Learning objectives
1. Knowledge and understanding. The course is finalized to the knowledge of pharmacokinetic and pharmacodynamic properties of the main drugs classes acting at the nervous system, smooth and skeletal muscle, cardiovascular, respiratory and immune systems. Such notions will allow the student to better understand the basic biometabolic events in the body and how exogenously-administered drugs substances modify them. Particular attention will be paid to the knowledge of mechanisms involved in cell excitability, cell proliferation and tissue repair.
2. Ability to apply knowledge and understanding. Students will be stimulated to elaborate the acquired notions in the whole animal and human being, and in vitro biological activity of the preparations or isolated cells. Such knowledge will focus on signs and/or symptoms that develop following the administration/intake of medicines, and to assess the effects they produce.
3. Making judgments. The student will acquire the knowledge for future planning of study protocols, aimed at the characterization of new molecules, as well as the ability to choose the correct medicament in specific patients.
4. Communication skills. Students will acquire the terminology to describe objectively the actions of drugs and biomathematician models currently applied to quantify the effect of drugs on the different organs and systems.
5. Learning ability. Students should be able to use the acquired knowledge to understand and re-elaborate the literature regarding drugs, the use them in the treatment of specific conditions or for research purposes.
Course unit content
The course is aimed at understanding the effects of experimental as well as therapeutic drugs and their application in the clinical odontoiatric practice.
Full programme
GENERAL PHARMACOLOGY: INTRODUCTION
Definitions of Pharmacology and Medicine. Branches of pharmacology: pharmacokinetics, pharmacodynamics, pharmacotherapy, toxicology. Regulation and pre- and post-marketing development of an innovative drug.
PHARMACOKINETICS. Mechanisms of passage of drugs through biological membranes, physico-chemical factors. Absorption and routes of administration of drugs. Pharmaceutical forms. Distribution and binding to plasma and tissue proteins. Redistribution. Biotransformation of drugs. Phase I and phase II. Hepatic microsomal system. Cytochrome P450 monooxygenase. Biotransformations independent of the microsomal system. Factors influencing biotransformations: induction, inhibition, genetic polymorphism. Excretion routes.
Clinical pharmacology. Clearance, hepatic first pass effect, concept of bioavailability, volume of distribution, plasma half-life. Dosage of drugs. Attack dose, maintenance dose. Optimization of dosage regimens.
PHARMACODYNAMICS. Mechanism of action of drugs, sites of action, physiological receptors for endogenous substances and their molecular structure. Membrane and intracellular receptors. Ionotropic and metabotropic receptors (examples), signal transduction systems within the cell and role of G proteins. Role of second messengers, membrane transporters, ion channels. Receptor dynamism (desensitization, down-regulation). Drug-receptor interactions and dose-response curves. Classic and current theories relating to drug-receptor interaction, affinity, efficacy, intrinsic activity. Dose-response curves. Effective dose 50 (DE50). Total and partial agonists, antagonists (competitive and non-competitive), inverse agonists.
SPECIAL SYSTEMS PHARMACOLOGY.
DRUGS ACTIVE ON THE AUTONOMOUS NERVOUS SYSTEM AND NEUROMUSCULAR JUNCTIONS
Physiology of the autonomic nervous system and the somatic motor nervous system.
Drugs active on the cholinergic system. Muscarinic agonists and antagonists. Reversible and irreversible acetylcholinesterase inhibitors. Acetylcholinesterase reactivators. Drugs active on the neuromuscular plate and autonomic ganglia.
Drugs active on the adrenergic system. Catecholamines: Adrenaline, Noradrenaline, Dopamine. Non-selective -adrenergic agonists. Selective 2-adrenergic agonists. 1 and 2-adrenergic agonists. -adrenergic antagonists. Non-selective and 1-selective -adrenergic antagonists.
DRUGS ACTIVE ON THE CENTRAL NERVOUS SYSTEM
Physiology of transmission at the CNS level. Neurotransmitters, neurohormones, neuromodulators. Drugs to control pain with loss (general anaesthetics) or maintenance (narcotic and non-narcotic analgesics, local anaesthetics) of consciousness.
General Anesthetics. Principles of anesthesiology, pharmacokinetic properties of gaseous anaesthetics, stages and signs of anaesthesia. Pre-anesthetic dressing. Balanced anesthesia. Inhalational and intravenous general anaesthetics: classification, pharmacological properties and therapeutic effects. Neuroleptoanalgesia and Neuroleptoanesthesia.
Local anaesthetics. General information, classification, pharmacological properties, therapeutic and toxic effects. Methods of application of local anesthetics and specific techniques: surface anesthesia, infiltration, loco-regional, truncal, spinal, epidural.
Opioid analgesics. Morphine and semi-synthetic and synthetic congeners, opioids with mixed actions, opioid antagonists. Use of opioids as analgesics. Notes on opioid addictions, tolerance, mental dependence, physical dependence, withdrawal syndrome
Therapeutic Gases. Oxygen and nitrous oxide.
Sedative-Hypnotics. Benzodiazepines. Classification. Therapeutic uses and side effects. Barbiturates. Classification. Therapeutic uses and side effects. Interactions with Alcohol. Conscious sedation
Pharmacotherapy of Inflammation and Fever. Inflammatory substances: cytokines, prostaglandins, prostacyclin, thromboxane and their functions performed in physiological and pathological processes. Non-steroidal anti-inflammatory drugs: General information, classification, COX-1 and COX-2 inhibitors. Steroid anti-inflammatories: Corticosteroids and their properties, systemic effects, pharmacological properties, therapeutic uses and adverse effects.
DRUGS ACTIVE ON THE CARDIOVASCULAR SYSTEM AND HEMOSTASIS.
Renin – Angiotensin – Aldosterone system and ACE-inhibitor and sartan drugs.
Pharmacotherapy of myocardial ischemia: organic nitrates, calcium channel blockers, -blockers.
Antihypertensive drugs.
Pharmacotherapy of heart failure: Cardioactive glycosides. Diuretics - Phosphodiesterase-III inhibitors. District and systemic vasodilators.
Antiplatelet agents. Heparins with different molecular weights. Oral anticoagulants. Thrombolytics.
DRUGS ACTIVE ON THE IMMUNE SYSTEM. Histamine and H1 antihistamines, immunostimulants and immunosuppressants.
HORMONES AND THEIR ANTAGONISTS. Hormones and drugs that influence calcification and bone turnover.
ANTIBACTERIAL CHEMOTHERAPY. General information, mechanisms of action of antibacterials, chemoresistance, general strategy in the use of antibiotics, with reference to the treatment of dental infections and prophylaxis in case of dental interventions.
Classes of antibacterials: Beta lactams (Penicillins, Cephalosporins, Carbapenems, Monobactams); Glycopeptides; Tetracyclines; Chloramphenicol; Macrolides; Lincosamides (Clindamycin) Aminoglycosides; Fluoroquinolones; Metronidazole;
Sulfonamides, Trimethoprim-Sulfamethoxazole.
DRUGS FOR DENTAL EMERGENCIES. Cardiovascular (angina, cardiovascular collapse, hypertensive crisis, myocardial infarction, syncope, arrhythmias), non-cardiovascular (acute allergic reactions, asthmatic attack, hemorrhage, hypoglycemia, reactions to local anaesthetics, seizures), anticonvulsants and antiepileptics.
DRUGS ACTIVE ON THE GASTRINTESTINAL SYSTEM: drugs for acid-related diseases (antacids, proton pump inhibitors, H2 blockers and gastric mucosal protective drugs). Drugs active on gastrointestinal motility (prokinetics and antispasmodics), antiemetics.
Bibliography
Amico-Roxas M, Caputi AP, Del Tacca M. Farmacologia in odontoiatria. EDRA, 2017.
Katzung GB, Trevor AJ. Basic and clinical pharmacology. XIII Edition. McGraw-Hill, 2015 (or newer release).
Teaching methods
The course will be held through lectures. In case the COVID-related emergence continues, frontal lessons will proceed remotely through the Teams platform (for instructions, see http://selma.unipr.it). Lessons will be carried out with the aid of iconographic material collected in PowerPoint files that, at the end of the course, will be made available to students on the Elly site at the course pages.
Assessment methods and criteria
Oral examen.
In case of the persistence of the health emergency, the exams will be conducted remotely, as follows:
remote oral questions, through the Teams platform (guide http://selma.unipr.it/).
Students with SLD / BSE must first contact Le Eli-che: support for students with disabilities, D.S.A., B.E.S. (https://sea.unipr.it/it/servizi/le-eli-che-supporto-studenti-con-disabilita-dsa-bes)
