Objectives
1. Emphasis on the basic principles of pharmacology and pharmacotherapy
2. Emphasis on the experimental evidence underlying the basic principles of pharmacology and pharmacotherapy
3. Reinforcement of the basic principles of pharmacology and pharmacotherapy during the study of each class of pharmacological agents
4. Introduction to the chemistry, pharmacological effects, pharmacokinetics, toxicity, mechanism of action and therapeutic application of major classes of drugs
5. Emphasis on the study of classes of drugs and representative individual drugs, rather than on a complete appraisal of available drugs
6. Emphasis on the link between normal physiological mechanisms and pathophysiology and how drugs reverse pathophysiology back to the normal physiological state
7. In the study of the various classes of drugs, ensure alignment with the related topics in pathology-pathophysiology which are considered prerequisites

Expertise, knowledge and skills to be acquired from the course
1. Acquisition of the general principles of pharmacology relating to:
- Pharmacokinetics
- Pharmacodynamics
- Pharmacotherapeutics
2. Familiarity with the main classes of drugs
3. Familiarity with pertinent experimental evidence underlying principles, concepts and properties of drugs
4. Acquisition of expertise in the approach to the appraisal of new drugs
5. Training in the development of one’s own personal essential drug list

The ultimate goal of the course
Train the student to practice effective and safe pharmacotherapy with special emphasis on:
1. The need for drug therapy
2. Mono-drug therapy versus multiple drug therapy
3. Factors affecting effective and safe drug therapy
- Bioavailability
- Age
- Sex
- Genetics
- Interaction with receptors
- Drug-drug interaction
- Recognition of special toxicities
- Drug elimination as a function of toxicity

General organization
Lectures
Laboratories
Case discussions

Lectures

Section I (General Pharmacology, 10 hours)
- Pharmacokinetics
- Pharmacodynamics
- Mechanisms of drug action
- Drug development

Section II (Cardiac – Renal, 16 hours)
- Diuretics
- Positive inotropic agents
- Antiarrhythmics

Section III (Autonomic Pharmacology – The Peripheral Nervous System – Autacoids, 26 hours)
- The sympathetic system
- The parasympathetic system
- Neuromuscular blockers
- Local anesthetics
- The autacoids
- Antihypertensives
- Antianginal
- Drugs for hyperlipoproteinemias

Section IV (Central Nervous System Pharmacology, 17 hours)
- General anesthetics
- Hypnotics – sedatives – alcohol
- Narcotics
- Addiction
- Antipsychotics
- Anti-Parkinson’s disease
- Anticonvulsants
- Analgesics – antipyretics – antiinflammatory – treatment of gout
- Central nervous system stimulants

Section V (Uterine Pharmacology, 1 hour)

Section VI (Antimicrobial, Antifungal, Antiviral, Antiparasitic Drugs, 12 hours)

Section VII (Oncology – Hematology, 5 hours)

Section VIII (Locally-acting Drugs, 4 hours)

Section IX (Prescription Writing, 1 hour)

Section X (Toxicology, 4 hours)

Section XI (Endocrine Pharmacology, reading assignment)

Case Discussions
General Pharmacology (6 cases)
Cardiovascular (8 cases)
Autonomic Nervous System (4 cases)
Central Nervous System (3 cases)

 Pharmacology laboratory exercises
1. Renal Pharmacology
2. Cardiac Pharmacology
3. Pharmacology of the Autonomic Nervous System – The Adrenergic System
4. Pharmacology of the Autonomic System – The Cholinergic System
5. Drugs Acting on the Neuromuscular Junction of the Cat
6. Histamines and Antihistaminics
7. Effect of Nitrites
8. Pressor Drugs Given as Unknowns
9. Depressor Drugs Given as Unknowns
10. General Anesthetics
11. Local Anesthetics
12. General Properties of the Opioids and Barbiturates
13. Convulsants and Anticonvulsants
14. Respiratory Depressants and Stimulants
15. Drugs Acting on the Uterus

Educational objectives of each section
Section I – General Pharmacology
The student is introduced to the basic principles governing drug administration, absorption, distribution, action, mechanism of action, toxicity and elimination. This is supplemented by six case discussions. Furthermore, in the study of each class of drugs these basic principles are re-emphasized

Section II – Cardiac-Renal
Although the cardiac glycosides are presented as a potentially useful class of drugs for the treatment of myocardial failure, when sufficient and viable myocytes are still present and in accordance with the recommendations in the literature (Harisson, New England Journal of Medicine 336:525, 1997; 329:1,1993), they are used as practical examples on no less than 10 basic concepts in pharmacology. Coming at the start of the course, they help lay the grounds in terms of basic principles in the study of subsequent classes. The time spent on them, although in excess of their therapeutic usefulness, is considered appropriate when the broad educational objective is kept in view.
The diuretics on the other hand, are far more commonly used as therapeutic agents. Given at the beginning of the course, they are presented as drugs that can distort basic function for a useful purpose, but can lead to serious toxicity through an exaggeration of this distortion. They are also used to illustrate, in a practical fashion, no less than five basic general principles and concepts in pharmacology. This is further supplemented by one laboratory exercise with extensive discussion and by case studies.

Section III – Autonomic Pharmacology – the Peripheral Nervous    System – the Autacoids
This section emphasizes the modulating role on organs and systems of the autonomic system and the various autacoids under physiological and pathophysiological conditions and how by modifying these systems with various classes of drugs, modification of disease processes is achieved. The topics in this section should be given together to impart to the student a complete and comprehensive picture of phenomena that are interrelated. The best example is the interaction between the sympathetic system and the renin – angiotensin system where the former activates the latter but then angiotensin II feeds back on the sympathetic system and in turn activates it at the level of the centers, the sympathetic ganglia and the peripheral receptor mechanisms. In this section, the treatment of no less than 20 conditions is represented, including such important conditions as arrhythmias, angina, hypertension, glaucoma, myasthenia gravis, the bulk of gastrointestinal problems, anesthesiology, migraine, anxiety states, Parkinson’s disease, to mention a few

Section IV – Central Nervous System Pharmacology
This section embraces a wide variety of classes of drugs which if given as such, will appear disjointed and difficult to learn. Instead, they are given as a composite group of drugs which in their pharmacological effects, fall on the bands of a spectrum where at one end, there are the general central nervous system depressants, like the general anesthetics, the barbiturates and alcohol and on the opposite end of the spectrum, the general central nervous system stimulants. In between, drugs are depressants of selective functions, like antiepileptics, analgesics, anti-Parkinsonism, antipsychotics, anti anxiety or stimulants such as the antidepressants. It is an approach that links these seemingly disjointed topics in a meaningful manner and provides the student with an easier task in remembering their highlights and classifying them in a pattern. Common mechanisms underlying stimulation and depression are presented. This is further reinforced by laboratory exercises and case studies

Section V – Uterine Pharmacology
This section deals with oxytocics and tocolytics. It emphasizes the practical application of the drugs and concludes by linking the ergot alkaloids to the treatment of migraine

Section VI – Antimicrobial, Antifungal, Antiviral, Antiparasitic and Drugs for the Treatment of Tuberculosis
Every effort is made not to duplicate what the student has acquired in the course of microbiology and the section of infectious diseases. The subject matter is approached from a pharmacological standpoint with emphasis on effective and safe use of these drugs

Section VII – Oncology – Hematology
For continuity, the section on cancer chemotherapy is given by a member of the Division of Oncology. The hematology section is given by the Department with special care to avoid repetition of information covered in hematology

Section VIII – Locally-acting Drugs
This includes a variety of drugs which act locally in the gastrointestinal tract (the antacids, protectives, adsorbants, secretagogues, laxatives, etc), on the skin or act as antiseptics. The section is brief and focuses more on classification so that the students can recognize these classes of compounds when they encounter them in their practice

Section IX – Prescription Writing
Emphasizes the legal aspects and basic principles of prescription writing

Section X – Toxicology
Emphasizes the basic principles of toxicology and handling of the intoxicated patient, followed by an appraisal of environmental, industrial, agricultural and other intoxicants. During the study of the various classes of drugs emphasis is placed on toxicity, its mechanisms and its prevention

Section XI – Endocrine Pharmacology
This is given as supplementary reading assignment to the section on the Endocrine System in Introduction to Medicine and Pathology