Pharmacology

Lectures

The Part IB Pharmacology course is an excellent introductory course, with content shared with the Medics and VetMeds. It covers how various types of therapeutics can interact with and influence biological systems, from the chemical mechanisms to whole body responses. The course will also teach fundamental practical techniques commonly used in pharmacological research in the practical lessons.

Part IB Pharmacology can be neatly split into content-based and practical-based lecture series, which will be examined accordingly in separate papers. It builds up neatly from both the Part IA Physiology of Organisms and Biology of Cells courses, leading on from the courses on the different human physiological systems, and in biochemistry and cellular signalling. A typical content-based lecture series can be divided into two parts, one covering the physiology of the systems involved and the pathophysiology of related diseases, and the other discussing the possible pharmacological interventions to influence the systems or target the diseases as mentioned. Practical-based lecture series aim to teach the more technical concepts of pharmacology, such as on ligand binding and pharmacokinetics, which will be considered and applied in practice to a large extent.

All lectures will come with the relevant handouts, and most lecturers’ slides will largely follow the content in the handouts (except for a few). Keep in mind that some handouts can be quite wordy and content-heavy, with their associated lectures being considerably fast-paced. It is advisable to read up more on these handouts outside of lectures, as the content covered will be highly useful in the examinations. Lectures will usually be held at 11am on Mondays, Wednesdays, and Fridays.

The lecture synopses are given below (P for practical-based, C for content based):

Michaelmas:

• Drug-Receptor Interactions (P): The course starts with the most fundamental concept in pharmacology, where a drug interacts with a receptor and thus discussing what the drug does to the body. Foundational pharmacological concepts will be discussed in greater detail, such as affinity, efficacy, selectivity, specificity, agonism and antagonism etc.. Different types of receptors will be explained, each functioning via different mechanisms of action – leading on from the Cellular Signalling course in IA Biology of Cells. It is useful to remember the different ways receptors can be activated, as they will be seen again repeatedly throughout the whole course.
• Synaptic Pharmacology (C): Here is where the content begins – and it rolls fast and hard, especially in these lectures. This lecture block focusses on pharmacology of the nervous system, and introduces the basic mechanism of neurotransmission. It then goes into detail to how each step of neurotransmission can be targeted pharmacologically by various classes of drugs. Cholinergic and adrenergic neurotransmission will be discussed, covering the different types of receptors and their respective locations and functions. Non-cholinergic and non-adrenergic (NANC) neurotransmission will also be covered, such as purinergic and nitric oxide neurotransmission.
• Small Molecule Drug Discovery (C): A slight aside from the usual biology-related pharmacology content, this small lecture block gives a brief overview of the drug discovery process for contextualization, though it will mainly focus on the early stages of small molecule drug discovery. You’ll be introduced to various types of techniques used in hit finding, hit to lead, and lead optimization, such as virtual screening, fragment-based drug discovery, and drug repurposing.
• Antimicrobial & Antiviral Drugs (C): These classes of drugs are extremely important in a medical setting, and in this lecture series, antibiotics and antivirals will be discussed in further detail. The course begins with the development of antibiotics, and the different mechanisms in which they work alongside the drugs that treat them. It then touches on anti-parasitic drugs – split into anti-protozoal and anti-helminthic drugs, before moving onto detailing the mechanisms behind antivirals. The course ends with an important (examinable) section on various mechanisms of drug resistance, and several strategies to counter them.
• Growth Factor Signalling (C): This short lecture series mainly covers the physiology of growth factors, with emphasis on signalling pathways. Receptor tyrosine kinases (RTKs), G-protein cascades, and various types of growth factors will be further discussed as well. It ends with what can go wrong in these signalling pathways, which nicely lead up to the final course of the Michaelmas term…
• Anti-cancer Drugs (C): This series touches briefly on the pathophysiology of cancer and the various types of treatments that we have come up for it, comparing traditional chemotherapy and modern targeted anti-cancer therapy. The whole series will be contextualized in how these treatments target the ever-evolving hallmarks of cancer.

Lent:

• Pharmacokinetics (P): The second practical-based course, pharmacokinetics is one of the cornerstones of pharmacology, discussing what the body does to the drug. The course is logically structured around the ADME scheme. It first covers different types of drug administration with their respective benefits and disadvantages, before moving into how the drug is distributed across different compartments of the body. First and second-pass metabolism via a range of enzymes is then explained, before ending with how the drug or its metabolites are excreted from the body. Various pharmacokinetic concepts and metrics such as clearance, volume of distribution and bioavailability (along with many others) will be introduced here, which constitutes another important component for the practical examination.
• Inflammation, Immunosuppression, and Pain (C): This lecture series begins with a brief explanation of the physiology of inflammation and the role, synthesis, and metabolism of histamine. Other peptide inflammatory mediators like bradykinin and lipid inflammatory mediators like leukotrienes and prostanoids will be discussed with respect to how they influence inflammation. As expected, the pharmacology of NSAIDs will be discussed extensively here. The course then proceeds to explain more about immunology and the pharmacological action of corticosteroids, before moving into various inflammatory-related diseases such as Asthma and COPD and autoimmune disorders like rheumatoid arthritis, explaining the pathophysiology and pharmacological interventions. This is followed by a section which details more immunosuppressive drugs before a brief explanation on the production of monoclonal antibodies. Lastly, the series rounds up with explaining the pharmacology of pain management, with a discussion on opioids and other types of painkillers.
• Cardiovascular and Renal Pharmacology (C): This is the longest IB Pharmacology lecture series (and yet somehow the most enjoyable one). It first introduces the structure, role, and distribution of K+, Na+ and Ca2+ ion channels across the cardiovascular system, before explaining the physiology and pharmacology of the heart, delving into the production of both pacemaker and ventricular action potentials. The series then discusses how to target dysrhythmia (cardiac conduction) and cardiac contraction, before moving onto the pharmacology of the vascular system, where renal physiology plays a large role in controlling as well. Diseases like hypertension, chronic heart failure, angina, and myocardial infarction, alongside thrombosis, will be discussed in both pathophysiology and pharmacology. The course then ends with a short discourse on beta-blockers, which are extremely instrumental in the treatment of cardiovascular disorders.
• Endocrinology and Reproductive Pharmacology (C): This short chapter on the endocrine system is explored in two distinct settings: reproductive pharmacology and diabetes. It first covers the hormonal physiology of various sex hormones and various treatments for issues like contraception and infertility. The lecture series then explains the different types of pharmacological interventions available for treating diabetes (in particular, type II diabetes mellitus – T2DM).

Easter:

• Central Nervous System (CNS) Pharmacology (Neuropharmacology) (C): The IB pharmacology course ends with arguably one of the least understood areas in medical sciences. It begins with a brief physiological overview of the CNS, before expanding on the excitatory glutaminergic and inhibitory GABA neurotransmission, both vital forms of regulatory neurotransmission which are crucially balanced.  The pharmacology of various disorders is then discussed, such as anxiety, insomnia, and epilepsy. Antidepressants are covered extensively, before moving into dopaminergic neurotransmission, which brings disorders like Parkinson’s and schizophrenia into the picture and ways to treat them via anti-Parkinsonian drugs and antipsychotics. The lecture series then ends with a brief mention of Alzheimer’s disease and related emerging therapies.

Supervisions

Supervisions aim to consolidate your understanding of the important ideas from each lecture series. Supervision work usually comprises practice from past year tripos essays for the relevant topics, as well as past year practical questions, which should be at least reviewed by your supervisors and advised on. Otherwise, supervisors often spend supervision time going through the content from each lecture series. In addition, as the examination format has only been revised very recently in 2021, it is advisable to ensure that both you and your supervisor are aware of the new format such that you’re able to get adequate experience practising the relevant examination questions in the appropriate time frame given.

Practicals

Part IB Pharmacology practical sessions mainly aim to give you first-hand experience on techniques used in pharmacological research. These sessions will cover basic pharmacological assays used (e.g. saturation binding assays, competitive binding assays etc.) and methods to analyse experimental data, such as deriving dose ratios. You’ll have plenty of experience hooking up a guinea pig ileum to a force transducer too, which will be a staple experimental set-up in determining the effects of drugs on ileum contraction. Usually, these practical sessions will be on either Tuesday or Wednesday afternoons from about 2pm to 5pm and will primarily take place in Michaelmas.

In Lent, in addition to a few in-person practical sessions, you’ll spend most practical slots working on a drug review project in your own time, which requires you to compile information about a drug and present it with relevant slides within 3 minutes. You’ll be selecting the drug from a chosen list and will be given an allocation based on your preference which you’ll indicate. Each drug will be paired with a supervisor as well, which you can direct any specific questions about the chosen drug towards. You’ll also have the chance to send a first draft of your slides and recording for them to provide feedback on before the final submission. This is the only examinable ‘practical’ component, taking up 10% of your total grade. Just for fun, there will be a chance to have your recording uploaded for the rest of the cohort to view and vote upon, with prizes (typically vouchers) for the top 3 videos with the most votes.

Revision and Exams

Once again, it is absolutely essential that you familiarize yourself with the examination format which was revised in 2021. This new format confers 60% of your total grade to Paper 1 (Extended Answers), 30% to Paper 2 (or WP: written practical), and 10% to the drug review project. Moving forward, the written examinations are likely to be closed book and are quite likely to be conducted online on the Inspera exam portal.

Paper 1 is 3 hours long and contains a total of 6 short-essay (or ‘extended answer’) questions, each of which you’ll have 2 parts: (a) or (b) that you can choose either from, giving a total of 6 responses which you should ideally spend ONLY 30 minutes each. The two parts can either be from the same lecture series (typically a longer one), or from two separate lecture series (typically the shorter ones). You can refer to past year or specimen papers for a better grasp of the types and range of questions that can be asked. This can be used to your advantage in strategizing which sub-topics you wish to focus on within each lecture series when prioritising what to revise under limited revision time.

Paper 2 (or WP) is also 3 hours long and contains 4 questions of 20 marks each. Question 1 is a practical-based question on ligand binding, typically involving the analysis and interpretation of experimental binding data obtained from a series of experiments. This is followed by question 2 which is an essay-based question on the theory behind ligand binding. Question 3 is a practical-based question on pharmacokinetics, which often involves detailed pharmacokinetic calculations based on the type of drug administration and dosage, as well as your interpretation regarding the results. Lastly, question 4 is an essay-based question on the theory of pharmacokinetics. 2 practical (short answer/calculation) questions, 2 essay questions: plan your time wisely according to what is the best strategy for yourself.

A common strategy for revision is to split your notes into two sections for each topic. The first section covers the physiology of relevant systems and the pathophysiology of diseases involved. The second section, and the core of pharmacology, is to compile a list of drugs which can be used to target the relevant diseases or conditions. Within each list, drugs can be categorised separately (e.g. by mechanism of action or side effects etc.). Additional information about each drug (e.g. side effect profile, pharmacokinetics, contraindications etc.) can be added such that pharmacological treatments can be more easily compared and contrasted as well (which is an important skill often required in Tripos essay questions).

It is encouraged to try to simulate closed-book conditions, and attempt essay questions within the given time limit, then review your answers either with your supervisors to evaluate the structuring and coverage of your essay or by cross-checking with your own notes to see if there is anything you wished to write but you missed out on. The same kind of timed practice is also relevant for practical-based questions as well. You’ll be given a formula sheet that you can refer to, but practising how to use the formulae is also important and can save you a fair amount of time during the WP paper to spend on essay-based questions.

Useful resources

• The bible for Part IB Pharmacology: Rang & Dale’s Pharmacology (Rang et al., latest edition not required) – the go-to for all additional knowledge required about literally any topic, complete with stylish and detailed diagrams (most lecture notes/diagrams are based on this book too). For any other information about the course, a good reference would be the latest edition of the NST Part IB Pharmacology Course Handbook typically available on Moodle.