C
Basic Pharmacology
Medical School e-Learning
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digital learning
PCS Unit 3 20/21
Prof MJ Coffey (CoffeyMJ@cardiff.ac.uk)
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Beta-lactams
Tetracyclines
Resistance
Aminoglycosides
Quinolones
Macrolides
Sulfonamides
Glycopeptides
Section 3
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Section 2
Section 1
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Section 1: Definitions
What you will learn:
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The Learning Outcomes for this Section are:
1. To define what Pharmacology is
2. To appreciate its role in Medicine
3. To define what a drug is and what it can target in the body
3
Quiz
5
2
4
1
Definition:
The component of Medicine that explains the use, mechanisms and effects of drugs.
1: What is Pharmacology?
Section 2: Drug Science
The Learning Outcomes for this Section are:
1. To define common pharmacological terms
2. To appreciate the role of clinical trials
3. To chart a drug’s journey through the body
(Correctly answering the Section 1 questions will give you the password for this Section)
Learning Outcomes
Please enter the case-sensitive Section 2 password:
1: Pharmacodynamics (PD)
Blood pressure monitoring
As a doctor, what are you measuring… and why?
“What" is a function of the condition being treated, but it has to be compared against a drug’s dose vs. no treatment.
How the drug works is called:
PHARMACODYNAMICS
(i.e. how the drug’s dose & mechanism of action is affecting a body function)
How the drug effects body functions
Please enter the case-sensitive Section 3 password:
Section 3: Clinical Practice
The Learning Outcomes for this Section are:
1. To appreciate that drugs may cause harm
2. To recognise your role as a ‘prescriber'
3. To appreciate Pharmacology’s contribution to the Case-Based Learning curriculum
(Correctly answering the Section 2 questions will give you the password for this Section)
Summary
Any unwanted or unexpected effects of drugs are termed ‘adverse drug reactions’ (ADRs). They are caused by a number of reasons but dose-related ADRs may be common if the drug accumulates to toxic levels.
Adverse drug reactions (ADRs)
Pharmacokinetics has a big influence on the ‘steady state’ plasma concentration of the drug
1: Side effects
24th Nov at 9am. You will be sent a link to join the session
Recommended Website
Pharmacology
Rang & Dale
Elsevier
Recommended Textbook
Feedback & Queries to
This material links with PCS Unit 3 content and the CBL cases in spring term and Year 2
Resources & Information
Q&A on this session
Spiral Curriculum
Medicines Complete:
https://www.medicinescomplete.com/#/browse/bnf
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Prof MJ Coffey
CoffeyMJ@cardiff.ac.uk
Allotrope
A drug that works by blocking a receptor on or within a cell, goes by what name?
Adjuvant
D
Agonist
A
E
Antagonist
B
Agitator
Question 1:
Section 1: Quiz
Instant feedback on the answer you picked:
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[D] is incorrect because the word agitator is not a pharmacological term.
Correct! [C] Drugs that block other ligands from activating receptors are referred to as antagonists.
Click on the forward button to try the next question...
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[E] is incorrect because an allotrope refers to physical variants of an element that can co-exist in the same environment, e.g. oxygen (O2) and ozone (O3).
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[B] is incorrect because drugs that are termed agonists are able to bind to receptors and activate them, triggering a cellular response.
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[A] is incorrect because and adjuvant typically refers to a secondary type of therapy but it is not a term specifically associated with cell receptors.
What is the name of the annually updated reference guide that lists all UK licensed drugs that doctors are allowed to prescribe?
Medicines Complete
Medicines & Heathcare Products Regulatory Agency (MHRA)
Science Direct
British National Formulary (BNF)
National Institute for Health & Care Excellence (NICE)
Question 2:
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[D] is incorrect because the MHRA is part of the Dept of Health & Social Care responsible for medical device safety and function.
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[A] is incorrect because Science Direct is an online database of medical and scientific research journals.
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[B] is incorrect because Medicines Complete is the online home for a number of UK pharmacological publications (including the correct answer to this question!)
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[C] is incorrect because NICE is the UK body that makes evidence-based guidelines for clinical practice.
Correct! [E] The BNF is the ‘drug bible’ for UK doctors
Please make a note of the password for the next section...
The case-sensitive password for Section 2 is: Mandalorian
The volunteers wear blindfolds during the trial
A single-blinded, randomised, controlled clinical trial is started with a cohort of volunteers, to test the safety and effects of a new drug.
What does ‘single-blinded’ mean in this context?
Only male test subjects are used in the trial
The volunteers do not know what they are being given to avoid bias
The test subjects are randomised according to gender & ethnicity
Only female test subjects are used in the trial
Section 2: Quiz
Pharmacodynamics
Drug metabolism
Drug distribution
Drug interactions
Pharmacokinetics
The process within the body that describes how enzymes modify and de-activate drugs in advance of their excretion is defined as what?
Teratogens cause serious embryonic and foetal defects
Teratogens cause premature delivery of the baby
Section 3: Quiz
The foetus may become addicted to the teratogenic drug
The mother may become addicted to the teratogenic drug
Teratogens cause prolapse of the uterus
A woman who is 3 months pregnant asks her GP why she cannot take a particular type of drug during her pregnancy. The GP tells her it is contraindicated in pregnancy because the drug is a teratogen. What is the definition of a teratogenic drug?
amiodarone
lidocaine
A patient is being treated with a drug to help manage their particular type of cardiac arrhythmia. The patient develops pulmonary fibrosis and thyroid dysfunction as side effects.
Which one of the following drugs would give these ADRs?
atenolol
amlodipine
ramipril
Try again!
[D] is incorrect because picking only 1 demographic of subjects will bias the data, i.e. how would this drug work in female subjects? You wouldn’t know with this approach
Correct! [A] To avoid bias, the subjects are not aware of the type of drug they are given or whether they are given a placebo.
Click on the forward button to try the next question...
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[B] is incorrect because….seriously… this is the obviously wrong answer. It would be impractical and inappropriate to say the least!
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[C] is incorrect because although randomisation of subjects avoids biassing the results, single-blinding is not the term that describes this aspect.
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[E] is incorrect because picking only 1 demographic of subjects will bias the data, i.e. how would this drug work in male subjects? You wouldn’t know with this approach
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[A] is incorrect because distribution refers to how a drug spreads to tissues and organs within the body following its absorption or IV administration.
Correct! [B] Drug metabolism is the right answer.
Make a note of the password to access the next section...
The case-sensitive password for Section 3 is: Ugnaught
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[E] is incorrect because pharmacokinetics refers to the processes by which the body deals with the drug as it journeys through the body.
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[C] is incorrect because ‘drug interactions’ refer to how the presence of 1 drug will influence the effect of another drug if the patient is prescribed both at the same time.
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[D] is incorrect because pharmacodynamics refers to how the drug at a given dose will cause an effect within the body, e.g. an anti-hypertensive drug will lower blood pressure etc.
Correct!
[D] is correct. Teratogens cause embryonic/foetal malformations (e.g. phocomelia caused by thalidomide).
Click on the forward button to try the next question...
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[A] is incorrect. A miscarriage of an embryo/foetus that becomes non-viable because of a teratogen can occur, but this is not the definition of a teratogen.
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[B] is incorrect because teratogenic drugs do not cause dependency (addiction).
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[C] is incorrect because teratogenic drugs do not cause dependency (addiction).
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[E] is incorrect because there is no evidence that teratogenic drugs cause uterine prolapse.
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[D] is incorrect because this is not the ADR profile for atenolol.
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[C] is incorrect because this is not the ADR profile for lidocaine.
Correct! [E] amiodarone causes these serious side effects (and occasionally Torsade de Pointes).
You have now finished this e-learning resource!
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[B] is incorrect because this is not the ADR profile for ramipril.
Try again!
[A] is incorrect because this is not the ADR profile for amlodipine.
Click on this LINK to register your completion
Start
2: Why is it important?
Virtually every medical speciality is supported by Pharmacology.
Whether you’re treating diabetes with insulin or cardiac failure with a diuretics the use of drugs will be part of your daily clinical practice.
Pharmacology underpins all of Medicine
3: What is a drug?
The definition of a 'drug'
“A drug is a chemical substance of known structure (other than a nutrient or dietary factor) which, when administered, produces a measurable biological effect”(Pharmacology, Rang & Dale)
But what do people use drugs for?
Contraindications
Mechanism of action (MOA)
Updates on the drug’s use
Doses for prescribing
Research into new drug development
Therapeutic indications
4: What you need to know
In whichever speciality of Medicine you choose
Adverse drug reactions (ADRs)
(& other drugs)
click
Drugs can increase or decrease the activity of:
5: Drug targets
Alice Cooper
What pharmacological term links the following people?
Enter the word in CAPITALS
Bell Biv Davoe
Just before the "proper" questions...
End of section break
Prodigy
... all had songs called 'POISON'
2: Dose-response curves
The importance of measuring drug effects
Pharmacodynamic measurements are the only way to evaluate that the drug is having the desired (and safe) effect.
Think of the ‘Goldilocks zone’...
Creating & evaluating research evidence
3: Clinical drug trials
You need to be sure a drug is safe and effective at the dose given.
Extensive experimental research and data analysis is the only way to gather evidence of a drug’s efficacy...
The journey of a drug through the body and how it is affected can be described by considering each of the separate components of pharmacokinetics...
How the body effects the drug
4: Pharmacokinetics (PK)
5: PK components
Absorption, distribution, metabolism & excretion
B
R
O
D
S
Crossword (drag the letters over the boxes)
Down & across: Period of 1st order decline in plasma drug concentration (4, 4)
Down: Amount of a drug that a patient should take (4)
Down: Abbreviation for measure of all cells in the plasma (3) Across: Title abbreviation of what you will become in 4 years’ time (2)
Across: Abbreviation for drugs that are taken orally (2)
Across: Abbreviation that describes statistical dispersion of data around the mean (2) Across; X-ray method that takes ‘slice’ images during scan (2)
A
T
P
F
L
H
I
F
Ultrasound scan of developing foetus @20 weeks
2: Contraindications
Instances when drugs should be avoided
Because of their potential to cause harm, some patients should not take certain drugs under certain conditions (e.g. if pregnant or if previous allergic reactions etc.)
The BNF lists contraindications for all UK licenced drugs.
Applying evidence-based medicine
3: You as ‘Prescriber'
Prescribing safely & competently is a REALLY big deal!
Picking the right drug at the right dose can be a game-changer in many illnesses.
Getting it wrong can endanger patient lives.
If your signature is on the prescription, you are medico-legally responsible and accountable.
4: Safety & competency
Before you qualify as a doctor, in your 5th Year you will have to pass the Prescribing Safety Assessment (PSA).
The exam tests knowledge of:
> Principles of prescribing
> Data interpretation
> Planning management
> Communicating information
> Numeracy skills
> Drug monitoring
> Adverse drug reactions
"Do no harm"
Get to know Pharmacology and you will be a better doctor for it!
Pharmacology in Case-Based Learning
5: What’s to come...
Every case in Phase I has elements of Pharmacology. Some more obviously than others, but you will build and integrate your drug knowledge as the cases progress.
1. Pharmacology is an essential component in becoming a competent and safe doctor.
2. Pharmacology comprises basic science, drug development, clinical application, patient safety and education.
3. The patient cases you will study all have drug themes you need to become familiar with.
4. Do not confuse pharmacology with ‘pharmacy’. Both are linked but pharmacology is a clinical science.
Summary of topic
You have now been introduced to Pharmacology
Pharmacology is like a trusty Swiss Army knife: it’s the sum of its parts...
Intent?
Therapeutic
Toxic
Illegal
Cosmetic
Drugs can bind to membrane receptors and either activate or block intracellular processes
Agonist = activation Antagonist = block
RECEPTORS
ION CHANNELS
e.g. local anaesthetic drugs block action potentials in nerve axons
ENZYMES
Drugs can block active sites or induce conformational changes to the enzyme structure
GENES / DNA
Drugs can bind to DNA / RNA to promote or suppress supercoil unwinding & transcription
How does a drug get from here?
To here?
Click
Absorption:
The absorption of an orally administered drug is a function of how well it can cross the physical barriers between the stomach and circulation. Lipid soluble drugs can passively traffic through cell membranes,
Polar drugs rely on aqueous pores and active transporters.
Drug absorption is also hindered by chemical and enzymic degradation and drug-effluxer pumps
Excretion
Excretion:
Once a drug has been metabolised into something that is inert and water-soluble, it needs to be eliminated from the body in an aqueous medium. This can either mean ‘renal excretion’ where the drug metabolite is eliminated through passing into the urine, or by ‘hepatobiliary excretion’ where the drug metabolite is trafficked direct from the liver through the bile duct into the lumen of the gut and lost in the faeces.
Distribution
Distribution:
Once in the circulation a drug distributes itself around the body as a function of cardiac output, regional blood flow to tissues and organs and the lipid solubility of the drug itself.
Lipid solubility of drugs that are ‘weak electrolytes’ is influenced by the local pH of the tissue and this will determine how much drug actually gets to its target on or within a cell.
Absorption
Metabolism
Metabolism:
The body perceives the presence of a drug as a protential biohazard so will actively break it down using liver enzymes to de-activate its pharmacological activity and also to water-solubilise the drug to make it easier to excrete.
Phase I drug metabolism chemically modifies the drug in preparation for Phase II drug metabolism, which renders the drug inert and makes it water-soluble.
therapeutic range
minimum
Dose too high = toxic
Dose too low = no effect
maximum