Objectives. The geriatrics concentration elective sequence in the entry-level doctor of pharmacy program at the Mylan School of Pharmacy at Duquesne University was devised, first, to introduce students to the complex pharmaceutical care needs of the elderly; second, to expose students to career options and enhance employability through credentialing in geriatrics; and third, to increase the confidence and motivation for graduates to pursue advanced geriatrics education, training, and specialist certification. Design. The curriculum consists of a didactic elective sequence of 3 courses (8 total credits) offered in the evenings of the fifth and sixth academic years. Sixth year students must complete at least one specialized experiential rotation and pass a final comprehensive geriatrics certification examination. Assessment. Preliminary data from university teaching and clinical teaching effectiveness questionnaires in didactic and experiential courses, respectively, are presented. Available data are limited by voluntary student participation in instructor evaluation and by the short amount of time since program inception. Methods tentatively planned for assessing program outcomes are included. Conclusion. The geriatrics concentration has been positively received in the first 2 years since its inception, as suggested by sustained enrollment figures and preliminary teaching effectiveness evaluation data.

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Myasthenia gravis (MG) is a complex autoimmune neurologic disorder of unknown etiology, characterized by fluctuating skeletal muscle weakness most commonly involving the muscles of the head, neck, and upper extremities. Autoantibodies directed against acetylcholine receptors on the postjunctional membrane decrease the numbers of functional acetylcholine receptors and cause membrane alterations, resulting in neuromuscular transmission failure. Diagnosis is established by history and physical examination, the "Tensilon Test," and acetylcholine receptor antibody titers. Treatment modalities include drug therapy, thymectomy, and plasmapheresis. The drugs most commonly employed are anticholinesterases, corticosteroids, and immuno-suppressive agents. Cyclosporine and intravenous immunoglobulin are promising investigational treatments. The purpose of the article is to review current concepts in the pathophysiology, immunopathology, diagnosis, and treatment of MG. Special emphasis is placed on the autoimmune form of the disease and the drugs employed in its management. Standard regimens as well as some experimental treatment modalities are reviewed.

VALPROIC ACID (VA) is a carboxylic acid derivative whose unique structure and pharmacologic activity have contributed to its popularity in the treatment of epilepsy. Although phenobarbital (PB) and phenytoin are still the mainstays of anticonvulsant therapy, refractory seizure disorders sometimes necessitate their combined use with VA. Combination therapy with VA frequently may result in improved seizure control; however, it also may result in valproate-mediated variations in the pharmacokinetics of both phenytoin and PB. The variations are such that they subsequently may result in toxicity from either of these two drugs. The purpose of this article is threefold: to review the proposed mechanism for the effect of VA on PB and phenytoin kinetics, to discuss the clinical significance of the interactions, and to identify patient management steps. Valproic Acid-Phenobarbital InteractionIn a randomized, crossover study of six normal subjects, mean PB elimination half-life was prolonged from 96 to 142 hours (p s 0.006) when VA steady-state plasma concentrations of 20-30 #Lg/ml (500 mg/d) were achieved. Mean PB plasma clearance was reduced from 4.2 to 3.0 mllh/kg (p s 0.009) and the calculated PB metabolic clearance was decreased from 3.3 to 2.0 mllh/kg (p s 0.005). Renal clearance of PB, urine pH, and PB volume of distribution did not change

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