Feb 252019

Toxicology and Drugs is the study of the nature, effects, and detection of poisons. Medicos Library has provided high standard Toxicology and Drugs Notes by Dr. Yousif Abdallah Hamad.

Summary of Notes:

Pharmacokinetics: metabolism

  • phase I reactions: oxidation, reduction, hydrolysis. Mainly performed by the P450 enzymes but some drugs are metabolised by specific enzymes, for example alcohol dehydrogenase and xanthine oxidase. Products of phase I reactions are typically more active and potentially toxic
  • phase II reactions: conjugation. Products are typically inactive and excreted in urine or bile. Glucuronyl, acetyl, methyl, sulphate and other groups are typically involved

Drug metabolism in patients with advanced liver disease

  • Drug processing via mixed function oxidases is affected early in liver disease
  • Conjugation reactions are affected to a lesser extent by advanced liver disease and only occur in very late stage disease
  • Plasma proteins fall in liver disease and may negatively affect drug distribution
  • Both intrahepatic and extrahepatic cholestasis may affect the metabolism of drugs that are actively secreted into bile, eg ciprofloxacin

Effects of age on drug metabolism

  • For these reasons, ‘box-ticking’ healthy elderly studies are rarely able to detect problems associated with the use of new drugs in the elderly age group
  • Many problems associated with the use of new drugs in the elderly may only be discovered through adverse event reporting during the post-launch period

Advice form Dr. Yousif Abdallah Hamad

How to use the notes to study for MRCP:

  • Initially, you need to skim through the notes at least twice to build up an idea about the syllabus of MRCP. Highlight any portion that is difficult so that you can concentrate on that during your revision.
  • Next proceed to the question banks. You can choose to do Passmedicine, onexamination or Pastest. I usually recommend students to do Passmedicine and the Pastest.
  • As you go through the questions make a super-revised notes of your own. Write down in one sentence what you learned from the question you just attempted.
  • If you get any question wrong or you get confused then return to the notes and re-read one more time before attempting the question again. And write down the point in red in you revision notes so that you can skim through it easily during your revision.
  • I have highlighted some points in yellow and green to help you concentrate on those points. As you go through passmedicine and pastest, you can highlight the points further to help in your revision.
  • During your revision before the main exam, only read the highlighted portions including those that you highlighted when practicing the question bank. And also read your super-revised notes that you made from the question banks.

I believe these method has worked for many students and will help you in your journey to be successful in MRCP part 1 and as well as build your basics for Part 2.

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Find more Notes By Dr. Yousif Abdallah Hamad

Notes Basic Science Biostatistics Notes Basic Science Immunology
Notes Basic Scienses Biochemistry Metabolism Notes Cardiology
Notes Dermatology Notes Endocrinology
Notes Gastroenterology Notes Haematology
Notes Infectious Diseases Notes Neurology
Notes Ophthalmology Notes Pharmacology
Notes Renal System Notes Respiratory Medicine


Jan 282019

Toxicology and Drugs is a essential part of MRCP exam carrying 16 marks in the exam. Most student usual attain low marks in this section. Toxicology and Drugs is the study of  the nature, effects, and detection of poisons. Medicos Library has provided high standard Toxicology and Drugs on examination revision materials for medical exams.

Clinical pharmacology, therapeutics and clinical toxicology

  • Pharmacology
    - Mechanisms by which drugs produce their pharmacological effects
    - Basic principles of agonism and antagonism
    - Clinical implication of drugs that act at different receptor sites
    - Links between the pharmacological effects of drugs at the molecular level, the cellular level, and the tissue / organ level, and how these are affected by disease processes and other drugs
    - Principles by which both therapeutic and adverse effects occur
  • Clinical pharmacokinetics
    - Processes of drug absorption and distribution
    - Bio-transformation and excretion
    - Concepts of drug half-life and clearance
    - First order and zero order kinetics
  • Monitoring drug therapy
    - Direct measurement of therapeutic response
    - Measurement of plasma drug concentrations
    - Scientific basis for the measurement of drug concentration and its link to the principles of pharmacokinetics
  • Adverse drug reactions
    - Epidemiology of adverse drug reactions: recognition and avoidance
    - Important adverse effects of commonly used drugs
    - Importance of adverse drug reaction reporting schemes
  • Drug interactions
    - Adverse drug interactions and mechanisms by which interaction may occur
    - Common drug interactions and their clinical consequences
  • Pharmacogenetics
    - Principles of pharmacogenetics and its importance in determining variations in response to drugs in man, both in term of efficacy and toxicity
    - Clinical consequences of the common pharmacogenetic variations relevant to clinical practice
  • Therapeutics for specific patient groups
    - Principles of therapeutics as they apply in the following circumstances:
    The elderly
     Pregnancy and breast feeding
    — Patients with renal disease
     Patients with hepatic disease
    —– Effects of these altered physiology on the pharmacokinetics and pharmacodynamics of drugs
     Principle underlying drug choice, in pregnancy and breast feeding
     Teratogenic effects of drugs that may be used in pregnancy – Drugs that may produce toxicity in the case of renal and hepatic disease
  • Clinical toxicology
    - Principle of management of patients poisoned by drugs or other toxic substances
    - Assessment, recognition of common symptom patterns
    - Principles of removal of toxic substances
    - Antidotes where these approaches may be appropriate
  • Criteria for selecting drugs in a therapeutic class
    - Criteria used to select a drug from among drugs in a popular therapeutic class including:
    Differences in pharmacokinetics and pharmacodynamics
     The approved indications of the drug 
     Possible adverse effects or drug inteactions 
     Cost effectiveness 
    —– Used to describing studies that may be used to underpin drug selection
  • Drug formulations and routes of administration
    - Various formulations of medicines available
    - Routes by which medicines may be administered
    - Advantages and disadvantages of various routes and preparation
    - Most appropriate formulation selection and drug administration in common clinical scenarios

MRCP(UK) develops and delivers postgraduate medical examinations around the world on behalf of the three Royal Colleges of Physicians of the UK.

Part 1 at a glance

  • one-day examination
  • two three-hour papers
  • 200 mutiple-choice (best of five) questions
  • no images
  • sat in an examination hall.

Exam pass marks

MRCP(UK) examinations

Examination Pass mark
Part 1 540
Part 2 Written 454
PACES 130 (see individual skills breakdown below)

The composition of the papers is as follows:

Specialty Number of questions*
Cardiology 15
Clinical haematology and oncology 15
Clinical Pharmacology, Therapeutics and Toxicology 16
Emergency and Critical care
Clinical sciences** 25
Dermatology 8
Endocrinology 15
Geriatric medicine 4
Gastroenterology 15
Infectious diseases and GUM 15
Neurology 15
Nephrology 15
Ophthalmology 4
Psychiatry 8
Respiratory medicine 15
Rheumatology 15

* This should be taken as an indication of the likely number of questions – the actual number may vary slightly.

** Clinical sciences comprise:

Cell, molecular and membrane biology 2
Clinical anatomy 3
Clinical biochemistry and metabolism 4
Clinical physiology 4
Genetics 3
Immunology 4
Statistics, epidemiology and evidence-based medicine 5

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