Clinical pharmacology

Clinical pharmacology is the science of drugs in humans and their optimal clinical use in patients. It is underpinned by the basic science of pharmacology, with an added focus on the application of pharmacological principles and quantitative methods in the real human patient's population. It has a broad scope, from the discovery of new target molecules to the effects of drug usage in whole populations.[1]

Clinical pharmacologists usually have a rigorous medical and scientific training that enables them to evaluate evidence and produce new data through well-designed studies. Clinical pharmacologists must have access to enough outpatients for clinical care, teaching and education, and research as well as be supervised by medical specialists. Their responsibilities to patients include, but are not limited to, analyzing adverse drug effects, therapeutics, and toxicology including reproductive toxicology, cardiovascular risks, perioperative drug management and psychopharmacology.

Clinical pharmacology also connects the gap between medical practice and laboratory science. The main objective is to promote the safety of prescription, maximize the drug effects and minimize the side effects. In this aspect, there can be an association with pharmacists skilled in areas of drug information, medication safety and other aspects of pharmacy practice related to clinical pharmacology. In fact, in countries such as USA, Netherlands, and France, pharmacists can be trained to become clinical pharmacists, to improve optimal drug therapy with clinical pharmacology related knowledge.

In addition, the application of genetic, biochemical, or virotherapeutic techniques has led to a clear appreciation of the mechanisms involved in drug action.

A bachelor's degree, in a clinical, health science or bioscience related field is typically required for enrollment on a master's degree level course in pharmacology.[2] Institutions may also hold specific coursework and credit requirements for enrollment on advanced degrees in pharmacology.[3]

Branches

Clinical Pharmacology consists of multiple branches listed below:

  • Pharmacodynamics - what drugs do to the body and how. This includes not just the cellular and molecular aspects, but also more relevant clinical measurements. For example, not just the biology of salbutamol, a beta2-adrenergic receptor agonist, but the peak flow rate of both healthy volunteers and real patients.
  • Pharmacokinetics - what happens to the drug while in the body. This involves the body systems for handling the drug, usually divided into the following classification:
    • Absorption - the process of the drug moving into the bloodstream
    • Distribution - the reversed transmission of the drug from one location to the other in the human body
    • Metabolism - the process of how the drug is metabolized in the liver of the human body
    • Excretion - the process of how the drug expels, happens in the liver and kidneys.[4]
  • Rational Prescribing - using the right medication, at the right dose, using the right route and frequency of administration for the patient, and stopping the drug appropriately.
  • Adverse Drug Effects - determining the side effects of the medicine
  • Toxicology - deals with the negative effects on a living system caused by chemicals
  • Drug interactions - the study of how drugs interact with each other. Two drugs may negatively or positively affect the drug effects.
  • Drug development - usually culminating in some form of clinical trials and marketing authorization applications to country-specific drug regulators such as US FDA.
  • Molecular Pharmacology - studying drug action at the molecular level. This is also a branch of pharmacology in general, but the ultimate interest is in human as a system.
  • Pharmacogenomics - studying human genome to learn interaction of drugs with genetics, etc. [5][6]

History

Medicinal applications of plant and animal resources have been common since prehistoric times. Many countries have written documentation of their early traditional remedies of many types, like China, Egypt, and India. Some of these remedies are still identified as helpful in today's society, but most have them have been discarded due to the fact that they were useless and potentially harmful. During the 1500s, intermittent attempts were made to advance the methods of medicine. Schools were made to teach these advances, but none of these methods was effective and this led to the domination of thought that claimed to explain everything in regards to biology and disease with no experimentation to back it up. These schools would come up with strange methods that they believed were the answers to disease and injury. They thought that a wound could be healed if an ointment was applied to the weapon, and that disease was caused by having too much bile and blood in the human body.

Around the 17th century, theoretical medicine was set aside and forgotten about, and people started to use medicine that was based on analysis and experimentation. Physicians began to apply these new methods to the traditional drugs and remedies that they had in their own culture. This is when the sciences of the preparation and use of medical drugs began to develop, although they still lacked methods to test some of the hypotheses they had about how drugs worked in the body.[7]

By the late 18th century and early 19th century, the development of the methods of experimental physiology and pharmacology by François Magendie and his student Claude Bernard.

From the late 18th century to the early 20th century, advances were made in chemistry and physiology that laid the foundation that was needed in order to understand drugs at the organ and tissue level. The advances that were made at this time gave manufacturers the ability to make and sell medicine that they claimed to be legitimate but were worthless. These claims were not able to be evaluated until the rational therapeutic concepts were reestablished in medicine about 60 years later.

Around that same time, major development and growth in biology began. Information started to pile up on biological substrates and drug movements as soon as new techniques and concepts arose. During the last half-century, many new and some old drug groups were introduced. There has been even more rapid growth in even the last three decades, with understanding the bases of drug action at a molecular level. This new information has helped to identify the molecular mechanisms of many dugs and separate receptors and clone them. These methods aided in the many discoveries dealing with receptors.

The expansion of scientific principles of pharmacology is still on-going today.[8][6]

References
  1. Atkinson, Arthur (2012). Principles of clinical pharmacology. London: Elsevier Academic Press. ISBN 978-0123854711.
  2. Herbert, Nikki, MA (2018). "MS Clinical Pharmacology Curriculum". The Ohio State University. Archived from the original on 2018-01-19. Retrieved 2018-04-10.
  3. Burnbaum, Dr., Angela. "Degree Requirements, College of Pharmacy". University of Minnesota.
  4. Ambrose, Paul G (January 2007). Pharmacokinetics-Pharmacodynamics of Antimicrobial Therapy, Clinical Infectious Diseases, Volume 44, Issue 1.
  5. Chatu, Sukhdev., and Christopher. Tofield. The Hands-on Guide to Clinical Pharmacology. 3rd ed., Wiley-Blackwell, 2010
  6. Zatzung, Bertman G. (2010). Basic & Clinical Pharmacology. San Francisco, California: McGraw Hill Companies.
  7. Paul G. Ambrose, Sujata M. Bhavnani, Christopher M. Rubino, Arnold Louie, Tawanda Gumbo, Alan Forrest, George L. Drusano; Pharmacokinetics-Pharmacodynamics of Antimicrobial Therapy: It's Not Just for Mice Anymore, Clinical Infectious Diseases, Volume 44, Issue 1, 1 January 2007, Pages 79–86, https://doi.org/10.1086/510079
  8. Clinical Pharmacology. The SAGE Encyclopedia of Pharmacology and Society. 2015.
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