Pharmacology: The most important topics to be read for your EDAIC examination.

Pharmacology is ‘THE TOPIC’ that must be mastered, from baseline physics to detailed knowledge of individual drugs, for a productive EDAIC preparation (MCQ or viva-exam). Questions based on pharma are frequently asked in both parts, forming a significant chunk of the overall score. Fortunately, the questions revolve around limited topics and specific drugs that are not very difficult to memorise and retain, provided you know where to concentrate your efforts. This list includes the most common exam questions that you are likely to be asked in the EDAIC examination. Although the examiner is at liberty to test or ask anything, there are all-time favourites that you must know.

To make the challenging terrain a little less painful, we have tried to compile a list of the most important topics to be read from these systems, a bare minimum yet essential topics’ compilation.

Targetedaic recommends: What to read in pharmacolocy?

PHARMACOKINETICS AND DYNAMICS

• VD. Difference between adult and child/ old age.
• Distribution of drugs.
• Compartmental models and CSHT
• Compartment models diagram and variation
• One/ two and three-compartment model
• TCI. Reference to compartment models and how the above graph is influenced by the models- what variables of a drug and distribution? What do you need to know for building these models?
• First metabolism pass
• Clearance
• How to calculate loading and maintenance doses.
• What is ED50?
• Therapeutic index, an example of drugs with low therapeutic index. Relevance
• Therapeutic index.
• Vaporizers
• Receptors (agonists / antagonists) ***
• Isomerism with examples
• Physical properties of drugs help in reaching them at target sites
• Bolus vs Infusion kinetics
• Ionization and solubility pKa, pH, Hasselback equation
• Dose-response EC.
• Bioavailability. The volume of distribution. Half-life elimination. Context-sensitive half-life
• Target controlled infusions- graph
• TCA drugs have a high volume of distribution…explain
• Pka and clinical significance

DRUGS

INHALATIONAL AGENTS

• Comparison of physical properties (M.wt/ blood-gas and oil-gas coefficients/
• Factors affecting the speed of inhalation induction
• How are inhalational agents measured clinically? Sources of error in measurement. o Comparison between desflurane and halothane concerning high low cardiac output/ high low alveolar ventilation
• N2O talk about everything (mechanism of analgesia and neurotoxicity
• Toxic effects of inhalational anaesthetics
• Factors affecting MAC and how to speed induction.
• Desflurane – all details about desflurane, including SVP and blood-gas and coefficients.
• Choose a drug of induction and show changes in concentration after induction.
• Blood gas and oil gad partition coefficient
• Inhalational agents and their pharmacokinetics. Describe concentration and second gas effect.
• Measurement of inhalational Anaesthetic agents with explanation
• Compare sevoflurane with TIVA.
• Ideal inhalational agent o Graph of FI/FA of inhalational anaesthetic agents
• NO: what is it, uses, how it works, benefits, dose in pulmonary HTN

IV INDUCTION AGENTS

Propofol

• Structure
• Mechanism of action
• Composition of commercial formulations.
• P/kinetics in detail. Vd and difference with thiopentone
• How to calculate the dose of Propofol for infusion and what will happen after taking a single dose of morphine (they Discuss all the pharmacokinetics in detail)
• Propofol and remifentanil TIVA; TCI. Comparison of drug differences in TCI
• Halothane vs Propofol, compartment model, CSHT
• Difference between Propofol and thiopental.
• Pharmacology: – a stat dose of 200 mg of Propofol was given to a 70 kg patient. How to estimate plasma concentration and What you will need to know to do that. -Single and multi-compartment models.
• What level of Propofol in plasma do you expect after administering ____mg (for example:200 mg) i.v. What additional information do you need to count this? What do levels of Propofol look like after a single i.v. dose? How to keep Propofol plasma level in a narrow range? What is context-related half-life?

Others

• Thiopentone; compare thio to prop; thio to methohexitone
• Ketamine
• Etomidate
• Opioids as induction agents
• Comparison of pharmacokinetic and dynamic properties of all induction agents

OPIOIDS

• Pharmacokinetics of opioids
• Natural and synthetic opioids
• Agonist/ partial agonist and antagonists.
• Which anaesthetics you can/cannot use in surgery for cancer. (Recent studies showed that patients with cancer anaesthetized with GA+ regional technique had less recurrence than when opioids were used)
• Comparisons of physical properties, p/kinetics, p/dynamics
• Opioid receptors
• Draw dose-response curve for opioid drug and describe on its potency, EC50, competitive antagonist, partial agonists

DIURETICS

• Mechanism of action,
• Sites of action
• Indications
• Perioperative use.
• Describe your perioperative management and considerations.
• Diuretics esp. thiazides and drug reactions.

MUSCLE RELAXANTS

o Details of NM junction with diagram
o P/kinetics comparison of all muscle relaxants.
o Succinylcholine vs NMDRs
o Sch side effects and contraindications
o Comparison of amino steroid and benzylisoquinolinium group
o Metabolism of muscle relaxants
o Suxamethonium in detail
o Isomerism. Isomers of atra, cisatra, miva.
o Compare atra with cisatra
o Neuromuscular blockers, their pharmacology, antidotes, and their pharmacology, Sugammadex, Neostigmine and ceiling effect
o Muscle relaxants that can be used in renal/hepatic failure
o Dantrolene
o Sugammadex
o Reversal agents
o Neostigmine
o Anticholinesterases and uses beyond reversal. Poisoning.
o Atropine vs glyco for reversal
o Myasthenia and Eaton-lambert syndrome and how to differentiate. What is the shape of TOF IN myasthenia? Treatment of myasthenia including steroids (what are the benefits and side effects) and plasmapheresis (what is the dose???).

LOCAL ANAESTHETISTS

• Mechanism of action
• Amide vs ester
• Toxicity
• Comparison of bupivacaine and lignocaine. Details of effect of pka on the onset of action and protein binding on the duration of action.
• Compare ropivacaine to bupivacaine.

ALHA and BETA-BLOCKERS

• Alpha and beta receptors, subtypes and actions
• Type of receptors
• Perioperative use of beta-blockers
• Dexmed and clonidine comparison
• Alpha-blockers
• Beta receptors, their function and distribution

CARDIAC DRUGS

• Antihypertensives. Peri-op recommendations
• Adenosine
• Statins
• Antiarrhythmics. Classification. Mechanism of action.
• Amiodarone. Side effects
• Atrial natriuretic peptide
• Betablocker, Ca channel blocker
• Pharmacodynamics of Adrenalin, Dopamine (function, clinical use, group, dose, side effects etc.)
• Differential effects of ADR and noradrenaline on alpha and beta receptors
• Fenoldopam. Role in renal protection?

INTRAVENOUS FLUID AND FLUID DYNAMICS

• Starling forces
• Intravenous fluids and comparisons; colloids vs crystalloids
• Osmolality and osmolarity definition and how to measure and normal blood osmolarity and tonicity definition and starling forces Equation for plasma osmolarity measurement
• Different IV fluids
• Physical properties of fluids (comparison of NS/RL/Hartmann’s/dextrose)
• Colloids (differences between starches/gelatin and dextran)
• Plasma expanders
• Crystalloids vs colloids

OTHERS

• Drugs for multiple sclerosis/ myasthenia gravis/ thyroid disorders/ renal/ hepatic disease
• Anticholinesterase effects
• Drugs acting on the uterus
• How would you introduce a new drug being used on a trial basis to the patient and take consent for it? (What all things you would like to know about the drug before talking to the patient)
• Patient taking oral steroids for 2 months, your concerns (she wants to hear the adverse effects and steroids cover according to the operation minor moderate or major)
• Antidepressants, antipsychotics, and antiepileptics: types and concerns in anaesthesia
• CO2 absorbents. Colour indicators. Reaction. Soda-lime vs. baralyme and newer absorbents.

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