Syllabus (Fourth Edition, 2023)
Topics
i. Describe the pharmaceutics and formulation of drugs including packaging, formulation, isomerism, compatibility, and excipients (additives) as they pertain to level 1 drugs.
Topics not covered in previous SAQs
packaging, formulation, compatibility and excipients (additives)
Learning Objectives for the First Part Examination in Intensive Care Medicine
- This will ensure that trainees, tutors, and examiners can work from a common base.
- All examination questions are based around this Syllabus.
- These learning objectives are designed to outline the minimum level of understanding required for each topic.
- The accompanying texts are recommended on the basis that the material contained within them provides sufficient information for trainees to meet the learning objectives.
- Trainees are strongly encouraged to explore the existing and evolving body of knowledge of the Basic Sciences as they apply to Intensive Care Medicine by reading widely.
- For all sections of the syllabus an understanding of normal physiology and physiology at extremes of age, obesity, pregnancy (including foetal) and disease (particularly critical illness) is expected.
- Similarly, for pharmacology, trainees are expected to understand a drug’s pharmacology in these contexts.
- An understanding of potential toxicity and relevant antidotes is also expected.
Definitions
Throughout the document specific wording has been used under the required abilities to indicate the level of knowledge and understanding expected and a glossary of these terms is provided.
Definitions
| Calculate | Work out or estimate using mathematical principles. |
| Classify | Divide into categories; organise, arrange. |
| Compare and contrast | Examine similarities and differences. |
| Define | Give the precise meaning. |
| Describe | Give a detailed account of. |
| Explain | Make plain. |
| Interpret | Explain the meaning or significance. |
| Outline | Provide a summary of the important points. |
| Relate | Show a connection between. |
| Understand | Appreciate the details of; comprehend. |
SAQs
i. Describe the pharmaceutics and formulation of drugs including packaging, formulation, isomerism, compatibility, and excipients (additives) as they pertain to level 1 drugs.
2012B 20
What are drug enantiomers? (20% of marks).
Explain the clinical relevance of enantiomerism (60% of marks).
Give a clinically relevant example (20% of marks).
CICMWrecks Answer
Enantiomers
- Molecules which have the same bond structure but are mirror images of each other.
- These molecules rotate light in opposite directions:
- (S)-(+)-naproxen is used to treat arthritis pain
- (R)-(–)-naproxen causes liver poisoning with no analgesic effect.
- (S)-(+)-warfarin, metabolised by CYP2C9, 3-5 times more potent
- (R)-(–)-warfarin, metabolised by CYP2C19, CYP1A2, CYP3A4
- These are isomers which share pharmachemical properties (boiling point, density…) and chemical formula but different 3-D structural arrangement.
- If action depends on pharacochemical properties then it is shared between enantomes
- If action depends on binding to specific sites then it can be markedly different between enantomers.
Enantomers are a subclass of Sterioisomers which are molecules with the same bond structure, different 3D arrangement.
- Sterioisomers have a singel chiral center and can be either:
- Geometric
- Optical or enantomeric
- Diastereoisomers have more than one chiral center and can be either:
- Geometric
- Optical non-enantomeric
Gladwin 2016
Examiner Comments
9 (41%) of candidates passed.
Enantiomers refer to isomeric molecules with centres of asymmetry in 3 dimensions that are mirror images of each other but not superimposable. Enantiomers may be distinguished by the direction in which polarised light is rotated. Interactions involving weak drug-receptor bonds feature a dependence upon recognition of shape, i.e. stereochemical structure is often important. Frequently one enantiomer may bind to a given receptor more avidly than the other, thus pharmacodynamics, pharmacokinetics and toxicity may vary between enantiomers. Many drugs are supplied as racemic mixtures, the components of which have different activity. Clinically relevant examples that candidates could have mentioned, included bupivacaine, ropivacaine, ketamine and carvedilol.
VIVAs
| 2019A | Drugs: Role of excipients (additives) |
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