Core Curriculum in Pharmacology for Pharmacy courses
Introduction
Pharmacology is taught in a variety of ways in Australian Pharmacy courses. The following curriculum is intended to reflect the areas that should be covered in an undergraduate Pharmacy degree, whether under a pharmacology banner or taught in another subject. As an integral part of the professional preparation of a pharmacist, any pharmacology curriculum must be actively and closely integrated with the rest of the course.
A thorough understanding of Pharmacology requires knowledge of a range of related disciplines. These are generally taught across a range of subjects within a Pharmacy program, including physiology, pharmacokinetics, medical chemistry, biochemistry, physical pharmaceutics, formulation and pharmaceutical microbiology – each of which is recognised as a stand alone sub-discipline. A brief summary of the areas that form the wider context upon which pharmacology is based is included.
Aspects of the clinical practice of Pharmacy that do not relate to the mechanism of action or adverse effects of therapeutic agents are generally covered in subjects such as Clinical Pharmacy. These areas, such as counselling issues, drug choices within a class etc, are not included in this document.
“Pharmacology” has been defined here as “pertaining to the study of the mechanism of action and clinical use of drugs for the treatment of human disease states”.
Finally, “emerging drugs” have not been included in this document; as these drugs become clinically relevant they will be included in the appropriate clinical section.
Physiology and Pharmaceutical Biology underlying the actions of drugs in human systems
Detailed knowledge of the actions of drugs within living systems, the therapeutic uses of drugs and medicines in man, the aetiology and epidemiology of major diseases and the principles of their drug treatment and the clinical evaluation of new drugs and medicines must be set in the wider context of an understanding of:
- Systems physiology and basic anatomy
- Pathophysiology and physiological adaptations to disease states
- Awareness of primary and secondary disease states, idiopathic and well-described pathophysiology
- Mechanisms of drug absorption and the passage of drugs across cell membranes; routes of administration, bioavailability and dosage forms
- The distribution of drugs. Drug biotransformation; sites of metabolism and the activation/inactivation of drugs. Drug excretion and the entero-hepatic circulation. Factors affecting the absorption, distribution, metabolism and excretion of drugs.
- Alterations in drug absorption, distribution, metabolism and excretion upon ageing, disease and other changes;
- Clinical toxicology associated with drug over-dosage, drug or substance misuse or accidental exposure;
- Properties of materials used in formulations and devices for the delivery of biologically-active molecules;
- Functionality of pharmaceutical excipients;
- Pharmacopoeial and regulatory requirements; degradation of medicines: evaluation and control of biological, chemical and physical degradation. Systems physiology Pharmacokinetics and concepts of therapeutic range; H
- Half-life, clearance, first order and zero order kinetics, loading dose and maintenance dosing. Factors affecting pharmacokinetics such as disease, physiologicalconditions (eg age, pregnancy, obesity etc), drug interactions and pharmacogenetics.
- Compliance/adherence to medication regimes
Core Curriculum
The curriculum for Pharmacology has been divided into two overlapping sections:
a) Basic Pharmacology
b) Clinical Pharmacology
A. Basic Pharmacology
Molecular targets of drug action
- Protein targets vs others (e.g., nucleic acids)
- Proteins = receptors, enzymes, ion channels, other proteins (see below); structure, function, classification
- Principles of drug-receptor interactions: Concepts of affinity, intrinsic activity and efficacy;
- Occupancy theory. Dose response relationship. Rate and receptor inactivation theories. Multi-state theory. Selectivity versus specificity
- Classification of drugs: Agonists, antagonists/inhibitors, inverse agonists, allosteric modulators
- Signal transduction. G proteins and accessory cellular proteins.
Neurotransmitter and endocrine pharmacology
- Adrenergics. The pharmacological actions of noradrenaline; comparison with adrenaline and isoprenaline/dopamine. Actions and uses of a- and b- adrenoreceptor agonists and antagonists; adrenergic neurone blocking drugs. Drugs that interfere with synthesis, storage and metabolism of noradrenaline.
- The pharmacological actions of acetylcholine. Drugs affecting cholinergic transmission. Anticholinesterases. Actions and uses of selective agonists and antagonists for muscarinic and nicotinic receptors.
- Non-adrenergic, non cholinergic transmission. Nitric oxide, adenosine and other NANC transmitters.
- Central neurotransmission. Location and function of neurones that release dopamine, GABA, glutamine, 5-HT and acetylcholine.
- Lipid mediators - endocannabinoids
Autacoid Pharmacology
- Histamine receptor sub-types; clinical uses of histamine receptor antagonists.
- 5-hydroxytryptamine (5-HT) – synthesis, storage, release, catabolism and pharmacological effects. 5-HT receptor sub-types, clinical uses of receptor selective antagonists. Drugs that inhibit formation or actions of bradykinin. Prostaglandins and their pathophysiological roles in inflammation, fever and pain. Drugs that block prostaglandin production; COX-1 and COX-2 inhibition; leukotrienes – synthesis, actions, pathological roles. 5-lipoxygenase and FLAP inhibitors, LT receptor antagonists.
B. Clinical Pharmacology
Analgesics
- Opioid and non-opioid analgesics. Sites of analgesic activity; local and central analgesia.
Anaesthetics
- Local anaesthetics. General anaesthetics. Inhalational and intravenous anaesthetics.
Anti-infectives
- Antibiotic treatment, modes of action and resistance including penicillins, cephalosporins, carbapenems, monobactams, b-lactamase inhibitors, tetracyclines, aminoglycosides, erythromycin, 4-quinolones, vancomycin and fusidic acid and anti-tuberculosis agents. Antimicrobial synergy, antagonism and resistance.
- Viral infections and their treatment including Herpes, Varicella and HIV. Fungal infections including dermatophytes and Candida albicans and treatment with amphotericin and azole agents. Treatment of protozoal infections, including malaria. Helminths and arthropods, especially tropical issues such as schistosomiasis, filariasis.
- Tropical diseases: malaria, tuberculosis, leprosy, trypanosomiasis; also public health issues.
Cancer Drugs
- Introduction and principles of chemotherapy. The mechanisms of action, uses and limitations of the major groups of chemotherapeutic agents, e.g. alkylating and cross linking agents, antimetabolites, topoisomerase inhibitors, spindle inhibitors and biologicals. New and future therapies.
- Immunomodulation, monoclonal antibodies and conjugates, pro-drugs, vaccines, gene and RNA targeting, aptomers, gene therapy, DNA repair and resistance inhibition. Novel delivery systems. Inhibition of angiogenesis and the metastatic cascade. Radiation and chemotherapy sensitisers and protectors.
Cardiovascular Drugs
- Hypertension and antihypertensive drugs. Diuretics, vasodilators, ACE inhibitors, AT1 antagonists, a-adrenoceptor blockers; b-adrenoceptor antagonists, calcium entry blockers and CNS active drugs, diuretics, endothelin antagonists, endopeptidase inhibitors
- Ischaemic heart disease and its treatment; nitrates, b-adrenoreceptor blockers and calcium channel blockers.
- Lipid lowering drugs including the statins, cholestyramine, nicotinic acid and ACAT inhibitors.
- Arrhythmias and antiarrhythmic drugs. Class I-IV anti-arrhythmic drugs Sodium channel blockers such as quinidine and lignocaine, Potassium channel blockers such as amiodarone and sotalol; calcium entry blockers, digoxin, adenosine, beta-adrenoceptor antagonists.
- Heart failure: ACE inhibitors, b-blockers, adrenoceptor antagonists, inotropic agents and vasodilator drugs in the treatment of heart failure, such as digoxin and dopamine
- Anticoagulant therapy - warfarin, heparin, ximelagatran.
- Fibrinolytic mechanisms. Pharmacology and therapeutic role of streptokinase and tissue plasminogen activator (tPA) . Anti-platelet drugs and their use in vascular embolic disease. Treatment of anaemia
Clinical Toxicology
- Concepts of drug toxicology. Therapeutic index, adverse drug reactions, “predictable” versus unexpected toxic actions of drugs. Non-drug toxicology, industrial and environmental toxicants. (Adverse effects of drugs would generally be covered in each of the other clinical pharmacology sections)
Dermatological Drugs
- Acne, pathogenesis and treatment; keratolytics, comedolytics, antibiotics, retinoids.
- Psoriasis – inflammatory and hyperproliferative nature of the disease. Use of topical vitamin D analogues, corticosteroids, dithranol; use of intravenous therapy in resistant cases.
- Alopecia – involvement of androgens. Use of minoxidil, anti-androgens.
Ear Nose and Throat Drugs
- Drugs for rhinitis and sinusitis - Oral and topical sympathomimetics, nasal corticosteroids, antibiotics.
Endocrine and Reproductive Drugs
- Drug treatment of diabetes mellitus. Insulin and oral hypoglycaemics. (sulphonylureas, metformin, thiazolidinediones).Hormones of the pituitary and hypothalamus. Drugs suppressing prolactin release. Vasopressin and analogues.
- Drugs used in diseases of the thyroid. Corticotrophin and adrenal steroids.
- Drugs affecting calcium homeostasis. Osteoporosis and Paget’s disease. Use of calcitonins, bisphosphonates, oestrogen receptor modulators, vitamin D analogues, calcium
- Hormone replacement therapy.
- Drugs used for contraception; oestrogens and progestagens. Mechanism of contraceptive action. Drugs affecting the uterus – uterine relaxants (b-agonists) and stimulants (prostanoids, oxytocin).
- Anabolic/androgenic steroids - use and abuse
Eye Drugs
- Glaucoma – open and closed angle glaucoma. Pharmacotherapy – b-blockers, a2 agonists, cholinergic drugs. Drugs for allergic and inflammatory eye conditions – decongestants and antihistamines.
Gastrointestinal Drugs
- Drugs for peptic ulcer disease – antacids, cytoprotective agents, H2 antagonists and proton pump inhibitors. Antibiotic treatment to eliminate H. pylori.
- Drugs for motility disorders – stimulants and anti-spansmodics.
- Drugs for nausea and vomiting – dopamine antagonists, antihistamines, anticholinergics and 5HT3 antagonists.
- Laxatives – bulking agents, stool softeners, stimulant and osmotic laxatives
Genitourinary Drugs
- Drugs for urinary incontinence – anticholinergics, antidiuretic hormone analogues
- Drugs for benign prostatic hypertrophy – a blockers and 5-a reductase inhibitors. Antiandrogens and prostate cancer.
- Drugs for erectile dysfunction – phosphodiesterase inhibitors.
- Treatment of impotence
Anti-inflammatory / Musculoskeletal Drugs
- Anti-inflammatory drugs – first-line, second-line, third-line. Non-steroidal anti-inflammatory drugs (NSAID). Glucocorticoids as anti-inflammatory agents. Second-line antirheumatic drugs. Pharmacology of immuno-modulatory drugs used to treat autoimmune diseases, including cytotoxic and immunosuppressive agents.
Drugs for Neurological diseases and Psychotropics
- First line and second line anti-epileptic drugs. Side effects and mechanisms of action.
- Alzheimer’s disease. Drug treatment of memory disorders. Anticholinesterases, muscarinic agonists, nicotine, nootropics and cognitive enhancers.
- Drug dependence. Definitions of dependence, misuse and abuse of drugs. Classification of drugs of dependence. Mechanisms of dependence.
- Parkinson’s disease and its treatment. L-dopa, decarboxylase inhibitors, MAO inhibitors, Muscarinic antagonists, dopamine receptor agonists.
- Other neurodegenerative disorders. Huntington’s chorea; Amyotrophic lateral sclerosis; drugs used to treat spasticity.
- Treatment of depression – Electroconvulsive therapy (ECT). Monoamine oxidase inhibitors (MAOI). Reversible inhibitors of monoamine oxidase A (RIMA). Tricyclic antidepressant drugs and Selective Serotonin Reuptake Inhibitors (SSRI). ‘Atypical’ antidepressants. Mania and its treatment. Prophylactic and therapeutic uses of lithium. Antipsychotics, antidepressants and anticonvulsants in the treatment of mania.
- Antipsychotics for the treatment of schizophrenia. Typical vs atypical agents.
- CNS stimulants. Caffeine, amphetamines, cocaine, hallucinogens. Treatment of attention deficit hyperactivity disorders.
- Hypnotics and sedatives: the barbiturates, benzodiazepines, non-benzodiazepine anxiolytics and sedatives.
Respiratory Drugs
- Pathophysiology of asthma – constrictive and inflammatory components. Role of eosinophils. Pharmacotherapy of asthma – bronchodilators; b-agonists, xanthines, anticholinergics, leukotriene receptor antagonists. Anti-inflammatory drugs – corticosteroids, chromoglycate, etc. Use of longer acting b-agonists.
- Chronic obstructive pulmonary disease. – chronic bronchitis, emphysema and smoking. Pharmacotherapy