GMC Domains
- THE DOCTOR AS A SCHOLAR
- TD 8: APPLICATION OF BIOMEDICAL SCIENTIFIC PRINCIPLES, METHOD AND KNOWLEDGE
- Medical knowledge: ANATOMY (TD 8.1)
- Medical knowledge: PHYSIOLOGY (TD 8.2)
- Medical knowledge: BIOCHEMISTRY (inc. Metabolism) (TD 8.3)
- Medical knowledge: CELL BIOLOGY (TD 8.4)
- Medical knowledge: MOLECULAR BIOLOGY and GENETICS (TD 8.5, 8.6)
- Medical knowledge: PATHOLOGY (TD 8.7)
- Medical knowledge: CANCER
- Medical knowledge: IMMUNOLOGY and INFLAMMATION (TD 8.8)
- Medical knowledge: MICROBIOLOGY and INFECTION (TD 8.9)
- Medical knowledge: PHARMACOLOGY (TD 8.10)
- Medical knowledge: NUTRITION (TD 8.11)
- Medical knowledge: CLINICAL FEATURES of DISEASE (TD 8 b)
- TD 9: APPLICATION OF PSYCHOLOGICAL PRINCIPLES, METHOD AND KNOWLEDGE
- TD 10: APPLICATION OF SOCIAL SCIENCE PRINCIPLES, METHOD AND KNOWLEDGE
- TD 11. PRINCIPLES, METHODS AND KNOWLEDGE OF POPULATION HEALTH
- TD 12; APPLICATION OF SCIENTIFIC METHOD AND APPROACHES TO MEDICAL RESEARCH
- TD 8: APPLICATION OF BIOMEDICAL SCIENTIFIC PRINCIPLES, METHOD AND KNOWLEDGE
- THE DOCTOR AS A PRACTITIONER
- TD 13: CARRY OUT A CONSULTATION WITH A PATIENT
- TD 14: DIAGNOSE AND MANAGE CLINICAL PRESENTATIONS
- Clinical skills: INTERPRETING FINDINGS AND INITIAL ASSESSMENT (TD 14 a-b)
- Clinical skills: PLANNING AND INTERPRETING INVESTIGATIONS (TD 14 c-d)
- Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
- Clinical skills: FORMULATING A TREATMENT PLAN (TD 14 g)
- Clinical skills: SURGERY and ANAESTHETICS (TD 14 g)
- Clinical skills: SUPPORTING PATIENTS and IDENTIFYING ABUSE and NEGLECT (TD 14 h-i)
- Clinical Skills: CARE OF PATIENTS AND RELATIVES AT END OF LIFE (TD 14 j)
- TD 15: COMMUNICATE EFFECTIVELY WITH PATIENTS AND COLLEAGUES
- TD 16: PROVIDE IMMEDIATE CARE IN MEDICAL EMERGENCIES
- TD 17: PRESCRIBE DRUGS SAFELY, EFFECTIVELY AND ECONOMICALLY
- TD 18: CARRY OUT PRACTICAL PROCEDURES SAFELY AND EFFECTIVELY
- TD 19: USE INFORMATION EFFECTIVELY IN A MEDICAL CONTEXT
- THE DOCTOR AS A PROFESSIONAL
- TD 20: BEHAVE ACCORDING TO ETHICAL AND LEGAL PRINCIPLES
- TD 21: REFLECT, LEARN AND TEACH OTHERS
- TD 22: LEARN AND WORK EFFECTIVELY WITHIN A MULT-PROFESSIONAL TEAM
- TD 23: PROTECT PATIENTS AND IMPROVE CARE
- Professional issues: DUTIES OF A DOCTOR (TD 23 a-b)
- Professional issues: MEDICAL FRAMEWORK IN THE UK (TD 23 c)
- Professional issues: RISK MANAGEMENT and PATIENT SAFETY (TD 23 d)
- Professional issues: GOVERNANCE, QUALITY MATTERS and AUDIT (TD 23 e)
- Professional issues: PERSONAL ATTITUDES and SELF CARE (TD 23 f-j)
TD 8: APPLICATION OF BIOMEDICAL SCIENTIFIC PRINCIPLES, METHOD AND KNOWLEDGE: Medical knowledge: PHARMACOLOGY (TD 8.10)
Index
- General Principles of Clinical Pharmacology and Therapeutics
- Cardiovascular Pharmacology
- Respiratory Pharmacology
- Metabolism (GI, Endocrine and Renal)
- Human Development (Child Health, Sexual Health, O&G, Healthcare of the Elderly)
- Brain and Behaviour (Psychiatry, Neuroscience and Ophthalmology)
- Locomotor (Musculoskeletal and Dermatology)
- Infection
- Cancer and Immunosupression
- General Principles of Clinical Pharmacology and Therapeutics
- Pharmacological Principles - General
- Know what is meant by the term selective toxicity and distinguish between an antibiotic and antimicrobial agent (CSP3)
- Understand and know the principles of good prescribing including the most commonly prescribed drugs.
- Know the indications for use of anti-emetic drugs and those most commonly used.
- List sites of action of antimicrobials with examples (CSP3)
- Discuss selectivity of drug actions
- List mechanisms of resistance and factors predisposing to increased resistance (CSP3)
- Relate how being weak acids or weak bases influences a drugs activity
- Describe the forces used between a drug and its receptors
- Know about the increasing importance of antifungals in medicine and some examples of these agents (CSP3)
- Compare efficacy and potency
- Pharmacokinetics and Pharmacodynamics
- 4. Outline how the body composition and organ metabolic changes impact on pharmacology
- Describe drug binding sites giving examples of both site and drug that attaches to it.
- Define and explain Pharmacokinetics/Pharmacodynamics (CSP3)
- Explain some of the mechanisms of actions which underlie both the beneficial and harmful effects of these drugs
- Note G-protein-coupled receptors (GPCRs) compose largest group of drug binding sites
- Be able to define and discuss the following: affinity; full agonist; partial agonist; neutral agonist; inverse agonist; pure antagonist; potency; efficacy; selectivity; specificity; reversible; irreversible; competitive; non-competitive
- Understand uses of PK-PD Modelling (CSP3)
- Define Hysteresis and how it is modelled (CSP3)
- Discuss selectivity of drug action
- Be able to define pharmacokinetics and pharmacodyamics (GEP/BB)
- Explain how long-term corticosteroid therapy disrupts endogenous corticosteroid secretion (GEP/DGM)
- Understand what is meant by structure-action relationships
- Distinguish and define pharmacokinetics /pharmacodynamics; liberation; absorption; volume of distribution; distribution; exretion; metabolism; clearance; half life
- Understand the importance of Pharmacoeconomics (CSP3)
- Compare and contrast routes of drug administration
- Understand how outcomes can be improved through use of pharmacodynamics (CSP3)
- Distinguish and define half life; narrow / wide therapeutic window; zero order kinetics; first order kinetics; peak levels; trough levels; bioavailability; loading dose, maintenance dose
- Understand what is meant by pharmacokinetics
- Define absorption and the various mechanisms
- Describe various methods of drug formulation resulting in its liberation
- Discuss the factors influencing pharmacokinetics
- Understand how and where drugs act - give examples
- Drug Receptor Interactions
- Define the terms: agonist, antagonist, EC50, efficacy and potency
- Describe how the volume distribution of a drug is calculated and the factors that affect the distribution of a drug in the body (FM1)
- Draw idealised concentration vs response curves to distinguish between drugs of high and low potency and/or high and low efficacy
- Describe the four major classes of receptors (FM1)
- Describe, with a clinical example, the characteristics of competitive antagonism
- Describe how drug activity can be modified by changes in receptor interactions (FM1)
- Distinguish competitive antagonism from non-competitive and physiological antagonism
- Drug Absorption and Elimination
- Explain drug absorption with reference to the pH-partition hypothesis, as applied to aspirin
- Define the term apparent volume of distribution and discuss why drugs have different values for this; explain pre-systemic (first pass) metabolism
- Briefly describe the ways in which drugs are eliminated from the body
- Safe Prescribing and Drug Administration
- By using suitable drug examples discuss the advantages and disadvantages of the following routes of administration: oral, intravenous; intramuscular; subcutaneous; sublingual; rectal; transdermal; inhalation
- Recall and describe what BRAINS&AIMS stands for and use the format when presenting a drug.
- Understand unit conversion and be able to express percentage concentrations (CSP3)
- To increase your awareness of the prevalence of medication incidents in the NHS
- Define prescribing error
- Focus main learning about drugs ie pharmacology / prescribing (BRAINS&AIMS) around the top 100 Drugs you are most likely to prescribe as a junior doctor
- Appreciate the danger of misprescribing.
- Define and identify the steps involved in Drug reconciliation (CSP3)
- Describe the main routes of drug administration (FM1)
- Define the 10 principles of safe prescribing (CSP3)
- Interpret drug dosing information in the BNF (CSP3)
- Understand the inputs to the EQUIP enquiry quoted in the lecture, including those concerning the source & frequency of errors.
- Identify the routes of administration that lead to 1st pass metabolism and how this contributes to the activity of a drug (FM1)
- Learn about key features of other drugs eg interesting mechanisms that help understand underlying physiology; dangerous drugs that may have been prescribed by someone else and affect your patients
- Classify the error
- Identify how to use the BNF to access information about drug treatments (CSP3)
- Understand how crucially important they are through illustrated examples
- Define displacement volume
- Calculate weight-related doses (CSP3)
- Define in which patients this is needed and where it should be documented (CSP3)
- To highlight the importance of patient safety and how prescribing error is one of the major causes of harm to patients.
- State the difference between formulations of medicine (CSP3)
- List the common causes of prescribing errors
- Recognise how phase I and phase II reactions contribute to the drugs elimination (FM1)
- Keep a portfolio of all the drugs you have learnt about / seen being used in a patient; it takes a long time to build up a good knowledge base so start now and keep revising and building; accept minor modifications if the list changes over time
- Understand the EQUIP recommendations quoted in the lecture.
- Calculate IV flow rates for drug infusions (CSP3)
- Know how to record Allergy status (CSP3)
- Identify other sources of information about drugs (CSP3)
- Be aware of recent prescribing errors that have occurred in NHS trusts
- Describe how dosage regimes affect the activity of a drug (FM1)
- Understand the risks involved after seeing a video of a medication incident (CSP3)
- Manage the above through a series of worked examples (CSP3)
- Understand the requirements of “Tomorrow’s doctors” regarding prescribing skills of doctors.
- Recognise the factors that affect drug interactions (FM1)
- Understand the principles of prescribing (CSP3)
- Understand the format, syllabus, purpose & significance of the Prescribing Skills Assessment.
- Guidelines and policies for antimicrobial prescribing in general (CSP3)
- Pharmacological Emergencies
- Define the ABCDE approach to enable systematic management of emergencies
- Recognise the different types/routes of drug poisoning
- Understand how and when to use activated charcoal
- Understand the acute management principles of the following emergencies: Myocardial infarction, Cardiac failure, Arrythmias, Respiratory failure
- Recognise the clinical features of commonly encountered poisoning/overdose scenarios
- Understand the management principles of paracetamol, aspirin, opiate and benzodiazepine overdose
- IV Fluids and Prescribing
- State the distribution of fluids in a healthy subject
- State the contents of commonly prescribed fluids
- State the daily fluid / electrolyte requirements of a healthy 70kg subject
- State symptoms and signs consistent with fluid depletion / overload
- State potential adverse events related to intravenous fluid therapy
- Recognise situations where fluid therapy differs from a healthy subject
- Formulate an appropriate intravenous fluid prescription
- Drug Monitoring (inc. Therapeutic Drug Monitoring)
- Be able to apply therapeutic drug monitoring to the following: Vancomycin Digoxin Gentamicin Phenytoin (CSP3)
- Be able to distinguish between the following: Narrow therapeutic window, Half life, Wide therapeutic window, Zero order kinetics, First order kinetics, Trough levels (CSP3)
- Demonstrate the ability to appropriately adjust dosage regimens by the use of therapeutic drug monitoring (CSP3)
- Describe how to obtain information needed to evaluate plasma drug concentrations e.g. time of sample, history of drug administration, concurrent drug therapy, accurate sample (CSP3)
- Know that other drugs that may also require therapeutic drug monitoring e.g. Ciclosporin, lithium (CSP3)
- Know the impact of pharmacogenetics on drug dosing, give examples (CSP3)
- Recognize the differences between wide and narrow therapeutic windows (CSP3)
- Understand the rationale of therapeutic drug monitoring as a guide to therapy and outline areas where it is useful (CSP3)
- Specialist Drugs
- Describe the different groups of antiretroviral drugs and their mode of action (I&I 4)
- To understand the new biological for RA (LOC2)
- Describe examples of the most commonly prescribed antiretroviral drugs including major side-effects and interactions of therapy (I&I 4)
- Describe why adherence to ARVs is important (I&I 4)
- Review the specific details of development of ARV resistance (I&I 4)
- Consider specific difficulties associated with ARVs that have an impact on adherence and resistance including: bioavailability; side-effects (short and long-term); confidentiality; interactions (I&I 4)
- Adverse Drug Reactions
- Describe other unwanted effects arising from long-term therapy with glucocorticoids
- Be able to inform the patient of common and serious adverse effects and advise them on what to do.
- Define adverse drug reactions (ADRs) (CSP3)
- Define and distinguish between pharmacodynamic and pharmacokinetic interactions (CSP3)
- Be able to describe different forms of pharmacokinetic interaction: absorption/distribution/metabolism/excretion (CSP3)
- To understand the side-effects and how newer drugs can reduce side effects (LOC2)
- Be able to prevent adverse drug reactions (ADR's). Using the BNF, learn common and serious ADRs for key drugs prescribed by FY1's; avoid harmful interactions; use prophylaxis if necessary; be aware of susceptible patients; use the appropriate dose regimen
- Understand that drug interactions are mostly unwanted and increase patient risk although some are beneficial (CSP3)
- To understand the side-effects and how newer drugs can reduce side effects (GEP/M&P)
- Give graphic illustrations of some of the serious side effects of corticosteroid use
- Know and identify which patients / patient groups have increased susceptibility to adverse effects of certain drugs (A SAD GAP - Age, Sex, Diseases, Genetic, Altered Physiology, pregnancy); take necessary precautions, avoid such drugs or adjust doses
- Be able to use appendix 1 of the BNF in order to look up information regarding drug interactions (CSP3)
- Know how to classify adverse drug reactions using DOTS - Dose - dependent (Type A); independent (Type b); Time dependent; Independent; Susceptible patients
- Know how to diagnose an adverse drug reaction (ADR) and be able to differentiate a suspected ADR from known common and serious ADRs
- Know how to treat adverse drug reactions (ADR): stop drug; supportive and /or specific treatments if indicated eg for anaphylaxis
- Know which adverse reactions (ADRs) to report and how.
- Drug Interactions
- To describe the basic principles of anti-HIV therapy, including major side-effects and interactions of therapy (I&I 4)
- Define pharmacodynamic interactions ie what drugs do to the body.
- Define pharmacokinetic interactions ie what the body does to the drug - absorption, distribution, metabolism, excretion
- Know how to avoid harmful (adverse) interactions
- Know how to identify potential or actual interactions by looking up in Appendix I in the BNF and learning common and important interactions by understanding the mechanisms
- Know key drugs that modify pharmacokinetic processes
- Give examples of antimicrobial side effects and interactions (CSP3)
- Use beneficial interactions
- Evidence Based Pharmacology
- Discuss attempts to produce new drugs which work in the same way as steroids but without the side-effects
- Be aware of the various milestones and pitfalls in drug development (FM1)
- Be able to describe the levels of evidence and recommendations for drug therapeutic strategies
- Define the phases of clinical trials
- Be able to describe, discuss and assess harm:benefit ratio
- Highlight the central importance of volunteer and patient safety
- Understand the importance of the consent process throughout a clinical trial
- Be able to define the following: Randomised trial; double blind; multi-centre; placebo-controlled; cohort study; case control study; systematic review/meta-analysis; case-series; risk:benefit ratio; phase 1,2,3,4 trials
- Understand the importance of the ten principles of safe prescribing within clinical trials
- Understand the limitations of using information from clinical trials eg extrapolating results to individual patients
- Provide an overview of the widespread use of corticosteroids in clinical medicine
- Use evidence obtained from studies to guide drug selection
- Be aware of the importance of clear diagnosis and documentation of this
- Use sources such as BNF, NICE Guidelines, Clinical Evidence, Cochrane Database, medical journals, PubMed to guide drug selection
- Understand the need to share the patient’s ideas, concerns and expectations of treatment
- Be aware that making sure that the patient understands the equipoise that lies at the heart of a comparative trial “what is the question?”
- Understand the need to make sure that the patient understands their role in the trial and what is expected from them
- Be aware of the need for a clear understanding of medication history and previous adverse reactions or allergies
- Be aware of paper and electronic case report forms, study monitoring and audit Be able to describe the roles of endpoint committees and data safety monitoring boards in endpoint trials
- Distinguish between audit and regulatory inspection
- Be able to describe a clinical trial which has changed clinical practice and guidelines
- Pharmacological Principles - General
- Cardiovascular Pharmacology
- General Outcomes for Cardiovascular Pharmacology
- Briefly describe how drugs may be used for treatment of hypertension and angina. (CR1)
- Describe the actions of the main groups of treatments used to prevent heart disease.
- List the common types of drugs used to control hypertension.
- Describe the newer anti-thrombotic agents, e.g. fondaparinux, direct thrombin inhibitors, antiplatelet drugs and thrombolytic agents (CR2)
- Anticoagulation
- Heart Failure
- Anaemia
- IV Fluids
- Cardiac Arrest and Anti-dysrhythmics
- Cardiovascular Risk (inc. Hypertension)
- Define Essential/Secondary hypertension and CV risk
- Understand the difference between primary and secondary prevention of cardiovascular disease
- Manage the Therapeutics of hypertension using BHS Guidelines: Non-pharmacological measures; Drug treatment of hypertension
- Know the Clinical Pharmacology of the main classes of anti-hypertensives (Thiazides, ACEi & ARBs, CCBs, ?-blockers, MR antagonists)
- Ischaemic Heart Disease
- Blood Transfusion
- General Outcomes for Cardiovascular Pharmacology
- Respiratory Pharmacology
- General Outcomes for Respiratory Pharmacology
- List and describe the actions of the autonomic nervous system on bronchial smooth muscle and secretory mucosa, relating these actions to the microscopic structure of the airway.
- List and give mode of action of agents which induce bronchoconstriction and bronchosecretion.
- Outline the consequences of antigen interaction with fixed mast cell antibody and the actions of mediators released from mast cells. (CR1, GEP/CO2)
- Oxygen and Respiratory Support
- Asthma and COPD
- Altitude Sickness
- General Outcomes for Respiratory Pharmacology
- Metabolism (GI, Endocrine and Renal)
- Diabetic Non-Emergencies
- Thyroid Disease
- Adrenal Disease
- Inflammatory Bowel Diseases
- Liver Disease
- Define the key changes (Pharmacodynamics/pharmacokinetics) in liver disease?
- Understand how these changes alter handling of, and responses to drugs?
- Manage altered prescribing in liver disease?
- Recognise which drugs are potentially damaging to the liver (hepatotoxic) and how?
- Recognise which drugs are beneficial in liver disease?
- PUD, GORD and Dyspepsia
- Diabetic Emergencies
- Renal Tract Disease
- Be familiar with drugs that are mostly or exclusively renally cleared
- Understand the different locations in the nephron that drugs that act on the kidney work
- Be familiar with commonly prescribed nephrotoxic drugs and how to monitor them and patients safely
- Understand the different types of ADRs on the kidney
- Be able to dose-adjust important drugs for patients will renal failure
- Know important drugs that are used for bladder and prostate disease
- Vomiting, Constipation and Diarrhoea
- Human Development (Child Health, Sexual Health, O&G, Healthcare of the Elderly)
- Contraception and HRT
- Describe to a patient methods of emergency contraception, indications and guidance for use (I&I 4)
- Demonstrate basic knowledge of currently available contraceptive methods and be able to communicate to patients the mechanisms of action and failure rate (I&I 4)
- Manage under supervision or refer as appropriate the contraceptive needs of a patient presenting with a medical condition which may contraindicate the method s/he is currently using (I&I 4)
- Breastfeeding
- Prescribing for Children
- Prescribing for the Elderly
- Pregnancy and Labour
- Contraception and HRT
- Brain and Behaviour (Psychiatry, Neuroscience and Ophthalmology)
- Synaptic Transmission
- Describe the neuronal structures involved in synaptic transmission. (BB2)
- Describe how the action potential is propagated down a myelinated and unmyelinated axon
- Review the various types of receptors (FM1)
- Be able to explain how changes in axon diameter and myelination affect the conduction velocity of axons (FM1)
- Describe the main steps involved in neurotransmission. (BB2)
- Recall how synapses integrate excitatory and inhibitory signals (FM1)
- Describe how the action potential is converted into a chemical signal at the synapse (FM1)
- Recall how 2nd messengers transduce for GPCRs
- List and classify major types of neurotransmitters. (BB2)
- Describe the effects of neurotransmitters at postsynaptic level. (BB2)
- Explain why pre-synaptic calcium is important for chemical transmission (FM1)
- Describe how sensory information is integrated and a motor response initiated if appropriate (FM1)
- Compare the effects of excitatory and inhibitory neurotransmitters on the post-synaptic membrane potential (FM1)
- Review the basic mechanisms underlying neuronal excitability. (BB2)
- Dopaminergic Systems
- Demonstrate knowledge of therapeutics, pharmacokinetics, side effects and interactions for carbidopa / levodopa (NEURO4)
- Describe the dopaminergic pathways in the central nervous system. (BB2)
- List and characterise the main types of dopaminergic receptors. (BB2)
- Describe the mechanism of action of drugs that act on dopaminergic systems. (BB2)
- Review the main circuits involved in the control of movement. (BB2)
- 5-HT Transmission
- Drug Dependence and Addiction
- Psychosis
- Migraine and Dementia
- Depression and Anxiety
- Review the neurobiology of depression.
- Describe the mechanism of action of benzodiazepines.
- Describe the pharmacology of tricyclic antidepressants
- Discuss the use of benzodiazepines as anxiolytics, hypnotics and sedatives.
- Describe the pharmacology of monoamine oxidase inhibitors
- Describe the pharmacology of selective serotonin reuptake inhibitors.
- Compare the pharmacological profile of barbiturates and benzodiazepines.
- Describe non-benzodiazepine hypnotics and anxiolytics.
- Epilepsy
- Parkinsonism
- Synaptic Transmission
- Locomotor (Musculoskeletal and Dermatology)
- Hypercalcaemia and Osteoporosis
- Joint and Skin Disease
- Recognise and be able to distinguish between: eczema, psoriasis, dermatitis, acne, ulcer, warts
- Safely treat common skin conditions
- Be familiar with the following medications: aqueous cream and emollients, benzoyl peroxide, vitamin A analogues, tetracyclines, erithromycin and other antibiotics, dithranol, octenisan, topical corticosteroids, vitamin D preparations
- Describe important adverse effects or complications of common therapies employed in the treatment of Psoriasis; Eczema and Lichen planus (DERM4)
- Recognise that some drugs are for use under only specialist advice and direction
- Recognise dermatological adverse reactions
- Infection
- Bacterial Infection
- Antimicrobial therapy (LOC2)
- Tuberculosis
- Viral, Parasitic and Fungal Infections
- Bacterial Infection
- Cancer and Immunosupression