Ateneo - UPO

The course of Special Pharmacology provides a comprehensive and systematic description of the main therapeutic classes and active substances used in clinical practice, framing their use within the context of evidence-based medicine, and introduces the fundamentals of Clinical Toxicology.
For each pharmacological class, the pharmacokinetic profile (absorption, distribution, metabolism, and elimination), mechanisms of action, therapeutic indications, and toxicity profile will be analyzed with reference to the different pathophysiological settings. Particular attention will be devoted to the rationale guiding the choice of one drug over others within the same class, according to the individual characteristics of the patient, adverse effects, relative and absolute contraindications, drug–drug interactions, and issues of treatment adherence.
Through lectures and critical discussion with the teaching staff, students will develop the ability to appraise and interpret pharmacological data and to translate this knowledge into clinical practice, with the aim of establishing a rational, effective, safe, and appropriate therapy.

- “Goodman & Gilman: Le basi farmacologiche della terapia”
- "Katzung & Vanderah: Farmacologia Generale e Clinica"
- “Rang and Dale: Farmacologia"
Texts should be supplemented with lecture notes and further information from accredited sources. Relying solely on the material provided during lectures is considered inadequate. Examples of additional sources of information include scientific literature (Pubmed), the National and International Guidelines, the EPARs of centrally authorized drugs (www.ema.europa.eu), the Summary of Product Characteristics (SmPCs, available online from the AIFA Drug Database at https://medicinali.aifa.gov.it/it/#/it/), and the Osmed report (https://www.aifa.gov.it/rapporti-osmed), which provides context on current drug usage in Italy.

The main objective of the course is the acquisition of knowledge, understanding, and the ability to apply concepts relating to medicinal products and their clinical use. Specifically, the course aims to:
- provide the foundations and skills for understanding pharmacotherapy and its rational development;
- provide knowledge of the main pharmacological classes and of the specific drugs available;
- provide solid training for the evaluation of new drugs that may emerge during the students’ professional future;
- provide the fundamentals of Clinical Toxicology and of antidotal and supportive therapies relevant to clinical practice;
- highlight elements of sex- and gender-based pharmacology and of age-related pharmacology across the patient lifespan.
The overall aim is to foster in the student the development of independent judgement, communication skills, and learning ability within the discipline.

The course of Special Pharmacology represents the natural continuation of the General Pharmacology course, taught in the third year of the MD degree program: pharmacokinetics and pharmacodynamics constitute its fundamental concepts, on which the study of the pharmacology of the therapeutic specialties is based. The General Pharmacology examination is therefore a prerequisite for the Special Pharmacology examination.
Since a drug is defined by its ability to modify a biological system at its different levels of organization — molecular, cellular, organ, and systemic — for optimal benefit from the course the student should possess adequate knowledge of chemistry, biology, molecular biology, anatomy, physiology, general pathology, immunology, and pathophysiology.

The course is delivered through lectures, given entirely by the titolar teacher with the aid of slides, in which the main concepts underlying pharmacological therapy will be examined. Students will be actively involved in the learning process and in the development of critical thinking, also through the discussion of clinical case examples. The lectures cover the fundamental topics of the syllabus but, as they cannot be exhaustive, they are not to be regarded as a substitute for the textbook: their aim is in fact to convey a method of critical approach to pharmacology rather than purely factual knowledge.
Teaching material will be made available to students through the dedicated e-learning platform (DIR). This material is to be considered supplementary to, and not a substitute for, the textbook, which constitutes the reference for the final examination.

The teacher is available for consultation by prior appointment via email.
Students with physical disabilities, Learning Disabilities or Special Education Needs can request specific services and tools via the Staff Sviluppo e Coordinamento Carriere e Servizi alle Studentesse e agli Studenti, consulting the University webpage: https://www.uniupo.it/en/services/services- students-physical-or-learning-disabilities Students with disabilities, learning disabilities or special education needs, once they have contacted the University Staff, can refer to the tutor in charge of the course to define the examination modalities, concerning academic aspects.

The examination is oral. It will assess: (a) the knowledge acquired on the specific pharmacological classes; (b) the ability to correctly place each active substance within its respective class, describing its distinctive pharmacokinetic, pharmacodynamic, and prescribing features; and (c) the ability to integrate the different therapeutic classes into the specific clinical context.
The student will be asked to describe one or more therapeutic classes, indicating their main active substances, mechanisms of action, the advantages and disadvantages of each agent, clinical uses, main adverse effects, and any off-label uses, as well as the rationale for the choice of a given active substance according to the patient's characteristics; recognition of individual drugs will also be required.
The assessment is expressed in thirtieths, on a progressive scale from a minimum of 18 to a maximum of 30 according to the level of preparation. Specifically, a mark between:
- 18 and 21 indicates a modest knowledge of the topics covered and a sufficient ability to place individual active substances in their correct therapeutic use;
- 22 and 24 indicates a sufficient knowledge of the topics covered, an adequate ability to address them in a cross-cutting manner and to place the knowledge in the clinical context, and a fair ability to place individual active substances in their correct therapeutic use;
- 25 and 27 indicates a good knowledge of the topics covered, a good ability to address them in a cross-cutting manner and to contextualize the knowledge, and a more than good ability to place individual active substances in their correct therapeutic use;
- 28 and 30 indicates an excellent knowledge of the topics covered, an excellent ability to address them in a cross-cutting manner and to contextualize the knowledge, and an excellent ability to place individual active substances in their correct therapeutic use.
Honours (cum laude) are awarded when the student stands out for a particularly thorough knowledge of the subject and an appropriate use of scientific terminology.

For each pharmacological class, the following will be addressed: mechanism of action, pharmacokinetics and therapeutic implications, clinical uses and indications, the main active substances and their distinctive features, and the reference guidelines.
- Nervous system: drugs acting on the peripheral autonomic and somatic nervous system; drugs for the main neuropsychiatric disorders (anxiety, depression, bipolar disorder, psychosis, sleep disorders and sedative-hypnotics); antiseizure drugs; drugs for Parkinson's disease and Alzheimer's disease; local and general anaesthetics.
- Pain therapy and anti-inflammatory drugs: opioid and non-opioid analgesics; non-steroidal anti-inflammatory drugs (NSAIDs); glucocorticoids (corticosteroids); antihistamines; immunosuppressants and drugs used in immune-mediated inflammatory diseases, including biological and biotechnological agents; acute and prophylactic treatment of migraine.
- Respiratory system: drugs for asthma and chronic obstructive pulmonary disease (COPD); antitussive and expectorant drugs.
- Gastrointestinal system: drugs for disorders related to gastric secretion; antiemetic drugs; prokinetic drugs.
- Metabolism, endocrine system and haematopoiesis: drugs for hypercholesterolaemia and dyslipidaemias; drugs for diabetes mellitus; drugs for the treatment of gout; drugs affecting bone mineral homeostasis; hormones and their antagonists; haematopoietic growth factors (erythropoietins and G-CSF).
- Cardiovascular system and haemostasis: diuretics; drugs for arterial hypertension; drugs for pulmonary hypertension; drugs for myocardial infarction; drugs for heart failure; antiarrhythmic drugs; antiplatelet agents and anticoagulants; fibrinolytics; antidotes and reversal strategies for anticoagulants; drugs for erectile dysfunction.
- Antimicrobial therapy: definitions and framing of antibiotics versus synthetic chemotherapeutic agents; the concept of selective toxicity; pharmacodynamic characteristics (spectrum of action, bactericidal versus bacteriostatic activity); pharmacokinetic characteristics; PK/PD relationships; bacterial resistance; classification according to mechanism of action: inhibitors of folic acid metabolism, inhibitors of bacterial cell-wall synthesis, drugs acting on the mycobacterial cell wall and treatment of tuberculosis, drugs acting on the cytoplasmic membrane, inhibitors of protein synthesis, inhibitors of nucleic acid synthesis; antiviral drugs; antifungal drugs; antiparasitic drugs.
- Antineoplastic chemotherapy and oncological therapies: biological features of the tumour cell as pharmacological targets; treatment strategies and principles (primary, adjuvant, neoadjuvant and maintenance therapy; rationale of polychemotherapy); classical cytotoxic chemotherapy; toxicity of chemotherapy and supportive care; therapies for hormone-sensitive tumours; molecularly targeted therapies (tyrosine kinase inhibitors, monoclonal antibodies, epigenetic and apoptotic-pathway modulators); immunotherapy and immunomodulatory drugs; cell therapies with CAR-T.
- Clinical toxicology. The fundamental principles of clinical toxicology will be addressed in conjunction with the relevant topics of the Pharmacology course, with discussion of the most clinically relevant examples and their respective antidotes.

The expected learning outcomes consist of a non-rote knowledge of the covered topics, the critical ability to address them in a cross-cutting manner and to place the knowledge in the clinical context, and the understanding of the correct therapeutic use of the main active substances, including the issues specific to Clinical Toxicology. These outcomes are defined according to the Dublin Descriptors.
- Knowledge and understanding. Starting from an understanding of pharmacotherapy and its rational development, the student will become familiar with the main pharmacological classes and the specific drugs available, understanding their mechanism of action, therapeutic applications, and toxicity profile, as well as the fundamentals of Clinical Toxicology.
- Applying knowledge and understanding. The student will be able to correctly place each active substance within its therapeutic use, to address the topics in a cross-cutting manner and to contextualize them clinically, adopting a professional approach to problem-solving. The student will also be able to evaluate the pharmacological profile of new drugs that will be developed and approved in the future, applying the knowledge acquired to novel or unfamiliar clinical situations as well.
- Making judgements. The student will be able to gather and interpret the pharmacological data needed to make autonomous judgements on the choice and use of drugs, integrating knowledge and managing the complexity of the individual clinical case, and reflecting on the ethical and deontological responsibilities associated with the prescription and appropriate use of drugs.
- Communication skills. The student will be able to communicate clearly and unambiguously information, therapeutic rationale, and conclusions concerning drugs and therapies, to both specialist and non-specialist interlocutors, including the patient, using appropriate scientific terminology.
- Learning skills. The student will have developed the learning skills required to pursue further studies with a high degree of autonomy and to update their pharmacological knowledge in a continuous and self-directed manner — an essential prerequisite for clinical practice and for the critical appraisal of drugs that will be introduced into clinical practice in the future.