PHYSIOLOGICAL SCIENCES AND PHARMACOLOGY

Integrated educational activity

Course Sheet

Course code:

FIS12A6

Academic Year of enrolment:

2019

Year of supply:

2019/2020

Degree:

Course of 1st Cycle Degree in Physiotherapy

Language:

Italian

Moduls:

PHARMACOLOGY - 2 credits
GENERAL PATHOLOGY - 1 credits
PHYSIOLOGY - 3 credits
PHYSIO-PATHOLOGY - 1 credits

Location:

CHIETI

Credits:

Programme Year:

Cycle:

Second semester

Hours of classroom activity:

Prerequisites:

As expected from academic regulations.
Physiology, to be successfully followed and learned (and successfully studied for passing the exam) requires that the student has acquired knowledge of Chemistry, Biochemistry, Physics, Histology and Anatomy.
The students should have passed the exams of the first semester in order to better understand the information given in the Physiopathology Course. The student must have basic knowledge of applied biology, biochemistry, anatomy and physiology.

Objectives

The course of pharmacology is part of the specific objectives of the study program aimed at training a professional figure able to: know and understand the concepts of general pharmacology and the main classes of drugs (action mechanisms, therapeutic indications, side-effects).
In particular, the Pharmacology course aims to allow the student to develop:
i) the principles of pharmacokinetics (the path of the drug within the human organism, assessed in its qualitative / quantitative aspects) and of the pharmacodynamics (drug / target interactions and analysis of the dose-response relationship); ii) adequate knowledge on the pharmacological basis of therapy, with particular attention to anti-hypertensive, anti-inflammatory and anti-spastic drugs
EXPECTED LEARNING RESULTS
At the end of the course the student, as far as he is competent, will be able to: i) know the pharmacological basis of the therapy; ii) to know the collateral and toxic effects of drugs and the potential interactions between them.
The course will help to provide the student with tools that will enable him to enhance his ability to relate in team with other professional figures (doctors, nurses, psychologists, etc.) who, in an increasingly multidisciplinary approach, will be called to take care of the patient.

Physiology is an integrative science which studies the functioning of life processes at many levels of complexity from cells, to organs, to apparatuses, to the whole organism.
The objective of this course is to provide the theoretical bases which allow the student to understand the cellular mechanisms underlying the function of the major apparatuses and organs that make up the human organism. Particular attention will be provided to the nervous, musculoskeletal, cardiovascular and respiratory systems, given their central importance in preparing physiotherapists to carry out a person-centered professional activity.
EXPECTED RESULTS
• Knowledge and ability to understand
At the end of the course students must be able to:
i) comprehensively expose and discuss the questions using an appropriate language;
ii) show communication skills of the acquired concepts;
iii) demonstrate that they understand the mechanisms underlying the functioning of cells and organs;
iV) be able to draw the required structures and graphics (see program).
• Ability to apply knowledges
The student must also be able to apply the knowledge derived from the course, integrated with those deriving from previous courses, to the understanding of human physiology.
• Transversal skills:
i) Autonomy of judgment
The student must be able to collect and interpret data useful for the development of judgments in an autonomous way.
ii) Communication skills
The student must be able to communicate informations to specialists and non-interlocutors.
Ability to learn
The student, through the methodological criterion that the study of Physiology provides, must be able to develop the skills necessary to undertake further studies with a good degree of autonomy.

The pathophysiology course aims to make the student aware of the mechanisms, causes, risk factors and effects of atherosclerosis and strategies to prevent it.The course is inserted within the GENERAL OBJECTIVES of the study program in Physiotherapy aimed at providing knowledge about the most relevant alteration of the biochemical/molecular mechanisms that cause diseases that develop during all the different phases of the life (childhood, adulthood, oldness). The specifics aims of the Course concern the comprehension of the physiopathological mechanisms of the human diseases focusing on the interests of the specific course in Physiotherapy. The Course will allow the students to acquire the specific skills in terms of scientific and technical terminology devoted to the understanding of the appearance and the development of the diseases. The Course will allow the student to acquire scientific expertise that will aid the future Physiotherapist to work in different sanitary environments, Public and Private.
The course will help to provide the student with tools that will enable her/him to improve the skills in relating to other professional figures (doctors, nurses, psychologists) who, in an increasingly multidisciplinary approach, will be called to take care of the patient.
Finally, the student will be induced to ameliorate his/her skills for an independent study and will acquire the functional methodological tools for an autonomous update.

The course of general pathology aims to acquire the basic elements related to:
a) the physical, chemical, biological and genetic causes responsible for the alteration of body homeostasis and the onset of diseases in humans;
b) the reactive and degenerative mechanisms of the organism;
c) the molecular mechanisms underlying the changes in cell proliferation and the onset of tumors.

Contents

The integrated course of PHYSIOLOGICAL SCIENCES AND PHARMACOLOGY consists of the following courses: pharmacology, physiology, pathophysiology, general pathology.
The course of pharmacology includes two sections:
1) General pharmacology: this section describes the principles that underlie the human-drug interactions and that in turn are divided into two chapters, the one related to Pharmacokinetics (the effects that the body has on drugs) and the one on Pharmacodynamics (the cellular and molecular mechanisms that underlie the therapeutic, unwanted and toxic effects of drugs).
2) Special Pharmacology: this section describes the characteristics of some classes of drugs with particular attention to anti-hypertensive, anti-inflammatory and anti-spastic drugs.

The course of physiology includes:
1. Introduction to Physiology.
2. Neuron physiology and generation of electrical signals.
3. Central Nervous System (CNS): structure and function.
4. Peripheral Nervous System (SNP): afferent and efferent pathways.
5. Skeletal and Smooth Muscle: structure and function.
6. Physiology of the Cardiovascular System.
7. Physiology of the Respiratory System.
8. Kidney and Water Balance.

The Physiopathology course includes the study of the disordered physiological processes that cause, result from, or are otherwise associated with a disease or injury. The Course will describe the mechanisms, the risk factors and the effects of the main pathologies in the fields of Physiotherapy. Particular attention will be devoted to the physiopathology of the cardiovascular and neuromuscular systems.

The course of General Pathology intends to clarify the different elements that contribute to determine the state of health and illness, in the context of the homeostasis of the organism

Extended Syllabus

Pharmacology
Principles of Pharmacokinetics: absorption, distribution, metabolism, half-life, elimination of drugs.
Principles of Pharmacodynamics: ionotropic and metabotropic receptors (G protein coupled receptors).
Mechanisms of signal transduction
Antihypertensive drugs: diuretics; centrally acting sympatholytic drugs; ganglionic blockers; Beta and alpha adrenergic receptor antagonists; direct acting vasodilators; calcium channel blockers; ACE-inhibitors (mechanisms of action, pharmacological properties, side effects)
Anti-inflammatory drugs: nonsteroidal anti-inflammatory drugs (NSAIDs, coxibs and antileukotriene drugs); steroidal anti-inflammatory drugs: natural and synthetic glucocorticoids (mechanisms of action, pharmacological properties, side effects).
Bronchodilators: beta adrenergic receptor agonists (mechanism of action, pharmacological properties, side effects)
Drugs for the treatment of spasticity and acute muscle spasms: benzodiazepines; Baclofen, Dantrolene (Mechanism of action, pharmacological properties, side effects)

Physiology
1. Introduction to Physiology.
1.1 Definition of Physiology and its areas of interest; concept of internal and external environment for the cell and for the organism; homeostasis concept.
1.2 General characteristics of plasma membranes; fluid mosaic model; integral and associated proteins; receptors and transport proteins; difference between carrier and channels.
1.3 The movement of substances through membranes and epithelia; concept of simple or mediated diffusion through the membranes; active transport; concept of simporto and antiporto: the examples of Na + / K + pump and of the Na + -glucose simulator; transport by vesicles: exocytosis, endocytosis and transcitosis.
2. Neuron physiology and generation of electrical signals.
2.1 Distribution of solutes in the various liquid compartments of the organism (schematic drawing); resting membrane potential; equilibrium potentials of Na + and K +.
2.2 The structure of the neuron (schematic drawing of its different parts); glial cells; myelin sheath; axonal transport.
2.3 The resting membrane potential of the neuron; changes in membrane potential and potential generation; concept of depolarization and hyperpolarization; the movement of ions across the membranes; the generations of potential graduates (chart); concept of potential sub-threshold and above-ground levels (graph); spatial and temporal summation of potential graduates; action potential (graph); absolute and relative refractory periods (graph).
2.4 Communication between neurons: chemical synapses (schematic drawing of its different parts) and electrical ones; mechanisms of release and inactivation of neurotransmitters in chemical synapses; concept of convergence and divergence of the signal; concept of stimulus intensity and role of the discharge frequency in the release of the neuro-transmitter.
3. Central Nervous System (CNS): structure and function.
3.1 Communication and integration between different systems of our organism; introduction to the central nervous system; brain and spinal cord; gray matter (or substance) and white matter (or substance) in the brain and in the spinal cord; spinal cord structure; meninges; cerebrospinal fluid; cerebral ventricles and chorioid plexuses; hematoencephalic barrier.
3.2 Structure and function of the brain: encephalic trunk (bulb, bridge and midbrain); the cerebellum; the diencephalon and the homeostatic control centers (thalamus, hypothalamus, pituitary and epiphysis); the telencephalon and the cerebral cortex; ganglia of the base; limbic system: amygdala, cingulum track and hippocampus.
3.3 Brain functions: organization of the cortex in sensory, associative and motor areas; concept of cerebral lateralization; the behavioral status system; diffused modulator systems.
4. Peripheral Nervous System (SNP): afferent (sensory) and efferent (motor-somatic and autonomous) pathways.
4.1 General properties of sensory systems; types of sensory receptors; generator and receptor potential; concept of primary and secondary receptive field; spatial resolution of the stimulus; encoding and processing of sensory stimuli (marked line code, population coding, frequency coding); concept of lateral inhibition; receptor adaptations; the somatosensory pathways and cortex; touch and heat receptors; nociceptors and the retraction reflex; gate-control theory.
4.2 The autonomic nervous system or: sympathetic and parasympathetic branch; the centers of homeostatic control of the encephalic trunk and of the thalamus; localization of the cell bodies of autonomic neurons in the spinal cord; differences and similarities between sympathetic and parasympathetic pathways: localization of pre-ganglional neurons and ganglia; neurotransmitters and adrenergic and cholinergic receptors; neuro-effector junction.
4.3 The somatic motor system: motoneurone and motor unit; localization of the motor bodies of the motor neurons in the spinal cord; neuromuscular junction (schematic drawing of its different parts); acetylcholine, nicotinic receptors, and translation of the signal to the driving plate; signal termination mechanisms.
5. Skeletal and Smooth Muscle: structure and function.
5.1 The three types of muscle of our organism: skeletal, cardiac, smooth; general structure of skeletal muscle fiber: myofibrils, sarcomeres, and membrane systems.
5.2 The excitation-contraction coupling mechanism (EC) and the electrical signal transduction in chemical; transversal tubules and sarcoplasmic reticulum; the voltage sensor (DHPR); the Ca2 + release channel of the sarcoplasmic reticulum (RyR); the triads or calcium release units (schematic drawing of its different parts); differences between skeletal and cardiac EC coupling.
5.3 The sarcomere (schematic drawing of the organization of filaments, lines, and bands); the main sarcomere proteins: contractile, regulatory and accessory; role of troponin and tropomyosin in the activation of the contraction; myosin head cycle; voltage length regulation curve of the sarcomere (graph); concept of motor unit and recruitment.
5.4 Classification of muscle fibers based on metabolism and rate of contraction; classification in red and white fibers; functional differences between slow, intermediate and fast fibers.
5.5 Mechanism of contraction: relationship between electrical events and mechanical events; simple shock (graph), summation (graph), incomplete and complete tetanus (graphs); definition of fatigue (and graph); definition of isometric and isotonic contraction (and role of elastic and contractile components). Concept of motor unit and recruitment.
5.6 General characteristics of smooth muscle cells; organization of thick and thin myofilaments in smooth cells; molecular mechanisms of contraction: role of calmodulin and phosphorylation of the myosin light chain.
6. Physiology of the Cardiovascular System.
6.1 Introduction to the cardiovascular system: anatomy and general functions.
6.2 The heart (schematic drawing): pacemaker and contractile tissue; contractile myocardial cells and intercalary disks (schematic drawing); the conduction system (schematic drawing of its various components); the potential of pacemaker cells (graph); the action potential of contractile cells (graph); the electrocardiogram (graph); the cardiac cycle explained with the 5 phases; the cardiac cycle explained with the pressure-volume curve of the left ventricle (graph); cardiac output (formula); Frank-Starling's law (graph).
6.3 Small and large circulation; arterial pressure and its measurement (concept of systolic pressure and diastolic pressure); mean arterial pressure and factors affecting it; structure of blood vessels: differences between arteries and veins; role of arteries and veins in helping the heart to pump blood; regulation of arterial pressure and baroceptive reflex (schematic drawing of its functioning).
6.4 Blood (plasma and corpuscular component); plasma composition; corpuscular component: red blood cells, white blood cells and platelets; hematocrit concept; hematopoiesis; hemostasis and coagulation.
7. Physiology of the Respiratory System.
7.1 Introduction to the respiratory system: anatomy and general functions; the reason for an internalized respiratory system; upper and lower airways; structure of the lung and alveoli; the pleura and their role; inspiratory and expiratory muscles; concepts of lung compliance and elasticity; concept of instability of the alveoli; the 4 phases of external respiration.
7.2 Ventilation (inhalation and exhalation) and gaseous exchange with blood; the laws of gas; muscles involved in ventilation at rest and under stress; ventilatory mechanics; spirometry and measurement of pulmonary volumes and capacities (graph); concept of pulmonary and alveolar ventilation (formulas); alveolar gaseous exchange; hyperventilation curve and hypoventilation (graph).
7.3 Gaseous blood transport and gaseous exchange with tissues; transport of O2; hemoglobin / O2 dissociation curve (graph); pH effect (Bohr effect) and temperature on the dissociation curve; blood transport of CO 2 and effect on blood pH.
7.4 Reflex control and ventilation regulation (schematic drawing of its operation);
respiratory centers of the bulb and of the bridge; dorsal and ventral respiratory nuclei; central and peripheral chemoreceptors.
8. The Kidney and the Water Balance.
8.1 Introduction to the urinary system: urinary tract and kidney (cortex and medullary), main functions of the kidneys. The nephron: tubular elements and vascular elements, structure of the renal corpuscle, the four fundamental processes (filtration, reabsorption, secretion, excretion), filtration fraction, filtration pressure, self-regulation of the filtration speed, myogenic response and tubulo-glomerular feedback.
8.2 Water balance and role of the kidney in its regulation: vasopressin or antidiuretic hormone, countercurrent exchange in the loop of Henle.

Pathophysiology
- Elements of blood pathophysiology: hematopoiesis, anemia, alteration of leukocytes and platelets.
- Physiopathology of the circulatory system: hyperemia, ischemia, hemorrhage, hypertension and hypotension, thrombosis, embolism and infarction.
- Pathogenesis of atherosclerosis: alterations of lipoproteins, hypercholesterolemia and inflammation.
Physiopathology of the respiratory system: pulmonary edema, pulmonary fibrosis, pleurisy, pneumothorax.
- Type I and type II diabetes mellitus, and pathophysiological aspects of diabetic syndrome.
- Elements of liver pathophysiology: viral hepatitis, jaundice and cirrhosis.
- Muscle tissue pathophysiology: primary myopathies, myopathies associated with motor neuron diseases, neuromuscular transmission alteration.

General pathology
General etiology:
- concept of illness and morbid state
- biological, chemical and physical agents as a cause of illness
Acute inflammation (angioflogosis):
- vascular changes
- cells of the inflammatory process (properties, functions, leukocyte formula)
-chemiotaxis (leukocyte activation and phagocytosis)
- information about the exudate: characteristics, function, types of exudate, reabsorption of the exudate
-muscle chemical agents (property, function, mechanism of action): vasoactive amines, the complement, the coagulation system, arachidonic acid metabolites, cytokines and chemokines
Chronic inflammation (histoplogosis):
-cause and histological features
granulomatous inflammation
- morphological frameworks of acute and chronic inflammation
Systemic manifestations of inflammation (fever)
Healing process: resolution, repair and regeneration
The neoplasms:
- epidemiology and classification of tumors
-the molecular basis of cancer (oncogenes and tumor suppressors)
-mechanisms of invasion and metastatisation

Recommended Bibliography

Pharmacology
Panus PC, Katzung B, Jobst EE, Tinsley SL, Masters SB, Trevor AJ
Farmacologia in riabilitazione
Edi-ermes

Physiology
The student will be able to deepen the topics covered during lessons (and listed in detail in the extended program) in all the books of Human Physiology on the market. Following some recommended texts are:
1. Fisiologia Umana (o Fisiologia): un approccio integrato; autore: Dee Unglaub Silverthorn.
2. VANDER - Fisiologia, Seconda edizione; autori: Eric P. Widmaier, Hershel Raff, Kevin T. Strang.
3. Fisiologia Umana: dalle cellule ai sistemi; autore: Lauralee Sherwood.
4. Fondamenti di Fisiologia Umana; autore: Lauralee Sherwood.
5. Fisiologia; autore; autore: Cindy L. Stanfield.

Pathophysiology
To the students of this type of Study Program a specific texbook is available:
G.M Pontieri. Elementi di Fisiopatologia generale per i corsi di Laurea in Professioni Sanitarie, Ed. Piccin.
Other important tools for the individual preparation are represented, based on teacher’s advice, by the consultation of "Pubmed" and/or of scientific papers, useful for an updated comprehension of the course.
Further specific bibliographic indications can be provided directly by the teacher during the course. Any additional materials will be made available by the teacher to supplement the recommended texts and uploaded on the dedicated website.

General pathology
Tim D. Spector, John S. Axford, Introduzione alla Patologia Generale, Ed. Casa Editrice Ambrosiana.
Material provided during lessons

Teaching Methods

Pharmacology
The course includes lectures and interactive lessons.
The course aims to provide the theoretical basis necessary for a reasoned understanding of what the drug produces once it has been introduced into the human organism (pharmacodynamics) taking into account how it is distributed and modified in the organism itself (pharmacokinetics). At the same time, special care will be taken in linking theoretical knowledge with the evidence emerging from the use of drugs as tools of therapeutic armamentarium. In itinere will be proposed exercises (multiple choice quizzes) to verify the level of personal learning on the various topics covered.

Physiology
The course is structured in 30 hours of frontal teaching, divided into 15 lessons of 2 hours. The frontal lesson will be supported by the projection of slides (prepared by the teacher) and animations related to the topics covered.

pathophysiology
The Course is structured in 10 hours (1 CFU) learning subdivided into 2-3 hours lessons, according to the academic calendar. The frontal teaching is caracherized by lectures, supported by the projection of slides prepared by the teacher, whose purpose is to transmit concepts, information and schemes useful for the comprehension of the scientific subjects. During the Course, the teacher will propose some checks of learning to be performed in groups of study to test "in itinere" the students' learning. The frequency of the course is obligatory and the final test will be equal for frequenting and non-frequenting students.

general pathology
Frontal lessons

Evaluation methods

Verification of learning:

For the course of pharmacology, the exam will include a written test [multiple choice questions (each question has 4 answers, only the correct one)]and an oral one aimed at providing a balanced assessment of the achievement of the objectives of the Core Curriculum. The written exam must be completed within 30 minutes of the start. The examination procedure and its evaluation are indicated by the teacher at the beginning of the lessons.

For the physiology course, The student preparation will be verified through an exam that will focus exclusively on the topics covered during the lessons (and listed in detail in the extended program). The exams will consists of a written test and an oral test to be held on the same day. The written test is preliminary to the oral examination. If the exam will be not completed on the same day due to excessive numbers of students, it will be postponed to the following day.
The written test will last 20 minutes and will consist of 10 multiple choice questions with only one correct answer. The total points of the written test will be 30 (3 points for each correct answer, 0 points for each wrong answer). To access the oral exam the student must have answered correctly 6 questions out of 10. The weight of the written test on the final exam grade will be 1/3 of the entire exam.
The oral test will instead be based on pre-formulated questions (published and provided to the student before the exam) taken from the student during the oral examination. Each student will extract 2 questions for the oral exam and must reach the sufficiency (18/30) in each of the 2 questions extracted. In case the student does not reach the sufficiency in the first of the two questions extracted, the oral exam will be considered concluded with a negative result.
The final mark of the exam will be determined by the weighted average of the scores obtained in the written test (which weighs 1/3) and the oral test (which weighs 2/3).

For the pathophysiology course an oral examination will be performed and the topics under examination will reflect those discussed during the lessons and present in the program. The exam mode and the evaluation methods will be indicated by the teacher at the beginning of the lessons.
The evaluation will be based on the knowledge of the topics covered by the exam questions and the student's logical-argumentative skills. For the purposes of the evaluation, the quality of the oral presentation will also be taken into consideration with particular reference to the competence in the use of the specialized lexicon.
The final grade is calculated as the average of the individual modules (with score equal or above 18/30) of the different modules that, together with that of Physiopathology, are included in the integrated course.

For the general pathology course an oral/written exam will be performed

Contacts/More Information

Each teacher indicated the information deemed appropriate

Università degli Studi
"G. d'Annunzio"

Chieti - Pescara

Aree