CCMAS Course Search

Pathological functional sates of the heart: systolic and diastolic dysfunction; arrhythmias; ischaemic heart diseases. Cardiomyopathies. Dilated, restrictive and hypertrophic. Peripheral vascular diseases. Acute and chronic arterial diseases, embolic diseases, venous thromboembolism. CVS infections. Congenital abnormalities. Valvular abnormalities. Emergencies in cardiology.

Symptoms and signs of common lesions in cardiothoracic and vascular surgery, including their interpretations. Chest trauma and chest wall tumours. Introduction to principles of management of common lesions in cardiothoracic surgery including relevant investigations, treatment and complications. Congenital malformations and their management.

Evaluation of the cardiovascular system, epidemiology and aetiology of common cardiovascular disorders. Classification of CVS disorders. General examination findings of a child with cardiovascular lesion. Examination of the peripheral pulses. Blood pressure measurement. Jugular venous pressure measurement, examination of the precordium. The role of chest radiograph, ECG and echocardiography in the diagnosis of common CVS disorders. Congenital heart disease I. Classification of acyanotic congenital heart diseases. Pathophysiology and clinical features of ventricular septal defects (VSD), atrial septal defects (ASD) and persistent ductus arteriosus (PDA). To recognise the peculiar clinical features of VSD, ASD and PDA. The role of chest radiograph, ECG and echocardiography in the diagnosis of VSD, ASD and PDA. Medical treatment, intervention cardiology and the role of surgery in the management of acyanotic heart disease. Congenital heart diseases II. Classification of cyanotic congenital heart diseases. Pathophysiology and clinical features of cyanotic congenital heart diseases. To recognise the peculiar clinical features of tetralogy of fallot (TOF). Clinical features and management of hypercyanotic spells. The role of chest radiograph, ECG and echocardiography in the diagnosis of TOF. Typical chest radiograph, ECG and ECHO findings of common cyanotic CHDs. Medical treatment, intervention and the role of surgery in the management of cyanotic congenital heart disease. Heart failure in infancy and childhood, definition, pathophysiology, signs and symptoms, causes by age, management. Acquired heart diseases, acute rheumatic fever. Rheumatic valvular heart disease. Cardiomyopathy. Infective endocarditis. Myocarditis. Pericarditis. Kawasaki disease. Evaluation of the respiratory system, brief anatomy and physiology of the respiratory system. Basic principle in history taking of the respiratory system. Steps in general physical examination relating to the respiratory system. Examination of the respiratory system. Investigation of the respiratory system. Communication. Disorders of the upper respiratory tract. Definition of the upper airway. Classification of disorders of the upper airway. History and common clinical presentations, investigations, communication. Asthma and chronic 116 respiratory disorders. Definition of asthma, mechanism/pathophysiology, history taking/presentation, investigation, treatment, prevention, communication. The wheezing child.

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).

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, 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 79 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.

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.

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.