Download REM 132

SHIFA COLLEGE OF MEDICINE
STUDY GUIDE
ESSENTIALS OF MEDICINE ll
(EOM ll-Y3)
3rd Year-Spiral ll
Table of Contents
1. Introduction
2. Themes of the module
3. List of Recommended Books
4. Faculty to contact
4
1. INTRODUCTION
This study guide is for the module of Essentials of Medicine II (EOM II) for the 2nd
spiral. The duration of the module is two weeks. Clinical cases have been developed
for the topics to be covered and these cases will be used as triggers to deliver the
respective objectives, using different learning strategies.
Learning Strategies:
Large group interactive sessions
These sessions are used to introduce and to discuss concepts in an interactive manner
utilizing audiovisual aids.
Small group discussions
Some of the objectives included in the curriculum, are discussed in small groups of 810 students. These sessions involve a facilitator who mainly controls the process.
These discussions are structured as reading the case scenario by students,
brainstorming within the group about the application of the learnt knowledge, and
clarification of concepts by facilitator.
Integrated practical sessions
Students are divided into groups which perform relevant practical in basic sciences
and clinical skill laboratories.
Self directed learning
Sufficient time is allocated for self directed learning.
Assessment
Formative assessment during the module would not be held as it is a very short
module. Summative assessment will be done at the end of the module and will
comprise of MCQs and SAQs. Performance assessment (Skill) would be in the block
IPE.
The module asks you to plan your time right at the very beginning. So look at the
following tips which should help you to plan your time, to protect it from other
distractions and to keep up at the rate of two hours a day for just three weeks:
• Decide to give yourself the gift of 2 hours a day – you deserve it!
5
• Think about the times of day when you study best and when you know that you can
close the door, switch off your phone and just study – is this the morning, the evening
or after dinner?
• Talk with your friends, your room mate or your parents about how they could help
you to protect those hours of the day.
• Make sure that you have organized somewhere to study, to keep your books and to
have access to a computer. A desk with good lighting and a comfortable chair will
help.
It’s as easy as that!
We hope that this study guide will help you organize the learning process during
this module.
Good Luck!
6
INTRODUCTION TO EXIT COMPETENCIES
The CanMEDS framework is a guide to the essential abilities physicians need for
optimal patient outcomes. The framework defines the competencies needed for
medical education and practice. This framework of core competencies are organized
thematically around 7 key physician Roles: “Medical Expert, Communicator,
Collaborator, Manager, Health Advocate, Scholar and Professional”. These seven
Roles have been clarified and defined by Key competencies. Each key competency
has been further outlined into multiple Enabling competencies. The enabling
competencies specify the behaviors, skills and attitudes that must be displayed by the
learner.
As a scholar, one must demonstrate the ability to engage in self-directed learning and
problem solving skills. As a medical expert, one must demonstrate a thorough medical
knowledge including skills appropriate for academic level. He/she should demonstrate
knowledge expertise in procedural skills for academic level. As a communicator,
learner must communicate effectively with peers through verbal and other non-verbal
means of communication. As a collaborator, he/she must demonstrate teamwork and
show sensibility to diversity. As manager, he/she must demonstrate punctuality;
display organization in assigned tasks; and deepen his/her understanding of the
appropriate use of health care resources. As health advocate, one must recognize
important determinants of health and principles of disease prevention. As
Professional, learner should behave in an altruistic manner; dress appropriately;
demonstrate respect for others (peers and facilitators); demonstrate reliability and a
strong sense of responsibility in accomplishment of assigned tasks; and demonstrate
honor and integrity by upholding student and professional code of conduct.
7
2. THEMES OF THE MODULE
1.
Overview of Pathology, Pharmacology and Forensic Medicine
05%
3. General Pharmacology
a) Pharmacokinteics
b) Pharmacoodynamics
c) Pharmacogenetics
3. Pathogens, chemotherapy and toxicology
20%
20%
03%
12%
4. Autonomic nervous system
a) Adrenergic Pharmacology
b) Cholinergic Pharmacology
20%
20%
8
2. THEMES OF THE MODULE
Theme 1: Overview of Pathology, Pharmacology and Forensic
Medicine (5%)
Learning Objectives: At the end of this theme, students should be able to:
1. Describe general principles of Pharmacology, sources of drugs and essential
drugs concept.
2. Describe branches and divisions of sciences of Pathology and Forensic
Medicine.
3. Describe uses / applications of the above mentioned sciences.
Critical questions:
1. What are the different branches of pathology, pharmacology and forensic
medicine?
2. What are the uses and applications of the above mentioned sciences?
3. What is relevance of forensic medicine in our local setting?
4. What are the commonly used tools, techniques and methods of the above
mentioned sciences?
9
Theme 2: General Pharmacology
a) Pharmacokinetics
(20%)
KNOWLEDGE
Learning Objectives: At the end of this section, students should be able to:
1. Describe various routes of drug administration and their advantages and
disadvantages
2. Describe drug transport across biological membranes and various factors
modifying drug absorption
3. Relate concepts of half life of drug, plasma protein binding drug and volume
of distribution of drugs to its bioavailability.
4. Describe loading dose, steady state concentration, target concentration,
maintenance concentration and bioequivalence of drugs.
5. Relate drug metabolism, factors affecting drug metabolism and its clinical
significance.
6. Describe drug excretion, clearance, zero and first order kinetic of drugs.
7. Appreciate the clinical importance of applying the knowledge of these
pharmacokinetic parameters in designing drug dose- regimens to achieve drug
effectiveness and safety.
8. Recognize that these parameters can be modified in certain disease states such
hepatic, renal or cardiac failure which necessitate dose adjustment to avoid
drug toxicity.
b) Pharmacodynamics (20%)
KNOWLEDGE
Learning Objectives: At the end of this section, students should be able to:
1. Relate drug receptor concepts, antagonism, synergism, drug-receptor
interaction and signaling mechanism of drugs.
2. Describe the relationship between drug concentration and response
3. Analyze drug response curves (graded and quantal).
4. Appreciate the general phenomenon of biological variation.
10
5. Describe variations in drugs responsiveness e.g., tolerance, tachyphylaxis.
6. Describe drug toxicity, therapeutic index and therapeutic window.
7. Caclulate dosage of drugs in relation to age and weight,
8. Apply principles of drug prescription in pregnancy and the special formulas for
calculation of dose for pediatric and geriatric patients.
9. Describe the general phenomenon of biological variation.
10. Apply the concept of individualization of drug therapy.
11. Discuss the important variables which can influence drug action.
Pharmacogenetics: (3%)
Learning Objectives:
By the end of this part, the student should be able to :
1. Describe the factors responsible for variations in drug response in different
individuals
2. Appreciate the clinical importance of applying the knowledge of
pharmacogenetics in designing drug dose- regimens to achieve drug
effectiveness and safety.
SKILL
1. Identify essential components of prescription.
2. Estitimate the hald life of a drug based on its clearnan ce and volume of
diustrivution or froma graph of plasma concentration over time
3. Define various pharmaceutical terminologies, calculate various strengths of
solutions.
4. Calculate the disage adjustment required for a patient with imp\iared renal
function
11
Critical questions:
1. What is the relative ease of permeation of a weak acid or base from
knowledge of it pKa , the pH of the medium and the Handerson
Hasselbalch equation?
2. What is Bioavailability? Which factors influence bioavailability of drugs
after oral administration?
3. What is the importance of routes of administrations of in terms of
bioavailability?
4. What is the importance of blood flow in relation to clearance of some
drugs
5. What is the study state concentration and when is it reached?
6. What is first pass effect?
7. What are prodrugs?
8. What is the importance of therapeutic index, therapeutic window and
margin of safety?
9. Which enzymes and their reactions are involved in the metabolism of
Xenobiotics?
10. What are the effects of smoking, liver and kidney disease on drug
elimination? Mention some well defined genetically determined
differences in metabolism
11. What are zero-order and first order kinetics of drug elimination?
12. What is the difference between affinity, efficacy, and potency of drugs?
13. What is the difference between pharmacological physiological and
chemiocal antagnomism
14. Wht is the effect of a partial agonist in the presence and absence of full
agonist
15. What is the difference between graded and quantal dose response curves
12
Theme 3: Pathogens, chemotherapy and toxicology (12%)
Learning Objectives: At the end of this section, students should be able to:
1. Describe structure of pathogens
2. Describe principles of chemotherapy
3. Describe principles of toxicity of drugs
Critical questions:
1. What are the important factors to keep in consideration while selecting
appropriate anti microbial therapy?
2. What are the differences between concentration dependent killing and time
dependent killing ?
3. What are the differences among broad spectrum, narrow spectrum and
exteneded spectrum anti biotics ?
4. What are the main differences between bactericidal and bacteriostatic anti
microbial drugs?
5. What are the advantages and dis advantes of combination of anti microbial
drugs?
6. What are the main mechanisms of resistance against anti microbial therapy?
7. What is cell cycle specificity of anti cancer drugs?
8. What are the problems encountered with cancer chemotherapy?
9. What are the main mechanisms of resistance against anti cancer drugs?
13
Theme 4: Autonomic nervous system (40%)
a) Adrenergic Pharmacology
20%
KNOWLEDGE
Learning Objectives: At the end of this section, students should be able to:
1. State types of neurotransmitters involved in autonomic pharmacology
2. State types and location of adrenergic receptors.
3. Describe steps involved in synthesis of nor epinephrine and potential actions of
drugs to block these syntheses.
4. Describe mechanism of action, effects, clinical uses, adverse effects and toxicity
of adrenergic agonists / antagonists
5. Describe mechanism of action of drugs used to reverse toxicity of adrenergic
agonists and antagonists.
b) Cholinergic Pharmacology 20%
KNOWLEDGE
Learning Objectives: At the end of this section, students should be able to:
1. State types of neurotransmitters involved in autonomic pharmacology.
2. State types and location of cholinergic receptors.
3. Describe steps involved in synthesis of acetylcholine and potential actions of
drugs to block these syntheses.
4. Describe mechanism of action, effects, clinical uses, adverse effects and toxicity
of cholinergic agonists / antagonists
5. Describe mechanism of action of drugs used to reverse toxicity of cholinergic
agonists and antagonists
14
Critical questions:
1. What are the main differences between adrenergic and cholinergic
transmission?
2. What is the classification of cholinergic and adrenergic drugs??
3. How is acetylcholine formed and which drugs can be used to block
acetylcholine synthesis and release at various stages?
4. How are epinephrine and nor epinephrine formed and which drugs can be
used to block adrenergic synthesis and release at various stages?
5. What is the mechanism of action of adrenergic and cholinergic agonists
and antagonists?
15
3.
RESOURCE MATERIAL
a) Basic & Clinical Pharmacology by Katzung (latest edition)
b) Robbins’ Pathologic Basis of Disease (latest edition)
c) Levinson’s Review of Medical Microbiology & Immunology (latest edition)
d) Parikhs Textbook of Medical Jurisprudence and Toxicology (latest edition)
e) Naseeb R Awan Textbook of Forensic Medicine and Toxicology (latest
edition)
f) Simpson’s Forensic Medicine and Toxicology (latest edition)
g) Jaypee Principles and Practice of Forensic Medicine & Toxicology (latest
edition)
NOTE: Please do not restrict yourself to textbooks, make sure to look for the
latest best available Evidence and also consult other reference books.
16
FACULTY TO CONTACT
Please don’t hesitate to Contact
1. Dr. Talat Ahmad
Professor, Pharmacology
Ext: 3403
Email: [email protected]
2. Dr. Abida Shaheen
Assistant Professor, Pharmacology & Therapeutics
Ext: 3755
Email: [email protected]
3.
Dr. Riffat Nadeem
Associate Professor, Pathology
Ext: 3765
4. Dr. Zubaida Zain
Assistant Professor, Forensic Medicine
Ext: 3383
5.
Dr. Sameena Ghayur
Associate Professor, Pathology
Ext: 3761
e-mail:[email protected]
6. Dr Rifat Nadeem Ahmed
Assitant Professor, Pathology
Ext: 3761
e-mail:rifatnahmad @yahoo.com
7. Dr. Fareeha Iram
SCIL Lab
Ext: 3773
[email protected]
&
8. Dr. Fahad Azam
Assistant Professor, Pharmacology & Therapeutics
Ext: 3755
Email: [email protected]
Course Director Essentials of Medicine II
Team 3 members (Dr. Sara Iftikhar Rathore, Dr. Syeda Hanaa Fatima, Dr.
Muhammad Umer Farooq, Dr. Syeda Sitwat Mahmud, Dr. Zubia Arshad, Dr.
Gemza Shah, Dr. Ali Azeem, Dr. Urooj Anthoni, Dr. Iqra, Dr. Imran Khan)
17