INTRODUCTION TO PHARMACOLOGY

1. INTRODUCTION TO PHARMACOLOGY Pharmacist Jeanette Jasper Tenga (Mrs. J. Senkondo) 9th of November 2016

2. Common ground for the task ahead • Why do you want to become a medical professional? • What would you like to be? • What do you think are going to be your responsibilities? (a) as a medical student and (b) later as a medical professional. • What are your expectations during your time learning Pharmacology? 2

3. Assignment • Read/watch the story of the following:- • Alice in Wonderland • The Life of an Eagle • Understand, describe and practice principles applied and the lessons learnt from the above stories

4. Alice in Wonderland • A young girl when she 1st visited magical Underland, Alice Kingsleigh (Mia Wasikowska) is now a teenager with no memory of the place –except her dreams. Her life takes a turn for the unexpected when, at a garden party for her fiance and herself, she spots a certain white rabbit and tumbles down a hole after him. Reunited with her friends the Mad Hatter (Johnny Depp), the Cheshire Cat and others, Alice learns it is her destiny to end the Red Queen’s (Helena Bonham Carter) reign of terror

5. Lessons to be learnt from Alice in Wonderland • Do go down the rabbit hole (always follow the white rabbit) sometimes you have to fall down a rabbit hole to get to where you need to be • Know yourself • You are a different person today than you were yesterday • Advice can come from the most unexpected places • Believe in the impossible (dream of impossible things)

6. Lessons to be learnt from Alice in Wonderland • Wandering doesn’t mean you are lost (there isn’t just one way to get to a goal or destination) • My reality is different than yours • Existence is a lifetime of adventures ( in addition to feelings, life is full of twists, turns, surprises, disappointments, and so much more. You need to accept that existence is a lifetime of adventures

7. 7 Principles of the Eagle • The Eagle flies at high altitude and it does alone (If you ever want to do something great in life, learn to be alone and when you are with people, share your time with people of same ambition and desires) • It has strong and unbelievable vision (Many obstacle will appear to distract you in life. Stay focused and never allow dissenting views and voices to deter you from your vital goals in life) • Eats fresh prey ( Update yourself regularly with fresh information from reliable sources)

8. 7 Principles of the Eagle… • Gets excited in the midst of storm (Challenges should be your stepping stone to your success and not to your destruction. Learn to rest and soar during the time of storm in your life) • Tests before trusting (test the commitment of people before you trust them with your time and resources)

9. 7 Principles of the Eagle • Prepares for training (the better you are at managing your battles in life, the wiser and more responsible you become. Preparation is vital for future success) • Whet it feels weak, and about to die, he retires to a place far away in the dark ( There is a need to learn how to retire to a quiet place for periodic retreat and strategic thinking with planning)

10. Lessons to be learnt from The Life of an Eagle • Decision • Following up on the decision (need determination) • Killing the “Pity-party’ Syndrome (when someone loves to get sympathetic platitudes on any predicament they find themselves • Things get worse before it gets better • Change is a constant phenomenon

11. Lessons to be learnt from The Life of an Eagle Conclusion: • The art of give and take is the only way we can achieve anything tangible. • You have to be willing to do something in order to get what you want

12. Important Tips • Do not walk in the dark during your medical training • Define where you want to go • Think seriously on how to achieve your goal and have the right attitude towards learning, your lecturers, leaders and others • In other words, create a reason to learn 12

13. Important Tips... • To anything you want to do make sure you Plan-Do-Check-Act (PDCA cycle) • Use the formula 5W2H i.e. • What • Why • Where • Who • When • How • How much

14. Important Tips... To whatever you do, consider 3 things: interest time concentration N.B: Fall in Love with Pharmacology 14

15. Important Tips... • To whatever you do, consider 3 things:… • interest : (a feeling of wanting to learn more about something or to be involved in something; a quality that attracts your attention and makes you want to learn more about something or to be involved in something ) • time: (plan, schedule, set, arrange when (something should happen or be done, organize) • concentration: ( the action or power of focusing all one’s attention, close attention) 15

16. Fall in Love with Pharmacology

17. Department of Clinical Pharmacology and Therapeutics • Clinical Pharmaclogy : • the science of drugs and their clinical use. • It is underpinned by the basic science of pharmacology, with added focus on the application of pharmacological principles and quantitative methods in the real world. • Therapeutics: • the branch of medicine concerned with the treatment of disease and the action of remedial agents.

18. Department of Clinical Pharmacology and Therapeutics • Head of Department: Prof. G. Rimoy • Coordinator: Mr. Walter Msangi • Technician: Mr. Walter Msangi • Lecturers: 1. Pharm. Jeanette Senkondo : 2. Pharm. Amani Phillip

19. Challenges in Clinical Pharmacology for tomorrow’s doctors • The number of licensed medicines is rapidly increasing and doctors are increasingly expected to prescribe medicines that are less familiar to them • Pace of new drug development is accelerating rapidly as a result of advances in molecular biology and mapping of the human genome 19

20. Challenges in Clinical Pharmacology for tomorrow’s doctors... • Patients are taking more medicines than before, increasing the complexity of their treatment regimen and the potential for drug interactions • Newer drugs, capable of targeting previously untreatable conditions, are often more powerful but also more toxic • The expansion of evidence-based medicine and health technology assessment has enabled the beneficial and adverse effects of drugs to be more accurately quantified 20

21. Challenges in Clinical Pharmacology for tomorrow’s doctors... • There are more sources of opinion and disinformation available to patients and doctors (increasing access to the internet) • Marketing activites of the pharmaceutical industry are a potential threat to cost-effective prescribing decisions 21

22. Clinical Pharmacology Training at HKMU • Semester 3 • Semester 4 • All in MD2 22

23. Clinical Pharmacology Training at HKMU ..... • Semester 5 (MD3) • Only protected time to concentrate on learning the scientific basis for the principles of therapeutics and gaining core knowledge and understanding about drugs • Clinical rotations • Witness and learn about the use of drugs in practice and gain skills in prescribing, drug administration and attitudes towards the use of drugs 23

24. The burden of factual knowledge is high in Pharmacology • You may feel overwhelmed by the number of drugs described in pharmacology text books • It is important to understand general pharmacological principles, and to appreciate the pharmacology of the main classes of drugs rather than attempting to memorise details of individual drugs • Specific therapeutic drugs are best learned about near a patient’s bedside 24

25. For each of the commonly used drugs in our setting we expect the following from you: • Know the name and class • Have an understanding of the mechanism of action • Recognise the appropriate indication for use • Know the appropriate route, frequency and duration of administration • Know the important contraindications, potential interactions and adverse effects • Know how to monitor the drug’s effects • Be able to explain the salient features of all the above to the patient 25

26. General Learning Objectives • To produce graduates who are competent to prescribe safely, effectively and cost-effectively. • To provide the appropriate framework to be able to assimilate information about new drug developments that will occur throughout a professional career 26

27. Course Content General Principles of Pharmacology Chemical Mediators Systems Pharmacology (Drugs affecting major organ systems) Antimicrobial and Cancer Chemotherapy (Drugs used for the treatment of infections, cancer and immunological disorders) Special Topics 27

28. Tutors’/Lecturers’/Instructors’ Responsibility • Have a responsibility to the public, to employers and the profession to make sure that graduates are fit topractice; and • prescribing drugs is a key component of medical practice • WE ARE NOT INTERESTED IN FAILING ANY ONE! 28

29. Fall in Love with Pharmacology

30. INTRODUCTION TO PHARMACOLOGY

31. Some Key Definitions • Pharmacology: • the study of the effects of chemical substances/drugs on the function of living systems OR • the study of the manner in which the function of living systems is affected by chemical agents N.B: Knowledge of the normal & abnormal functioning of the body is necessary 31

32. Some Key Definitions.... • Drug: a chemical substance of known structure, other than a nutrient or an essential dietary ingredient, which, when administered to a living organism, produces a biological effect NB: like most definitions, this one has its limits. E.g. There are a number of essential dietary constituents, such as iron and various vitamins, that are used as medicines. 32

33. Drugs may be: • Synthetic chemicals • Chemicals from plants or animals • Products of genetic engineering (biotechnology) • To count as a drug, the substance must be administered intentionaly to produce a certain desired biological effect. i.e the substance must be administered as such, rather than released by physiological mechanisms. • Many substances, e.g. Insulin or thyroxine, are endogenous hormones but are also drugs when administered intentionally 33

34. Some key definitionsDrug… • Many drugs are not used in medicines but are nevertheless useful in research tools. • The word drug is often associated with addictive, narcotic or mind-altering substances- an unfortunate negative connotation that tends to bias uninformed opinion against any form of chemical therapy. • We will focus mainly on drugs used for therapeutic purposes but also describe important examples of drugs used as experimental tools. 34

35. A medicine: chemical preparation which usually but not necessarily contains one or more drugs, administered with intention of producing a therapeutic effect. • Medicines usually contain other substances (excipients, stabilisers, solvents etc) besides the active drug, to make them more convenient to use 35

36. Some key definitions….Poison • Poison: a substance that causes death or harm when introduced into or absorbed by a living organism. • Scientifically, a poison is any substance taken into the body by ingestion, inhalation, injection, or absorption that interferes with normal physiological functions. • Virtually any substance can be poisonous if consumed in sufficient quantity; therefore the term poison more often implies an excessive degree of dosage rather than a specific group of substances. • Although poisons fall strictly within definition of drugs they are not used in therapy 36

37. Question! • What is the difference between a Drug and a Medicine???? 37

38. INTRODUCTION TO PHARMACOLOGYSome Key Definitions… Pharmacology can be defined as: • The study of the manner in which the functions of living systems is affected by chemical agents • Knowledge of the normal & abnormal functioning of the body is necessary

39. Pharmacology…. • Pharmacology comprises two broad divisions, which are: • 1. Pharmacodynamics-the biological and therapeutic effects of drugs • 2. Pharmacokinetics-the absorption, distribution, metabolism and excretion of drugs

40. Pharmacology…. • The distinction can be put crudely thus • Pharmacodynamics is what drugs do to the body while • Pharmacokinetics is what the body does to the drugs

41. Pharmacology…. • It is self evident that knowledge of pharmacodynamics is essential to the choice of drug therapy. • But the well-chosen drug may fail (or be poisonous) because too little or too much is present at the site of action for too short or too long a time. • Drug therapy can fail for pharmacokinetic as well as for pharmacodynamic reasons.

42. Pharmacodynamics • Understanding the mechanisms of drug action is not only an objective of the pharmacologist who seeks to develop better drugs , but also permits a more intelligent use of medicines

43. Pharmacodynamics… • Consider the treatment of hypertension or asthma for e.g.- • Using combinations of drugs with the same mode of action will not only provide additive therapeutic effect but also additive adverse effects. • Selection of combinations of drugs having different modes of action will also provide additive therapeutic efficacy and reduce the risk of additive adverse effects

44. Pharmacokinetics • Studies in absorption/distribution/ metabolism and elimination of the drug in man • Will be studied in details later

45. Development of Pharmacology as a Scientific Discipline Overview: The objective of this introduction to pharmacology session is: • to explain how pharmacology came into being and evolved as a scientific discipline and • describe the present day structure of the subject and its links to other biomedical sciences 45

46. Development of Pharmacology as a Scientific Discipline.... • Ancient prescientific therapeutics • Herbal remedies were widely used • No application of scientific principles to therapeutics • Dogma used to explain therapeutic effects (magic, vital forces) • Pharmacology in the 19th century • As a science Pharmacology was born in the mid-19th century, out of increasing skills among doctors at clinical observation and diagnosis but being ineffectual when it came to treatment • A need to improve outcome of therapeutic interventions by doctors provided impetus for pharmacology 46

47. Development of Pharmacology as a Scientific Discipline.... • Until the late 19th century, knowledge of the normal and abnormal functioning of the body was too rudimentary to provide even a rough basis for understanding drug effects; • Disease and death were regarded as semi sacred subjects, appropriately dealt with by authoritarian, rather than scientific doctrines. • Clinical practice often displayed an obedience to authority and ignored what appear to be easily ascertainable facts. 47

48. motivation for pharmacology (i.e. understanding what drugs can and cannot do) came from clinical practice, however, the science could be built only on the basis of secure foundations in physiology, pathology and chemistry which fortunately developed • Rudolf Buchheim created the first pharmacology institute (in his own house) in Estonia in 1847 • In its beginnings, before the advent of synthetic organic chemistry, pharmacology concerned itself exclusively with understanding of the effects of natural substances (mainly plant extracts and a few toxic chemicals e. g. Mercury and arsenic) • Purification of active compounds from plants was possible through early development in chemistry 48

49. 1805, Friedrich Serturner, a young German apothecary, purified morphine from opium, and other substances quickly followed, and, even though their structures were unknown, these • Compounds showed that chemicals, not magic or vital forces, were responsible for the effects that plant extracts produced on living organisms. • 1858, Virchow proposed the cell theory • the first use of structural formula to describe chemical compounds was in 1868 • 1878, Bacteria as a cause of disease were discovered by Pasteur 49

50. Early pharmacologists focused most of their attention on such plant-derived drugs as quinine, digitalis, atropine, ephedrine, strychnine etc ( many of which are still used today and maybe will have become old friends by the time you graduate as a medical doctor). 50