CCMAS Course Search

General characteristics and functions of blood. Properties and functions of plasma. Red blood cells factors involved in erythropoiesis, blood groups. White blood cells, origin, type, properties, functions, antigenicity and immunities. Platelets and hemostatic mechanisms. Reticulo-endothelial system. Clotting and fibrinolytic systems. Immunity and immunodeficiency disease and HIV.

Introduction to red blood cell serology. Antigens and antibodies of ABO and Rh blood group systems, haemolytic diseases of foetus and newborn. Blood donation. Donor recruitment including criteria for acceptance and deferrals for allogenic blood donors. Blood collection and screening for TTIs including HIV–screening and window period. Clinical blood transfusion. Indications for blood transfusionn, blood storage, blood fractionation and component therapy, rational use of blood, blood compatibility testing, bedside pre-transfusion check. Complications of blood transfusion and management. Immediate, delayed, immunological and non- immunological.

Classification and chemistry of carbohydrate. Chemistry and biochemistry of the polysaccharide including the amino sugars, mucopolysaccharides, blood group substances.

Glycolysis (Embden- Meyerhof pathway), aerobic and anaerobic phases. Control mechanisms and substrate level phosphorylation. The kerb’s cycle/citric acid cycle. Metabolism of galactose 195 and fructose the uronic acid pathway gluconeogenesis, glycogenesis and glycogenolysis. The HMP shunt and its biochemical importance.

Approach to the evaluation of the cardiac patients and common symptomatology in cardiovascular diseases. Chest pain. Dyspnoea. Orthopnoea. Paroxysmal nocturnal dyspnoea and palpitations. Approach to cardiovascular system examination, the precordium, valvular areas, heart sounds and murmurs. Introduction to common cardiovascular diseases, hypertension, heart failure (epidemiology, clinical features, mechanisms/pathophysiology, investigation and diagnosis). Introduction to ECG.

Hypertension and blood pressure regulation. Aetiology of hypertension. Normal regulation of blood pressure. Postural baroreflex. Renal response to decreased blood pressure, therapeutic implications, diagnosis. Basic pharmacology of antihypertensive drugs in relation to mechanism and site of action, haemodynamic effects, dosage, pharmacokinetics and toxicity, 213 diuretics, sympatholytic drugs, direct vasodilator, and drugs that block production or action of angiotensin. Angina pectoris and anti-anginal Drugs. Pathophysiology of angina, determinants of coronary blood flow and myocardial oxygen supply, specific therapeutic interventions (nitrates, beta blockers, calcium entry blockers). Basic and Clinical pharmacology of anti- anginal drugs. Historical concepts, chemistry, pharmacokinetics, pharmacodynamics, toxicity and tachyphylaxis. Congestive heart failure and Drugs used in Management, pathophysiology of heart failure, pathophysiology of cardiac performance, pathophysiology of the peripheral vasculature in congestive heart failure. Basic and clinical pharmacology of drugs used in congestive heart failure (cardiac glycosides and others like amrinone and beta-adrenergic stimulants), Administration, dosage, interactions, other clinical uses, toxicity, chemistry, pharmacokinetics, pharmacodynamics (mechanical and electrical effects). Cardiac arrhythmias and anti-arrhythmic drugs, electrophysiology of normal cardiac rhythm, mechanisms of arrhythmias. Basic and clinical pharmacology of anti-arrhythmic drugs, classes and types, mechanism of action, specific drugs, pharmacokinetics, pharmacodynamics and extracardiac effects, principles of anti-arrhythmia. Diuretics, renal tubule transport mechanism. Proximal and distal tubules, loop of Henle and collecting ducts. Basic and clinical pharmacology-types (carbonic anhydrase inhibitors, thiazides, loop diuretics, potassium-sparing (aldosterone antagonist), chemistry, pharmacokinetics, pharmacodynamics, clinical indications, dosage, toxicity, contraindications, combination therapy. Drugs that affect water excretion. Mannitol. Clinical pharmacology of diuretics - Oedematous state (CHF, hepatic cirrhosis, nephritic syndrome) non-oedematous states (hypertension, renal potassium wasting), alteration of urinary pH, tract infections, renal failure immunity, immunosuppressive drugs. Drugs used in hyperlipidaemic conditions, Pathophysiology of hyperlipoproteinemia, Normal lipoprotein metabolism review, the hyperlipoproteinemic states (primary hypertriglyceridemia, primary hypercholesterolaemia; deficiency of high-density lipoproteins, secondary hyperlipoproteinemia). Role of elevated serum LDL concentrations in promoting risk of developing cardiovascular disease, protective role of increased serum HDL concentration in decreasing risk, presently accepted values for desirable LDL, HDL and triglyceride concentrations in normal individuals, treatment goals for individuals with hyperlipidaemia. Role of diet and lifestyle, pharmacology of specific drugs used (nicotinic acid, clofibrate, gemfrozil, bile acid-binding resins, sitosterols, neomycin, HMG-CoA reductase inhibitors, dextrothyroxine, probucol), drug combinations. Drugs Acting on blood. Cytopenia and Drugs used in treatment anaemias. Iron deficiency and other hypochromic anaemias, megaloblastic anaemia, basic pharmacology of drugs used in management, iron, cobalamins (B12), folates. Basic pharmacology, clinical indication, mechanism of action, adverse effects and contraindications of the growth factors used in management of cytopenia, including, erythropoietin, G-CSF, GM- CSF and IL-II. thrombosis and thrombolytics, principles of blood coagulation, plasma coagulation factors, regulation of coagulation and fibrinolysis. Basic pharmacology of drugs used to treat thrombosis, types of anti-coagulants (heparin and low molecular weight heparins, coumarins, indandiones), chemistry, pharmacokinetics, mechanism of action, administration and dosage, role of aPTT in heparin monitoring, concept of using INR in management of warfarin therapy. Platelet aggregation inhibitors, drugs that inhibit platelet function, aspirin and related cyclooxygenase inhibitors, imidazole, sulphinpyrazone. Drugs used in bleeding disorders. Vitamin K. Factor VIII. Factor IX. Fibrinogen. Fibrinolysis inhibitors (aminocaproic acid, tranexamic acid).

Aetio-pathogenesis of caries oral pathology. Microbiology of caries oral pathology. Immunology of dental caries oral pathology. Clinical appearance and presentations of dental caries. Conservative dentistry. Clinical detection of carious lesions. Conservative dentistry. Tooth-wear lesions. Restorative dentistry. Caries risk assessment. Paediatric dentistry. Treatment of non-cavitated lesions. Paediatric dentistry. Measurement of dental caries. Dental public health. Epidemiology of dental caries. Dental public health. Prevention of dental caries. Economic and policy implications of dental caries. Dental PH.

Introduction to Biochemistry. Review of concepts in chemistry applicable to biological systems, chemical bonds covalent and ionic, biomolecules, elementary thermodynamics, reaction equilibria. Henderson equation application. Water, physical, biological and chemical properties. Acid-base chemistry, buffer systems and application to living systems. Introduction of terms used to describe acid-base disorders in the body, academia, alkalemia, acidosis and alkalosis. Enzymes, their properties and kinetics. Diversity of biomolecules, carbohydrates, lipids, proteins, amino acids and nucleic acids in nature. Structure, properties, and biochemical/biological functions of carbohydrates. Lipids, amino acids, proteins and nucleic acids.

Pain and Analgesics. Narcotic analgesics opioid system. Receptors, endogenous ligands, signal transduction pathways, role in pain. Concept of opioid-induced tolerance, physical dependence, addiction and pseudo-addiction. Basic pharmacology of narcotic analgesics (morphine, pethidine, methadone and congeners), narcotic antagonists, full and partial antagonists (nalorphine, levallorphan, naloxone). Non-Steroidal Anti-Inflammatory drugs (NSAIDs). Role of cyclo-oxygenase and prostaglandins in aetiology of inflammation, pain and fever, role of prostaglandins in homeostatic regulation of gastric function, kidney function, vasoconstriction and platelet activation. Basic pharmacology of NSAIDs (aspirin and salicylates, traditional NSAIDs, COX-2 inhibitors, acetaminophen). Rationale behind unique indication for low-dose aspirin as prophylactic treatment in development of CV disease. Pharmacokinetics of aspirin and the mechanism that lead to the development of salicylate toxicity. Mechanism underlying acetaminophen poisoning and its treatment. Epilepsy and Antiepileptic Drugs. Different types of seizures. Seizure types as determinants of specific antiepileptic drugs used in management. Spectrum of action of most commonly used drugs. Selection process of an epileptic drug for a given seizure type, based on its mechanism of action efficacy, clinical pharmacokinetics (ease of use), drug-drug interaction potential, tolerability (common side effects), serious toxicity (idiosyncratic reactions). Role of co-morbidities in the selection of an epileptic drug. Antidepressants Primary sites of action of the different classes of antidepressants, Tricyclic antidepressants, TCAs, (imipramine, amitriptyline, clomipramine, desipramine, doxepin). Selective-serotonin reuptake inhibitors, SSRIs, (citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline), Noradrenaline/serotonin reuptake inhibitors, SNRIs, (Venlafaxine, desvenlafaxine, nefazodone), monoamine oxidase inhibitors, MAOIs, (Irreversible, phenelzine, tranylcypromine and selegiline and reversible such as moclobemide). Adverse side effects of the different classes with respect to use in certain population (elderly, pregnancy), Pharmacological sites of actions that contribute to the acute or chronic side effects of these drugs. Proposed mechanism underlying the delayed therapeutic effects. Considerations in using irreversible MAOIs, their potential adverse effects and the important considerations in switching between MAOIs and SSRIs or other antidepressants. Antipsychotic drugs, the four well-defined dopamine systems in the brain as they relate to antipsychotic drug action and side effects. Distinction between the typical (chlorpromazine, haloperidol) and atypical antipsychotics (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, paliperidone); difference in mechanism of action between the typical antipsychotics, atypical antipsychotics and the partial agonist, aripiprazole, common and rare side effects associated with use of both low potency and high potency antipsychotics as well as the second-generation antipsychotics. Sedative-Hypnotic Drugs used in treating anxiety and sleep disorders. Sleep and wakefulness. Structural aspects of GABAA receptor and the receptor. components (binding sites) mediating 232 the effects of drugs that modulate GABAA receptor activity. Differences between benzodiazepines with respect to time of onset, potency, metabolism and elimination half-lives. Similarities and differences between the benzodiazepines and the barbiturates in producing sedative-hypnotic effects. Factors to consider in choosing the most appropriate drug for specific clinical situations and/or individuals. Characteristics of benzodiazepines and other sedative-hypnotics that contribute to different degrees of abuse liability and withdrawal symptoms. Target sites or putative mechanisms of non-benzodiazepine drugs that can be used to treat sleep disorders, Barbiturates, bromides, cyclic ethers, paraldehyde, carbamic acid esters (meprobamate), chloral derivatives (chloral hydrate) piperazine dienes (glutethimide, methyprylon) alcohols. Target sites of action for SSRIs and strategy for using SSRIs in combination with benzodiazepines in the treatment of anxiety. Bipolar affective disorder and drugs used in management. Target sites of action for lithium, its pharmacokinetics, adverse effects and considerations in its use. Sites of action, adverse effects and considerations in using anticonvulsants (carbamazepine, lamotrigine, valproate) and the atypical antipsychotics (aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone) to treat bipolar disorder. Potential risks of birth defects with use of lithium, valproate, carbamazepine and lamotrigine in pregnant women. Parkinson’s disease and drugs used in management. Pathophysiology of Parkinson’s disease and its presentation; functional circuitry of the nigrostriatal system. Major classes of drugs used in management and the timeline for their use, indications, mechanism of action, adverse effects and contraindications. Types and mechanisms of alternative treatments. Local Anaesthetics. Mechanism by which local anaesthetics block nerve conduction, how their physiochemical properties (esters and amides) influence their pharmacodynamics and pharmacokinetics. The side effects that may occur with their use and why they occur. Unique characteristics and the common clinical use for each prototypical local anaesthetic. Common uses with emphasis on spinal and epidural anaesthesia, commonly caused severe complications of their use. General anaesthetics. Definition of general anaesthesia and how it is achieved, stages of anaesthesia. Pharmacokinetics of inhalational anaesthetics. Blood, gas coefficient, ventilation rate and pulmonary blood flow influence on the onset (and termination) of action of inhalational anaesthetics, influence of tissue blood flow on the tension of anaesthetic gas in that tissue, definition of minimum alveolar concentration (MAC) and what information it provides on a volatile anaesthetic. Pharmacokinetic properties of the ultra-short-acting hypnotics and how they make this class of drugs popular general anaesthetic drugs. Advantages and disadvantages of clinically used inhaled and intravenously administered general anaesthetics, when they should be used, their contraindications. Concept that inhalational and intravenous anaesthetics cause varying degrees of respiratory depression with exception of ketamine. Use of anaesthetics in persons already taking drugs such as neuromuscular blocking drugs and CNS stimulants.

Definition of common pharmacodynamics terminology used to describe the effects of antimicrobial therapy. Bacteriostatic. Bactericidal. Concentration-dependent and time- dependent bactericidal activity. Antimicrobials that display each of these properties. Combinations of antibiotics. Choice of antibacterial drugs in common infections. Penicillin, differences in chemical structure between the penicillins. Cephalosporins. Carbapenems and monobactams. General characteristics of β-lactam antibiotics including their mechanism of action. Elimination half-life, route of elimination and potential for cross-allergenicity. Differences in spectrum of activity between the natural penicillins. The penicillinase-resistant penicillins. The aminopenicillins. The carboxypenicillins. The ureidopenicillins and the β- lactamase inhibitor combinations with attention to the specific drugs that have activity against Staph. aureus, Pseud. aeruginosa and Bact. fragilis, distribution characteristics into the cerebrospinal fluid, urinary tract, lungs, skin/soft tissue and bone. Indications. Mechanism of action. Adverse effects and contraindications of each group. Mechanism by which bacteria develop resistance to penicillins. Cephalosporins, carbapenems and monobactams. Differences in spectrum of activity between the four generations of cephalosporins, as well as the carbapenems and aztreonam, indications, mechanism of action, adverse effects and contraindications, mechanism by which bacteria develop resistance, pharmacokinetics particularly those drugs that penetrate the CNS and those that require dosage adjustment; risk of cross-reactivity between these classes and the penicillins, major clinical uses of representative drugs within each generation of cephalosporin, carbapenems and aztreonam. Quinolones. The various generations, spectrum of activity of the older and respiratory fluoroquinolones, particularly those with activity against Staph. aureus, Strep. pneumonia, Pseud. aeruginosa, atypical bacteria and anaerobes, indications, mechanism of action, adverse effects, contraindications and major drug interactions, mechanism of resistance to the drugs. Major pharmacokinetic differences in terms of oral bioavailability, half-life, dosing interval, CSF penetration, route of excretion, necessity of dosage adjustment in renal insufficiency and removal by haemodialysis. Aminoglycosides. Spectrum of activity with attention to drugs that display activity against Staph. aureus, Pseud. aeruginosa and tuberculosis, indications, mechanism of action, adverse effects, contraindications and major drug interactions; mechanism of resistance to the drugs, major pharmacokinetic characteristics including understanding of patient characteristics that may alter the pharmacokinetic parameters of volume of distribution and clearance, as well as how these alterations may influence dosing. Vancomycin and other drugs with activity against Gram-positive aerobes. General spectrum of activity of vancomycin, quinupristin-dalfopristin, linezolid and daptomycin, indications, mechanism of action, adverse effects and contraindications, mechanism of resistance to the drugs, major pharmacokinetic characteristics including bioavailability, half-life, dosing interval, CSF penetration, route of excretion, necessity of dosage adjustment in renal insufficiency and removal by haemodialysis. Tetracyclines and sulphonamides. Spectrum of activity, indications, mechanism of action, adverse effects, contraindications and major drug interactions, mechanism of resistance to the drugs, major pharmacokinetic differences in terms of oral bioavailability, half-life, dosing interval, CSF penetration, route of excretion, necessity of dosage adjustment in end-organ dysfunction and removal by haemodialysis, potential therapeutic advantages of the glycylcycline antibiotics. Clindamycin and metronidazole. Spectrum of activity with emphasis on activity against anaerobes and Clostridium difficile, indications, mechanism of action, adverse effects, contraindications and major drug interactions, mechanism of resistance to the drugs, major pharmacokinetic differences in terms of oral bioavailability, half-life, dosing interval, CSF penetration, route of excretion, necessity of dosage adjustment in end-organ dysfunction and removal by haemodialysis. Antimycobacterial drugs. Indications, mechanism of action, adverse effects and contraindications of the first line antituberculosis drugs, treatment principles in treating M. tuberculosis infection, therapeutic indications of rifampicin, mechanisms of primary and 236 secondary resistance in M. tuberculosis infection, reasons for resurgence of tuberculosis and ways to stop epidemic, major determinant outcome of treatment and ways to improve this basic pharmacology of drugs used in the treatment of leprosy (sulphones). Anti-parasitic drugs, distinction between protozoal and helminth infections, general approaches to therapy, general strategies and relevant drugs used to treat the following infections, malaria Amoebiasis, African Trypanosomiasis, American trypanosomiasis, Cryptosporidiosis and Toxoplasmosis. General strategies and relevant drugs used to treat major helminth infections. Principal indications, mechanism of action, adverse effects and contraindications of the major drugs used in treatment of protozoal and helminth infections. Malaria. Chloroquine, diamino pyrimidines, proguanil, primaquine, quinine and quinidine, artemisinins, antibiotics. Amoebiasis, metronidazole, emetine, dihydroemetine, iodoquinol, paromycin, amoebic liver abscess. Trypanosomiasis. Suramin, melarsoprol, melarsonyl, nifurtimox, benznidazole. Cryptosporidiosis, nitazoxanide. Toxoplasmosis, pyrimethamine, folinic acid, sulfadiazine, clindamycin. Schistosomiasis and paragonimiasis. Niridazole, antimony compounds, bithionol. Leishmaniasis, Sodium stibogluconate, pentamidine. Filariasis, diethylcarbamazine. Tapeworms, niclosamide. Roundworms, piperazine, thiabendazole, tetrachlorethylene, mebendazole. Antimycotic drugs Indications, mechanism of actions, adverse effects and contraindications of the most commonly used drugs; polyene antifungals (amphotericin B, nystatin), azole antifungals (imidazoles such as miconazole, clotrimazole and ketoconazole, triazoles such as fluconazole and itraconazole), echinocandins (caspofungin, micafungin and anidofungin) and others such as 5-flucytosine, griseofulvin and terbinafine. Antiviral Drugs. Mechanism of action of major nucleoside and non-nucleoside analogues. Viruses targeted by the major nucleoside and non-nucleoside analogues and the relative benefits of each drug. Indications, mechanism of action and clinical efficacy of inhibitors of viral entry or dissemination. Mechanism of action leading to antiviral resistance. How drugs targeting different stages of viral infection can be synergistic when administered simultaneously. Nucleoside analogues (acyclovir, ganciclovir, idoxuridine, vidarabine, azidothymidine, dideoxy inosine, dideoxy cytosine). Non-nucleoside analogues (ribavirin, foscarnet), inhibitors of viral entry and dissemination (amantadine, neuraminidase inhibitors, pieconoril, interferons, passive antibody transfer). Antiretroviral drugs. How distinct antiretroviral drug classes target the different phases of HIV replication cycle, diagnostic criteria and therapeutic goals, indications, clinical uses, major adverse effects, contraindications and significant drug interactions for each class, utility and effectiveness of combination therapy, influence of presence of co-morbid conditions on antiviral regimen; nucleoside/nucleotide reverse transcriptase inhibitors, non-nucleotide reverse transcriptase inhibitors, protease inhibitors, viral integrase inhibitors, fusion inhibitors and chemokine receptor antagonists. Drugs used in treatment of malignant diseases. Major features of malignant disease. Review of cell kinetics, cell cycle specificity, cell cycle non- specificity. Cancer cell vs. bacterial infections. Importance of tumour cell heterogeneity and the development of resistance to chemotherapy as critical factors in determining treatment outcome. Process of antineoplastic drug development. Criteria for determining response to antineoplastic drugs. Importance of tumour staging in patient management. General principles of antineoplastic drug treatment. Rationale for administration of adjuvant chemotherapy. Concept of multiple drug-resistance, cumulative toxicity, schedule independent toxicity, concept of hormonally sensitive neoplasms and their treatments. Pharmacology of cytotoxic drugs. Characteristic indications, adverse effects, mechanism of resistance. Alkylating drugs (mechlorethamine, cyclophosphamide, chlorambucil, melphalan, busulfan). Antibiotics (Actinomycin D, Daunorubicin, Anthracycline mithramycin, Adriamycin), Antimetabolites (methotrexate, cytarabine, 5-flurouracil), Miscellaneous (procarbazine, nitroureas, hydroxyureas). Radioactive isotopes. Adrenal corticosteroids. Steroid hormones and antagonists. Drugs for immunotherapy. 237