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Optometry 226a

General Pharmacology Materials
Dr Christine Wildsoet (office/laboratory: Room 588, Minor Hall)
Class Materials

OVERVIEW
This course covers
  1. basic pharmacology terminology and concepts (both pharmacodynamic and pharmacokinetic) as applied to the eye and ophthalmic drugs,
  2. clinical prescribing issues including formulation, dosing and prescribing, and
  3. pharmacotherapy of anti-inflammatory, centrally acting, hormonal and other "specialist" systemic drugs.
The presentation mode will be through formal lectures, using computer-based slides that will be available from the web.

OBJECTIVES
This course has two principal objectives:
  1. to familiarise you with basic pharmacology terminology and concepts (both pharmacodynamic and pharmacokinetic) as they apply to the eye and ophthalmic drugs, and
  2. to review drugs used in the diagnosis and/or treatment of ocular disease as well as drugs used in the treatment of central nervous system, auto-immune disease and hormonal disorders.
An understanding of how such drugs work is fundamental to understanding their potential to produce side-effects (both systemic and ocular), and to interact with drugs used in optometric practice. The overall goal of the course is to equip you with a good working knowledge of drugs commonly encountered in clinical practice, to facilitate recognition of ocular and systemic manifestations of such drugs, and accordingly, modification of diagnostic and/or therapeutic management strategies as indicated. A final objective is to increase your working knowledge of common drug names.

COMPETENCIES
  1. Be able to explain and describe the significance of pharmacokinetic and pharmacodynamic principles to ophthalmic drug therapy.
  2. Understand the mechanisms of action, and their relationship to the therapeutic and adverse effects and drug interactions, of commonly used ophthalmic drugs.
  3. Understand the mechanisms of action and their relationship to the therapeutic and adverse effects, and drug interactions for commonly used centrally acting, anti-inflammatory and hormonal drugs.
  4. Be able to identify the ophthalmic drug groups that are most likely to cause interactions with systemically used drugs.
  5. Develop a working knowledge of both proprietary and nonproprietary names of commonly prescribed ophthalmic drugs.
ASSESSMENT
The assessment for this course will comprise three components:
  1. Mid-term examination (1 hr, 25%)
  2. Final examination (2 hr, 60%)
  3. Weekly quizzes (5%)
  4. Assignment (10%)
A requirement for passing this course is that you complete all components of the assessment satisfactorily.

Each of the two exams will comprise mainly of multiple choice questions, although some short answer type questions may also be included. The final examination will cover all material covered in the semester. There will also be the option for having the final examination count for 85% of the score for the mid-term examination is less than that achieved on the final examination. Weekly quizzes will be directed specifically at knowledge of drug names.

You are required to complete a group assignment as a component of the assessment for this course. The details of the assignment are provided in a separate handout along with topic allocations which have been done on a group basis. You are required to work together in groups for this assignment, and present a short seminar on your allocated group topic at the end of the semester. The submission date for this written requirement for this assignment is April 25.

As an extra bonus credit scheme, you will be able to accrue up to 5% in bonus marks by submitting reference details relating to new, grounding breaking pharmacological research findings of relevance to this course. Items should be submitted electronically to me at wildsoet@uclink.berkeley.edu, using the subject title "New finding". You must include full reference (citation) details as well as a short (100-300 words) summary written by you of the finding and its clinical significance; for articles available in digital form, please attached a pdf version of the article. Each item will accrue 1% credit. When more than one student describes the same finding, only the first submission received will be credited. All credited items will be posted on the web for general access.

LECTURE TOPICS
  1. Ocular application of pharmacokinetic & pharmacodynamic principles
  2. Ophthalmic drug formulation & dosing
  3. Diagnostic agents I: vital stains, local anesthetics
  4. Diagnostic agents II: miotics, mydriatics, cycloplegics
  5. Ophthalmic antibiotics: anti-bacterial, -viral, -fungal, -parasitic drugs
  6. Drugs for ocular allergies: tear supplements, decongestants, anti-histamines, mast-cell stabilisers
  7. Anti-inflammatory drugs: Corticosteroids, NSAIDs & other specialist drugs (SARDs, anti-gout, other immunosuppressive drugs)
  8. Ophthalmic application of anti-inflammatory drugs: NSAIDs, corticosteroids, cyclosporine
  9. Glaucoma drugs: sympatho-lytics, -mimetics, miotics, CAIs, prostaglandin analogs, calcium channel blockers, osmotic agents, miscellaneous new drugs
  10. Psychopharmacology (anxiolytics, antidepressants, anticonvulsants, antipsychotics, antiparkinson drugs)
  11. Hormone derivatives (drugs for diabetes, thyroid disease, growth abnormalities, menopause, oral contraceptives, cancer prophylactics)
  12. Miscellaneous drug groups (including for GI problems, migraine)

REFERENCES
Recommended textbooks
Bartlett JD, Jaanus SD (eds). Clinical Ocular Pharmacology. 4thd ed. Boston: Butterworth-Heinemann, 2001.
AND
Katzung BG (ed). Basic and Clinical Pharmacology. Stamford: McGraw Hill, 8th edition, 2001.
OR
Rang HP, Dale MM, Ritter JM, Gardner P. Pharmacology. 5th ed. New York: Churchill Livingstone, 2003.

There are other good alternatives or supplements to the above textbooks as indicated by * on the following list; you may find one of these more suited to your style of learning.

Other relevant monographs
  1. * Amerson SR. Ocular Side-effects of Drugs and Basic Pharmacology. St. Louis: Optometric Development Enterprises, 1972.
  2. Anderson, Knobin. Handbook of Clinical Drug Data. Appleton & Lange, 1997-8.
  3. * Bartlett JD, Fiscella RG, Bennett E, Jaanus SD, Rowsey JJ, Zimmerman TJ (eds). Ophthalmic Drug Facts. St Louis: Wolters Kluwer Co, 2001.
  4. Brody TM, Larner J, Minneman KP. Human Pharmacology. Molecular to Clinical. 3rd ed. St Louis: Mosby, 1998.
  5. Chiou GCY. Ophthalmic Toxicology. Target Organ Toxicology Series. New York: Raven Press, 1992.
  6. Clark WG, Brater DC, Johnson AR (eds). Goth's Medical Pharmacology. St Louis: Mosby, 1991.
  7. * Craig CR, Stitzel RE (eds). Modern Pharmacology with Clinical Application. 5th ed. Boston : Little & Brown, 1997.
  8. Davies DM (ed). Textbook of Adverse Drug Reactions. Oxford: Oxford University Press, 1981.
  9. DiGregorio GJ, Barbieri EJ, Sterling GH. Handbook of Commonly Prescribed Ocular Drugs. West Chester PA: Medical Surveillance Inc, 1991.
  10. Dukes MNG. Meyler's Side-effects of Drugs. 9th ed. Amsterdam: Excerpta Medica, 1980.
  11. Duvall B, Kershner RM. Ophthalmic Medications and Pharmacology. Thorofare NJ: Slack, 1998.
  12. Edman P (ed). Biopharmaceutics of Ocular Drug Delivery. Boca Raton: CRC Press, 1993.
  13. Fechner PU, Teichmann KD. Ocular Therapeutics: Pharmacology and Clinical Applications. Thorofare NJ: Slack, 1998.
  14. * Fraunfelder FT. Drug Induced Ocular Side-effects and Drug Interactions. 4th ed. Baltimore: Williams & Wilkins, 1996.
  15. * Grant WM, Schuman JS. Toxicology of the Eye. 4th ed. Springfield: CC Thomas, 1993.
  16. * Hardman JG, Limbird LE, Molinoff PB, Ruddon RW, Goodman Gilman A. (eds). Goodman & Gilman's The Pharmacological Basis of Therapeutics. 9th ed. New York : McGraw-Hill, 1996.
  17. * Mauger TF, Craig EL. Havener's Ocular Pharmacology. 6th ed. St Louis: Mosby, 1994.
  18. * Mauger TF, Craig EL. Mosby's Ocular Drug Handbook. St Louis: Mosby, 1996, (companion to "Havener's Ocular Pharmacology").
  19. Mitra AK (ed). Ophthalmic Drug Delivery Systems. New York: Marcel Dekker, 1993.
  20. * Mycek MJ, Harvey RA, Champe PC (eds). Lippincott's Illustrated Reviews: Pharmacology. 2nd ed. Philadelphia: Lippincott-Raven, 1997.
  21. * Page CP, Curtis MJ, Sutter MC, Walker MJA, Hoffman BB. Integrated Pharmacology. St Louis : Mosby, 1997.
  22. * Pavin-Langston D, Dunkel EC. Handbook of Ocular Drug Therapy and Ocular Side-Effects of Systemic Drugs. Boston: Little Brown & Co, 1991.
  23. Physicians' Desk Reference. Montvale: Medical Economics (current edition; also PDRs for Ophthalmology & Nonprescription drugs).
  24. Rakel RE (ed). Conn's Current Therapy. Philadelphia: WB Saunders, 1997.
  25. Reynolds JEF (ed). Martindale. The Extra Pharmacopoeia. 30th ed. London: Pharmaceutical Press, 1993.
  26. Roberts DK, Terry JE. Ocular Disease, Diagnosis and Treatment. Oxford: Butterworth-Heinemann, 1996.
  27. Schlesser JL (ed). Drug Available Abroad: A Guide to Therapeutic Drugs Available and Approved Outside the US. Detroit: Gale Research Inc, 1991.
  28. Singh K, Zimmerman TJ, Stamper RL (eds). Advances in Ocular Pharmacology. Philadelphia: Saunders, 1997.
  29. * Stahl SM. Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 2nd ed. Cambridge: Cambridge Univ Press, 2000.
  30. Stockely IH. Drug Interactions. Oxford: Blackwell Sci Pub, 1994.
  31. Tabbarra KF, Hyndiuk RA. Infections of the Eye. 2nd ed. Boston: Little & Brown, 1996.
  32. * Woodard DR, Woodard RB. Handbook of Drugs in Primary Eyecare. Norwalk: Appleton & Lange, 1991.
  33. Zimmerman TJ, Kooner KS, Sharir M, Fechtner RD (eds). Textbook of Ocular Pharmacology. Philadelphia: Lippincott-Raven, 1997.
  34. Wells BG, DiPiro JT, Schwinghammer TL, Hamilton CW. Pharmacotherapy Handbook. Connecticut: Appleton & Lange, 1998.
There is a selection of pharmacological references on reserve in the Optometry library. Periodical holdings in the University's libraries are another useful resource. Below are listed some papers of interest.

Examples of relevant readings from periodicals
  1. Hedman K, Alm A, Gross RL (2003) Pooled-data analysis of three randomized, double-masked, six-month studies comparing intraocular pressure-reducing effects of latanoprost and timolol in patients with ocular hypertension. J Glaucoma. 12: 463-465.
  2. Houde M, Castilloux AM, Tingey D, Assalian A, LeLorier J (2003). Prescription of topical antiglaucoma agents for patients with contraindications to beta-blockers. Can J Ophthalmol. 38: 469-475.
  3. Bee WH (2001). Standardized electroretinography in primates: a non-invasive preclinical tool for predicting ocular side effects in humans. Curr Opin Drug Discov Devel 4: 81-91.
  4. Bramble D, Klassen A, Raina P, Miller A, Lee S, Thambirajah MS, Weaver A, Kewley (1998). Attention deficit hyperactivity disorder in children. BMJ 317: 1250-1251.
  5. Fraunfelder FT, Fraunfelder FW, Edwards R (2001). Ocular side effects possibly associated with isotretinoin usage. Am J Ophthalmol 132: 299-305.
  6. Jaanus SD (1992). Ocular side-effects of selected systemic drugs. Optom Clin 2: 73-96.
  7. Onofrey B (1998). The mixed reactions of drug interactions. Review Optom Jun 15: 79-84.
  8. Rhee DJ et al. (2002). Prevalence of the use of complementary and alternative medicine for glaucoma. Ophthalmology 109: 438-443.
Examples of useful web sites
http://www.nnlm.nlm.nih.gov/healthinfoquest/pathfinders/px_p2.html
(drug information - how to find; listed sites below)
http://medlineplus.gov/
http://rxlist.com/
http://pharminfo.com/
http://healthcare.micromedex.com/
http://www.ncbi.nlm.nih.gov/PubMed/
http://www.fda.gov/cder/approval/index.html
http://www.fda.gov/medwatch/safety.html
http://www.fda.gov/oc/buyonline/faqs.html
http://cp.gsm.com/
http://www.drugtopics.com/newirx.html
http://www.carefirst.com/pages/customer/formulary.htm
http://www.marcap.net/kwikmed/index.shtml
http://www.mayohealth.org/
http://www.thomasjmoore.com/index.shtml
http://my.webmd.com/medcast_toc/pdr_herbs_and_vitamins
http://www.cnn.com/2000/HEALTH/aging/
http://www.healthsquare.com/fgpd/fg4ch23.htm
http://library.uchc.edu/departm/hnet/inters.html
http://www.medscape.com
http://www.ncbi.nlm.nih.gov:80/entrez (pubmed)
http://redatlas.com/Main.htm
http://www.citizen.org/hrg/
https://www.worstpills.org/
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