures. 40 1 17 12


16 Namecommonfattyacidsandclassifyassaturated,monounsaturated,orpolyunsaturated. 23 3 11 33


17 Describethecompositionandstructureoftriglycerides,phosphatidyllipidsandsphingolipids. 37 3 14 16


18 Describethestructuresofcholesterol,steroids,andcholesterolester. 27 1 13 29

1a.CellBiology 19 Definemicellesandliposomesanddescribehowtheyareformedspontaneouslyfromdetergent,bileacids,

andphospholipids. 28 7 11 24

CellBiology

20 Describetheroleofcollagenandelastininconnectivetissue 47 0 10 13

2

Structureandfunctionofproteinsandenzymes:StudentPharmacistshouldbeabletodescribethedifferentlevelsofproteinstructuralorganization,describetheforcesthatstabilizeproteinsandtheirinteractionotherbiomolecules.Describethepropertiesofenzymes,thecatalyticstrategiestheyuse,explaintheparametersthatareusedtocharacterizeenzymeactivityandevaluatethedifferenttypesofenzymeinhibitors.

21 Describethebondsandforces(peptide,disulfide,andhydrogenbonds;hydrophobic,dipole-dipole,vanderWaalsandelectrostaticinteractions)thatcontributetotheconformationofproteinsandtheinteractionofproteinswithotherbiomolecules.

38 6 9 17


22 Defineanddiscussthefollowingterms:peptidebond,peptidebackbone,N-terminus,C-terminus,disulfidebridges,α-helices,β-sheets,β-strands,β-turns. 41 9 12 8


23 Discriminatebetweenprimary,secondary,tertiary,andquaternaryproteinstructure. 41 7 8 14


24 DeterminethechargeonasmallpeptideatagivenpH 56 6 3 5


25 Defineandexplaintheroleofmembraneproteins 34 6 10 20


26 Explaintheroleofhemoglobininthedeliveryofoxygen,removalofwasteandbuffering. 7 6 7 50


27 Describethestructuraldifferencebetweenhemoglobin,myoglobinandmethemoglobin(oxidizedhemoglobin)andcompareO2bindingpropertiesofhemoglobin,methemoglobinandmyoglobin. 42 7 4 17


28 Describethe6majorenzymeclassificationsandthebasictypeofreactioncatalyzed,including:oxidoreductases,transferases,hydrolases,lyases,isomerases,andligases. 34 12 5 19


29 Defineanddescribetherolesofthefollowingenzyme-relatedterms:zymogen/proenzyme,coenzyme,co-factors,prostheticgroup,apoenzyme,holoenzyme,andisozymes. 42 3 1 24


30 Explainhowanenzymefunctionsasacatalystinloweringtheactivationenergyofreactions. 43 0 15 12


31 Proposeathermodynamicexplanationofwhyenzymescannotaltertheequilibriumofreactions. 58 3 8 1


32 Definethetermtransitionstateandproposearoleforthetransitionstateinloweringactivationenergy. 55 10 4 1


33 Explainhowtransitionstateinhibitorsworkasdrugs. 53 3 6 8


34 Explaintheinducedfit(conformationalchange)modelofenzymecatalysis. 42 0 16 12


35 Nameanexampleanddescribebasiccatalyticmechanisms,including:serineproteases,covalentandacid-basecatalysis. 51 9 6 4


36 Defineinitialvelocity(V0)andexplaintheeffectofsubstrateconcentrationonenzymevelocityforasinglesubunitenzyme. 59 4 3 4


37 ExplainMichaelis-MentenkineticsandbeabletoapplytheMichaelis-Mentenequationtocalculatevelocity,maximumvelocity(Vmax)andtheMichaelisconstant(Km).

44 8 8 10


38 Describethesignificanceofanenzyme’sKmvalueinmetabolicsystems. 43 3 14 10


39 DrawaLineweaver-Burkplot,definingVmaxandKmandusetheplottoevaluatetypesofinhibition,including:competitive,non-competitive,andmixedinhibitionindrugs. 49 5 6 10


40 Compareandcontrastthedifferenttypesofinhibitors,withexamplesincluding:transitionstateinhibitors,suicideinhibitors,irreversibleinhibitors,competitiveandnoncompetitiveinhibitors. 17 0 15 38


41 Evaluatethedifferencebetweenacompetitiveversusnon-competitivedruginhibitor(e.g.usingfomepizoleandethanoltreatmentsformethanolpoisoning.) 23 0 15 32


42 Defineandexplainallosterismandtheimportantphysiologicalroleofallostericenzymeinhibitionoractivation. 49 3 13 5


43 Defineandcompareandcontrastfeed-backversusfeed-forwardregulation. 32 1 15 22



44 Explaintheroleofpost-translationalmodificationsinregulatingenzymeactivity,including:proteolysis,and

reversiblephosphorylation. 48 3 12 7

45 Proposewhysomeenzymereactionsareconsideredirreversibleinthecell. 50 2 11 73 StructureofDNA,DNA

damageandrepair,replication,transcriptionandtranslationofgeneticinformation:StudentPharmacistshouldbeabletodescribethestructureofDNA,howitisdamagedandtherepairmechanisms.Describehowgeneticinformationisorganizedandexpressedwithincells.Describetheprocessesofreplication,transcriptionandtranslation,comparingthemineukaryotesandprokaryotes.IdentifyrelevantdiseasesassociatedwithDNAprocessedandtherapeutictargets.

46 Summarizethecentraldogmaofmolecularbiology,andcitetheexceptions,notablyinviruses. 30 0 16 24

StructureofDNA,DNAdamageandrepair,replication,transcriptionandtranslationofgeneticinformation:StudentPharmacistshouldbeabletodescribethestructureofDNA,howitisdamagedandtherepairmechanisms.Describehowgeneticinformationisorganizedandexpressedwithincells.Describetheprocessesofreplication,transcriptionandtranslation,comparingthemineukaryotesandprokaryotes.IdentifyrelevantdiseasesassociatedwithDNAprocessedandtherapeutictargets.

47 DescribethechemicalcompositionofDNA,itsstructure,anditsrelationshiptotheprocessesofreplication,transcription,recombinationandrepair. 31 0 15 24


48 SummarizethemechanismofDNAreplication. 41 7 7 15


49 Compareandcontrastpolymeraseproofreading,directrepair,baseexcisionrepair,nucleotideexcisionrepair,mismatchrepair,andrecombination. 50 6 8 6


50 NamethedifferenttypesofmutationsthatoccurinDNA. 42 0 12 16


51 DescribethechemicalcompositionofRNA. 48 0 15 7


52 Summarizetheinitiation,elongation,andterminationoftranscription,comparingandcontrastingtheseprocessesineukaryoticandprokaryoticcells. 50 2 11 7


53 Describetheuniversalfeaturesofthegeneticcodeanditsbiologicalrelevance. 47 1 14 8


54 Summarizethethreestepsofproteinsynthesis(translation):initiation,elongation,andtermination.Compareandcontrasttheseprocessesandtheirregulationineukaryoticandprokaryoticcells. 39 3 10 18


55 Describethemechanismsofgeneregulation,bothnegativeandpositive,asexemplifiedbyprokaryoticsystems. 52 0 14 4


56 DescribeeukaryoticgenestructureandtheroleofchromatininmakingDNAaccessibleforbiologicalprocesses 54 7 7 2

StructureofDNA,DNAdamageandrepair,replication,transcriptionandtranslationofgeneticinformation:StudentPharmacistshouldbeabletodescribethestructureofDNA,howitisdamagedandtherepairmechanisms.Describehowgeneticinformationisorganizedandexpressedwithincells.Describetheprocessesofreplication,transcriptionandtranslation,comparingthemineukaryotesandprokaryotes.IdentifyrelevantdiseasesassociatedwithDNAprocessedandtherapeutictargets. 57 DescribehowDNAandDNAprocessescanbeusedastherapeutictargets(e.g.anticancerandantibacterial

drugs). 24 2 10 34


58 SummarizewhymutationsinDNArepairsystemscanleadtodisease,includingcertaintypesofcancer. 30 1 12 274 Metabolicpathwaysfor

biosynthesisanddegradationofcarbohydrate,aminoacids,nucleotidesandlipids:StudentPharmacistshouldbeabletodescribethedifferentcomponentsofeachmetabolicpathway,identifythemetabolitesthatintegratedifferentmetabolicpathwaysandexplainhowmetabolicpathwaysareregulated.Studentsshouldalsobeabletointerpretmetabolicchangesintermsofcarbohydratelipid,aminoacidandlipidmetabolism.

59 Evaluateandpredicttheeffectsofpartialorcompleteenzymedeficiencyonametabolicpathway. 37 5 7 21

Metabolicpathwaysforbiosynthesisanddegradationofcarbohydrate,aminoacids,nucleotidesandlipids:StudentPharmacistshouldbeabletodescribethedifferentcomponentsofeachmetabolicpathway,identifythemetabolitesthatintegratedifferentmetabolicpathwaysandexplainhowmetabolicpathwaysareregulated.Studentsshouldalsobeabletointerpretmetabolicchangesintermsofcarbohydratelipid,aminoacidandlipidmetabolism.

60 Describetheoverallpurposeofglycolysis,itsreactantsandproducts,itscellularlocalizationandtissuedistribution. 26 9 2 33


61 Describetherolesofhexokinase/glycokinase,phosphofructokinase-1(PFK-1)andpyruvatekinaseinglycolysis,andthemechanisms(allosteric,covalentmodification)bywhichtheiractivityisregulated. 56 7 2 5


62 Describethepurposeofthereactioncatalyzedbylactatedehydrogenase,itsreactantsandproducts,cellularandtissuelocalizationandhowitisregulated. 51 4 5 10


63 Explaintheconceptofsubstrate-levelphosphorylationandwhyitisimportant. 58 4 6 2


64 DescribetheroleandfateofthecytosolicNADHproducedinglycolysis 56 6 6 2


65 Describetheoverallpurposeofgluconeogenesis,itsreactantsandproducts,itscellularlocationanditstissuedistribution. 22 5 9 34


66 Describetherolesofpyruvatecarboxylase,PEPcarboxykinase,fructose-1,6-bisphosphataseandglucose-6-phosphatase,andthemechanismsbywhichtheiractivityisregulated. 57 10 1 2


67 Evaluatetherelativeimportanceofdifferentprecursorsforgluconeogenesisinfeeding,fastingandexercise. 34 5 5 26


68 Explainhowtheactivitiesofglycolysisandgluconeogenesisareregulatedinrelationshiptofattyacidandproteinmetabolism,andinresponsetoglucagonandinsulin 15 3 8 44

Metabolicpathwaysforbiosynthesisanddegradationofcarbohydrate,aminoacids,nucleotidesandlipids:StudentPharmacistshouldbeabletodescribethedifferentcomponentsofeachmetabolicpathway,identifythemetabolitesthatintegratedifferentmetabolicpathwaysandexplainhowmetabolicpathwaysareregulated.Studentsshouldalsobeabletointerpretmetabolicchangesintermsofcarbohydratelipid,aminoacidandlipidmetabolism. 69 Describetheoverallpurposeofthepentosephosphatepathway,itsreactantsandproducts,itscellular

locationanditstissuedistribution 57 11 2 0


70 Describetheoverallpurposeofglycogenesisandglycogenolysis,theirreactantsandproducts,theircellularlocalizationandtissuedistribution. 41 8 6 15


71 Describetherolesofglycogensynthaseandbranchingenzymeinglycogenesisandpredictthebiochemicalconsequencesindeficienciesoftheseenzymes. 60 3 3 4


72 Describetherolesofglycogenphosphorylase,debranchingenzyme,andglucose-6-phosphataseinglycogenbreakdownandpredictthebiochemicalconsequencesindeficienciesintheseenzymes. 59 4 3 4


73 Compareandcontrastthepurposeandregulationofglycogenolysisinhepatocytesversusskeletalmuscle. 57 4 1 8


74 Explainhowglycogensynthesisandglycogenolysisareregulatedbyinsulin,glucagonandcatecholamines. 27 3 13 27


75 Explainthecontributionofglycogenolysisandglycogenesistobloodglucoseregulationduringthefedstate,thefastingstateandexercise 34 1 11 24


76 Describetheoverallpurposeofthepyruvatedehydrogenasecomplex,itsreactantsandproducts,itscellularlocalizationandtissuedistribution 59 6 3 2


77 DescribetheregulationofthePDHcomplexandthecellularconditionswhentheenzymewillbeactiveorinactive 68 1 1 0


78 Describethedynamicsofthefreeaminoacidpool,including(A)inputsfromdiet,bodyproteinbreakdown,anddenovosynthesis,and(B)outputstoproteinsynthesis,ureaproduction,synthesisofspecializedproductsandothermetabolicprocesses

47 7 3 13


79 Describetheactivationofpancreaticzymogensandtherolesoftheactiveenzymesinproteindigestion 54 1 3 12


80 Explaintherationaleoftheureacycleinammoniaexcretion 42 10 3 15


81 Defineessential,conditionallyessential,andnonessentialaminoacids,andlistthemaccordingly 47 6 11 6


82 Explaintheroleoftransaminationreactionsinaminoacidsynthesisandidentifythevitaminessentialforthisreaction(tieintoureacycle) 62 3 1 4


83 Defineketogenicandglucogenicaminoacids,andlistthemasexclusivelyketogenic,glucogenic,orboth 64 2 1 3


84 Describethebiosynthesisofthepurineandpyrimidinenucleotideswithemphasisonthekeyregulatedsteps. 54 4 4 8


85 Explainthesalvagepathwaysforuracilandthymineandtheirrelevancetopharmacotherapy(suchasforthetreatmentofcancerorherpesinfections).

57 5 2 6


86 Connectthepentosephosphatepathwayto5’phosphoribosyl-1-pyrophosphate(PRPP)synthesisandexplainthecentralroleofthismetaboliteinnucleotidemetabolism.

66 3 1 0



87 Summarizefolatemetabolismandexplainitsconnectiontonucleotidemetabolism(suchasthesynthesisof

thymidineandIMP)39 5 1 25

88 Describethepathwayoffattyacidsynthesisandinparticulartheroleofacetyl-CoAcarboxylaseandfatty

acidsynthase.53 8 2 7

89 Explaintheconceptsofelongationanddesaturationofthefattyacidchain. 65 3 2 0 90 Describethesynthesisandcatabolismoftriglycerides 48 2 3 17 91 Describethemechanismforactivationandtransportoffattyacidsintomitochondriaforcatabolism. 64 2 2 2 92 Outlinethesequenceofreactionsinvolvedinoxidationoffattyacidsinmitochondria 64 2 3 1

93 Explainthemechanismfortheformationofketonebodiesandidentifythephysiologicalandpathological

rolesofthosemolecules31 3 5 31

94 DescribethestagesofcholesterolsynthesisandinparticulartheroleofHMG-CoAreductase 22 1 2 45 95 ExplaintheregulationofcholesterolclearancefrombloodthroughtheLDLreceptor. 27 0 8 35 96 Summarizetheroleofcholesterolinthesynthesisofbileacids,steroidsandvitaminD 42 1 6 21

97 Compareandcontrastthelifecycleofthevariouslipoproteinparticleswithrespecttotheircomposition,

metabolismandtransport57 2 3 8

98 Distinguishtheeffectsoffeeding,fasting,exerciseandhormonalregulationonbodylipids.Differentiatethe

contributionofdietandendogenoussynthesistolipidlevels.32 1 5 32

99 Detailthemechanismbywhichenergychargeregulateslipidmetabolism. 63 0 1 6 100 Describetheendocrinefunctionofadiposetissue 59 0 4 7 101 Describetheoverallpurposeofthecitricacidcycle(CAC),itscellularlocationandtissuedistribution. 64 0 1 5

102 DescribethereactantsandproductsoftheCAC,asrelatedtothefatesofthebreakdownproductsof

carbohydrates,fattyacidsandaminoacids.60 1 3 6

103 DescribetherolesofCACintermediatesassourcesofreactantsforbiosyntheticpathways. 68 1 0 1

104 ExplaintheeffectofthefollowingparametersontheactivityoftheCACandthemechanismsbywhichthe

effectoccurs:mitochondrialNADH/NADratio,ATP/ADPratio,succinyl-CoAconcentration.67 0 1 2

105 DescribethecentralroleoftheCACinconnectingglycolysis,gluconeogenesis,oxidativephosphorylation,

fattyacidmetabolismandaminoacidmetabolism61 2 3 4

106 Describethepurposeoftheelectrontransportchain(particularlycomplexesI,IIIandIV)andATPsynthase,

theirsubstratesandproducts,cellularlocationandtissuedistribution.42 0 17 11

107 ExplainhowelectrontransportandATPsynthasearefunctionallycoupled. 53 6 7 4 108 ExplainhowtheprocessofoxidativephosphorylationisinfluencedbytheavailabilityofoxygenandNADH. 53 6 7 4 109 ExplainhowthecellularATP:ADPratioregulatestherateofATPproductionbyoxidativephosphorylation. 56 12 1 1

110 Discusshowsuccinatedehydrogenase,mitochondrialglycerol-3-phopshatedehydrogenaseandacyl-CoA

dehydrogenasestransferelectronstoubiquinonefromsuccinate,cytosolicNADHandacyl-CoA,respectively. 63 3 2 2

111

Describetheeffectsofelectrontransportchaininhibitors,ATPsynthaseinhibitorsanduncouplersonoxidativephosphorylationandpredicttheeffectsoftheseagentsonglycolysis,thecitricacidcycleandlactateproduction

56 4 6 4

112 DescribethetypesofReactiveOxygenSpecies(ROS)andhowtheyaregenerated 54 3 6 7 113 Identifythemetabolicproductsofethanolmetabolism,includingacetyl-CoA 46 4 6 14 114 Describethepropertiesofreceptor-ligandinteractions 37 1 14 18

115 Describetheroleofsignaltransductionpathwaysincontrollingnormalcellular,systemicandorganismal

functions. 43 2 11 14

116 Describehowalterationsinsignaltransductionpathwayscanleadtohumandisease 41 0 12 17

117 Compareandcontrasthoweachofthefollowingaffectsglucagonsecretion:glucose,aminoacids,ketone

bodies,epinephrine. 32 3 7 28

118 Describetheeffectofglucagononmetabolicprocessesintheliverandhowthishormonefunctionsto

regulatebloodglucosehomeostasis 28 2 7 33

5 Signalingmechanismshormonesanddiabetes:StudentPharmacistshouldbeabletoexplainhowhormonesleadtochangesinintracellulargeneexpressionandmetabolism.Describethekeysecondmessengersandsomespecificsignalingmechanism(e.g.GProteincoupledreceptors).

119 Signaling 35 0 14 21

6Functionofvitaminsandmineralsinmetabolismanditsimplicationindiet:StudentPharmacistshouldbeabletodescribetheessentialvitaminandmineralsneededforhumanhealth,describetheamountsneededinthedietandbeabletoidentifydifferentdietarysourcesnotingtheirrelativerichness.Describethefunctionofvitaminsandmineralsinenzymaticreaction.

120 Knowthevitaminsthatareprecursorsofthefollowingcofactors:NADandNADP(niacin),FMNandFAD(riboflavin),TPP(thiamin),THF(folate),CoenzymeA(pantothenate),PLP(B6),B12,Biotin.

18 12 1 39

Functionofvitaminsandmineralsinmetabolismanditsimplicationindiet:StudentPharmacistshouldbeabletodescribetheessentialvitaminandmineralsneededforhumanhealth,describetheamountsneededinthedietandbeabletoidentifydifferentdietarysourcesnotingtheirrelativerichness.Describethefunctionofvitaminsandmineralsinenzymaticreaction.

121 Knowthemainmetabolicrolesof,andthemainconsequencesofdeficienciesorexcessiveintakeof,theBvitamins,vitaminC,andvitaminsA,D,EandK 5 9 4 52

Functionofvitaminsandmineralsinmetabolismanditsimplicationindiet:StudentPharmacistshouldbeabletodescribetheessentialvitaminandmineralsneededforhumanhealth,describetheamountsneededinthedietandbeabletoidentifydifferentdietarysourcesnotingtheirrelativerichness.Describethefunctionofvitaminsandmineralsinenzymaticreaction.

122

Defineessentialandlistexamplesofessential,conditionallyandnon-essentialnutrients 39 1 4 26

334



7Structureandfunctionofbiologicalmembranes:StudentPharmacistshoulddescribethestructuralcomponentsofbiologicalmembranesandtheirphysicalproperties.Describehowproteinsareassociatedwithbiologicalmembranesandrelatehowthetypeofproteinassociationrelatestoitsbiologicalfunction.Describetheroleofbiologicalmembranesindrugabsorption,distributionandaction.

123 Listanddescribethephysiologicalrolesofmembranesincluding:compartmentation,electrochemical/membranepotential,transport,anchoring. 38 5 9 18

Structureandfunctionofbiologicalmembranes:StudentPharmacistshoulddescribethestructuralcomponentsofbiologicalmembranesandtheirphysicalproperties.Describehowproteinsareassociatedwithbiologicalmembranesandrelatehowthetypeofproteinassociationrelatestoitsbiologicalfunction.Describetheroleofbiologicalmembranesindrugabsorption,distributionandaction.

124 Listanddescribetherolesofeachofthemajorcomponentsofmembranesandintegrateeachintoaworkingmodelofagenericmembrane,including:phospholipids,sphingolipids,cholesterol,andprotein[forexamplelipidraftsandcaveola].

32 8 7 23


125 Explaintheroleofmembranefluidityanddescribehowitcanbealteredbybiologicalprocesses. 41 8 7 14


126

Listthevariousspecifictypesofmajormembranelipidsanddescribetheroleofmembraneasymmetry. 59 3 6 2

7a.(Transport) 127 Nametwoexampleseachofpassivediffusion,activetransport,andfacilitatedtransportviaachannelor

carrierandbrieflysummarizethedifferencesbetweeneach. 37 2 9 22

(Transport)

128 Compareandcontrastthemajordifferencesbetweenapore/channelandatransmembranecarrierproteinandproposereasonswhymembranesneedboth. 50 0 13 7

(Transport)

129 Describeandevaluatetheroleofiongradients,cotransporters,andATPinactivetransportmechanisms. 40 0 14 168 RecombinantDNA:

StudentPharmacistshouldbeabletodescribetheprocessofmolecularcloningandhowitisusedtoexpressproteinsfortherapeuticuse.Describehowmoleculartechniquesareusedtodiagnosediseaseandhowthisleadstoeffectivetreatment.

130

RecombinantDNA 43 9 4 14

131 Describewhatismeantbypharmacogenomicswithoneormoreexamples. 22 0 18 30High: 68 12 28 52Low: 5 0 0 0

335



Documents

What do pharmacy students need to know about biochemistry?