OVERVIEW

Pharmacology is the science which study the interactions between drugs and the organisms. It includes the study of the origin and structure of the drugs, the mechanisms of their action, pharmacokinetics, their clinical use, their side effects and toxicity.

AIMS AND CONTENT

LEARNING OUTCOMES

Didactic goal will be the acquisition of the basic pharmacological knowledge to be able to prescribe and administer the drugs of common use during the odontoiatric practice, focusing on composition, mechanism of action, pharmacokinetics, clinical use, side effects, toxicity, and interactions. Moreover, effects, contraindications and interactions of other drugs commonly used in internal medicine, should be known as possible interferents with the common odontoiatric procedures.

AIMS AND LEARNING OUTCOMES

At the end of the course the student must know:

- the general bases of pharmacokinetics and pharmacodynamics

- the mechanisms of action, route of administration, distribution, metabolism and elimination, clinical indication, side effects, and toxicity of the most relevant drugs used during odontoiatric procedures (i.e. NSAIDs, local anesthetics, antibiotics, etc.), and the main pharmacological interactions with other internistic drugs.

- how to choose the most appropriate drug therapy for dental interventions

TEACHING METHODS

Teaching of pharmacology will be performed by frontal lessons, Total CFU are 6 (60 hours).

Students with valid certifications for Specific Learning Disorders (SLDs), disabilities or other educational needs are invited to contact the lecturer and the School/Departmental Disability Liaison at the beginning of the course to agree on teaching modalities that, while respecting the teaching objectives, take into account individual learning patterns.

SYLLABUS/CONTENT

1) Introduction to the study of pharmacology. Definition of drug, medicament, poison, toxicant; pharmaceutical forms, origin of drugs, the branches of pharmacology.

The phases of drug experimentation

Pharmacognosy

2) Drug routes of administration and their characteristics. Bioavailability.

Passage through cellular barriers. Biotransport processes involved in uptake of drugs and toxicants across cell membranes.

3) Distribution of drugs in the body, pharmacoprotein binding, apparent volume of distribution. Biotransformation and bioactivation processes, role of cytochromes P450, enzyme induction and inhibition

4) Renal and extrarenal drug excretion processes. First-order and 0-order kinetics, half-life, clearance, steady state.

5) Receptor theories; gradual and quantal concentration-response curves; agonists, competitive and noncompetitive antagonists, partial agonists and reverse agonists.

Assessment of drug toxicity: toxic dose 50 and significance and utility of therapeutic index. Phenomena of receptor adaptation: up- and down-regulation.

Significance of specificity and measures of potency, efficacy and affinity of a drug.

6) Structure and function of G-protein-coupled receptors, tyrosine kinase receptors, receptor-channels and intracellular receptors. Ion channels.

Mechanisms of receptor transduction. Enzymes of physiological interest as drug attachment points.

7) Adverse drug reactions. Drug-allergy, idiosyncrasy, tolerance, tachyphylaxis, receptor adaptations.

Factors affecting drug response (age, pathology of excretory organs, drug interference)

8) Adrenergic transmission: Neuroanatomy, neurochemistry and functions of catecholaminergic pathways in the peripheral and central nervous system.

Structure, function, classification and distribution of catecholamine receptors. Drugs active on synthesis, storage, release, reuptake and metabolism of catecholamines.

Drugs active on adrenergic receptors (sympathomimetics and sympatholytics).

9) Cholinergic transmission: neuroanatomy, neurochemistry and functions of cholinergic pathways in the peripheral and central nervous system.

Structure, function, classification and distribution of acetylcholine receptors. Drugs active on acetylcholine synthesis, release, metabolism and reuptake: reversible and irreversible anticholinesterases. Drugs active on nicotinic receptors. Drugs active on muscarinic receptors.

10) BENZODIAZEPINE: mechanism of action, spectrum of activity, kinetic differences between different molecules, toxicity aspects, potential for abuse, negative interactions with non-dental drugs.

Other drugs: Z compounds.

11) Pharmacology of nociception and generalities on opioid drugs.

12) NSAIDs: nonselective, preferential COX 2 and COXIB. Paracetamol.

13) Steroidal anti-inflammatory drugs, corticosteroids (mechanism of action, spectrum of activity, kinetic differences between molecules, toxicity aspects, adverse interactions with non-dental drugs

14) LOCAL ANESTHETICS

Esters (Cocaine, procaine, benzocaine, tetracaine); Amides (lidocaine, bupivacaine, prilocaine, etc.)

Differential criteria of kinetic type among various local anesthetics. Toxicity of local anesthetics; interactions between local anesthetics and other drugs.

The combination of local anesthetics-sympathomimetic amines: advantages and limitations

Hints on GENERAL ANESTHETIC drugs (inhaled and intravenous) Generalities on central narcotic analgesics and N2O

15) General considerations on antibacterial chemotherapy.

Concepts of pharmacokinetics/pharmacodynamics as applied to antibiotic therapy. Choice of chemotherapy, Associations, Antibiotic prophylaxis,

Misuse of antibiotics, Bacterial resistance and its mechanisms.

16) Antibiotics of first choice odontostomatology:

Beta-lactams (Penicillin G, semisynthetic penicillins) beta-lactamase inhibitors

17) First-choice odontostomatologic antibiotics: Cephalosporins.

Other beta-lactam antibiotics (carbapenems, monobactams) Glycopeptides

18) First-choice odontostomatologic antibiotics:

  Macrolides (Erythromycin, azithromycin, clarithromycin)

19) Fluoroquinolones (ciprofloxacin, levofloxacin, pefloxacin, etc.) 

20) Other antibiotics: clindamycin, metronidazole, linezolid, etc.

21) Bacterial protein synthesis inhibitors (aminoglycosides, tetracyclines, CAFs)

22) Antiviral chemotherapy

Antiherpetic drugs (acyclovir, ganciclovir, etc.)

Antihepatitis drugs (interferons, lamivudine, ribavirin, DAAs and new drugs)

Influenza drugs (zanamivir, oseltamivir, amantadine)

Antiretrovirals (Nucleoside reverse transcriptase inhibitors, Non-competitive reverse transcriptase inhibitors, Protease inhibitors, etc.).

23) Antifungals (especially those for topical use in the oral cavity)

polyene macrolides (amphotericin B);

imidazoles (ketoconazole, miconazole, clotrimazole)

24) Antiseptics and disinfectants

25) Drugs active on calcium metabolism

26) H1 and H2 histamine receptors: topography and functional correlates.

H1 antagonists as drugs of allergic reactions, and sedative-antiemetic-anticinetosic drugs.

H2 antagonists as antiulcerosis drugs and for gastric protection in NSAID-treated subjects. Other drugs for gastric protection in combination with NSAIDs (omeprazole, synthetic prostaglandins). Protocols for prevention and treatment of NSAID-induced gastro-intestinal toxic damage.

27) Blood-active drugs:

Antiplatelet agents, heparin, oral anticoagulants vit K antagonists and DOACs, fibrinolytics, plasmin inhibitors

28) Drugs for the treatment of emergencies in dentistry: bleeding syndromes, shock and anaphylactic syndromes, hypoglycemia,.

Emergency pharmaceutical handbook in the dental clinic. Toxicology from materials

29) Drug prescribing in Italy.

RECOMMENDED READING/BIBLIOGRAPHY

All the slides shown during the frontal lessons will be made available to the students on the Aulaweb site.

All the pharmacology textbooks for Dentistry are suitable to integrate the lessons (i.e. Farmacologia in odontoiatria di Matilde Amico Roxas, UTET editore)

TEACHERS AND EXAM BOARD

LESSONS

LESSONS START

Second semester

Class schedule

PHARMACOLOGY

EXAMS

EXAM DESCRIPTION

The exam of pharmacology will be performed as an interview, focusing on the topics discussed during tke lessons

Students can choose among 3 sessions during the winter semester (in January and February) and 4 sessions in the summer one (June, July and September).

Students with valid certifications for Specific Learning Disorders (SLD), disabilities or other educational needs regularly presented to the University, may request adaptations during the exam that must be made strictly at least 10 working days before the scheduled exam date by carefully following the instructions reported at https://unige.it/disabilita-dsa/comunicazioni.

ASSESSMENT METHODS

The student will have to demonstrate knowlege of the mechanisms involved in the reciprocal interactions between human body and drugs (pharmacodynamics and pharmacokinetics); drug mechanism of action, their clinical use, side effects and toxicity, and the possible drug interactions of the main pharmacological classes described during the course.