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