La enseñanza de la farmacología en las escuelas de medicina: situación actual y perspectivas / The teaching of pharmacology in medical schools: current status and future perspectives

La farmacología es una ciencia básica que estudia las interacciones entre los fármacos y la materia viva. En las escuelas de medicina se imparte en el segundo año y su estudio se centra en los fundamentos de la disciplina y en los fármacos útiles en el tratamiento de las enfermedades del hombre. Se asume que este conocimiento farmacológico se repasa y expande en los cursos clínicos y que los estudiantes están preparados para prescribir fármacos apropiadamente cuando se gradúan. Sin embargo, desde hace varios años se sabe que la educación farmacológica es insuficiente y que la prescripción irracional de medicamentos es muy frecuente. La sobrecarga de información y la proliferación de nuevos medicamentos son dos factores que contribuyen a este problema. Para enfrentar esta situación se ha recomendado la elaboración de programas básicos de farmacología y una lista de fármacos prototipo. Con base en nuestra experiencia docente identificamos el contenido de lo que debe constituir un programa básico de farmacología, y publicamos una guía para orientar el estudio de la disciplina. Ambos documentos permiten a los estudiantes apreciar qué necesitan aprender del conocimiento farmacológico y los fármacos que deben manejar; el total de ellos se limita a 168. Nuestro programa representa el primer esfuerzo para medicalizar la enseñanza de la farmacología en las escuelas de medicina; esperamos que la mayoría de ellas lo consideren, ya que se puede aplicar a todas las modalidades curriculares vigentes.

Pharmacology is a core course in all medical school curricula. In most medical schools, pharmacology is taught during the second year and teaching covers both basic aspects and useful drugs for the treatment of human diseases. It is assumed that relevant pharmacologic knowledge is revisited during the clinical clerkships and that students are adequately trained to prescribe drugs upon graduation. However, for many years it has been noted that pharmacological training is sometimes insufficient and that inadequate and irrational prescription of drugs is a very common problem in clinical settings. Information overload and proliferation of new drugs have been recognized as two of the major contributing factors. To address this issue, many authors have recommended the development of a core curricula in pharmacology which all students would have to complete coupled with a restricted list of drugs. Based on our own teaching experience we have identified what should constitute the core content of pharmacology courses in medical schools and have written a study guide for this discipline. Both documents provide an organizational framework to help second year medical students ascertain what part of the vast knowledge in pharmacology they need to learn. The number of drugs that students have to manage is limited to 168. Our program constitutes the first effort to medicalize the teaching of pharmacology in medical schools. We expect that most medical schools will follow our guidelines as our program is applicable to all curricula modalities.

Tachyphylaxis and sensitization to nicotine-induced tachycardiac and pressor effects after nicotine infusions

This work examined the effects of nicotine on mean arterial pressure and heart rate in non-anesthetized as a single bolus, as infusions lasting 7.5, 15 or 30 min, and as a post-infusion bolus. A nicotine bolus increased pressure and rate. These effects were less marked as the rate of infusion decreased. The infusions affected differentially the effects of a subsequent bolus. Thus, while tachycardia was decreased, the blood pressure rise was increased. An initial transiet bradycardia was observed after bolus administration, but not during infusions; this effect was unchaged after post-infusion boluses. Pharmacological analysis indicated that tachycardia and bradycardia were predominantly due to ganglionic stimulation, while adrenal and sumpathetic nerve catecholamine release played a major role in the pressor response., These results indicate that slow nicotine infusions do not induce tachyphylaxis for all of the cardiovascular effects of a subsequent bolus, and that development of acute tolerance appears to depend on the mechanism of action of the response

Patterns of heart rate responses to hydralazine in normotensive and hypertensive rats

Hydralazine (H) induces hypotension acompanied by cardiac stimulation due to activation of ther arterial baroreflex. Both clinical and experimental observations suggest, however, that in certain conditions H hypotension can be accompanied by unchanged or even depressed cardiac performance. The present study determined whether varying petterns of heart rate responses could be detected in large populations of conscious normotensive (n=61) and renal hypertensive (n = 59) rats receiving a single dose of H. These patterns were compared with those of normotensive pentobarbital-anesthetized rats (n = 43). In the three groups, hypotension was accompanied by either tachycardia, unchanged heart rate or bradycardia. Tachycardia was found in 52 percent of normotensive conscious rats, in 51 percent of hypertensives and in only 14 percent of anesthetized animals. Heart rate did not change in 26, 35 and 23 percent, while bradycardia was detected in 22, 14 and 63 percent, respectively . These results were explained by postulating the initiation by H of two reflexes with opposite effects on heart rate: the arterial baroreflex producing tachycardia and a cardiac mechanoreceptor reflex producing bradycardia. These reactions would compete with each other, with results depending on their relative sensitivity in a given animal

Trabajos de investigación 1990 / Research works 1990

El estudio surgío con la necesidad de revisar la confiabilidad diagnóstica de los pacientes (82 expedientes primer trimestre 1988) el tratamiento y la evolución hospitalaria que se ha brindado a pacientes con diagnóstico de esquizofrenia, siendo que este diagnóstico es uno de los más frecuentes en el Hospital Psiquiátrico "Fray Bernardino Alvares". Se encuestaron 44 pacientes masculinos y 38 del sexo femenino, 30-36 promedio de edad, escolaridad 15.9% primaria completa, 13.4% con secundaria, 7.3% con preparatoria, 2.4% educación profesional y 2.4% analfabeta; 56.1% no tenian ocupación, la mayoria provenian del D.F. o Valle de México; 74.4% su estado civil eran solteros, 23 pacientes se hospitalizaron por primera vez; 32 pacientes provenian de familias desintegradas, 25 de familias integradas y 2 no se corroboró. El promedio de estancia en el hospital es de 68-93 días. El uso de fármacos demostró que la perfenazina tuvo un 92% de resultados satisfactorios,los medicamentos más usados fueron los neviolepticos (125 ocasiones). A su egreso se ha controlado el brote agudo de enfermedad y diagnóstico emitido es concordante en un 71% con el