Pharmacology II

A.Y. 2021/2022
3
Max ECTS
36
Overall hours
SSD
BIO/14
Language
English
Learning objectives
The course intends to provide medical students with information on the mechanisms of action, pharmacological properties and therapeutic application of drugs affecting 1) endocrine system; 2) cardiovascular system 3) respiratory System. An introduction to neuropharmacology is also provided together with the specific treatment of specific neurodegenerative disease and epilepsy .
Expected learning outcomes
Students will learn:
- The pharmacological treatment of neurological diseases (Parkinson, Alzheimer, Epilepsy...)
- The pharmacological treatment of endocrine diseases (Diabetes, thyroid disfunctions, methabolic disfunctions )
- The pharmacological treatment of cardiovascular diseases
- The pharmacological treatment of pulmonary diseases (Asthma and Chronic Obstructive Pulmonary Disorder)
Course syllabus and organization

Single session

More specific information on the delivery modes of training activities for academic year 2021/22 will be provided over the coming months, based on the evolution of the public health situation.
Course syllabus
TOPIC 1: ENDOCRINE PHARMACOLOGY
· Diabetes Mellitus: pathogenesis and therapeutic interventions
· Thyroid hormones: mechanisms of action
· Pharmacology of gonadal steroid hormone (asynchronous)
· Pharmacology of bone metabolism (asynchronous)
· Pharmacology of cholesterol and lipoprotein metabolism
· Regenerative medicine

TOPIC 2: NEUROPHARMACOLOGY
· Pharmacological treatment of Parkinson's disease
· Alzheimer's disease (asynchronous)
· Epilepsy

TOPIC 3: CARDIOVASCULAR PHARMACOLOGY
· Pharmacology of volume regulation
· Pharmacology of vascular tone
· Pharmacology of cardiac rhythm.
· Pharmacology of cardiac contractility
· Pharmacology of hemostasis and thrombosis.

TOPIC 4: PULMONARY PHARMACOLOGY
· Asthma and COPD
· Drugs for asthma and COPD

TOPIC 5: DRUG-DRUG INTERACTIONS (asynchronous)
· Pharmacokinetic interactions
· Pharmacodynamics interactions

TOPIC 6: PHARMACOLOGY OF IMMUNESUPPRESSION (asynchronous)


EXPECTED OUTCOMES

The students are expected to know:

ENDOCRINE PHARMACOLOGY
Diabetes Mellitus: pathogenesis and therapeutic interventions
· glucose-dependent insulin secretion
· effects of insulin and glucagon on intermediary metabolism and ion transport.
· effects of incretin hormones, esp. GLP-1, on insulin and glucagon secretion.
· molecular mechanism of action of each drug in each drug class.
· clinical manifestations and management of overdose with insulin and oral hypoglycemic agents, respectively.

Thyroid hormones: mechanisms of action
· regulation and the key steps in thyroid hormone synthesis and peripheral conversion
· mechanisms by which thyroid hormones regulate cellular function.
· molecular mechanism of action of each of the drugs used for thyroid diseases

Pharmacology of gonadal steroid hormone
· gametogenic and steroidogenic functions of the ovary and their regulation by gonadotropins.
· in general terms, the cellular/molecular mechanism of action of sex steroids.
· the routes of administration, absorption and relative duration of action of synthetic estrogens.
· major adverse effects/contraindications for estrogens and progestins alone and in combination.

Pharmacology of bone metabolism
· the biological mechanism of bone formation and bone resorption
· the endocrine regulation of bone metabolism
· List the major bone metabolism disorders
· the molecular mechanism of action of each of the drugs used for modulating bone metabolism

Pharmacology of cholesterol and lipoprotein metabolism
· in general terms, the cellular/molecular mechanism involved in lipid metabolism
· the pathophysiology of dyslipidemia
· the molecular mechanism of action of each of the drugs used for modulating lipid metabolism
- Inhibitors of cholesterol synthesis
- Inhibitors of VLDL secretion
- Inhibitors of bile acid absorption
- Inhibitors of cholesterol, absorption
- Fibrates
- Niacin
- Omega-3 Fatty acid
- PCSK9 inhibitors
· the most recent guidelines for treating patients with dyslipidemia.

Regenerative medicine
· a definition of clinical grade stem cells and of Good Manufacturing Procedures (GMP)
· the different source of stem cells highlighting for each class the advantages and disadvantages
· the current available in human therapies using stem cells
· the necessary requisites defining an approved clinical trial for stem cell therapy


NEUROPHARMACOLOGY
Pharmacological treatment of Parkinson's disease
· the cellular and molecular mechanisms underlying Parkinson's disease
· the mechanism of action of drugs used in Parkinson's disease
L-DOPA, DOPA decarboxylase inhibitors
Dopamine agonists (ergot and non ergot derivates)
MAO B inhibitors; COMT inhibitors
Amantadine
Anticolinergic agents
Safinamide
Novel therapeutic strategies (immunotherapy, gene and cell-based therapy)

Pharmacological treatment of Alzheimer's disease
· the cellular and molecular mechanisms underlying Alzheimer's disease
· the mechanism of action of drugs used in Alzheimer's disease
acetylcholinesterase inhibitors (AChEIs)
NMDA receptor antagonist.
New disease-modifying drugs
Other pharmacological therapies include antipsychotics, antidepressants, sedatives.

Pharmacological treatment of Epilepsy
· the cellular and molecular mechanisms underlying epilepsy
· the mechanism of action of anticonvulsant drugs acting on:
Sodium channel
Calcium channel
GABAergic system
Glutamatergic system
· Carbonic anhydrase

CARDIOVASCULAR PHARMACOLOGY
Pharmacology of volume regulation
· inhibitors of the renin-angiotensin system: aliskiren, beta-blockers, ACEi, ARB, aldosterone receptor antagonists
· B-type natriuretic peptide; neprilisin inhibitors
· Agents that decrease renal Na+ and H2O reabsorption: diuretics
Carbonic anhydrase inhibitors, osmotic diuretics, loop diuretics, thiazide diuretics, potassium sparing diuretics
· Vasopressin receptor-2 antagonist

Pharmacology of vascular tone
· Nitric oxide donors
· Ca2+ Channel blockers (dihydropiridines, benzothiazepine, phenylalkylamine)
· K+ Channel openers
· Endothelin receptor antagonists
· cGMP potentiators (PDE5 inhibitors, riociguat, nesiritide)
· ACEi and ARB
· Hydralazine,
· α1-adrenergic antagonist
· β-adrenergic antagonist
· prostacyclin analogues (for pulmonary hypertension)

Pharmacology of cardiac rhythm.
· Classes of Antiarrhythmic Agents (I, II, III, and IV)
· Other drugs (adenosine, ivabradine, ranolazine)

Pharmacology of cardiac contractility
· Cardiac glycosides
· Beta-adrenergic agonists
· Phosphodiesterase inhibitors
· Calcium-sensitizing agents (levosimendan)

Pharmacology of hemostasis and thrombosis.
· Antiplatelet agents (Cyclooxygenase inhibitors, Phosphodiesterase inhibitors., ADP receptor pathway inhibitors, GPIb-IIIa antagonists)
· Anticoagulants (Warfarin, Heparins, DOACs)
· Thrombolytic agents (Streptokinase, recombinant t-PA, Retaplase)
· Pharmacology of Hemophilia A

PULMONARY PHARMACOLOGY

Asthma and COPD
· Bronchodilators: beta-adrenergic agonists, Definition of SABA, LABA, ultra-LABA
· Anticholinergic drugs. Definition of SAMA, LAMA ultra-LAMA
· The role of inflammation in airway diseases. Remodeling of the airways in asthma and COPD
· Inhaled steroid
· Steroids in COPD
· PDE inhibitors
· Leukotriens pathway modifying agents
· Omalizumab

DRUG-DRUG INTERACTIONS
· Pharmacokinetic drug-drug interactions affecting, absorption, metabolism, distribution and elimination.
· Classification of different types inhibition of metabolizing enzymes
· Pharmacodynamic interaction: direct, indirect, agonist and antagonist interactions.
· How to handle a drug-drug interaction. The use of databases.

PHARMACOLOGY OF IMMUNOSUPPRESSION
· Immunosuppression in transplantation.
· CNI, mycophenolate, mTOR inhibitors, antithymocite immunoglobulin, basiliximab, steroids. Inhibition of co-stimulation
· Immunosuppression in autoimmunity.
· TNF inhibitors (decoy, mAbs) IL-1 inhiibitors (antagonist, decoy, mAbs) Il-6 antagonist
· Blockade of cell adhesion (Natalizumab).
Prerequisites for admission
To take the Pharmacology 2 exam, students must have already passed all the exams of the first and second year (Fundamentals of Basic Sciences, Cells, Molecules and Genes 1 and 2, Human Body, Functions and Mechanisms of Diseases).
Teaching methods
Synchronous learning: video conferences, interactive webinars, chat-based online discussions and lectures
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)




ATTENDANCE:
Attendance is required to be allowed to take the exam. Unexcused absence is tolerated up to 34% of the course activities. University policy regarding excused illness is followed.
Teaching Resources
TEXTBOOKS:
· General and Molecular Pharmacology. Principles of drug action" Edited by Francesco Clementi and Guido Fumagalli. Wiley.
· Goodman & Gilman's. "The pharmacological basis of therapeutics". 13th Edition. The McGraw-Hill companies
Assessment methods and Criteria
Students' assessment is based on an oral exam. The exam will be focused on the subjects described in the EXPECTED OUTCOMES

Registration to the exam through SIFA is mandatory.
· Transplantation
· Autoimmunity
BIO/14 - PHARMACOLOGY - University credits: 3
Lessons: 36 hours