 Why do you want to become a medical

professional?
 What would you like to be?
 What do you think are going to be your
responsibilities?
 What are your expectations during your time
learning Clinical Pharmacology?
 Do not walk in the dark during your medical
training
 Define where you want to go
 Think seriously on how to achieve your goal
and have the right attitude towards learning,
your teachers, and others
 In other words, create a reason to learn
 The number of licensed medicines is rapidly
increasing and healthcare personnel are
increasingly expected to deal with medicines
that are less familiar to them
 Pace of new drug development is accelerating
rapidly as a result of advances in molecular
biology and mapping of the human genome
 Patients are taking more medicines than before,
increasing the complexity of their treatment
regimen and the potential for drug interactions
 Newer drugs, capable of targeting previously
untreatable conditions, are often more powerful
but also more toxic
 The expansion of evidence-based medicine and
health technology assessment has enabled the
beneficial and adverse effects of drugs to be more
accurately quantified
 There are more sources of opinion and
disinformation available to patients and doctors
(increasing assess to the internet)

 Marketing activites of the pharmaceutical industry

are a potential threat to cost-effective prescribing
decisions
 Semesiter 5
 Onlyprotected time to concentrated on
learning the scientific basis for the principles
of therapeutics and gaining core knowledge
and understanding about drugs
 Clinical rotattions
 Witnessand learn about the use of drugs in
practice and gain skills in prescribing, drug
administration and attitudes towards the use of
drugs
 The burden of factual knowledge is high in
Pharmacology

 You may feel overwhelmed by the number of

drugs described in pharmacology text books

 It is important to understand general

pharmacological principles, and to appreciate
the pharmacology of the main classes of drugs
rather than attempting to memorise details of
individual drugs

 Specific therapeutic drugs are best learned

about near a patient’s bedside
 For each of the commonly used drugs in our setting
we expect the following from you
 Know the name and class
 Have an understanding of the mechanism of action
 Recognise the appropriate indication for use
 Know the appropriate route, frequency and duration of
administration
 Know the important contraindications, potential
interactions and adverse effects
 Know how to monitor the drug’s effects
 Be able to explain the salient features of all the above
to the patient
 To produce graduates who are competent to
safely, effectively and cost-effectively deal with
medicines
 To provide the appropriate framework to be able
to assimilate information about new drug
developments that will occur throughout a
professional career
 Course Content

General Principles
of Pharmacology Chemical Mediators

Systems Antimicrobial and Special

Pharmacology Cancer Topics
Chemotherapy
 We have a responsibility to the public, to
employers and the profession to make sure that
graduates are fit to practice. ... and prescribing
drugs is a key component of medical practice
 We are not interested in failing any one!
 Pharmacology: study of the effects of drugs
on the function of living systems
 Drug: a chemical substance of known
structure, other than a nutrient or an
essential dietary ingredient, which, when
administered to a living organism, produces a
biological effect
 Drugs may be:
 Synthetic chemicals
 Chemicals from plants or animals
 Products of genetic engineering (biotechnology)
 To count as a drug, the substance must be
administered intentionaly to produce a certain
desired biological effect. Hormones (insulin,
thyroxine) when administered as such are drugs
 Poison: a substance that causes death or harm
when introduced into or absorbed by a living
organism. Although fall strictly within
definition of drugs they are not used in therapy
 A medicine: chemical preparation which usually
but not necessarily contains one or more drugs,
administered with intention of producing a
therapeutic effect. Usually contains other
substances (excipients, stabilisers, solvents ect)
besides the active drug, to make them more
convenient to use
 Ancient prescientific therapeutics
 Herbal remedies widely used
 No application of scientific principles to therapeutics
 Dogma used to explain therapeutic effects (magic,
vital forces)
 Pharmacology in the 19th century
 Pharmacology was born out of increasing skills
among doctors at clinical observation and diagnosis
but being ineffectual when it came to treatment
 A need to improve outcome of therapeutic
interventions provided impetus for pharmacology
 However, the pharmacology could be built only on the
basis of secure foundations in physiology, pathology
and chemistry which fortunately developed
 1847, first pharmacology institute in Estonia (Rudolf
Buchheim, in his house)
 Exclusively concerned with understanding of the
effects of natural substances (plant extracts and toxic
chemicals e. g. Mercury, arsenic)
 Purification of active compounds from plants was
possible through early development in chemistry
 1805, Friedrich Serturner purified morphine from opium,
and other substances quickly followed
 Compounds showed that chemicals, not magic or vital
forces, were responsible for the effects that plant
extracts produced on living organisms
 1858, Virchow proposed the cell theory
 1868, the first use of strucural formular to describe
chemical compounds
 1878, Bacteria as a cause of disease were discovered by
Pasteur
 Pharmacology in the 20th and 21st centuries
 Growth of synthetic chemistry, and resurgence of
natural product chemistry revolutionalised the
pharmaceutical industry and the science of
pharmacology
 New synthetic drugs (barbiturates, local anaesthetics)
appeared
 Era of microbial chemotherapy began with the
discovery by Paul Ehrlich in 1909 of arsenical
compounds for syphilis
 Gerhard Domagk, discovered sulfonamides, the first
antibacterial drugs in 1935
 Chain and Florey developed penicillin during the
Second World War, based on the earlier work of
Fleming
 By this time, pharmacology had really established its
identity and status among the biomedical sciences
 Physiology was also making rapid progress particulary
in relation to chemical mediators
 Many hormones, neurotransmitters and inflammatory
mediators were discovered
 The realisation that chemical communication plays a
central role in almost every regulatory mechanism in
living systems, established a large area of common
ground between physiology and pharmacology
(interaction between chemical substances and living
systems the interest of pharmacologists from begining)
 1905, Langley first proposed the concept of ‘receptors’
for chemical mediators, and this was quickly taken up
by pharmacologists
 Receptors concept and technologies developed from it,
have had a massive impact on drug discovery and
therapeutics
 Biochemistryalso emerged as a distinct science in
early 20th century

 Discovery
of enzymes and delineation of biochemical
pathways provides yet another framework for
understanding drug effects
Figure 1-2 Pharmacology today with its various subdivisions. Interface disciplines (brown boxes) link pharmacology to other mainstream biomedical disciplines (green boxes).
 Allopathy
 Homoeopathy
 Acupuncture
 Herbalism
 Aromatherapy
 Modern medicine rely heavily on drugs as the
main tool of therapeutics (surgery, diet
excercise less commonly used)
 Therapeutic principles outside the domain of
science are currently gaining ground as
alternative or complementary medicine
 The problem: they reject the medical model
which attributes disease to underlying
derangement of normal function
 Focus on subjective malaise
 Abandon objectivity in defining and measuring
disease
 Depart from scientific principles in assessing
therapeutic efficacy and risk
 Unfortunately, practices can gain public
acceptance without satisfying any of the criteria
of validity