ISBN 978-81-8448-362-8 Typeset at JPBMP typesetting unit Printed at Ajanta Offset & Packagins Ltd., New Delhi To My beloved students (who have been my teachers too) and My daughter Anvi Preface
We are what we repeatedly do,
excellence then is not an act, but becomes a habit. —Aristotle To impart skills to budding doctors practical pharmacology is an essential area of teaching. This practical manual describes what you do with your own hands which will help you throughout the life. This manual has been written keeping in view the desired shift in the pharmacology practical teaching from pharmacy based redundant experiments to more meaningful, clinically relevant problem based exercises. The topics covered in the manual have been carefully selected based on the most recent (2007) improvised problem based curriculum design for pharmacology (Appendix I). The book covers all essential components to impart the necessary required skills to students in the subject of pharmacology as per prevailing regulations in the country. The manual highlights the important skills to be imbibed by budding doctors which will aid in rational therapeutics. The manual covers all feasible exercises in pharmacology. The manual is flexible enough to suggest various modifications for various medical colleges as per availability of material for practicals. A time schedule is also included (Appendix II), which can be modified as per requirements. The exercises vary from simple demonstrations to computer simulation models. Special care is taken to keep the cost of material needed for practicals as low as possible. There are sufficient examples for students to apply the concepts learned in practicals. There are also new topics like ethics, which has become very important now after implementation of consumer protection Act to doctors. I am thankful to all my students for sharing their concern about existing pharmacology practicals and for their views on modifications in pharmacology practical training. That in a way, encouraged me to write this manual. I am thankful to Mr Tarun Duneja of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi for expediting the publication. I hope that students and teachers would benefit from this manual. Suggestions for improvements from teachers and students are most welcome. Dinesh Badyal dineshbadyal@rediffmail.com Contents
Section 1: Clinical Pharmacy
1. Introduction to Clinical Pharmacy ........................................................................ 3 2. Weights, Measures and Abbreviations ............................................................... 7 3. Labeling of Drugs ....................................................................................................13 4. Pharmacy Preparations ..........................................................................................21 5. Common Dosage Forms and Routes of Administration-I .............................30 6. Common Dosage Forms and Routes of Administration-II ............................39 7. Common Dosage Forms and Routes of Administration-III ..........................54
Section 2: Experimental Pharmacology
8. Introduction to Experimental Pharmacology ....................................................73 9. Effects of Drugs on Rabbit Eye ............................................................................75 10. Effect of Drugs on Frog Heart ...............................................................................80 11. Effect of Drugs on Rabbit Intestine ....................................................................86 12. Effect of Drugs on Dog Blood Pressure .............................................................90 13. Short Experiments for Efficacy and Safety .......................................................94 14. Ethics and Animals ................................................................................................. 98
Section 3: Clinical Pharmacology
15. Introduction to Clinical Pharmacology ........................................................... 103 16. Pharmacokinetic Parameters and Calculations ............................................ 104 x Practical Manual of Pharmacology
17. Prescription Writing Through Problem Based Learning
(Rational Prescribing) .......................................................................................... 112 18. Critical Evaluation of Prescription (Audit of Prescriptions) ..................... 157 19. Problem Based Drug Interactions .................................................................... 162 20. Adverse Drug Reaction (ADR) Monitoring ................................................... 178 21. Therapeutic Drug Monitoring (TDM) ............................................................. 187 22. Drug Use in Special Population/Diseases/Physiological Conditions ...... 194 23. Critical Appraisal of Drug Promotional Literature ..................................... 207 24. Therapeutic Follow-up Cases/Problems ......................................................... 215 25. New Drug Development ..................................................................................... 219 26. Calculation of Drug Doses and Dilutions ...................................................... 223 27. Evaluation of Drug Formulations ..................................................................... 232 28. Ethics and Humans .............................................................................................. 238 29. Management of Some Common Poisonings .................................................. 243 30. Objective Structured Practical Examination (OSPE) ................................... 253
Appendix I ............................................................................................................... 257
Appendix II ............................................................................................................. 259 Appendix III ............................................................................................................ 261 Appendix IV ............................................................................................................ 262 Terminologies Used in Pharmacology ............................................................... 283
Index ......................................................................................................................... 287