THE CANADIAN COLLEGE OF NATUROPATHIC MEDICINE _____________________________________________________________

PHARMACOLOGY _______________________________________
COURSE OUTLINE
2006-2007 Term II

Course Course code Times/Location Lecturers

Pharmacology BAS 208 Winter/Spring Term: Tuesday 2-4pm/Multipurpose room Thursday 4-7pm/Classroom #4 Paul Saunders Ph.D., N.D.; psaunders@ccnm.edu Carol Laic B.Sc., N.D., M.Ed.; claic@cogeco.ca Jenny Ng B.Sc.Phm.; jenny.ng@sw.ca (thurs. 9-11am) Salma Satchu B.Sc.Phm.; satchus@smh.toronto.on.ca Laura Margaritis N.D., lmargaritis@sympatico.ca

Course co-ordinator E-mail: Office hours

Carol Laic B.Sc., N.D., M.Ed. claic@cogeco.ca Tuesday 11:30 –2 pm Thursday 2-4 pm

Classes begin: January 8, 2007 Classes end: April 20th, 2007 No Classes: Reading Week: February 19th – 23rd, 2007 Exam Period: April 23rd – May 4th, 2007

Evaluation Timetable:
PERCENT Test #1 Test #2 Test #3 Test #4 Team Based Learning: Case Analysis /Discussion (Submissions and Presentations) 20% 20% 20% 20% 20% (4 cases, 5% each) TEST DATE / DUE DATE February 1, 2007 February 27, 2007 March 27, 2007 April 19, 2007 January 23, 2007 February 15, 2007 March 20, 2007 April 10, 2007

NOTE:

• • •

Because brand names in Canada and US are frequently different, only GENERIC NAMES will be used (and tested) *(as noted in NPLEX 2006 Blueprint) Examination material is based on the lecture and small group presentation contents. Exams are NOT cumulative. Students are required to fulfill all evaluation requirements and receive a passing grade to complete the pharmacology course. 70 % is the minimum passing grade for the course

Supplemental examination: Will consist of multiple choice questions and short answer questions covering material from all terms.

Attendance Requirements:
90% attendance is mandatory to successfully complete this course. Absence due to exceptional circumstances (e.g. illness, death of a close family member) requires appropriate supportive documentation submitted to Dr. N. Pachkovskaja.

Goals /Course Description: The course is designed to: ♦ provide students with fundamental knowledge of the mechanisms by which drugs alter the functions of living cells to relieve the symptoms and pathophysiological manifestations of disease; as well as the potential of cross reactivity with botanical medicines;possible nutritional deficiencies incurred by the drug, to be able to understand the indications and adverse effects of certain common drugs ♦ help students organize thinking about given categories of information ♦ help students to develop skills in integrating knowledge learned in basic science (anatomy, physiology, biochemistry, microbiology, pathology) with patients clinical presentations commonly encountered in clinical practice ♦ initiate in students the development of skills in the problem-solving process using team based dialogue ♦ assist students to recognize the importance of complementary (i.e., allopathic and naturopathic) approaches used together in patient management and the use of certain naturopathic therapies to enhance standard medical care

Learning Objectives:
Upon completion of this course students are expected to: • • • • • • • • Become familiar with the names of common pharmacological drugs used to treat disease Understand the physiological mechanism of action of these drugs Become familiar with the usage and contraindications to commonly used drugs Recognize adverse reactions related to drug usage Develop awareness of potential interactions with other drugs / herbs / nutrients as well as possible drug-induced nutrient deficiencies Know botanical medicines that have similar actions Understand therapeutic drug monitoring protocols Abe to counsel patients on appropriate use and administration of OTC drugs

CASE REPORT: TEAM BASED LEARNING
Learning objectives for Team-based Learning: Case analysis and report: The Case report will help the students to: • Review pharmacological topics and related drug therapies • Develop skills in identifying uses / adverse effects and interactions between drugs, nutrients and herbs • Develop critical thinking skills in patient drug management (laboratory tests / physical exams needed for appropriate drug monitoring) • Explore controversial issues between conventional and naturopathic medicine • Stimulate thought, dialogue and research as to possible naturopathic alternatives / supportive therapy that may be necessary in the specific case situations. Expectations for Case Analysis and Report (5% each): • Students will be randomly divided into 20 groups (groups of six-seven) and will be given time in class to begin analyzing a case pertaining to previously presented material (some exceptions) and a research portion. ALL groups are responsible for answering their case questions and submitting their full report on the designated due date, to Dr.Carol Laic. Each report must be 3-4 pages in length (typed). This report must include all references used (minimum of 3 references). Each group will be responsible for completing 4 cases during the course. Each case will be worth 5% of the course final grade. Each case will be marked out of 5 marks (5% of final grade). The marks are based on report content (resources used / referenced, comprehensive information presented, demonstrate critical thinking skills), as evaluated by the instructor, and on the quality of group participation, as evaluated by peers. At the beginning of the semester, each group will be assigned a presentation date. At the beginning of the class that reports are submitted, the 5 selected groups will be presenting their findings (in a power point presentation format). Each group is responsible for ONE presentation in the semester. The presentation (including discussion) must not exceed 15 minutes. Presentations must be in typed format (i.e. power point) with appropriate references and SUBMITTED ELECTRONICALLY to Dr. Carol Laic. Cases will be graded with all group members receiving the same grade.

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Cases not handed in at the start of the class, before presentations begin, will receive a mark of ZERO.

Required Readings
There is NO mandatory text for this course. All course content will be delivered during lecture time. Students are responsible for the content delivered in class lectures and handouts and peer presented cases.

Recommended Readings /websites:
1. Brenner, G. Pharmacology, 2nd ed.. W.B. Saunders Co. ; 2006 2. Kalant, H., Walter H.E., Roschlau. Principals of medical Pharmacology, 7th ed., 2007 3. Mycek M.J., Harvey R.A., Champe P.C. Lippincot’s Illustrated Reviews: Pharmacology 2nd ed. 4. Minneman K., Wecker, L. Brody’s Human Pharmacology.4th ed. 2005 Refer to individual weekly outlines for additional recommended and suggested readings. Textbooks, web sites, and professional journals complement the class material and do not replace
each other.

Suggested Resources for Case Analysis:
Texts in the disciplines of: 1. Differential diagnosis 2. Pathology 3. Physical Examination 4. Laboratory diagnosis 5. Pharmacology 6. Physician’s Desk Reference / CPR 7. Herb-drug-nutrient interactions

CLINICAL PHARMACOLOGY TIMETABLE 2007*
Week 1a 1b 2a Date Jan. 9 Jan. 11 Jan. 16 Topic Introduction - course format Pharmacological Principals (Part 1) Pharmacological Principals (Part 2) Lecturer Dr. Laic Dr. Laic Dr. Laic

Individual variation and drug responses
CASE #1

2b 3a 3b

Jan 18 Jan. 23 Jan. 25

Drugs acting on the Autonomic Nervous System L. Margaritis Drug Dependence and Abuse CASE #1 Presentations / Discussion Dr. Laic S. Satchu

Adverse Drugs Reactions and Drug Interactions
Drugs acting on the Respiratory System TEST #1 (20%) Drugs acting on the Central Nervous System

4a 4b 5a 5b

Jan. 30 Feb. 1 Feb. 6 Feb. 8

Dr. Laic
Dr. Laic Dr. Laic Dr. Laic

Drugs acting on the Central Nervous System CASE #2

6a

Feb. 13

Drugs used as analgesics (opioid and non-opioid Dr. Laic drugs) Drugs used as analgesics (opioid and non-opioid Dr. Laic drugs) / Heavy Metals CASE #2 Presentations / Discussion

6b

Feb. 15

Feb.19-23 READING WEEK – no classes

7a 7b 8a 8b 9a

Feb. 27 TEST #2 (20%) March 1 Drugs acting on the Gastrointestinal system March 6 Drugs acting on the Cardiovascular system March 8 Drugs acting on the Cardiovascular system March 13 Drugs acting on the dermatologic system / anemia / bones CASE #3 March 15 Renal Pharmacology / Genito-urinary drugs March 20 CASE #3 Presentations / Discussion March 22 Drugs acting on the endocrine system (Part 1) March 27 TEST #3 (20%) March 29 Drugs acting on the endocrine system (Part 2) April 3 April 5 Antimicrobial drugs (Part 1) CASE #4

Dr. Laic
J. Ng Dr. Laic Dr. Laic Dr. Laic

9b 10a 10b 11a 11b 12a 12b

S. Satchu Dr.Laic

L. Margaritis
Dr. Laic J. Ng Dr. Laic

Herb and Drug Interactions (Part 1)

Dr.Saunders Dr. Laic Dr.Saunders

13a 13b

April 10 Antimicrobial drugs (Part 2) CASE #4 Presentations / Discussion April 12

Herb and Drug Interactions (Part 2)

14a 14b

April 17 Cancer Chemotherapy and Immunopharmocologies

Dr. Laic

Dr. Laic April 19 TEST #4 (20%) * The Academic Department reserves the right to make schedule changes

WEEK 1a + 1b: Jan 9, 11, 07 INTRODUCTION TO PHARMACOLOGY (Part 1 & 2)

Learning Objectives - familiarity with terms and definitions used in pharmacology - understand the principles of pharmaceutical preparations and prescription writing - comprehend the different routes of administration, and types of drug preparations - knowledge of the pharmacokinetic principals of drug absorption, distribution, biotransformation and elimination - through cases develop critical thinking skills as to the factors that may influence each of these pharmacokinetic principals Topics covered include: - brief history and development of pharmacology - definitions of key term (toxicology, pharmacokinetics, pharmacodynamics, etc.) - drug sources and preparations - routes of administration - drug names - drug absorption and factors influencing absorption - drug distribution - biotransformation of drugs - drug excretion - process of drug development and common adverse effects and interactions - prescription writing - reporting on adverse drug reactions Suggested Readings Minneman K., Wecker, L. Brody’s Human Pharmacology.4th ed. 2005 Rang, Dale, Ritter, Moore. Pharmacology, 5th ed. 2003 Brenner, G. Pharmacology, 2nd ed.. W.B. Saunders Co. ; 2006 Page, Curtis, Sutter, Walker, Hoffman. Intergrated Pharmacology, 2nd ed. Mosby; 2002 Kalant, H., Walter H.E., Roschlau. Principals of medical Pharmacology, 7th ed., 2007 Mycek M.J., Harvey R.A., Champe P.C. Lippincot’s Illustrated Reviews: Pharmacology 2nd ed. Olson J. Clinical Pharmacology Made Ridiculously Simple, 2nd ed. Stringer J.L. Basic concepts in pharmacology: a student’s survival guide, 1996 Craig C.R. Modern pharmacology with clinical applications, 1997

WEEK 2a: Jan 16, 07 INDIVIDUAL VARIATION TO DRUG RESPONSES
Learning Objectives: - familiarity with terms used in defining drug use and abuse - recognize the factors that affect the dynamics of in vivo drug actions - identify individual variables that will influence drug usage - understanding of factors that influence drug responses and drug dependency - integrate naturopathic principals, in a case format, to define alternate approaches to drug dependence / individual variation Topics covered include: - Factors influencing drug response (including body size, age, sex, genetic factors, health conditions, psychological factors) - Defining characteristics of drug addiction, dependence and abuse - Factors that influence the extent of drug use - Behavioural drug dependance - The development of drug tolerance and physical dependance - Drugs used for recreational purposes (cannabis, cocaine, heroin, MDMA, methamphetamine) CASE #1 Suggested Readings: Minneman K., Wecker, L. Brody’s Human Pharmacology.4th ed. 2005 Rang, Dale, Ritter, Moore. Pharmacology, 5th ed. 2003 Brenner, G. Pharmacology, 2nd ed.. W.B. Saunders Co. ; 2006 Page, Curtis, Sutter, Walker, Hoffman. Intergrated Pharmacology, 2nd ed. Mosby; 2002 Pelton, R., et. al. Drug-Induced Nutrient Depletion Handbook 2nd ed. Lexi-comp 2002 Kalant, H., Walter H.E., Roschlau. Principals of medical Pharmacology, 7th ed., 2007 Newall et al., Herbal Medicine A Guide for Health – Care Professional , © 1996 Pharmaceutical Press Binker, F. ND. Herb Contraindications and Drug Interactions, Eclectic Medical Publications, Oregon; 1998

WEEK 2b: Jan 18, 07
DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM

Learning Objectives
review knowledge of the physiologic roles of the sympathetic and parasympathetic divisions of the nervous system in homeostasis and general physiology understanding of the physiological responses produced by activation of the sympatho-adrenal systems in fight or flight situations identify and define the cholinergic and adrenergic receptor subtypes, and describe their physiological roles familiarity with drugs used in the manipulation of the autonomic nervous system comprehend and describe their effects, adverse effects, indications, contraindications and potential interactions these drugs may exhibit with other drugs / herbs / nutrients

Topics covered include: Anatomy and physiology of ANS Transmission of impulses in the ANS Response of effector organs to autonomic transmissions Nicotinic agonist (nicotine patches) Muscarinic /cholinergic antagonists (donepezil,oxybutynin, tolterodine) Adrenergic receptor agonists (uses, adverse effects, precursors, and route of administration of sympathetic catecholamines, uses and adverse effects of general sympathomimetics (amphetamines, pseudoephedrine, methylphenidate, oxymetazoline) Adrenergic antagonists (atenolol, metoprolol) Suggested Readings: Hardman et al., The Pharmacological Basis of Therapeutics, ., 9th Edition, McGraw- Hill publishers Newall et al., Herbal Medicine A Guide for Health – Care Professionals, 1996 Pharmaceutical Press Brenner, G. Pharmacology. W.B. Saunders Co. ; 2000. Page, Curtis, Sutter, Walker, Hoffman. Intergrated Pharmacology, 2nd ed. Mosby; 2002 Kalant, H., Walter H.E., Roschlau. Principals of medical Pharmacology, 7th ed., 2007 Pelton, R., et. al. Drug-Induced Nutrient Depletion Handbook 2nd ed. Lexi-comp 2002

WEEK 3a: Jan 23, 07
DRUG DEPENDENCE AND ABUSE

CASE #1 PRESENTATIONS / DISCUSSION
WEEK 3b: Jan. 25, 07
ADVERSE DRUG REACTIONS AND DRUG INTERACTIONS Learning Objectives - understand the various mechanisms and classification of adverse drug reactions (ADR) - understand the risk factors associated with the development of ADRs - develop skill in assessing suspected ADRs - appreciate the impact and relevance of drug interactions (DI) - comprehend the various mechanisms and classification of DI - develop skill in evaluating a suspected DI Topics covered include: Types and mechanisms of ADRs Predisposing risk factors for ADR Assessment of suspected ADR Relevance of DI Classification of DI: Pharmacodynamic versus Pharmacokinetic interactions Evaluation of Drug Interactions Suggested Readings: Brenner, G. Pharmacology, 2nd ed.. W.B. Saunders Co. ; 2006 Page, Curtis, Sutter, Walker, Hoffman. Intergrated Pharmacology, 2nd ed. Mosby; 2002 Kalant, H., Walter H.E., Roschlau. Principals of medical Pharmacology, 6th ed., 1998 Dipiro et al. Pharmacotherapy, 4th ed. Appleton & Lange, Stamford 1999; Chap 40-47 Koda-Kimble MA, Young LY. Applied Therapeutics, 6th ed. Applied Therapeutics, Vancouver 1995; Chap 3 ** Cardi-Active Drug Interactions CME Program Pocket Reference, Solvay Pharma Inc, 2002 www.Rxfiles.ca www.intelihealth.com

WEEK 4a: Jan 30, 07
RESPIRATORY SYSTEM ACTING DRUGS Learning Objectives - familiarity with drugs used in the treatment and management of respiratory diseases - comprehend the biochemical and physiological mechanism of their action, - know the uses, adverse effects and potential interactions these drugs may exhibit with other drugs / herbs / nutrients Topics covered include: First generation H1 blockers (diphenhydramine (Benadryl), cetirizine) Second generation anti-histamines (loratadine (Claritin), fexofenadine (Allegra)) Inhalant medications (cromolyn sodium (Intal), albuterol (Proventil, Ventolin), monelukast, salmeterol, bedomethasone, budesomide, fluticasone, ipratropium, triamcinolone OTC: common respiratory drugs found in pharmacies, over the counter. (class presentation) Suggested Readings: Minneman K., Wecker, L. Brody’s Human Pharmacology.4th ed. 2005 Rang, Dale, Ritter, Moore. Pharmacology, 5th ed. 2003 Brenner, G. Pharmacology, 2nd ed.. W.B. Saunders Co. ; 2006 Page, Curtis, Sutter, Walker, Hoffman. Intergrated Pharmacology, 2nd ed. Mosby; 2002 Kalant, H., Walter H.E., Roschlau. Principals of medical Pharmacology, 7th ed., 2007 Pelton, R., et. al. Drug-Induced Nutrient Depletion Handbook 2nd ed. Lexi-comp 2002 Mycek M.J., Harvey R.A., Champe P.C. Lippincot’s Illustrated Reviews: Pharmacology 2nd ed. Olson J. Clinical Pharmacology Made Ridiculously Simple, 2nd ed. Stringer J.L. Basic concepts in pharmacology: a student’s survival guide, 1996 Craig C.R. Modern pharmacology with clinical applications, 1997 Newall et al., Herbal Medicine A Guide for Health – Care Professional , © 1996 Pharmaceutical Press Binker, F. ND. Herb Contraindications and Drug Interactions, Eclectic Medical Publications, Oregon; 1998 http://www.drugdigest.org www.Rxfiles.ca

WEEK 4b: Feb. 1, 07 TEST #1 (20%) WEEK 5a + 5b: Feb 6, 8, 07
DRUGS AFFECTING THE CENTRAL NERVOUS SYSTEM Learning Objectives - Describe the mechanisms of action, use, adverse effects and potential interactions of drugs used to treat disorders of the nervous system listed below - Apply knowledge of the material presented in a case discussion Topics covered include: Muscle relaxants (carisoprodol (Soma), cyclobenzaprine (Flexeril)) Hypnotics/ sedatives and anxiolytics (alprazolam (Xanax), lorazepam, melatonin, temazepam, zolpidem) Drugs used in psychiatric disorders (phenothiazines; haloperidol (Haldol); tricyclic antidepressants; serotonin re-uptake inhibitors, fluoxetine (Prozac) sertraline (Zoloft); MAO inhibitors; lithium, amitriptyline, bupropion, citalopran, paroxetine, trazadone) Anti-epileptics ( pheytoin (Dilantin), clonazepam (Klonopin), carbamazepine (Tegretol), gabapentin, divalproex) Drugs in treatment of movement disorders (levodopa/carbodopa (Sinemet)) Antipsychotics (olanzapine, quetiapine, risperidone) Drugs in the treatment of migraine (sumatriptan) CASE #2 Suggested Readings: Kalant, H., Walter H.E., Roschlau. Principals of medical Pharmacology, 7th ed., 2007 Hardman et al., The Pharmacological Basis of Therapeutics, 9th Edition, McGraw- Hill publishers Brenner, G. Pharmacology, 2nd ed.. W.B. Saunders Co. ; 2006 Hardman et al. Goodmans & Gilmans The Pharmacological Basis of Therapeutics 9th Edition, McGraw- Hill publishers Olsen, James. Clinical Pharmacology Made Ridiculously Simple, Medmaster, 1998. Mycek M.J., Harvey R.A., Champe P.C. Lippincot’s Illustrated Reviews: Pharmacology 2nd ed. , 2000 Page, Curtis, Sutter, Walker, Hoffman. Intergrated Pharmacology, 2nd ed. Mosby; 2002 Newall et al., Herbal Medicine A Guide for Health – Care Professional , 1996 Pharmaceutical Press Pelton, R., et. al. Drug-Induced Nutrient Depletion Handbook 2nd ed. Lexi-comp 2002 http://www.pdf.org/index.cfm, http://www.neuropat.dote.hu/movement.htm http://www.drugdigest.org www.Rxfiles.ca

WEEK 6a +6b: Feb 13,15, 07 ANALGESIC AND ANTI-INFLAMMATORY DRUGS/HEAVY METAL CHELATORS
Learning Objectives
familiarity with drugs used in the manipulation of inflammatory processes and in pain management comprehend the biochemical and physiological mechanism of their action, know the uses, adverse effects and potential interactions these drugs may exhibit with other drugs / herbs / nutrients

Topics covered include: Review of biochemical components of the inflammatory reaction Topical analgesics (Benzocaine, capsaicin, methyl salicylate) Opioids (codeine, oxycodone (Percodan), morphine, hydrocodone, methadone, fentanyl) Non-opioids (acetaminophen, NSAIDs (asprin, ibuprofen, naproxyn), celecoxib, rafecoxib, sulfasalazine) Rheumatic disorders (methotrexate, hydroxychloroquine) Drugs used to treat Gout (allopurinol, colchicines) Penicillamine, EDTA, DMPS, DMSA, deferoxamine CASE #2 PRESENTATIONS/DISCUSSION Suggested Readings: Mycek M.J., Harvey R.A., Champe P.C. Lippincot’s Illustrated Reviews: Pharmacology 2nd ed. , 2000 Minneman K., Wecker, L. Brody’s Human Pharmacology.4th ed. 2005 Rang, Dale, Ritter, Moore. Pharmacology, 5th ed. 2003 Olson J. Clinical Pharmacology Made Ridiculously Simple, 2nd ed. Stringer J.L. Basic concepts in pharmacology: a student’s survival guide, 1996 Craig C.R. Modern pharmacology with clinical applications, 1997 Brenner, G. Pharmacology, 2nd ed.. W.B. Saunders Co. ; 2006 Page, Curtis, Sutter, Walker, Hoffman. Intergrated Pharmacology, 2nd ed. Mosby; 2002 Pelton, R., et. al. Drug-Induced Nutrient Depletion Handbook 2nd ed. Lexi-comp 2002 Kalant, H., Walter H.E., Roschlau. Principals of medical Pharmacology, 7th ed., 2007 Marz , R., Medical Nutrition from Marz 2nd ed. Omni-Press, 1997 Newall et al., Herbal Medicine A Guide for Health – Care Professional , © 1996 Pharmaceutical Press Binker, F. ND. Herb Contraindications and Drug Interactions, Eclectic Medical Publications, Oregon; 1998 http://www.paincare.org/ http://www.drugdigest.org

WEEK Feb 19-23: READING WEEK ( no classes ) WEEK 7a: Feb. 27, 07 TEST #2 (20%) WEEK 7b: March 1, 07 DRUGS USED IN THE GASTROINTESTINAL SYSTEM (GI)
Learning Objectives - familiarity with the major classes of medications used in the treatment of gastrointestinal disease (peptic ulcer disease, constipation, diarrhea, nausea, IBD, gallstones, alcoholism, liver disease) - comprehend the biochemical and physiological mechanism of their action, - know the uses, adverse effects and potential interactions these drugs may exhibit with other drugs / herbs / nutrients Topics covered include: H2 blockers (ranitidine (Zantac), esomeprazole), Anti-diarrheals -Agents that decrease motility (loperamide (Imodium)) Agents that increase motility: laxatives and cathartics (polyethylene glycol, bulking agents (psyllium)), stool softeners (docusate), stimulating agents (magnesium, bisacodyl) Digestive aides (hydrochloric acid, enzymes, Ca++ carbonate,) Anti-emetics (prochlorperazine) Treatment of hyperlipidemia (atorvastatin, lovastatin, niacin, simvastatin) Suggested Readings: Kalant, H., Walter H.E., Roschlau. Principals of medical Pharmacology, 7th ed., 2007 Convington TR. Handbook of Nonprescription Drugs. APhA. 1996 Koda-Kimble MA. Applied Therapeutics: The clinical use of drugs. 2001 Grey J. Therapeutic Choices-3rd Edition. CPhA. 2000 – pp. 373-395, 867-881 Jellin JM, Gregory P, Batz F, Hitchens, K et al. Pharmacist’s Letter/ Prescriber’s Letter Natural Medicines Comprehensive Database 3rd Ed. Stockton, CA: Therapeutic Research Faculty; 2000 Binker, F. ND. Herb Contraindications and Drug Interactions, Eclectic Medical Publications, Oregon; 1998 http://www.drugdigest.org/DD/HC/Treatment/0,4047,21,00.html – Peptic Ulcer disease http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/index.htm -Constipation http://www.drugdigest.org/DD/HC/Treatment/0,4047,550307,00.html - IBD

WEEK 8a +8b: March 6, 8, 07 DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM
Learning Objectives - Describe the mechanisms of action, use, adverse effects and potential interactions interactions these drugs may exhibit with other drugs / herbs / nutrients of drugs used to treat cardiovascular disorders ( listed below) - Apply knowledge of the material presented in a disease state discussion, on hypertension, congestive heart, failure, hyperlipidemia, arrhythmia and acute coronary syndromes. - Apply knowledge of the material presented in a case discussion - familiarity with drugs used in the management of cardiac insufficiency, hypertension and lipid imbalances - comprehend the biochemical and physiological mechanism of their action, - know the uses, adverse effects and potential Topics covered include: Cardiac glycosides (digoxin (Lanoxin), carvedilol) Anti-arrhytmics (amiodarone, propafenone) Anti-hypertensives (B-blockers: atenolol, metoprolol, losartan; ACE inhibitors; benazepril, lisinopril, verapamil; Ca++ chanel blockers: clonidine, diltiazem; Diuretics: furosemide (Lasix), propanolol (Inderal), hydrochlorothiazide/tiramterene (Dyazide), spironolactone; a1 selective blocker: doxazosin (Cardura); reduce central sympathetic outflow: guanfacine (Tenex)) Anti-anginals / vasodilators (nitrogycerin, Ca++ channel blockers) Anti-coagulants and anti-thrombotics (warfarin (Coumadin), aspirin, heparin, clopidogrel, vitamin K) Suggested Readings: Minneman K., Wecker, L. Brody’s Human Pharmacology.4th ed. 2005 Rang, Dale, Ritter, Moore. Pharmacology, 5th ed. 2003 Hardman et al., The Pharmacological Basis of Therapeutics, 9th Edition, McGraw- Hill publishers Newall et al., Herbal Medicine A Guide for Health – Care Professional , © 1996 Pharmaceutical Press Ernst E., Cardiovascular adverse effects of herbal medicine: A systemic review of the recent literature, Can J Cardiol Vol 19 No.7; 818-827. www.theheart.org, www.americanheart.org, www.arrhythmiaonline.com, http://ww1.heartandstroke.ca, www.pulsus.com, www.chs.md/ Brenner, G. Pharmacology, 2nd ed.. W.B. Saunders Co. ; 2006 Page, Curtis, Sutter, Walker, Hoffman. Intergrated Pharmacology, 2nd ed.; 2002 Pelton, R., et. al. Drug-Induced Nutrient Depletion Handbook 2nd ed. Lexi-comp 2002 Kalant, H., Walter H.E., Roschlau. Principals of medical Pharmacology, 7th ed., 2007

WEEK 9a: March 13, 07 DRUGS USED TO TREAT ANEMIA/BONE/DERMATOLOGIC CONDITIONS

CASE # 3
WEEK 9b: March 15, 07
RENAL PHARMACOLOGY Learning Objectives - review renal anatomy and physiology as it relates to drug elimination - understand the sub-processes involved in renal drug elimination - become familiar with the various clinical presentations of end stage renal disease - appreciate the effect of end stage renal disease on drug dosing - comprehend the importance of drug-induced nephrotoxicity Topics covered include: - Renal anatomy and physiology - Renal drug elimination: filtration, secretion and reabsorption - End stage renal disease (ESRD) - Symptomatic and clinic abnormalities of ESRD a. Fluid and electrolyte imbalances b. Renal osteodystrophy c. Anemia d. Vitamin deficiency e. Constipation f. Cardiovascular disease - Drug dosing in renal failure - Drug-induced nephrotoxicity Suggested Readings: Brenner, G. Pharmacology, 2nd ed.. W.B. Saunders Co. ; 2006 Page, Curtis, Sutter, Walker, Hoffman. Intergrated Pharmacology, 2nd ed. Mosby; 2002 Kalant, H., Walter H.E., Roschlau. Principals of medical Pharmacology, 6th ed., 1998 ** Bennet WM et al. Drug Prescribing in Renal Failure, 4th ed. American College of Physicians. Philadelphia 1999 Dipiro et al. Pharmacotherapy, 4th ed. Appleton & Lange, Stamford 1999; Chap 40-47 Fox Stuart Ira. Human Physiology, 5th ed. Wm. C. Brown Publishers, 1996; Chap 17 Harrison’s Principles of Internal Medicine, Chap 112 Koda-Kimble MA, Young LY. Applied Therapeutics, 6th ed. Applied Therapeutics, Vancouver 1995; Chap 29,20,32 **

WEEK 10a : March 20, 07
CASE #3 Presentations/Discussion

WEEK 10b: March 22, 07 DRUGS AFFECTING ENDOCRINE SYSTEM (PART 1)
Learning Objectives - Understand and be able to explain Hypothalamic – Pituitary Target organ axes - List the types of estrogens used therapeutically, explain their therapeutic actions, adverse effects ,contraindications, interactions, recognize the therapeutic uses for antiestrogens . - List the reasons for use of progestins in oral contraceptives; discuss other uses for progestins and their adverse effects. - Recognize the clinical and non clinical uses of antiandrogens, recognize the side effects of androgens . Describe the synthesis of thyroid hormone, point out the sites of action for inhibitors of thyroid hormone synthesis, and explain the therapeutic effects of thyroid hormones in the treatment of hypothyroidism; explain the therapeutic effects of anti-thyroid drugs in the treatment of hyperthyroidism. Describe the mechanisms of action, use, adverse effects and potential interactions these drugs may exhibit with other drugs / herbs / nutrients - Apply knowledge of the material presented in a case discussion Topics covered include: Birth control and hormone replacement (conjugated estrogens, drospirenone, estradiol, estriol, estrone), progesterone, medroxyprogesterone, clomiphene, norgestimate, norelgestromin, tamoxifen Male hormonal treatments (testosterone) Other steroids (DHEA, pregnenolone, androstenedione) Thyroid (USP (dessicated) thyroid, levothyroxine (Synthroid), triiodothyronine) Melatonin Suggested Readings: Hardman et al., The Pharmacological Basis of Therapeutics, 9th Edition, McGraw- Hill publishers Newall et al., Herbal Medicine A Guide for Health – Care Professional , © 1996 Pharmaceutical Press Jellin JM, Gregory P, Batz F, Hitchens, K et al. Pharmacist’s Letter/ Prescriber’s Letter Natural Medicines Comprehensive Database 3rd Ed. Stockton, CA: Therapeutic Research Faculty; 2000 Binker, F. ND. Herb Contraindications and Drug Interactions, Eclectic Medical Publications, Oregon; 1998

http://www.thyroid.org/resources/professionals/nacb.html,http://www.thyroidmanager.org /, http://www.thyroidmanager.org/thyroidbook.htm, http://www.patient.co.uk/illness/h/hypothyroidism.html

WEEK 11a: March 27,07 TEST #3 (20%) WEEK 11b: March 29, 07 DRUGS AFFECTING ENDOCRINE SYSTEM (PART 2)
Learning Objectives • Understand the basic pharmacological action of diabetic medications • • To learn about diabetic complications and medications used to treat these complications To gain a better understanding of how these medications may interact with naturopathic remedies - familiarity with drugs used in hormone based therapy - comprehend the biochemical and physiological mechanism of their action, - know the uses, adverse effects and potential interactions these drugs may exhibit with other drugs / herbs / nutrients

Topics covered include:

Insulin (regular, NPH, isophane insulin)
Oral hypoglycemic agents (glucagons, glyburide, metformin, rosiglitazone) Suggested Readings: Kalant H, Roschlau, Walter HE. Principles of Pharmacology 6th edition 1998 Koda-Kimble MA. Applied Therapeutics: The clinical use of drugs. 2001 Grey J. Therapeutic Choices-3rd Edition. CPhA. 2000 Jellin JM, Gregory P, Batz F, Hitchens, K et al. Pharmacist’s Letter/ Prescriber’s Letter Natural Medicines Comprehensive Database 3rd Ed. Stockton, CA: Therapeutic Research Faculty; 2000 Binker, F. ND. Herb Contraindications and Drug Interactions, Eclectic Medical Publications, Oregon; 1998 www.diabetes.ca/cpg2003/chapters.aspx http://www.pharmacyconnects.com/ce/practice/index.jsp – click on article on treatment of type II diabetes

WEEK 12a + 13a: April 3, 10, 07
ANTI-MICROBIAL DRUGS Learning Objectives - familiarity with drugs used in the treatment of bacterial, fungal, parasitic and viral diseases - comprehend the biochemical and physiological mechanism of their action, - know the uses, adverse effects and potential interactions these drugs may exhibit with other drugs / herbs / nutrients Topics covered include: Anti-fungals: nystatin, clotrimazole (gyne Lotrimin), fluconazole, terbinafine) Anti-parasitics / helmintics: metronidazole (Flagyl), piperazine) Anti-malarials (cholorquine) Penicillin and derivatives (amoxicillin, amoxicillin/clavulinic acid (Augmentin)) Cephalosporins (cephalexin (Keflex) Erythromycin and derivatives (incl. azithromycin (Zithromax)) Tetracycline and derivatives (doxycycline) Sulfanomides and trimethoprim/ sulfamethoxazole (Bactrim, Septra), ciprofloxacin, triple sulfa Aminoglycosides (tobramycin) Anti-virals (acyclovir (Zovirax), amantadine, didanosine, famciclovir, indinavir, lamivudine, vancyclovir, zidovudine) Urinary antiseptics: phenzopyridine Others: muprocin, silver nitrate CASE #4 Presentations / Discussions Suggested Readings: Minneman K., Wecker, L. Brody’s Human Pharmacology.4th ed. 2005 Rang, Dale, Ritter, Moore. Pharmacology, 5th ed. 2003 Kalant, H., Walter H.E., Roschlau. Principals of medical Pharmacology, 7th ed., 2007 Brenner, G. Pharmacology, 2nd ed.. W.B. Saunders Co. ; 2006. Mycek M.J., Harvey R.A., Champe P.C. Lippincot’s Illustrated Reviews: Pharmacology 2nd ed. , 2000 Page, Curtis, Sutter, Walker, Hoffman. Intergrated Pharmacology, 2nd ed. Mosby; 2002 Pelton, R., et. al. Drug-Induced Nutrient Depletion Handbook 2nd ed. Lexi-comp 2002 Newall et al., Herbal Medicine A Guide for Health – Care Professional , © 1996 Pharmaceutical Press Binker, F. ND. Herb Contraindications and Drug Interactions, Eclectic Medical Publications, Oregon; 1998

WEEK 12b + 13b: April 5, 12, 07
HERB AND DRUG INTERACTIONS Learning Objectives - familiarity with known drug and herb interactions - recognize herb categories / mechanisms of action that may interfere with or enhance drug absorption, assimilation, biotransformation and / or elimination or may decrease drug side effects - students are expected to be familiar with drugs by name as well as the herbs by their scientific binomial name Topics covered include: These two lectures will be organized around drug categories and then herbs with real (human, animal), or test tube, or theoretical interactions will be presented Possible mechanisms of interactions will be given where know or where there is some theoretical basis Doses will be presented, especially when dose is critical to the interaction process Selected Botanical References : Weiss, Rudolf Fritz. 1988. Herbal medicine. Translated from 6 th German Edition. Beaconsfield Publishers Ltd., Beaconsfield, England. 362p. Brinker, Francis J. 1983. The toxicology of botanical medicine. 2nd Edition. National College of Naturopathic Medicine, Portland, OR. 141p. Hsu, Hong-Yen, Yuh-Pan Chen, Shuenn-Jyi Shen, Chau-Shin Hsu, Chien-Chih Chen,and Hsien-Chang Chang. 1986. Oriental materia medica: a concise guide. Oriental Healing Arts Institute, Long Beach, CA. 932p. Chandler, Frank, et al. (eds.). 2000. Herbs: everyday reference for health professionals. Canadian Pharmacists Association and Canadian Medical Association. Ottawa, ON. 240p. Brinker, Francis. 2001. Herb contraindications and drug interactions. 3rd Edition. Eclectic Medical Publications. Sandy, OR. 432p. Boon, Heather and Michael Smith. 2004. The complete natural medicine guide to the 50 most common medicinal herbs. Robert Rose, Toronto, ON. 352p. Barnes, Joanne, Linda A. Anderson, J David Phillipson. 2002. Herbal medicines: a guide for healthcare professionals. 2nd Ed. Pharmaceutical Press, London, UK. 530p Evans, William Charles, Daphne Evans. 2002. Trease and Evans Pharmacognosy. 15th Edition. W.B. Saunders, Toronto, ON. 585p. Brinker, Francis. 2004. Complex herbs-complete medicines. Eclectic Medical Publications, Sandy, OR.

WEEK 14a: April 17, 07
CANCER CHEMOTHERAPY AND IMMUNOPHARMACOLOGY Learning Objectives - familiarity with drugs used in the manipulation of the immune system and tumor growth - comprehend the biochemical and physiological mechanism of their action, - know the uses, adverse effects and potential interactions these drugs may exhibit with other drugs / herbs / nutrients Topics covered include: Tumorigenesis Principals of cell proliferation and chemotherapeutics Principals of combination chemotherapeutics, commonly used “cocktails” Resistance to chemotherapeutics DNA interferance drugs (alkylating – mechlorethamine; nitrosureas- carmustine; platinum compounds – cisplatin/ carboplatin; misc. – pro/dacarbazine) Indirect DNA damaging drugs (anthracyclines – doxo/danuorubicin; topoisomerases – eto/teniposide; misc. – bleomycins, dactinomycin ) Anti-metabolites (methotrexate) Pyrimidine analogs (5-fluorouracil) Purine antimetabolites (fludarabine) Tubulin binding agents (vinka alkaloids, paclitaxel) Tamoxifen, Aromatase inhibitors Suggested Readings: Minneman K., Wecker, L. Brody’s Human Pharmacology.4th ed. 2005 Rang, Dale, Ritter, Moore. Pharmacology, 5th ed. 2003 Brenner, G. Pharmacology, 2nd ed.. W.B. Saunders Co. ; 2006 Page, Curtis, Sutter, Walker, Hoffman. Intergrated Pharmacology, 2nd ed. Mosby; 2002 Pelton, R., et. al. Drug-Induced Nutrient Depletion Handbook 2nd ed. Lexi-comp 2002 Kalant, H., Walter H.E., Roschlau. Principals of medical Pharmacology, 7th ed., 2007 Newall et al., Herbal Medicine A Guide for Health – Care Professional , © 1996 Pharmaceutical Press Binker, F. ND. Herb Contraindications and Drug Interactions, Eclectic Medical Publications, Oregon; 1998 www. afscme.org/health/faq-cyto.htm http://www.drugdigest.org

WEEK 14b: April 19, 07 TEST #4 (20%)

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