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Final syllabus: Applied clinical pharmacology

Created: 7/4/2004
This section requires a wider knowledge of drugs than in the Primary FRCA examination. For drugs used in anaesthesia and intensive care medicine, candidates will also be expected to be aware of new drugs which are undergoing evaluation and whose human application has been reported in the mainstream anaesthetic journals.

There will be emphasis on the practical application of pharmacological and pharmacokinetic knowledge, and upon an appreciation of the hazards and limitation of individual techniques.

General therapeutics

Pharmacological management of:

Heart failure, coronary insufficiency and arrhythmias
Hypertension, including hypertension in pregnancy
Acute and chronic respiratory diseases
Hepatic and renal failure
Gastrointestinal disorders including modification of gastric contents
Musculo-skeletal problems such as rheumatoid and osteoarthritis
Myasthenia and muscle diseases
Pituitary, adrenal and thyroid dysfunction
Depression, anxiety states and schizophrenia
Bacterial, fungal and viral infections
Malignant disease
Adverse reactions: types of reactions
The yellow card system
Regulation of drug licensing
Application of pharmacological principles to the practical management of anaesthesia:

The use of anxiolytics, sedatives and antisialogogues. Pro-kinetic and anti-emetic drugs
H2 and proton pump antagonists
Inhalational anaesthesia
Control of alveolar tension during induction and recovery
Control of anaesthetic depth and prevention of awareness
Management of sedation techniques
Intravenous anaesthesia
Methods for achieving specified plasma concentrations. Bolus, infusion, and profiled administration
Management of neuromuscular blockade
Techniques for the use and reversal of muscle relaxants
Management of abnormal responses
Regional anaesthesia
Choice of agent and technique
Systemic effects
Avoidance of toxicity
Application of pharmacological principles to the control of acute pain (including intraoperative analgesia and postoperative pain management) and chronic pain:
Opioid and non-opioid drugs
Opioid infusions
Patient-controlled analgesia
Regional techniques
Inhalational techniques
Other drugs used to manage chronic pain - antidepressants, anticonvulsants, antiarrhythmics, etc.
Management of severe pain and associated symptoms in terminal care
Non-pharmacological methods (e.g. T.E.N.S., acupuncture)
Application of pharmacological principles to neurosurgery and management of head injuries:
Effect of drugs on cerebral blood flow
Control of intracranial pressure
Control of convulsions
Management of cerebral ischaemia
Pharmacological control of myocardial function, vascular resistance, heart rate and blood pressure:

Anticoagulant and thrombolytic therapies
Management of coagulopathies
Pharmacological control of blood sugar
Pharmacological problems in cardiopulmonary bypass
Therapeutic problems associated with organ transplantation: heart, lung, liver,
Management of malignant hyperthermia
Pharmacological considerations in cardiopulmonary resuscitation, major trauma and exsanguination
Pharmacological control of severe infections
Pharmacological treatment of severe asthma
Effects of renal or hepatic impairment on drug disposition
The statistical basis of clinical trial management
Candidates will be expected to understand the statistical fundamentals upon which most clinical research is based. They may be asked to suggest suitable approaches to test problems, or to comment on experimental results. They will not be asked to perform detailed calculations or individual statistical tests.
Data collection and analysis:

Simple aspects of study design
Defining outcome measures and the uncertainty of measuring them
Application to clinical practice:

Distinguishing statistical from clinical significance
Understanding the limits of clinical trials 
The basics of systematic review and its pitfalls

Study design:

Defining a clinical research question
Understanding bias
Controls, placebos, randomisation, blinding exclusion criteria
Statistical issues, especially sample size, ethical issues

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