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PHARMACOLOGY

(CPHAD301M)

Study Guide

KING ABDULAZIZ UNIVERSITY

Faculty of Medicine

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Table of content Study Guide ........................................................................................................................... 1

Table of content ..................................................................................................................... 2

القسم رئيس كلمة ........................................................................................................................... 3

Course Description and Organization .................................................................................... 4

Major Course Objectives ....................................................................................................... 5

STUDY STRATEGIES AND CLASS PARTICIPATION EXPECTATIONS .................... 6

Instructional Methods .............................................................................................................. 6

Instructional Materials And Resources .................................................................................... 6

Assessment ............................................................................................................................... 7

Students support ....................................................................................................................... 8

Male Section: Men Medical Complex ..................................................................................... 8

Female Section: Women Medical Complex ............................................................................ 8

Department Web Site ............................................................................................................... 9

Time Allocations .................................................................................................................... 10

Icons (standards) .................................................................................................................. 11

Topic Outlines ...................................................................................................................... 12

1-Lectures ............................................................................................................................ 13

2-Practical ............................................................................. Error! Bookmark not defined.

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كلمة رئيس القسم

م عليكم وبعدالابنائى وبناتى الطالب الس

مرحبا بكم فى قسم علم االدويه

:أن رسول هللا صلى هللا عليه وسلم قال رضي هللا عنه عن أبي سعيد الخدري

رواه "ما خلق هللا من داء إال وجعل له شفاء،علمه من علمه،وجهله من جهله ، إال السام "

حث "علمه من علمه ، وجهله من جهله : " الموت وفي قوله صلى هللا عليه وسلم والسام ابن ماجه

وقد ربط . لألطباء المسلمين على البحث واالستقصاء الكتشاف أدوية ألمراض لم يعرف لها بعد دواء

ال يزيد وينبغي أ به،فلكل دواء مقدار معين يعمل للداء،النبي صلى هللا عليه وسلم الشفاء بموافقة الدواء

.وال ينقص

لذلك انتم تدرسون علم الدواء واألمل معقود عليكم لتحقيق االستخدام األمثل لالدويه الحالية والمضي

-المستقبل الكتشاف وتطوير أدويه جديدةفى قدما

إن علم االدويه علم متعدد الروافد ومتعدد العطاء للعلوم األخرى و فهم علم االدويه سوف يؤهلكم

ينتظره المجتمع االستخدام األمثل للدواء وهذا ما قعلم العالج وتحقي مدة قويه لفهبقاع

السعودي منكم وإنها أمانه وانتم بإذن هللا أهال لحمل االمانه

كما اوصيكم باالستفاده من اعضاء هيئة الحرص على حضور المحاضرات هو مفتاح النجاح والتفوق

التدريس من خالل التواصل االليكترونى والمباشر خالل الساعات المكتبيه

اسأل هللا لكم التوفيق وعليكم ببذل الجهد والمثابرة في مدارسة المادة وسوف تجدون أعضاء القسم

الدراسي وتوجيهكم مستعدون لتذليل كل الصعاب التي تواجهكم للفهم واستيعاب المنهج

والفهم للطرق المثلى للمذاكرة

سمير الحارثى د

رئيس قسم علم االدويه

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Course Description and Organization

The aim of pharmacology course in dentisry is to introduce you to the

basic principles of pharmacokinetics & pharmacodyanmics ; to recognize

adverse drug effects and drug-drug interaction and to understand the

rational basis of selection optimal drugs & dosing regimens in view of patients

Dr.ile

The course includes and covers the following topics: disinfectants and

antiseptic in dental practice, Anticaries, clinically important drugs affecting

autonomic nervous system; chemotherapy for bacterial, fungal and viral

infections. . and anti cancer drugs. It also covers drugs affecting CNS : Non-

Steroidal Anti-inflammatory Drugs, Central Nervous System Stimulants; ,

Antiparkinsonian. The course includes three tutorial sessions : Antibiotics,

Cancer chemotherapy and CNS drugs. Practical sessions illustrate Prescription

writing, Pharmacokinetic calculations, Drug forms and routes of administration,

and demonstrate the effect of autonomic drugs on rabbit eye. . It also includes

clinically relevant case studies , on ANS and bacterial chemotherapy and Drug-

drug , interactions.

The course consists of lectures, practical classes and tutorials.

Core Course

Code/No

Course Units

Credit

Hours Lectures Practical SPP Tutorial

Pharmacology PHAD301 15 2 2

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Major Course Objectives

.

The course offered to 3rd

year dental students in pharmacology consists of scheduled

lectures, practical and tutorial which ensure smooth flow of the scientific material, in a

controlled manner, through several pathways to achieve our objectives. There is some

suggestion for optimal utilization of these classes by the students.

A. Lectures: The aim of the lecture is not to give all information but to highlight the

clinically relevant topics and to explain difficult points: students are advised to

1) Understand the course objectives of each lecture and read the topic from the

recommended textbook.

2) Pay attention during the lecture; write down your notes and, questions.

3) Make a summary, utilize self-testing in order to assess your grasping of the subject if is

possible to study the lecture in the same day which is highly recommended.

B. Practical class: For optimal utilization of the practical class time it is advisable to:

1. Read your practical worksheet so as to have view of what is expected from you to

perform, observe and draw conclusions on your practical work.

2. Use a record of the practical session according to instructions.

3. Use the practical time for discussing difficult theoretical or practical points with

the instructor.

4- Submit your homework on time ( as directed by instructors )

C. Tutorials: For optimal benefit of the tutorial, the tutorial will be reserved for open

discussion about the subjects listed in the tutorial schedule. The students will be

assigned these topics and will be asked to present them and be ready to discuss the most

recent knowledge about these topics and how to defend their thoughts on scientific

bases

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STUDY STRATEGIES AND CLASS PARTICIPATION EXPECTATIONS

Instructional Methods

The main instructional material includes lectures and practical to streamline the applied

and clinical aspects of the lectures, and tutorials session to stimulate the students to

participate in the teaching/learning activities.

Instructional Materials And Resources

1. Required Text(s)

1) Lippincott's Illustrated Reviews: Pharmacology, 5th Edition

by Richard A Harvey ;Pamela C Champe ;Richard Finkel ;Luigi Cubeddu &, Michelle A

Clarke (Editors) . Lippincott Williams & Wilkins 5th ed.

2 ) Katzung & Trevor's Pharmacology Examination and Board Review: 10th Edition

by Anthony Trevor, Bertram Katzung, and Susan Masters . MCGraw Hill, ; 12th ed 3- Practical ( Manual of practical & clinical pharmacology )

3- Recommended Books and Reference Material (Journals, Reports, etc) (

1- Integrated Pharmacology:

by Clive Page ;Brian Hoffman ;Michael Curtis ; Michael Walker (Authors) ; 3rd edition , Mosby & Elisevier; 2006

2- Goodman & Gilman's The Pharmacological Basis of Therapeutics

by Laurence Brunton), John Lazo (), Keith Parker ; McGraw-Hill Dr.essional; 12th Edition; 2011

4-.Electronic Materials, Web Sites etc ( assessed September 2015 )

http://www.icp.org.nz/ ( very important for pharmacokinetics )

http://www.cochrane.org. Mechanism of drug action Chemotherapy

http://www.cdc.gov/ncidod/srp/drugs/drug-service.html

http://www.merck.com

http://www.psychiatryonline.com/

5- Other learning material such as computer-based programs/CD, Dr.essional

standards/regulations

Software for experimental pharmacology& clinical pharmacokinetics

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Assessment

Summative This type of assessment is used for judgment or decisions to be made about your performance.

It serves as:

a. Verification of achievement for the student satisfying requirement

b. Motivation of the student to maintain or improve performance

c. Certification of performance

d. Grades

In this Course your performance will be assessed according to the following:

Schedule of Assessment Tasks for Students During the Semester

Asses

sment Assessment task ( Week due

Proportion of

FinalAssessment

1.

Quiz 1 10 %

2. Mid Year Exam 20 %

3 Quiz 2 10 %

4 ( Practical ) 10

5 Final exam 50% Total = 100 Marks

Grades

95-100 5 A+

90-94 4.75 A ( excellent )

85-89 4.5 B+

80 - 84 4 B (very good )

75 - 79 3.5 C+

70-74 3 C (Good)

65 - 69 2.5 D+

60 - 64 2 D ( pass )

Less than 60 1 F ( fail )

All grades will be assigned as follows:

Exams might include short answer and multiple choice questions (MCQs). They will cover

material presented in lecture, tutorials and integrated with the practical sessions . Practical

exams might include : MCQ , problem solving short essay and prescription writing .

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Students support

All teaching staff are available daily for individual student consultations and academic

advice from the start time of the module throughout the whole module period. Office hours

would by announced as a schedule at the start of the module showing periods per week each

faculty member are available in his office to be contact with students to answer their quires) .

The following is a list of the faculty members and staff of the Department of Pharmacology.

Students are welcome to contact any of the members of the department to answer any of their

inquiries.

Male Section: Men Medical Complex

Pharmacology dept., Bld No.( 7 )

Name/Status Room

No

Phone

No

E-Mail Address Office Hours

Dr. Sameer E. Alharthi 763/G 20106 Salharthe@Kau.edu.sa

10 am-1.00 pm

Dr..Abdel-Moneim Mahmoud

Sameer E. Alhathi

754A 20218 Amthman1@ kau.edu.sa 10AM-01 PM

Dr. Ahmed Shaker Ali 755G 22330 Asali@kau.edu.sa 1.00- 2.00 PM

Dr. Lateef Mohiuddin Khan 740G 20343 lmkhan@kau.edu.sa

10AM- 11.00

daily

Female Section: Women Medical Complex

Pharmacology dept., Bld No.( 6 )

Name/Status Room

No

Phone

No

E-Mail Address Office Hours

Dr.. Magda Mohamed Hagras 673 G, 23100 magyhagras@hotmail.com 11. 12 AM-

Dr. Mai Abdul Alim Abdul Sattar 672 G, 23102 drm_aalim2000@yahoo.com 9. -11. AM

Dr Huda Alkreathy 672 G 23090 halkreathy@kau.edu.sa 1-12 AM

Dr. Fatma Kamel 674 A 23564? foakamel@kau.edu.sa 10-12 AM?

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Department Web Site

http://medical-pharmacology.kau.edu.sa

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Time Allocations

List of topics Contact hours

Lecture practical Tutorial

1-Introduction to general pharmacology in dentistry (

overview of drug classification ) 1

2-Introduction to disinfectants and antiseptics in dentistry 1

3.Pharmacodynamics 1 4.Anticaries 1 5- pharmacokinetics 1 Pharmacokinetics Tutorial 1 Practical pharmacology (routes , dosage forms ) 1 6.Factor affecting drug response 1

7.Unwanted drug effects 1 9.NSAINDs 1

9.NSAINDs 1 10. Immunosupressive drugs 1 11. Histamine and antihistamine 1 12-Sertonin and serotonin antagonists,Prostaglandins 13-Corticosteroid and its antagonists 1 14 Corticosteroid and its antagonists 1 15.Antiplaque and antigingivitis 1 16-Introduction to Antimicrobial therapy in dentistry 17. Antibiotics , cell wall inhibitors 18. Antibiotics protein synthesis inhibitors 19. Antimicrobials : quinolones, folate antagonists Applied antimicrobial therapy ( integrated with oral

medicine ) ** ( case –based ) 2

20- Antifungal agents 1 Practical Prescription writing 1 21. Antiviral agents

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Icons (standards)

The following icons have been used to help you identify the various

experiences you will be exposed to.

Learning objectives

Content of the lecture

Independent learning from textbooks

Independent learning from the CD-ROM. The computer cluster is in the 2

nd floor of the medical library, building No.

7.

Independent learning from the Internet

Problem-Based Learning

Self- Assessment (the answer to self-assessment exercises will be discussed in

tutorial sessions)

The main concepts

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Topic Outlines

21: Lectures ,

3: Tutorials

3: practical class

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1-Lectures

Lecture: 1. Introduction to general pharmacology in dentistry

Department : Pharmacology

Lecturer: Prof.Dr.Abdel-Moneim (M.sec) Prof . Magda (F. sec )

TEACHING LOCATION :

Objectives

At the end of the lecture you should be able to

1. Describe and define the basic terms and concepts of

pharmacology?

2. define Pharmacokinetics , pharmacodyanamics , adverse drug

effects ,

3. Understand basics of classification of drugs *** ,

4. Recognize the basic principles of rational use of drugs. ( benefit./

risk )

Topics

1. Definition the science of pharmacology

2. Sources of drugs

3. Types of drug action

4. Mechanism of drug action

5. Routes of drug administration

6. Drug classification, therapeutic uses , mechanism , chemistry

Student Notes:

(Insert here

handouts and

additional pages

for notes if

needed)

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Continued

Remember

All members of health care team must exercise care to

promote therapeutic effects and minimize drug induced

harm

Text book

1. Lippincott’s illiterated review , 5th

Edition, R.D. Howland M.J.

Mycek. Lippincott’s Williams & Wilkinsp 1-22

2. Handout & solved problems provided by the lecturers

CD

CP – Pham & an educational program for PK analysis will be

provided.

Independent learning from the Internet

valuable web www.icp.org.nz (pK animation)

http://www.pjonline.com/pdf/cpd

/pj_20040619_pharmacokinetics01.pdf { basic Pk }***

/pj_20040626_pharmacokinetics02.pdf ( variability in dose

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requirement ) /pj_20040807_pharmacokinetics04.pdf { TDM }

/pj_20040731_pharmacokinetics03.pdf ( dose adjustment )

Self- Assessment (the answer to self-assessment exercises will be discussed

in tutorial sessions or with staff during office hours )

I- MCQ

1- Which of the following is true concerning drugs definition

A. Any substance used to relief pain and anxiety. B. Any substance in tablets, capsules, or injection forms. C. Any substances used treat diseases and cause no side effects. D. Any substance used to cure, or prevent diseases E. Any low molecular weight substance with high fats solubility.

2- Which of the following best describe the science of pharmacology?

A. Science of the study of drugs in all aspects B. Science of how drugs treat diseases C. Study of biochemical and physiological effects of drugs and their

mechanisms of action D. Study of how drugs should be administrated E. Science of how to prescribe drugs

3- Which of the following is true concerning the role of physician and dentists in the traditional health care

A. Dispensing drugs B. Prescribing drugs C. Monitoring therapeutic response D. B and C E. A , B, and C

4- Which of the following is true concerning the role of clinical pharmacist in traditional health care

A. Monitor drugs concentrations in the plasma. B. Monitor drugs adverse reaction and side effects C. Metabolism of the drug always abolish their pharmacological activity D. Dispensing drugs and teach the patients who to use them E. All of the above.

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5- Which of the following best describe the concept of active principle.

A. A substance responsible for drugs side effects B. A substance responsible for drugs therapeutic response and causes

little side effects or no. C. A substance responsible for toxic effects in herbal products. D. A and C E. A, B, ad, C

6- Which of the following is true Concerning active principles in a drug

A. The drug may contain one active principle B. The drugs may contain two active principles. C. The drug may contain more than four active principles D. The drug may contain no active principles E. All of the above

II- Short answer questions

1. What is Pharmacology?

2. What is the importance of pharmacology to drugs prescribers (physician, dentists, and pharmacists)?

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Lecture 2 : Disinfectants and antiseptics in dentistry Students notes

Department : Pharmacology

Lecturer : Dr.Ahmed Shaker (Male Section) and Prof.Magda (Female Section

Objectives

1. Define the different terms related to disinfictant and antiseptics

2. Classify disinfictants and antiseptics

3. Identify their mechanism of action

4. Apply their use clinically according to mechanism of action

5. Design a strategy for infection control for dental patients

Topics

1. Properties of good antiseptic/ disinfectant

2. Mechanisms of action of antiseptic and disinfectants

3. ClassificationAlcohols: Ethanol, isopropanol

4. Aldehyde: – Formaldehyde

5. Acids:– Acetic acid, boric acid

6. Metallic salt– Mercuric compounds , silver –& zinc salts

7. Dyes:– Gentian violet, acriflavine

8. What are the natural antiseptics disinfictant that can be used?

Disinfectants and antiseptics should never be used interchangeably

because tissue toxicity and damage to equipment can result

The 10 points to be considered for selection of optimal Antiseptics or

Disinfectants

1. Chemical nature of disinfectant.

2. Spectrum of activity , mechanism, (-cidal or bstatic

3. Type of contaminating microorganism. ( bacteria, virus etc )

4. Degree of contamination..( size of inoculums )

5. Temperature, pH, concentration , time of contact

6. Presence of blood , pus , organic matter ( reduce effect of some

disinfectants ).

7. Biofilms and microbial load ( web search task 1 )

8. Residual activity and effects on fabric and metal

9. Toxicity to the environment and relative safety to people

10. Cost

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Self- Assessment (the answer to self-assessment exercises will be

discussed in tutorial sessions or with staff during office hours )

1- Hydrogen perioxide produce its antiseptic effect through which of

the following mechanism

A. Producing highly reactive hydroxyl-free radicals that damage protein and

DNA

B. Altering permeability of bacterial membrane

C. Alkylating protein and DNA of bacteria

D. React with bacterial enzymes , inhibiting their activity

2-Alcohol my be used at appropriate concentration ( 70-90 % ) as antiseptic

in dental practice. It has the following characteristics EXCEPT

A. it has bactericidal effect against vegetative forms of bacteria (Gram + and

Gram -);

B. it has tuberculocidal, fungicidal, and virucidal effect against enveloped

viruses.

C. It is considered as an alternative to hand washing

D. It is effective against most bacterail spores

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Lecture 3. Pharmacodynamics Lecturer: Dr Ahmed Shaker (M.sec) Prof . Magda (F. sec )

TEACHING LOCATION : Department : Pharmacology

:

Objectives

At the end of the lecture you should be able to

1. Specify whether an antagonist is competitive or irreversible

based on its effect on the dose-response curve of an agonist

2. Give examples of competitive and irreversible pharmacologic

antagonists, and physiologic and chemical antagonists

3. Name the main 4 receptor subfamilies

4. Describe the term desensitization phenomenon and its

underlying mechanism

Topics

1. Competitive and irreversible pharmacologic antagonists

2. Physiologic antagonists, chemical antagonists

3. Signaling mechanisms: intracellular receptors, G-protein receptors,

tyrosine-kinase receptors, and ion channel receptors

4. Desensitization or tachyphylaxis of receptors

Remember O Pharmacodynamics deals with the actions, interactions and the

mode of action of drugs.

O Receptors are macro- molecular proteins on which drugs (ligand)

interact and produce a biological response

O Agonist is a drug which binds to the receptor (has affinity) and

activate it (has intrinsic efficacy) while antagonist has affinity but no

intrinsic efficacy.

O efficacy refers to the maximum or peak response produced by a

drug

O Drug tolerance means requirement of a higher dose of a drug to

produce a given therapeutic response. It mabe natural or acquired

Students notes

(Insert here

handouts and

additional pages

for notes if needed)

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Text book Katzung & Trevor's Pharmacology Examination and Board Review: 9

th ed.

by Anthony Trevor, Bertram Katzung, and Susan Masters . MCGraw Hill,

CHAPTER 2

CD ; available in lab to demonstrate pharmacodynamic of

hypertension , bronchial asthma , smooth muscle contraction

Check internet for Animation of receptor

Self- Assessment (the answer to self-assessment exercises will be discussed

in tutorial sessions)

Which of the following describes an agonist?

A-: a drug have minimal adverse effects

B- a specific receptor in the biologic system where a drug

interacts

C- a drug that binds to a receptor and stimulates cellular activity

D- a drug that binds to a receptor and inhibits cellular activity

If drug A has a greater efficacy than drug B, then drug A

a. Is more toxic than drug B

b. Has a greater affinity for the receptor than drug B

c. Has a greater margin of safety than drug B

d. Is capable of producing a greater maximum effect than drug B

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The results shown in the graph were obtained in a comparison of

positive inotropic agents

a) Drug B is the least potent

b) Drug C is the most potent

a) Drug B is more potent than drug C and more effective than drug

A

c) Drug A is more potent than drug B and more effective than drug

C

The maximum effect (Emax) achieved by a drug is a measure of

b) Potency

c) Efficacy

d) The quantal response

e) The therapeutic index (TI)

Agonists are drugs that

a) Block tissue receptor sites

f) Activate tissue receptor sites and leads to clinical response

b) Reverse the effect of other drugs on tissue receptor sites

c) Irreversibly bound to receptor sites

How is the therapeutic index of a drug calculated

a) Half the toxic dose is divided by half the therapeutic dose

b) The maximum tolerated dose is divided by the minimum

therapeutic dose

a) The toxic dose for 50 % of animals is divided by the therapeutc

dose for 50% of animals

c) The therapeutic dose for 50% of animals is divided by the toxic

dose for 50% of animals

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Lecture 4 :Anticaries

Department : Pharmacology

Lecturer : Prof.Abdel-Moneim Osman both (Male Section) and (Female Section)

OBJECTIVES

At the end of the lecture you should be able to

1- to classify anticaries agents

2- to be able to list anticaries agents

3- to identify the mechanism of action of each group

4- to know how to apply anticaries agents

5- to realize the difference between different agents

6- to distinguish any side effects or limitations in the use of these agents

TOPICS

-Identify caries

2- Main criteria required for caries formation

3-Prevention and dietary modification

4- Fluoride and other anticaries and how they induce their action (

mechanism of action).

5-Toxicity of Fluoride.

Self- Assessment (the answer to self-assessment exercises will be discussed in

tutorial sessions or with staff during office hours )

Describe the mechanism of action of Fluoride in caries prevention?

??

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Lecture 5 :Pharmacokinetics of drugs ( 2h ), 1 h tutorial

Department : Pharmacology

Lecturer : Dr. Shaker (M Section) and Prof.Magda (F Section

At the end of the lecture you should be able to

Objectives .

1. 3-Recognize the fundamental pharmacokinetic process (ADME).

absorption, distribution, metabolism and excretion

2. 5- Identify variables affecting bioavailability, drug distribution,

metabolism and Execration.

3. 7- Correlate the variability in drug response to the changes in

pharmacokinetics

Topics

1. Variables affecting drug absorption , bioavailability: first pass effect

2. , Variables affecting drug distribution , , blood flow , capillary

permeability, blood brain barrier, protein binding

3. , phase 1 & phase II metabolic pathways ,

4. enzyme induction & enzyme inhibition

5. Renal elimination and assessment of renal function its uses to

guide dosing intervals of antibiotics

Self- Assessment (the answer to self-assessment exercises will be discussed in

tutorial sessions or with staff during office hours )

What does the term “bioavailability” mean?

a) Plasma protein binding degree of substance

b) Permeability through the brain-blood barrier

c) Fraction of an unchanged drug reaching the systemic circulation

following any route administration

d) Amount of a substance in urine relative to the initial doze

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Which route of drug administration is most likely to lead to the

first-pass effect?

a) Sublingual

b) Oral

c) Intravenous

d) Intramuscular

Biotransformation of the drugs is to render them:

a) Less ionized

b) More pharmacologically active

c) More lipid soluble

d) Less lipid soluble

Stimulation of liver microsomal enzymes can:

a) Require the dose increase of some drugs

b) Require the dose decrease of some drugs

c) Prolong the duration of the action of a drug

d) Intensify the unwanted reaction of a drug

Metabolic transformation (phase 1) is:

a) Acetylation and methylation of substances

b) Transformation of substances due to oxidation, reduction or

hydrolysis

c) Glucuronide formation

d) Binding to plasma proteins

Half life (t ½) is the time required to:

a) Change the amount of a drug in plasma by half during elimination

b) Metabolize a half of an introduced drug into the active metabolite

c) Absorb a half of an introduced drug

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Lecture 5 :Factors affecting drug response

Department : Pharmacology

Lecturer : Dr.Lateef (Male Section) and Prof.Magda (Female Section

objectives At the end of the lecture you should be able to

1. Discuss the influence of age, sex, race and the environmental

factors on drug response ( both PK & PD aspects )

2. Describe the effect of diseases on drug action ( PD aspects )

Topics

1-Physiological Factors altered in

Age Newborns Children Geriatric age group (> 60 yrs)

Altered body composition , altered drug PK

2-Pregnancy and alteration of PK

3. Allergy to drugs

4. Pathological Factors Liver Disease Renal Disease

5. Malnutrition , effect on PK and PD

6. Genetic Factors

At the level of receptors At the level of drugs metabolizing enzyme

Idiosyncrasy

7. Environmental Factors , Time of Administration

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Remember

Text books

1. Integrated Pharmacology. Latest edition. Page, Curtis, Sutter,

Walker, and Hoffman. Mosby

2. Clinical Pharmacology, 9th edition P.N. Bennett and M.J. Brown.

Churchill Livingstone

MCQs

1. Liver disease may result in one of the following:

a) Increase in the excretion rate of a drug.

b) Impaired ability to metabolize or detoxify a drug.

c) Necessity to increase the dosage of a drug.

d) Decrease in the rate of drug absorption.

2. Pharmacological response to a drug is increased in infant because of:

a) More absorption of a drug

b) Better distribution of a drug

c) Decrease metabolism of a drug

d) Increase affinity of a drug for receptor site

3. Dose of a drug is generally reduced in elderly person due to:

a) Better absorption and distribution of a drug

b) Degenerative changes in liver and kidney

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c) Number of receptors are increased in old age

d) Increase in protein binding of a drug

4. In presence of liver disease one of the following changes is

observed:

a) Increase in Plasma protein binding.

b) Metabolism of a drug is reduced.

c) Microsomal enzyme activity is increased.

d) Half – life of a drug is reduced.

5. Which effect may lead to toxic reactions when a drug is taken

continuously or repeatedly?

a) Refractoriness

b) Cumulative effect

c) Tolerance

d) Tachyphylaxis

6. What term is used to describe a more gradual decrease in

responsiveness to a drug, taking days or weeks to develop?

a) Refractoriness

b) Cumulative effect

c) Tolerance

d) Tachyphylaxis

7. What term is used to describe a decrease in responsiveness to a drug

which develops in a few minutes?

a) Refractoriness

b) Cumulative effect

c) Tolerance

d) Tachyphylaxis

8. Pharmacokinetic variation of a drug response is due to:

a) Reduction in number of receptors.

b) Increase in number of receptors.

c) Increase in metabolism of a drug.

d) None of the above.

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Lecture 6 :Unwanted effects of drugs

Department : Pharmacology

Lecturer : Dr.Lateef (Male Section) and Prof.Magda (Female Section

Objectives

At the end of the lecture you should be able to

1. Classify the types of adverse drug effects.

2. What are the common causes of ADRs?

3. What are the risk factors for ADR?

4. How to prevent and reduce the incidence of ADRs?

Topics

1. Normal and abnormal adverse reactions and adverse reactions

2. Types of adverse drug reactions, pharmacovigilance, and

pharmacoepidemiology

Remember

Side Effects – collateral or other unpleasant pharmacological effects

of a drug observed in therapeutic doses.

Toxic effects - Harmful effects of a drug observed in either

overdose or due to its prolonged use

Allergic drug reactions: Harmful effects of a drug due to altered

immunological response.

Idiosyncrasy: Harmful effects of a drug due to genetic defect.

Teratogenecity – Ability of a drug to produce congenital defects in

the developinf fetus during pregnancy

Harmful withdrawal effects of a drug on prolong use are totally

preventable by tapering their doses

ADR are common and could be dangerous.

Many ADR can be predicated and avoided.

Special attention should be given to elderly, neonates, pregnant

women those suffering from chronic disorders.

29

Self- Assessment (the answer to self-assessment exercises will be discussed in

tutorial sessions or with staff during office hours )

MCQs on ADRs

1. Characteristic unwanted reaction which is not related to a dose or to a

pharmacodynamic property of a drug is called:

a) Idiosyncrasy

b) Toxic effect

c) Tolerance

d) Teratogenic action

2. Idiosyncratic reaction of a drug is:

a) A type of hypersensitivity reaction.

b) A type of drug antagonism.

c) Unpredictable, due to genetic enzyme deficiency and qualitatively

abnormal reaction to a drug. d) Quantitatively exaggerated response.

3. An undesirable effect of a drug that occurs at therapeutic doses and can

be predicted from its pharmacological action is called:

a) Side effect

b) Toxic effect

c) Allergic reaction

d) Idiosyncrasy

4. Which of the following is a type II (unpredictable) adverse drug reaction?

a) Side effect

b) Toxic effect

c) Idiosyncrasy

d) Physical dependence

5. The side effect of a drug which can been used as a therapeutic effect in

another condition is:

a) Dryness of mouth caused by atropine

b) Cough caused by Captopril

c) Uterine stimulation caused by Quinine

d) Diarrhea caused by Ampicillin

6. A pregnant woman developed a urinary tract infection caused by

Pseudomonas aeruginosa, and was treated with gentamicin. Which of

the following adverse effects was a risk to the fetus ?

a) Skeletal deformity.

b) Hearing loss.

c) Teratogenesis.

d) Blindness.

30

1- A pregnant woman developed a urinary tract infection caused by

Pseudomonas aeruginosa, and was treated with gentamicin. Which of the

following adverse effects was a risk to the fetus ?

A. Skeletal deformity.

B. Hearing loss.

C. Teratogenesis.

D. Blindness.

E. Mental retardation

31

Lecture 7& 8 :Non steroid anti-inflammatory drugs (NSAIDs)

Department : Pharmacology

Lecturer : Prof.Abdel-Moneim (Male Section) and Prof.Magda (Female Section

Objectives

At the end of the lecture you should be able to

1. Contrast the functions of COX-1 and COX-2

2. Describe the effects of aspirin on prostaglandin synthesis

3. Identify therapeutic uses, adverse effect and contraindication of

aspirin

4. Contrast the actions and toxicity of aspirin, the older non selective

NSAIDs and the COX-2-selective drugs

5. Explain the toxicity of aspirin and its management

6. Describe the actions of paracetamol (acetaminophen), its

pharmacokinetic effects, its clinical uses ,adverse effects and

toxicity.

Topics:

1. Aspirin and salicylates, diflunisal, ibuprofen

2. Indomethacin, piroxicam, mefenamic acid, diclofenac.

3. COX-2-selective NSAID’s: celecoxib.

4. Acetaminophen, acetylcysteine.

Remember

* Serious cardiovascular events associated with COX-2 inhibitors.

* Aspirin is unique among the NSAIDs in that it irreversibly acetylates

(and, thus, inactivates) cyclooxygenase.

* NSAIDs should be avoided in patients with asthma, hypertension,

and renal disease.

32

Self- Assessment (the answer to self-assessment exercises will be discussed in

tutorial sessions

An 8-year-old girl has a fever and muscle aches from a presumptive viral

infection. Which one of the following drugs would be most appropriate to

treat her symptoms?

A. Acetaminophen.

B. Aspirin.

C. Celecoxib.

D. Codeine.

E. Indomethacin.

Which one of the following statements concerning COX-2 inhibitors is

correct?

A. The COX-2 inhibitors show greater analgesic activity than traditional

NSAIDs.

A. B. The COX-2 inhibitors decrease platelet function.

B. The COX-2 inhibitors do not affect the kidney.

C. The COX-2 inhibitors show anti-inflammatory activity similar to

that of the traditional NSAIDs.

D. The COX-2 inhibitors are cardioprotective.

A 26-year-old woman takes a “handful” of acetaminophen in a suicide

attempt. At the emergency department, it is determined that she has taken

enough to be potentially harmful. Which of the following is the best

treatment for this patient?

A. Calcium gluconate

B. IgG against acetaminophen

C. N-acetylcysteine

D. Penicillamine

33

In which of the following conditions would aspirin is contraindicated?

A. Myalgia.

B.Peptic ulcer.

C.Toothache.

D.Rheumatoid arthritis.

-In addition to providing symptomatic ,supportive care, which of the

following would be a helpful adjunct to manage severe aspirin poisoning?

A-Actaminophen.

B-N-acetylcysteine.

C-Sodium bicarbonate.

D-Phenobarbital.

34

Lecture 9 :Immunosuppressive drugs

Department : Pharmacology

Lecturer : Prof.Abdel-Moneim (M Section) and Prof.Magda (F.Section

Objectives

At the end of the lecture you should be able to

1- Identify different classes of immunosuppressive agents

1- Describe The pharmacokinetics and mechanisms of action of different

immunosuppressive drugs.

2- Know the effect if immunosuppressive drugs on immunosystem.

Topics:

1. -Immunosuppressive drugs e.g. Cyclosporine,Sirolimu,Azathioprine

2. -Adverse effects of immunosuppressive drugs.

3. -Mechanism of Action of Immunosppressive drugs

Self- Assessment (the answer to self-assessment exercises will be discussed in

tutorial sessions

35

Lecture 10:Histamine and antihistamines

Department : Pharmacology

Lecturer : Prof.Abdel-Moneim for Male and Female Section

At the end of the lecture you should be able to

1. Recognize the pharmacological effects of histamine on various histamine

receptors

2. 2-Identify the drugs which antagonize the effects of released histamine.

3. 3-Describe the pharmacological effects, side effects and toxicity and

indications of H1 and H2 receptor antagonists.

Topics

1. First generation antihistamines

2. Second generation antihistamine

3. Mechanism of action and side effects of antihistminc drugs

Self- Assessment (the answer to self-assessment exercises will be discussed in

tutorial sessions

1-which of the following antihistaminc is most effective agent in preventing

motion sickness and nausea?

A-Cyclizine

B-Loratadine

C-Terfenadine

D-Desioratidine

36

Lecture 11 :5 HT and 5HT antagonists+Prostaglandin

Department : Pharmacology

Lecturer : Prof.Abdel-Moneim (Male Section) and Prof.Magda

(Female Section

Objectives

At the end of the lecture you should be able to

1-Recognize the main classes of prostaglandins and the basis of this

classification

2-Describe the pharmacological effects and therapeutic potentials of

each class of prostaglandins

3. Recognize the drugs which inhibit the synthesis and actions of

prostaglandins

4-Identify the biosynthesis and metabolism of 5-HT

5-Describe the pharmacological effects of 5-HT

6-List the names of some compounds which antagonize the effects of 5-

HT and their therapeutic uses.

Topics

1. Main Classes of Prostaglandins

2. -Mechanism of action of prostaglandin

3. Mechanism of action of serotonin and its therapeutic uses

Self- Assessment (the answer to self-assessment exercises will be discussed in

tutorial sessions

Sumatriptan succinate is effective for the treatment of acute migraine

headaches by acting as:-

A. An antagonist at β1 and β2 adrenergic receptors.

B. A selective antagonist at histamine (H1) receptors.

C. A selective agonist at 5-hydroxytryptamine 1D (5HT1D) receptors.

D. An inhibitor of prostacyclin synthase

37

38

Lecture 12 & 13 :Corticosteroids and antagonists

Department : Pharmacology

Lecturer : Prof.Abdel-Moneim (Male Section) and Prof.Magda (Female Section

Objectives

1. Classify the corticosteroids (natural and synthetic), the different

preparations available for systemic and topical applications

2. Identify the uses and contraindication of use of corticosteroids

3. Identify the adverse effects of the corticosteroids, and how to minimize

these adverse effects

4. Identify the withdrawal of systemic corticosteroid therapy

5. Recognise the use of adrenocorticol antagonists for tumour treatment.

Topics

1-Mechanism of action of corticosteroid 1- Classes of corticosteroid and their antagonists

2- Precautions taken during corticosteroid treatment

3- Side effects and withdrawal symptoms

4- Therapeutic uses of corticosteroid antagonists

Self- Assessment (the answer to self-assessment exercises will be discussed in

tutorial sessions

1-Corticosteroid therapy is practically mandatory in the following

condition:-

A- Septic shock.

B-Renal transplant.

C-Rheumatoid arthritis.

D- Exfoliative dermatitis.

39

Lecture 14 :Antiplaque-Antiginivitis

Department : Pharmacology

Lecturer : Dr.Ahmed Shaker (Male Section) and Prof.Magda (Female Section

Objectives

-Definition and reviewing the plaque and gingivitis

-Different antiseptic mouth wash

-Antimicrobial mouth rinse safety

-Adverse effect opf mouth wash

How antimicrobial mouthrinses work

Topics

Add the topics

Self- Assessment (the answer to self-assessment exercises will be discussed in

tutorial sessions

1-Do mouthrinses affect salivary flow?

2- Are there adverse effects on taste or tooth deposits?

40

Lecture 16 :Antimicrtobial therapy in dentistry (introduction)

Department : Pharmacology

Lecturer : Dr.Sameer(Male Section) and Prof.Magda (Female Section

Objectives

1. List common classes of anti-microbial agents used in dental practice

2. To understand variables affect efficacy of the antibiotics

3. To discuss the patients factors to be considered to insure safety

4. To discuss use of combination , minimizing resistance

5. To discuss how to select optimal regimen

Topics

1. Effect of the site of infection on therapy on efficacy.

2. Patient factors : Immune system: Renal , Hepatic dysfunction:

Pregnancy: Lactation etc

3. Mode of antibiotic efficacy and selection of optimal regimen

Concentration-dependent killing Time-dependent killing

4. Spectrum : Narrow-spectrum , Extended-spectrum Broad-spectrum

antibiotics

5. Combinations of Antimicrobial Drugs

6. Resistance

7. Prophylactic Antibiotics

8. Complications of Antibiotic Therapy

Resources , remember m self assessment

Will be provide at the end of this Block

41

Lecture : 17-19: Antimicrobial therapy and antibiotics 3lectures Cell wall Inhibitors, protein synthesis inhibitors, quinolones , others Department : Pharmacology

Lecturer: Dr. Sameer E. Alhathi (M.sec) Prof.. Magda . H(F. sec )

TEACHING LOCATION :

Objectives

At the end of the lecture you should be able to

1. Describe the mechanism of action of beta-lactam antibiotics.

Discuss their pharmacokinetics, clinical uses and adverse effects

2. Define the actions and uses of vancomycin

3. Describe the pharmacodynamic and pharmacokinetic properties

of the protein synthesis inhibitors:

4. Discuss the pharmacodynamic and pharmacokinetic effects,

clinical uses and adverse effects of the fluoroquinolones and

folic acid antagonists

Topics

:

1- Cell -wall inhibitors:Penicillins and cephalosporins, carbapenems,

monobactams. Beta-lactamase inhibitors, vancomycin

2- Protein synthesis inhibitors: , aminoglycosides, , macrolides,

clindamycin

3- Fluoroquinolones and folic acid antagonists

Students notes

(Insert here

handouts and

additional pages

for notes if

needed)

42

Continued

Remember

*Cross allergy is present- to some extent- between penicillins and cephalosporins. *Quinolones are contraindicated for patients less than 18 year old. **Antibiotics should be used for proper duration to obtain complete cure.

Text book

2 ) Katzung & Trevor's Pharmacology Examination and

Board Review: 10th Edition by Anthony Trevor, Bertram

Katzung, and Susan Masters . MCGraw Hill, 2012

1-Lippincott's Illustrated Reviews: Pharmacology, 5th Edition

by Richard A Harvey ;Pamela C Champe ;Richard Finkel ;Luigi Cubeddu &, Michelle A Clarke (Editors) . Lippincott Williams & Wilkins 2011

CD

Independent learning from the Internet

Self- Assessment (the answer to self-assessment

exercises will be discussed in tutorial sessions

Pls add MCQ related t to dental practice

43

Lecture :. 20-21 Antiviral Drugs & Antifungal drugs 2 Lecture Department : Pharmacology

Lecturer :Dr. Sameer E. Alhathi (M.sec) Prof .. Mai (F. sec ) TEACHING LOCATION :

Objectives

At the end of the lecture you should be able to

1. Describe the mechanisms of action , pharmacokinetic

properties, and the clinical uses, and adverse effects of drugs,

herps, and cytomegalovirus.

2. Discuss different classes of drugs used in treatment of AIDS

( HIV); their mechanisms of action and adverse effects.

3. Illustrate the mechanisms of action, pharmacokinetics and

clinical use of the major drugs used for fungal infections in

dental practice

Topics

1. Antiherpes drugs: acyclovir,..

2. Anti-HIV agents: nucleoside reverse transcriptase inhibitors

(NNRTIs), non-nucleoside reverse transcriptase inhibitors,entry

inhibitors,integrase inhibitors and protease inhibitors.

3. Antifungal drugs for systemic mycoses: amphotericin B,

flucytosine, and azoles

4. Antifungal drugs for cutaneous mycoses either used

systemically as terbenafine or topically as nystatin,

miconazole, clotrimazole,

Remember (1)

*Acyclovir is the drug of choice for herpetic infections. *Crystalluria ia an adverse effect of IV administration of acyclovir. *Myelosuppression is increased when gancyclovir is combined with zidovudine

Students notes

(Insert here

handouts and

additional pages for

notes if needed)

44

Remember (2) *Amphotericin B is The drug of choice in life threatening systemic mycoses, used in combination with flucytosin in cryptococcal meningitis . *Ketoconazole and amphotericin B should not be given together because the decrease in ergosterol of fungal membrane reduces the fungicidal action of amphotericin B. *Ketoconazole should be avoided in pregnancy

Text book

1-1-Lippincott's Illustrated Reviews: Pharmacology, 5th Edition

by Richard A Harvey ;Pamela C Champe ;Richard Finkel ;Luigi Cubeddu &, Michelle A Clarke (Editors) . Lippincott Williams & Wilkins 2009 2 ) Katzung & Trevor's Pharmacology Examination and

Board Review: Eighth Edition by Anthony Trevor, Bertram

Katzung, and Susan Masters . MCGraw Hill, 2008

Web search Recently approved antiviral ant antifungal drugs

Self- Assessment (the answer to self-assessment exercises

will be discussed in tutorial sessions

A.

45

2- Practical Practical pharmacology: 1-Drug forms and routes of drug

administration

Department : Pharmacology

Lecturer : : Dr Saad Mahrous & Dr. Fatma Kamel (Female

Section

Objectives

At the end of the lecture you should be able to

1. Know different dosage forms, advantage and disadvantages

of each form.

2. Know different routes of drug administration, advantage

and disadvantages of each form.

Topics

contents:

1. Different forms of tablets and factors affecting drug

absorption

2. Syrup, Suspension and Emulsion.

3. Difference between ampoule and vial.

4. Difference between cream and ointment

5. Inhalers

6. Skin patches

7. Sachets and their solubility

8. Advantages & disadvantages of Enteral route (oral, buccal,

rectal and sublingual)

9. Advantages & disadvantages of Parenteral route (IV, IM,

ID, SC…..etc)

46

Practical 3 : Prescription writing

Department : Pharmacology

Lecturer : Dr Saad Mahrous & Fatma Kamel

TEACHING LOCATION :

Objectives

At the end of the lecture you should be able to

1. How to prescribe proper medicine and to know the rational

steps in writing a prescription and the common prescribing

errors

2. Get the knowledge to consider the pathophysiology of the

diagnosis selected, select the specific therapeutic objective,

and determine the proper dosing regimen

Topics

1. Ordinary prescription

2. Narcotic prescription

Student Notes:

(Insert here

handouts and

additional pages

for notes if

needed)

47