Pharmacology MBBS Curriculum PDF

CURRICULUM AND SYLLABUS UNDER THE NEW REGULATIONS FOR THE M.B.B.S. COURSE OF STUDIES OF PHARMACOLOGY. THIRD SEMESTER: A. Didactic Lectures 40hrs I. General Consideration & Basic Principles...

CURRICULUM AND SYLLABUS UNDER THE NEW REGULATIONS FOR THE M.B.B.S. COURSE OF STUDIES OF PHARMACOLOGY. THIRD SEMESTER: A. Didactic Lectures 40hrs I. General Consideration & Basic Principles 15hrs (Introduction, Historical perspective, Pharmacokinetic principles, Pharma- codynamics, Issues relating to pharmacotherapeutics, Essential Drugs concept, Steps in New Drug Development: Ethics and Regulation). II. Autonomic Pharmacology 6hrs (Introduction, Historical Perspectives, classification of drugs affecting ANS, Muscarinic receptor agonists and antagonists, Adrenergic receptor agonists and antagonists). III. Autacoids &Related Pharmacology 3hrs (Introduction, Eicosanoids & NSAIDs, Histamine &Antihistaminics, Bradykinin & its antagonists, Renin-angiotensin system, 5HT & its antagonists). IV. Neuropharmacology 16hrs (Benzodiazepines, Barbiturates, Anticonvulsants, Antiparkinsonian drugs, Neuroleptics, Anxiolytics, Lithium, Antidepressants, General Anaesthetics, Skeletal Muscle Relaxants, Local Anaesthetics, Opioid & Non-Opioid analgesics, Pharmacotherapy of pain & Gout). B. Group Dynamics 40hrs (This includes continuous assessment of each student through Item Cards). I. Problem based Learning/Tutorials 25hrs In these small group sessions (comprising of 25 students and one teacher facilitator in each group) the students will be required to resolve specific problems that would be designed by the faculty members of the department addressing issues covered in the didactic lectures in this semester. II. Student’s seminar to be arranged. 15hrs C. Practicals / Demonstration 40hrs (All practical hours must be small group sessions. Students are required to maintain required to maintain record books which will be continuously assessed by teacher). I. Prescription writing Principles & format 2hrs Abbreviations used, Weights & Measures 2hrs Rational Selection of a Drug while prescribing (WHO P-drug concept) 4hrs Writing specific problem-led prescriptions for common ailments. 10hrs (A list of such specific problem-led prescriptions are given in Annexure-1. These may be revised as per the need of the day ) II. Therapeutic problem-solving addressing the issues of clinically relevant 10hrs adverse drug reactions (ADR’s) and adverse drug interactions (DI’s). (Coloured photographs of some typical ARD’s may be used additionally).  (A list of such therapeutic problems are given in Annexure-2). III. Pharmacy Compounding & Dispensing of some common dosage forms eg. Mixture, 12 hrs Lotion/ ointment, Powder, etc. I) Alkali mixture/S.S. of Magsulph II)Carminative mixture. III) ORS Powder IV) Calamine lotion V) Atropine sulphate ointt.(1%) VI) Gamma-benzene hexachloride ointment(1%). FOURTH SEMESTER A. Didactic Lectures 30hrs V. Renal Pharmacology. 4hrs Diuretics & Anti Diuretics Drugs for acid –base & Electrolyte balance. VI. Cardiovascular Pharmacology. 9hrs Angina pectoris, Myocardial infraction ,Cardiac arrhythmias, Hyperlipidemias, Hypertension, Heart failure. VII. Gastrointestinal Pharmacology 6hrs Laxatives & Non–specific antidiarrhoeals Pharmcotherapy of Peptic ulcer Antiemetic & Prokinetic agents, Drugs for portal hypertension, Pancreatitis, Gall stones, Ulcerative colitis. VIII. Haemato-pharmacology. 4hrs Haematinics, Coagulants & Anticoagulants,Antithrombotics, Fibrinolytic, Antiplatelet agents. IX. Endrocrine Pharmacology. 7hrs Insulin & Oral hypoglycemic agents, Thyroid and anti thyroid drugs,Corticosteroids, Oral contraceptives, Vitamin D, Parathormone, Calcium homeostasis. B. Group Dynamics 30hrs I. Problem-based learning / Tutorials similar to 3rd Semester. 20hrs II. Integrated teaching –learning / Student’s seminar. Topics like Anaemia, Hypertension, Angina pectoris, Peptic ulcer, Oral contraceptives, Rickets, Diabetes mellitus etc. should be dealt in integrated sessions involving other para-clinical (and clinical) disciplines like pathology, Microbiology, Community Medicine etc. In such seminars students will take active part and teachers of different disciplines will act as facilitators. The seminars hours will be treated as common credit hours for the para –clinical disciplines that are directly involved in the concerned topic of discussion.For the logistic convenience, these sessions will not be required to attend at a time. Each session will be of 2 hours duration. They may be scheduled to be held on the last Saturday of each month. The minimum number of such integrated sessions will be 5 in this semester. 2 C. Practicals /Demonstrations 30hrs I. Prescription writing. 6hrs Writing specific problem led prescriptions (for common aliments) II. Therapeutic problem solving 4hrs Similar to 3rd Semester III. Demonstration of different dosage forms, formulations and delivery systems. 6hrs Tablets, Scored tablets, Capsules, Coated tablets, Drug suspensions, Suppositories, Enema, Eyedrops, Injectables(Ampoules & Vials), Transdermal systems(NTC Patch), Fluid transfusion bottles (Glass vs plastics), Blood Transfusion sets & Donor sets syringes (Tuberculin, Insulin,2 ml, 5 ml, 10 ml, 50ml,) (Glass vs Disposable) Needles –different sizes. Butterfly canula Scalp vein sets Inhalers, Spacer devices, Nebulizers. Different types of packaging: Blister packs, Coloured bottles. IV. Experimentals. 14hrs Demonstration of drug effects A. Animal experiments 8hrs 1.Effects of mydriatics &miotics in Rabbit’s eye. 2.Demostration of drug effect in amphibian heart /cat blood pressure preparation. 3.Guinea pig ileum B. Actual patient situation 6hrs Visit to the indoor/ in patient’s deptt. (General medicine, Pediatrics, or Maternity ward.) to oversee the drug prescribing and utilization. FIFTH SEMESTER A. Didactic Lectures 30hrs X.Respiratory System Pharmacology 2hrs Pharmacotherapy of Cough Drug therapy of Bronchial Asthma. XI. Chemotherapy & Anti-infectives 14hrs General consideration ,Antiseptics and disinfectants B-lactam antibiotic, Aminoglycosides, Tetracyclines, Chloromphenicol, Macrolides, Quinolones & Sulphenamides, Antiamoebic, Anti tubercular, Anti fungal and Antiviral drugs with pharmacotherapy of AIDS. XII. Cancer Chemotherapy 2hrs Principles & general consideration Treatment approach in some common malignancies. XIII. Immunopharmacology 1hrs Immuno suppressants & Immunostimulants. Vaccines & Sera. 3  XIV. Toxicology 3hrs Drug overdose & poisoning Heavy metals & Metal antagonist Environmental toxicants & Drug dependence, Drug abuse, Adr monitoring XV. Miscellaneous 8hrs Vitamins & minerals Dental Pharmacology Dermatopharmacology Ocular pharmacology Drugs & uterine motility Drugs used in medical emergencies Rational use of drugs/Rational therapy Gene therapy Drug prescribing in Pregnancy, Infants and Children, Geriatric patients and Hepato-renal insufficiency. B. Group Dynamics 30hrs I. Problem-based learning / Tutorials 20hrs II. Integrated learning / Students seminar 10hrs Similar to that in 4th Semester. Seminar topics: Bronchial asthma, Rational use of antibiotics, Tuberculosis, Malaria, Worm infestations, Management of poisons, Vaccine preventable diseases, Acute Respiratory Infection and Diarrhoeal Disorders in Children. C. Practicals/Demonstrations 30hrs I. Prescription writing Writing specific problem related prescription ( for common aliments ) 8hrs II. Therapeutic problem solving 6hrs III. Pharmacy 10hrs a) Criticism of prescription 6hrs b) Developing critical appraisal skill in scanning information from 4hrs i) Pharmaceuticals Promotional Literature ii) Package Inserts/ Patient Information Leaflets iii) Published Documents in Independent Medical Journals. IV. Experimentals 6hrs Actual Patient Situation a) Visit to the General Emergency to oversee the management of any one Medical/Surgical Emergency. b) Visit to the surgical Operation Theatre to over see the effects of drugs used anaesthetic practice. Annexure-1. (A list of problem-led prescriptions) 1. A drug for “TYPHOID FEVER”. 2. A drug for “BACILLARY DYSENTRY”. 4  3. A drug for “DUDENAL ULCER”. 4. A drug for “AMOEBIC DYSENTRY”. 5. A drug for “TONIC CLONIC SEIZURES”. 6. PURGATIVE FOR RADIOLOGICAL EXAMINATION. 7. A drug for “MULTI-BACILLARY LEPROSY”. 8. A drug for “TINEASIS”. 9. A drug for “URINARY TRACT INFECTION”. 10. A drug for “ACUTE BACTERIAL CONJUNCTIVITIS”. 11. A drug for “FILARIASIS:” 12. A drug for “ACUTE GOUT”. 13. A drug for “NAUSEA AND VOMITING”. 14. A drug for “UNCOMPLICATED PULMONARY TUBERCULOSIS.” 15. A drug for “MIXED WORM INFESTATION”. 16. A drug for “MIGRAINE”. 17. A drug for “SYPHILIS”. 18. A drug for “GONORRHOEA”. 19. A drug for “ACUTE ATTACK OF ANGINA PECTORIS”. Annexure-2 (DRUG INTERACTION) 1. Amoxicilin & Clavulanic Acid. 2. Metronidazole& Ethylalcohol. 3. Ciprofloxacin &Theophylline. 4. Aspirin &Warfarin. 5. Rifampicin & Cobined OCP. 6. Chloroquine & Alkali mixture. 7. Sucralfate &Antacid. 8. L-dopa & Pyridoxine. 9. Propranolol & Verapamil. 10. Digoxin & Hydroclorothiazide. 11. Chlorpropamide & Dicommurol. 12. Gentamycin & gallamine. 13. Lithium & Thiazide. 14. Propranolol & Insulin. 15. Enalapril & Spironolactone. Annexure-3 (THERAPEUTIC PROBLEMS ) 1. A 10 year old school girl suffering from mild exercise induced bronchial asthma has been treated with a metered does inhaler containing 500g of Terbutaline per inhalation as and when required, which effectively controls the individual attack. However, she has attacks of wheezing every 3 to 4 weeks occurring during exercise even after above treatment schedule. What treatment should now be given to reduce the frequency of attacks? 2. A 16 years old girls has admitted to the emergency department with severe short of breath. She is diagnosed as acute bronchial asthma. She has been using metered dose inhalation of Salbutamol, Ipratropium and Beclomethasone. In spite of the above treatment, the present attack is not controlled. What will be her immediate treatment? 5 3. A 69 year old woman suffering from congestive heart failure has been treated with 0.25 mg Digoxin tablet daily for last 3 months. But the heart failure is not controlled adequately. What will be the treatment to control the heart failure adequately? 4. A 45 year old male patient with history of smoking presented with exertional retrosternal compressing pain radiating to the left arm and lasts for 2-5 minutes. The pain is relieved after taking rest. After proper investigation, he has been diagnosed as a case of stable angina pectoris. What will be the treatment to control the attack? 5. A 45 old patient suffering from angina pectoris was on treatment with isosorbide dinitrate. He is admitted to the hospital with severe chest pain and sweating and diagnosed to be a case of acute myocardial infarction. What will be the management of this patient? 6. An overweight middle aged man is found to be hypertensive while attending a clinic for medical cheek up. His B.P. is 170/105 mm of Hg on two successive observations. What will be the treatment for this patient? 7. A 58 year old man with history of severe hypertension for 20 years, which was well controlled with medication. He stopped taking drugs for a prolonged period. His blood pressure is found to be 240/135 mm of Hg with papillaedema. What will be the management of this case? 8. A 25 year old lady is brought to emergency unit by her family members. She is unconscious with constricted pupils and froth coming out of her mouth. She is reported to consume an organo- phosphorus insecticide. How will you manage the case? 9 A middle aged person was watching T.V. in dark ,suddenly develops pain in right eye, vomiting and blurring of vision. On examination, right pupil is dilated, sluggishly reacting to light with raised intra-ocular pressure. The condition is diagnosed as a case of acute congestive glaucoma. What will be the medical management of this clinical condition? 10. A 20 year old diabetic man on insulin therapy suddenly developed fever and Missed his usual doses of insulin and became unconscious. What measures will you take to manage this condition? 11. A middle aged diabetic patient with oral anti-diabetic agent (Tolbutamide) underwent prolonged exercise and missed his usual breakfast. He developed unconsciousness, respiratory distress and profuse sweating with tachycardia. How will you manage the case? 12. A person is willing to travel an endemic area of malaria. What chemoprophylaxis has to be given to him? Subsequently, he developed chloroquine-resistant malaria. How will you manage the case? 13. A male patient develops fever with chill and rigor. P. vivax is found in his blood smear. What will be the management of this case? 14. A woman in 2nd trimester pregnancy is found to be moderately anemic on routine antenatal check- up. What will be the management of this case ? 15. A 6 year old boy while playing in a village ground was beaten by a snake. The snake was identified as a poisonous one. How will you manage this case? 16. A patient with chronic psychiatric illness was treated with largactil (chlorpromazine) for a prolonged period. He developed tremor, bradykinesia and rigidity What treatment should be given to the patient without stopping the drug ? 6  ITEM CARD OF PHARMACOLOGY CONTINUOUS DAY-TO-DAY ASSESSMENT NAME: COLLEGE: ROLL NO: BATCH: SESSION Signature of teacher-in-charge Signature of the H.O.D. THIRD SEMESTER:THEORETICALS ITEM DATE TOTAL MARKS MARKS OBTAINED EXAMINER I. GENERAL PHARMACOLOGY 15 Historical considerations, Steps of drug development, Dosage forms, Drug delivery systems Routs of drug administration, Pharmacokinetics, Phamacodynemics, Factors affecting therapeutic outcome, Drug prescribing in altered physiological states (Pregnancy and lactation, neonates and elderly, hepatic and renal impairment), Essential drugs concept, Rational use of drugs and Good prescribing practice. II. AUTONOMIC PHARMACOLOGY 15 Basic considerations, Muscarinic& Adrenergic receptor agonists and antagonists. III. AUTACOIDS & RELATED 15 PHARMACOLOGY Eicosanoids, Histamine & antihistaminics, 5HT & drugs used in Migraine, Kinins and Angiontensin. IV. NEUROPHARMACOLOGY 15 Benzodiazepines & Barbiturates, Drug treatment of Parkinsonism & Epilepsy, Neuroleptics & Anxiolytics, Antidepressants & Lithium, Drugs used in Anaesthetic practice including Neuromuscular blocker, Opioids & non-opioid analgesics and Pharmacotherapy. THIRD SEMESTER: PRACTICALS ITEM DATE TOTAL MARKS EXAMINER MARKS OBTAINED I. Prescription writing 15 II.Therapeutic problem solving 15 III. Pharmacy 15 IV. Experimentals 15 V. Criticism of prescription 15 FOURTH SEMESTER: THEORETICALS 7  ITEM DATE TOTAL MARKS EXAMINER MARKS OBTAINED I. RENAL PHARMACOLOGY 15 Diuretics & Antidiuretics, Drugs for BHP; Drugs for ACID-BASE and Electrolyte imbalance, II. CARDIOVASCULAR PHARMACOLOGY 15 Drug therapy of CHF, Hypertension, Hyperlipidemias, Cardiac Arrhythmias and in Ischaemic heart diseases. III. GASTROINTESTINAL 15 PHARMACOLGY Drug treatment for peptic ulcer, laxatives & antidiarrhoeals, Antiemetics & prokinetics agents and drugs for portal hypertension, pancreatitis, Gallstones and ulcerative colitis. IV. HAEMAOPHARMACOLOGY 15 Iron, folic acid, Treatment of anaemias, Heparin and anticoagulants; Antithrombotic and fibrinolytic & antiplatelet agents. V. ENDOCRINE PHARMACOLOGY 15 Insulin & Oral hypoglycemics, Thyroid & antithyroid drugs, Estrogens & Antiestrogens, Oral contraceptives, Androgens & antiandrogens, Corticosteroids, Calcium, Vitamin D, Parathormone & calcitonin. FOURTH SEMESTER: PRACTICALS ITEM DATE TOTAL MARKS EXAMINER MARKS OBTAINED I. PRESCRIPTION 15 II. THERAPEUTIC PROBLEM SOLVING 15 III.PHARMACY IV.EXPERIMENTALS 15 V. CRITISM OF PRESCRIPTION 15 15 FIFTH SEMESTER: THEORETICALS ITEM DATE TOTAL MARKS EXAMINER MARKS OBTAINED I. RESPIRATORY SYSTEM Pharmacotherapy of cough and 15 Pharmacotherapy of bronchial asthma. II. CHEMOTHERAPY & ANTI- INFECTIVES 15 Beta-lactam antibiotics, Quinolones & Sulfonamides, Aminoglycosides, Tetracyclines, Chloramphenicol & Macrolides, Drug therapy of tuberculosis and leprosy, Antivirals and drug treatment of AIDS, Antifungals, Anthelmintics & antiamoebics and drug treatment of malaria & Kala-azar. III. CANCER CHEMOTHERAPY 15 Principles & general considerations & Methotrexate, Cyclophosphamide, vinca alkaloids and Corticosteriods and others 8 IV. IMMUNOPHARMACOLOGY 15 Vaccines & sera, Immuno modualators. V. TOXICOLOGY 15 Heavy metal poisoning & drug poisoning & treatment, Drug dependence & treatment and ADR monitoring center & poisoning information center. VI. MISCELLANEOUS 15 Drugs & uterine motility and Vitamins & Nutrients FIFTH SEMESTER: PRACTICALS DATE TOTAL MARKS EXAMINER ITEM MARKS OBTAINED I. PRESCRIPTION 15 II. THERAPEUTIC PROBLEM SOLVING 15 III.PHARMACY 15 IV.EXPERIMENTALS 15 V. CRITISM OF PRESCRIPTION 15 ASSESSMENT OF STUDENTS: 1.Internal Assessment: Theoretical …….15marks Practical …….15 marks Assessment of theoretical and practical are to be done through day-to-day assessment (Weekly /fortnightly) through ITEM CARDS and THREE PERIODICAL Examination at the end of 3rd ,4th & 5th Semester. Assessment for practical will also be done through day to day evaluation of the students’ performance in the Practical Record Book. No Marks should be separately allocated for Practical Record Book- but its maintenance must be made mandatory. Marks of Theory + oral and Practical are to be computed separately. Written/Oral Practical Full marks Marks Full marks Marks obtained obtained At the end of first semester 50 25 At the end of second 50 25 semester At the end of third 50 25 semester Periodical Institutional Assessment Examination: Final Internal Assessment: PHARMACOLOGY Continuous day to day Periodical Assessment Total Internal Assessment Assessment Theory/oral(a) Practical(b) Theory/oral(c) Practical(d) Theory/oral(a+c) Practical(b+d) 7.5 7.5 7.5 7.5 7.5+7.5=15 7.5+7.5=15 9 Signature of thePrincipal Signature of the H.O.D  10  PHARMACOLOGY Module of Questions: Paper-I Total : 40 Marks 1.General Pharmacology 2.Autonomic Pharmacology 3.Cardiovascular Pharmacology 4.Renal Pharmacology including Acid-base and fluid-electrolyte balance 5.Respiratory Pharmacology 6.Haematopharmacology 7.Vitamins and micronutrients 8.Toxicology including Heavy metals antagonist Q. 1Applied part of Pharmacology(Therapeutics) 10 marks Q. 2 + Q. 3 + Q. 4 (9+9+12) 30 marks (Each question to be answered in a separated answer script) Explain why? Short note; Mechanism of action. Compare and Contrast; Effects of etc; Short questions of above types may be set for the examination. No question shall carry more than 3 marks. Paper-II 1. Pharmacology of Central nervous system. 2. Endocrine Pharmacology 3. Autacoids and immuno-pharmacology. 4. Skeletal muscle relaxants and local anaesthetics. 5. Gastrointestinal Pharmacology. 6. Drugs acting on uterus. 7. Anti infective and cancer chemotherapy. 8. Antiseptics, Disinfectants and ecto -parasiticides. 9. Dermatomucosal agents. Q. 1. Applied part of Pharmacology (Therapeutics.) 10 marks Q.2 + Q.3 + Q.4 30 marks 11 Shall be of Explain Why? Short Notes; Mechanism of action, Compare and Contrast; Effects of etc; Short questions of above types may be set for the examination. No question shall carry more than 3 marks. PHARMACOLOGY ORAL: 15 marks PHARMACOLOGY PRACTICAL: Total 25 marks 1. Prescription-one Total Format- 1 Writing- 1 Oral Crossing- 2 Total: 4 2. Pharmacy- one item Preparation & Labeling- 2 Oral Crossing- 2 Total: 4 3. Therapeutic Problem – One Correct interpretation of Therapeutic Situation In writing 2 Oral Crossing 2 Total: 4 4. Drug interaction-one Interpretation in writing- 2 Oral Crossing- 2 Total: 4 5. Experimental Pharmacology Chart and diagram on Experiments demonstrated Identification-2 In Practical classes & Interpretation-2 charts on pharmacokinetics Total: 4 6. Sample based Knowledge testing- 2 Two samples per question in writing 7. Criticism of prescription - 3 ( Oral table) Total: 25 Practical Notebooks- Two One-Therapeutics Record Book-Containing patterns utilization of drugs in emergency and in-patient departments. One-Pharmacy. 12 Practical Note-books must be submitted in practical Examination- without which students are NOT ALLOWED to appear. MODEL QUESTION PHARMACOLOGY FIRST PAPER FULL MARKS - 40 Time 2 hrs The figure in the margin indicate full marks. Candidates are required to give their answer s in their own words as far as practicable. 1. Outline the therapeutic regime for a case of hypertension with reference to the advantages and disadvantages of ACE inhibitors. 7+3 Or How do you treat a case of anaemia in Pregnancy (Early pregnancy term & late pregnancy )? How will you treat Drug induced anaemias ? 2. Explain why (any three) a) salbutamol is used in bronchial asthma. b) Presumide is called high ceiling diuretic. c) Dimercaprol is used in heavy metal poisoning. d) Atropin substitues are used in Drug induced Parkinsoniism. 3.What are the effects of (any three) : 3+3+3 a) atropine on eye b) aspirin on platelrt function. c) Mannitol in the treatment of oedema. d) Digoxin in atrial flutter. 4. Write short notes on (any four) : 3+3+3+3 a) fixed does combination 13 b) sublingual route of administration c) 'P' - drug concept d) zero-order kinetics of drug elimination e) neostigmine PHARMACOLOGY SECOND PAPER Full marks - 40 Time - 2 hrs The figures in the margine indicate full marks Candidate s are required to give their answer s in their own words as far as practicable 1. Discuss briefly the drug treatment of Chloroquin sensitive and Chloroquin resistant falcifarum malaria. How will you treat a case of cerebral malaria. 3+3+4 Or Describe the drug treatmant of acute thyrotoxicosis. How do you prepare the Patient for surgery ? 6+4 2. Explain why (any three) 3+3+3 a) oxotocin is used for induction of labour. b) Calvulanic acid combined with amoxicillin. c) Morphine is contradicted in head injury. d) Allopurinol is used in chrinic gout. 3.What are the effects of (any three) : 3+3+3 a) iodides and iodine in thyroid disorders. b) Benzhexol in parkinsonian disease. c) Morphine in respiratory function. d) Methotrexate in autoimmune disorders. 4.Write short notes on any four of the following : 3+3+3+3 14 a) d-penicillamine. b) Clofazimine c) Norfloxacin d) Rosiglitazone e) Emergency contraceptives. 15