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Learning Objectives
Learning Objectives. Listed below are learning objectives and lists of important drugs for each contact hour in Medical Pharmacology. By the end of each contact hour, students are expected to be able to answer each learning objective. The drug lists summarize the essential drugs covered for each contact hour. Questions on the progress exams will be designed to assess your mastery of the learning objectives. Drugs shown in bold in the drug lists are those included in the top 200 most commonly prescribed drugs based upon the number of prescriptions dispensed. Please note that not all important and commonly used drugs are necessarily "commonly prescribed" if, for example, they are used primarily in a hospital setting (e.g. lidocaine, epinephrine, general anesthetics), are sold over the counter (e.g. aspirin), or are highly abused (cocaine).

Fall Semester 2007 (Last Modified on: March 19, 2008 )

Basic Principles Autonomic Pharmacology
Introduction: Overview of Medical Pharmacology Introduction to Autonomic Nervous System
Basic Principles of Pharmacology Cholinomimetics
Dosage Forms & Prescription Writing (self study)* Cholinolytic Drugs
* (handout or downloadable video/podcast) PBL- Chemical Warfare
Drug Disposition Sympathetic ANS I
Drug Metabolism Sympathetic ANS II
Pharmacokinetics I & II Sympathomimetics
Pharmacogenetics Sympatholytics
PBL -Drug Metabolism Lab - Adrenergics/Cholinergics
  PBL - Autonomic Unknowns
Inflammation  
Immunopharmacology Cardiovascular Pharmacology
Eicosanoids Hypolipidemic Drugs
Histamines/Antihistamines Digitalis glycosides
Clinical Pharmacology: NSAIDs, Steroids & Disease Modifying Drugs Antianginal Drugs
Glucocorticoids Vasodilators and Afterload Reducers in the Rx of CHF
Dermatopharmacology (self sudy - handout) Mechanisms for Cardiac Arrhythmias (self study)
  Antiarrhythmic Drugs I & II
Antimicrobials PBL - Antiarrhythmic Pharmacology
Antiviral Drugs   
Principles of Antimicrobial Action Pulmonary Pharmacology
Penicilliins Respiratory Pharmacology
Cepalosporins / Vancomycin Antimycobacterials
Chloramphenicol / Tetracyclines / Quinolones  
Sulfonamides / Metronidazole Renal Pharmacology
Aminoglycosides / Macrolides Treatment of BPH & ED
Clindamycin  Renal Pharmacology - ACE Inhibitors
Streptogramins Diuretics I & II
Antifungal Drugs Antihypertensive Agents
AIDS Drugs PBL - Hypertension
PBL - Antibiotics  
   
Cancer Chemotherapy  
Principles of Cancer Chemotherapy  
Cancer Chemotherapy  
Chemical Carcinogenesis (self study - handout)  
Cancer Chemotherapy - Case Reports  
   
Heme  
Antianemia drugs  
Thrombolytics & Anticoagulants  
Anticoagulants - Clinical Correlations  
   

Basic Principles

Introduction to Medical Pharmacology Dr. Clarkson

Students will be introduced to:

  1. Course administrators.
  2. Recommended textbooks.
  3. Organization of the course.
  4. Exam and grading policies
  5. The course Web Site.
Basic Principles of Pharmacology I & II Dr. Clarkson

By the end of this session, you should be able to:

  1. Define the terms: pharmacology, drug, poison, pharmacodynamics and pharmacokinetics.
  2. Describe the two primary properties of a drug receptor, and how a receptor differs from an inert binding site.
  3. Define the following drug properties: agonist, antagonist, partial agonist, affinity, efficacy, potency.
  4. Describe a typical dose-response curve for a drug, and label the positions on the curve that are used to define drug potency and efficacy.
  5. Describe several different signal transduction mechanisms by which agonists exert their effects.
  6. Explain the difference between selectivity and specificity of drug effect, and which is more commonly observed.
  7. Describe what is meant by the term Therapeutic Window.
  8. Describe and explain the effect(s) of competitive and non-competitive antagonists on the dose-response curve for an agonist.
  9. Explain how a quantal dose-response curve is constructed.
  10. Explain what is meant by additive and synergistic drug effects.
  11. Define what "desensitization" means & explain how it can occur.
  12. Define the terms ED50, LD50, TD50 , and Therapeutic Index.
Dosage Forms (Self Study / Handout) Dr. Clarkson

By the end of this session, you should be able to:

  1. Describe how different dosage forms alter the absorption, distribution and onset of action of drugs.
  2. Describe different dosage forms, their correct names and special characteristics.
Prescription Writing (Reading Assignment - Chapter 66 in Katzung) Dr. Clarkson

By the end of this session, you should be able to:

  1. List the different parts of a prescription.
  2. List from memory the meaning of the abbreviations: q.d., b.i.d., t.i.d., q.i.d, p.r.n, non.rep., q., p.o., p.c., a.c.
Drug Absorption, Distribution, Disposition & Excretion Dr. George

By the end of this session, you should be able to:

  1. Explain what is meant by the term drug disposition.
  2. Explain the which drug properties facilitate absorption.
  3. Discuss which biological properties faciliate absorption.
  4. Explain the mechanism of pH-dependent ion trapping with respect to accumulation of drugs.
  5. Explain which chemical properties make a drug more water soluble.
  6. Explain which chemical properties make a drug more lipid soluble.
  7. Discuss protein binding and the effect of concomitant administration of two protein-binding drugs on drug effect.
  8. Discuss the impact of drug distribution and redistribution on drug action.
  9. Explain the basic principles by which drugs are excreted from the body.

DRUG LIST:

Drug Absorption: Weak acids (e.g. aspirin), Weak bases (e.g.quinidine), PGP inducers (rifampin & St. John's wort), PGP inhibitors (cimetidine & grapefruit juice), Drugs with first pass effect (propranolol, morphine, nitroglycerin).

Drug Distribution Highly lipid soluble (thiopental), Large Vd (quinacrine, digoxin)

Drug Metabolism Dr. George
  1. Explain the principle of the chemical defense hypothesis.
  2. Explain what is meant by the term drug metabolism.
  3. List the major mechanisms responsible for drug metabolism.
  4. Describe the major enzyme systems in the body that are responsible for oxidation, reduction and/or hydrolysis of selective pharmacological agents.
  5. Describe the basic principles of how drug metabolism alters drug action.
  6. Define cytochrome p-450.
  7. Explain how drugs are chemically altered by cytochrome p-450.
  8. Explain the rate limiting step in the general non-specific pathway for drug metabolism in the liver.
  9. Discuss the difference between acute and chronic drug treatment with respect to drug metabolism by the liver.
  10. Explain how drug-induced enzyme induction and inhibition can alter responses to drugs.
  11. Discuss the basic clinical interactions that can result from changes in drug metabolism during co-administration of drugs.
DRUG LIST:

Cyt-P450 inhibitors: cimetidine, erythromycin, ciprofloxacin, fluoxetine (Prozac ®), grapefruit juice

Cyt-P450 inducers: rifampin, barbiturates, phenytoin, carbamezepine, St. John's wort, (ethanol in large amounts), thyroid hormone

Cyt-P450 substrates: warfarin, theophylline, oral contraceptives

Cyt-P450 drug interactions: sulfa drugs & phenobarbital, ethanol & tolbutamide, phenobarbital & warfarin, phenobarbital & phenytoin

Other metabolism related drug interactions: ethanol & disulfuram, MAO inibitors & tyramine

 

Pharmacokinetics I & II Dr. Clarkson

By the end of this session, you should be able to:

  1. Define the concepts of loading dose, maintenance dose, volume of distribution, clearance, elimination half-life.
  2. Calculate the initial volume of distribution given a loading dose and initial plasma drug concentration at time zero.
  3. Explain the difference between first-order and dose-dependent (zero-order) kinetics of drug elimination.
  4. List three examples of commonly used drugs that follow dose-dependent (zero-order) kinetics.
  5. Describe the concept of steady-state with regard to plasma drug concentrations.
  6. Explain the importance of different pharmacokinetic parameters on the duration of drug action.
  7. Calculate how long it will take to reach 90% of the steady state plasma drug level given a drug’s elimination half-life.
  8. Given a drugs half-life of elimination, calculate how long it will take for a plasma drug level to fall to 50%, 25% and 10% of its current value if drug administration is discontinued.
  9. Describe what is meant by a one-compartment and two-compartment model of drug distribution and elimination.
  10. Calculate a loading dose to achieve a target plasma drug level given the drug’s Vd.
  11. Given a drug’s elimination clearance, calculate the maintenance dose needed to achieve or maintain an average steady-state drug level (Css) using either a continuous infusion (mg/hr) or dose per time interval (e.g. 300 mg q.i.d.).
  12. Explain why Cl and Vd are considered “primary” pharmacokinetic parameters, while half-life (t1/2) is not.

DRUG LIST: phenytoin, aspirin, ethyl alcohol

 

Pharmacogenomics Dr. Gregory

By the end of this session, you should be able to:

  1. Define pharmacogenomics.
  2. Explain the different ways that genetics plays a role in drug metabolism/response (e.g. for succinylcholine).
  3. Explain the relationship between Glucose-6-Phosphate dehydrogenase deficiency & drug induced hemolytic anemia by primaquine & other drugs.
  4. Explain the relationship between “acetylator phenotype” and the incidence of side effects when patients are treated with isoniazid, procainamide, sulfa drugs or dapsone.
  5. Describe how mutations can alter patient response to 5-fluorouracil treatment.
  6. Describe how an understanding of the genomics of chronic myelogenous leukemia (CML) resulted in the identification of a new drug target to treat CML.
 

DRUG LIST:primaquine, isoniazid, succinylcholine, imatinib (Gleevac ®), 5-Fluorouracil

 

PBL-Drug Metabolism Drs. George & Faculty

By the end of this session, you should be able to:

  1. Explain the role of drug metabolism in drug interactions.
  2. Describe the process of enzyme induction.
  3. Describe the process of enzyme inhibition.
  4. List the major isozymes of cytochrome P-450 (CYP) with respect to drug metabolism in humans.

DRUG LIST:cimetidine, warfarin, rifampin

 

Inflammation

Immunopharmacology Dr. Beckman

By the end of this session, you should be able to:

  1. Define the general principles of immunosuppression.
  2. Name seven immunosuppressants and, for each, describe the mechanism of action, clinical uses and toxicities.
  3. Describe the mechanisms of action, clinical uses and toxicities of antibodies used as immunosuppressants.
  4. Describe the general principles of immunostimulants and their indications.
  5. Describe the different types of allergic reactions to drugs.

DRUG LIST: prednisone, cyclosporine, tacrolimus, sirolimus (rapamycin), azathioprine, cyclophosphamide, antithymocyte globulin, Rho(D) immune globulin, muromonab-CD3, infliximab, daclizumab, etanercept, thalidomide, mycophenolate mofetil, aldesleukin, interferons (alpha, beta & gamma), methotrexate.

 

Eicosanoids Dr. Kadowitz

By the end of this session, you should be able to:

  1. Explain the origin and definition of eicosanoids.
  2. Describe the physiologic and pathophysiologic roles of COX-1 and COX-2.
  3. Discuss the different types of eicosanoid receptors.
  4. Explain the role of eicosanoids in:
a. Smooth muscle function
b. Gastric acid secretion
c. Platelet function
d. Renal function
  1. Describe the role of eicosanoids in:
a. Inflammation
b. Pain
c. Fever
  1. Describe the lipoxygenase pathway of arachidonic acid metabolism.
  2. Discuss the biologic role of PAF.
 

DRUG LIST: Selective COX-2 inhibitors: Celecoxib (Celebrex ®). Nonselective COX inhibitors: aspirin, ibuprofen, naproxen, nabumetone, diclofenac. Analgesic & Antipyretic: acetaminophen. Glucocorticoids: beclomethasone, dexamethasone Prostaglandins: alprostadil, dinoprostone, misoprostol, latonoprost, PGI2 / prostacyclin; thromboxane. Leukotriene inhibitors: montelukast, zafirlukast, zileuton.

Recently removed from market: rofecoxib (Vioxx ®)

 
Histamines/Antihistamines Dr. Mondal

By the end of this session, you should be able to:

  1. Explain how histamine is formed and describe the locations of its synthesis, storage and catabolism.
  2. Explain the difference between H1 and H2 receptors and their physiologic/pathophysiologic function in:
    a) the cardiovascular system; b) the pulmonary system; c) non-vascular smooth muscle; d) sensory nerve endings; e) gastric glands
  3. Describe the "triple response of Lewis" and the mechanism(s) underlying each response.
  4. Describe the primary therapeutic uses, pharmacokinetic properties, and side effects of H1 and H2 antagonists and the antidegranulating drugs.

DRUG LIST:histamine. H2 agonist: betazole. H1 antagonists: bromopheniramine, chlorpheniramine, diphenydramine, fexofenadine, loratidine, hydroxyzine. Antigranulating drugs: cromolyn sodium, nedocromil sodium. H2 blockers: cimetidine, famotidine, nizatidine, ranitidine.

 

Clinical Pharmacology: NSAIDs, Steroids & Disease Modifying Drugs Dr. Kadowitz

By the end of this session, you should be able to:

  1. Describe the mechanism of action of selective and non-selective COX inhibitors (NSAIDs).
  2. Explain the special properties of aspirin.
  3. Describe the dose-dependent signs and symptoms of aspirin toxicity.
  4. Explain the mechanism of action of acetaminophen and describe the symptoms of acetaminophen toxicity.
  5. Explain the use of prostaglandins and prostaglandin analogs in the treatment of diseases such as glaucoma & pulmonary hypertension.
  6. Explain the use of NSAIDs and disease modifying drugs in the treatment of arthritis.
  7. Explain the use of lipoxygenase inhibitors and leukotriene antagonists in the treatment of asthma.
  8. Discuss the role of omega-3 and omega-6 polyunsaturates (fish oil) in the formation of lipid mediators.

DRUG LIST: NSAIDs & steroids (see above), acetaminophen (Rx for overdose: N-acetylcysteine).Disease-modifying antirheumatics: gold salts, azathioprine, chloroquine, penicillamine, methotrexate, TNF-alpha blocking antibodies (adalimumab, infliximab & etanercept). Rx of gout: colchicine, allopurinol, probenicid, sulfinpyrazone.

 
 
Pharmacology of the Glucocorticoids Dr. Beckman

By the end of this session, you should be able to:

  1. Explain the physiologic regulation of the hypothalamic-pituitary adrenal axis.
  2. List the natural and synthetic adrenocoritical steroids, their actions, therapeutic uses, and adverse effects.
  3. Describe the glucocorticoid and mineralcorticoid effects of adrenocortical steroids.
  4. List the adrenocortical antagonists and discuss their mechanism of action, uses, and adverse effects.

DRUG LIST: prednisone, hydrocortisone, dexamethasone, fludrocortisone, methylprednisone, mifepristone (RU-486), metyrapone .

 
Dermatopharmacology (Handout - Self Study) Dr. Beckman

By the end of this session, you should be able to:

  1. Describe the unique features of dematopharmacology.
  2. Describe the principles of percutaneous absorption.
  3. List the indications for topical uses of corticosteroids.
  4. List the indications for the topical use of retinoids.
  5. Explain how photochemotherapy works.
  6. Explain the clinical case and the pharmacology of the drugs used to treat the patient's condition (see case in handout).
  7. List two antipruritic agents and their clinical profile.
  8. List three trichogenic and antitrichogenic agents and their clinical profile.

DRUG LIST: Antiinflammatory Steroid: triamcinolone acetonide; Acne Preparations: adapalene, azelaic acid, benzoyl peroxide, tretinoin, isotretinoin (Accutane); Drugs for Psoriasis: alefacept, calcipotriene, efalizumab, etanercept, tazarotene; Anti-pruritics: doxepin, pramozine; Treatment of Alopecia: finasteride (Propecia), minoxidil (Rogaine); Rx of Excessive Hair Growth in Women: eflornithine; Rx of T cell lymphoma: denileukin diffitox, bexarotene

EXAM - Basic Principles & Inflammation Block

Antibacterial Drugs

 
Principles of Antimicrobial Action Dr. Agrawal

By the end of this session, you should be able to:
  1. Define the terms: antibiotics, selective toxicity, therapeutic index, bacteriostatic and bactericidal.
  2. Explain the host determinants in relation to selection of an antimicrobial drug for therapy.
  3. Define MIC and MBC values.
  4. Describe the methodology for sensitivity assays.
  5. Define bacterial resistance and list the mechanisms involved in acquiring bacterial resistance.
  6. Explain the mechanisms involved in transfer of drug resistance to bacterial cells.
  7. Describe the basic principles of combination therapy with antimicrobial drugs.
  8. Describe the terms of synergism and antagonism by giving examples.
  9. Discuss the classification of antimicrobial drugs based upon the mechanism of action.
  10. Explain the modes of action of various antimicrobial drugs.
 
Penicillins Dr. Agrawal

By the end of this session, you should be able to:
  1. Describe the structural relationship of the penicillin molecule with antimicrobial activity.
  2. Explain the mechanism of action of b-lactam antibiotics.
  3. Describe the pharmacokinetic properties of penicillins.
  4. Discuss primary therapeutic indications for penicillin G.
  5. Describe the repository penicillins.
  6. Explain the major side effects of penicillins.
  7. Describe the indications for broad-spectrum penicillins.
  8. List  the penicillinase-resistant penicillins.
  9. List the combinations of inhibitors of b-lactamase with penicillins.
  10. Describe the antimicrobial activity of monobactams and carbapenems.
  11. Explain the pharmacological basis for combining imipenem with cilastatin.

DRUG LIST: penicillin G, penicillin V, methicillin, oxacillin, cloxacillin, nafcillin, ampicillin, amoxicillin, carbenicillin, indanyl carbenicillin , ticarcillin, piperacillin, mezlocillin, meropenem, imipenem, aztreonam. Beta-lactamase inhibitors: clavulanic acid, sulbactam & tazobactam.

Cephalosporins & Vancomycin
Dr. Agrawal

By the end of this session, you should be able to:

  1. Describe the structural differences between penicillins and cephalosporins.
  2. Explain the mechanism of action of cephalosporins.
  3. Describe the four generations of cephalosporins with specific examples and the differences in their antimicrobial spectrum and pharmacokinetic properties.
  4. Describe the adverse effects due to cephalosporins.
  5. Explain the terms superinfection and cross-hypersensitivity.
  6. Discuss the mechanism of action of vancomycin.
  7. Describe the pharmacokinetic properties of vancomycin.
  8. Describe the main therapeutic indications and toxicities of vancomycin.

DRUG LIST: cephalexin, cefazolin, cefoxitin, cefaclor, cefprozil (Cefzil ®), cefotaxime, ceftriaxone, ceftazidime, cefepime, vancomycin

 

Chloramphenicol/Tetracyclines/Fluoroquinolones Dr. Agrawal

By the end of this session, you should be able to:

  1. Explain the mechanism of action and the mode of bacterial resistance of each class of antibiotics.
  2. Discuss and compare the pharmacokinetics.
  3. Describe the therapeutic indications for each class of antibiotics.
  4. List the various toxicities associated with each class of antibiotics.
  5. Explain the drug interaction of tetracyclines and antacid, and tetracyclines and penicillins.
  6. List the advantages of newer fluoroquinolones over older fluoroquinolones.
  7. Describe the adverse effects of ciprofloxacin, including contraindications in children and  pregnant women.

DRUG LIST: chloramphenicol, tetracyclines (tetracycline, doxycycline, minocycline), fluoroquinolones (ciprofloxacin, levofloxacin).

 
Sulfonamides Dr. Agrawal

By the end of this session, you should be able to:

  1. Discuss the mechanism of action of sulfonamides and explain the synergistic inhibition due to sequential blockade with cotrimoxazole.
  2. Classify sulfonamides giving an example for each group.
  3. Describe the pharmacokinetic properties of sulfonamides and discuss the principles for use of combination of sulfonamides to avoid crystalluria.
  4. Describe the major therapeutic indications of sulfonamides alone, and in combination with trimethoprim (cotrimoxazole).
  5. Describe the major adverse effects associated with the use of sulfonamides.

DRUG LIST: sulfamethoxazole, trimethoprim (Bactrim ®, Cotrim ®, cotrimoxazole).

 
Metronidazole & Miscellaneous Agents Dr. Agrawal

By the end of this session, you should be able to:

  1. Explain the mechanism of action of metronidazole, mupirocin and nitrofurantoin.
  2. Describe the pharmacokinetic properties of metronidazole, mupirocin and nitrofurantoin..
  3. Describe the major therapeutic indications for use of these 3 drugs against anaerobic bacterial infections and their use as an antiparasitic agents.
  4. Describe the major toxicities of these drugs (including the disulfiram-like reaction with metronidazole due to alcohol).

DRUG LIST: metronidazole, mupirocin, nitrofurantoin

Aminoglycosides Dr. Agrawal

By the end of this session, you should be able to:

  1. Discuss the mechanism of action of aminoglycosides.
  2. Describe the pharmacokinetic properties of aminoglycosides. Explain the importance of peak and trough levels of aminoglycosides.
  3. Discuss the need of and the method of dose adjustment for aminoglycosides in patients with compromised renal function.
  4. Explain the mechanism of acquired drug resistance due to aminoglycosides and compare the relative ease development of resistance to streptomycin, gentamicin, tobramycin and amikacin.
  5. Describe the therapeutic indications of aminoglycosides.
  6. Explain the rational basis for combination therapy with an aminoglycoside and a penicillin, cephalosporin, or vancomycin.
  7. Discuss the main three toxicities of aminoglycosides and precautions taken to limit them.

DRUG LIST: streptomycin, neomycin, gentamicin, tobramycin, amikacin, netilmicin.

Macrolides, Clindamycin and Streptogramins Dr. Agrawal

By the end of this session, you should be able to:

  1. Describe the mechanism of action of macrolides, clindamycin and streptogramins.
  2. Explain the pharmacokinetic properties of erythromycin and compare with clarithromycin, azithromycin and clindamycin.
  3. Describe the primary therapeutic indications for each class of antibiotics.
  4. Describe the major drug interactions of macrolides due to inhibition of cytochrome P450 enzymes.
  5. Discuss the major side effects of each class of antibiotics.

DRUG LIST: erythromycin, clarithromycin (Biaxin ®), azithromycin (Zithromax ®), clindamycin, Streptogramins (quinupristin/dalfopristin)

 
PBL - Antibiotics Dr. Agrawal/Faculty

By the end of this session, you should be able to:

  1. Generate hypotheses in relation to a patients illness.
  2. Predict the infecting organisms and list the antibiotics that can be used to treat the infection.
  3. Define cross-hypersensitivity and cite examples of drugs that exhibit this behavior.
  4. List the drugs used for prophylaxis against subacute bacterial endocorditis involving upper respiratory tract procedures and genitourinary/gastrointestinal procedures.
  5. Discuss the drugs which are effective against penicillin-resistant organisms.
  6. Learn to calculate the dose of gentamicin based on the body weight of the patient.
  7. Explain the adjustment of doses of gentamicin in patients with compromised renal function.
  8. Describe the common feature of nosocomial infections in the ICU.

Antifungals

Antifungal Drugs Dr. Mondal

By the end of this session, you should be able to:
  1. List the various antifungal drugs useful in the treatment of fungal infections.
  2. Discuss the mechanism of action of these drugs.
  3. Describe the pharmacokinetic properties of the various antifungal drugs.
  4. Describe the liposomal preparations of amphotericin B.
  5. Describe the major therapeutic indications of these drugs.
  6. Describe the important adverse effects of the various antifungal drugs.
  7. Discuss the drug interactions of griseofulvin and warfarin; ketoconazole and warfarin.

DRUG LIST: amphotericin B, nystatin, flucytosine, ketoconazole, fluconazole,

EXAM - Antibacterial & Antifungal Drugs

Antiparasitics

Antiparasitic Drugs (self study - handout & Chapters 52-54 in Katzung) Dr. Agrawal

By the end of this session, you should be able to:
  1. List the drugs of choice and alternate drugs available for treatment of diseases due to various helminths.
  2. List the opportunistic infections commonly occurring in patients with AIDS and the drugs used for their treatment.
  3. Describe the mechanism of action of ivermectin, mebendazole, praziquantel, pentamidine, trimetrexate and atovaquone.
  4. List the broad spectrum anthelmintic drugs and their spectrum of activity.
  5. Learn the drug of choice for treatment of asymptomatic, mild to moderate intestinal disease, severe intestinal disease and hepatic abscess due to E. histolytica.

DRUG LIST: atovaquone, mebendazole, thiabendazole, albendazole, pyrantel pamoate, ivermectin, diethylcarbamazine, nifurtimox, suramin, pentamidine, praziquantel, trimetrexate

Antivirals

Antiviral Drugs Dr. Mondal

By the end of this session, you should be able to:
  1. Classify antiviral drugs based upon their site of inhibition in the viral replication cycle.
  2. Explain their mechanisms of action.
  3. Describe their major therapeutic indications.
  4. Compare their pharmacokinetic properties.
  5. List their adverse side effect and potential drug interactions.
  6. Explain the factors that regulate antiviral drug resistance.

DRUG LIST: amantadine, rimantadine, zanamivir, oseltamivir, idoxuridine, trifluridine, vidarabine, acyclovir, valacyclovir, ganciclovir, valganciclovir, foscarnet, ribavirin, interferon alpha

Drugs for Treatment of HIV Infection and AIDS Dr. Mondal


By the end of this session, you should be able to:

  1. Describe how treatment of HIV has dramatically changed the prognosis of this previously fatal disease.
  2. List the drugs (antiretrovirals) used for treatment of HIV-1 infection by:
    a. Classification
    b. Toxicities
  3. Explain the rationale for combination of nucleoside analogue reverse transcriptase inhibitors (NRTIs), nonnucleoside transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs).
  4. Explain the following concepts needed for the understanding of the clinical decision making process when treating HIV-infected patients:
    a. Viral replication and suppression
    b. Viral drug-resistance
    c. Adherence to treatment
    d. Immune reconstitution
    e. Complications of treatment
  5. Describe the current guidelines for the treatment of HIV-infected patients.
  6. Explain why the guidelines change

DRUG LIST:HAART, zidovudine (azt), didanosine (ddi), lamivudine (3tc), stavudine (d4t), abacavir, nevirapine, delavirdine, efavirenz, indinavir, nelfinavir, ritonavir / lopinavir, amprenavir, enfuvirtide

EXAM - Antivirals & Antiparasitics

Cancer Chemotherapy / Neoplasia

Principles of Cancer Chemotherapy I & II Dr. Agrawal

By the end of this session, you should be able to:

  1. Explain the role of chemotherapy in the management of patients with cancer.
  2. Describe the prospects for "cure", or long term survival in cases of advanced cancer.
  3. Describe the various limitations to effective drug treatment.
  4. Define and explain the terms: selective toxicity, mass doubling time and growth fraction.
  5. Explain the concept of "total cell kill" in cancer patients.
  6. Define the optimal dosage schedules in cancer patients.
  7. Explain the term cell cycle specificity and be able to classify the various anticancer agents based on this parameter.
  8. Describe the principles of combination chemotherapy in the treatment of cancer.
  9. Explain the mechanisms for resistance to anticancer drugs.
Cancer Chemotherapy Dr. Agrawal

By the end of this session, you should be able to:

  1. Describe the mechanism of action and therapeutic indications of various anticancer drugs (see below).
  2. Describe the common toxic effects for each major class of anticancer drugs (alkylating agents, antimetabolites, natural products and miscellaneous agents) (see drug list below).
  3. Learn the relative differences in toxicity of drugs within each major class.
  4. Explain the bioactivation pathways required for the action of cyclophosphamide.
  5. Describe the intracellular activation of different antimetabolites.
  6. Explain the use of antidotes in high dose methotrexate therapy.
  7. List the specific toxic effects of commonly used anticancer drugs.
  8. Describe the cumulative dose dependent toxicity of anthracyclines.
  9. Describe the preferred drug combinations that have major activity against specific types of cancer.
  10. Explain the concept of adjuvant chemotherapy, and learn the regimens used in breast adenocarcinoma and osteogenic sarcoma.
 

DRUG LIST:

Alkylating agents: busulfan, cyclophosphamide, dacarbazine, mechlorethamine, melphalan, nitrosoureas
Antimetabolites: cytosine arabinoside or Cytarabine, 5-fluorouracil, 6-mercaptopurine, methotrexate, thioguanine
Natural products: dactinomycin (actinomycin D), bleomycin, daunorubicin, camptothecins (irinotecan, topotecan), doxorubicin, etoposide, paclitaxel, vinblastine, vincristine
Miscellaneous agents: cisplatin, imatinib, procarbazine
 
Chemical Carcinogenesis - Independent Study Dr. Agrawal

By the end of this session, you should be able to:

  1. Describe the chemical structural requirements for carcinogenicity of polycyclic aromatic hydrocarbons (PA).
  2. Explain the mechanism of activation of PAHs for their carcinogenic effects.
  3. Describe the mechanism of activation of aromatic amines, azo dyes and nitrosoamines for their carcinogenic potential.
  4. Explain the mechanism of chemical carcinogenesis involving three stages and learn the various agents that can modify their processes.
  5. Learn the increased risk of developing lung cancer with smoking.
  6. Describe the important chemical carcinogenic constituents in the side stream smoke.
Cancer Chemotherapy - Case Reports Dr. Weiner

By the end of this session, you should be able to:

  1. Explain the concept of neoadjuvant and adjuvant chemotherapy.
  2. Explain the rationale of high dose therapy at short intervals.
  3. Learn the basic principle of the combination chemotherapy.
  4. Describe the role of G-CSF in chemotherapy.
  5. Explain the role of allopurinol in chemotherapy.
  6. Describe the rationale for using docetoxal and/or trastuzumab (herceptin ®) in breast cancer.
  7. Describe the role of rituximab (rituxan ®) in the treatment of large cell lymphoma.

DRUG LIST: allopurinol, G-CSF(filgrastim ®), trastuzumab (Herceptin ®), rituximab, tamoxifen

Heme Block

Antianemia Drugs Dr. George

By the end of this session, you should be able to:

  1. Describe the causes of different anemias.
  2. Explain the type of anemia expected as a result of deficiencies of iron, erythropoietin, Vitamin B12 and folic acid.
  3. Discuss the nature, production, and effects of erythropoietin.
  4. Describe the primary sites of action of erythropoietin.
  5. Explain the approved indications for treatment of anemia by erythropoietin, iron, folic acid and Vitamin B12.
  6. Describe the absorption of iron by the intestines.
  7. Explain the treatment for iron toxicity or overdose.
  8. Explain the mechanistic reason why folic acid alone is contraindicated in the treatment of pernicious anemia.
  9. Discuss the mechanismss by which drugs interfere with the effects of folic acid
  10. Define atrovorum factor.
 

DRUG LIST: erythropoietin, ferrous sulfate, deferoxamine, folic acid, Vitamin B12, iron dextran

Anticoagulants, Thrombolytics & Antiplatelet Agents Dr. George

By the end of this session, you should be able to:

  1. Define the terms: anticoagulant, thrombolytic, antiplatelet agent.
  2. Describe the general stages of the clotting process.
  3. Describe the role of the major clotting factors in the coagulation scheme.
  4. Describe the different tests that are used to assess the effects of anticoagulant therapy.
  5. Describe the indications and contraindications for anticoagulant therapy.
  6. Describe the mechanism of action of heparin and coumadin.
  7. Explain the procedures for treatment of overdosing with heparin and coumadin.
  8. Describe the mechanisms by which other drugs can modify the effect of anticoagulants.
  9. Describe the mechanism by which aspirin and dipyridamole act as antiplatelet agents.
  10. Describe the indications for use of thrombolytic agents, and their side effects.
 

DRUG LIST: warfarin, heparin, enoxaparin (LMW heparin), vitamin K, protamine sulfate, aspirin, streptokinase, clopidogrel

Clinical Correlations - Thrombolytics/Anticoagulants Dr. Kahn

By the end of this session, you should be able to:

  1. List common drugs used to inhibit the primary hemostatic system.
  2. Explain the role of glycoprotein IIb/IIa and the effects of drugs that interact with this receptor complex.
  3. List common drugs used to inhibit secondary hemostatis.
  4. Explain the the pharmacologic treatment of deep venous thrombosis.
  5. List the indications for thrombolytic therapy.
  6. Explain the anticoagulant managment of coronary artery disease.
  7. List common factor replacement products.
  8. Describe how to medically manage von Willebrand's disease.
  9. Describe how to use laboratory tests to determine the level of anticoagulant therapy.
  10. Explain the difference in onset of time required for anticoagulant action of heparin and coumadin.
DRUG LIST: warfarin, heparin, aspirin, Tissue-type plasminogen activators (alteplase or t-PA, reteplase, tenecteplase), GP IIb/IIIa receptor inhibitors (abciximab, eptifibatide, tirofiban).

 

 

 

EXAM - Cancer Chemotherapy (Neoplasia) & Heme Blocks

Autonomic Pharmacology

Introduction to Autonomic Nervous System - I & II Dr. Taylor

By the end of this session, you should be able to:

  1. Compare and contrast the anatomy of the sympathetic and parasympathetic divisions of the autonomic nervous system (ANS).
  2. Review the concept of neurotransmitters, cotransmitters, and end-organ receptor specificity.
  3. Define words containing the suffixes, -ergic, -mimetic, -lytic and –ceptive
  4. Describe homeostasis, fight-or-flight, and rest-and-repair with regard to ANS activity.
  5. Describe how the central nervous system controls the activity of the ANS.
  6. List and compare/contrast the physiological responses of end organs produced by activation of the sympathetic and parasympathetic nervous systems.
  7. Explain what tone is, and apply knowledge of predominant tone to the regulation of dually-innervated organs.
  8. Deduce the diverse physiological effects of muscarinic receptor activation in the ANS

DRUG LIST: acetylcholine, norepinephrine, epinephrine (adrenaline), dopamine

Cholinomimetics Dr. Taylor

By the end of this session, you should be able to:

  1. List the steps in the synthesis, release and inactivation of acetylcholine.
  2. List the locations and the differences between muscarinic and nicotinic receptors.
  3. Deduce the physiological effects of muscarinic or nicotinic receptor activation: therapeutic and adverse effects.
  4. Compare the two major cholinesterases: acetylcholinesterase and butyryl-cholinesterase as to anatomical locations, sites of synthesis, and function.
  5. Explain anticholinesterases are reversible or irreversible, and indicate which anticholinesterases are in each category.
  6. Describe the physiological effects of accumulated acetylcholine at muscarinic and nicotinic receptors in the periphery and the central nervous system.
  7. List the therapeutic uses for and adverse side effects of anticholinesterases.
  8. Describe the use and mechanism of action of pralidoxime, and explain why pralidoxime is not effective at reactivating all AChE.
  9. Explain why anticholinesterase agents can be used as insecticides and chemical warfare agents, and discuss antidotes in case of poisoning.

DRUG LIST: