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Department of Pharmacology Poznan University of Medical Sciences Guidance and syllabus for the course of pharmacology 5-yearDDS Programme Poznań 2016/17 1 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. 2 1. 2. 3. 4. 5. 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 3 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- 4 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. 5 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, 6 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). 7 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 8 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- 9 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 10