Objectives. To integrate an Internet-based medical chart (IMC) system into a pharmacotherapy course to facilitate evaluation and feedback processes, foster development of written documentation skills, and prepare pharmacy students for future changes in electronic medical documentation systems.Design. An IMC system was introduced into a pharmacotherapy course for third-professional year pharmacy students and 4 ''finish the SOAP note'' activities were added to the curriculum. Students' performance on the SOAP notes were assessed by a team of evaluators. At the end of the semester, students and evaluators completed separate 6-item survey instruments concerning the usefulness of the IMC system in meeting the course objectives. Assessment. Students' performance on documentation activities improved over the course of the semester: 87% of the students avoided repeating previous mistakes by their final documentation activity. The vast majority of the students and evaluators found the system easy to use and the activities helpful. Conclusion. The development, implementation, and initial expansion of the IMC system across both laboratory and pharmacotherapy courses was a success. Continued integration into clinical coursework is planned and will further expand opportunities for applied learning experiences to prepare students for their experiential program and beyond.

A method to determine heparin kinetics and dosage requirements was examined in 20 patients with active thromboembolic disease. Pretreatment heparin sensitivities were determined to establish the relationship between heparin concentration and activated partial thromboplastin times (APTTs). After an initial bolus dose, serial APTTs were measured, heparin concentrations were estimated, and kinetic determinations followed. Heparin elimination rate, distribution volume, and clearance were used to calculate dosage requirements. There was a 500% range in pretreatment heparin sensitivities. Smokers had more rapid heparin elimination rates and t 1/2s than nonsmokers did. Men had more rapid drug clearances than women did. Body weight was related to heparin dosage requirements. Patients treated early after onset of symptoms required higher doses than patients in whom treatment was delayed. A multiple regression model was developed for heparin dosage requirements from body weight, sex, delay between onset of symptoms and treatment, and smoking. This statistical model explained 78% of the variance in heparin requirements.

Cefazolin kinetics was studied in 8 patients the day before (PREOP), during (SURG), and the day after (POSTOP) cardiopulmonary bypass (CPB) surgery. PREOP (48.6 ml/min) and POSTOP (46.6 ml/min) total body clearances were of the same order and both were greater than the SURG (27.4 ml/min) total body clearance. Since cefazolin is almost entirely eliminated by the kidney, the lower SURG clearance is a result of reduced renal elimination, as confirmed by measuring cefazolin SURG (28.7 ml/min) and POSTOP (52.9 ml/min) renal clearance. The reduction in cefazolin renal elimination was the same throughout the surgical procedure, including the period of extracorporeal circulation. Cefazolin distribution was altered by the operative procedure as evidence by a higher SURG steady-state volume of distribution. This increase in apparent cefazolin distribution volume brought about by surgery was not seen with cephalothin, which was investigated by us in a similar group of patients. The different effect of CPB surgery on cefazolin and cephalothin distribution may be due to differences in plasma protein binding.