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Examination Questions EXAMINATION QUESTIONS CHAPTER I. GENERAL PHARMACOLOGY AND PRESCRIPTION 1. Essence of pharmacology as a science. Parts and fields of modern pharmacology. The main terms and concepts of pharmacology – pharmacological activity, action, efficiency. 2. Sources and stages of drug development. Drugs – generics, placebo effects. Definition of such concepts as medicinal agent (medicinal drug, drug), medicinal substance, medicinal form. 3. Routes of drug administration into the body and their characteristic. Presystemic drug elimination. 4. Drug transfer through biological barriers and their types. The main factors influencing on the drug transfer in the body. 5. Drug transfer of variable ionization substances through membranes (Henderson-Hasselbach's equation of ionization). Principles of transfer management. 6. Drug transfer in the body. Aqueous diffusion and lipid diffusion (Fick's diffusion equation). Active transport. 7. Central postulate of pharmacokinetics: concentration of medicinal substance in blood plasma – the main parameter for management of the pharmacological effect. The tasks solved on the basis of this postulate. 8. Pharmacokinetic models (one-compartment and two-compartment), quantitative laws of absorption and drug elimination. 9. Bioavailability of drugs – definition, essence, quantitative expression, determinants. 10. Drug distribution in the body: compartments, ligands, the main determinants of distribution. 11. Elimination rate constant, its essence, dimension, connection with other pharmacokinetic parameters. 12. Excretion half-life of drugs, its essence, dimension, connection with other pharmacokinetic parameters. 13. Clearance as the main parameter of pharmacokinetics for management of the dosing regimen. Its essence, dimension and connection with other pharmacokinetic parameters. 14. Dose. Types of doses. Units of drug dosage. Aims of drug dosage, ways and variants of administration of drugs, dosing interval. 15. Administration of drugs at the constant rate. Kinetics of drug concentration in blood. Steady- state concentration of drug in the blood (Css), achievement time, its calculation and management. 16. Discrete administration of drugs. Kinetics of drug concentration in the blood, therapeutic and toxic ranges (intervals) of concentrations. Calculation of steady-state concentration (Css), limits of fluctuations and its management. Choice of interval of discrete doses administration. 17. Load (initial) dose. Therapeutic essence, calculation using other pharmacokinetic parameters, conditions and restrictions of its use. 18. Maintaining doses, their therapeutic essence and calculation of an optimal dosing regimen. 19. Individual, age and sex differences of pharmacokinetics of drugs. Amendments in the calculation of individual values of volume of distribution. 20. Renal clearance of drugs, mechanisms, their quantitative and qualitative characteristics. 21. The factors influencing on renal clearance of drugs. Dependence of renal clearance on physical and chemical properties of drugs. 22. Hepatic clearance of drugs, its determinants and restrictions. Enterohepatic circulation of drugs. 2 23. Correction of drug therapy at liver and kidneys diseases. General approaches. Correction of dosing regimen under the control of general clearance. 24. Correction of the dosing regimen of drugs under control of residual renal function. 25. Factors changing the drugs clearance. Strategy of individual drug therapy. 26. Biotransformation of drugs, its biological sense, main orientation and influence on drug activities. The main phases of metabolic transformations of drugs in an organism. 27. Clinical value of a biotransformation of drugs. Factors influencing on their biotransformation. Metabolic drug interactions. 28. Routes and mechanisms of elimination of drugs. Possibilities of management of elimination processes of drugs. 29. The concept of receptors in pharmacology: molecular nature of receptors, signal mechanisms of action of drugs (types of the transmembrane signaling and the secondary intermediaries). 30. Physical-chemical and chemical mechanisms of action of drugs. 31. Selectivity and specificity of drugs effects. Therapeutic, side and toxic effects of drugs, their nature from positions of the concept of receptors. Therapeutic strategy of struggle against side and toxic effects of drugs. 32. Terms and concepts of quantitative pharmacology: effect, efficiency, activity, agonist (full, partial), antagonist. Clinical difference between activity and efficiency of drugs. 33. Quantitative patterns of pharmacological effect. Law of diminishing of biological systems response. Clark-Ariens model and its consequences. General view of the concentration – effect dependence in normal and log-normal (half-logarithmic) coordinates. 34. Gradual and quantum assesment of the effect, essence and clinical use. Quantitative assesment of the drug activity and efficiency in experimental and clinical practices. 35. Types of drug effects. Change of drug action at continuous administration. 36. The dependence of action of drugs on age, sex, specific features of an organism. The influence of daily rhythms. 37. Variability in the drug actions. Hypo- and a hyperreactivity, tolerance and tachyphylaxis, hypersensitivity and idiosyncrasy. Reasons of variability of action of drugs and rational strategy of therapy. 38. Assessment of safety of drugs. Therapeutic index and standard safety margins. 39. Pharmacokinetic drug interactions (examples). 40. Pharmacodynamic drug interactions. Antagonism, synergism, their types. The nature of the effect changes of drugs (activity, efficiency) depending on the type of antagonism. 41. Side and toxic effects of drugs. Teratogenic, embryotoxic, mutagenic actions of drugs. Medical and social aspects of the struggle with drug abuse, narcomania and alcoholism. The concept of toxicomania. 42. Pharmaceutical drug interactions. Precautions during infusion therapy. 43. Types of pharmacotherapy. Deontological problems of pharmacotherapy. 44. Basic principles of treatment and prevention of medicinal substances poisoning. Antidote therapy (examples). 45. Prescription and its structure. General rules for writing out a prescription. State regulation of writing out and dispensing drugs. 46. Rules of writing out narcotic, poisonous and potent substances. 47. Drugs under control. Drugs prohibited for prescribing. 3 CHAPTER II. SPECIAL PHARMACOLOGY Characteristics of each group of drugs should include: Ɣ classification with indicating of drugs; Ɣ mechanism of action; Ɣ pharmacological effects; Ɣ main pharmacokinetic characteristics of the drugs of the group; Ɣ use in clinical medicine (indications); Ɣ main side and toxic effects; Ɣ main contraindications. For antimicrobial drugs in addition to know: Ɣ antimicrobial spectrum; Ɣ effect (bactericidal / bacteriostatic); Ɣ tactics of rational dosing. 1. The scheme of the functional organization of the peripheral nervous system. Excitation transmission in cholinergic and adrenergic synapses. 2. Astringent, mucilaginous drugs, absorbents and irritants. 3. Local anesthetic drugs. 4. M, N-cholinomimetics and stimulants of endogenic acetylcholine release. 5. Anticholinesterase drugs. Acute poisoning and medical aid. 6. M-cholinomimetics. 7. N-cholinomimetics. Nicotinomimetics use in smoking control. 8. Ɇ-cholinergic antagonists. 9. Ganglionic blockers. 10. Muscle relaxant drugs (curare-type). 11. Adrenomimetics. 12. Adrenergic antagonists. 13. Sympatomimetics and sympatholytics. 14. General concept of pain and pain relief. Drugs, used in neuropathic painful syndromes. 15. General anesthetics. Definition. Determinants of depth, speed of development and anesthesia recovery. The requirements for an ideal anesthetic. 16. Drugs for inhalation anesthesia. 17. Drugs for non inhalation anesthesia. 18. Ethyl alcohol. Acute and chronic poisoning. Treatment. 19. Narcotic analgesics. Acute and chronic poisoning. Principles of the treatment and medical aid. 20. Nonnarcotic analgesics and antipyretics. 21. Sedative-hypnogenic drugs. Acute poisoning and medical aid. 22. Anticonvulsants. 23. Antiparkinsonian drugs and drugs for the treatment of spasticity. 24. Psychopharmacology. The classification of psychotropic drugs. Tonics. 25. Antipsychotic drugs. 26. Antidepressants (thymoleptics). Normothymic (antimanic) drugs. 4 27. Anxiolytic drugs. 28. Psychostimulants, actoprotectors, analeptics. 29. Nootropic drugs. 30. Drugs for the prevention and relief of bronchospasm. 31. Antitussives, expectorant and mucolytic drugs. 32. Diuretics. 33. Principles of pharmacotherapy of pulmonary edema. 34. Principles of pharmacotherapy of heart failure (specify groups of drugs). Drugs reducing the load on the heart. 35. Drugs with positive inotropic effects. Cardiac glycoside intoxication, medical aid. 36. Antiarrhythmic drugs. 37. Principles of IHD pharmacotherapy. Antianginal drugs. 38. Principles of pharmacotherapy of acute myocardial infarction. 39. Antihypertensive sympathoplegic drugs. Principles of pharmacotherapy of arterial hypertension (specify groups of drugs). 40. Antihypertensive drugs that affect electrolyte balance, renin-angiotensin system. 41. Myotropic vasodilators, calcium channel blockers. 42. Drugs affecting hematopoiesis and regeneration. 43. Antithrombotic drugs. 44. Haemostatic drugs. 45. Drugs affecting appetite and the processes of digestion. 46. Principles of pharmacotherapy of gastric ulcer and duodenal ulcer. Antiulcerogenic drugs. 47. Stimulants of motility of the gastrointestinal tract.
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