A

UPDATED 1/28/08

Exam I

A.Introduction/ Historical

1. Drug Legislation (cause and effect for each)

- Pure Food and Drug Act (caused by addiction to opium and cocaine; patent medicines)

- Modified Food, Drug and Cosmetic Act

- Durham-Humphrey Amendment

- Kefauver-Harris Amendment (caused by thalidomide tragedy)

2. Distinction between prescription and OTC drugs

3. Vocabulary: FDA (what it is; what it does), efficacy vs. safety, patent medicines, OTC (nonprescription)

B. Drug Development

1. Benefit/Risk Analysis (What determines benefit/risk? When apply?)

2. Scientific Method (When and how to apply? What are limitations?)

- hypothesis, testing, conclusion

- independent and dependent variable

- "control" and placebo

- sample size ("n")

- statistics, type I and II errors

- "significance"

- blind and double-blind studies

- confounding issues

- limitations

3. Drug Marketing and Assessment

- How prescription and OTC drugs are evaluated and classified; also limitations of process

- Phases of Drug Testing (for example, preclinical; also phases I, II & III)

- IRB (institutional review board)

- NDA (new drug application)

- IND (investigational new drug #)

- Orphan Drug Act

- Fast Track Rule

- Know about proprietary and generic drug products; How do they differ and what difference does it make?

- Switching Policy of FDA

- Non-prescription drug catagories

- Know information available on drug labels and package inserts.

- Know FDA policy regarding herbal products

- Know problems associated with herbal products (lack of control, label and marketing regulations)

- Know significance of "Dietary Supplement Health and Education Act"

4. Vocabulary: labeled and non-labeled uses, herbs (herbal medicines)

C. Drugs and Medicines

1. Types of side effects, and who is vulnerable to them

2. Sources of information

3. Margin of safety and therapeutic index

4. Drug interactions (type and consequence)

5. Guidelines to reduce side effects

6. Vocabulary: additive (drug interaction), antagonistic (infra-additive; drug interaction), synergistic (supra-additive: drug interaction), drug vs. medicine, toxicity, PDR (Physicianπs Desk Reference)

D. Drug Responses

1. Pharmacokinetic factors (know why and how they affect response)

- dose response, plateau and threshold

- therapeutic range

- mode of administration (i.v., i.m., parenteral, oral, suppository, topical, transdermal)

- distribution (factors that alter such as chemistry and barriers)

- water and fat soluble

- elimination (effects of metabolism and excretion)

- roles of liver and kidneys

2. Vocabulary: pharmacokinetics, pharmacological, placebo, tolerance, topical, systemic

E. Drugs and Nervous System

1. Role of neurons and how they work

2. Role of neurotransmitters

3. CNS (brain and spinal cord; function and drugs that affect)

4. Peripheral Nervous System

- somatic (voluntary)

- autonomic (unconscious)

- sympathetic (noradrenaline and sympathomimetics)

- parasympathetic or cholinergic (acetylcholine and drugs that block are anticholinergic such as antihistamines)

5. Drugs and Substances

- xanthines (caffeine, theophylline and theobromine)

- sympathomimetics (phenylephrine; ephedrine)

- amphetamine

- cocaine

- benzodiazepines (Valium, Halcion, Xanax)

- antihistamines (diphenhydramine)

- barbiturate (Seconal)

6. Vocabulary: caffeinism, stimulant, depressant, cardiovascular system, CNS (central nervous system), neurons, neurotransmitter, respiratory tract, receptor, nerve terminal, sedative, hypnotic, anesthetic

F. Psychiatric Drugs

1. Know basis of mental illness (distorted sensory input or processing and imbalance of neurotransmitters)

2. Know relevance of L-DOPA, dopamine, and Parkinson's disease

3. Know drugs that can induce and naturally occurring causes

4. Drugs can aggravate underlying mental disorders

5. Anxiety disorders (neurosis, panic attack; symptoms and, drug treatments)

6. Psychosis (schizophrenia; positive and negative symptoms, paranoia and treatment)

7. Affective (mood) disorders (depression symptoms; types of depression and drug therapy)

- major depression (monopolar)

- dysthymia

- major bipolar

- cyclothymia

- reactive depression

8. Drugs and Substances

- BuSpar (antianxiety)

- benzodiazepines (Valium)

- Chlorpromazine (thorazine; antipsychotic)

- Clozapine (antipsychotic)

- Elavil (tricyclic antidepressant)

- Prozac, Zoloft (SSRI antidepressants)

- Lithium (bipolar disorder)

- Depakote (bipolar disorder)

- L-DOPA (for Parkinson's disease)

- amphetamine

9. Vocabulary: affective disorders (mood disorders), antipsychotic, anxiety, anxiolytic, central nervous system (CNS), cyclothymia, depressant, depression (monopolar and bipolar), dopamine, dysthmia, manic, mania, panic attack, paranoia, pathological, psychiatric disorders (mental illness), psychosis

G. Introduction to Drug Abuse

1. Reason for abusing drugs.

2. Define drug abuse, addiction, dependence, tolerance and withdrawal.

3. Significance of Comprehensive Drug Abuse Control Act and Harrison Act

4. Know meaning of scheduling (I-V) and the schedule designation of the drugs discussed.

5. Vocabulary: addiction, drug abuse, schedules, dependence, tolerance, withdrawal

6. What are approaches to eliminating drug abuse? Do they work?

H. Stimulants

1. Why are they abused?

2. What is the toxicity on CNS and cardiovascular system?

3. Know the mechanisms of action for cocaine and amphetamines.

4. What are the FDA-approved uses for amphetamine and cocaine?

5. What are the sources for methamphetamine and cocaine?

6. What are the principal forms of administering cocaine and what are the consequences of these effects?

7. Drugs and Substances

- amphetamines

- cocaine

- ephedrine

- MDMA (ecstasy)

- methamphetamine

- Ritalin

8. Vocabulary: designer amphetamines, euphoria, narcolepsy, snorting, stimulant, sympathetic nervous system, sympathomimetics

I. Alcohol (ethanol)

1. Social impact

2. CNS effects (dose-dependent sedative-hypnotic: low dose vs. moderate and high doses)

3. Effect on other systems such as cardiovascular, liver, stomach, kidneys

4. Other effects: cancer, fetal alcohol syndrome, hangover

5. Drug interactions

6. Pharmacokinetics

7. CNS effects like barbiturates/ Interacts with benzodiazepines

J. Hallucinogens/Club Drugs

1. Sources

2. Define hallucinogens

3. General use patterns

4. Identify the 4 main features of hallucinogens.

5. Three main categories of hallucinogens

6. What are the properties and physiological effects of LSD?

7. What are the properties and effects of ecstasy (MDMA)?

8. Drugs and Substances

- LSD (mescaline - peyote; psilocybin - mushrooms)

- MDMA (ecstasy) - phenylethylamines

- anticholinergics (atropine, scopolamine, antihistamines); Jimson weed

9. Vocabulary: psychedelic

10. Inhalants (volatile)

- patterns of abuse

- why popular

- examples

- effects

K. Marijuana

1. What are the historical uses of hemp?

2. What is current status of marijuana?

3. What are the pharmacological effects of THC? Know about cannabinoid receptors (natural transmitter)

4. Know significance of the "amotivational syndrome."

5. What are the tolerance and dependence liabilities of marijuana?

6. Proposed clinical uses.

7. What are patterns of abuse?

8. Pharmacokinetics

9. What are physiological effects?

10. Drugs and Substances

- THC (tetrahydrocannabinol)

- marijuana (Schedule I)

- marinol (oral form of THC)

- Rimonabant (proposed therapeutic use and side effects)

9. Vocabulary: cannabinoid, cannabis (marijuana), hemp

L. Weight Management

1. Know the definition of and mechanisms contributing to obesity.

2. Know the consequences of obesity.

3. Know nonmedicinal strategies to treat obesity.

4. Know role of drugs in general to manage obesity.

5. Know the role of artificial sweeteners and fat substitutes in weight control.

6. Drugs and Substances

- aspartame

- amphetamine-types (fenfluramine, phentermine, fen/phen)

- ephedrine

- Meridia

- Olestra

- Orlistat

- Prozac

- saccharin

- sucralose

8. Vocabulary: anorexiants, body mass index (BMI), calories, diet aid, obesity

M. Narcotics

1. Know definition of narcotics and opioid

2. Know general pharmacology of opiate drugs.

3. Know why narcotics became a major drug problem.

4. Know relationship of endorphin system to narcotics.

5. Know side effects of narcotics.

6. Know about the stages of heroin dependence and association with crime

7. Know details about treatment for heroin dependence.

8. Drugs and Substances

- buprenorphine

- codeine

- fentanyl (most potent)

- heroin (Schedule I)

- methadone

- morphine

- naloxone

- Oxycontin

9. Vocabulary: antitussive

N. Steroids and Performance Enhancing Drugs

1. What are the medically approved uses of steroids (as generally administered at low/moderate doses)?
2. What are the non-medically approved (illegal) uses of steroids (as generally administered at high doses)?
3. What are the routes of steroid administration and how long are they typically used?
4. What are the adverse side effects of anabolic steroid use (physical, psychological, dependency, etc.)?
5. Drugs and Substances
- testosterone
6.. Vocabulary: anabolism, anabolic, steroid, plateauing, cycling, stacking, pyramiding

O. Drugs and Cardiovascular System

1. Cardiovascular system: Know role and elements.

2. Heart, arteries, veins and capillaries: Know function and how affected by autonomic nervous system. Know how vessel diameter affects blood pressure.

3. Heart Failure: Know cause, effects and treatments.

4. Heart Ischemia: Know cause, types (reversible and irreversible) and treatments.

5. Stroke: Know cause and effects.

6. Hypertension:

a. What are symptoms?

b. How is it diagnosed (diastolic and systolic blood pressure)?

c. Know causes, consequences and treatments.

7. Drugs and Substances

- "Alpha-blockers" (Prazosin)

- "Beta-blockers" (Atenolol)

- Digitalis

- Diuretic (Lasix)

- Noradrenaline

- Vasodilators (nitroglycerin)

8. Vocabulary: alpha-receptor, angina, arteries, beta-receptor, capillaries, cardiovascular, diastolic, diuretic, heart attack, hypertension, ischemia, pacemaker, pulse, receptor, systolic, vasoconstriction (vasoconstrictor), vasodilation (vasodilator), vein

P. Drugs and Cholesterol

1. Know the differences between saturated, monounsaturated, polyunsaturated and trans fats including sources, properties and associated health risks

2. Define hydrogenation and know its purpose

3. Define lipoprotein, and contrast LDL vs. HDL cholesterol

4. Know non-pharmacological ways to lower cholesterol (i.e., soluble fiber, alcohol, exercise and stop smoking)

5. Know drugs used to lower cholesterol levels, what they do and side effects

8. Drugs and Substances

- binding resin (Colestipol)

- Niacin

- Lipitor

9. Vocabulary: hydrogenation, lipoprotein, saturated, unsaturated

Q. Diabetes

1. Know role of pancreas, insulin, glucose and fats

2. Differences between Type I and Type II (juvenille and adult-onset)

3. Consequences of diabetes (short- and long-term) - especially cardiovascular

4. Basis of treatment

5. Drugs and Substances

- Insulin (short-acting, intermediate)

- Oral hypoglycemics

- Acarbose

6. Know importance of lifestyle for treatment

7. Vocabulary: glucose, glucosuria, hypoglycemia, hyperglycemia, insulin

R. Gastrointestinal

1. Know functions of various GI systems

2. Know factors for normal GI function

3. Know mechanisms for acute gastric indigestion, ulcers, constipation & diarrhea

4. Know symptoms of concern when determining if acute gastric indigestion should be self-medicated

5. Know about the role of H. pylori in ulcers

6. Know aggravating factors for ulcers

7. Drugs and Substances

- Antacids (sodium bicarbonate, calcium carbonate, magnesium salts aluminum salts)

- Simethicone (antiflatulent)

- Antihistamines (H2-blockers): Tagamet, Zantac, Pepcid

- Sucralfate

- Antibiotics to treat H. pylori (tetracycline, metronidazole, bismuth)

9. Vocabulary: constipation, diarrhea, digestive enzymes, esophagus, gastric acid and juices, gastrointestinal (GI), hydrochloric acid (HCl), indigestion, ulcer

S. Accidental Poisonings

1. Know the definition of a poison.
2. Know 3 steps in poison prevention
            - identify poison (medication, cleaners, gasoline, cosmetics, etc.)
            - child-proof home (storage sites, child locks, etc.)
            - educate children
3. Know factors that cause damage (duration of exposure, concentration of toxin, inherent toxicity of agents)
4. Know treatment of external, inhaled, and internal/ingested poisons.
5. List 3 steps in treatment of poisonings
            - terminate exposure
            - provide support
            - call poison control center
6. Know how, when, and when not to use syrup of ipecac
7. Know definition of antidote and the antidotes for methanol and carbon monoxide
8. Drugs and Substances
- Syrup of ipecac
- Activated charcoal

T. Drugs in the Young and Elderly

* Pay particular attention to the material highlighted in red in the chapter available online.

U. Analgesics

1. What is function of pain?

2. What are elements of pain?

3. Be able to compare uses for aspirin-type and narcotic analgesics

4. Antiinflammatory - how it works

5. Antipyretic - when should or should not be used

6. Pain mechanisms, types (somatic vs. visceral) and response to drugs

7. Anticlotting (prevent heart attacks & strokes)

8. Drugs and Substances

- Acetaminophen

- Acetylsalicylic acid (aspirin)

- Codeine (narcotic)

- Ibuprofen

- Naproxen (Alleve)

- Ketoprofen (Orudis)

- Morphine (narcotic)

- Salicylate

9. Vocabulary: analgesic, antipyretic, anti-inflammatory, anticlotting, dysmenorrhea, prostaglandins, Reyeπs syndrome, somatic (musculoskeletal) pain, visceral pain

V. Antihistamines and Cold Medicines

1. Cold symptoms - what causes and which drugs will relieve

2. Rationale for drug combination - is it justified

3. Colds vs. allergies (what works for each)

4. Anticholinergics to dry runny nose

5. Rationale for cough medicines (antitussives and expectorants)

6. New antiviral agents

7. Drugs and Substances

- Codeine (antitussive)

- Dextromethorphan (antitussive)

- Diphenhydramine (antihistamine, antitussive)

- Guaifenesin (expectorant)

- Phenylephrine (sympathomimetic)

- Amantadine

- Zanamavir

8. Vocabulary: antihistamine, antitussive, expectorant, sympathomimetic, vasoconstriction, vasodilation

W. Antibacterials and Related Agents

1.Allergic reactions (drug sensitization)

2.Antibiotic therapy (reasons for failure, problems, forms of administration and rationale)

3. Bactericidal vs.bacteriostatic

4. Bacterial resistance

5. Broad vs. narrow spectrum

6. Normal body flora

7.Suprainfections

8.Topical vs. systemic antibiotics

9. Viral, fungal, bacteria & protozoan infections and their response to drugs

10. Drugs and Substances

- Acyclovir

- Amoxicillin

- Erythromycin

- Monistat

- Penicillin

- Polysporin, Neosporin (topical, OTC)

- Tetracycline

11. Vocabulary: antibacterials (antibiotics), immunological, microorganism, non-compliance, normal flora, pathogen (disease causing)

X. Drugs and Skin

1. Know the structure and function of skin

2. Know function of skin glands

3. Know what causes open/closed comedones

4. Know aggravating factors of acne

5. Know the principal treatments (both OTC and Rx) of acne

6. Know the differences between emollients, astringents, keratolytics and demulcents

7. Drugs and Substances

- Accutane (oral pill, vitamin A)

- Alcohol wipes

- Antibiotics (tetracycline, erythromycin)

- Benzoyl peroxide

- Salicylic acid

- Retin A (vitamin A, keratolytic)

8. Vocabulary: antibacterials (antibiotics), apocrine glands, comedones, cyst, demulcent, dermis, eccrine glands, emollient, epidermis, keratin, keratolytic, sebaceous glands, sebum