Core Adult Internal Medicine Disciplines

Clinical Pharmacology

Topics

• Principles underlying rational drug use:
  
  • Pharmacodynamics including receptor/drug interactions, dose-response, efficacy, tolerance, potency, agonists and antagonists.
    
  • Pharmacokinetics including definition of drug clearance, half-life, volume of distribution, therapeutic ratio, absolute and comparative bioavailability, drug transport and metabolism, the cytochrome family of enzymes. The importance of these concepts to choice of route, dose, dose-frequency of medications.
• Mechanisms of drug interactions and therapeutic drug monitoring.
  
• Systematic clinical pharmacology:
  
  • Cardiovascular: diuretics, beta-blocking drugs, ACE inhibitors, calcium channel blockers, nitrates, anticoagulants and thrombolytics; aspirin; anti-dysrrhythmics (atropine, adrenaline, digoxin, lignocaine, amiodarone).
    
  • Respiratory: beta-agonists and steroids, local vs. systemic delivery.
    
  • Endocrinology: insulin, sulphonylurea, metformin, statins, fibrates, thyroxine, carbimazole, desmopressin, glucocorticoids/mineralocorticoids and sex steroids, dopamine agonists.
    
  • Infections: penicillins, cephalosporins, aminoglycosides, acyclovir, amphotericin ketaconazole, AZT, protease inhibitors.
    
  • CNS: benzodiazepines, SSRIs, tricyclics, MAOI, lithium, phenothiazines, levodopa (with carbidopa), ergotamine, sumatriptan.
    
  • GI: anti-emetics, laxatives, antacids, H₂ blockers, proton pump inhibitors, sulphasalazine.
    
  • Rheumatology: paracetamol, NSAIDSs, methotrexate, gold, corticosteroids, cyclosporin A, bisphosphonates, calcitonin.
    
  • Oncology: cyclophosphamide, azathioprine, methotrexate.
• Clinical toxicology including overdoses, management of addiction, adverse drug reactions and management of anaphylaxis.
  
• Drug development including the regulatory processes that apply in Australia.
  
• Problems of drug treatment in the elderly.
  
• Drugs and therapeutics committees - their roles and functions; evidence-based drug information - sources and uses.

Practical Skills for all Trainees

• Being able to undertake a thorough medication review.
  
• Being able to monitor drug therapy clinically and with laboratory assistance.

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