Download Department of Pharmacology

Department of Pharmacology
Poznan University of Medical Sciences
Guidance and syllabus for the course of pharmacology
5-yearDDS Programme
Poznań 2016/17
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Course coordinator: dr hab. Przemysław Mikołajczak Ph.D, prof. UM
Co-coordinator: dr hab.Marzena Dworacka M.D., Ph.D., prof. UM
 is available most Thursday’s between 12.00-13.30 - an appointment should made
by e-mail
 e-mail address: [email protected]
 pharmacology website: farmakologia.ump.edu.pl
Recommended textbook:
Yagiela, Dowd, Neidle: Pharmacology and Therapeutics for Dentistry, 6th
Edition, Elsevier Health Sciences
Supplementary textbook:
Tripathi KD: Essentials of pharmacology for dentistry, 3rd edition, Jaypee
Brothers Medical, 2016.
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DDS – 2nd year
Pharmacology Course Regulations 2016/17
The material of the course will be presented through lectures and seminars. During the
seminars students must be prepared to discuss corresponding topics.
Attendance:
 Each student must be present with the group they have been assigned to.
 Student’s attendance during the seminars is mandatory – only 1 unjustified absence during the whole course will be accepted.
 The absence during the seminar must be justified by a duly authorised document
(doctor’s note, University’s letter, letter from other authorities, etc.)
 Students with unjustified absences have to take the integrative test independent on their component tests (quizzes) results.
Completion of the course of seminars (earning a credit):
 Students’ progress shall be evaluated on an ongoing basis based on the results of
component tests (quizzes) carried out at the end of each seminar or at the time indicated in the schedule. Each component tests can be taken once only (no retakes).
 The whole course of the seminars is considered successfully completed and the
student earns a credit if the following condition is met:
o a student gains a minimum grade of 3.0 calculated as a mean value from the
grades of all component tests the student wrote (each student must take the
component test at the time indicated in the schedule)
o The student whose absence is justified as explained above need not take the
component test from the lectures and seminars he failed to attend.
o The student whose absence is not justified as explained above receives grade 2.
 Each student who fails to obtain a minimum grade of 3.0 as mentioned above is
given a chance of taking the Integrative Test to improve. The Integrative Test can
be taken once. The Integrative Test gives the student the credit equivalent with
successful completion of the course of seminars. The results of the Integrative
Test are passed or failed. Student who passed the Integrative Test receives grade
3.0 as the mean credit grade. Failure to pass the Integrative Test is equivalent to
failure to successfully complete the course of pharmacology.
Completion of the whole course of pharmacology (final grade):
The mean grade of all credit tests a student wrote, together with the result of
the Final Exam, shall be the basis for calculation the final grade from the
pharmacology course, as follows:
FINAL grade= final exam grade x 0.6 + seminars mean grade x 0.4
 The Final Exam must be passed to qualify for pharmacology course completion.
 If a student fails to pass the Final Exam, they are still allowed two attempts at the
Repeat Final Exams.
 If a student fails the Final Exam on any attempt, the failing grade must alwaysbe
entered in their Student’s Book and the Examination Card.
Grading scale: 5.0 = Very Good; 4.5 = Better than Good; 4.0 = Good; 3.5 = Fairly
Good; 3.0 = Satisfactory; 2.0 = Unsatisfactory
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DETAILED SYLLABUS OF PHARMACOLOGY
5-YEAR PROGRAMME - DDS
The required scope of information that students should learn with regard to each
drug and drug category/class includes: classification; mechanism of action; therapeutic indications; adverse effects; contra-indications.
Topic
Principles
of
Description and details
pharmacology. The prescription, drug names and generic substitution,
Prescription writing, component parts of the prescription,
drug names, abbreviations,
incompatibilities. Drugs formulations, routes of administration
equivalence: chemical, pharmaceutical, biologic and therapeutic. Component parts of the prescription. Dosage calculation. Drug formulations (oral and parenteral drug formulations). Routes of drug administration (oral and parenteral
routes of drug administration and the choice of most optimal
route of drug administration)
Pharmacodynamics and gen- Drug-receptor interactions, dose response relationship, alloeral mechanisms of drug in- steric model of drug action, receptor-independent drug acteractions
tions. General mechanisms of drug interaction (classification
of drug interactions, mechanisms of drug interactions, factors
influencing drug interactions, drug interaction used in pharmacotherapeutics). Implications for dentistry.
Pharmacokinetics
Passage of drugs across membranes, absorption, distribution,
metabolism, excretion, time course of drug action, pharmacokinetic-pharmacodynamic modelling
Principles of chemotherapy.
For repetition: classification of microbes.
General principles and limitations of chemotherapy in outpatient and hospital practice. The basic terms: antibiotics,
bacteriostatic and bactericidal effect, synergism, antagonism,
additive result, the empiric and definitive therapy, MIC,
MIB, SBT, resistance to antibiotics. Post-antibiotic effect.
The principles of antimicrobial agents selection. The antimicrobial prophylaxis. Superinfections. Therapy with combination of drugs. The principles of antibiotics use as prophylaxis
in dental practice.
Antiviral agents
Drugs used in treatment of herpes virus infections (idoxouridine, vidarabine, trifluridine, acyclovir, gancyclovir,
famciclovir, foscarnet); anti-HIV drugs (nucleoside antiretroviral agents, nonnucleoside antiretroviral agents, protease inhibitors). Interferons. Drugs used in the treatment of
influenza (amantadine, neuraminidase inhibitors, ribavirin).
Other antivirals. Mechanisms of action, main adverse effects.
Implications for dentistry.
-Lactam antibiotics
Penicillins, cephalosporins, carbapenems, monobactams.
Mechanism of action, classification, spectrum of antimicrobial activity, pharmacokinetics, examples of preparations,
side effects. Therapeutic use in dentistry.
Non--lactam antibiotics – Macrolides, tetracyclines, glycylcyclines, lincosamides, chlo-
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protein synthesis inhibitors
ramphenicol, aminoglycosides, polymyxines, vancomycin,
streptogramines, oxazolidinones. Mechanisms of action,
classification, spectrum of antimicrobial activity, pharmacokinetics, examples of preparations, side effects. Therapeutic
use in dentistry.
Quinolones, imidazoles, sul- Mechanisms of action, classification, spectrum of antimicrofonamides
bial activity, pharmacokinetics, examples of preparations,
side effects.
Antifungal agents
Antifungal agents. Introduction: classification of fungal infections. Classification of antifungal agents. Mechanisms of
action, spectrum of antifungal activity, pharmacokinetics,
examples of preparations, side effects. Therapeutic use in
dentistry.
Antibiotics summary
Case study (beta-lactams, protein synthesis inhibitors, antifungal agents, antiviral agents, antibiotics use in dental therapy and in prophylaxis).
Antiparasites and antihel- Antiprotozoal drugs, antihelmintic drugs. Mechanisms of
mintes
action. Spectrum of activity. Examples of preparations.
Local anaesthetics.
Anaesthetics in dentistry.
Local anaesthetics. Mechanism of action. Pharmacologic
effects. Pharmacokinetics, adverse effects, techniques of
anaesthesia, uses in dentistry, drug selection for parenteral
administration (procaine, lidocaine, mepivacaine, prilocaine,
articaine, bupivacaine), agents limited to surface application
(benzocaine, tetracaine, dyclonine, chlorobutanol, cocaine,
lidocaine/prilocaine).
Agents used in general anaes- Introduction: principles of general anaesthesia (theories of
thesia
anaesthetic action, behavioural manifestation of anaesthesia,
uptake and distribution of inhalation anaesthetics, elimination and metabolism of anaesthetic gases, chemical properties of inhalation anaesthetics, pharmacological effects of
inhalation anaesthetics). Inhalation agents (nitrous oxide,
halothane, enflurane, isoflurane, desflurane, sevoflurane, αadrenergic agonists). Intravenous agents (barbiturates,
propofol, ketamine, etomidate, benzodiazepines, opioids).
Anaesthetic properties, adverse effects. Anaesthetic adjuvants and premedication. Muscle relaxants. Anticholinesterases used in anaesthesia. Antagonists for central and respiratory depression.
Antiseptics. Disinfectants.
Classification. Pharmacologic characteristics. Antimicrobial
activity. Uses in dentistry. List of agents: halogens and halogen-releasing compounds, aldehydes, phenols, alcohols,
chlohexidine, surface-active agents, oxidizing compounds,
heavy metals.
Antiplaque/antigingivitis
agents
Introduction: patophysiology of dental plaque. Criteria for
classifying plaque-control agents. Types of chemotherapeutic
agents (oxygenating agents, halogens, fluorides, quaternary
ammonium compounds, sanguinarine, bis-biguanides, phenolic compounds). Controlled local drug delivery.
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Anti-caries agents
Systemic fluoride (fluoridation of communal water supplies,
fluoridation of school water supplies, fluoride supplements)
Topical fluoride (professional topical application of fluorides: solutions, gels, foams, varnishes; self-applied topical
fluoride in the home, fluoride mouth rinses, fluoride dentifrices), fluoride toxicology.
Drugs affecting calcium ho- Vitamin D3 and its derivatives; PTH; calcitonin; bisphosphomeostasis. Vitamins.
nates; fluorides; anabolic agents; hormonal replacement therapy; calcium. Drugs used in the treatment of hyper- and hypocalcemic conditions.
Vitamin A, B, C – biological properties. Implications for
dentistry.
Opioid analgesics and antag- Basic of opioid action. Agonists, mixed agonist-antagonists,
onists
partial agonists and antagonist drugs. List of drugs: morphine, codeine, meperidine, methadone, propoxyphene, naloxone and naltrexone, pentazocine, butorphanol, buprenorphine). Pharmacological actions. Adverse effects. Implications for dentistry.
NSAIDs.
Groups of non-steroid anti-inflammatory drugs; COX-II seMiscellaneous agents for lective NSAIDs. Mechanism of action and pharmacologial
effects, adverse effects. Implications for dentistry. Miscellarheumatoid arthritis.
neous agents for rheumatoid arthritis (gold compounds, anDrugs used to treat gout.
timalarial agents, penicillamine, sulfasalazine, immunosppressants, biologic agents). Drugs used to treat gout (allopurinol, colchicine, probenecid, sulfinpyrazone).
Analgesics use for effective Pain classification and assessment. Choice of analgesic regpain control
imen. Use of NSAIDs and opioids in the control of pain.
Sedative-hypnotics. Antianxiety drugs.
Management of fear and anxiety.
Benzodiazepines (chemistry and structure-activity relationship, mechanism of action, pharmacologic effects, pharmacokinetics, adverse effects and drug interactions, inverse
agonists and antagonists, general therapeutic uses). Zolpidem
and zaleplon, Barbiturates (chemistry and structure-activity
relationship, mechanism of action, pharmacologic effects,
pharmacokinetics, adverse effects and drug interactions, general therapeutic uses). Chloral hydrate and other sedative
hypnotics. Antihistamines. General therapeutic uses of sedative-hypnotics. Azaspirodecanediones. Management of fear
and anxiety- general principles. Pharmacologic approaches.
Conscious sedation. Deep sedation. Reversal agents.
Drugs affecting coagulation.
Management of local or systemic bleeding. The use of
anticoagulant drugs in time
of extraction
For repetition: hemostasis and coagulation cascade. Regulation of coagulation.
Procoagulant agents: topically applied clotting factors, astringents and stypics, vasoconstrictors. Procoagulant preparations used in the management of bleeding disorders. Treatment of hemophilia and von Willebrand’s disease. Anticoagulants: heparins, direct thrombin inhibitors, miscelleous
agents, oral anticoagulants (acenocoumarol/warfarin). Heparin antidotes. Vit. K. Fibrynolytic agents (tPA; streptokinase,
anistreplase). Antifibrinolytics (aminocaproic acid, tranexamic acid). Platelet inhibitors (cyclooxygenase inhibitors,
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Antipsychotic drugs.
Antidepressant drugs.
Antiparkinson drugs.
Anticonvulsants.
Autonomic drugs
ADP receptor inhibitors, glycoprotein IIb/IIIa inhibitors)
Antipsychotics - pharmacological effects, antipsychotics
effects, sedative actions, extrapyramidal effects, seizure
threshold, other central nervous system actions, pharmacokinetics, adverse effects (phenothiazines and thioxanthenes,
butyrophenones, dihydroindolones, dibenzoazepines, diphenylbutylpiperidines, dibenzodiazepines, thienobenzodiazepines, benziosoxazoles, other atypical antipsychotic drugs).
General therapeutic uses. Implications for dentistry. Antidepressants- pharmacologic effects, pharmacokinetics, adverse
effects (tricyclic antidepressants, second- and thirdgeneration antidepressants, selective serotonin reuptake inhibitors, MAO inhibitors). Lithium salts, other normothymic
agents. Mechanisms of action, pharmacological effects. Implications for dentistry.
Antiparkinson drugs: neurobiology and pathophysiology,
drug therapy for Parkinson’s disease (levodopa, MAO inhibitors, direct dopamine receptor agonists, amantadine, anticholinergic agents – mechanisms of action, adverse effects).
Implications for dentistry.
Classification of epileptic disorders. Anticonvulsant agents
(hydantoins, barbiturates, carbamazepine, valproic acid, succinimides, benzodiazepines, gabapentine, lamotrigine, carbonic anhydrase inhibitors, topiramate, zonisamide, levetiracetam, magnesium salts – mechanisms of action, adverse effects, general therapeutic use). Implications for denistry.
For repetition: functional characteristics of autonomic nervous system, neurotransmitters, signal transduction and second messengers.
Adrenergic agonists (norepinephrine, epinephrine, dopamine,
α-adrenergic receptor agonists, β- adrenergic receptor agonists, mixed- and indirect-acting adrenergic agonists) –
pharmacological effects, pharmacokinetics, general therapeutic uses. General therapeutic uses, therapeutic uses in dentistry, adverse effects.
Adrenergic blocking agents (nonselective α-adrenergic receptor antagonists – selective α1-adrenergic receptor antagonists, β-adrenergic receptor antagonists, drugs with combined
α- and β-adrenergic receptor antagonist activity, adrenergic
neuron-blocking drugs). Implications for dentistry.
Cholinomimetic agonists (chemistry and classification,
pharmacologic effects, pharmacokinetics, adverse effects).
Anticholinesterases (chemistry and classification, mechanism of action, pharmacological effects, pharmacokinetics,
adverse effects, general therapeutic uses, therapeutic uses in
dentistry.
Antimuscarinic drugs (chemistry and classification, mechanism of action, pharmacologic effects, general therapeutic
uses, adverse effects, therapeutic uses in dentistry).
Drugs affecting nicotinic receptors (ganglionic blocking
drugs, nicotine).
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Antineoplastic drugs
Principles of cancer chemotherapy. Chemotherapeutic agents
-mechanisms of action, adverse effects: (alkylating agents,
antimetabolites, antibiotics, vinca alkaloids, hormonal
agents, enzymes, platinum complexes, podophyllotoxins,
camptothecins, taxoids, others. Retinoids, biologic response
modifiers (interferons, aldesleukin, oprelvekin), thyrosine
kinase inhibitors, proteasome inhibitors, matrix metalloproteinase inhibitors, monoclonal antibodies (rituximab,
trastuzumab, gemtuzumab ozogamicin, ibritumomab, tositumomab, alemtuzumab, bevacizumab). Combination therapy. Implications for dentistry.
Antihyperlipidemic drugs
HMG-CoA reductase inhibitors, bile acid binding resins,
fibrates, niacin, unsaturated free fatty acids (FFAs),
probucol, cholesterol absorption inhibitors. Mechanisms of
action, main adverse effects.
Drugs used in therapy of my- Introduction: mechanisms involved in myocardial insuffiocardial insufficiency.
ciency development. Cardiac glycosides (mechanism of action, pharmacological effects, adverse effects, general therapeutic uses, conditions affecting digitalis therapy). Angiotensin converting enzyme inhibitors, diuretics, dopamine, dobutamine, phosphodiesterase inhibitors, beta-adrenolytic
agents, nesiritide. Mechanisms of action and pharmacological activity responsible for their use in therapy of myocardial
insufficiency, adverse effects. Implications for dentistry
(stress factors, drug interactions).
Antianginal drugs.
Introduction: pathophysiology of angina. Beta-adrenolytic
agents, nitrates, calcium channel blockers, sydnoimines.
Mechanisms of action and pharmacological activity responsible for their use in therapy of angina, adverse effects.
Antiarrhythmic drugs.
Introduction: mechanisms of arrhythmias. Classes of antiarhythmic drugs IA,B,C, II, III, IV. Adenosine. Digoxin.
Magnesium and potassium salts. Links between electrophysiology of the heart and mechanisms of antiarrhythmics action, adverse effects. Implications for denistry.
Diuretics.
For repetition: general mechanisms of renal epithelial
transport. Loop diuretics; thiazides and thiazide-like drugs;
carbonic anhydrase inhibitors; osmotic diuretics; K+-sparing
agents. Adverse effects. Implications for dentistry.
Antihypertensive drugs.
Introduction: definition of arterial hypertension and its classification. Diuretics used as antihypertensive agents,
adrenolytic agents; diuretics; angiotensin converting enzyme
inhibitors; calcium channel blockers; angiotensin receptor
antagonists; centrally acting antihypertensive agents; vasodilators, ganglionic blockers. Mechanisms of action and pharmacological activity responsible for their use in therapy of
hypertension, adverse effects. Implications for dentistry.
Hypothalamic and pituitary Hypothalamic releasing and inhibiting hormones; pituitary
gland hormones.
hormones. Bromocriptine.
Thyroid and antithyroid Thyroid hormones (levothyroxin, liothyronine). Antithyroid
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drugs.
Adrenocortical hormones.
drugs (propylthiouracil, carbimazole, iodine and iodide).
Radioactive iodine. Biological and pharmacological properties. Implications for dentistry.
Glucocorticoids and mineralocorticoids. Biological and
pharmacological properties. The principles of glucocorticosteroids therapeutic use. Therapeutic uses in dentistry. Adverse effects.
Steroid hormones of reproduc- Estrogens and anti-estrogens, progestins, hormonal contration and sexual development. ception, androgens and anti-androgens, anabolic steroids.
Estrogens, progestins and Biological and pharmacological properties. Adverse effects.
antiestrogens. Androgens and Implications for dentistry.
antiandrogens.
Insulin and oral antidiabetic Introduction: diabetes mellitus and hyperglycemia – definidrugs.
tion and classification. Insulin – biological properties, adverse effects. Oral antidiabetic agents: sulfonureas, glucosidase inhibitors, meglitinides,biguanides, thiazolidinodines.
Mechanisms of action, adverse effects. Glucagon – biological properties and therapeutic use.
Respiratory pharmacology.
Tuberculostatics.
Agents used to support or stimulate respiration (oxygen,
doxapram). Drugs used to treat asthma. Drugs used to improve ventilation (antitussives, opioid analgesics, benzonatate, dextrometorphan, nasal decongestants, intranasal steroids, expectorants, mucolytics). Mechanisms of action, main
therapeutic uses and implications for dentistry.
Tuberculostatics. Mechanisms of action, main therapeutic
uses and implications for dentistry.
Drugs used in peptic ulcer Introduction: pathophysiology of peptic ulcer disease. H2disease.
receptors antagonists, selective antimuscarinics, chelates and
complexes, prostaglandin analogues, proton pump inhibitors,
prostaglandins, gastric antacids. Mechanisms of action, main
adverse effects. Implications for dentistry.
Other drugs used in gastroin- Antisialagogues. Antiemetic agents (5-HT3 antagonists, antitestinal disorders.
histamines, metoclopramine and other dopaminergic blockers). Laxatives (fibre, bulk forming laxatives, osmotics,
stimulant laxatives, faecal softeners, bowel cleansing solutions). Antidiarrheal agents (antimotility drugs, adsorbents
and bulk forming agents). Gastrointestinal stimulants (cisapride, metoclopramide). Mechanisms of action, main adverse effects.
Immunosuppressive agents
Components of the immune system. Immunotherapeutic
agents (immunophilin ligands, glucorticosteroids, thalidomide, cytotoxic drugs, cytokines, interferones, antibody
preparations, immunostimulants). Mechanisms of action,
main adverse effects.
Toxicology and drug abuse
General principles (dose-response relationships, factors that
change dose-response relationship, acute versus chronic toxicity). Principles for therapy of poisoning. Specific toxicants
(mercury, lead, iron, heavy metal chelators, carbon monoxide, ozone, sulphur dioxide, nitrogen oxides, chlorinated sol-
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vents, benzene, methyl methacrylate, insecticides, fumigants,
herbicides, rodenticides).
Drug abuse characteristics and terminology. Abuse of opioid
analgesics, sedative-hypnotics, amphetamines, cocaine and
other psychomotor stimulants, hallucinogens, marijuana,
inhalants. Pharmacological effects, abuse characteristics,
toxicity. Implications for dentistry.
Oral complications of phar- Oral complication of cancer chemotherapy (direct and indimacotherapy.
rect oral toxicities. Other common oral complications of
pharmacotherapy: acute - erythrema multiforme - StevensJohnson syndrome, Lyell syndrome, Quincke’s oedema,
chronic - papular eruptions, erythrema, blisters, aphtae, erosions, gingival hyperplasia, enamel impairement; xerostomia,
dysgeusia.
Drugs and schedules
medical emergencies.
for Schedules of management of: cardiac arrest, hyperventilation, hypoglycemia, anaphylactic shock/severe allergic reactions, asthma, hypertensive emergency, pulmonary edema,
acute coronary event, epileptic seizures
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