Pharmacology

A.Y. 2019/2020
10
Max ECTS
120
Overall hours
SSD
BIO/14
Language
Italian
Learning objectives
The course aims to offer students a broad overview of the principles of General Pharmacology, including the issue of polytherapy and drug interaction, and a thorough exposition of Clinical Pharmacology. Principal aims of this course are that students: i) acquire up-to-date knowledge on drugs, ii) learn relevance of the correct use of drugs in the context of therapeutic approaches to different disorders; iii) acquire the tools for future updating their knowledge in the field.
Expected learning outcomes
Students will acquire adequate tools to understand the relevant parameters of pharmacokinetics and pharmacodynamics and the methods of their correct use in patient management. Students will learn names, mechanisms of action, therapeutic indications, contraindications, side effects, and appropriate administration procedures of the main drugs.
Course syllabus and organization

Linea: Policlinico

Responsible
Course syllabus
The course program includes presentation and discussion of the following topics:

General pharmacology
· concept of drug as a substance capable of modifying the biological functions of the organism for curative, prophylactic or diagnostic purposes
· clinical trials of drugs and pharmacovigilance
· principles of Pharmacoeconomics
· critical aspects of "alternative" therapies
· mechanisms that regulate the absorption of drugs in relation to the different routes of administration
· mechanisms of drug distribution in the body and drug binding to plasma proteins
· biotransformation processes and their clinical importance
· drug elimination mechanisms
· distribution volume, half-life, clearance and steady-state plasma concentration of a drug; practical examples of the application of these pharmacokinetic parameters in simulations of clinical conditions
· molecular targets and cascade of events through which a drug produces a cellular response
· various types of drug-receptor interaction (full and partial agonists, inverse agonists, antagonists, orthosteric and allosteric interaction) and possible alterations of the receptor response during prolonged treatments or in particular pathological conditions
· efficacy and potency of drugs, based on their dose-response curves
· selectivity, specificity, and toxicity of drugs
· therapeutic index
· variability in the response to drugs in relation to pathologies, concomitant therapies, genetic profile, and gender

Pharmacology and Clinical Therapeutics
· drugs that modulate synthesis, storage, release, catabolism and interaction with the receptors of the main neurotransmitters and autacoids
· drugs for the treatment of obesity, metabolic syndrome and eating behavior diseases
· drugs for the treatment of heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF)
· drugs for the treatment of high blood pressure
· anticoagulant drugs (including the parenteral anticoagulant heparin and its derivatives; the coumarin anticoagulants; the direct oral anticoagulants
· antiplatelet drugs which attenuate platelet activation (such as aspirin, clopidogrel, ticagrelor) or platelet aggregation (glycoprotein IIb / IIIa inhibitors)
· fibrinolytic drugs which degrade fibrin
· vitamin K, which is required for the biosynthesis of key coagulation factors
· drugs for the treatment of dyslipidaemias, including statins, bile acid-binding resins, nicotinic acid (brief notes), fibric acid derivatives (fibrates), inhibitors of cholesterol absorption (ezetimibe), omega-3, PCSK9 inhibitors, bempedoic acid
· drugs and their use in different types of angina
· anti-arrhythmic drugs (brief notes)
· drugs that affect kidney function, including carbonic anhydrase inhibitors, osmotic diuretics, loop diuretics, thiazide diuretics, K+-sparing diuretics, aldosterone antagonists, natriuretic peptide analogues (nesiritide), vasopressin receptor agonists and antagonists (brief notes)
· drugs for the treatment of gastric acidity, peptic ulcer and gastroesophageal reflux, including pump inhibitors, histamine 2 receptor antagonists, mucosal defensive agents
· drugs for the treatment of gastrointestinal motility and water flux (prokinetic, laxative, antidiarrheal agents)
· anti-nausea and anti-emetic drugs
· steroid and nonsteroidal anti-inflammatory drugs (NSAIDs)
· drugs for the treatment of bronchial asthma, chronic obstructive pulmonary disease
· drugs that modulate neuronal transmission
· drugs for the treatment of depressive and anxiety disorders, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, atypical antipsychotics, MAO-A inhibitors, atypical antidepressants (bupropion, trazodone, nefazodone, mirtazapine), benzodiazepines
· drugs used for the therapy of psychosis and mania
· hypnotic drugs
· antiepileptic drugs
· drugs used in the treatment of the central nervous system degenerative disorders, including anti-Parkinson (l-DOPA, Carbidopa, dopaminergic agonists, COMT inhibitors, MAO-B inhibitors, amantadine, triexifenidil, benztropine), anti-Alzheimers (acetylcholinesterase inhibitors, low-affinity uncompetitive NMDA antagonist (memantine), anti-Huntington, anti-ALS (riluzole), anti-spastic agents (baclofen, benzodiazepine, dantrolene)
· pain management
· anesthetic drugs (brief notes)
· drug use disorders and addiction
· drug treatment of diabetes mellitus, including insulin (different insulin formulations), oral glucose-lowering agents (biguanides: metformin; -glucosidase inhibitors; DPP-4 inhibitors; insulin-secretagogues sulfonylureas and non-sulphonylureas ; thiazolidinediones; SGLT2 inhibitors); GLP-1 analogues; amylin analogue (pramlintide)
· drugs to reverse hypoglycaemia (glucagon)
· drugs for the treatment of osteoporosis
· drugs that modulate the reproductive system (estrogens, progestins) and selection criteria for contraception and hormone replacement therapy in menopause

Chemotherapy
· spectrum of action, mechanisms of action and specific targets of the main classes of antibiotic-chemotherapy drugs
· selection criteria and appropriate use of antibiotic-chemotherapy drugs in relation to the pathogen and the type of patient
· antibacterial drugs, including sulfonamides, -lactams, aminoglycosides, macrolides, lincosamides, tetracyclines, chloramphenicol
· agents for urinary tract infections
· chemotherapy of tuberculosis
· antiviral agents
· antifungal, antiprotozoal and antihelminth infection agents
· anticancer drugs and their mechanism of action
· mechanisms of resistance to chemotheraputics, developed by microorganisms and cancer cells
· immunomodulatory drugs
Prerequisites for admission
Preparatory knowledges of biology, human anatomy, biochemistry, human physiology, pathophysiology, general pathology and microbiology are required
Teaching methods
Lectures and analysis/discussion of clinical case reports, with the help of iconographic material, partially made available on UniMI computer platforms. The consultation of the material presented during the lectures does not replace the study on textbooks. The teachers deny consent to disseminate the registration of the lessons in any form.
Teaching Resources
A textbook chosen from the following (authors, title, publisher, year). Please note that UniMI has activated the subscription to the Access Medicine platform, so some texts are available in the original language (English) and others free online with university credentials.

Laurence L. Brunton Randa Hilal-Dandan Björn C. Knollmann. Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition, 2018

Goodman and Gilman Manual of Pharmacology and Therapeutics, Second Edition (Goodman and Gilman's Manual of Pharmacology and Therapeutics) 2014

Katzung BG, Masters SB, Trevor AJ. Basic and Clinical Pharmacology, 11th Edition Mcgraw-Hill

Stefano Govoni. Farmacologia. Casa Editrice Ambrosiana. Distribuzione esclusiva Zanichelli 2014

Clementi F, Fumagalli G, Farmacologia generale e molecolare, 5a edizione EDRA 2018
Assessment methods and Criteria
The methods used to achieve and ascertain the effective achievement of the learning outcomes expected by the student are:
- oral examination
- questions of general pharmacology, special and clinical pharmacology, chemotherapy including antibiotics, antineoplastics, antifungals or anthelmintics
- the evaluation parameters include: framing ability and general presentation of the topic, ability to describe the pharmacokinetic and pharmacodynamic characteristics of the drugs, demonstration of knowledge of the use and clinical indications of the drugs, description of the side effects of the drugs, ability to identify interactions between drugs in polytherapy
- the exam is delivered by at least two teachers separately
- the final evaluation is made globally by the examination commission, not necessarily based on the average of the single evaluations
BIO/14 - PHARMACOLOGY - University credits: 2008
Lessons: 120 hours

Linea: San Donato

Responsible
Course syllabus
The course program includes presentation and discussion of the following topics:

General pharmacology
· concept of drug as a substance capable of modifying the biological functions of the organism for curative, prophylactic or diagnostic purposes
· clinical trials of drugs and pharmacovigilance
· principles of Pharmacoeconomics
· critical aspects of "alternative" therapies
· mechanisms that regulate the absorption of drugs in relation to the different routes of administration
· mechanisms of drug distribution in the body and drug binding to plasma proteins
· biotransformation processes and their clinical importance
· drug elimination mechanisms
· distribution volume, half-life, clearance and steady-state plasma concentration of a drug; practical examples of the application of these pharmacokinetic parameters in simulations of clinical conditions
· molecular targets and cascade of events through which a drug produces a cellular response
· various types of drug-receptor interaction (full and partial agonists, inverse agonists, antagonists, orthosteric and allosteric interaction) and possible alterations of the receptor response during prolonged treatments or in particular pathological conditions
· efficacy and potency of drugs, based on their dose-response curves
· selectivity, specificity, and toxicity of drugs
· therapeutic index
· variability in the response to drugs in relation to pathologies, concomitant therapies, genetic profile, and gender

Pharmacology and Clinical Therapeutics
· drugs that modulate synthesis, storage, release, catabolism and interaction with the receptors of the main neurotransmitters and autacoids
· drugs for the treatment of obesity, metabolic syndrome and eating behavior diseases
· drugs for the treatment of heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF)
· drugs for the treatment of high blood pressure
· anticoagulant drugs (including the parenteral anticoagulant heparin and its derivatives; the coumarin anticoagulants; the direct oral anticoagulants
· antiplatelet drugs which attenuate platelet activation (such as aspirin, clopidogrel, ticagrelor) or platelet aggregation (glycoprotein IIb / IIIa inhibitors)
· fibrinolytic drugs which degrade fibrin
· vitamin K, which is required for the biosynthesis of key coagulation factors
· drugs for the treatment of dyslipidaemias, including statins, bile acid-binding resins, nicotinic acid (brief notes), fibric acid derivatives (fibrates), inhibitors of cholesterol absorption (ezetimibe), omega-3, PCSK9 inhibitors, bempedoic acid
· drugs and their use in different types of angina
· anti-arrhythmic drugs (brief notes)
· drugs that affect kidney function, including carbonic anhydrase inhibitors, osmotic diuretics, loop diuretics, thiazide diuretics, K+-sparing diuretics, aldosterone antagonists, natriuretic peptide analogues (nesiritide), vasopressin receptor agonists and antagonists (brief notes)
· drugs for the treatment of gastric acidity, peptic ulcer and gastroesophageal reflux, including pump inhibitors, histamine 2 receptor antagonists, mucosal defensive agents
· drugs for the treatment of gastrointestinal motility and water flux (prokinetic, laxative, antidiarrheal agents)
· anti-nausea and anti-emetic drugs
· steroid and nonsteroidal anti-inflammatory drugs (NSAIDs)
· drugs for the treatment of bronchial asthma, chronic obstructive pulmonary disease
· drugs that modulate neuronal transmission
· drugs for the treatment of depressive and anxiety disorders, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, atypical antipsychotics, MAO-A inhibitors, atypical antidepressants (bupropion, trazodone, nefazodone, mirtazapine), benzodiazepines
· drugs used for the therapy of psychosis and mania
· hypnotic drugs
· antiepileptic drugs
· drugs used in the treatment of the central nervous system degenerative disorders, including anti-Parkinson (l-DOPA, Carbidopa, dopaminergic agonists, COMT inhibitors, MAO-B inhibitors, amantadine, triexifenidil, benztropine), anti-Alzheimers (acetylcholinesterase inhibitors, low-affinity uncompetitive NMDA antagonist (memantine), anti-Huntington, anti-ALS (riluzole), anti-spastic agents (baclofen, benzodiazepine, dantrolene)
· pain management
· anesthetic drugs (brief notes)
· drug use disorders and addiction
· drug treatment of diabetes mellitus, including insulin (different insulin formulations), oral glucose-lowering agents (biguanides: metformin; -glucosidase inhibitors; DPP-4 inhibitors; insulin-secretagogues sulfonylureas and non-sulphonylureas ; thiazolidinediones; SGLT2 inhibitors); GLP-1 analogues; amylin analogue (pramlintide)
· drugs to reverse hypoglycaemia (glucagon)
· drugs for the treatment of osteoporosis
· drugs that modulate the reproductive system (estrogens, progestins) and selection criteria for contraception and hormone replacement therapy in menopause

Chemotherapy
· spectrum of action, mechanisms of action and specific targets of the main classes of antibiotic-chemotherapy drugs
· selection criteria and appropriate use of antibiotic-chemotherapy drugs in relation to the pathogen and the type of patient
· antibacterial drugs, including sulfonamides, -lactams, aminoglycosides, macrolides, lincosamides, tetracyclines, chloramphenicol
· agents for urinary tract infections
· chemotherapy of tuberculosis
· antiviral agents
· antifungal, antiprotozoal and antihelminth infection agents
· anticancer drugs and their mechanism of action
· mechanisms of resistance to chemotheraputics, developed by microorganisms and cancer cells
· immunomodulatory drugs
Prerequisites for admission
Preparatory knowledges of biology, human anatomy, biochemistry, human physiology, pathophysiology, general pathology and microbiology are required
Teaching methods
Lectures and analysis/discussion of clinical case reports, with the help of iconographic material, partially made available on UniMI computer platforms. The consultation of the material presented during the lectures does not replace the study on textbooks. The teachers deny consent to disseminate the registration of the lessons in any form.
Teaching Resources
A textbook chosen from the following (authors, title, publisher, year). Please note that UniMI has activated the subscription to the Access Medicine platform, so some texts are available in the original language (English) and others free online with university credentials.

Laurence L. Brunton Randa Hilal-Dandan Björn C. Knollmann. Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition, 2018

Goodman and Gilman Manual of Pharmacology and Therapeutics, Second Edition (Goodman and Gilman's Manual of Pharmacology and Therapeutics) 2014

Katzung BG, Masters SB, Trevor AJ. Basic and Clinical Pharmacology, 11th Edition Mcgraw-Hill

Stefano Govoni. Farmacologia. Casa Editrice Ambrosiana. Distribuzione esclusiva Zanichelli 2014

Clementi F, Fumagalli G, Farmacologia generale e molecolare, 5a edizione EDRA 2018
Assessment methods and Criteria
The methods used to achieve and ascertain the effective achievement of the learning outcomes expected by the student are:
- oral examination
- questions of general pharmacology, special and clinical pharmacology, chemotherapy including antibiotics, antineoplastics, antifungals or anthelmintics
- the evaluation parameters include: framing ability and general presentation of the topic, ability to describe the pharmacokinetic and pharmacodynamic characteristics of the drugs, demonstration of knowledge of the use and clinical indications of the drugs, description of the side effects of the drugs, ability to identify interactions between drugs in polytherapy
- the exam is delivered by at least two teachers separately
- the final evaluation is made globally by the examination commission, not necessarily based on the average of the single evaluations
BIO/14 - PHARMACOLOGY - University credits: 2008
Lessons: 120 hours

Linea: San Giuseppe

Responsible
Course syllabus
The course program includes presentation and discussion of the following topics:

General pharmacology
· concept of drug as a substance capable of modifying the biological functions of the organism for curative, prophylactic or diagnostic purposes
· clinical trials of drugs and pharmacovigilance
· principles of Pharmacoeconomics
· critical aspects of "alternative" therapies
· mechanisms that regulate the absorption of drugs in relation to the different routes of administration
· mechanisms of drug distribution in the body and drug binding to plasma proteins
· biotransformation processes and their clinical importance
· drug elimination mechanisms
· distribution volume, half-life, clearance and steady-state plasma concentration of a drug; practical examples of the application of these pharmacokinetic parameters in simulations of clinical conditions
· molecular targets and cascade of events through which a drug produces a cellular response
· various types of drug-receptor interaction (full and partial agonists, inverse agonists, antagonists, orthosteric and allosteric interaction) and possible alterations of the receptor response during prolonged treatments or in particular pathological conditions
· efficacy and potency of drugs, based on their dose-response curves
· selectivity, specificity, and toxicity of drugs
· therapeutic index
· variability in the response to drugs in relation to pathologies, concomitant therapies, genetic profile, and gender

Pharmacology and Clinical Therapeutics
· drugs that modulate synthesis, storage, release, catabolism and interaction with the receptors of the main neurotransmitters and autacoids
· drugs for the treatment of obesity, metabolic syndrome and eating behavior diseases
· drugs for the treatment of heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF)
· drugs for the treatment of high blood pressure
· anticoagulant drugs (including the parenteral anticoagulant heparin and its derivatives; the coumarin anticoagulants; the direct oral anticoagulants
· antiplatelet drugs which attenuate platelet activation (such as aspirin, clopidogrel, ticagrelor) or platelet aggregation (glycoprotein IIb / IIIa inhibitors)
· fibrinolytic drugs which degrade fibrin
· vitamin K, which is required for the biosynthesis of key coagulation factors
· drugs for the treatment of dyslipidaemias, including statins, bile acid-binding resins, nicotinic acid (brief notes), fibric acid derivatives (fibrates), inhibitors of cholesterol absorption (ezetimibe), omega-3, PCSK9 inhibitors, bempedoic acid
· drugs and their use in different types of angina
· anti-arrhythmic drugs (brief notes)
· drugs that affect kidney function, including carbonic anhydrase inhibitors, osmotic diuretics, loop diuretics, thiazide diuretics, K+-sparing diuretics, aldosterone antagonists, natriuretic peptide analogues (nesiritide), vasopressin receptor agonists and antagonists (brief notes)
· drugs for the treatment of gastric acidity, peptic ulcer and gastroesophageal reflux, including pump inhibitors, histamine 2 receptor antagonists, mucosal defensive agents
· drugs for the treatment of gastrointestinal motility and water flux (prokinetic, laxative, antidiarrheal agents)
· anti-nausea and anti-emetic drugs
· steroid and nonsteroidal anti-inflammatory drugs (NSAIDs)
· drugs for the treatment of bronchial asthma, chronic obstructive pulmonary disease
· drugs that modulate neuronal transmission
· drugs for the treatment of depressive and anxiety disorders, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, atypical antipsychotics, MAO-A inhibitors, atypical antidepressants (bupropion, trazodone, nefazodone, mirtazapine), benzodiazepines
· drugs used for the therapy of psychosis and mania
· hypnotic drugs
· antiepileptic drugs
· drugs used in the treatment of the central nervous system degenerative disorders, including anti-Parkinson (l-DOPA, Carbidopa, dopaminergic agonists, COMT inhibitors, MAO-B inhibitors, amantadine, triexifenidil, benztropine), anti-Alzheimers (acetylcholinesterase inhibitors, low-affinity uncompetitive NMDA antagonist (memantine), anti-Huntington, anti-ALS (riluzole), anti-spastic agents (baclofen, benzodiazepine, dantrolene)
· pain management
· anesthetic drugs (brief notes)
· drug use disorders and addiction
· drug treatment of diabetes mellitus, including insulin (different insulin formulations), oral glucose-lowering agents (biguanides: metformin; -glucosidase inhibitors; DPP-4 inhibitors; insulin-secretagogues sulfonylureas and non-sulphonylureas ; thiazolidinediones; SGLT2 inhibitors); GLP-1 analogues; amylin analogue (pramlintide)
· drugs to reverse hypoglycaemia (glucagon)
· drugs for the treatment of osteoporosis
· drugs that modulate the reproductive system (estrogens, progestins) and selection criteria for contraception and hormone replacement therapy in menopause

Chemotherapy
· spectrum of action, mechanisms of action and specific targets of the main classes of antibiotic-chemotherapy drugs
· selection criteria and appropriate use of antibiotic-chemotherapy drugs in relation to the pathogen and the type of patient
· antibacterial drugs, including sulfonamides, -lactams, aminoglycosides, macrolides, lincosamides, tetracyclines, chloramphenicol
· agents for urinary tract infections
· chemotherapy of tuberculosis
· antiviral agents
· antifungal, antiprotozoal and antihelminth infection agents
· anticancer drugs and their mechanism of action
· mechanisms of resistance to chemotheraputics, developed by microorganisms and cancer cells
· immunomodulatory drugs
Prerequisites for admission
Preparatory knowledges of biology, human anatomy, biochemistry, human physiology, pathophysiology, general pathology and microbiology are required
Teaching methods
Lectures and analysis/discussion of clinical case reports, with the help of iconographic material, partially made available on UniMI computer platforms. The consultation of the material presented during the lectures does not replace the study on textbooks. The teachers deny consent to disseminate the registration of the lessons in any form.
Teaching Resources
A textbook chosen from the following (authors, title, publisher, year). Please note that UniMI has activated the subscription to the Access Medicine platform, so some texts are available in the original language (English) and others free online with university credentials.

Laurence L. Brunton Randa Hilal-Dandan Björn C. Knollmann. Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition, 2018

Goodman and Gilman Manual of Pharmacology and Therapeutics, Second Edition (Goodman and Gilman's Manual of Pharmacology and Therapeutics) 2014

Katzung BG, Masters SB, Trevor AJ. Basic and Clinical Pharmacology, 11th Edition Mcgraw-Hill

Stefano Govoni. Farmacologia. Casa Editrice Ambrosiana. Distribuzione esclusiva Zanichelli 2014

Clementi F, Fumagalli G, Farmacologia generale e molecolare, 5a edizione EDRA 2018
Assessment methods and Criteria
The methods used to achieve and ascertain the effective achievement of the learning outcomes expected by the student are:
- oral examination
- questions of general pharmacology, special and clinical pharmacology, chemotherapy including antibiotics, antineoplastics, antifungals or anthelmintics
- the evaluation parameters include: framing ability and general presentation of the topic, ability to describe the pharmacokinetic and pharmacodynamic characteristics of the drugs, demonstration of knowledge of the use and clinical indications of the drugs, description of the side effects of the drugs, ability to identify interactions between drugs in polytherapy
- the exam is delivered by at least two teachers separately
- the final evaluation is made globally by the examination commission, not necessarily based on the average of the single evaluations
BIO/14 - PHARMACOLOGY - University credits: 2008
Lessons: 120 hours