CCMAS Course Search

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 100 (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 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 101 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. 104 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 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. 105 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.

Immunisation, availability, awareness and implementation. Introduction, vaccine types and storage. National programme on immunisation/schedule. National immunisation days, implementation and challenges in Nigeria. Childhood poisoning. Definition of poisons and examples. Clinical features of childhood poisonings-clinical toxidromes. How to evaluate a patient with suspected childhood poisoning. Principles of management of poisoning in children. Common childhood poisonings and how to manage them. Dog and snake bite, epidemiology, clinical features, management. Non-accidental childhood injuries introduction, epidemiology, at risk groups, clinical presentation, evaluation of a suspected case, management, prevention. Child abuse; introduction, epidemiology, at risk groups, clinical presentation, evaluation of a suspected case, management, prevention. Paediatric emergencies, definition of paediatric emergency. Triaging and how to recognise a paediatric emergency, urgent and non- urgent conditions in the emergency. Principles of management of paediatric emergencies. Common paediatric emergencies and how to manage. Primary care. Diarrhoea training, demographic characteristics of children attending clinic and anthropometry. Clinical characteristics of children attending primary health care clinic. Talking to mothers about hygiene and illnesses. economic disposition of mother attending primary health care clinic. Triage in the primary health care clinic. Nutritional issues in primary health care. Integrated management of childhood illnesses (IMCI), background, rationale, components of the integrated approach. IMCI strategy. Benefits and limitations. IMCI case management process.

Diagnosis and management of ENT, HNS disease. Basic knowledge on how to investigate and interpret the results. Learning to identify problems, which are beyond level of skill, referral processes and skills for onward referral to a specialist, relevant hospital. Awareness of noise pollution as a health hazard for industrial workers, hearing conservation. Epidemiological surveys into prevalence of deafness in the community, with field trips into the community (perhaps via CBME in our case), Early screening test for ENT problems, universal neonatal hearing screening. Methods of seeking information on the web via ICT for the ORL disease and recent advances in the field of ORL practice. Revision of basic examination of the ear, nose and throat so as to be able to give first aid treatment to common ENT problems.

Blood glucose homeostasis. Glucose tolerance tests, performance and interpretation, diabetes mellitus. Formation of free fatty acid, ketone bodies and lactate. Plasma lipids, cholesterol, triglycerides, phospholipids and non-esterified fatty acids. Plasma lipoproteins and causes of hyper and hypolipoproteinaemia. Concept of risk factors for diseases and significance in 82 prevention. Plasma proteins, reference values, separation of fractions and variations in health and disease. Paraproteinaemias. Bence-Jones proteinuria and significance. Renal function, dysfunction and investigations. Definitions, causes and consequences of azotaemia, uraemia, creatinine clearance. Liver function, dysfunction and investigations. Biochemical assessment of hepatic function, jaundice, hepatocellular, haemolytic and obstructive.

Hypothalamo, Neuro and adreno hypophysis, functions, dysfunctions and investigations. Pituitary, thyroid functions, dysfunctions and investigations. Biochemical assessment of gonadal function in men and women. Investigations of fertility disorders. Biomarkers of cardiovascular disease. Adrenocortical function, dysfunction and disorders. Biochemical changes in pregnancy. Diagnosis of pregnancy. Assessment of foetal and placental integrity. Role of chemical pathology in the diagnosis and management of cancer. Gastrointestinal functions, dysfunction and investigations, xylose absorption, pancreolauryl test, PABA test, faecal elastase, disaccharidases test, Schilling’s test, hydrogen breath test. The role of tumour markers in screening, diagnosis, treatment and monitoring of cancers. 92

Plasma enzymes, transaminases, alkaline and acid phosphatases, creatine kinase, lactic dehydrogenases and their uses in diagnosis and management of various diseases. Interpretation of enzyme levels in various diseases. Non-pathologic causes of elevation of selected plasma enzymes. Inborn errors of metabolism, definition, causes, consequences, and an overview of the management of common inborn errors of metabolism. Galactosaemia, lactose intolerance, albinism, aminoaciduria, phenylketonuria. 108

Nutritional requirements and nutritional disorders. Biochemical functions of micronutrients and trace elements. Lipid soluble vitamins. Water soluble vitamins. Coenzyme structure and functions, biochemical investigations of various micronutrients associated disorders. Nutritional support in clinical medicine, indications of enteral and parenteral nutritional support, complications of various forms of nutritional support. Role of chemical pathology laboratory in the diagnosis and monitoring of nutritional disorders and nutritional support.

Clinical pharmacology general aspect. Evaluation of drug therapy, clinical aspects of adverse drug reaction (inherent anomalies, acquired anomalies, treatment of adverse reactions). Basic mechanisms of drug-drug interactions. Consequences of drug-drug interactions. Clinically important drug interactions, beneficial embryonic and foetal clinical pharmacology, drug use in pregnancy, teratogenicity. Paediatric clinical pharmacology and therapeutics. Altered drug response in infants and response in infants and children, drug dosage in paediatrics. Geriatric clinical pharmacology and therapeutics. Altered drug response in the elderly drug dosage in geriatrics. 88

Clinical application of basic medical and basic clinical sciences. Clinical skills. Principles of courses taught in basic medical and basic clinical science.