Pathophysiology and Pharmacotherapy I

Code:

MI074236

Acronym:

FPFTE1

Keywords
Classification	Keyword
OFICIAL	Health Sciences

Instance: 2022/2023 - 2S

Active?	Yes
Responsible unit:	Pharmacology Laboratory
Course/CS Responsible:	MSc in Pharmaceutical Sciences

Cycles of Study/Courses

Acronym	No. of Students	Study Plan	Curricular Years	Credits UCN	Credits ECTS	Contact hours	Total Time
MICF	188	Official Curriculum	4	-	6	52	162

Teaching language

Suitable for English-speaking students

Objectives

Pathophysiology and Pharmacotherapy I is a curricular unit (CU) integrated into a sequence of CUs that include Pharmacology I and II and Pathophysiology and Pharmacotherapy II. This sequence of CUs aims to be a core component of the General Objective of the Integrated Master in Pharmaceutical Sciences at the FFUP, once they provide the student with deep knowledge about the relationship drug/patient.Taken together, these CUs have the overall goal of helping the student to:
1. Understand the way drugs act in man;
2. Understand the factors that determine the permanence of the drugs in the body and know the methods that allow to calculate the doses and adjust the dosage regimens to ensure the maintenance of the adequate concentrations to obtain the desired therapeutic effects;
3. Understand the occurrence of adverse reactions and explain those arising from predictable pharmacodynamic responses;
4. Understand interindividual variability in response to drugs in functions of genetic and non-genetic factors.
5. To know the pharmacological targets most exploited for therapeutic purposes, the most representative drugs of each group and the contexts in which they are used clinically.
6. Understand the general aspects of the pathologies that are the main indications of each group of drugs.
7. Identify relevant information on new drugs, their mechanisms of action and pharmacological targets where they operate.

When considering the FIP Global Competency Framework v2, Pathophysiology and Pharmacotherapy I contributes to virtually all the competencies included in the Pharmaceutical Care competency cluster, namely 2.1 Assessment of medicines, 2.2 Dispensing, 2.4 Medicines, 2.5 Monitor medicines therapy, 2.6 Patient consultation and diagnosis, as well as competencies from other clusters like 1.3 Medicines information and advice, and enables students to a more effective Interprofessional collaboration and increases their Communication skills.

Lectures will be used for generic presentations of each of the themes, aiming to give the students an overview of each chapter that prepares them for autonomous learning and for a continuous education throughout their professional life.

In each chapter, key points will be selected to help the student:

1. To understand the pharmacodynamic fundamentals resulting from the performance in each target;
2. To know the main pharmacological effects resulting from this action, regardless of whether they are exploited for therapeutic purposes or can be classified as adverse reactions to the present therapeutic indications;
3. Know the historical context of your discovery
4. Understand the disease and the therapeutic objectives of the various pharmacological interventions.
5. To know the reference drugs of each class and the pharmacodynamic and pharmacokinetic limitations that conditioned and/or condition the appearance of new drugs in the group;
6. To know the present therapeutic indications and future perspectives of new drugs or new indications.

In this context, the curricular unit of Pathophysiology and Pharmacotherapy I has as specific objectives:
1. To help the student to obtain a pharmacological and pharmacotherapeutic knowledge consistent and critical, suitable for graduation in Pharmaceutical Sciences in the area of immunopharmacology;
2. To know the main groups of drugs used in the areas addressed, their mechanisms of action and adverse reactions as well as particularities about their clinical use.

Learning outcomes and competences

As learning outcomes, it is expected that, upon completion of this curricular unit, students will:
a) Demonstrate detailed knowledge of the pharmacological targets and reference drugs;
b) Be able to critically evaluate historical information and the state of the art in each of the pharmacological areas addressed;
c) Know the conditioning factors present in the access and use of reference drugs.
d) Demonstrate an in-depth knowledge of recent research progress in each area and are able to gather relevant information and transmit it in written and oral form;
e) Develop inter-group and intra-group work dynamics and demonstrate the ability and resourcefulness to communicate and discuss pharmacological knowledge through different forms of communication and to different audiences.

Working method

Presencial

Pre-requirements (prior knowledge) and co-requirements (common knowledge)

Students should be knowledgeable about human physiology as well as the general mechanisms of drug action and their general cycle in the body.

Program

THEORETICAL CLASSES (Lectures)

1. DRUG INFORMATION
1.1. Evidence-based practice
1.1.1. Concepts of evidence
1.1.2. Systematic review
1.1.2.1 Primary studies quality assessment
1.1.2.2 Methods for qualitative evidence synthesis
1.1.3. Meta-analysis
1.1.3.1 Effect size
1.1.3.2. Meta-analyses assessment
1.1.3.3. Indirect evidence (NMA)

1.2. Clinical practice guidelines
1.2.1. Recommendations
1.2.1.1. Levels of evidence
1.2.1.2. Grading recommendations (GRADE)

2. IMMUNOPHARMACOLOGY
2.1. Cellular and molecular context of pharmacological intervention in immunopharmacology.
2.2. General aspects of the host's defense mechanisms.
2.2.1. Molecular patterns of pathogen recognition
2.2.2. Molecular patterns of danger recognition
2.2.3. Danger receptors
2.2.3.1. Membrane receptors
2.2.3.2. Soluble receptors
2.2.3.2.1. Complement system.
2.2.3.2.1.1. Forms of activation
2.2.3.2.1.2.Pathologies associated with complement dysfunctions
2.2.3.2.1.3. Modes of pharmacological intervention. Representative drugs.
2.3. Inflammation
2.4. Inflammation phases: induction and resolution of inflammation.
2.4.1. The main inflammatory cells. Notion of phenotype and functional changes associated with phenotype changes.
2.5. Mast cells
2.5.1. Role of mast cells in the detection of pro-inflammatory stimuli
2.5.2.Types of mast cell activating stimuli
2.5.3.Messengers released by mast cells
2.5.4.Mastocytosis and other pathologies associated with mast cell degranulation
2.5.5. Drugs inhibiting mast cell degranulation
2.5.6.Other modes of pharmacological intervention on mast cells
2.5.6.1. Innovative drugs
2.5.6.2. Repurposed drugs with effects on mast cells
2.6. Histamine: its role as an inflammatory messenger and in hypersensitivity
2.6.1. Mechanism of histamine synthesis and action.
2.6.1.1. Types of histamine receptors and most representative drugs
2.6.1.1.1. H1 antagonists: types and differential characteristics of the two drug subclasses.
2.6.1.1.1.1. Therapeutic indications for H1 antagonists / blockers
2.6.1.1.2. H2 antagonists
2.6.1.1.3. H3 antagonists / inverse agonists
2.6.1.1.4. H4 antagonists.
2.7. Non-steroidal anti-inflammatory drugs
2.7.1. Eicosanoid synthesis pathways
2.7.1.1. COX pathway
2.7.1.1.1. Main prostanoids, receptors and mediating effects
2.7.1.1.2. Inhibitors of prostanoid synthesis: main classes and differentiating characteristics
2.7.1.1.2.1. Forms of COX inhibition
2.7.1.1.2.2. Selectivity for COX2
2.7.1.1.2.3. Other targets that contribute to the anti-inflammatory effect
2.7.1.1.2.4. Analgesic, antipyretic and anti-inflammatory effects
2.7.1.1.2.5. Other effects of non-steroidal anti-inflammatory drugs
2.7.1.2. Via the lipoxygenase
2.7.1.2.1. Main classes of leukotrienes, receptors and mediating effects
2.7.1.2.2. Forms of pharmacological intervention on the leukotriene pathway
2.7.1.2.3. Clinical indications for drugs that interfere with leukotriene synthesis.
2.8. Other lipid-derived messengers that interfere with inflammation.
3. Resolution of inflammation
3.1. Role of prostaglandins in resolving inflammation
3.2. Resolving messengers derived from arachidonic acid and other long-chain unsaturated fatty acids
3.3. Glucocorticoids
3.3.1. Synthesis, distribution and action of endogenous glucocorticoids.
3.3.2. Mechanism of action of glucocorticoids in resolving inflammation
3.3.3. Metabolic changes associated with glucocorticoids.
3.3.4. Forms of pharmacological intervention
3.3.4.1.Analogues of glucocorticoids used in pharmacotherapy
3.3.4.2. Differential features
3.3.4.3. Main rules for an effective and safe use of glucocorticoids as anti-inflammatories.
4. Drugs that modify the evolution of the disease
4.1. Biological drugs
4.1.1. Introduction to biological drugs
4.1.2. Mechanism of action and efficacy and safety profile of the most common biological drugs used in inflammatory diseases.
4.1.3. Anti-IL2 drugs
4.1.4. Anti-IL-6 drugs
4.1.5. Anti-TNF drugs
4.1.6. Other drugs for specific inflammatory diseases.
4.2. Drugs inhibiting the JAK / STAT pathway
4.3. Non-biological and non-targeted disease-modifying drugs
4.3.1. Drug classes and general mechanisms of action
4.3.2. Pharmacotherapeutic profile of representative drugs
4.3.2.1. Methotrexate
4.3.2.2. Leflunomide
4.3.2.3. Hydroxychloroquine
4.3.2.4. Azathioprine
4.3.2.5. Sulfasalazine
5. Immunochemicals in specific contexts: integration of the options presented in the course in the treatment guidelines for some representative inflammatory diseases
5.1. Rheumatoid arthritis
5.2. Asthma and other inflammatory diseases
5.3. Inflammatory bowel diseases
5.4. Lupus
5.5 Cardiovascular inflammatory diseases

Mandatory literature

Carol Mattson Porth; Pathophysiology. ISBN: 0-397-54723-4
Joseph T. DiPiro; Pharmacotherapy. ISBN: 0-07-136361-0
Serafim Correia Pinto Guimarães; Terapêutica medicamentosa e suas bases farmacológicas. ISBN: 972-0-06029-8
Alfred Gilman; Goodman and Gilmans. the pharmacological basis of therapeutics. ISBN: 0-02-344710-9

Comments from the literature

Appropriate bibliography will be provided for each chapter through the Moodle platform.

Teaching methods and learning activities

The teaching methodologies adopted in the lectures are based on general expositions by the academic staff, with the presentation of the state of the art for each of the chapters of pharmacology and pharmacotherapy addressed, with the aim of helping students to achieve the learning objectives. 
Lectures will serve for presentation of general concepts and to support an autonomous work of students in deepening each topic, based on scientific papers available through the Moodle platform. 

The laboratory teaching will work as a complement to the topics presented in the lectures with the aim of helping the student to select, in a rigorous and rigorous manner, the diverse sources of reliable information, know the general aspects that influence the use of the main drugs of each group, the therapeutic limitations of each therapeutic group, and develop communication skills that allow them to interact with other health professionals on topics related to the use of medicines.
The laboratory teaching aims to promote the competencies of students to address real-world situations autonomously, by solving problems from the clinical pratice related with pathologies/groups of drugs addressed in this UC.

keywords

Health sciences > Pharmacological sciences
Health sciences > Medical sciences > Medicine > Immunology
Health sciences > Medical sciences > Medicine > Oncology
Health sciences > Pharmacological sciences > Pharmacy
Health sciences > Medical sciences > Medicine > Rheumatology

Evaluation Type

Distributed evaluation without final exam

Assessment Components

designation	Weight (%)
Teste	70,00
Trabalho escrito	15,00
Trabalho prático ou de projeto	15,00
Total:	100,00

Amount of time allocated to each course unit

designation	Time (hours)
Estudo autónomo	120,00
Frequência das aulas	30,00
Trabalho laboratorial	30,00
Total:	180,00

Eligibility for exams

Student attendance at laboratory classes is compulsory. Students attending less than 3/4 of the classes actually taught (provided that they represent more than 50% of the classes scheduled) will not be admitted for evaluation.
Student attendance at lectures is not compulsory.

Calculation formula of final grade

The evaluation will include all the subjects taught in lectures and in the practical/laboratory classes.
 
It consists of the sum of the evaluation to the laboratory component (maximum quotation of 6 values (scale from 0 to 20) with the note of direct participation and that of the theoretical component (maximum quotation of 14 values).
The evaluation of the laboratory component will be based on an evaluation of papers presented in each laboratory class by each group of students and their discussion. The evaluation will be based in (i) the ability to select reliable and science-based information on the topic addressed; (ii) the communication skills revealed during the presentation to peers and (iii) the level of knowledge of the topic and their capacity to translate data from fundamental research to the clinical use.

The evaluation of the theoretical component will be carried out in a distributed way in two evaluation events (frequencies) according to the official evaluation calendar. It will consist of a questionnaire with multiple-choice questions and/or short answer questions. Unless technological or logistical limitations appear, the final exam will be done in a computer, through the platform Moodle.

For the approval in the UC is required a minimum of 6.5 values in the theoretical component (quotation from 0 to 14).

Special assessment (TE, DA, ...)

Students with worker-student status may be exempted from the laboratory evaluation component. In this case, they will have to do only a final exam that will include all the subjects taught in the lectures and laboratory classes, and that will have the quotation up to 20 values.
For these students, the final exam will occur simultaneously with the second frequency and according to the official evaluation calendar. 

The same procedure may be applicable to the ERASMUS students who do not wish to participate in the continuous evaluation of the laboratory component. However, they must attend laboratory classes to obtain the possibility to be admitted to the final exam.

The students must communicate to the academic staff of the CU their decision at the beginning of the semester.