DEPARTMENT OF CLINICAL PHARMACOLOGY AND THERAPEUTICS
|No.||Name||Status||Qualifications||Google scholar URL|
|01||Professor Ambrose O. Isah||Professor||MBBS (Ib), FMCP (Nig), FWACP, FRCP (Edin), MD(Newcastle upon Tyne, UK)||https://scholar.google.com/citations?hl=en&user=V8A3p2UAAAAJ&scilu=&scisig=AMD79ooAAAAAX8oQHZegOEamhDe-tF8tbmLUClpqxIb-&gmla=AJsN-F5VWxxxNkHZtPaLeo-8oPyJ0-MoAhNh47qYiU-LP3mgKHUg6KgrxO1RZsRZfYoNkFqXzijMqw73CfqZDEMVHfENaIFNoa-3Ic-XyRBHgTczLotE2fA&sciund=9207024586843219204|
|02||Dr. Abimbola O. Opadeyi||Senior
|MBBS (Benin), FMCP (Nig), FWACP, PhD (Bordeaux)||https://scholar.google.com/citations?hl=en&user=uONJ84sAAAAJ|
|03||Dr. Stephen A. Ayinbuomwan||Senior Lecturer||MBBS (Benin), FMCP (Nig.)||https://scholar.google.com/citations?view_op=list_works&hl=en&authuser=6&user=X0L-3FoAAAAJ|
ASSOCIATE LECTURERS (Medicine and Dentistry)
|04||Prof. (Mrs) O.A. Akoria||Professor||MBBS, MSc, FMCP|
|05||Prof. Eddy Ehikhamenor||Professor||BDS, MSc, PhD, Cert.(Lab Anal)|
|06||Dr. Emeka D. Odai||Senior Lecturer||BDS, MSc, FMCS,|
ASSOCIATE LECTURERS (Pharmacology and Toxicology)
|06||Professor Stephen Okpo||Professor||BSc, MSc, PhD|
|07||Dr. Loretta Iniaghe||Senior Lecturer||B.Pharm, MSc, PhD|
|18||Dr. Aghahowa Sylvester||Senior Lecturer||B.Pharm, MSc, PhD|
Clinical Pharmacology and Therapeutics (CPT) is a subspecialty of Medicine. CPT is a scientific discipline that involves all aspects of the relationship between drugs and human. It is relatively new when compared to other older more established disciplines in Medicine. CPT focuses on the main areas of Teaching, Clinical Care and Public Health and Research and provides a platform for collaboration and interaction with governments, regulatory agencies, pharmaceutical industries and other stakeholders. CPT is a medical specialty and was accorded due recognition in the University/Teaching Hospital in 1989 with the appointment into the Department of Medicine of a Lecturer (A.O. Isah) with postgraduate training in Internal Medicine and CPT (at the Wolfson Unit of Clinical Pharmacology University of Newcastle Upon Tyne). The appointment was coupled with a Consultant position at the University of Benin Teaching Hospital (UBTH), which enabled in-depth access to patient care and pharmaceutical facilities in the hospital. In 1994 the hospital authorities established CPT as one of the subspecialty units in Internal Medicine.
Futuristically, the CPT outfit will ensure the production of Medical and Dental graduates skilled in pharmacotherapeutics and its standard of care and to facilitate the development of medicines in our local settings. Since 1994 the established UNIT of Clinical Pharmacology and Therapeutics has propelled the use of medicines in an appropriate trajectory. It participated in the Essential Medicines and Rational Use of Medicines programme and in the establishment of a National Pharmacovigilance System to promote the safety of medicines.
The enormous potential of this discipline has been recognised globally by competent bodies (WHO, CIOMS, IUPHAR etc.) since the 1970s. The actualisation of the establishment of a department in the University of Benin followed the insistence of the Medical and Dental Council of Nigeria during its 2006 accreditation exercise to ensure proper training of Medical and Dental Students. The curriculum for the training of undergraduate Medical and Dental students was developed in line with the benchmark of the National University Commission (NUC) and the Medical and Dental Council of Nigeria (MDCN).
The Senate of the University of Benin approved the programme after an in-depth review by the School Board of Studies, College of Medicine Academic Board, and the Academic Policy and Planning Committee (APPC) in October 2017. The Vice Chancellor appointed Prof Ambrose .O. Isah as the pioneer Head of Department.
The Department runs undergraduate programme and in the near future postgraduate programmes
- The Undergraduate Programmes include the Basic and Clinical Pharmacology and Therapeutics (including Toxicology) Course for Students in Medicine and Dentistry
Undergraduate Academic Programme
Course for Medical (MBBS) and Dental (BDS) Students
The subject Pharmacology refers to the study of drugs while Clinical pharmacology is the scientific discipline that involves all aspects of the relationship between drugs and humans. Therapeutics addresses the entire process of the use of medicines in disease states. The knowledge of basic and clinical pharmacology is of utmost relevance and importance in making therapeutic decisions to prescribe the selected medicines in a rational manner. It is important for the student to note early in his/her training that the treatment of diseases goes through some processes that require an understanding of the medicines and related products which serve as tools, the inherent properties and how they interact with the human body in normal as distinct from the disease states where they are applied. The thought process goes through the chain of patient evaluation, choice of medicines, the issuance of a prescription order and the monitoring of the beneficial and adverse effects.
The competence of a medical graduate using medicines in a rational manner which implies its efficient, cost effective and safe use is the intended goal of the course.
The choice of the appropriate medicine, its administration or use, its monitoring and measurement of the outcome is a process which should be acquired through scholarly tutelage to a studentship requiring some early apprenticeship to acquire a measured degree of skills and competences preparatory for immediate supervised practice on qualification.
Thereafter, to practice medicine with the aid of a template set on sound principles during the formative years of training
- Vision Statement
Health facility and Public health environment manned by professionals of excellence in pharmaco-therapeutics.
- Mission Statement
To produce well-trained knowledgeable medical and dental graduates with a level of pharmaco-therapeutic preparedness for patient care equipped with the appropriate skills, competencies and attitude.
- To impart knowledge of the understanding of properties of drugs, the mechanisms of action and how they produce their effects in diseased conditions.
- To introduce the medical students to the principles of drug treatment in diseased states.
- To enable the medical students at the end of the course to be competent in the rational selection of drug(s) for the treatment of diseases diagnosed on a scientific basis and monitor their beneficial and adverse effects.
- To acquaint students with the concept of Essential Medicines and the Nigeria National Essential Medicines List.
- To acquaint students with the concept of Standard Treatment Guidelines and the National Standard Treatment Guidelines
- To acquaint students with the process and actual art of issuing a prescription order
- To utilize the knowledge acquired to prescribe safe medicines efficiently and effectively for diseased states in man.
- Admission Requirements
The training in Clinical Pharmacology and Therapeutics is an important element of and an integral component in the overall training of the Medical and Dental Student. The student commences this course as an aspect of the training following a successful completion of the second MBBS Examinations having obtained a pass in the subjects of Anatomy, Physiology and Biochemistry.
- Duration of the Course
The course will run over the period to cover Basic Pharmacology, Clinical Pharmacology and Therapeutics. The duration of the course spans the entire period from the 3rd Clinical year to Final Clinical year. There will be a Block posting of 24 weeks during which the Basic aspect of the Course and introduction to Clinical Pharmacology and Therapeutics is delivered. This is followed by a further 3 weeks Subspecialty postings devoted mainly to Therapeutics including Toxicology. Thus the Course plan will ensure that the student in a phased manner acquires knowledge of the drugs, its use and monitoring in various disease states as they progress to higher levels and all other clinical departments prior to completion.
- Course Content
The course will include in a phased manner the following:
- Basic Pharmacology
- Clinical Pharmacology
- Therapeutics (including Toxicology)
The course should aim at providing the students with basic knowledge of drug action and extension of this knowledge to drug therapy. Systemic pharmacology should include wide areas of selected topics in different systems and organs of the body.
There are many drugs in use and it is impossible for the student to have knowledge of them all. Emphasis will be placed on the prototype for each class and the common ones in use especially those in the standard treatment guidelines and Essential Medicines List.
For each drug, graduates are expected to have an understanding of the following:
- the classification – therapeutic category and class
- the mechanism of action,
- recognize the appropriate indications for use,
- know the appropriate route(s) of administration,
- know the important contra-indications
- know the adverse effects.
- know the relative/ comparative cost
Core knowledge and understanding, skills and attitudes required to support rational prescribing.
Topics for Lectures/Tutorials
6.1 Basic and Clinical Pharmacology
(A) General Pharmacology CPT 301 (2 units) :
The history and scope of Pharmacology; Origin and Sources of Drugs;
Routes of Administration of Drugs.
- the mechanisms of drug absorption, distribution, metabolism (biotransformation, microsomal mixed function oxidase system and phase 1 reactions –cytochrome P450 oxidations) and excretion
- the concepts of bioavailability, volume of distribution, clearance and half-life and their clinical relevance; dose and response
- how these factors determine the optimal route, dose, frequency and duration of drug administration, rational dosing and the time course of drug action
Effects of diseases on disposition of drugs
Therapeutic Drug Monitoring
- the general mechanisms of action of drugs at a molecular, cellular, tissue and organ level
- the receptor as a target of drug action and related concepts such as agonism, antagonism, partial agonism and selectivity
- the ways in which these actions produce therapeutic and adverse effects
- the development of tolerance to drugs; tachyphylaxis
Drug interactions (with other drugs and foods concurrently or previously administered)
Introduction to the following subjects:
Pharmacovigilance (Introduction – definition, scope)
Adverse Drug Reactions
Factors that determine inter-individual variation in drug response
- adherence to therapy
- pharmacodynamic variation
- pharmacokinetic variation
- pharmacogenetic variation
- pharmaceutical variation
(B) Systemic Pharmacology CPT 401 (4 units)
- Introduction to Autonomic Pharmacology (Neurohumoral Transmission and other signalling mechanisms):
Transmitters in the Central and Peripheral Nervous Systems; Cholinergic and Adrenergic receptors; Cholinergic Agonists and Antagonists; Adrenergic Stimulants and Blocking Agents; Cyclic Adenosine monophosphate (c-AMP)
Histamine Receptors and Histamine Antagonists: Serotonin and serotonin receptor antagonists,-Angiotensin; Kinins-Bradykinin-Kallikrein; Substance P, The Eicosanoids: Prostaglandins, Thromboxanes, Leukotrienes, & Related Compounds vasoactive peptides (Vasopressin, VIP, Endothelin, Natriuretic Peptide, and other mediators
The Ergot alkaloids
Serotonin Syndrome and other hyperthermic syndromes Pharmacology of Nitric Oxide
- Drugs acting on the Cardiovascular System: Drugs for the treatment of Hypertension, Drugs for the treatment of Heart Failure, Drugs for the treatment of Angina and Ischaemic Heart Disease; Antiarrhythmic Drugs; Vasodilators; Drugs used in the treatment of erectile dysfunction, Lipid lowering drugs. Principles in the use of drugs
- Drugs acting on the Urinary System: Diuretics; Clinical Pharmacology of diuretics, Drugs used in the alteration of Urinary PH, Urinary Tract lnfections; Use of drugs in Renal Failure; Immunopharmacology; Immunosuppressive agents.
- Drugs acting on the Respiratory System: Oxygen therapy;
Drugs for the Treatment of Asthma: Bronchodilators, Muscarinic antagonists, Leukotriene receptor antagonists, Corticosteroids, anti –IgE monoclonal antibodies. Mast Cell stabilizers. Cough Suppressants; Mucolytic Agents; Respiratory Stimulants.
- Drugs Acting on the Alimentary System: Antiemetic Agents; Drugs stimulating gastrointestinal motility, Laxatives, Drugs used in Acid Peptic Diseases, Antidiarrhoeal Agents; Drug used for the treatment of Irritable Bowel syndrome, Drugs used for the treatment of Inflammatory Bowel Disease, Drugs for the treatment of variceal bleeding Bile Acid treatment for gall stones’, Pancreatic Supplements, Gastrointestinal Hormones.
- Drugs Acting on Blood-Forming Organs: Anaemia; Iron Deficiency and other Hypochromic Anaemias; Megaloblastic Anaemia; Iron; Cobalamins; Folates; Anticoagulants; Heparin; Coumarins; Indandiones, Fibrinolysis Fibrinolysin; Thrombus~ Platelet Aggregation Inhibitors.
- Drugs acting on the Endocrine System: Mechanism of action of Hormones,
CNS-Hypothalamus-Adenohypohysis-Endocrine Glands; Anterior and Posterior Pituitary Hormones, Thyroid Hormones and Antithyroid Drugs. Parathyroid Hormones;Thyrocalcitonin; Antidiabetic Drugs; Insulin; Oral hypoglycaemics;
Adrenocortical Hormones; Glucocorticoids; Mineralocorticoids;
Sex Hormones: Oestrogens; Androgens; Progestogens; Antagonists to Hormones.
- Drugs in Obstetrics and Gynaecology: Drugs in Pregnancy, Drugs affecting
Uterine Motility; Ergot; Oxytocin, Prostaglandins; Tocolytics, B2 Adrenoceptor stimulant, Pharmacologic Methods of Family Planning.
Systemic Pharmacology CPT 402 (4 units)
- Drugs Acting on the Central Nervous System)
Entry of Drugs into CNS; Non-Narcotic Antagonists and Partial Agonists; Salicylates and other Analgesics and Antipyretic Agents; Opioid antagonists; Sedative-Hypnotic drugs; Benzodiazepines Barbiturates and Non-barbiturate. Agents, GABA receptor agonists; 5HT receptor agonist, Melatonin receptor agonist, Alcohol;
Review of General and Local Anaesthetic Drugs; Neuromuscular blocking Agents; Central Nervous system stimulants;
Antiseizure Drugs; Epilepsies; Principles of treatment of Epilepsies;
Review of Different groups of Antiepileptic Drugs; Status Epilepticus; Epilepsy and Special situations. Pregnancy, Contraception, Anaesthesia, Surgery; Miscellaneous
Drug Treatment of Parkinsonism; Levodopa; Dopa Decarboxylase Inhibitors;
Dopamine agonists – bromocriptine, pergolide, pramipexole and ropinirole; amantadine; Anticholinergics; Monoamine Oxidase inhibitors – selegiline
Anthihistaminics; Phenothiazines; Drug therapy of Spasticity; Dantrolene, Baclofen,
Interneuronal Blockers; Drugs in Myasthenia Gravis; Drugs in Migraine.
- Drugs in Mental Disorders:
Antipsychotics: Phenothiazines, Thioxanthenes; Butyrophenones; Atypical antipsychotics: Clozapine, Quetiapine,, Risperidone etc.; Antidepressants; Monoamine Oxidase Inhibitors; Tricyclics; Tetracyclics; Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine, paroxetine, sertraline, citalopram; Serotonin – Norepinephrine reuptake inhibitors – Venlafaxine, Antimanic – Dibenzazepines; Lithium; Anxiolytics Benzodiazepine; Pyrimidylbutyldione; Drug Dependence.
- Drug Treatment of Joint Diseases: Inflammatory Anthropathy and Degenerative Joint Disease; Metabolic Disposition Anthropathy; Analgesics; Nonsteroidal Anti-inflammatory Drugs (NSAIDS); Corticosteriods, Disease Modifying Antirheumatic Drugs, Long-term Antirheumatic Agents. Gold salts, d-peniciliamine; Chloroquine; Immunosuppressive Agents; Levamisole; Gout: Colchicine; Indomethacin; Probenecid; Sulphinpyrzazone; Febuxostat Allopurinol.
- Drugs acting on the Skin: General aspects of the Dermal Pharmacokinetics; forms of Topical application and systemic administration in Dermal conditions; topical Antifungal and Steroid preparations and their adverse effects.
Chemotherapeutic Drugs CPT 403 (3 units)
(i) Antimicrobials: Antibacterials/antibiotics, Antiviral including Antiretrovirals, and Anti-protozoal drugs, Antifungal
Beta-Lactam and other Cell Wall and Membrane–active Antibiotics (Penicillins, Cephalosporins, Monobactams, Carbapenems and Beta-Lactamase Inhibitors), Vancomycin, Teicoplanin, Bacitracin, Cycloserine; Tetracyclines, Macrolides (Erythromycin, Clarithromycin, Azithromycin); Ketolides, Clindamycin, Chloramphenicol, Streptogramins and Oxazolidinones; Aminoglycosides and Spectinomycin; Sulphonamides, Trimethoprim, Quinolones (Nalidixic acid, Ciprofloxacin, Ofloxacin);
Drugs used in Leprosy; Drug used in Tuberculosis (including drugs for multiple drug resistance)
Antiviral Agents; Oral nucleoside analogues – acyclovir, valacyclovir, famciclovir: ganciclovir, forscanet, Methisazone; Idoxuridine, Cytarabine; Adenine Arabinsoside, Interferons; Humoral Immunoglobulins etc.
Drugs for the treatment of Hepatitis B and C infections.
Drugs for the treatment of Lassa fever, Influenza, viral haemorrhagic fevers and other exotic viral illnesses eg Ebola.
Antiretroviral drugs: nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors, CCR5 co-receptor antagonists (also called entry inhibitors), and HIV integrase strand transfer inhibitors (INSTIs)
Drugs for the treatment of protozoal diseases and helminths Malaria; Amoebiasis;Amoebic Liver Abscess; Trypanosomiasis, Leishmoniasis, Giadiasis; Trichomoniasis; Ankylostomiasis; Ascariasis; Trichuriasis; Strongyloidiasis; Enterobiasis; Trichinosis, Filariasis, Loiasis, Onchocerciasis; Dracontiasis;. Schistosomiasis;Fasciolopsis; Clonorchiasis; Paragonimiasis; Taeniasis; Cystecercosis; Hydatid Disease; Diphyllobothriasis etc.
Nitroimdazoles: Metronidazole (antiprotozoal and action against anaerobic bacteria), Tinidazole.
Antifungal Agents; Polyene Antifungals Amphotericin and its formulations; the azoles- Imidazoles (ketoconazole miconazole, clotrimazole) and Triazoles (fluconazole, itraconazole etc); Miscellaneous (Griseofulvin, Nystatin, Terbinafine etc.)
Antimicrobial Resistance: Mechanism, relevance, public health importance prevention.
Disinfectants, Antiseptics and Sterilants.
Rational Use of Antimicrobials.
Chemotherapy of Malignant Disease: Major Features of Malignant
Diseases; Review of Cell Kinetics, Cell-Cycle specificity; Cell-cycle Non specificity;
Cancer cell versus Bacterial Infection; Principles of Cancer Chemotherapy: Adverse effects of Antineoplastic Drugs; Alkylating Agents; Antimetabolites: Purines and Pyrimidines Analogues; Natural products; Anthracyline Antibiotics; other Antibiotics; Enzymes; Steroid Hormones and Antagonists, Miscellaneous Anti-cancer Drugs; Agents for Immunotherapy; Radioactive Drugs.
Practical Classes / Demonstrations CPT 404 (2units)
A reasonable number of practical classes and demonstrations would be organized to make the students understand the nature of drug action and how drugs can affect organ systems, e.g. Heart, Kidneys, Respiratory and Vascular systems. This will be followed by clinically oriented sessions to enable the students understand the relationship to clinical states
Local Anaesthetics; Drug formulations; Scope of Pharmacovigilance – Medication Errors, SSFFCs; Drug packaging, SPCs and PILs; Prescription writing
- Introduction to Therapeutics 1 CPT 405 (2 units)
- Taking a drug history
- taking accurate information about current prescription and non-prescription drugs
- making an assessment of adherence to a medication regimen
- recording current and past ADRs and allergies
- Essential Medicines – Concept, List and Programme;
- Standard Treatment Guidelines,
- Drug Utilization,
- Rational Drug Use:
- Prescription writing – the prescription order / treatment sheets/ drug charts etc.
- Guide to Good Prescribing
- Monitoring drug therapy
- the importance of monitoring the effect of drug therapy
- the ways in which this can be achieved (e.g. measuring plasma drug concentrations or assessing pharmacodynamics responses)
- the variable relationship between drug dose, plasma concentration and clinical effect
- Adverse drug reactions
- the different types of ADRs
- the frequency of adverse reactions in primary and secondary care
- recognition of common susceptibility factors and how risks of harms can be minimized
- the importance of reporting adverse reactions and other approaches to pharmacovigilance
- Drug–drug interactions
- the potential for drugs to interact to cause beneficial and harmful effects
- the mechanisms by which drugs interact
- pharmaceutical, pharmacokinetic, pharmacodynamics
- the ways in which interactions can be predicted and avoided
- Medication errors
- the different types of medication errors
- the common reasons medication errors occur in practice
- the ways in which individual prescribers can reduce the risk of medication errors
- Clinical toxicology
- the assessment, recognition and treatment of common intoxications (e.g. paracetamol)
- the principles of removing or counteracting the effects of toxic substances after ingestion
- toxicokinetic and toxicodynamics
- Subspecialty Posting 2 Therapeutics CPT 501 (5 units)
The subspecialty posting is a continuum of the block posting and provides a period to consolidate on the core knowledge already acquired. The time will be spent to acquire further knowledge and core skills, competencies and attitude expected of a medical and dental graduate. Emphasis will be placed on the process of patient evaluation, appropriate choice of treatment and where medicines are needed a rational selection, its prescription and thereafter its monitoring. The period of the posting will be further devoted to the science and art of some peculiarities of prescribing
The Student is expected to learn more of the commonly used drugs in the clinical setting the mechanism of action, the indications for use, the appropriate route, frequency and duration of administration, and the important contra-indications and adverse effects.
For Dental Students the second week will be devoted to Dental Therapeutics
Topics to be covered will include the following:
- Prescribing for special patient groups with altered physiology, pharmacokinetic handling and pharmacodynamic responses
- elderly patients
- women who are pregnant, breast-feeding or of childbearing potential
- patients with renal or liver disease
- Legal aspects of prescribing drugs
- categorization of drugs as OTC preparations, prescription-only medicines, controlled drugs
- the prescribing of ‘unlicensed’ preparations
- the responsibilities associated with prescribing controlled drugs
- Developing new drugs
- drug development including clinical trials (Phase I to Phase IV)
- the approval process and major regulatory authorities in the relevant country
- the requirements of good clinical trial design
- consent, ethics, bias, statistics, dissemination of information
- Managing the prescribing of medicines in the health service
- the role of local formularies
- the role of drug and therapeutics committees
- the influences that affect individual prescribing choices
- the rational assessment of new drugs based on safety, efficacy and cost-effectiveness
- Costs, Management of Drug supplies; Drug Revolving fund and user fees.
- Ethics of prescribing
- informed patient consent and adherence to therapy
- Common therapeutic problems
- the management of common acute and chronic therapeutic problems Malaria, Meningitis, Tetanus
- Treatment of other prevalent communicable and non –communicable diseases e.g. hypertension asthma diabetes mellitus etc.
- Management of Pain
- Management of poisonings (e.g. paracetamol, aspirin, opioids (morphine, heroin etc.), cocaine alcohols (methanol, ethanol, diethylene glycol) petroleum distillates (e.g. kerosene, petrol) organophosphates, paraquat and other pesticides, carbon monoxide, cyanide, heavy metals – lead, arsenic, mercury, herbal products)
- Antidotes used in poisons
- Management of envenomations – snake bites, scorpion, spider and bee stings etc.
- Fluid and Electrolytes in clinical care; Dietary Supplements
- Alternative therapies
- the motivations that lead patients to seek alternative therapies; herbal medications
- some common indications and appraisal of the evidence for their efficacy
- how such therapies interact with prescription drugs that patients are receiving
- Drug information retrieval
- Retrieval of drug information for prescribers and other healthcare staff
- Acquisition of knowledge and practice in how to assess the value and reliability of drug information sources
6.4 Core skills for the Subspecialty Posting
- Taking a drug history
- taking accurate information about current prescription and non-prescription drugs
- making an assessment of adherence to a medication regimen
- recording current and past ADRs and allergies
- Prescription writing II
- choosing a safe and effective drug and an appropriate dose
- writing accurate, legible and legal prescriptions including controlled drugs
- keeping accurate records of prescriptions and response
- calculation of drug doses based on patient weight or a nomogram
- calculation of the strength of an infusion based on the required rate of drug administration
- prescribing oxygen (flow rate, delivery) and intravenous fluids
- Drug administration
- selecting the appropriate route of administration
- administering subcutaneous, intra-muscular and intravenous injections
- preparing drugs for parenteral administration including mixing and dissolving drugs
- preparing and administering drugs by an infusion pump
- preparing and administering nebulized drugs
- advising patients about special modes of drug delivery, e.g. inhalation, topical
- Prescribing drugs in special groups
- elderly, children, pregnancy and breast-feeding, renal, and liver failure
- Prescribing drugs to relieve pain and distress
- palliation of pain and other distressing symptoms
- Adverse drug reactions and interactions
- assessing drugs as a possible cause of symptoms and signs
- examples of drug-induced organ involvement (liver, kidney etc)
- recognizing the potential for adverse interactions
- reporting ADRs and interactions
- Drug allergy
- recognizing allergic drug reactions and taking a history of allergic reaction
- treating allergic reactions, emergency treatment of acute anaphylaxis
- Clinical pharmacokinetics
- using core knowledge of pharmacokinetics to inform safe prescribing
- Monitoring drug therapy
- identifying which therapeutic effect to observe
- using measurements of plasma drug concentrations appropriately (which and when)
- acting appropriately with the results
- Analysing new evidence
- practicing evidence-based prescribing
- assessing the validity of evidence presented on new drugs or therapies
- reading, assessing and criticizing clinical studies
- spotting methodological flaws including sources of bias
- recognizing the difference between clinical and surrogate end-points
- Obtaining accurate objective information to support safe and effective prescribing
- using National Standard Treatment Guidelines and Essential Medicines Lists
- accessing reliable drug information from medical journals and medical databases
- accessing Poisons Information Services
- assessing the reliability of varying sources of evidence and opinion
- Obtaining informed consent to treatment
- providing patients with enough information about drugs to allow them to make informed decisions about their treatment
- discussing benefits and harms of drug therapy with the patients
- exploring patients’ own views and wishes in relation to drug treatment
Dental Therapeutics CPT 502 (2units)
Toothpastes, Mouthwashes; Sialagogues, Obstudents and Analgesics, Root canal medicaments, thrombin, Periodontal packs and dressings, Antibiotics, antiviral and antifungal preparations. Topical Steroids, Vehicles for oral applications of drugs, Dentine desensitising agents, Plaque disclosing and removing agents, Topical Local Anaesthetics, Flouride and forms of administration. Substances used in oral surgery – Styptics, white head varnish, carbolized resin, tannic acid powder, fibrinogen, thrombin, oxycel, ephedrine, Russel viper venom
Drugs used in Emergencies in dental surgery: hydrocortisone sodium succinate, 10% Calcium Chloride, 0.1% epinephrine (adrenaline), Solution, glyceryl trinitrate, phytamenadione (Vit K), Phentolamine methane sulphonate.
6.5 The Core attitudes expected of a Student at the Subspecialty Postings.
- A rational approach to prescribing and therapeutics
- identifying the correct clinical diagnosis
- understanding the pathophysiological processes involved
- knowing the drugs that might beneficially influence these processes
- establishing the end-points with which to monitor therapeutic response
- assessing the potential harms and benefits of treatment
- communicating with the patient in making the decision to treat
- Assessing the balance of benefit to harm
- recognizing that there are harms and benefits associated with all drug treatments
- recognizing these may differ between patients depending on a variety of factors
- recognizing that doctors should monitor the effects of the drugs they prescribe
- Recognizing the responsibilities of a doctor as part of the prescribing community
- avoidance of wasteful prescribing and consumption of limited resources
- recognizing the need to report ADRs for the common good
- controlling the availability of restricted drugs
- adhering to therapeutic guidelines and drug formularies as appropriate
- avoidance of indiscriminate prescribing of antibiotics
- Recognizing personal limitations in knowledge
- recognizing the need to seek further information about drugs when faced with unfamiliar prescribing problems
- Responding to the future
- recognizing the need to update prescribing practices
- ensuring that patients benefit when possible from advances in medical knowledge
- recognizing the need to assess the benefits and harms of new therapies
- knowing the limitations of applying clinical trial data to individual patients
- Recognizing the effect of drugs on the environment.