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Primary syllabus: Pharmacology

Created: 7/9/2004

Candidates should have a good understanding of general pharmacological principles, together with knowledge of drugs likely to be encountered in (a) basic anaesthetic practice and (b) current treatment of patients presenting for anaesthesia.


Applied chemistry

Types of intermolecular bonds

Laws of diffusion. Diffusion of molecules through membranes

Solubility and partition coefficients

Ionisation of drugs

Drug isomerism

Protein binding

Mode of action of drugs


Dynamics of drug:receptor interaction. Graphical representations of receptor binding. Agonists, antagonists, agonist/antagonists, partial agonists, inverse agonists. Efficacy and potency. Receptor function and regulation. Tolerance

Metabolic pathways; enzymes; drug:enzyme interactions; Michaelis-Menten equation

Ion channels:

Types of ion channels. Relation to receptors. Gating mechanisms. Types of drug action

Signal transduction: cell membrane/receptors/ion channels to intracellular molecular targets, second messengers


Action of gases and vapours

Other mechanisms:

Osmotic effects. pH effects. Adsorption and chelation. Oxidation and reduction

Mechanisms of drug interactions:

Inhibition and promotion of drug uptake. Competitive protein binding. Receptor interactions. Enzyme inducers and inhibitors. Addition, subtraction and synergism

Effects of metabolites and other degradation products.

Methodology of clinical trials


Drug uptake from the gastrointestinal tract

Presystemic metabolism: bioavailability

Drug uptake from the skin. Transdermal administration systems

Drug uptake by tissues:

Muscle, subcutaneous, cerebrospinal fluid (CSF), extradural space. Factors determining the distribution of drugs: perfusion, molecular size, solubility, protein binding. Significance of drug uptake by the lung

The influence of drug formulation on disposition

Body compartments

Distribution of drugs to organs and tissues:

Influence of specialised membranes. Tissue binding and solubility. Materno-fetal distribution. Distribution in CSF and extradural space

Modes of drug elimination:

Direct excretion

Metabolism in organs of excretion: phase I & II

Non-organ breakdown of drugs

Pharmacokinetic analysis:

Concept of a pharmacokinetic compartment

Apparent volume of distribution

Clearance. Clearance concepts applied to whole body and individual organs

Relation to the Fick principle

Simple compartmental models

Physiological models based on perfusion and partition coefficients

Pharmacokinetic variation: influence of body size, sex, age, disease, pregnancy, anaesthesia, trauma, surgery, smoking, alcohol and other drugs

Pharmacodynamics: concentration-effect relationships. Hysteresis

Pharmacogenetics: familial variation in drug response

Adverse reactions to drugs: hypersensitivity, allergy, anaphylaxis, anaphylactoid



Anaesthetic gases and vapours

Hypnotics, sedatives and intravenous anaesthetic agents

Opioids and other analgesics

Non-steroidal anti-inflammatory drugs

Neuromuscular blocking agents

Drugs acting on the autonomic nervous system: cholinergic and adrenergic agonists and antagonists

Drugs acting on the heart





Corticosteroids and other hormone preparations

Antacids. Drugs influencing gastric secretion and motility

Antiemetic agents

Local anaesthetic agents

Plasma volume expanders




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