Total marks – 300
Formative assessment marks=10
• Written = 90
– [MCQ=20 (Multiple True False-10 + SBA-10),
– SAQ+SEQ = 70
– Making a total of 100 marks
• Structured Oral Examination (SOE) = 100
• Practical: 100 OSPE =40 (08 procedure stations, each having 05 marks]
Traditional =60 (Prescription writing 10, Drug interaction 05 x 02 =10,
Tracing and plotting = 10, Integrated teaching and Case report = (5+15) = 20,
Practical notebook =10)
Term I
Core Contents
A. GENERAL PRINCIPLES OF PHARMACOLOGY
Lectures:
01: Introduction to Pharmacology
02: Drug Compendia (Information sources)
Pharmacopoeia, Formulary, Treatment guidelines (BP, INN, BNF and BDNF)
03. Drug Administration
Routes, drug delivery, and formulations for local & systemic effects
04: Drug Absorption
Transfer of drugs across cell membrane & specialized barriers, Factors influencing absorption
05: Bio-availability
Studies to compare bio-equivalence & to monitor therapy
06: Drug Distribution
Vd, Plasma protein & tissue binding, redistribution
07: Drug Metabolism
Where, why, and how of bio-transformation, hepatic microsomal enzymes- induction & inhibition Genetic influence on Drug metabolism (Pharmacogenetics)
08: Drug Elimination
Routes, Renal Excretion & factors influencing renal excretion
09: Clinical Pharmacokinetics
Vd, Cl, First & Zero order kinetics of Elimination, t½, Steady state concentration, loading dose & maintenance dose
10: Pharmaco-Dynamics:
Specific and non-specific mechanisms Receptors involved Second messenger system Enzyme mediated drug action
11: Quantitative aspects of drug action Dose-response relationships & curves Therapeutic Index and window-importance Information obtained from D-R curves Agonists – efficacy, potency, shift of curves Antagonists – efficacy, potency, shift of curves
12: Individual variations in drug responses
13. Drug Interaction at different levels
14: Drug Safety and Pharmacovigilance
Adverse drug reactions: Types, detecting & managing ADR ADR monitoring & reporting
Core Contents
A. AUTONOMIC PHARMACOLOGY
Lectures
01: Introduction
Organization of ANS – sympathetic, parasympathetic, and enteric NS. Transmitters in ANS (ACh, NA, NANCs) Co-transmission, pre and postsynaptic modulation Cholinergic neurotransmission & drugs modifying the events, Cholinergic receptors
02: Cholinergic Drugs
Effects of the stimulation of Cholinoceptors Classification of cholinergic drugs – cholinoceptor agonists and anti-cholinesterase
03: Drugs for Glaucoma
Role of Cholinergic drugs compared to other drugs
04: OPC insecticide poisoning
Manifestation & management
05: Anti-cholinergic Anti-muscarinic
Atropine and atropine substitutes
06: Anti-cholinergic anti-nicotinic
Classification – Neuromuscular blockers & their role as skeletal muscle relaxant during anesthesia Ganglion blocker (names only) (No-6 red part to be deleted)
07: Adrenergic neurotransmission
Drugs modifying the events Adrenergic receptors Effects of stimulation of adrenoceptors
08: Adrenergic Drugs
Classification Adrenergic inotropic agents & their role in therapy Role of Adrenaline, Noradrenaline, Isoprenaline, Dopamine & Dobutamine in therapy Adrenergic vasoconstrictors, nasal decongestants
09: Selective β2 agonists as Bronchodilators, Other bronchodilators
used in bronchial asthma
10: α–adrenoceptor antagonist
Role of selective α1 antagonist in therapy
11: β- adrenoceptor antagonist
Role of β blockers in therapy
Core Contents
Renal & Cardiovascular Pharmacology Lectures:
01: Diuretics
Classification of diuretics: based on sites & mechanism of action and efficacy Pharmacology of Thiazides, Loop, Potassium-sparing diuretics: their role in therapy edema and hypertension
02: Drugs used in hypertension
Epidemiology and pathophysiology of hypertension, Objectives of anti-hypertensive therapy, Classification of anti-hypertensive drugs. Pharmacology of Diuretics, blockers, Ca channel blockers, ACE inhibitors, Angiotensin receptor antagonists, blockers, methyl dopa, Vasodilators Principles of selection of drug in different clinical situations
03: Drugs used in congestive cardiac failure
Pathophysiology of heart failure Objectives of therapy Drugs used in CCF: Diuretics, ACE inhibitors & ARBs, Selective -blockers, (Additional) Cardiac glycosides, vasodilators, and Phosphodiesterase inhibitors.
04: Antianginal drugs
Pathophysiology of angina, Objectives of therapy Drugs used in angina: Nitrates, β- blockers, Ca2+ channel blockers.
05. Antiarrhythmic Drugs
Pathophysiology of arrhythmia Pharmacology of antiarrhythmic drugs
Core Contents
HEMATOPOIETIC PHARMACOLOGY
Lectures:
01: Anticoagulants & Thrombolytics
Pathophysiology of thrombo-embolism Pharmacology of Anti-coagulants: Heparin and LMW heparin, warfarin. Pharmacology of thrombolytics: Streptokinase, Alteplase, Rerelease, etc.
02: Antiplatelet drugs
Pharmacology of low dose aspirin, clopidogrel, glycoprotein IIb/IIIa inhibitors and their role in therapy
03: Lipid-regulating drugs
Pharmacology of statins. fibrates, nicotinic acid, resins etc.
04: Drugs for anemia
Pathophysiology of anemia Pharmacology of hemopoietic iron, folic acid, vit B12 Pharmacology of erythropoietin
Core Contents
Endocrine Pharmacology
Lectures
01: Endocrine Pancreas and control of blood glucose
Islet hormones, control of blood glucose Diabetes mellitus – types, diagnostic criteria, monitoring Insulin & preparations Oral Hypoglycemic agent’s Hypoglycemic reactions & management
02: Adrenal cortex and drugs used in therapy
Adrenocortical hormones: synthesis & blockers; Control of secretion, mechanism of action Pharmacological actions, uses, and preparations Adverse effects
03: Reproductive system
Hormonal control of the female reproductive system Estrogens & anti-estrogens Progesterone & anti-progesterone Hormone replacement therapy (HRT) Drugs used for contraception
04: The Uterus
Drugs that stimulate uterine contraction (oxytocic) Drugs that inhibit uterine contraction
05: The Thyroid
Synthesis, storage & secretion of thyroid hormones Thyroid functions & regulations Abnormalities of thyroid function Drugs used in disease of thyroid
Core Contents
Gastrointestinal Pharmacology
Lectures
01: Drugs used in Peptic ulcer
Pathophysiology of peptic ulcer Therapeutic goal and approach Antacids, H2- blockers, Proton pump inhibitors, gastric cytoprotective agents, Helicobacter pylori eradication regimen Gastroprokinetic drugs and other agents
02: Drugs to treat diarrhea
Epidemiology, Principles of management Fluid and electrolyte replacement Selection of route and preparations ORS and different IV fluids Role of Antimicrobial drugs Antimotility drugs
03: Drugs used in helminthiasis
04: Laxatives
05: Drugs for Inflammatory Bowel Diseases (IBS) & irritable bowel syndrome (IBS)
06: Anti-emetic and Pro-kinetic drugs
Term II
Core Contents
Central Nervous System
Lectures
01: Introduction to CNS Drugs
Neurotransmitters of CNS (distribution, ion channel) general characteristics of CNS drugs
02: Opioid analgesic
Pathophysiology of pain, Pain pathway, endogenous opioids and opioid receptors Opioids: morphine, codeine, pethidine, tramadol, fentanyl used as analgesics compared. Role of morphine in myocardial infarction and pulmonary edema. Other clinical uses of opioids
03: Anxiolytics and hypnotics
Pathophysiology of sleep Benzodiazepines and other non-BDZ sedative-hypnotics Centrally acting muscle relaxants
04: Antidepressant drugs
Neurochemical basis of depression TCAs, SSRIs, MAOIs and other atypical antidepressants, Antimanic drugs
05: Antipsychotic drugs
Neurochemical basis of psychosis Pharmacology of anti-psychotic drugs:
06: Local anesthetic
Drugs, mechanism of action, techniques of local anesthesia, uses and hazards
07: General anesthetics
Principles of General Anesthesia Preanesthetic medication, Balanced Anesthesia Induction & Maintenance: Intravenous anesthetics &Inhalation anesthetics (nitrous oxides, halothane, fluranes)
08: Skeletal muscle relaxation
Depolarizing and non-depolarizing
09: Antiparkinsonian Drugs
Pathophysiology of Parkinson’s diseases Pharmacology of antiparkinsonian drugs
10: Antiepileptics/Anticonvulsants
Pathophysiology of epilepsy Pharmacology of antiepileptic drugs
Core-Content
Autacoids and drugs used in inflammation
Lectures:
01: Autacoids
Definition and lists of autacoids
Histamine: synthesis, storage & release, pharmacological actions & physiological role
Histamine antagonist: H1 antagonists: classification, role in allergic conditions & other clinical uses and adverse reactions
H2-receptor antagonists: role in peptic ulcer (covered with GIT Pharmacology)
02: Ecosanoids Prostaglandins, Leukotrienes, Platelet Activating Factor (PAF) Synthetic pathways & antagonists’ Physiological roles, pharmacological actions and possible clinical uses of synthetic analogues and antagonists
03: NSAIDs / Non-opioid analgesics delete red part* of the line Paracetamol (mechanism of antipyretic and analgesic action, adverse effects) Other NSAIDs (mechanism of action, adverse effects and precaution) Selective COX II inhibitors
04. Drugs for Migraine
Core Contents
CHEMOTHERAPY
Lectures:
01: Introduction
The general concept, Mode of action & Classification of antimicrobials Principles of antimicrobial therapy
02: Drug Resistance Mechanism of development of drug resistance by microbes
03: Cell wall synthesis inhibitors Penicillin’s Cephalosporins Other -lactams Non -lactam antibiotics
04: Protein Synthesis Inhibitors
Aminoglycosides
Tetracyclines
Macrolides
Chloramphenicol
Newer Protein synthesis inhibitors
05: Sulfonamides & Cotrimoxazole
Sulfonamides combinations, Topical uses Cotrimoxazole
06: Quinolones & Fluoroquinolones
07: Anti Amoebic Drugs:
Metronidazole and other uses of Metronidazole
08: Drugs used in Tuberculosis
09: Drugs used in Leprosy
10: Drugs used in Malaria & Kala-Azar
11: Drugs used in Fungal Infections
12: Drugs used in Viral Infections
13: Cancer Chemotherapy
14. Anti-Helminthic Drugs
Core Contents
CLINICAL PHARMACOLOGY
Lectures:
01: Rational Prescribing
General Principles, cusses & consequences of irrational prescribing, Measures to prevent irrational prescribing
02: Essential Drug concept
Definition, Selection criteria, Essential Drug List Rationale for prescribing from this Drug List
03: ‘P’ Drug concept
Definition, Selection criteria, selection of ‘P’ Drug for some clinical situations 04: Drug selection for some special clinical conditions: Pregnancy, Lactating mother, elderly, children, renal / hepatic failure or impairment 05: Anti-Microbial Resistance and how to overcome the indiscriminate use of antimicrobials
Pharmacology Practical
Core Contents
GENERAL PRINCIPLES OF PHARMACOLOGY
1. Prescription writing
Format, legal & ethical aspects, drug nomenclature, compliance and Exercise on Prescription Writing
2. Drug Dosage Formulations
Source & Routes of drug administration Drug Formulation & Delivery Techniques Exercise on Drug Dosage Formulations
3. Clinical Pharmacokinetics Study of Time-Plasma Concentration Curves Determination of t½, Vd, Cl, Ke, steady-state concentration, Loading & Maintenance dose
4. Study of Pharmacodynamics
I. Study of Dose-Response Relationship
Construction of Log Dose-Response Curves
II. Study of Drug Antagonism
Construction of Log Dose-Response Curves in presence of Antagonists
5. Adverse drug Reaction
Exercise on ADRs reporting & monitoring
Core Contents
AUTONOMIC PHARMACOLOGY
1. Interpretation of Tracings on Blood Pressure
Demonstration of the presence of Autonomic receptors
2. Study of Effect of Drugs on Skeletal Neuromuscular Junction
Demonstration of the presence of Nicotinic receptors & effect of competitive reversible & irreversible neuromuscular blockers on them
Core Contents
CLINICAL PHARMACOLOGY
1. Drug Information Sources
A comparative study of the ‘Prescribing information of Drugs’ as provided by the Manufacturers’ Product Literature and the authentic Drug Compendia (British National Formulary/ Bangladesh National Formulary)
2. Essential Drug Concept Exercise on selection Essential Drugs
3. ‘P Drug’ Concept
Exercise on selection ‘P Drugs for different clinical situations & preparation of student formulary
4. Prescription Audit
Exercise on ‘Prescription Audit’ using INRUD indicators
Pharmacology Tutorial
Contents
Term I
General Pharmacology:
Pharmacokinetics and Pharmacodynamics
Autonomic Pharmacology:
• Review of Cholinergic–Anticholinergic drugs
• Revives of Adrenergic–Antiadrenergic drug
• Drugs acting on Renal & CVS
• Review on Endocrine drug
• Drugs for Bronchial asthma, PUD, Anemia
Term II
• Drugs used in Anxiety, sleep disorder
• Drugs used in depression, epilepsy and parkinsonism
• Autacoids & NSAIDs
• Chemotherapy for specific infections: Shigellosis, Enteric fever, ARIs, UTIs, malaria, tuberculosis, fungal infections
• RUM: Principles of Rational prescribing & means to resist pressure for irrational prescribing, Essential Drug Concept
Clinical case studies & presentation – 5 Clinical Cases