• Understand mechanisms and processes underlying acute and chronic diseases induced by toxic chemicals. • Develop capacity with current methods for evaluation and clinical management of toxic diseases, in particular acute poisoning and drug dependence.
Prerequisiti
A thorough knowledge of human physiology and the principles of pharmacokinetics and pharmacodynamics is required.
Metodi didattici
The course includes formal lectures. Faculty members are available at times reserved for student visits to provide clarifications about topics included in the course.
Verifica Apprendimento
The examination consists in an oral evaluation addressing the topics included in the programme. Oral or written in itinere evaluations may be conducted. Students must demonstrate that they achieved the learning objectives of the course.
Testi
A1. SL Greene et al: Acute poisoning: understanding 95% of cases in a nutshell. Postgrad Med J, 81: 204-216 (2005). Contents: epidemiology, general management, immediate care, investigations, antidotes, paediatric poisoning, paracetamol, anti-inflammatory drugs (NSAIDS and salicylates), benzodiazepines, tricyclic antidepressants, selective serotonin reuptake inhibitors, cocaine-related acute coronary syndrome.
A2. JF Boyle et al: Management of the Critically Poisoned Patient. Scand J Trauma Resuscit Emerg Med, doi:10.1186/1757-7241-17-29, 2009. Contents: Initial management, diagnostic approach, hyperthermia syndromes, electrocardiogram, laboratory analysis, treatment approach, antidotes, enhancement of clearance/dialysis.
A3. FM Henretig et al: Hazardous Chemical Emergencies and Poisonings. New Engl J Med 380: 1638-1655 (2019). Contents: Overview of hospital-based emergency management, toxicologic principles, classes of hazardous substances.
A4. SN Kales and DC Christiani: Acute Chemical Emergencies. N Engl J Med, 350: 800-808 (2004). Contents: General principles, asphyxiants (carbon monoxide, cyanide, hydrogen sulphide), cholinesterase inhibitors (organophosphate and carbamate pesticides), respiratory tract irritants, vesicants and skin caustics. B1. Facing Addiction in America. The Surgeon General’s Report on Alcohol, Drugs and Health US Department of Health & Human Services, Washington DC, November 2016. Topics: Mechanism of action of individual substances (opioids, cannabinols, ethanol, cocaine, amphetamines); animal models, dopamine and addition; long-term drug use and neuroadaptation. Accessible online at https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf
B2. ND Volkov et al: Addiction circuitry in the human brain (Neurobiology of addiction) Ann. Rev Pharmacol Toxicol 52: 321-336 (2012) Contents: Drug reward in addiction, conditioning in addiction, corticostriatal circuitry, motivation for drug reinforcers, mood and stress reactivity
B3. EW. Boyer: Management of opioid analgesic overdose. N Engl J Med, 367: 146-155 (2012). Contents: Epidemiology of overdose, pathophysiology of opioid analgesics, toxicokinetics, clinical manifestations, diagnosis and management.
Contenuti
A. EMERGENCY TOXICOLOGY, ACUTE POISONING • Epidemiology and pathophysiology of human toxic diseases • Emergency management of poisoning. • The diagnostic process in medical toxicology • Supportive, general care • Decontamination procedures • Antidotes and symptomatic therapy • Enhancement of elimination of absorbed toxicants • Major toxidromes
B. DRUG DEPENDENCE AND ADDICTION MEDICINE • Epidemiology and pathophysiology of drug dependence • Classes of abusable drugs • Neurobiology of addiction • Toxicological profile of abusable substances • Withdrawal states from addictive agents • Management of overdose (alcohol, opioids, cocaine) • Detoxification methods and prevention of relapse in chronic drug dependence