Clinical Pharmacology of the Gastroenteric, Pulmonary, and Immunosuppressive Systems

Comprehensive vocabulary regarding gastrointestinal pharmacology (antiemetics, laxatives, antidiarrheals), pulmonary treatments (asthma, COPD), and an introduction to immunosuppressors based on clinical lecture notes.

CTZ (Chemoreceptor Trigger Zone)

An area located in the floor of the fourth ventricle, outside the blood-brain barrier, capable of detecting chemicals and transmitting emetic information to the vomiting center via dopamine, histamine, acetylcholine, serotonin, and neurokinins.

Vomito a getto (Projectile vomiting)

Emetic episodes not preceded by nausea or premonitory symptoms, caused by direct stimulus from central traumas involving the meninges or the CNS at the cuneal, thalamic, or hypothalamic levels.

Vomito cinetosico (Motion sickness)

Common vomiting resulting from increased sensitivity of the vestibular area (histaminergic and cholinergic receptors) to variations in motion, such as sea or car travel.

5-fluorouracile

The first molecule synthesized in the 1960s for the chemotherapy of solid tumors, specifically colorectal cancer, which remains in use more than six decades later.

Metoclopramide

A dopamine receptor antagonist antiemetic with a strong recommendation from AIFA not to be used for more than five days in adults and contraindicated in children aged 0-1 years due to neurological risks and methemoglobinemia.

Domperidone

An over-the-counter antiemetic molecule that, at therapeutic doses, increases the risk of QT interval prolongation and ventricular arrhythmias such as torsione di punta.

Sindrome extrapiramidale (Extrapyramidal syndrome)

A primary side effect of first-generation antipsychotics that can also occur with prolonged use of antidopaminergic antiemetics like metoclopramide or prochlorperazine.

Discinesie tardive (Tardy dyskinesia)

Irreversible neurological complications that can arise following the use of metoclopramide for long periods, specifically exceeding a 12-week threshold.

Palonosetron

A second-generation 5HT3 antiserotoninergic derivative with much higher receptor affinity and longer effect duration than first-generation drugs like ondansetron.

Granisetron

The only antiserotoninergic molecule that is not a substrate of CYP2D6, making it the preferred choice for patients classified as ultrarapid metabolizers to ensure effective antiemetic action.

Sindrome serotoninergica (Serotonin syndrome)

A severe adverse reaction that can occur when antiserotoninergics are combined with drugs like linezolid, which acts as a secondary MAO inhibitor.

Aprepitant

A neurokinin receptor antagonist (NK1) with a prolonged action exceeding $150$ hours, often used for managing delayed chemotherapy-induced emesis.

Xerostomia

Dryness of the mouth, a common side effect of antimuscarinic drugs like atropine or scopolamine due to the block of cholinergic receptors.

Loperamide

A synthetic opioid antidiarrheal with a bioavailability of less than $1\%$, targeting $\mu$ receptors in the intestine; it is contraindicated in children under 6 years old because of their developing blood-brain barrier.

Lattulosio (Lactulose)

A high molecular weight sugar with high osmotic power used as a laxative to draw water into the intestine and facilitate progression, particularly in elderly patients with diverticula.

FEV1

Forced Expiratory Volume in 1 second; the clinical measurement used to evaluate obstructive respiratory pathologies like asthma.

SABA (Short-acting Beta2-agonists)

Fast-acting bronchodilators like salbutamolo, used to treat acute asthma crises, typically requiring 4-6 administrations.

LABA (Long-acting Beta2-agonists)

Bronchodilators such as salmeterolo and formoterolo that provide longer-lasting relief and are often used as maintenance therapy in asthma and COPD.

Teofillina (Theophylline)

A drug that inhibits PDE3 and PDE4 to increase cAMP and antagonizes adenosine receptors; it has a narrow therapeutic index of $10-20\,mg/mL$.

Candidiasi orofaringea (Oral Thrush)

A local side effect of inhaled corticosteroids caused by the overgrowth of Candida; patients are advised to rinse their mouths after inhalation to prevent it.

Montelukast

An anti-leukotriene receptor antagonist administered orally which has been linked by AIFA to neuropsychiatric changes, including mood disturbances, insomnia, and anxiety.

Omalizumab

A monoclonal antibody target-specific treatment for severe asthma that acts directly against IgE.

Tezepelumab

An advanced monoclonal antibody treatment for asthma that targets TSLP (thymic stromal lymphopoietin), an alarmin produced by epithelial cells.

BPCO (COPD)

Broncopneumopatia Cronica Ostruttiva; a chronic inflammatory disease mainly caused by cigarette smoking, characterized by mucus overproduction, alveolar destruction (emphysema), or fibrotic proliferation.

GVHD (Graft-versus-Host Disease)

An exaggerated immune response where the recipient's body reacts against a transplanted organ or tissue, which immunosuppressors aim to prevent.

Interleuchina 2 (IL-2)

A critical pro-inflammatory cytokine that triggers the immune response and promotes the proliferation of T lymphocytes; it is a primary target for immunosuppressive drugs.