Medical academy named after S. I. Georgievsky

MEDICAL ACADEMY NAMED AFTER S.I. GEORGIEVSKY

(academic unit)

Department

Internal Medicine No.1 with the course Clinical Pharmacology

 

Methodical guidelines

For classes of

Seminar type

«APPROVED»
Head of department
Prof. Ushakov A.V.
(Full name, title)
(signature)
«  » ___________ 20   y.
«  » ___________ 20 y.
«   » ___________ 20 y.

 

Major educational program: 31.05.01 Medicine (шифр и название ОПОП)

 

Course:

VI

Class type           practical lesson_______________________

(семинар, практическое занятие, лабораторная работа)

 

Discipline:

Clinical pharmacology

 

Title of discipline section/topic:

The subject and objectives of clinical pharmacology. The basics of pharmacokinetics and pharmacodynamics. Drug interactions, types of side effects of drugs, complications of drug therapy. Clinical and pharmacological characteristics of drugs that affect lipid metabolism.

 

 

Topic Curator:

Egorova Elena Alexandrovna, assistant professor ______________

   (Ф.И.О., должность, подпись, дата)

 

Discussed at department meeting «    »____________20 y., protocol №____

 

Discussed at department meeting «    »____________20 y., protocol №____

 

Discussed at department meeting «   »____________20 y., protocol №____

 

The class objective

To provide students with the concept of principles and tasks of clinical pharmacology, knowledge of methods used for monitoring of the effectiveness and safety of drug therapy, as well as the mechanism of action of drugs, their pharmacological effects and changes in the state of body functions in response to the action of drugs. To study modern drugs and approaches used for the treatment of hyper- and dyslipidemia.

 

Lesson format – practical class

 

Methodology and procedure

№	Stages of study	Methodology
1.	Organizational part: Goals setting and motivation, incoming control of knowledge	Test control with discussion of answers or interrogation
2.	Main part:
	1) Student’s individual work with methodological materials under lecturer supervision (development of professional skills)	Work with tales, schemes and abstracts from medical records. Case studies.
	2) Analysis of examples of pharmacotherapy from viewpoint of efficacy and safety (with interpretation of clinical and laboratory tests data).	Analysis and discussion of case studies, correction of mistakes and analysis of medical records.
3.	Closing part: Outgoing knowledge control, closing remarks, and self-preparation assignment	Test control

 

4. 1. Control questions on discipline section / topic:

1.	Subject and tasks of clinical pharmacology. Basic concepts of pharmacokinetics and pharmacodynamics.
2.	Methods of drug therapy safety and efficacy control.
3.	Routs of drug administration, distribution, biotransformation and elimination.
4.	Mechanisms of drug action, their pharmacological effects and changes of organism functions in response to drug action.
5.	Classification of agents used in dyslipidemia.
6.	Choosing the drug in accordance to the type of dyslipidemia. Dosing regimen and interaction with other classes of drugs.
7.	Assessment of efficacy and safety of hypolipidemic drugs.
8.	Side effects of and contraindications for the use of hypolipidemic drugs.

 

4.2. Tests and case studies.

 

  Tests.

What characterizes the rate of drug elimination more accurately?

А. Т ½

B. total clearance

C. bioequivalence

D. bioavailability

E. biotransformation of the drug in the liver

2. What is Т ½?

А. time required for destruction of the half of the administered drug dose

B. time required for excretion of 50 % of the administered drug dose

C. time required to decrease the drug concentration in blood by 50%

D. time required to increase the drug concentration in blood by 50%

E. time required for maximal drug effect development

Contraindication for statin therapy is

А. pregnancy

B. treatment with immune suppressants

C. hypersensitivity to statins

D. liver disease with elevation of amine transferase levels

E. severe diabetes mellitus

 

Case studies.

Case №1

Match pharmacokinetic parameter with its definition:

1. Clearance.

2. Bioavailability.

3. Half-life period.

4. Volume of distribution

 

А. The fraction of unchanged drug reaching the systemic circulation following administration by any route.

B. The volume of the blood plasma cleared of the drug per unit of time.

C. The fluid volume that is required to contain the entire drug in the body at the same concentration measured in the plasma.

D. The time required to reduce the amount of drug in the blood by one-half.

Case №2

A 52-year-old patient, who has been suffering of chronic obstructive pulmonary disease for several years, is diagnosed with essential hypertension moderate degree, II stage, risk II. A physician is planning to administer him a beta-blocker as a part of combination pharmacotherapy.

Questions. What types of pharmacotherapy do you know? What type of pharmacotherapy is represented by the therapy of essential hypertension with beta-blockers. Define the following basic concepts: mechanism of action, types of mechanisms of action, selectivity, delayed results of treatment.

 

Case №3

Female patient N., 65-year-old, is treated in hospital for heart disease with chronic heart failure. She also has an accompanying disease chronic pyelonephritis, phase of remission, CKD II stage. She is taking digoxin as a part of her therapy for 4 days. At the exam patient complains of worsening of her condition due to periodic attacks of nausea, not associated with eating, lack of appetite, poor sleep. Her heart beat rate is 52 bpm.

Questions. How can you explain newly appeared patient’s complains? What parameters characterize rate of drug elimination and dosing regimen for the drug? Define the concept of therapeutic window. Give examples of drugs with a narrow therapeutic window and factors that increase the risk of side effects when prescribing these drugs.

 

Case №4

Twenty clinical studies on the efficacy and safety of the original glucosamine sulfate preparation at a dose of 1500 mg once a day in the treatment of knee osteoarthritis were discovered in the Cochrane systematic review

All studies were conducted in different countries, were randomized, double-blind, with a total number of patients 2570.

       Question. What is the name of this type of studies? What is the level of evidence for such trials?

 

Case №5

A patient K, 54-year-old, visited clinic for the first time with complaints of a periodic increase in blood pressure, headaches. An examination revealed an increase in his body weight and lab tests revealed hypercholesterolemia and an increased content of LDL in his blood.

Задание. Develop a reasonable treatment program for the patient, including drugs and their dosing regimen. Explain the MA of the main drugs and criteria for the effectiveness of therapy.

 

Case №6

A 45-year-old man, who has been suffering of diabetes mellitus, type II, for 2 years, has hyperlipidemia (elevation of low density lipoproteins and triglycerides) that is not corrected with diet. Atorvastatin prescribed to the patient 2 weeks ago caused reaction that includes skin rash, itching and redness of the face.

Задание. What hypolipidemic drugs could be used in this patient instead of atorvastatin? What are their side effects?

 

Case №7

Patient К., 55-year-old, was admitted to the hospital with diagnosis of essential hypertension stage II, grade II, risk II, IHD stable exertional angina FC I, CHF stage 0. Family history of the patient revealed that his mother suffered for ischemic heart disease and his brother suffers for essential hypertension and IHD as well. At examination patient is overweight, smokes. Lab tests revealed cholesterol level of 6.5 mmol/L and triglyceride level of 3.4 mmol/L.

Question. What regimen of pharmacotherapy for hyperlipidemia will you use for this patient? Will it be monotherapy or combination therapy? Make the choice of a drug, dosing regimen and duration of treatment.

 

Case №8

A 62-year-old man complains of feeling of discomfort at large skeletal muscles, their pain at palpation, “tea-like” urine discoloration, and periodic attacks of nausea. Patient indicates that he has recently been treated for myocardial infarction and took a cholesterol-lowering drug orally once daily as a component of his therapy.

Question. Identify the pharmacological group of the drug. Write a prescription for the drug of this group. List contraindications for its use and side effects. What side effect has occurred in the patient, explain the mechanism.

 

Sources of information

Basic textbooks:

1. Bennet NB, Brown MJ, Sharma P. Clinical Pharmacology. Elsevier, 2012

2. DiPiro JT et al. Pharmacotherapy. A Pathophysiologic Approach. McGraw-Hill Education, 2016

3. Katzung BG. Basic and Clinical Pharmacology. McGraw-Hill Education, 2018.

 

Additional textbooks:

1. Rang HP et al. Rang and Dale’s Pharmacology. Elsevier, 2016.

2. Brunton LL et al. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. McGraw-Hill Education, 2018.

3. Tripathi KD. Essentials of Medical Pharmacology. Jaypee Brothers Medical Pub, 2018

 

Internet rsources:

1. www.drugs.com

 

Testing

 “Excellent” - correctly performed 20-21 tests

“Good” - correctly performed 15-19 tests

“Satisfactory” - correctly performed 10-14 tests

 “Unsatisfactory” less than 10 tests performed correctly

Answering the control questions:

“Excellent” - full answer

“Good” - makes minor mistakes in the answer,

“Satisfactory” - the answer is incomplete, allows a large number of errors

“Unsatisfactory” - makes fundamental mistakes in the answer or cannot answer the question posed

Solving the situational problem (case study):

“Excellent ”- the situational problem is solved correctly.

“Good” in solving a problem, minor errors are noted, which the student corrects on his own

“Satisfactory” - significant errors were made in solving the problem, which the student corrects with the help of the teacher.

“Poor” - the wrong solution to the problem

MEDICAL ACADEMY NAMED AFTER S.I. GEORGIEVSKY

(academic unit)

Department

Internal Medicine No.1 with the course Clinical Pharmacology

 

Methodical guidelines

For classes of

Seminar type

«APPROVED»
Head of department
Prof. Ushakov A.V.
(Full name, title)
(signature)
«  » ___________ 20   y.
«  » ___________ 20 y.
«   » ___________ 20 y.

 

Major educational program: 31.05.01 Medicine (шифр и название ОПОП)

 

Course:

VI

Class type           practical lesson_______________________

(семинар, практическое занятие, лабораторная работа)

 

Discipline:

Clinical pharmacology

 

Title of discipline section/topic:

The subject and objectives of clinical pharmacology. The basics of pharmacokinetics and pharmacodynamics. Drug interactions, types of side effects of drugs, complications of drug therapy. Clinical and pharmacological characteristics of drugs that affect lipid metabolism.

 

 

Topic Curator:

Egorova Elena Alexandrovna, assistant professor ______________

   (Ф.И.О., должность, подпись, дата)

 

Discussed at department meeting «    »____________20 y., protocol №____

 

Discussed at department meeting «    »____________20 y., protocol №____

 

Discussed at department meeting «   »____________20 y., protocol №____

 

The class objective

To provide students with the concept of principles and tasks of clinical pharmacology, knowledge of methods used for monitoring of the effectiveness and safety of drug therapy, as well as the mechanism of action of drugs, their pharmacological effects and changes in the state of body functions in response to the action of drugs. To study modern drugs and approaches used for the treatment of hyper- and dyslipidemia.