Pharmacology

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Pharmacology

Understand the complex mechanisms of how drugs work to give therapeutic benefit, and the importance of understanding side effects and interactions.

1. Research Methods in Pharmacology

Evidence-based medicine and the three components: evidence, expertise, patient preference.
The hierarchy of evidence: systematic reviews of RCTs through to expert opinion.
Statistical interpretation — P values, confidence intervals, forest plots, NNT/NNH.
Phases I–IV of drug development and the role of post-marketing surveillance.

2. Pharmacokinetics

What the body does to the drug: absorption, distribution, metabolism, excretion (ADME).
Bioavailability, volume of distribution, clearance and half-life.
First-order vs zero-order elimination kinetics, with worked examples.
Steady state, loading doses and the ≈5 half-life rule.

3. Pharmacodynamics

What the drug does to the body: receptors, enzymes, channels and transporters.
Affinity, efficacy and potency on the dose–response curve.
Full and partial agonists, antagonists and inverse agonists.
Competitive vs non-competitive antagonism, and the therapeutic index.

4. Pharmacovigilance and Pharmacogenetics

Adverse drug reactions: Type A and Type B, and the DoTS classification.
The Yellow Card scheme and the MHRA's role in UK drug safety.
Pharmacogenetic variants in clinical use: TPMT, HLA-B*5701, CYP2D6, DPYD.
Drugs that mandate genotyping before prescribing in UK practice.

5. Safe Prescribing

The principles of safe prescribing: indication, contraindications, interactions, monitoring.
Common high-risk prescribing errors and how electronic prescribing reduces them.
Prescribing in pregnancy, paediatrics, the elderly, and renal/hepatic impairment.
Daily-use resources: BNF, BNFc, NICE, TOXBASE and STOPP/START criteria.

6. Hypertension and Heart Failure

Definition and stages of hypertension (NICE NG136) and the ACD pathway.
The renin–angiotensin–aldosterone system and the drugs that block it.
HFrEF disease-modifying therapy: ACE inhibitor/ARB, beta-blocker, MRA, SGLT2 inhibitor.
Acute decompensated heart failure: diuretics, vasodilators and inotropes.

7. Cardiac Arrhythmias

The fast (working myocyte) and slow (SA/AV node) cardiac action potentials.
The Vaughan-Williams classification of antiarrhythmic drugs.
NICE-aligned management of atrial fibrillation: rate, rhythm and stroke risk.
QT-prolonging drugs and torsades de pointes.

8. Antiplatelets, Anticoagulants and Thrombolysis

Antiplatelets: aspirin, clopidogrel, ticagrelor, prasugrel, abciximab.
Anticoagulants: warfarin, DOACs (-xabans, dabigatran), heparin and LMWH.
Thrombolysis with alteplase in stroke and STEMI.
Major bleeding management and reversal agents.

9. Hyperlipidaemias

Lipid metabolism, LDL and the pathology of atherogenesis.
Statins for primary and secondary prevention (NICE thresholds).
Ezetimibe, PCSK9 inhibitors and bempedoic acid as adjuncts.
Statin-related myopathy, hepatotoxicity and other adverse effects.

10. Diuretics and Renal Pharmacology

The site of action of each diuretic class along the nephron.
Loop, thiazide, potassium-sparing and osmotic diuretics.
ADH (V<sub>2</sub>) antagonists and the use of SGLT2 inhibitors as diuretics.
Electrolyte disturbances and clinical pitfalls of diuretic therapy.

11. Pharmacology of Insulin

Glucose-stimulated insulin release from the pancreatic beta-cell.
Rapid, short, intermediate and long-acting insulin preparations and regimens.
Non-insulin therapies in type 2 diabetes: metformin, SGLT2i, GLP-1 RA, DPP-4i, sulphonylureas, pioglitazone.
Recognition and management of hypoglycaemia and DKA.

12. Reproductive and Post-reproductive Health

Combined and progestogen-only hormonal contraception.
HRT regimens and the balance of benefit against breast and VTE risk.
Drugs used in fertility, labour, and post-partum haemorrhage.
MHRA 2024 valproate restrictions and pregnancy-safe prescribing.

13. Antibiotics

Antibiotic classes mapped to their bacterial targets (cell wall, ribosome, DNA, folate).
Empirical therapy for common UK infections per NICE.
Mechanisms and prevention of antimicrobial resistance.
High-risk drugs: aminoglycosides, vancomycin, fluoroquinolones.

14. Antivirals

Antiretrovirals and HIV combination regimens.
Drugs for HSV, VZV, CMV, hepatitis B/C and influenza.
Post-exposure prophylaxis and pre-exposure prophylaxis.
Nephrotoxic and bone-marrow-suppressing antivirals.

15. Cancer Chemotherapy

The cell cycle and cytotoxic mechanisms of action.
Cytotoxic, hormonal, targeted and immunotherapy approaches.
Common chemotherapy toxicities and oncological emergencies (neutropenic sepsis, tumour lysis).
Biologic therapies and immune checkpoint inhibitors.

16. Anaesthetics

General anaesthetic induction, maintenance and adjunct agents.
Local anaesthetics: potency, duration and systemic toxicity.
Neuromuscular blockers and reversal agents.
Malignant hyperthermia and local anaesthetic systemic toxicity (LAST).

17. Opioids

The WHO analgesic ladder.
Weak and strong opioids: pharmacokinetics and indications.
Opioid toxicity and reversal with naloxone.
Safe opioid prescribing in chronic pain and palliative care.

18. Epilepsy and Anti-epileptic Drugs

Seizure classification and first-line AEDs per NICE.
Lamotrigine, levetiracetam, sodium valproate and carbamazepine.
Management of status epilepticus.
MHRA valproate restrictions in women of childbearing potential.

19. Parkinson's Disease and Myasthenia Gravis

Dopaminergic therapy: levodopa, dopamine agonists, MAO-B and COMT inhibitors.
Acetylcholinesterase inhibitors in myasthenia gravis.
Cholinergic and myasthenic crises.
Botulinum toxin and other adjunct neurological therapies.

20. NSAIDs

The arachidonic acid pathway and COX-1/COX-2 isoforms.
Non-selective NSAIDs and the COX-2-selective coxibs.
GI, renal and cardiovascular adverse effects of NSAIDs.
Corticosteroid pharmacology and cushingoid effects.

21. Immunosuppression and Disease-modifying Therapy

Corticosteroid, calcineurin inhibitor and antimetabolite immunosuppressants.
Conventional and biologic DMARDs in rheumatoid arthritis.
Solid-organ transplant immunosuppression regimens.
Infection risk and safe monitoring of immunosuppressed patients.

22. Pharmacology of Airway Control

NICE 2024 (NG245) stepwise pathway for asthma.
SABAs, LABAs, ICS, LAMAs, LTRAs and biologics.
COPD pharmacology and inhaled triple therapy.
Acute severe asthma: features and emergency management.

23. Drugs Affecting Acid Secretion

Parietal cell physiology and the H<sup>+</sup>/K<sup>+</sup> ATPase.
Proton pump inhibitors and H<sub>2</sub> receptor antagonists.
<em>Helicobacter pylori</em> eradication regimens.
Risks of long-term PPI use.

24. Antiemetics and Laxatives

The four inputs to the vomiting centre and their receptors.
Choice of antiemetic by underlying cause.
Bulk-forming, osmotic, stimulant and softening laxatives.
Pharmacological management of inflammatory bowel disease.

25. Poisoning and STOPP/START

Common poisoning syndromes and their specific antidotes.
Management of paracetamol, opioid, benzodiazepine and TCA overdose.
TOXBASE and the National Poisons Information Service.
STOPP/START criteria in older adults.

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