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Syllabus
Essentials of Medical Clinical Pharmacology
1. Routes of administration – Definition of pharmacology, pharmacokinetics, pharmacodynamics,
drug. Concept of essential drug, orphan drug. Concept of expiry date. Nomenclature of drugs –
Chemical names, Generic names, Brand names, trade names. Types of routes of administration
– Local and systemic, their subtypes.
2. Pharmacokinetics – Concept. Types of transports ‐ Active and passive. Concept of Ph and is
effect on kinetics of drug. Concept of ionization. Concept of absorption, factors affecting
absorption. Concept of bio‐availability. Concept of chemical equivalence and bio‐equivalence.
Distribution – Redistribution concepts. Concept of Blood Brain Barrier. Plasma protein binding of
drug. Its effects on pharmacokinetics. Concept of biotransformation. Concept of competitive
inhibition and enzyme induction. Consequences of enzyme induction ‐ Some clinical examples.
First pass metabolism. Excretion of drug. Details of routes of excretion. Kinetics of elimination.
First order kinetics, zero order kinetics. Plasma half life of drug. Some basic calculations related
to drug dosing. Plateau principle. Concept of loading dose and maintenance of dose. Plasma
drug monitoring.
3. Pharmacodynamics – Concept of pharmacodynamcis. Principles of drug action. Mechanisms of
drug action. Concept of receptors. Agonist, antagonist, ligand. Two state receptor model theory.
Some basic concepts like affinity, intrinsic activity, drug action, drug effect. Types of receptors.
Functions of receptors. Concept of Dose Response Curve (DRC). Drug potency, drug efficacy.
Selectivity of drug. Therapeutic index and safety margin. Concept of therapeutic window.
Combined drug effect. Types of drug doses. Factors modifying drug action – Body size, age, sex,
species and race, route of administration, environment time of administration, psychological
state and pathological state, effect of other drugs, cumulation, tolerance and cross tolerance.
4. Adverse drug reaction – Adverse effect, adverse drug reaction ‐ predictable non predictable.
Side effects, secondary effects, toxic effects, intolerance, idiosyncrasy, drug allergy, drug
dependence, drug abuse, drug addiction, drug withdrawal reactions, teratogenicity,
carcinogenicity‐mutagenicity and iatrogenic diseases.
5. General introduction to antimicrobial agents – Introduction. Definition of antibiotic. Concept of
AMA. Classification of AMAs. Problems with the use of AMA – Toxicity ‐ local systemic.
Hypersensitivity reactions. Drug resistance, cross resistance, super infections and nutritional
deficiencies. Factors affecting choice of AMA – Patient related factors – Age, Renal and hepatic
function, Local factors, drug allergy, impaired host defense and pregnancy. Organism related
factors, Drug related factors. Combined use of AMAs. Adverse effects of AMAs. Prophylactic use
of AMAs. Failure of chemotherapy.
6. Penicillins – General introduction to Penicillins, Mechanism of action of Penicillins. Chemical
structure of penicillin. Antimicrobial spectrum of Penicillin. Development of resistance to
Penicillin. Pharmacokinetic properties. Preparation and doses of Penicillin available in market
with their proper indication useful currently. ADRs of Penicillins. General uses of Penicillin. Semi‐
synthetic Penicillins. Ampicillin, Bacampicillin, Amoxicillin, Cloxicillin details. Carboxy‐penicillins –
Carbinicillin. Uredeo‐Penicillins ‐ Piparacillin. Beta‐lactamase inhibitors ‐ Clavulanic acid,
Sulbactum, Tazobactum.
7. Cephalosporins ‐ Introduction, Mechanism of action and mechanism of resistance. First
generation Cephalosporins. Cephalaxin, Cephadroxil, Cephazolin and Cephadrin. Second
generation Cephalosporins – Cefuroxime and Cephaclor. Third generation cephalosporins –
Cefotaxime, Cefoperazone, Cefexime, Ceftazidime, Cefodoxime, Ceftriaxone. Cefdinir,
Ceftibuten, Ceftamet provoxil. Forth generation cephalosporins – Cefepime and Cefirome.
Monobactums – Aztreonam. Carbapenems – Imepenem, Meropenems – Feropenem. ADRs of
Cephalosporins.
8. Aminoglycosides – Introduction. Common properties of Aminoglycosides. Mechanism of action
of Aminoglycosides. Mechanism of resistance of Aminoglycosides. Common toxicities of Amino
glycosides. Streptomycin in detail and concept of Streptomycin dependence. Cautions and
indications of Streptomycin. Gentamicin – spectrum and uses of Gentamicin. Tobramycin,
Amikacine, Sisomicin, Netilmicine and Neomycine differences with other drugs, indications and
market preparations.
9. Tetracycline – Introduction. Mechanism of action, antimicrobial action, mechanism of
resistance. Pharmacokinetic properties. ADRs of Tetracycline. Uses of Tetracycline.
10. Macrolide – Introduction. Erythromycin as prototype. Mechanism of action, antimicrobial
spectrum. Development of resistance. Pharmacokinetic properties, ADRs. Uses of Macrolides.
Roxithromycin, Clarithromycin, Azithromycin and Clindamycin in detail.. Glycopeptides
antibiotics ‐ Vancomycin and Teicoplanin.
11. Quinolone and fluroquinolones ‐ Introduction. Nalidixic acid details. Introduction to
Fluroquinolones, mechanism of action. Ciprofloxacin, Norfloxacin, Pefloxacin, Ofloxacin,
Lomofloxacin, Sparfloxacin, Levofloxacin, Gatifloxacin and Moxifloxacin in detail like
peculiarities, pharmacokinetic properties, doses, frequency and trade names.
12. Anti‐Tubercular drugs – Introduction. First line and second line drugs. Isoniazid, Rifampicin,
Pyrazinamide and Ethambutol in details like peculiarities, pharmacokinetic properties, doses,
frequency and trade names. WHO and RNTCP criteria to use ATT.
13. Anti ‐ fungal drugs – Introduction. Amphotericin B in detail. New Amphotericin B formulations.
Nystatin, Hamycin, Natamycin, Griseofulvin, Clotrimazole, Econazole, Miconazole, Oxiconazole,
Ketoconazole, Fluconazole, Itraconazole, Voriconazole and Terbinafine in detail like peculiarities,
pharmacokinetic properties, doses, frequency and trade names.
14. Anti‐Viral drugs – Introduction to conventional antiviral drugs like, Idoxuridine, Acyclovir,
Valaciclovir and Famciclovir in detail. Introduction to antiretroviral drugs (ART drugs).
Necleoside Reverse Transcriptase Inhibitors (NRTIs). Zidovudine, Didanosine, Stavudine,
Lamivudine, Abacavir, Non ‐ Necleoside Reverse Transcriptase Inhibitors (NNRTIs) – Navirapin
and Efavirenz. Retroviral Protease Inhibitors (PIs) – Indinavir, Nelfinavir, Ritonavir, Saquinavir
and Lopinavir. Osteltamivir – A effective drug in Swine flue and Bird flue.
15. Antimalarial drugs – Introduction to malaria, explanation of life cycle of malarial parasite.
Chloroquine – mechanism of action, Resistance, P/K, ADRs, Preparations and doses. Amodiquine
introduction. Detailed pharmacology of quinine, market preparations doses and indications.
Mefloquine in detail. Pyrimethamine, Sulphadoxine in detail. Primaquine in detail. Bulaquine –
new approach. Artisunate, Artemether, Lumefrantin and Alpha ‐ Beta Arteether in detail, with
market preparations, doses and indications. Proguanil.
16. Anti‐protozoal agents – Introduction. Metronidazole spectrum of activity, mechanism of action,
P/K, ADR, contraindications and uses. Tinidazole, Ornidazole, Secnidazole, Satronidazole,
Diloxanide and Quiniodochlor in detail.
17. Adrenergic stimulants – General introduction to CNS classification. Adrenergic and cholinergic
system basic consideration. Adrenergic ‐ basic classification of receptors. Adrenalin, Nor‐
adrenalin, Dopamine, Dobutamine and Isoprenaline.
18. Beta adrenergic blockers – Introduction. Effect of beta blockers on Heart, Blood vessels,
Respiratory system, CNS, metabolic activity and skeletal muscles. P/K, Interactions, ADR and
contraindications. Atenolol, (‐) Atenolol, Metoprolol, (‐)Metoprolol, Acebutol, Bisoprolol,
Emsolol, Carvedilol, Labatolol, Pindolol and Nebivolol their market preparations, indications and
doses. Uses of beta blockers.
19. Calcium Channel Blockers – Introduction, mechanism of action of calcium channel blockers.
Details of Varapamil, Diltazem, Amlodipine, Falodipine, Nitredipine, Lacidipine, Nimodipine,
Lercanidipin, Benidipine. Uses of calcium channel blockers.
20. ACE inhibitors – Introduction. Renin‐ angiotensin system. Mechanism of action of ACE inhibitors.
Captopril explained as prototype. Explanation of Enalapril, Lisinopril, Ramipril, Perindopril,
Benazepril, Fosinopril with their indications, market preparations and doses. Uses of ACE
inhibitors. Advantages of ACE inhibitors over other antihypertensive drugs. Angiotensin II
antagonist. Losartan explained as prototype. Explanation of Candesartan, Irbesartan, Valsartan,
and Telmisartan with their indications, market preparations and doses.
21. Diuretics – Introduction. The general mechanism of action of diuretics. High ceiling diuretics –
Furosemide ‐ mechanism of action, P/K, market preparation and doses. Bumetanide – P/K, ADR,
market preparation and doses with indications. Uses of High ceiling diuretics. Thiazide and
related diuretics. Introduction, mechanism of action, P/K etc. Explanation of
Hydrochlorothiazide, Chlorthalidone and Xipamide with their market preparation, doses etc.
Uses of Thiazide diuretics. Complications and interactions of high ceiling and Thiazide diuretics
therapy. Potassium sparing diuretics ‐ Spironolactone in detail. Inhibitors of renal epithelial Na+
channels. Explanation of Trimterene , Amiloride and Mannitol.
22. Cardiac glycosides – Definition of glycoside. Pharmacological profile of digitalis. Effect on heart,
blood vessles, kidney and CNS, P/K. Uses of cardiac glycosides. Market preparation of Digoxin
and doses.
23. Anti‐anginals – Introduction, mechanism of action in detail. P/K, ADRs, tolerance. Explanation
of GTN, Isosorbid mononitrate, Isosorbid dinitrate. Pottasium channel openers – Nicorandil, its
market preparations, doses uses. etc. Trimetazidine – (New arrival )introduction of a novel drug
with market preparations, doses and clinical application.
24. Some other drugs in hypertension – Alpha adrenergic blockers – Prazosin. Central sympatolytics
– Clonidine, Methyl dopa, Hydralazine.
25. Insulin and other hypoglycemic drugs – Introduction to DM, types, important role of insulin.
Preparations available in India. Insulin analogues (New arrival). Oral Hypoglycemic drugs.
Sulfonylureas Basic mechanism of action. First generation sulfonylureas – Chlorpropramide,
Tolbutamide in detail. Second generation Sulfonylureas – Glibeclamide, Glipzid, Gicazid and
Glymepride. Biguanides – Basic mechanism of action. Metformin and Phenformin. Meglitinide
analogues – Repaglinide and Netaglinide. Thiazolidinediones – Rosiglitazone and Pioglitazone
( Banned in India). Alpha glycosidase inhibitors.
26. Opioid analgesics – Introduction to opioids. Morphine is explained as prototype –
Pharmacological effects on CNS, analgesia, sedation, respiratory center, TRC, Vasomotor centre,
CTZ, Pupils, Vagus, Neuroendocrine, GIT, urinary system and respiratory system. P/K, ADRs,
idiosyncrasy and allergy. Acute morphine poisoning. Tolerance and dependence, precautions
and contraindications of opioids. Contraindications. Explanation of Codeine, Pethidine, Fentanyl,
Methadone, Dextropropoxyphene, Pentazocine, Butorphenol, Bupenorphine, Tramadol, opioid
antagonists – Naloxone and Naltrixone. Uses of opioid analgesics.
27. Non Steroidal Anti‐Inflammatory Drugs – NSAIDs –Explanation of Aspirin as a prototype,
Metamizol, Indomethacin,Propionic acid derivatives ‐ Ibuprofen, Naproxen, Ketoprofen,
Flubiprofen,Antranilic acid derivatives ‐ Mephenemic acid, Diclofenac sodium, Aceclophenac,
Oxicam derivaties ‐ Piroxicam, Tenoxicam, Pyrrolo‐pyrrole derivatives ‐ Ketorolac, Paracetamol,
Preferential cox‐2 inhibitors ‐ Nimesulide, Nabumetone. Selective COX‐2 inhibitors.
28. Anti‐epileptic drugs – Introduction and understanding of basic pathology of epilepsy.
Explanation of ‐ Phenobarbitone, Primidone, Phenytoin sodium, Fosphenytoin, Carbamazepine,
Oxcarbazepine, Ethosuxamide and Valproic acid with their market preparions, doses and uses.
Some new drugs in epilepsy – Explanation of Clonazepam, Clobazam, Lamotrigine, Gabapentin
and Topiramate with their market preparations, doses and uses.
29. Sedative and hypnotics – Definitions, Benzodiazepines – introduction and detailed discussions,
mechanism of action, P/K, ADR etc. Explanation of Flurazepam, Diazepam, Nitrazepam,
Alprazolam. Ultra short elimination – Midazolam. Uses of benzodiazepines. Non‐BZD hypnotics –
Zopiclone, Zolpidem and Zaleplon. Melatonin ‐ a new drug.
30. Drugs for Parkinson’s Disease ‐ Basic pathology in Parkinson’s disease. Drugs affecting brain
dopaminergic system and drugs affecting brain cholinergic system. Explanation of Levodopa in
detail. Explanation of Carbidopa, Bromocriptine, Ropinirole. Dopamine facilitators – Amentadine
and Selegiline.
31. Corticosteroids – Understanding the role of corticosteroids in normal functioning of body.
Mineral corticoid in detail and glucocorticoids ‐ action on carbohydrate, fat and protein
metabolism, calcium metabolism, CVS, Skeletal muscles, CNS, Stomach, Lymphoid tissue and
blood cells, inflammatory response, immunological and allergic responses. P/K, interactions and
uses of steroids. Contraindications of steroids. Market preparations, doses and indications.
32. Histamine and antihistaminic drugs – Histamine general introduction and details. Patho‐
physiological role. Histamine as a drug in Meniere’s disease. Anti‐histaminic drugs – types.
Effects on different system of body. Side effects and toxicity of antihistaminic drugs. Clinical uses
of antihistaminic drugs like in allergic reaction, pruritides, common cold, motion sickness,
vertigo, pre‐anesthetic medication, cough, Parkinson’s disease, sedative, hypnotic and
anxiolytic.
33. Drugs used for peptic ulcers – Explanation of Simple antacids‐ Magnesium trisilicate, Aluminium
hydroxide, H2 antagonist like Cemetidine, Ranitidine, Famotidine, Roxatidine, PPI like
Omeprazole, Lansoprazole, Pentoprazole, (s) Pentoprazole, Rabeprazole, Esomeprazole.
Sucralfate and Prostagladine analogues‐ like Mesoprostol with their market preparations, doses
and uses.
34. Drugs for gastro‐intestinal tract – Antiemetic drugs – Explanation of Metoclopramide,
Prochlorpromazine, Domperidone, Cisapride, Mosapride, Ondensetron, Granisetron and
Doxylamine. Antispamodic drugs – Hyscine and Dicyclomine. Anti‐motility drugs like Codeine,
Diphenoxylate and Loparamide.
35. Drugs for cough – Understanding the treatment of cough. Expectorants, mucolytics, anti‐tussive,
non‐opioids and antihistaminic drugs.
36. Drugs for bronchial asthma – General introduction to asthma. Sympatomimitics – Adrenalin,
Ephedrine, Isoprenalin, Orciprenaline,Beta 2 selective stimulants ‐ Salbutamol, Turbutalin,
Bambuterol, Salmeterol, Formeterol, Methyl xanthine derivatives ‐ Theophylline,
Aminophylline. Anti‐cholenergic drugs – Impratropium bromide. LT antagonist – Montelukast,
Zafirlukast. Mast cell stabilizers – Sodium cromoglycate and ketotifen. Anti‐IgE antibody.
37. Thyroid and anti‐thyroid drugs – Basic understanding of diseases of thyroid gland. Thyroxine by
external resource – Market preparations, doses and use. Thyroid inhibitors – Carbimazole.
38. Coagulants and anti‐coagulants – Introduction. Vit. K in detail with types, source, action,
utilization, deficiency states, market preparations, dose and uses. Anti‐coagulants – Heparin in
detail. Market preparations, dose and use. LMWH – peculiarities and indications. Oral anti‐
coagulants – Warferin – in detail, market preparations, doses and use.