Pharmacology ii

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).