Basic Pharmacology
What is an emulsion?
Additives to parenteral preparations
Effects of additives to drugs
Storage of drugs and potency
Drug interaction
Discuss the principles of drug interactions using opioids and MAOIs as examples
Define potency
Potency, dose response curves and use of log dose
Dose response curves
Draw a log dose/effect curve
Hill equation
ED 90
ED95
How do you express drug safety?
What is meant by the Therapeutic Index?
Mechanisms of drug effect
What is a receptor?
Receptor theory
Spare receptors
Evidence for the existence of receptors
Functional properties of receptors
GABA receptors
G-protein-linked receptors
Interactions of drugs and receptors
Tell me about pharmacogenetic disorders.
Pharmacogenetics - examples related to anaesthesia.
Tolerance - tachyphylaxis
Transdermal preparations
What is an isomer
Stereoisomerism
Pharmacology in neonates
Pharmacology in pregnancy
Pharmacotherapy
Cerebral blood flow and anaesthetic agents
Classify the drugs used in the treatment of asthma
Classify drugs used in cardiac failure
Define dissociative anaesthesia
Define the term "an Hypnotic drug".
Drug induced histamine release and anaphylaxis
Drugs acting on sodium channels
Drugs influencing ligand-gated vs voltage-gated ion channels
Effects of anaesthetic agents on CNS
Effects of isoflurane, propofol, fentanyl on blood pressure, in healthy adults
Factors predisposing to thrombogenicity of drugs
Influence of salbutamol, frusemide, captopril or ranitidine therapy on anaesthetic agents.
Interaction of chemotherapeutic agents and anaesthesia
Mechanisms of anaesthesia
Mechanisms of drug-induced histamine release
Methods to reduce stress response in anaesthesia
Obtundation of the pressor response to intubation
Precautions with "prophylactic" antibiotics
Pro-convulsant anaesthetic agents
Treatment of anaphylaxis
Treatment of hyperkalaemia
Pharmacokinetics
pH & pKa, Henderson Hasselbach equation.
Define bioavailability
Determination of, and factors influencing, oral bioavailability
First-pass metabolism
Difference between plasma and biophase concentrations
Effect site concentrations of drugs
What is protein binding?
What is meant by the term “volume of distribution”?
How do you calculate volume of distribution
Definition and clinical significance of volume of distribution
Volume of distribution, clearance and half-life
Redistribution
Steady state
Definition of clearance and estimation of clearance
What is clearance?
Explain clearance
Intrinsic clearance
Halflife and time-constant
What is meant by "loading dose"?
Enzyme substrate interactions
Esterases
Elimination half life
First order and second order kinetics
What is the difference between zero and first order kinetics?
Why infuse a drug?
Infusion kinetics
Infusion regimens to achieve target concentrations
Pharmacokinetics of propofol infusions
What do you understand by the term “context sensitive half-life”?
Kinetics of drugs in the epidural space
Kinetics of inhalational agents
Outline pharmacokinetic drug interactions
Drug delivery systems
Modelling
Drug handling by the liver
Cytochrome P450
Renal failure and drug metabolism
Pharmacokinetics in heart failure
How does liver disease affect the way the body handles drugs.
Influence of pregnancy and liver disease on pharmacokinetics
Inhalation Anaesthetic Agents
Define saturated vapour pressure and boiling point
Can you explain the concentrating and second gas effects?
Please explain the second gas effect.
Describe the uptake of volatile agents
Draw a set of wash in curves versus time for commonly used volatile anaesthetic agents.
Draw and explain the FA F1 curve. Does the curve reach unity at infinity ?
What determines uptake of volatile anaesthetic agents from the alveolus?
What factors influence the onset of action of volatile agent ?
Wash-in curves of volatile anaesthetics
Uptake and wash-out curves
Induction and recovery with inhalational agents
Definition and clinical utility of MAC, MACawake, MACBAR
MAC – Definition. Tell me about factors effecting MAC.
MAC uses and shortcomings
What is MAC 95?
Determination of MAC
Quantitation of agent potency
Draw or describe the concentration/response curve for an inhalational agent
Ideal volatile anaesthetic agent
Why is N2O used ?
N2O properties and contra indications
Nitrous oxide - indications
Adverse effects of nitrous oxide; diffusion hypoxia
How is nitrous oxide manufactured?
Contraindications to the use of nitrous oxide
Side effects of N2O.
Entonox
Uptake of nitrous-oxide
What are the side effectsof nitrous oxide?
Structure of an ether
Tell me about the structure-activity relationships of volatile anaesthetic agents.
Metabolism of inhaled anaesthetics
Discuss the metabolism of sevoflurane/halothane
Metabolism of halothane
Metabolism of sevoflurane
Chemical and biochemical breakdown of agents
Systemic effects of different agents
Respiratory effects of volatile anaesthetic agents
Inhalation agents and hypoxic drive to ventilation
Cardiovascular effects of inhaled anaesthetics
Effects of agents on blood flow in specific tissues
Endocrine and Metabolic effects
Changes of induction dose in different patient groups
Use in neonates
Use in pregnant patients
Toxicity of volatile anaesthetics
Renal/hepatic toxicity
Occupational hazards
What volatile agent are you most familiar with and can you tell me about that agent?
Advantages and disadvantages of enflurane
Draw the structure of sevoflurane/isoflurane/halothane
Isoflurane, Sevoflurane, Halothane
Comparison of enflurane and isoflurane
Isomerisation of isoflurane.
What are the cardiovascular effects of isoflurane?
Central nervous system effects of isoflurane
Can you describe the effects of Isoflurane on respiration?
Isoflurane and brain.
Discuss factors affecting awakening from isoflurane
Isoflurane vs sevoflurane
Sevoflurane - its advantages over other volatile agents
Structure/activity of sevoflurane.
Adverse effects of sevoflurane
Desflurane
Intravenous Hypnotic Agents
Classification of agents
Classification of hypnotics
Characteristics of intravenous induction agents
What factors determine variation in doses of induction agents, for example with age and shock?
Determinants of an induction dose
Influence of age, anxiety, hypovolaemia on induction of anaesthesia
Metabolism of different agents
What is the structure activity relationship of barbiturates?
Draw barbituric acid nucleus. What are the keto and enol forms ?
Comparision of Thiopentone and Methohexitone.
What are the contents of an ampoule of Sodium Thiopentone? Role of each adjuvent.
Pharmacokinetics and biotransformation of thiopentone
Time course of plasma concentrations of thiopentone
Metabolism of thiopentone
Cardiovascular effects of thiopentone
Compare thiopentone and propofol
Comparison of thiopentone and propofol induction
Compare propofol and midazolam as induction agents
Tell me about the formulation of Propofol.
What are the contents of a propofol ampoule?
Factors determining the effect of propofol
What is the induction dose of propofol and what is its disposition in elderly patients?
Propofol uptake and distribution
Draw a concentration/time curve after an IV bolus of propofol
Pharmacokinetics of propofol infusions
Calculation of propofol dosage for TIVA
Draw the plasma concentration time curve of propofol and the effect site (brain) concentration time
curve.
Effects of propofol on cardiovascular system
Non anaesthetic effects of propofol
Offset of action of propofol
Ketamine
Ketamine - advantages
Ketamine, mechanism of action
Ketamine, Propofol, Thiopentone
Analgesic actions of ketamine
Cardiovascular effects of ketamine
Discuss the properties of benzodiazepines
Benzodiazepene kinetics
Benzodiazepine receptors
Gaba receptor
How do benzodiazepines exert their effects in the body?
Mechanism of action of benzodiazepines
Diazepam metabolism.
Differences between midazolam & diazepam.
Metabolism of midazolam vs diazepam
Formulation and pharmacology of midazolam
Structure of midazolam
Flumazenil
Alpha-2 agonists in anaesthesia
Neuromuscular Blocking Drugs
What is muscle relaxation and how can it be achieved.
Nicotinic cholinergic receptors
Please describe the site of action of neuromuscular blocking agents.
Margin of safety of neuromuscular function.
Describe events during onset of depolarising / non-depolarising neuromuscular block
Characteristics of depolarising and non depolarising block
Comparison of depolarising and non-depolarising neuromuscular blockers
Structural features of non-depolarising muscle relaxants
Structure activity relationships
Classify muscle relaxants.
Absorption and elimination of quarternary ammonium compounds
Advantages of newer NMBs
Factors affecting onset of muscle relaxants
Factors determining onset time
Can you explain the offset of non-depolarising muscle relaxants?
Dose-response curves of neuromuscular blocking agents.
Dose-response curve of different muscle group
Definitions of ED95
Cardiovascular effects
Drug effects on skeletal muscle tone
Intraocular pressure
Elimination of NMBs
Breakdown of agents
Effects of antibiotics on neuromuscular blockade
Renal failure and use of muscle relaxants
Prolonged blockade
Sevoflurane Cisatracurium
Suxamethonium
Types of block with suxamethonium
Can you classify and list the side effects of Suxamethonium administration?
Contraindications and side-effects of suxamethonium,
Suxamethonium apnoea.
Dibucaine number.
Site of action of atracurium
Rocuronium
Contents of an ampoule of Vecuronium
Vecuronium infusion
Compare/contrast pancuronium and vecuronium
Account for a case of delayed recovery from vecuronium
Vecuronium vs atracurium kinetics
Vecuronium, Pancuronium, Suxamethonium
Formulation of atracurium
Metabolism and chemical breakdown of atracurium
Cardiovascular effects of atracurium
Cis-atracurium vs atracurium
Cisatracurium
Mivacurium
Laudanosine
Explain the techniques used to monitor neuromuscular block.
Measurement of muscle relaxant effect
Use of peripheral nerve stimulator
Train of four ratio
Assessment of neuromuscular block.
How do you assess reversal of muscle relaxants?
Monitoring of adequacy of reversal of block
Tell me about neuroleptic malignant syndrome.
Dantrolene
Reversal Agents
Antagonism of residual neuromuscular block
Cholinesterase and anticholinesterases
Types of anti-cholinesterase drugs.
Explain the mechanism of action of anticholinesterases.
Atropine, Glycopyrrolate, Neostigmine
How does neostigmine act on acetylcholinesterase?
Neostigmine
Compare neostigmine and edrophonium
Neostigmine like drugs
Organophosphate toxicology
Anticholinergics
Atropine toxicity
Comparison of atropine and glycopyrrolate
Discuss the pharmacodynamics of atropine.
Pharmacology of atropine and scopolamine
Synthesis and release of acetylcholine
Opioids
Mechanism of action of opioids
Opiate receptors
Structure activity relationships of opioids
Epidural/intrathecal opioids
Conversion to oral opioids
Log dose-response curves for opioids
Opioid metabolism
Duration of action
Discuss the clinical uses of long acting opioids.
What are the side effects of opioids ?
Describe tolerance to opioids
What drug factors influence the side effects of opioids ?
Cardiovascular effects of opioids
Codeine bioavailability and metabolism
Codeine, Morphine, Fentanyl, Alfentanil, Remifentanil, Tramadol
Pentazocine
Remifentanil, kinetics and cardiovascular effects
Onset of action of Fentanyl.
Tell me about the effects of Fentanyl on the cardiovascular system.
Compare fentanyl, alfentanil and remifentanil
Pharmacokinetics of pethidine and fentanyl
Morphine vs fentanyl vs alfentanil
Comparison of fentanyl and morphine
Fate of I.V. bolus of morphine.
Describe the metabolism of morphine
Plasma concentration time graph of morphine.
Change of etCO2 with time after an IV bolus of morphine.
Side effects of morphine
Morphine structure and substitutions
Tell me about the effects of Morphine on the cardiovascular system.
Comparison of morphine and pethidine
Pharmacology of naloxone
Naloxone pharmacokinetics
Analgesics
NMDA receptors
Codeine Tramadol
Compare and contrast Paracetamol and Acetylsalicylic acid.
Give a classification of non-opioid analgesic drugs.
How do N.S.A.I.D.S. work? (mechanisms of action)
Side effects nonsteroidal anti-inflammatory drugs.
Aspirin
Toxicity of aspirin and paracetamol
Paracetamol
What is your recommended dose of paracetamol?
What is the toxic dose of paracetamol?
Tramadol, kinetics and effects
Pharmacodynamics of tramadol.
Local Anaesthetics
Classification of local anaesthetics
Draw the structure of an ester local anaesthetic
Structure - Activity - Relationships of local anaesthetics
Describe the structure/function relationships of local anaesthetics
Isomers of local anaesthetics
Significance of isomers
Mechanism of action of local anaesthetics
Describe the site of action of local anaesthetics
Topical use of local anaesthetics
Contents in an ampoule
Additives to local anaesthetics
Effect of adrenaline and pH
Kinetics after epidural injection
Spread of agents administered into the epidural space
Significance of protein binding
Significance of pKA
Correlate the pKa of local anaesthetics and their activity
Metabolism of local anaesthetics
Local anaesthetic toxicity, toxic dose, blood levels
Systemic toxicity
Foetal LA toxicity
Toxicity lignocaine vs bupivacaine (R + S).
Toxicity of amide local anaesthetics (lignocaine, prilocaine and bupivacaine)
Treatment of amide local anaesthetic CVS/CNS toxicity
Cardiotoxicity of local anaesthetic
Comparative toxicity of bupivacaine vs ropivacaine
Ropivacaine
Ropivacaine, Lignocaine, Bupivacaine, Prilocaine, Cocaine
Comparison of bupivacaine with lignocaine
Epidural administration of bupivacane
Discuss the brain concentration of bupivacaine after an epidural dose
Recognition of structure of lignocaine.
Pharmacokinetcs of lignocaine
Metabolism and protein binding of lignocaine.
Effects of lignocaine on nerve conduction
EMLA
Cocaine
What are the effects of cocaine on the heart ?
Cardiovascular Pharmacology
Drugs acting on calcium channels
What drugs are used in cardiac arrest?
Management of myocardial ischaemia
Classify drugs used in cardiac failure
What is the structure-activity relationship of vasopressors?
Types of vasoconstrictors
Choice of drugs to treat hypotension after spinal anaesthesia
Catecholamines: structure-activity, receptors
Metabolism of catecholamines, MAO inhibitors
Direct and indirect adrenergic agents
Structure activity relationships in adrenergic agonists
Pharmacology of beta adrenergic agents
What is the structure-activity relationship in β agonists
What is the effect of B2 agonist drugs, how do they work ?
Adrenaline
Describe the production of adrenaline in the body.
Termination of effect of noradrenaline
Dopamine
Dopamine receptors
Pharmacology of ephedrine
Choosing between ephedrine and metaraminol
Comparison of ephedrine and metaraminol
Classify positive inotropic drugs
Classify inotropes
What is phosphodiesterase. What drugs affect it ?
Classification and clinical indications of phosphodiesterase inhibitors
PDE inhibitors: theophylline, milrinone
Antiarrhythmics: classification and electrophysiology
Pharmacological treatment of ventricular fibrillation
Adenosine, Amiodarone
Actions of adenosine.
Tell me about the cardiac effects of Adenosine.
Discuss digoxin
What are the side effects of digoxin?
Beta blockers
What are the side effects of sotalol?
What can you tell me about Esmolol?
Alpha blockers
2 agonists
a2 agonists pharmcodynamics.
The pharmacology of clonidine
Effects of IV clonidine
Classify the anti-hypertensive drugs
Tell me about agents that are used to lower blood pressure.
Antihypertensives in pregnancy
Discuss one parenteral antihypertensive.
Renin-Angiotensin system
Classification of vasodilators.
Glyceryl trinitrate and sodium nitroprusside
How does GTN work ?
Pharmacology, metabolism and toxicology of sodium nitroprusside
Sodium nitroprusside mechanisms of action and metabolic toxicity.
Pulmonary vasodilators
Nitric oxide
Diuretics
Classify diuretics by their site of action
Actions of diuretics,
Dose response curve for diuretics
Comparision of thiazide & loop diuretics
Specific Agents
Gastrointestinal Pharmacology
Antiemetics
Classification of anti-emetics
Pharmacology of anti-emetics
Classify drugs that affect the gastric acidity.
What agents can be used to decrease gastric acidity ?
Mechanisms of altering intraluminal gastric pH
Drugs that increase gastric emptying
Obstetric Pharmacology
What drugs affect uterine motility?
Can you tell me about Ergometrine?
Clinical toxicity of Mg
Drugs that affect the uterus
Oxytocics
Oxytocin
Uterine relaxants
Endocrine
Drugs that affect blood sugar
Classify insulins
Insulin preparations
Classify oral hypoglycaemics
Hypoglycaemic agents
Coagulation
Drugs affecting haemostasis
Drugs and haemostasis
Anticoagulants and the reversal of their effect
Action of warfarin
What are the kinetics of heparin?
Explain how Heparin exerts its anticoagulant effect.
Heparin vs LMW heparin
Heparin-effects, metabolism
Describe the anti-platelet agents
Heparin, Protamine, Antiplatelet agents
Side effects of Protamine
DDAVP, mechanism of action
Fluids
Dextrose vs dextran
Haemmaccel
Side effects of sodium bicarbonate
Mechanism of action of mannitol
Colloids; mannitol
Acetylcholine
Bradykinins
Histamine and antagonists
Histamine and histamine receptors
Describe the distribution of histamine receptors
Prostaglandins, synthesis and inhibition
Drugs used to treat asthma
Methylxanthines
Theophylline
Recognise 5-hydroxy typamine. What drugs interact with 5HT ?
Serotinergic receptors
Serotonin agonists and antagonists
Tricyclic antidepressants
Monoamine oxidase inhibitors
Describe the mechanism of action of anti-convulsants
Mechanism of action of antiepiliptic drugs
Can you tell me about Phenytoin?
Kinetics and side effects of phenytion
Antibiotics mechanisms of action
Differences within the penicillin class of drugs
DNA and RNA, and recombinant drugs
Statistics:
Types of data
Define nonparametric data ?
Parametric and non parametric data
What are ordinal data?
What are descriptive and inferential data?
Appropriate statistical test for various types of data
Selection of statistical tests
Type I and II errors
What is a type II error?
Power of statistical tests
Null hypothesis
Outline a chi-squared test
Normal distribution, Measures of central tendency
What is a standardised normal distribution?
Standard error of the mean
Role of SD versus SEM
What is a t distribution?
Can you define standard deviation and explain confidence levels?
Information from confidence intervals versus P-value
Confidence intervals
How does one determine sample size in statistics?
Methods of determination of statistical significance
Tests of significance
Meaning of P values (<0.5) and confidence limits
Modelling
What is meant by meta-analysis?
Odds ratio
Risk ratio
Specificity / sensitivity / predictive value
Correlation
What is bias?
What are some sources of bias
Bias in clinical research
Basics of study design and clinical trials
Early phase (I-II) drug testing
Statistical classification of data relating to trial of antiemetic drug and test that may be used to
analyse the data.
Statistical classification of data relating to trial to assess potency of inhalational agent and
appropriate statistical test.
Statistical determination of analgesic efficacy