Basic principles

Types of intermolecular bonds
Laws of diffusion. Diffusion of molecules through membranes
Osmotic effects. pH effects. Adsorption and chelation
Ionization of drugs
Drug uptake from: gastrointestinal tract, lungs, transdermal, subcutaneous, IM, IV, epidural, intrathecal routes
Inhibition and promotion of drug uptake. Competitive protein binding.
Protein binding
Factors determining the distribution of drugs: perfusion, molecular size, solubility, protein binding
The influence of drug formulation on disposition
Distribution of drugs to organs and tissues: Body compartments
Influence of specialised membranes: tissue binding and solubility
Materno-fetal distribution: Placental structure and mechanisms affecting drug transfer across the placenta
Distribution in CSF and extradural space
Modes of drug elimination:
Direct excretion
Metabolism in organs of excretion: phase I & II mechanisms
Renal excretion and urinary pH
Non-organ breakdown of drugs
Metabolic pathways; enzymes; drug: enzyme interactions; Michaelis-Menten equation
Oxidation and reduction
Effects of metabolites and other degradation products.
Pharmacogenetics: familial variation in drug response
Enzyme inducers and inhibitors
Effects of acute organ failure (liver, kidney) on drug elimination
Mechanisms of drug action
Receptor function and regulation
Signal transduction: cell membrane/receptors/ion channels to intracellular molecular targets, second messengers
Receptor interactions
Ion channels: types: relation to receptors. Gating mechanisms
Dynamics of drug-receptor interaction
Agonists, antagonists, partial agonists, inverse agonists
Pharmacodynamics: concentration-effect relationships: hysteresis
Efficacy and potency.
Mechanisms of drug interactions
Drug isomerism
Pharmacokinetic analysis:
Concept of a pharmacokinetic compartment
Apparent volume of distribution
Clearance concepts applied to whole body and individual organs
Simple 1 and 2 compartmental models: concepts of wash-in and wash-out curves
Methods for achieving specified plasma concentrations
Bolus, infusion, and profiled administration
Physiological models based on perfusion and partition coefficients
Effect of organ blood flow: Fick principle
Pharmacokinetic variation: influence of body size, sex, age, disease, pregnancy, anaesthesia, trauma, surgery, smoking, alcohol and other drugs

Core drugs in anaesthetic practice

Intravenous anaesthetic agents
Adverse reactions to drugs: hypersensitivity, allergy, anaphylaxis, anaphylactoid reactions. The yellow card system, regulation of drug licensing (appears in the IV anaesthetic section in Peck and Williams)
Anaesthetic gases and vapours
Action of gases and vapours
Control of alveolar tension during induction and recovery
Environmental effects
Solubility and partition coefficients
Oxygen therapy, indications and techniques
Use of Helium
Simple analgesics
Non-steroidal anti-inflammatory drugs
Opioids and other analgesics; and opioid antagonists
Local anaesthetic agents
Neuromuscular blocking agents (depolarising & non-depolarising), and anticholinesterases

Cardiovascular drugs

Drugs acting on the heart & cardiovascular system (including inotropes, vasodilators, vasoconstrictors, antiarrhythmics, diuretics)
Drugs acting on the autonomic nervous system: cholinergic and adrenergic agonists and antagonists
Drugs acting on the respiratory system (including respiratory stimulants & bronchodilators) Classified in sympathomimetics in the CV section in P and W

Other important drugs

Hypnotics, sedatives, anxiolytics
Antiemetic agents
Antacids. Drugs influencing gastric secretion (H2 blockers and PPIs) and motility therapeutics
Diuretics “Use of diuretics for cardiac and respiratory failure and to maintain urine output”
Antibiotics antivirals and antifungals
Thrombolytic therapy
Vitamin K, B12 and thiamine
Anti-diabetic agents
Corticosteroids and other hormone preparations

Not covered in Peck and Williams

Crystalloid Solutions
Plasma volume expanders
Blood substitutes
Alternative Oxygen carrying solutions
Use of magnesium sulphate
Action of anaesthetic drugs on the eye
Antihistamines Mentioned in P and W in the antiemetic section

The Final Syllabus: notes in CCT III

“This section requires a wider knowledge of drugs than in the Primary FRCA examination. For drugs used in anaesthesia and Intensive care medicine candidates will also be expected to be aware of new drugs which are undergoing evaluation and whose human application has been reported in the mainstream anaesthetic journals. There will be emphasis on the practical application of pharmacological and pharmacokinetic knowledge, and upon an appreciation of the hazards and limitation of individual techniques”.

CEACCP 2001: DECEMBER: Drug metabolism
GR Park

DG Lambert
Drugs and receptors

CEACCP 2002: FEBRUARY: An introduction to total intravenous anaesthesia
Gordon Yuill and Milda Simpson

CEACCP 2004: JUNE: Pharmacokinetics of drug infusions
SA Hill

CEACCP 2006: APRIL: The molecular mechanisms of general anaesthesia: dissecting the GABAA receptor
Cameron J Weir

CEACCP 2005: OCTOBER: Nitrous oxide
Amelia Banks and Jonathan G Hardman

CEACCP 2001: OCTOBER: Hyperbaric oxygen therapy
Andrew David Pitkin and Nicholas John Hawksley Davies

CEACCP 2001: AUGUST: Oxygen
Ravi Taneja and Ralph S Vaughan

CEACCP 2005: FEBRUARY: Opioid receptors
John McDonald and DG Lambert

CEACCP 2004: FEBRUARY: Pharmacology of neuromuscular blocking drugs
Jonas Appiah-Ankam and Jennifer M Hunter

CEACCP 2004: OCTOBER: Anticholinesterases and anticholinergic drugs
V Priya Nair and Jennifer M Hunter

CEACCP 2001: FEBRUARY: A systematic approach to cardiovascular pharmacology
Jonathan J Ross

CEACCP 2001: AUGUST: Diuretics and renal tubular function
Paul Clarke and Karen H Simpson

CEACCP 2001: FEBRUARY: Magnesium and the anaesthetist
Veronica F Watson and Ralph S Vaughan

CEACCP 2001: DECEMBER: Drugs and the eye
David Raw and SM Mostafa