KNOWLEDGE OBJECTIVES FOR MEDICAL PHARMACOLOGY CNS PHARMACOLOGY SPRING 2012 Pharmacology of sleep 1 Know the sleep stages 2 Know the effects of acute and chronic alcohol use on sleep 3 Know the role of GABA A receptor complex in the hypnotic action of barbiturates benzodiazepines and non benzodiazepines 4 Know the effects on sleep of benzodiazepines imidazopyridines and cyclopyrrolones Local anesthetics Basic structural characteristics of local anesthetics Examples of ester and amide linked anesthetics Mechanism of nerve conduction Mechanisms of local anesthetic action Metabolism of ester and amide linked local anesthetics Why are vasoconstrictors often added to the local anesthetic preparations Toxicity and side effects of local anesthetics Please pay attention to central nervous system toxicity and cardiovascular toxicity Major clinical uses of local anesthetics General Anesthetics Definitions partial pressure MAC blood gas partition coefficient oil gas partition coefficient What determines anesthetic potency What are the 4 potential targets for the action of general anesthetics How do blood gas solubility ventilation rate and cardiac output affect equilibration of anesthetics rate of induction of anesthesia What is the mechanism of the concentration effect and the related second gas effect 1 What factors determine the rate of anesthetic equilibration into different tissues What is the route of elimination of general anesthetics and how is recovery from anesthesia affected by the blood gas partition coefficient ventilation rate and cardiac output What are the common pharmacological effects of inhalational anesthetics Know the major differences between the inhalational anesthetics e g which is most least potent induction recovery rate etc see table on handout don t need to memorize numbers What are the major uses of the various intravenous anesthetic agents discussed and their major advantages and disadvantages Herb Drug Interactions Distinguish between pharmacokinetic and pharmacodynamic interactions Know the principle pharmacokinetic and pharmacodynamic interactions of St John s Wort i e induction of CYP and serotonin syndrome photosensitivity Know the main reasons for herb drug interactions with Warfarin i e vitamin K activity decreased GI absorption inhibition of CYP2C9 antiplatelet activity decreased thromboxane synthesis coumadin Know the main reasons for caution with herbs during surgical or dental procedures i e anticoagulant effects sedation or stimulus modify anesthesia Opioid Analgesic Drugs 1 Know about mechanism of nociception physiology Dorsal horn of the spinal cord gate control mechanism 2 Know about classification of opioid analgesic drugs Strong agonists morphine meperidine methadone heroin fentanyl Moderate agonists propoxyphene codeine Mixed agonists antagonists pentazocine nalbuphine buprenorphine Antagonists naloxone naltrexone 3 Know about endogenous opioid peptides Enkepalins endorphins dynorphins endomorphins 4 Know about opioid receptors and the mechanism of action Mu Kappa Delta All G protein coupled receptors Increase K efflux hyperpolarization and reduce voltage gated Ca2 entry 5 Know about the sites of opioid receptor expression Mu periaqueductal gray spinal trigeminal nucleus cuneate and gracile nuclei thalamus nucleus of solitract nucleus ambiguus parabrachial nucleus neurons of the postrema Kappa hyphothalamic region 2 Delta dorsal horn of the spinal cord 6 Know about the pharmacological actions of opioids CNS analgesia sedation euphoria mental clouding respiratory depression nausea and vomiting cough reflex pupillary constriction miosis GI constipation biliary tract spasm 7 Know about the contraindications of opioids Decreased respiratory reserve emphysema severe obesity asthma biliary colic head injury reduced blood volume hepatic insufficiency convulsant states 8 Know about tolerance and physical dependence Tolerance develops to analgesia euphoria sedation lethal dose nausea Tolerance does not develop to miosis constipation respiratory depression partial Physical dependence treat with methadone long acting opioid 9 Know about antitussive and anesthetic usage of opioids Antitussive codeine dextromethorphan Anesthetic fentanyl sufentanil 10 Know about antagonists Naloxone readily reverses the coma and respiratory depression of opioid overdose Naltrexone longer duration of action up to 48 hrs Antiseizure Drugs Know what a seizure is its potential causes and how it relates to epilepsy Know the mechanisms by which neurons become hyperexcitable Know how seizures are classified i e simple partial vs complex partial vs tonicclonic etc see table in handout Know the general principles of antiseizure drug therapy Know the identified mechanisms by which antiseizure drugs work Know the drugs of choice for the various types of seizures their mechanism of action and major side effects What are the 4 major types of drug interactions seen with antiseizure drugs Antihyperlipidemic Drugs Describe the pathophysiology involved in the formation and progression of atherosclerotic plaques and distinguish how HDL LDL and TG levels are related to the risk of atherosclerosis 3 For each class of antilipidemic drugs describe the mechanism of action effect on serum lipids salient adverse effects drug interactions and contraindications Lectures 57 59 Psychopharmacotherapy Antipsychotic Drugs 1 Know mechanism of action for first generation traditional and second generation atypical antipsychotics and the major classes of antidepressants and anxiolytics 2 Know how first generation traditional and second generation atypical antipsychotics differ 3 Understand what types of side effects are associated with blockade of alpha1adrenergic muscarinic and histamine receptors 4 Understand the principles of drug interactions such as CYP inhibitors and inducers protein binding and protein saturation Antidepressants and mood stabilizers 1 Discuss key difference s between unipolar and bipolar mood disorders Identify various antidepressants classified by mechanism of action s e g multiple receptor actions SSRIs MAO Is 2 Discuss the impact of agonism or antagonism at pre synaptic autoreceptors i e short loop negative feedback system 3 Recognize possible mechanisms by which mood stabilizers such as lithium may work e g NE AcH balance hypothesis thyroid catecholamine hypothesis 4 Discuss possible drug interactions with antidepressants and mood stabilizers mediated by the P450 microenzyme
View Full Document
Unlocking...