Cns
Content
INTERNATIONAL MEDICAL UNIVERSITY
MALAYSIA
Bachelor of Pharmacy (Hons)
Intake B1/07
Semester 5
Central Nervous System
(BPH3011)
Module Guide
(22 June 2009 – 2 October 2009)
TITLE: CENTRAL NERVOUS SYSTEM
LEVEL: SEMESTER 5
COURSE CODE: BPH3011
PROGRAMME: BPharm (Hons)
CONTENT SYNOPSIS
The Central Nervous System (CNS), consisting of the brain and spinal cord, integrates and
controls all the functions of the body via a system of neuronal networks. Communication
between nerves and the cells they innervate occurs via electrical and, more commonly,
chemical signals. Many compounds have been identified as neurotransmitters and their role in
physiological functioning and disease is increasingly understood. Drugs used for the prevention
and treatment of many CNS disorders have been shown to act on macromolecules called
receptors or second messenger systems involved in signal transduction. The chief aim of this
Module is to thus describe the role of the CNS in health and disease. Relevant anatomy,
physiology, pathology, pharmacology and practice skills are explored in an integrated manner.
OBJECTIVES:
The objectives of this module are to1.
describe the structure and function of the central nervous system;
2.
describe current understanding of the bases, and aims of treatment of common
neurological, psychiatric (including addictive) and neurodegenerative disorders; and to
3.
describe the mechanism of action, unwanted effects and rational use of pharmacological
agents in the management of these disorders.
LEARNING OUTCOMES:
On completion of this module, the student should be able to1.
describe the organization and function of the brain and spinal cord;
2.
describe cerebrospinal fluid formation, composition and function;
3.
outline the sensory system, motor system, ascending and descending tracts;
4.
describe neurotransmission in the central nervous system;
5.
describe the sites of action of drugs acting on the central nervous system;
6.
describe causes and risk factors for stroke, its clinical manifestations and management;
7.
describe theories for common neurodegenerative disease; their clinical manifestations
and their drug treatment;
8.
describe types of seizure disorder; their pharmacotherapy and its unwanted effects;
9.
describe pain transmission and the mechanism of action, effects, indications and
unwanted effects of local and general anaesthetics and agents adjunctive to
anaesthesia;
10.
describe the pharmacology, uses and unwanted effects of opioid analgesics;
11.
describe sleep disorders; drugs used in the treatment of these disorders and the
unwanted effects of these drugs;
12.
describe causes of anxiety disorders drugs used in the treatment of these disorders and
the unwanted effects of these drugs;
13.
describe causes of affective disorders, drugs used in the treatment of these disorders
and the unwanted effects of these drugs;
14.
describe causes of psychoses, drugs used in the treatment of these disorders and the
unwanted effects of these drugs;
15.
outline the effects of common substances of abuse;
16.
describe the phenomena of tolerance, dependence and addiction, in the context of
substance abuse;
2
17.
18.
19.
20.
outline the medical model of substance addiction and discuss whether substancedependent individuals should be treated;
describe the management of opioid-dependent individuals using substitution or
maintenance prescribing;
outline other harm-reduction measures in the management of substance dependence;
and to
outline theories underpinning the practice of acupuncture.
LEARNING HOURS:
Lectures
Video
Medical Museum Sessions
Workshops
PSD
PBL
CAL
Portfolio
Guided Reading
TOTAL LEARNING HOURS
33 hours
3 hours
4 hours
6 hours
1.5 hours
6 hours
4 hours
2 hours
10 hours
69.5 hours
ASSESSMENTS:
Coursework
CAL Quizzes
PBL
Portfolio
Written examination
Degree Paper, 3 hours
MEQ, I hour, 2 questions
Essay, 2 hours, 2 of 3 questions
TEACHING AND LEARNING METHODS:
Lectures
33 hours
Video
3 hours
Medical Museum Sessions
4 hours
Workshops
6 hours
PSD
1.5 hours
PBL
6 hours
TOTAL CONTACT HOURS
53.5 hours
20%
5%
5%
35%
30%
MODULE LEADER: Professor Dr Yeoh Peng Nam
ASSOCIATED LECTURERS: Dr Jimmy Jose, Dr. Madhu Katyayani Balijepalli, Dr Sathvik,
Belagodu Sridhar, Mr. David Chong, Mr. Benny Efendie, Ms. Wong Pei Se, Dr Liow Sook Mee..
Mr. Syed Shahzad Hasan.
SYLLABUS:
1.
Organisation of the nervous system (Lecture – 1 hr, Medical Museum Session – 2
hrs)
a.
The central nervous system: brain; spinal cord
b.
The peripheral nervous system: autonomic and somatic nervous system
Neurotransmission in the Central Nervous System is outlined in Human Biology
BPH1015, Semester 1
2.
Structure and function of the brain I (Medical Museum Session – 2 hrs; Guided
reading – 1 hr)
a.
The skull
b.
Meninges
c.
Blood supply
d.
Cerebrospinal fluid
3
e.
Blood brain barrier
3.
Structure and functions of the brain II (Lecture – 1 hr, CAL – 2 hrs; Guided Reading–
1 hr)
a.
Forebrain
b.
Cerebrellum
c.
Brainstem
d.
Midbrain; pons and medulla oblongata
4.
Motor and sensory systems (Lecture – 1 hr & Guided reading - 1 hr)
a.
Brain motor centers & descending pathways
b.
Neural pathways in sensory systems
c.
Reflexes (Guided reading)
5.
Stroke (PBL – 2 x 1.5 hrs)
The trigger is normally a scenario or clinical vignette involving stroke. The focus includes
clinical manifestations in relation to the area of the brain affected; interpretation of
investigations; prognosis; management and secondary prevention; counseling and
education of the patient, their family and care providers. Following completion of this
dual session or that described under Syllabus Item 26, a concise summary of one or
more aspects is written up as part of the student’s portfolio of learning.
Anti-thrombotic and fibrinolytic agents are covered in the Cardiovascular System
BPH1021, and in Haematology BPH1023, both in Semester 2
6.
Neurotransmitters and neuromodulators I (Lecture – 1 hr & Guided reading - 1 hr)
Acetylcholine and monoamines
7.
Neurotransmitters and neuromodulators II (Lecture – 1 hr & Guided reading - 1 hr)
Amino acids, neuropeptides, nitric oxide and others
Aspects of items 6 and 7 are covered in Human Biology BPH1015, Semester 1, and in
General Pharmacology BPH1022, Semester 2
8.
Visual and auditory impulse transmission, processing, integration and response
(Lecture – 1 hr)
9.
Infections of the Central Nervous System (Guided reading – 2 hrs)
Types, causative agents and management of bacterial, viral, fungal and protozoal
infections
10.
Learning and Memory (Lecture – 1hr)
a.
Definition
b.
Neural basis
c.
Cerebral dominance and language
d.
Diseases affecting learning and language
11.
Neurodegenerative disorders I (Lecture - 1 hr)
a.
Mechanisms of neuronal death
b.
Alzheimer’s disease
c.
Huntington’s disease
d.
Prion disease
4
12.
Neurodegenerative disorders II: Parkinson’s disease (Lecture – 1hr, Video – 1hr))
a.
Symptoms and pathophysiology
b.
Treatment
c.
Adverse effects
13.
Seizure disorders (Lecture – 1hr; Video – 1hr)
a.
Classification
b.
Seizure mechanisms
c.
Mechanism of action of anticonvulsant drugs
14.
Anti-epileptic drugs (Lecture – 1hr)
Mechanism of action, pharmacokinetics, pharmacodynamics, clinical uses and adverse
effects of
a.
Phenytoin
b.
Carbamazepine
c.
Sodium Valproate
d.
Ethosuximide
e.
Lamotrigine, topiramate, gabapentin, others
15.
Physiology of pain (Lecture – 1hr, Guided reading - 1 hr)
a.
Nociceptive afferent neurons
b.
Modulation in the nociceptive pathway
c.
Pain and nociception
d.
Gate control theory
e.
Transmitters and modulators in the nociceptive pathway
f.
Drugs used in the relief of pain: anaesthetics and local anaesthetics; opioids and
nonsteroidal anti-inflammatory drugs
Opioid alkaloids are described in Natural Products in Medicine BPH2012, Semester 3,
and their use in cancer in Cancer Chemotherapy BPH3021, Semester 6 Non-steroidal
anti-inflammatory drugs and their use are described covered in the Musculoskeletal
System BPH3027, Semester 6.
16.
Acupuncture (Lecture - 1 hr; Guided reading - 2 hrs)
a.
The science
b.
The art
c.
Myths
Acupuncture is outlined in Complementary Medicine BPH2022, Semester 4
17.
General anaesthetics I: Inhalation anaesthetics (Lecture – 1hr)
a.
Signs and stages of anaesthesia
b.
Mechanism of action of anaesthetics
c.
Gaseous anaesthetics, their property, side effects and uses
d.
Volatile anaesthetics, their property, side effects and uses
18.
General anaesthetics II (Lecture – 1hr)
a.
Intravenous anaesthetics, actions, side effects an uses
b.
Balanced anaesthesia
c.
Pre-operative medication
d.
Adjuncts used in anaesthesia
e.
Post-operative medication
5
19.
Local anaesthetics (Lecture – 1hr)
Types, mechanism of action, adverse reactions and clinical uses
20.
Opioid analgesics I (Lecture – 1hr)
a.
Endogenous opioid peptides
b.
The opioid receptor, agonists and antagonists
c.
Structure activity relationship
Opioid alkaloids are described in Natural Products in Medicine BPH2012, Semester 3,
and their use in cancer in Cancer Chemotherapy BPH3021
21.
Opioid analgesics II: Pharmacodynamics (Lecture – 1hr)
a.
Analgesia
b.
Mood altering, rewarding properties and other central effects
c.
Effects on the cardiovascular system
d.
Effects on the gastrointestinal tract
e.
Other effects
22.
Opioid analgesics III: (Lecture – 1hr)
a.
Types of opioid analgesics
b.
Pharmacokinetics
c.
Adverse drug reactions
d.
Clinical uses and illegal uses
e.
Treatment of dependence and withdrawal symptoms
23.
Sleep and wakefulness (Lecture – 1hr)
a.
Types of sleep
b.
EEG waves
c.
Insomnia
d.
Sleep apnoea
e.
Somnambulism
Sleep is also discussed in Understanding the Patient BPH1027 Semester 2
24.
Sedatives and hypnotics I (Lecture – 1hr)
Benzodiazepines
a.
Structure activity relationship
b.
Mechanism of action
c.
Pharmacological actions
d.
Pharmacokinetics
e.
Adverse effects
25.
Sedatives and hypnotics II (Lecture – 1hr)
a.
Barbiturates
b.
Chloral hydrate
c.
Paraldehyde
d.
Others
26.
“I can’t sleep” “I’m in pain” (PBL – 2 x 1.5 hrs)
The trigger is normally a scenario or clinical vignette involving insomnia, sleep disorder,
acute or chronic pain, or a combination of these. Learning issues include identification of
underlying problems, their progression, management and counseling.
6
27.
Anxiety and affective disorders (Lecture – 1 hr)
a.
Classification and description of anxiety disorders
b.
Affective disorders:
a. Classification and description of symptoms
b. The biogenic amine hypothesis of affective disorders
c. Role of 5-HT and NA systems in affective disorders
28.
Anxiolytics (Lecture – 1hr)
a.
Classification
b.
Benzodiazepines
c.
Benzodiazepine antagonists
d.
Buspirone
e.
Barbiturates and others
29.
Antidepressants (Lecture – 1hr)
Mechanism of action, pharmacokinetics, pharmacological and adverse effects and
Clinical uses of:
a.
Tricyclic antidepressants
b.
Atypical antidepressants
c.
Selective Serotonin Reuptake Inhibitors (SSRIs)
d.
Monoamine oxidase inhibitors (MAOIs)
e.
Electroconvulsive therapy
30.
Antimanic agents (Lecture – 1hr)
Mechanism of action, pharmacokinetics, pharmacological and adverse effects and
Clinical uses of:
a.
Lithium carbonate
b.
Sodium valproate
c.
Carbamazepine
d.
Anti-psychotic agents
31.
Schizophrenia (Lecture – 1hr, Video – 1 hr)
a.
The nature of schizophrenia
b.
Theories of schizophrenia
32.
Anti-psychotics (Lecture – 1hr)
Mechanism of action, pharmacokinetics, pharmacological and adverse effects and
clinical uses of:
a.
Phenothiazines
b.
Thioxanthenes
c.
Butyrophenones
33.
Atypical and second generation anti-psychotic agents (Lecture – 1hr)
Mechanism of action, pharmacokinetics, pharmacological and adverse effects and
clinical uses of:
a.
Clozapine
b.
Risperidone, Olanzapine
c.
Quetiapine, Aripiprazole
d.
Others
7
34.
Meningitis (Lecture – 1 hr)
a. Causative organisms
b. Clinical manifestations
c. Investigations
d. Empirical and definitive treatment; prevention
35.
Substance abuse and dependence I (Lecture – 1hr, CAL - 2 hrs)
a.
Definitions: abuse and misuse; tolerance, physical and psychological
dependence, “addiction”
b.
Cellular and molecular basis of tolerance and dependence
c.
Classification of substances of abuse
d.
Prevalence and types of abuse
e.
CAL: Unsupervised Internet search for information on the scope of substance
abuse in Malaysia and elsewhere. Sources of information include Agensi
AntiDadah Kebangsaan and the World Health Organisation
36.
Substance abuse and dependence II (Lecture – 1hr)
Mechanisms of action, development of tolerance, dependence and withdrawal effects;
medical harms ofa.
Tobacco and nicotine
b.
Depressants: alcohol, barbiturates, benzodiazepines, opiates and opioids
c.
Stimulants : cocaine, amphetamine type stimulants, caffeine
Nicotine dependence is outlined and smoking cessation is discussed in the Respiratory
System BPH2017 Semester 3
37.
Substance abuse and dependence III (Lecture – 1hr)
Mechanism of action, long term effects, tolerance, dependence, adverse and withdrawal
effects & management of:
a.
Psychomimetics: lysergic acid diethylamide, ketamine
b.
Cannabis
c.
Designer drugs
d.
Drug abuse in sports
38.
Substance abuse and dependence IV (Lecture – 1hr)
a. Medical and social harms and the public health perspective
b. Should dependence be treated? The medical model of addiction
c. Harm reduction, including substitution and maintenance prescribing and other
measures
39.
Seizure disorders and Parkinson’s Disease (Workshop – 3 hrs)
Case or scenario-based discussions with the focus on
a.
clinical presentations of these conditions
b.
interpretation of laboratory and clinical investigations
c.
pharmacotherapy and non-pharmacological treatments; unwanted effects,
interactions and monitoring
d.
counselling
8
40.
Affective and mood disorders; dependence (Workshop - 3 hrs)
Case or scenario-based discussions with the focus on
a.
clinical presentations of these conditions
b.
interpretation of laboratory and clinical investigations, including assessments of
mental state;
c.
pharmacotherapy and non-pharmacological treatments; unwanted effects,
interactions and monitoring
d.
counselling
41.
Pharmacy Skills Development (PSD - 1.5 hr)
Encounters with simulated (standardised) patients to provide practice in communication
and interpersonal skills required in interacting with patients with special needs, such as
those with mood disorders. Feedback is provided.
READING LIST:
Physiology:
1.
Marieb, E.N. & Hahn, J. (2006) Human Anatomy and Physiology, 7th Edition, The
Benjamin/Cummings Publishing Company.
2.
Widmaier E.P., Raff, H., & Strang, K.T. (2007) Vander’s Human Physiology, The
Mechanisms of Body Function with ARIS, 11th Edition, McGraw Hill.
3.
Martini, F.H. (2004) Fundamentals of Anatomy & Physiology 6th edition, Pearson,
Benjamin Cummings Publishing Company, San Francisco.
Pharmacology
4.
Rang, H.P., Dale M.M. & Ritter, J., & Flower, R. (2007) Pharmacology 6th Edition,
Churchill Livingstone
5.
Katzung, B.G. Basic & Clinical Pharmacology, (2007) 10th edition, Appleton and Lange
6.
Brunton, L., Lazo, J. & Parker, K. (2006). Goodman and Gilman’s The Pharmacological
Basis of Therapeutics, 11th edition, McGraw-Hill
Pathology
7.
Kumar, V., Cottran, R.S. & Robbines, S.L. (2004) Basic Pathology 7th Edition, WB
Saunders Company
8.
Chandrasoma, P., & Taylor, C.R. (2000) Concise Pathology 6th. Edition, Appleton &
Lange
9.
Rubin, E. (2008) Essentials of Rubin's Pathology 5th Edition, Lippincott Williams &
Wilkins.
10.
Underwood, J.C.E. (2000) General and Systemic Pathology 3rd Edition, Churchill
Livingstone
Pharmacotherapy
11.
DiPiro, J.T., Talbert, R.L., Yee, G.C., et al (2007) Pharmacotherapy: A Pathophysiologic
Approach 6th Edition, McGraw Hill
12.
Koda-Kimble, M.A., Young, L.Y., Kradjan W.A., et al (2008) Applied Therapeutics: The
Clinical Use of Drugs 9th Edition, Applied Therapeutics Inc.
13.
Walke, R., & Edwards, C.R.W. (2004). Clinical Pharmacy and Therapeutics, 3rd edition,
Churchill Livingstone.
Drug Abuse
14.
Doweiko, H.E. (2006) Concepts of Chemical Dependency, 6th edition, Thomson Brooks
Cole
15.
United Nations Office of Drugs and Crime. Annual World Drug Reports, available via
www.unodc.org
16.
Agensi AnitDadah Kebangsaan, Malaysia. www.adk.gov.my
9
17.
18.
Clinical Practice Guidelines, Ministry of Health, Malaysia
Evidence Based Treatment Guidelines
10
MALAYSIA
Bachelor of Pharmacy (Hons)
Intake B1/07
Semester 5
Central Nervous System
(BPH3011)
Module Guide
(22 June 2009 – 2 October 2009)
TITLE: CENTRAL NERVOUS SYSTEM
LEVEL: SEMESTER 5
COURSE CODE: BPH3011
PROGRAMME: BPharm (Hons)
CONTENT SYNOPSIS
The Central Nervous System (CNS), consisting of the brain and spinal cord, integrates and
controls all the functions of the body via a system of neuronal networks. Communication
between nerves and the cells they innervate occurs via electrical and, more commonly,
chemical signals. Many compounds have been identified as neurotransmitters and their role in
physiological functioning and disease is increasingly understood. Drugs used for the prevention
and treatment of many CNS disorders have been shown to act on macromolecules called
receptors or second messenger systems involved in signal transduction. The chief aim of this
Module is to thus describe the role of the CNS in health and disease. Relevant anatomy,
physiology, pathology, pharmacology and practice skills are explored in an integrated manner.
OBJECTIVES:
The objectives of this module are to1.
describe the structure and function of the central nervous system;
2.
describe current understanding of the bases, and aims of treatment of common
neurological, psychiatric (including addictive) and neurodegenerative disorders; and to
3.
describe the mechanism of action, unwanted effects and rational use of pharmacological
agents in the management of these disorders.
LEARNING OUTCOMES:
On completion of this module, the student should be able to1.
describe the organization and function of the brain and spinal cord;
2.
describe cerebrospinal fluid formation, composition and function;
3.
outline the sensory system, motor system, ascending and descending tracts;
4.
describe neurotransmission in the central nervous system;
5.
describe the sites of action of drugs acting on the central nervous system;
6.
describe causes and risk factors for stroke, its clinical manifestations and management;
7.
describe theories for common neurodegenerative disease; their clinical manifestations
and their drug treatment;
8.
describe types of seizure disorder; their pharmacotherapy and its unwanted effects;
9.
describe pain transmission and the mechanism of action, effects, indications and
unwanted effects of local and general anaesthetics and agents adjunctive to
anaesthesia;
10.
describe the pharmacology, uses and unwanted effects of opioid analgesics;
11.
describe sleep disorders; drugs used in the treatment of these disorders and the
unwanted effects of these drugs;
12.
describe causes of anxiety disorders drugs used in the treatment of these disorders and
the unwanted effects of these drugs;
13.
describe causes of affective disorders, drugs used in the treatment of these disorders
and the unwanted effects of these drugs;
14.
describe causes of psychoses, drugs used in the treatment of these disorders and the
unwanted effects of these drugs;
15.
outline the effects of common substances of abuse;
16.
describe the phenomena of tolerance, dependence and addiction, in the context of
substance abuse;
2
17.
18.
19.
20.
outline the medical model of substance addiction and discuss whether substancedependent individuals should be treated;
describe the management of opioid-dependent individuals using substitution or
maintenance prescribing;
outline other harm-reduction measures in the management of substance dependence;
and to
outline theories underpinning the practice of acupuncture.
LEARNING HOURS:
Lectures
Video
Medical Museum Sessions
Workshops
PSD
PBL
CAL
Portfolio
Guided Reading
TOTAL LEARNING HOURS
33 hours
3 hours
4 hours
6 hours
1.5 hours
6 hours
4 hours
2 hours
10 hours
69.5 hours
ASSESSMENTS:
Coursework
CAL Quizzes
PBL
Portfolio
Written examination
Degree Paper, 3 hours
MEQ, I hour, 2 questions
Essay, 2 hours, 2 of 3 questions
TEACHING AND LEARNING METHODS:
Lectures
33 hours
Video
3 hours
Medical Museum Sessions
4 hours
Workshops
6 hours
PSD
1.5 hours
PBL
6 hours
TOTAL CONTACT HOURS
53.5 hours
20%
5%
5%
35%
30%
MODULE LEADER: Professor Dr Yeoh Peng Nam
ASSOCIATED LECTURERS: Dr Jimmy Jose, Dr. Madhu Katyayani Balijepalli, Dr Sathvik,
Belagodu Sridhar, Mr. David Chong, Mr. Benny Efendie, Ms. Wong Pei Se, Dr Liow Sook Mee..
Mr. Syed Shahzad Hasan.
SYLLABUS:
1.
Organisation of the nervous system (Lecture – 1 hr, Medical Museum Session – 2
hrs)
a.
The central nervous system: brain; spinal cord
b.
The peripheral nervous system: autonomic and somatic nervous system
Neurotransmission in the Central Nervous System is outlined in Human Biology
BPH1015, Semester 1
2.
Structure and function of the brain I (Medical Museum Session – 2 hrs; Guided
reading – 1 hr)
a.
The skull
b.
Meninges
c.
Blood supply
d.
Cerebrospinal fluid
3
e.
Blood brain barrier
3.
Structure and functions of the brain II (Lecture – 1 hr, CAL – 2 hrs; Guided Reading–
1 hr)
a.
Forebrain
b.
Cerebrellum
c.
Brainstem
d.
Midbrain; pons and medulla oblongata
4.
Motor and sensory systems (Lecture – 1 hr & Guided reading - 1 hr)
a.
Brain motor centers & descending pathways
b.
Neural pathways in sensory systems
c.
Reflexes (Guided reading)
5.
Stroke (PBL – 2 x 1.5 hrs)
The trigger is normally a scenario or clinical vignette involving stroke. The focus includes
clinical manifestations in relation to the area of the brain affected; interpretation of
investigations; prognosis; management and secondary prevention; counseling and
education of the patient, their family and care providers. Following completion of this
dual session or that described under Syllabus Item 26, a concise summary of one or
more aspects is written up as part of the student’s portfolio of learning.
Anti-thrombotic and fibrinolytic agents are covered in the Cardiovascular System
BPH1021, and in Haematology BPH1023, both in Semester 2
6.
Neurotransmitters and neuromodulators I (Lecture – 1 hr & Guided reading - 1 hr)
Acetylcholine and monoamines
7.
Neurotransmitters and neuromodulators II (Lecture – 1 hr & Guided reading - 1 hr)
Amino acids, neuropeptides, nitric oxide and others
Aspects of items 6 and 7 are covered in Human Biology BPH1015, Semester 1, and in
General Pharmacology BPH1022, Semester 2
8.
Visual and auditory impulse transmission, processing, integration and response
(Lecture – 1 hr)
9.
Infections of the Central Nervous System (Guided reading – 2 hrs)
Types, causative agents and management of bacterial, viral, fungal and protozoal
infections
10.
Learning and Memory (Lecture – 1hr)
a.
Definition
b.
Neural basis
c.
Cerebral dominance and language
d.
Diseases affecting learning and language
11.
Neurodegenerative disorders I (Lecture - 1 hr)
a.
Mechanisms of neuronal death
b.
Alzheimer’s disease
c.
Huntington’s disease
d.
Prion disease
4
12.
Neurodegenerative disorders II: Parkinson’s disease (Lecture – 1hr, Video – 1hr))
a.
Symptoms and pathophysiology
b.
Treatment
c.
Adverse effects
13.
Seizure disorders (Lecture – 1hr; Video – 1hr)
a.
Classification
b.
Seizure mechanisms
c.
Mechanism of action of anticonvulsant drugs
14.
Anti-epileptic drugs (Lecture – 1hr)
Mechanism of action, pharmacokinetics, pharmacodynamics, clinical uses and adverse
effects of
a.
Phenytoin
b.
Carbamazepine
c.
Sodium Valproate
d.
Ethosuximide
e.
Lamotrigine, topiramate, gabapentin, others
15.
Physiology of pain (Lecture – 1hr, Guided reading - 1 hr)
a.
Nociceptive afferent neurons
b.
Modulation in the nociceptive pathway
c.
Pain and nociception
d.
Gate control theory
e.
Transmitters and modulators in the nociceptive pathway
f.
Drugs used in the relief of pain: anaesthetics and local anaesthetics; opioids and
nonsteroidal anti-inflammatory drugs
Opioid alkaloids are described in Natural Products in Medicine BPH2012, Semester 3,
and their use in cancer in Cancer Chemotherapy BPH3021, Semester 6 Non-steroidal
anti-inflammatory drugs and their use are described covered in the Musculoskeletal
System BPH3027, Semester 6.
16.
Acupuncture (Lecture - 1 hr; Guided reading - 2 hrs)
a.
The science
b.
The art
c.
Myths
Acupuncture is outlined in Complementary Medicine BPH2022, Semester 4
17.
General anaesthetics I: Inhalation anaesthetics (Lecture – 1hr)
a.
Signs and stages of anaesthesia
b.
Mechanism of action of anaesthetics
c.
Gaseous anaesthetics, their property, side effects and uses
d.
Volatile anaesthetics, their property, side effects and uses
18.
General anaesthetics II (Lecture – 1hr)
a.
Intravenous anaesthetics, actions, side effects an uses
b.
Balanced anaesthesia
c.
Pre-operative medication
d.
Adjuncts used in anaesthesia
e.
Post-operative medication
5
19.
Local anaesthetics (Lecture – 1hr)
Types, mechanism of action, adverse reactions and clinical uses
20.
Opioid analgesics I (Lecture – 1hr)
a.
Endogenous opioid peptides
b.
The opioid receptor, agonists and antagonists
c.
Structure activity relationship
Opioid alkaloids are described in Natural Products in Medicine BPH2012, Semester 3,
and their use in cancer in Cancer Chemotherapy BPH3021
21.
Opioid analgesics II: Pharmacodynamics (Lecture – 1hr)
a.
Analgesia
b.
Mood altering, rewarding properties and other central effects
c.
Effects on the cardiovascular system
d.
Effects on the gastrointestinal tract
e.
Other effects
22.
Opioid analgesics III: (Lecture – 1hr)
a.
Types of opioid analgesics
b.
Pharmacokinetics
c.
Adverse drug reactions
d.
Clinical uses and illegal uses
e.
Treatment of dependence and withdrawal symptoms
23.
Sleep and wakefulness (Lecture – 1hr)
a.
Types of sleep
b.
EEG waves
c.
Insomnia
d.
Sleep apnoea
e.
Somnambulism
Sleep is also discussed in Understanding the Patient BPH1027 Semester 2
24.
Sedatives and hypnotics I (Lecture – 1hr)
Benzodiazepines
a.
Structure activity relationship
b.
Mechanism of action
c.
Pharmacological actions
d.
Pharmacokinetics
e.
Adverse effects
25.
Sedatives and hypnotics II (Lecture – 1hr)
a.
Barbiturates
b.
Chloral hydrate
c.
Paraldehyde
d.
Others
26.
“I can’t sleep” “I’m in pain” (PBL – 2 x 1.5 hrs)
The trigger is normally a scenario or clinical vignette involving insomnia, sleep disorder,
acute or chronic pain, or a combination of these. Learning issues include identification of
underlying problems, their progression, management and counseling.
6
27.
Anxiety and affective disorders (Lecture – 1 hr)
a.
Classification and description of anxiety disorders
b.
Affective disorders:
a. Classification and description of symptoms
b. The biogenic amine hypothesis of affective disorders
c. Role of 5-HT and NA systems in affective disorders
28.
Anxiolytics (Lecture – 1hr)
a.
Classification
b.
Benzodiazepines
c.
Benzodiazepine antagonists
d.
Buspirone
e.
Barbiturates and others
29.
Antidepressants (Lecture – 1hr)
Mechanism of action, pharmacokinetics, pharmacological and adverse effects and
Clinical uses of:
a.
Tricyclic antidepressants
b.
Atypical antidepressants
c.
Selective Serotonin Reuptake Inhibitors (SSRIs)
d.
Monoamine oxidase inhibitors (MAOIs)
e.
Electroconvulsive therapy
30.
Antimanic agents (Lecture – 1hr)
Mechanism of action, pharmacokinetics, pharmacological and adverse effects and
Clinical uses of:
a.
Lithium carbonate
b.
Sodium valproate
c.
Carbamazepine
d.
Anti-psychotic agents
31.
Schizophrenia (Lecture – 1hr, Video – 1 hr)
a.
The nature of schizophrenia
b.
Theories of schizophrenia
32.
Anti-psychotics (Lecture – 1hr)
Mechanism of action, pharmacokinetics, pharmacological and adverse effects and
clinical uses of:
a.
Phenothiazines
b.
Thioxanthenes
c.
Butyrophenones
33.
Atypical and second generation anti-psychotic agents (Lecture – 1hr)
Mechanism of action, pharmacokinetics, pharmacological and adverse effects and
clinical uses of:
a.
Clozapine
b.
Risperidone, Olanzapine
c.
Quetiapine, Aripiprazole
d.
Others
7
34.
Meningitis (Lecture – 1 hr)
a. Causative organisms
b. Clinical manifestations
c. Investigations
d. Empirical and definitive treatment; prevention
35.
Substance abuse and dependence I (Lecture – 1hr, CAL - 2 hrs)
a.
Definitions: abuse and misuse; tolerance, physical and psychological
dependence, “addiction”
b.
Cellular and molecular basis of tolerance and dependence
c.
Classification of substances of abuse
d.
Prevalence and types of abuse
e.
CAL: Unsupervised Internet search for information on the scope of substance
abuse in Malaysia and elsewhere. Sources of information include Agensi
AntiDadah Kebangsaan and the World Health Organisation
36.
Substance abuse and dependence II (Lecture – 1hr)
Mechanisms of action, development of tolerance, dependence and withdrawal effects;
medical harms ofa.
Tobacco and nicotine
b.
Depressants: alcohol, barbiturates, benzodiazepines, opiates and opioids
c.
Stimulants : cocaine, amphetamine type stimulants, caffeine
Nicotine dependence is outlined and smoking cessation is discussed in the Respiratory
System BPH2017 Semester 3
37.
Substance abuse and dependence III (Lecture – 1hr)
Mechanism of action, long term effects, tolerance, dependence, adverse and withdrawal
effects & management of:
a.
Psychomimetics: lysergic acid diethylamide, ketamine
b.
Cannabis
c.
Designer drugs
d.
Drug abuse in sports
38.
Substance abuse and dependence IV (Lecture – 1hr)
a. Medical and social harms and the public health perspective
b. Should dependence be treated? The medical model of addiction
c. Harm reduction, including substitution and maintenance prescribing and other
measures
39.
Seizure disorders and Parkinson’s Disease (Workshop – 3 hrs)
Case or scenario-based discussions with the focus on
a.
clinical presentations of these conditions
b.
interpretation of laboratory and clinical investigations
c.
pharmacotherapy and non-pharmacological treatments; unwanted effects,
interactions and monitoring
d.
counselling
8
40.
Affective and mood disorders; dependence (Workshop - 3 hrs)
Case or scenario-based discussions with the focus on
a.
clinical presentations of these conditions
b.
interpretation of laboratory and clinical investigations, including assessments of
mental state;
c.
pharmacotherapy and non-pharmacological treatments; unwanted effects,
interactions and monitoring
d.
counselling
41.
Pharmacy Skills Development (PSD - 1.5 hr)
Encounters with simulated (standardised) patients to provide practice in communication
and interpersonal skills required in interacting with patients with special needs, such as
those with mood disorders. Feedback is provided.
READING LIST:
Physiology:
1.
Marieb, E.N. & Hahn, J. (2006) Human Anatomy and Physiology, 7th Edition, The
Benjamin/Cummings Publishing Company.
2.
Widmaier E.P., Raff, H., & Strang, K.T. (2007) Vander’s Human Physiology, The
Mechanisms of Body Function with ARIS, 11th Edition, McGraw Hill.
3.
Martini, F.H. (2004) Fundamentals of Anatomy & Physiology 6th edition, Pearson,
Benjamin Cummings Publishing Company, San Francisco.
Pharmacology
4.
Rang, H.P., Dale M.M. & Ritter, J., & Flower, R. (2007) Pharmacology 6th Edition,
Churchill Livingstone
5.
Katzung, B.G. Basic & Clinical Pharmacology, (2007) 10th edition, Appleton and Lange
6.
Brunton, L., Lazo, J. & Parker, K. (2006). Goodman and Gilman’s The Pharmacological
Basis of Therapeutics, 11th edition, McGraw-Hill
Pathology
7.
Kumar, V., Cottran, R.S. & Robbines, S.L. (2004) Basic Pathology 7th Edition, WB
Saunders Company
8.
Chandrasoma, P., & Taylor, C.R. (2000) Concise Pathology 6th. Edition, Appleton &
Lange
9.
Rubin, E. (2008) Essentials of Rubin's Pathology 5th Edition, Lippincott Williams &
Wilkins.
10.
Underwood, J.C.E. (2000) General and Systemic Pathology 3rd Edition, Churchill
Livingstone
Pharmacotherapy
11.
DiPiro, J.T., Talbert, R.L., Yee, G.C., et al (2007) Pharmacotherapy: A Pathophysiologic
Approach 6th Edition, McGraw Hill
12.
Koda-Kimble, M.A., Young, L.Y., Kradjan W.A., et al (2008) Applied Therapeutics: The
Clinical Use of Drugs 9th Edition, Applied Therapeutics Inc.
13.
Walke, R., & Edwards, C.R.W. (2004). Clinical Pharmacy and Therapeutics, 3rd edition,
Churchill Livingstone.
Drug Abuse
14.
Doweiko, H.E. (2006) Concepts of Chemical Dependency, 6th edition, Thomson Brooks
Cole
15.
United Nations Office of Drugs and Crime. Annual World Drug Reports, available via
www.unodc.org
16.
Agensi AnitDadah Kebangsaan, Malaysia. www.adk.gov.my
9
17.
18.
Clinical Practice Guidelines, Ministry of Health, Malaysia
Evidence Based Treatment Guidelines
10
