Nutrition, pharmacology and toxicology

A.Y. 2019/2020
Overall hours
Learning objectives
The aim of the course is to provide the students with an advanced knowledge and the pathological bases of the major metabolic diseases and nutritional disorders, as well as on the pharmacological and nutritional interventions for their treatment. In details, the course aims to develop the understanding of (i) the pathogenic mechanism of main metabolic diseases; (ii) the nature and mechanism of action of main drugs for their therapy; and (iii) the bases of the nutritional approaches for their treatment.
Expected learning outcomes
At the end of the course, students should have acquired an advanced understanding of the nature of most common metabolic diseases and nutritional disorders, as well as of the pharmacological and physiological bases of their treatment. They should be able to disseminate what they learned and to explain it to not scientifically trained people. They should also be able to tackle new topics of the field, during their future activity.
Course syllabus and organization

Single session

Lesson period
First semester
Course syllabus
· drug absorption, distribution, metabolism and excretion
· Phase I and II reactions
· Pharmacogenomics
· Classification of drug targets and mechanisms of action
· Interaction and efficacy parameters
· Therapeutic and adverse effects
Drug development
· Preclinical and clinical studies of kinetics, efficacy and toxicity
· Pharmacovigilance
· Ethical issues in drug development
· General causes of drug failure
· Atherosclerotic process
· Lipid and lipoprotein metabolism
· Classification of dyslipidemias and pharmacological targets
· Pharmacological management: statins, ezetimibe, PCSK9 inhibitors, PPAR-alpha agonists
· Dietary intervention: omega-3 fatty acids, phytosterols, fibers, berberine, red yeast rice
· Prevalence and classification
· Regulation of food intake
· Pharmacological management: sympathomimetics and orlistat
· Emerging targets: GLP-1, leptin, white and brown adipose tissue
· Dietary intervention: caloric restriction, fibers, omega-3, polyphenols
· Diagnosis and classification
· Mechanisms of glycemic control
· Pharmacological management: insulin, solfonylureas, GLP-1R agonists, DPP-4 inhibitors, metformin, PPAR-gamma agonists
· Dietary intervention: low-carbohydrate diet, fibers, olive oil
· Determinants of arterial pressure: role of sodium, renin-angiotensin system and sympathetic nervous system
· Pharmacological management: renin inhibitors, ACE-inhibitors, AT1 receptor antagonists, loop diuretics, thiazides, K+-sparing agents, beta-blockers, Calcium channel blockers
· Dietary intervention: weight loss, sodium restriction, DASH and Mediterranean diet, potassium, alcohol, cocoa flavonoids, garlic, beetroot, omega-3
Platelet aggregation and blood coagulation
· Platelets and coagulation factors
· Mechanisms of hemostasis
· Anti-aggregant drugs: acetylsalicylic acid, thienopyridines, thrombin receptor antagonists, gpIIb/3a antagonists
· Anticoagulant drugs: heparins, direct inhibitors of thrombin and Xa, warfarin
· Drug-food interactions: vitamin K, garlic, ginkgo, ginseng, ginger, omega-3, vitamin E, olive oil
· Regulation of serum uricemia and gout pathogenesis
· Pharmacological management: anti-inflammatory drugs, colchicine, uricosurics, xantine oxidase inhibitors, uricase
· Dietary intervention: weight loss, alcohol, purine-rich foods, diary products, fructose, coffee, vitamin C
· Red blood cell production
· Role of erythropoietin, iron, vitamin B12 and folic acid
· Classification of anemias and oral/parenteral treatment of nutritional deficiencies
· Dietary sources of iron, vitamin B12 and folic acid and their bioavailability
· Effect of Helicobacter pylori infection
Heart failure
· Definition, classification, pathogenesis and prognosis
· Pharmacological management: RAAS inhibitors, diuretics, beta-blockers, digoxin
· Dietary intervention for HF prevention: control of body weight, arterial pressure and glycaemia
· Dietary intervention for HF management: preservation of body weight, nutritional deficiencies, restriction of water and sodium intake, supplementation with aminoacids, coQ10, iron, omega-3, carnitine, creatinine and vitamins
Gastroesophageal reflux and peptic ulcer
· Regulation of gastric secretion
· Role of Helicobacter pylori and anti-inflammatory drugs
· Pharmacological management: proton pump inhibitors, H2 receptor antagonists, misoprostol, sucralfate and antacids
· Dietary intervention: weight loss, elimination diets, probiotics for Helicobacter pylori infection
Alteration of gastrointestinal motility
· Mechanisms of peristalsis regulation
· Classification, causes and consequences of altered GI motility
· Pharmacological management: prokinetics, laxatives, antidiarrheal, antinauseant and antiemetic agents
· Dietary intervention: elimination diets, FODMAP diet, probiotics and fibers
Non-alcoholic fatty liver disease
· Pathogenesis, diagnosis and classification
· Dietary intervention: weight loss, beneficial components of the Mediterranean diet, vitamin E, silybum marianum
Food-drug interactions
· Pharmacokinetic interactions
· Pharmacodynamic interactions
· Effect of meals, fibers, calcium-containing foods on drug absorption
· Enzymatic inductors and inhibitors: grapefruit, St. John's Wort, flavonoids
· Pharmacodynamic interactions: potassium- and tyramine-rich foods, licorice
Design of dietary intervention studies
· Key parameters of randomized controlled studies
· Inclusion and exclusion criteria
· Selection of intervention strategy, of the active treatment and of the control treatment
· Adherence and compliance: impact and measurement
Prerequisites for admission
Notions of biology, anatomy and physiology, biochemistry of nutrition, biology of Nutrition.
Teaching methods
Lectures supported by slides.
Teaching Resources
"Goodman & Gilman's: The Pharmacological Basis of Therapeutics" Ed. McGraw-Hill
Assessment methods and Criteria
Oral exam; questions are aimed to verify the student's knowledge on the course's topics. In itinere tests will not be performed.
BIO/14 - PHARMACOLOGY - University credits: 6
Lessons: 48 hours
Professor: Gomaraschi Monica