acem pharmacology
TRANSCRIPT
PHARMACOLOGYPharmacokinetics
Syllabus says:
1.1 Pharmacokinetics
1.1.1 absorption
1.1.2 distribution
1.1.3 biotransformation
1.1.4 elimination kinetics
1.1.5 other
Bryant, Knights and Salerno's Pharmacology for Health Professionals is the new book for 2010 Second sitting which says:
6. Drug absorbtion, distribution, metabolism and excretion
7. Pharmacokinetics and dosage regimens
(Katzung said, back in the day:
1. Introduction
3. Pharmacokinetics and pharmacodynamics: Rational Dosing and the Time Course of Drug Action
4. Drug Biotransformation)
Amit says:
Definitions – VD, clearance, half life, bioavailability, dosing rate, loading dose
What factors affect the volume of distribution
What is zero order and first order kinetics
Give examples of drugs with high/low extraction ratios
Describe biotransformation reactions in the liver, using paracetamol as e.g
List phase 1, and 2 reactions
List drugs that induce Cytochrome P450 pathways
List drugs that inhibit Cytochrome P450 pathways
Describe process of clinical trials
Past Exam Questions:
***NOTE: Each and every exam starts with a Q on PK or PD...
2009-2-1-1 Drug biotransformation
2009-2-3-1 Drug clearance
2009-1-1-1 volume of distribution
2009-1-2-1 Drug half life
2009-1-3-1 Zero-order and first-order kinetics
2008-2-1-1 First pass effect
2008-2-3-1 P450 Enzyme system
2008-1-3-1 Bioavailability
Pharmacodynamics Drug Evaluation
Syllabus says:
1.2 Pharmacodynamics
1.2.1 mechanisms of action
1.2.2 receptors and their regulation
1.2.3 second messengers / G protein
1.2.4 dose response
1.2.5 dosing issues
1.2.6 other
1.3 Drug evaluation
Pharmacology for Health Professionals says:
Amit Says:
Definitions – Receptors, potency, efficacy, agonist, antagonist, spare receptor
Name different types of antagonist, and give examples
Draw – Dose response curves for agonist/antagonist/partial agonist
Describe different types of receptor, and give examples.
Describe mechanism of action of 2nd Messengers with examples
Past exam Qs
***NOTE: Each and every exam starts with a Q on PK or PD...
2009-2-2-1 dose response
2008-2-2-1 Efficacy and potency
2008-1-3-5 Drugs that bind to transporters of biogenic amines
2008-1-2-1 competitive vs. irreversible antagonists
2008-1-1-1 second messengers
2007-1-2-1 Efficacy and potency
Neurotransmitter and Autonomic Pharmacology
Syllabus says:
4.1 Neurotransmitter
4.1.1 mechanism of action
4.1.2 metabolism
4.1.3 other
4.2 Autonomic nervous system
4.2.1 sympathetic
4.2.2 parasympathetic
4.2.3 other
Textbook says:
UNIT III Drugs affecting the peripheral nervous system
10 Overview of the autonomic nervous system
11 Drugs affecting cholinergic transmission
12 Drugs affecting Noradrenergic transmission
Amit Says:
Describe the classification of cholinoreceptors
Describe the actions and give examples of anticholinesterase inhibitors
Describe the pharmacology of anticholinergics – atropine
Can you describe the classification of inotropes
Describe the effects of adrenoceptors and distribution in the body
Exams have the final say...
2009-2-2-5 Amphetamines
2009-1-2-2 Classification of drugs used in acute asthma
2009-1-3-2 Classes of anti-hypertensives
2009-1-1-2 Adrenaline
2008-2-2-4 Salbutamol
Pharmacology of local and general anaesthetics
Syllabus says:
4.3 Local anaesthetics
4.4 General anaesthesia
4.4.1 induction agents
4.4.2 muscle relaxants
4.4.3 volatile anaesthetics
4.4.4 other
Bryant et al say:
UNIT IV Drugs Affecting the Central Nervous System
14 Overview of the central nervous system
15 Anaesthetics
General Anaesthesia
Local Anaesthesis
Amit Says:
Describe pharmacological properties of lignocaine and prilocaine
Describe the pharmacological properties of common agents – NO, Isoflurane
What is the MAC?
Classify muscle relaxants
Pharmacology of suxamethonium vs atracurium.
Exams final discussion:
2009-2-3-3 Succinylcholine/suxamethonium
2009-2-3-5 Topical anaesthetics
2009-2-2-3 Ketamine
2009-2-1-3 Propofol
2009-1-1-2 Adrenaline
Neuro 3
Syllabus says:
4.8 Hypnotics / sedatives
4.8.1 benzodiazepines
4.8.2 barbiturates
4.8.3 other
4.9 Opiates & opiate antagonists
Bryant says:
16 Analgesics
Physiology of pain
pain management
Analgesic drugs and methods
17 Antianxiety, Sedative and Hypnotic Drugs
Physiology of sleep
Sleep disorders
Anxiety
Drug use in specific groups
Benzodiazepines
Other antianxiety and sedative/hynotic agents
Amit Says:
Describe the mechanism of action of benzodiazepine
Describe ionic/receptor basis for inhibition – GABA Chloride channel
Past Exams...
2010-1-3-3 morphine
2007-2-3-2 clonazepam
2007-1-2-3 midazolam
2005-2-3-3 benzodiazepines
2005-2-2-3 opioid analgesics
Neuro 4
Syllabus says:
4.5 Antipsychotic agents
4.5.1 phenothiazines
4.5.2 butyrophenones
4.5.3 atypical
4.5.4 other
4.6 Antidepressives
4.6.1 tricyclics
4.6.2 serotonin re-uptake inhibitors
4.6.3 complex
4.6.4 lithium
4.6.5 other
4.7 Anticonvulsives
4.7.1 phenytoin
4.7.2 carbamezepine
4.7.3 valproate
4.7.4 other
Bryant, Knights et al ...
18 Antiepileptic Drugs
19 Psychotropic Agents
Amit says:
Describe the biogenic amine theory for depression
Describe classification of antidepressants
Describe classification of antipsychotics
What are the adverse effects of the antipsychotics?
What is serotonin syndrome?
What is PK of lithium?
Exams...
2010-1-3-2 Drugs in Status Epilepticus
2009-1-2-3 Chlorpromazine
2009-1-1-3 Carbemazepine
2008-2-3-3 Phenytoin
2008-2-2-3 SSRI
2008-2-1-3 TCAs
ACLS Drugs & Inotropes
Syllabus says:
3. Cardiovascular System
3.1 Emergency drugs (cardiac)
3.1.1 drugs used in cardiac arrest
3.1.2 inotropes
3.1.3 other drugs (including magnesium sulphate)
Bryant, Knights says:
Unit V Drugs affecting the heart and vascular system
23 Overview of the heart and vascular system
24 Drugs affecting cardiac function
25 Drugs affecting vascular smooth muscle
26 Lipid lowering drugs
ARC Guidelines say:
Adrenaline, Amiodarone, Atropine, Calcium,
Lignocaine, Magnesium, Potassium, Sodium Bicarbonate,
Vasopressin,
(aminophylline, fluids, thrombolytics)
ACLS guidebooks add:
procainamide, verapamil, adenosine, dopamine, dobutamine, noradrenaline, nitroglycerin, beta blockers, lasix
Amit says:
List the Vaughn Williams classification for antiarrhythmic drugs
List the drugs in each class
Learn PK of Amiodarone
Learn about mechanisms of additional drugs – digoxin and adenosine
Compare and contrast use of adrenaline/noradrenaline/dopamine
Which situations would you use the above drugs?
Exams say:
2010-1-1-4 Amiodarone
2010-1-2-4 Metoprolol
2010-1-3-4 Atropine
2009-2-1-4 tPA
2009-1-1-2 Adrenaline
2009-1-2-2 Digoxin
2008-2-3-5 flecainide
2008-1-3-2 nitrates
2008-1-1-4 atropine
2008-1-2-2 loop diuretics
(2008-1 Phys: vasopressin)
CVS II: anti-anginals, anti-arrhythmics inc digoxin
Syllabus says:
3.2 Antianginal drugs
3.2.1 nitrates
3.2.2 calcium channel blockers
3.2.3 beta blockers
3.2.4 other
3.3 Antiarrhythmic agents
3.3.1 sodium channel blockers
3.3.2 beta blockers
3.3.3 action potential prolonging drugs (atypical)
3.3.4 calcium channel blockers
3.4 Cardiac glycosides
Bryant, Knights etc... Says:
"you should stop reading me and read the review Katzung"
Amit says:
Describe pharmacological properties of nitrates
Describe pharmacological basis of calcium channel blockade using verapamil as an example
Describe the main features of B-Blockers and list different types, and the types of blockade that they cause
Discuss the side effects and toxicology of B blockade (Propranolol)
List the Vaughn Williams classification for antiarrhythmic drugs
List the drugs in each class
Learn PK of Amiodarone
Learn about mechanisms of additional drugs – digoxin and adenosine
Past Exam pointers:
CVS III: antihypertensives, diuretics
Syllabus says:
3.5 Antihypertensives
3.5.1 beta blockers
3.5.2 ACE inhibitors
3.5.3 vasodilators
3.5.4 sympatholytics
3.5.5 other
3.6 Diuretics
3.6.1 loop diuretics
3.6.2 agents acting on the proximal tubule
3.6.3 other
Bryant et al says:
Unit V Drugs affecting the Heart and Vascular System
Ch 25 Drugs affecting vascular smooth muscle
Management of Hypertension
Unit VI Drugs affecting kidney and Urinary System
Ch 27 Overview of the kidney and urinary tract
Ch 28 Diuretics and Drug Treatment of Urinary Incontinence
Amit says:
Describe pharmacological basis of calcium channel blockade using verapamil as an example
Describe the main features of B-Blockers and list different types, and the types of blockade that they cause
Discuss the side effects and toxicology of B blockade (Propranolol
Describe the pharmacological basis of different types of diuretic
Indicate which part of the nephron different diuretics act on
Describe PK of frusemide, thiazides, carbonic anhydrase inhibitor, as well as K sparing
Toxicology/side effects of diuretics – and uses in hypercalcaemia
VIVA Exams focus:
2009-2-3-4 Calcium Channel Blockers
2009-1-3-2 Classes of Anti-hypertensives
2008-1-2-2 Loop Diuretics
2008-1-1-2 Angiotensin II blockers
2007-1-2-2 beta Blockers
2007-1-2-4 Osmotic diuretics (including mannitol)
2006-2-2-2 Thiazide diuretics
2006-2-1-2 Calcium Channel Blockers
2006-1-2-2 ß blockers
CVS IV: Anticoagulation, Thrombolysis
Syllabus says:
3.7 Drugs used in anticoagulation, thrombolysis, angiography/plasty
3.7.1 streptokinase
3.7.2 tissue plasminogen activator
3.7.3 Abciximab
3.7.4 ticlopidine
3.7.5 aspirin
3.7.6 warfarin & heparin
3.7.7 other
Bryant et al wordily says:
Unit VII Drugs Affecting Blood
Ch 29 Overview of the Haemopoietic system
Ch 30 Drugs Affecting Haemostasis, Thrombosis and Haemopoietic System
Anticoagulants
Thrombolytics
Antiplatelet drugs
Amit says:
What are mechanisms of heparin/warfarin/aspirin/clopidogrel/TPA
What is mechanism of Vit K
Adverse effects of heparin
Adverse effects of warfarin
Interactions of heparin and warfarin
Exams prove:
2009-2-2-4 Warfarin
2009-2-1-4 tPA
2008-1-1-3 Low molecular weight heparins
2007-2-3-3 Aspirin
2007-1-1-4 tPA
2006-2-2-4 Clopidogrel
2006-1-2-4 Warfarin interactions
Respiratory Pharmacology
Syllabus says:
2. Respiratory System
2.1 Methylxanthines
2.2 Sympathomimetics
2.3 Disodium cromoglycolute & others
2.4 Muscarinic antagonists
2.5 Antitussives
2.6 Oxygen
2.7 Steroids in respiratory disease
2.8 Other
Bryant says (but who's listening)
Unit VIII Drugs Affecting the Respiratory System
Ch 31 Overview of the respiratory system
Ch 32 Drugs Used in Respiratory Disorders
Amit Says:
Describe the pharmacology of salbutamol and aminophylline
Describe the pharmacology of ipratropium bromide
Describe the pharmacology of sodium cromoglycate
Describe the pharmacology of corticosteroids
Exams reveal that thes focussed topics don't get 'hit' terribly often, and that the syllabus weighting is not too relevant to the exam.
2009-2-1-2 Classification of drugs in acute asthma
2008-2-2-4 Salbutamol
2008-1-2-5 Methylxanthines
2007-2-1-2 Beta 2 Agonists
2006-2-2-3 Dexamethasone
antimicrobial 1
Syllabus:
5. Antimicrobial Agents
5.1 Principles of action
5.2 Beta lactam agents
5.3 Aminoglyocides
5.4 Sulphonamides
5.5 Quinolones
5.6 Antimycobacterial agents
5.7 Miscellaneous
Bryant, Knights, Salerno
UNIT XIV Drugs affecting Microorganisms
50 Overview of Antimicrobial therapy and antibiotic resistance
51 Antibacterial drugs
Inhibitors of bacterial wall synthesis
Pens, Cephs, Carbapenems, Vancomycin, Aztreonam
Bacterial protein synthesis inhibitors
Macrolides, lincosamides, aminoglycosides, tetracyclines, chloramphenicol, flouroquinolones,
Miscellaneous antibiotics
Metronidazole, spectinomycin, trimethoprim-sulphamethoxazole,
Urinary tract antimicrobials
Hexamines, Nalidixic acid, nitrofurantoin
(52 Antifungal, Antiviral drugs)
(53 antiprotozoal, antimycobacterial, anthelminthic drugs)
Amit: Amit broke Anti-bacterials into two weeks:
Betalactam, Aminoglycosides, Sulphonamides
What is the mechanism of action of these agents?
Classify the cephalosporins into generations.
What is the PK and toxicology of Gentamicin?
What is unique about doxycycline?
What is concentration dependent, and time dependent killing?
What is trimethoprim? What is it’s mechanism of action and PK
Macrolides, Quinolones, Resistance
Describe mechanism of action of macrolides
Erythromycin vs azithromycin
What pathogens do the macrolides target
Describe the pharmacology of norfloxacin
Describe the main mechanisms of bacterial resistance
Past VIVAs:
2010-1-1-2 Antibiotics in urinary sepsis (gentamicin)
2010-1-2-2 Antibiotics in CNS infections (cephalosporins)
2009-1-1-4 Macrolides
2009-1-2-4 Antibiotics for staphylococcus infections
2009-1-3-4 (Acyclovir)
2008-2-1-2 Metronidazole
2008-2-2-2 Cephalosporins
2008-2-3-2 Gentamicin
2008-1-3-4 beta-Lactams
2007-1-1-3 Gentamicin
2007-1-3-4 Chloromycetin
2006-2-1-4 Penicillin
2006-2-3-4 Trimethoprim
Annoying nit-picking:
GENTAMICIN: It is synthesized by Micromonospora, a genus of Gram-positive bacteria widely present in the environment (water and soil). To highlight their specific biological origins, gentamicin and other related antibiotics produced by this genus (verdamicin, mutamicin, sisomicin, netilmicin, retymicin) generally have their spellings ending in ~micin and not in ~mycin.
Aminoglycosides that are derived from bacteria of the Streptomyces genus are named with the suffix -mycin, whereas those that are derived from Micromonospora are named with the suffix -micin.
Streptomycetes produce over two-thirds of the clinically useful antibiotics of natural origin (e.g., neomycin, chloramphenicol).[
Cephalosporin compounds were first isolated from cultures of Cephalosporium acremonium from a sewer in Sardinia in 1948 by Italian scientist Giuseppe Brotzu [2].
antimicrobials 2 - antifungal, antiparasitic,
Syllabus says:
5. Antimicrobial Agents
5.1 Principles of action
5.2 Beta lactam agents
5.3 Aminoglyocides
5.4 Sulphonamides
5.5 Quinolones
5.6 Antimycobacterial agents
5.7 Miscellaneous
5.8 Antifungal
5.9 Antiviral, including HIV prophylaxis
5.10 Disinfectants
5.11 Mechanism of resistance
5.12 Anti-protazoal, anti-parasitic, anti-helminithic
5.13 Macrolide agents
5.14 Other
Amits 2 cents...
Describe the treatment of TB
Describe PD and PK of acyclovir
What conditions can acyclovir treat?
What is chlorhexidine and how does it work?
Bryant et al
52. Antifungal and Antiviral Drugs
Antifungals - Azoles, Caspofungin, Flucytosine, Griseofulvin, Nystatin
Antivirals - non-retroviral (famciclovir, ganciclovir, valganciclovir, valaciclovir, oseltamavir, zanamavir, miscellaneous...)
- anti-retroviral - NRTIs (abacavir, didanosine, emtricitabine, lamivudine, stavudine, )
- NNRTIs (delavidine, efavirenz, nevirapine)
- Protease inhibitors (Nelfinavir, ritonavir, saquinavir)
- Others (enfuviritide, tenofovir)
53 Antiprotozoal, antimycobacterial, anthelmintic Drugs
Malaria (Mefloquine, Primaquine, Quinine, Artemether with lumefantine, Atovaquone wiht proguanil, Pyrimethamine wiht sulfadoxine)
Tuberculosis (Capreomycin, Cycloserine, Isoniazid, Rifampicin, Ethambutol, Pyrazinamide, Rifabutin, Streptomycin)
Amoebiasis, Toxoplasmosis, Trichonomiasis, Leprosy
Helminthiasis (Albendazole, Mebendazole, Praziquantel, Pyrantel)
56. Drugs affecting the Skin
Topical Antimicrobial Agents (Antiseptics, Neomycin, Bacitracin, Mupirocin, Acyclovir, Antifungals, antiparasitics)
Appendix 2. Antiseptics and Disinfectants
Exams...
2009-1-3-4 Acyclovir
2007-1-3-5 Antisepsis: chlorhexidine
2005-2-2-4 Mechanisms of antibiotic resistance
genitourinary
Syllabus says:
13. Genito-urinary Agents
13.1 Agents acting on vagina and uterus
13.2 Agents acting on bladder
Amit felt the yield was too low on this one...
Bryant et al...
Unit XII Drugs affecting the Reproductive Systems
Overview of the female and male reproductive systems
Drugs affecting the female reproductive system
Female sex hormones
Oral contraceptives
Menopause and HRT
Treatment of gynaecological disorders
UNIT VI Drugs affecting the Kidney and Urinary system
Overview of the Kidney and Urinary Tract
Diuretics and Drug Treatment of Urinary Incontinence
Past exams...
Amit may have a point here...
*analgesics + anti-inflammatories
*autacoidsEndocrine Pharmacology
Syllabus says:
7. Endocrine System
7.1 Drugs used in treatment of diabetics
7.2 Steroids
7.3 Oestrogen & progesterone
7.4 Drugs used in treatment of thyroid disease
7.5 Hypothalamic/pituitary hormone agents
7.6 Drugs affecting bone metabolism
7.7 Other
Bryant et al:
Unit XI Drugs affecting the endocrine system
37 Overview of the Endocrine System
38 Pharmacology of the pituitary gland and hypothalamic-pituitary axis
39 The thyroid gland and anti-thyroid drugs
40 Pharmacology of the adrenal cortex
41 The endocrine pancreas and the management of diabetes mellitus
42 Th parathyroid glands and calcium balance
Amit's contribution:
Can you outline the current rationale for migraine treatment?
How do antihistamines work?
Describe the pharmacology of insulin and glucagon
Describe the adverse effects of Carbimazole
Past Exams:
2009-2-1-2 Classification of drugs used in diabetes
2008-2-2-5 Thioamides
2008-2-1-4 Sulfonylureas
2008-1-1-5 (Octreotide)
2006-2-2-3 Dexamethasone
2005-2-1-5 Glucagon
Gatrointestinal Pharmacology
Syllabus says:
8. Gastro-Intestinal Tract
8.1 Antiemetics
8.2 Antidiarrhoeal
8.3 Laxatives
8.4 Anti-ulcer medication
8.5 Antispasmodics
8.6 Topical rectal agents
8.7 Other
Bryant says:
UNIT IX Drugs affecting the Gastrointestinal System
33 Overview of teh Gastrointestinal Tract
34 Drugs affecting the Gastrointestinal Tract
Drugs affecting the mouth
Drugs affecting the stomach
Drugs for nausea and vomiting
Drugs used to treat peptic ulcer disease
Pancreatic enzyme supplements
Drugs that affect the biliary system
Drugs that effect the lower GI tract
Amit's 2 cents:
Describe the pharm of PPI, and antiemetics
Past exams:
2009-1-3-3 Ondansetron
2009-1-2-3 Chlorpromazine
2008-2-3-4 Metoclopramide
2008-2-1-5 Laxatives
2008-1-1-5 Octreotide
Toxicology
Syllabus says:
10. Toxicology
10.1 Gastric decontaminants
10.1.1 emetics
10.1.2 adsorbants
10.2 Overdose
10.3 Adverse drug reaction
10.4 Withdrawal symptoms
10.5 Drug interaction
10.6 Drugs of abuse
10.7 Specific poisons
10.7.1 paracetamol
10.7.2 organophosphates
10.7.3 carbon monoxide
10.7.4 cyanide
Bryant says:
NOTHING! Better read some other book!
Amit says:
Paracetamol
Opiate
Benzodiazepine
TCA
Anti depressants
Use of charcoal
Past exams: (keeping in mind that many questions have a "toxic level" sub-question)
2010-1-2-3 Paracetamol toxicity
2009-2-2-5 amphetamines
2009-2-1-5 Activated charcoal
2008-2-1-3 TCAs
2008-1-3-5 Drugs that bind to transporters of biogenic amines
2007-2-3-5 dantrolene
2006-1-1-3 Salicylate toxicity
Drugs in special populations
Syllabus says:
11. Drugs & the Extremes of Age & Pregnancy
11.1 Drugs and the elderly
11.2 Drugs and children
11.3 Drugs and pregnancy / breast feeding
Bryant says:
8 Individual and lifespan aspects of drug therapy
Pregnancy
Lactation
children
elderly
Amit, too:
Pharmacological considerations of the elderly
Which drugs should be used in caution in the elderly?
How does metabolism in the liver change in the elderly
Give examples of drugs that are not safe in pregnancy
Past exams:
2010-1-3-5 Therapeutic drug monitoring
2009-2-3-5 Prescribing in children
2009-2-2-5 Prescribing in pregnancy
2009-2-1-5 Prescribing in the elderly
2006-2-3-5 Pharmacokinetic in the elderly
Past Topics
3.beta Lactams
4.Antiemetics
5.Drugs that bind to transporters of biogenic
amines - pp 552
SEPTEMBER 2008
Group 1
1.First pass effect
2.Metronidazole
3.Tricyclic Antidepressants
4.Sulfonylureas
5.Laxatives
Group 2
1.Efficacy and Potency
2.Cephalosporins
3.SSRIs
4.Salbutamol
5.Thioamides
Group 3
1.P450 Enzyme System
2.Gentamicin
3.Phenytoin
4.Metaclopramide
5.Flecainide
APRIL 2009
Group 1
1.Volume of Distribution
2.Adrenaline
3.Carbamazepine
4.Macrolides
5.Prescribing in the Elderly
Group 2
1.Drug Half Life
2.Digoxin
3.Chlorpromazine
4.Antibiotics for Staphylococcus infections
5.Prescribing in Pregnancy
Group 3
1.Zero Order and First Order Kinetics
2.Classes of Anti-hypertensives
3.Ondansetron
4.Acyclovir
5.Prescribing in Children
SEPTEMBER 2009
Group 1
1.Drug biotransformation
2.Classification of drugs in acute asthma
3.Propofol
4.tPA
5.Activated charcoal
Group 2
1.Dose response
2.Classification of drugs used in diabetes
mellitus
3.Ketamine
4.Warfarin
5.Amphetamines
Group 3
1.Drug clearance
2.Side effects of NSAID
3.Succinylcholine / Suxamethonium
4.Calcium channel blockers
5.Topical anaesthetics