2. Common ground for the task ahead
• Why do you want to become a medical
professional?
• What would you like to be?
• What do you think are going to be your
responsibilities?
• What are your expectations during your
time laerning Clinical Pharmacology?
3. Important tips
• Do not walk in the dark during your
medical training
• Define where you want to go
• Think seriously on how to achieve your
goal and have the right attitude towards
learning, your teachers, and others
• In other words, create a reason to learn
4. Challenges in clinical pharmacology
for tomorrow’s doctors
• The number of licensed medicines is rapidly
increasing and doctors are increasigly
expected to prescribe medicines that are less
familiar to them
• Pace of new drug development is
accelerating rapidly as a result of advances
in moleculat biology and mapping of the
human genome
5. • Patients are taking more medicines than
before, increasing the compleixty of their
treatment regimen and the potential for drug
interactions
• Newer drugs, capable of targeting previously
untreatable conditions, are often more
powerful but also more toxic
• The expansion of evidence-based medicine
and health technology assessment has enabled
the beneficial and adverse effects of drugs to
be more accurately quantified
6. • There are more sources of opinion and
disinformation available to patients and
doctors (increasing assess to the internet)
• Marketing activites of the pharmaceutical
industry are a potential threat to cost-
effective prescribing decisions
7. Clinical Pharmacology Training at
MUHAS
• Semesiter 5
– Only protected time to concentrated on leaning the
scientific basis for the principles of therapeutics and
gaining core knowledge and understanding about drugs
• Clinical rotattions
– Witness and learn about the use of drugs in practice and
gain skills in prescribing, drug administration and
attitudes towards the use of drugs
8. • The burden of factual knowledge is high in
Pharmacology
• You may feel overwhelmed by the number of drugs
described in pharmacology text books
• It is important to understand general pharmacological
principles, and to appreciate the pharmacology of the
main classes of drugs rather than attempting to
memorise details of individual drugs
• Specific therapeutic drugs are best learned about near
a patient’s bedside
9. • For each of the commonly used drugs in our
setting we expect the following from you
– Know the name and class
– Have an understanding of the mechanism of
action
– Recognise the appropriate indication for use
– Know the appropriate route, frequency and
duration of administration
– Know the important contraindications, potential
interactions and adverse effects
– Know how to monitor the drug’s effects
– Be able to explain the salinet features of all the
above to the patient
10. General learning objectives
• To produce graduates who are competent to
prescribe safely, effectively and cost-
effectively
• To provide the appropriate framework to be
able to assimilateinformation about new
drug developments that will occur
throughout a professional career
11. Course Content
General Principles
of Pharmacology Chemical Mediators
Systemems
Pharmacology
Antimicrobial and
Cancer
Chemotherapy
Speceal
Topics
12. Teachers’ Responsibility
• We have a responsibility to the public, to
employers and the profession to make sure
that graduates are fit to practise. ... and
prescribing drugs is a key componet of
medical practice
• We are not interested in failing any one!
13. Some key definitions
• Pharmacology: study of the effects of drugs
on the function of living systems
• Drug: a chemical substance of known
structure, other than a nutrient or an
essential dietary ingridient, which, when
administered to a living organism, produces
a biological effect
14. • Drugs may be:
– Synthetic chemicals
– Chemicals from plants or animals
– Products of genetic engineering (biotechnology)
• To count as a drug, the substance must be
administered intentionaly to produce a certain
desired biological effect. Hormones (insulin,
thyroxine) when administered as such are drugs
• Poison: a substance that causes death or harm
when introduced into or absorbed by a living
organism. Although fall strictly within definition
of drugs they are not used in therapy
15. • A medicine: chemical preparation which
usually but not necessarily contains one or
more drugs, administered with intention of
producing a therapeutic effect. Usually
contains other substances (excipients,
stabilisers, solvents ect) besides the active
drug, to make them more convenient to use
16. Development of Pharmacology as
a scientific discipline
• Ancient prescientific therapeutics
– Herbal remedies widely used
– No application of scientific principles to therapeutics
– Dogma used to explain therapeutic effects (magic, vital
forces)
• Pharmacology in the 19th
century
– Pharmacology was born out of increasing skills among
doctors at clinical observation and diagnosis but being
ineffectual when it came to treatment
– A need to improve outcome of therapeutic interventions
provided impetus for pharmacology
17. – However, the pharmacology could be built only
on the basis of secure foundations in physiology,
pathology and chemistry which fortunately
developed
– 1847, first pharmacology institute in Estonia
(Rudolf Buchheim, in his house)
– Exclusively concerned with understanding of the
effects of natural substances (plant extracts and
toxic chemicals e. g. Mercury, arsenic)
– Purification of active compounds from plants
was possible through early development in
chemistry
18. – 1805, Friedrich Serturner purified morphine from
opium, and other subsatances quickly followed
– Compounds showed that that chemicals, not magic
or vital forces, were responsible for the effects that
plant extracts produced on living organisms
– 1858, Virchow proposed the cell theory
– 1868, the first use of strucural formular to describe
chemical compounds
– 1878, Bacteria as a cause of disease were
discovered by Pasteur
19. • Pharmacology in the 20th
and 21st
centuries
– Growth of synthetic chemistry, and resurgence of
natural product chemistry revolutionalised the
pharmaceutical industry and the science of
pharmacology
– New synthetic drugs (barbiturates, local
anaesthetics) appeared
– Era of microbial chemotherapy began with the
discovery by Paul Ehrlich in 1909 of arsenical
compounds for syphilis
20. – Gerhard Domagk, discovered sulfonamides, the
first antibacterial drugs in 1935
– Chain and Florey developed penicillin during the
Second World War, based on the earlier work of
Flaming
– By this time, pharmacology had really
established its identity and status among the
biomedical sciences
– Physiology was also making rapid progress
particulary in relation to chemical mediators
– Many hormones, neurotransmitters and
inflammatory mediators were discovered
21. – The realisation that chemical communication
plays a central role in almost every regulatory
mechanism in living systems, established a large
area of common ground between physiology and
pharmacology (interaction between chemical
substances and living systems the interest of
pharmacologists from begining)
– 1905, Langley first proposed the concept of
‘receptors’ for chemical mediators, and this was
quickly taken up by pharmacologists
– Receptors concempt and technologies developed
from it, have had a massive impact on drug
discovery and therapeutics
22. – Biochemistry also emerged as a distinct science
in early 20th century
– Discovery of enzymes and delineation of
biochemical pathways provides yet another
framework for understanding drug effects
23.
24. Figure 1-2 Pharmacology today with its various subdivisions. Interface disciplines (brown boxes) link pharmacology to other mainstream biomedical disciplines (green boxes).
26. • Morden medicine rely heavily on drugs as
the main tool of therapeutics (surgery, diet
excercise less commonly used)
• Therapeutic principles outside the domain
of science are currently gaining groung as
alternative or complementary medicine
• The problem: they reject the medical model
which attributes disease to underlying
derangement of normal function
• Focus on subjective malaise
27. • Abandon objectivity in defining and
measuring disease
• Depart from scientific principles in assessing
therapeutic efficacy and risk
• Unfortunately, practices can gain public
acceptance without satisfying any of the
criteria of validity
