Medical pharmacology (4th year)

A.Y. 2020/2021
3
Max ECTS
36
Overall hours
SSD
BIO/14
Language
Italian
Learning objectives
The course aims to provide students with an advanced knowledge of:
i) the drug mechanism of action at molecular, cellular and organ/apparatus level;
ii) the main pharmacokinetic parameters and their clinical significance;
iii) factors influencing the drug response in relation with the pharmacologic interactions and individual features;
iv) the available drugs for different therapeutic areas, their side-effects and pharmacologic interactions;
v) the criteria for the rational choice among different drugs available for a specific therapeutic area.
Expected learning outcomes
Students:
a) know the fundamental mechanisms of drug action;
b) are able to apply the main pharmacokinetic parameters in the clinical practice;
c) are able to evaluate the influence of individual factors and pharmacological interactions in the therapy;
d) know the available drugs for different therapeutic areas, their potential side-effects and interactions in the polytherapy regimen;
e) are able to make a rational choice among different drugs available for a certain pharmacological therapy.
Course syllabus and organization

Single session

Responsible
In the first semester the lectures will take place as concurrent classroms:
·in the classroom with a limited number of students, who have previously booked using the "lezioniUnimi" app with the unimi e-mail account username and password; (https://www.unimi.it/it/studiare/frequentare-un-corso-di-laurea/seguire…) and at the same time through the "Teams platform" for online students ;
· The student must wear a surgical mask for the entire duration of his/her stay in the classroom and to sit using every other free seat
· the lectures will be recorded and made available on the teacher's Ariel website for students with proven difficulties to connect during classes
· the lectures will take place at the San Paolo Hospital on the 3rd floor of Blocco C. Students must access classrooms via Blocco C and exit via the side blocks (students leaving Pauling and Fleming rooms towards Blocco B and students leaving Curie, Golgi and Pasteur rooms towards Blocco A).
Students must enter from the main hall (R floor) of the San Paolo hospital and undergo body temperature measurement by the infrared cameras. It is strongly recommended to use the stairs for classrooms entering and/or leaving.
NB for any further information check the unimi.it website: (Home Studiare Frequentare un corso di laurea Seguire il percorso di studi Orari delle lezioni)
Course syllabus
3rd year program:

· General principle and drug molecular mechanisms
· Variability in the drug response
· Quantitative aspects of drug action, dose/response curve, potency, efficacy and therapeutic index
· Pharmacokinetics and pharmacodynamics
· Routes of administration for drugs and pharmaceutical formulations
· Biotransport mechanisms
· Adsorption and interference factors
· Drug distribution, binding to tissue components
· Drug biotransformation, P450 enzyme inducers and inhibitors
· Drug elimination
· Bioavailability, volume of distribution, half-life, clearance: clinical significance
· Drug interactions
· Adverse drug reactions
· Genetic basis of variability in drug response
· Personalized medicine
· Generic drugs and bioequivalence
· Biologics and biosimilars
· Preclinical and clinical drug development
· Clinical trials: design of the study, features, end points
· Ethics committee, regulatory authorities and law sources
· Pharmacovigilance and adverse events monitoring
· Autonomous nervous system

PHARMACOTHERAPY
- Modulation of the cardiovascular function (3th year)
· Medications for ischemic heart and angina pectoris
· Antihypertensive drugs
· ACE-inhibitors and diuretics
· Heart failures treatments
· Drugs for myocardial infarction
· Anticoagulants, thrombolytics and anti-platelet drugs
· Lipid-lowering agents
· Antiarrhythmic agents
- Drugs active on gastrointestinal function, respiratory apparatus, bones and hormones (4th year)
· Gastrointestinal agents: antiulcer drugs, prokinetics, laxatives, antiemetics,
· Drugs affecting bone metabolism
· Treatment of hyperuricemia and gout
· Hypothalamus-pituitary axis hormones: growth and metabolism regulation
· Oestrogens, progestins and androgens
· Thyroid and antithyroid drugs
· ACTH, adrenal steroids and the adrenal cortex pharmacology
· Anti-diabetics

4th year program:
- Drugs active on gastrointestinal function, respiratory apparatus, bones and hormones (4th year)
· Gastrointestinal agents: antiulcer drugs, prokinetics, laxatives, antiemetics,
· Drugs affecting bone metabolism
· Treatment of hyperuricemia and gout
· Hypothalamus-pituitary axis hormones: growth and metabolism regulation
· Oestrogens, progestins and androgens
· Thyroid and antithyroid drugs
· ACTH, adrenal steroids and the adrenal cortex pharmacology
· Anti-diabetics
- Inflammation and immunomodulation (4th year)
· Non-steroidal anti-inflammatory drugs
· Steroid anti-inflammatory agents
· Biologics in the treatment of chronic inflammatory and rheumatic diseases
· Medications for the treatment of inflammatory bowel disease
· Drugs for the respiratory tract: asthma and BPCO


5th year program:
- Antimicrobial and anti-cancer chemotherapy (5th year)
· Antibacterial chemotherapy
· Anthelminthic chemotherapy
· Antiprotozoal chemotherapy
· Anti-viral and anti-retroviral chemotherapy
· Antimycotic chemotherapy
· Antitumoral chemotherapy
· Antineoplastic drugs
- Neuropharmacology (5th year)
· Anatomical and functional basis of the action of CNS drugs
· Pharmacological approaches to Parkinson's disease
· Antipsychotic drugs
· Pharmacological approaches to various neurological diseases Alzheimer's and others
· Pharmacological approaches for SMA
· Antiepileptic drugs
· General anesthetics
· Antidepressant drugs
· Local anesthetics. Opioid analgesics. Ganglion and muscle blockers
· Drug addiction and drug abuse
· Anxiolytic and hypnotic drugs
· Ocular pharmacology
· General toxicology
· Poison centers
Prerequisites for admission
The student should have acquired Biochemistry, Physiology, and Pathology basic knowledge to understand at molecular, cellular and systemic levels the mechanism of action, therapeutic indications and potential side-effects of drugs.
Teaching methods
The program will be carried out through lectures (10CFU) with the help of teaching material (slides)
Teaching Resources
Rang HP, Dale MM, Ritter JM, Flower RJ, Henderson G, "Farmacologia", Casa Editrice Elsevier
Goodman & Gilman, "Le basi farmacologiche della terapia", McGraw Hill, Farmacologia generale e clinica Bertram G. Katzung VIII edizione italiana
Assessment methods and Criteria
The course is divided into three academic years (3th, 4th and 5th); the student can choose among the following examination modalities:
1) At the end of each year, there will be an in idoneative partial test and the final mark will be the weighted (based on the credits of each part) average of the marks acquired in the three exams. The idoneative test consists:
· A written exam of 30 multiple-choice questions (only one correct answer) on the programme of the year. Each correct answer gives one point: the threshold of 20 out of 30 correct answers will give access to the oral examination.
· An oral exam on the programme of the year will allow to evaluate the student's exposure abilities in the description of the therapeutic rationale, mechanism of action, side-effects and potential interactions of the drugs.
2) Alternatively, the student may choose a single final examination on the entire 3-years programme, at the end of the 5th year which consists:
· A written exam of 60 multiple-choice questions (only one correct answer) in 1 hour time. Each correct answer will give one point: 40 out of 60 correct answers will give access to the oral examination.
· The oral exam will allow to evaluate the student's exposure abilities in the description of the therapeutic rationale, mechanism of action, side-effects and potential interactions of the drugs.

Passing the test will result in a mark expressed in thirtieths.
BIO/14 - PHARMACOLOGY - University credits: 3
Lessons: 36 hours