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Curriculum

 Major objectives in Pharmacology course

1- Adequate knowledge and competence in pharmacology form the basis for rational drug therapy in medical practice

2-The student by the end of the course should be able to

3- Understand the mechanism of drug action at molecular as well as cellular level, both desirable and adverse.

4-Understand the principles of pharmacokinetics i.e. drug absorption, distribution, metabolism and excretion and  be able to apply these principles in therapeutic practice.

5- Recognize that drugs have action at all systems and should be able to group drugs with common pharmacological actions, and appreciate that this classification is not absolute.

6- Be able to know one or two prototype drug(s) of each pharmacological group especially those of clinical importance.

7- Acquire a comprehensive description of the major group of drugs as applied to medical practice and be sufficiently prepared to gather information on new drugs.

8- Know the common serious side effects and contraindications of each prototype drug, different mechanisms of drug toxicity, interactions and factors modifying drug action.

9- Know the general principles of acute drug poisoning and other drug related problems as addiction and abuse.

Syllabus Pharmacology for third year medical students

.Introduction

Definitions of a drug (sources of drugs, an ideal drug, main/side/toxic effects of a drug, drug action and drug effect, counterfeit drugs, essential drugs), pharmacology (pharmacopdynamics, pharmacokinetics), toxicology, pharmacy, clinical pharmacology, therapeutics, pharmacogenetics

Textbooks in pharmacology, methods of assessments and examinations, code of conduct in pharmacology

Evaluation of new drugs

Discovery of new drugs, pre-clinical evaluation (in vitro and in vivo testing), acute, subacute and chronic toxicity tests, LD50, therapeutic index, teratogenecity, mutagenecity and carcinogenicity. Clinical trials: aim, phases, designs, inclusion/exclusion criteria, use of placebo, sources of bias in clinical trials and measures used to eliminate them

Pharmacokinetics

Definition. Drug passage across cell membrane; passive diffusion, active transport, facilitated diffusion, filtration. Order of the pharmacokinetic process. Plasma elimination half life. Steady state concentration, biological half life. Absorption: sites, enterohepatic circulation, bioavailability, factors affecting systemic availability, pre-systemic (first-pass) elimination,effect of food on drug kinetics,. Distribution:volume of distribution, protein binding. Metabolism: results of metabolism of drugs, sites of metabolism, phases of metabolism, enzyme induction, enzyme inhibition. Elimination: excretion; renal, pulmonary, milk, fecal

 .Pharmacogenetics

Variation in human response to drugs: pharmacokinetic and pharmacodynamic variations. Genetic polymorphism; acetylator status. G6PD deficiency and response to drugs. Genetic factors that alter drug response

. Mechanism of drug action

Different mechanisms of drug action. Receptors: Drug binding to receptors, second messenger, receptor regulation. Dose-response relationship: agonist, antagonist, affinity, potency, efficacy, factors modifying drug response

Drug interactions

Definitions. Types of interaction: harmful and useful. Pharmacological basis of drug interaction: pharmacokinetic interactions; pharmacodynamic interactions;  antagonism, synergism. Interaction of drugs with food. Drug interactions outside the body, at site of absorption, during distribution, on or body systems, during metabolism, during excretiuon.

  Drugs acting on parasympathetic system

Brief anatomical description of autonomic nervous system. Sites of acetyl choline action as a neurotransmitter. Synthesis and enzymatic degradation of acetyl choline. Classification of  cholinergic receptors, their location and the pharmacological actions induced by their stimulation. Cholinomimetic drugs. Cholinestterase inhibitors. Antimuscarinic drugs. Atropine as a prototype drug. HExamples of adrenergic neuron blocking drugs and centrally acting α2- agonists

.Antihypertensive drugs

Definition of hypertension, factors regulating blood pressure. Classification of antihypertensive drugs. Diuretics, centrally acting drugs, vasodilators, calcium channels blockers and angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, rennin inhibitors and Beta-blockers. Non-pharmacological treatment of hypertension

Antiarrhythmic dugs

Pathophysiology of cardiac arrhythmias. Types of arrhythmias. Classification of antiarrhythmic drugs. Pharmacology of lignocaine, procainamide, quinidine, disopyramide, amiodarone, adenosine, β-blockers and calcium channel blockers

Drugs used in heart failure

Pathophysiology of heart failure. Cardiac glycosides. Pharmacology of digoxin as a prototype drug. Other cardiac glycosides. Vasodilators, and ACE inhibitors in heart failure. Positive inotropic drugs as amrinone and milrinone. Drug treatment of acute left ventricular failure

.Antianginal drugs   

  Definition of angina. Nitrates and nitrites: pharmacological features of GTN, mechanism of action, route of drug administration, side effects and tolerance. Other drugs useful in treatment of angina as calcium channel blockers and beta blockers, role of monoclonal antibodies, role of anti-platelets in angina

.Autacoids  

Definition of autacoids. Histamine and antihistamines. H1 and H2blockers. Their uses and side effects. Sodium cromoglycate, ketotifen and pizotifen as inhibitors of histamine release. Non-sedating antihistamines as terfenadine, loratadine, cetrizine and fexofenadine. Serotonin (5HT) and its antagonists such as ondansetron and its use as antiemetic in chemotherapy induced vomiting. Prostaglandins, synthesis and pharmacological actions and clinical uses. Drugs that act via prostaglandin inhibition.

 Analgesics: Narcotics and Non-narcotics

Narcotics: endogenous enkephalins and endorphins. Opiates receptors. Mechanism of action of narcotic analgesics. Morphine as a prototype drug. Other narcotic analgesics as pethidine, codeine, methadone, tramadole  and propoxyphene. Opiate antagonists: Naloxone and nalorphine

Non- narcotic analgesics ( Non steroidal anti-inflammatory drugs; NSAIDs: classifications, COX1-inhibitors such as  salicylates, ibuprofen, indometacin, COX2-inhibitors such as celecoxib. Differences between COX1 and COX2 in terms of their side effects. Other uses of NSAIDs with mechanism of action such as aspirin as anti-thrombotic.   Paracetamol (Acetaminophen): paracetamol overdose, specific antidotes

 Drugs used in rheumatoid arthritis and gout  

Aims of treatment of rheumatoid arthritis, NSAIDs and disease modifying drugs, role of corticosteroids in rheumatoid arthritis. Role of anti TNF-α agents

Pathophysiology of gout, precipitating factors, drugs for acute attack, role of colchicines in gout, drugs for chronic gout like probenecid and allopurinol

. Drugs used in migraine

Definition, phases of migraine attack, patophysiology, management; triggering factors, acute attack (specific and non-specificdrugs; antiemetics, triptans, ergotamine,…). Prophylactic therapy

  Drugs in hyperlipidemia

Pathways of lipid transport, types of hyperlipidemia, management of hyperlipidemia. Drugs like statins, fibric acid derivatives, anion exchange resins like cholestyramine, nicotinic acid and its derivatives, ezetimibe  and other drugs

   Antibacterial agents

Definition and introduction to antimicrobial therapy. Mechanism of action and resistance to antimicrobial agents. Sulfonamides and urinary tract antiseptics. Penicillins, cephalosporins (first to fourth generations), imipenem, vancomycin aminoglycosides, macrolides as erythromycin, clindamycin, tetracyclines, fusidic acid, chloramphenicol and quinolones

 .Antituberculous drugs  

                                                    Classification, first and second line drugs. Rifampicin, isoniazid, ethambutol, pyrazinamide, streptomycin, cycloserine, thiacetazon, para-aminosalicylic acid

 .Antifungal drugs

Drugs for systemic and superficial mycoses. Classification of antifungal drugs. Amphotericin, griseofulvin, nystatin, flucytosine, terbenafine and clotrimazole

 Antiviral drugs

Why it is difficult to treat viral infections? Classification of antiviral drugs according to mechanism and site of action . Aciclovir,  antiretroviral agents as zidovudine, lamivudine and stavudine. Protease inhibitors as indinavir, ritinovir. Antiinfluenza agents asd am,antadine, rimatadine and osdeltamivir. Drugs in viral hepatitis.

Antimalarial drugs

                                  Chloroquine (possible mechanism of action), quinine, primaquine, sulfonamides and combination antimalarial drugs.  Anti-malarial drugs and G6PD. New antimalarial drugs

 Antiprotozoal drugs

Luminal amoebicides: diloxanide furoate, paromomycin. Tissue amoebicides: metronidazole, chloroquine. Role of antibiotic in amoebiasis. Drugs for toxoplasmosis. Drugs for leishmaniasis

.Anthelminthic drugs

 Piperazine, pyrivinium pamoate, bephenium hydroxynaphthoate, mebendazole, albendazole, thiabendazole and levamisole. Antischistosomiasis: Drugs for cestodes like niclosamide. Drugs for trematodes like praziquantil and metrifonate. Drugs for nematodes: mebendazole, albendazole, piperazine, levamisiole and pyrantel pamoate

 Drugs acting in gastrointestinal tract 

1. Antacids

2. Antiulcer drugs include: H2-blockers, proton pump inhibitors, sucralfate, bismuth chelate , prostaglandins   analogues as  misoprostol.

    Antibiotics in the eradiction of H.pylori.

3. laxatives and purgatives

4. Antidiarrhoeal drugs

5. Antiemetic drugs as metoclopramide and domperidone

6. Drugs useful in ulcerative colitis

7. Drugs for dissolution of gall stones

 Drugs acting on the central nervous system

*Hypnotics and anxiolytics

Definitions. Benzodiazpines as diazepam, chlordiazepoxide, lorazepam and nitrazepam. Benzodiazepines antagonists as flumazenil. Meprobamate, chlormethiazole and chloralhydrate. Abuse potential of these drugs. Other drugs as beta-blockers and antihistamines in anxiety

*Antidepressants Tricyclic antidepressants; imipramine, amitriptyline, clomipramine, mechanism of action, clinical uses and adverse effects.Selective serotonine reuptake inhibitors as fluoxetine and paroxetine. Other antidepressants; maprotiline, nomifenesine and mianserine. Monoamine oxidase inhibitors. Lithium, clinical uses and adverse effects

*Antipsychotics

Brief definition of psychosis. Classification of antipsychotic drugs. Pharmacology of chlorpromazine as a prototype drug of phenothiazines.

Atypical antipsychotics as clozapine and olanzapine

*Antiepileptic drugs

Types of epilepsy, pharmacology of antiepileptic drugs, mechanism of action, drugs used in different types of epilepsy and status epilepticus: phenytoin, carbamazepine, sodium valproate, barbiturates, clonazepam, vigabatrin, lamotrigine, gabapentin, ethosuximide and others

 General anesthetics

Pre-anesthetic medications. Inhalational anesthetic agents; pharmacology and clinical application and important differences between them. Intravenous anesthetic agents ( thiopentone, propofol, ketamine , etomidate,…); their pharmacology and their cardiovascular, respiratory and adverse effects. Anesthesia for short procedures. Postoperative medications

*Local anesthetics

Types of local anesthetics,. Mechanism of action of LA. Lidocaine as a prototype  drug . Methods of prolongation of duration of action of LA. Methods of administration of LA. Other drugs as bupivacaine and  mepivacaine

 Muscle relaxants

Neuromuscular transmission, classification of muscle relaxants; depolarizing and non-depolarizing agents. Peripherally and centrally acting muscle relaxants. Dantroline, baclofen and benzodiazepines

 Antiparkinson’s drugs

Definition of Parkinson disease and pathophysiology. Cholinergic and dopaminergic mechanisms in Parkinson disease. Classification of drugs useful in Parkinson disease; their clinical uses and side effects: L-dopa, decarboxylase inhibitors, dopamine agonists as ropirinol, cabergoline bromocriptine. MAOI as type B (selegiline)

Dugs acting on uterine muscles  

           Oxytocin and ergometrine, prostaglandins pharmacology and mode of action, clinical uses. Uterine relaxants;:sulbutamol, nifedipine

 .Vasopressin and vasopressin analogues

Mechanism of action, clinical uses

.Drugs acting on respiratory tract

Pathophysiology of bronchial asthma. Bronchodilators; β2 stimulants, xanthine derivatives. Mast cell stabilizers: sodium cromoglycate and ketotifen. Leukotreine  antagonists: montelukast, zafirlukast.  Mechanism of cough and cough suppressants. Mucolytics and expectorants

Drugs acting on endocrine system 

*Diabetes mellitu

Drugs for type I and type II diabetes mellitus. Insulin: routes of  administration,actions, types of insulin, preparations, conditions in which insulin substitutes oral antidiabetic drugs, side effects ofinsulin. Oral antidiabetic drugs: classification; sulphonylureas, biguanides, meglitinides, thiazolidindiones, α-glucosidase inhibitors. Their mechanism of action, uses and side effects. New antidiabetic drugs like sitagliptin and excenatide

 Corticosteroids

Pharmacological actions of steroids, different preparations. Clinical uses, adverse effects of chronic steroid administration. Differences between glucocorticoids and mineralocorticoides. Differences between physiological and pharmacological doses of corticosteroides

*Sex hormones and contraceptive pills

Androgens; pharmacological actions and clinical uses. Abuse of androgens. Oestrogens; synthetic and natural. Pharmacological actions and clinical uses. Oral contraceptive pills  types, pharmacological actions and clinical uses. Adverse effects and contraindications of the oral contraceptive pills

 *Anti-thyroid drugs

  Thyroid hormones; biosynthesis and pharmacological actions. Aim of treatment of hyperthyroidism. Pharmacology of carbimazole and propylthiouracil. The use of radio-active iodine. Role of β-blockers in hyperthyroidism

.Drugs acting on the kidneys  

Renal handling of water and electrolytes. Diuretics; classification, mode and site of action, clinical uses and side effects. Drugs changing urinary PH and their clinical uses. Urinary tract antiseptics

.Drugs acting on blood 

*Anticoagulant drugs

Blood coagulation process. Oral anticoagulants likewarfarin. Parenteral anticoagulants like heparin, UFH, lepirudins. Mechanism of action, pharmacokinetics, clinical uses and adverse effects. Drug interactions, contraindications and antidotes. Advantages of the use of LMWH on UFH.  Platelets aggregation inhibitors, clopidogrel.  Fibrinolytic agents. Drugs to control bleeding: Vitamin K preparation, tranexamic acid and aminocaproaic acid

*Antianemic drugs

Mechanisms regulating iron in the body. Indications for parenteral iron. Treatment of iron overdose. Type of anemia resulting from vitamin B12 and folic acid deficiency and their treatment. Drugs interfering with folic acid. Erytropoietin

.Cancer chemotherapeutic agents  

Classification of cytotoxic drugs. Mechanism of action in general.  Clinical uses and adverse effects of cytotoxic drugs

 .Immunopharmacology 

Indications for immunosupressants, ciclosporin, tacrolimus, mycophenolate mofetil, Corticosteroids, cytotoxic drugs as  azathioprine,cyclophosphamide. Monoclonal antibodies as basiliximab and antilymphocytic immunoglobulins

.Alcohol and alcoholism

Metabolism and pharmacological action of ethanol. Acute and chronic actions of ethanol. Interactions with other drugs. Brief account on methanol poisoning

.Smoking

Acute effects of nicotine. Chronic effects of nicotine

.Vitamins and minerals

Water soluble vitamins; B-complex. Fat soluble vitamins; Vit. D and Vit. K. Calcium and iron

 .Skin pharmacology

Factors affecting drug absorption through the skin. Topical steroids and their adverse effects, miscellaneous topical substances, drugs used in treatment of psoriasis and acne vulgaris, antiseptic agents

.General management of poisoning

Heavy metal poisoning. Thallium poisoning. the use of chelating agents, activated charcoal, Berlin Blue (Prussian Blue for thallium poisoning)

  Genetic engineering in pharmacology

The use of genetic engineering technology in the preparation of some drugs, such as insulin, growth hormone, oxytocin, interferons