Introduction to Pharmacology أ. م. د. وحدة اليوزبكي

Objectives At the end of this lecture, students should be able to : 1- Define Pharmacology 2- Define some terms related to Pharmacology 3- List References accepted to Pharmacology 4- Identify Evidence-Based Medicine (EBM) 5- List Steps in EBM process 6- Recognize EBM website - At a level accepted to the quality assurance standards for the College of Medicine/ University of Mosul.

Some Definitions Pharmacology: It is the science that deals with the interaction between the living system & small molecules particularly chemicals Drug: It is the chemical molecules which alter biochemistry & physiology of the living system when introduced inside the body

Medical Pharmacology: The science of substances which are used for the prevention, diagnosis and treatment of diseases.

Toxicology: It is part of pharmacology which deals with the undesired or toxic effect of drugs. Pharmacy: It is the science that deals with the preparing & dispensing the drugs (medicine).

References I- Clinical Pharmacology, 10th edition 2008 Edited by Bennett PN and Brown MJ. المقرر II- Others: 1- Lippincott,s Illustrated Reviews of Pharmacology 5rd edition 2012 , Series editors: Harvey R.A. and Champe PC 2- Basic and Clinical Pharmacology, 11th edition 2009, Edited by Katzung BG 3- Evidence-Based Medicine (EBM)

Evidence-Based Medicine (EBM) (الطب المبني على الدليل) EBM is the combination of: Patient Concerns Clinical skill Best research evidence EBM

But, Experience “alone” can be a poor (and even dangerous) The recommendations that physicians make to patients without EBM depend on: - His current state of knowledge. - Colleagues suggestions and advices . - His experience with patients and diseases. - Textbooks. But, Experience “alone” can be a poor (and even dangerous)

Important facts -The knowledge base of clinical medicine is continuously expanded. - The history of medicine include countless examples of therapies that were once widely accepted but later were shown to be ineffective or even harmful for patients. -The physicians, ethically should search the latest available knowledge.

As Dr.Haines, stated, there are currently over 20 000 medical journals world-wide, and they publish a total of two million articles each year (if stacked on top of another, the pile would be 500 meter high). He estimated that any physician would have to digest 19 original articles "every day" in order to keep up to date in his subject. Is it possible??????

- One of the apparently promising solution for this problem is the introduction of "Evidence-Based Medicine" which both can actually filter all valid and reliable information and medical news into those more accurate, more relevant, and more specific to the subject of concern.

Sir Archie Cochrane, 1972 The founder of EBM

Steps in EBM process 1. Formulate an answerable question. 2. Find the best evidence. 3. Critically evaluate the evidence. 4. Integrate with clinical knowledge and patient values.

Methodology in EBM Formulating answerable questions: The first step in EBM is by converting a clinical situation into a searchable, (and hopefully answerable) question using: PICO: 1. PATIENT. 2. INTERVENTION. 3. COMPARISON. 4. OUTCOME.

PICO (P): “Patient” refers to the person presenting with the problem, or more simply, to the “problem” itself. (I): “Intervention” refers to the action taken in response to the problem. This is often a drug or surgical procedure, but it can take many forms. (C): “Comparison” Often it refers to another treatment, no treatment, or a placebo. (O): “Outcome” refers to the expected result of the intervention.

Clinical e.g. : A 60 years old lady with knee osteoarthritis (OA) not responding to non steroidal anti inflammatory drugs (NSAIDs), you know that intra articular (IA) steroid may improve her condition, but it is safety measure or not?? NOW PICO will be: P (patient): Knee OA I (intervention): IA steroids C (comparison): NSAIDs O (outcome): Safety The question will be as the following: Knee OA IA steroids VS NSAIDs Safety

Searching Tools: MEDLINE: Include both; 1. PubMed 2 Searching Tools: MEDLINE: Include both; 1. PubMed 2. Cochrane’s data Base & Best Evidence Thus the question here could be as: If you directly go to Yahoo or Google search Knee OA IA steroids Vs NSAIDs Safety PubMed or Knee OA IA steroids Vs NSAIDs Safety Best Evidence or Knee OA IA steroids Vs NSAIDs Safety EBM

Or, by entering to the EBM website directly and here you can choose with many different qualities of options such as the following:

At the end, we should remember that EBM is not cook-book medicine Because EBM is the combination of: with Best available evidence and Clinical skill Patient preference

The End