General Pathology
Immunology
Microbiology
Pharmacology
Key Categories of Pharmacologic Information
Weekly Quizzes
Student EvaluationCourse Design Group
| Overall Course Director & Director of Pathology Component |
Domenick J. Falcone, Ph.D. Associate Professor Dept. of Pathology & Lab Medicine |
| Director of Immunology Component | Xiaojing Ma, Ph.D. Professor Dept. of Microbiology & Immunology |
| Director of Microbiology Component | Neal Lue, M.D., Ph.D. Associate Professor Dept. of Microbiology & Immunology |
| Director Pharmacology Component | Arleen Rifkind, M.D. Professor Dept. of Pharmacology |
| PBL Coordinator | C. Richard Minick, M.D. Professor Dept. Pathology & Lab Medicine |
The Host Defenses course will introduce the principles of general pathology, immunology, microbiology and pharmacology in such a manner that the student can appreciate the individual disciplines, yet also see how they are integrated in the context of disease. In this regard, the Design Group has authored all of the PBL cases utilized in this course. Each week the PBL case introduces the theme of the week, which will include topics from the 4 core disciplines. These topics will then be developed and expanded upon by each discipline in lectures, lab and small group discussions.
General Pathology
Pathology is the study of disease. The study of pathology includes: the cause of disease (etiology), the mechanisms by which a causative agent leads to disease (pathogenesis), structural and functional consequences of disease. General pathology, the subject of this course, details the basic reactions of cells and tissues, which are common to all diseases. Each week basic pathological principles will be presented in the context of the PBL case, an overview lecture and histopathology laboratory. The histopathology laboratory exercises expand upon the pathological principles, which are either integral or related to the week’s PBL case. These laboratory exercises are intended to extend the students knowledge of pathology by demonstrating additional examples and by comparing and contrasting the PBL case material to other pathologic conditions. The laboratory exercises will usually not present the PBL case materials, which the students are expected to explore on their own, but will build upon that knowledge base. Microscopic slides and computer images, derived from representative pathologic specimens, will be examined in the context of new clinical scenarios. Students are expected to examine both slides and computer images prior to lab. Active participation is expected.
Immunology
In this course, the students are expected to acquire and integrate the basic mechanisms and functions of the immune system. They are also expected to understand in principle how the immune system has evolved phylogenetically and evolves ontogenetically in response to infectious agents. Topics presented and/or discussed will encompass the cells, molecules and organs of the immune system. The principles of the innate (natural) and the adaptive (learned) immune response to infections and tumors will be explored. The students will learn the differences between humoral and cellular immune responses, how they are triggered in response to bacterial, viral and tumor antigens, and how they mature and evolve such that effector cells are generated and immune memory is established.
Lectures have been selected to provide a backbone of information. The first three weeks of the course outline the elements and principles of the innate immune system and the maturation of adaptive immunity, via T and B lymphocytes. In the remaining weeks, students are expected to understand the regulation of the immune system, the role of antibodies, cytokines, and effectors T cells in the immune response. The Immunology lectures will provide students with the basic tools to handle immunological issues of the PBL cases.
Microbiology
The microbiology section of the host defenses course is designed to expose students to the basics of bacteriology, mycology and virology through lectures, case presentations, and laboratories. In the second year you will build on the foundation that we have established in Host Defenses. This course is primarily focused on bacteriology. The emphasis on bacteria stems from their clinical importance, the clinically treatable nature of bacterial infections and the diversity of diseases associated with bacterial infections. Virology is presented towards the end of the course with an emphasis on understanding virus-host interactions. Fungal infections are presented at the very end of the course as a survey of fungal infections. The PBL cases are used to present common types of bacterial or viral infections in the context of human disease. The lectures are designed to highlight basic principles of microbiology as well as clinical aspects of diseases cause by bacterial infections. Because of the need to address a broad range of infectious agents, there will be times when the lecture material will focus on organisms that are distinct from those being presented in the PBL cases. The laboratories will use additional cases to augment those presented in the PBL, and will involve wet lab exercises. The laboratory sessions in microbiology are primarily oriented around bacterial pathogens involved in human disease, and provide an opportunity to learn basic bacteriology. The reading material assigned each week complements the lectures, PBL, and laboratory exercises. During each laboratory we will be working toward the characterization of unknown samples and the identification of the presumptive pathogen(s) responsible for the disease presented in each week’s case(s). Before lab starts, it is expected that each student will have studied the cases, the lab material for the week and read the relevant text. Lab will begin by a student presentation of the unknown cases followed by a discussion of the lab strategy for characterization of the target pathogens. Each case has a number of study questions that are relevant to the cases as well as the common pathogens associated with the type of infections.
The first lab session will not have case presentations - we will discuss normal flora and become acquainted with basic techniques in microbiology. Chapters 1-3, 5, 6, 9, and 13 in the Levinson text are relevant to the topics being covered on the first day of class.
Pharmacology
The main focus of the Pharmacology section of the Host Defenses course is to introduce you to the basic principles of pharmacology. During the course you will also be introduced to the pharmacology of some important classes of drugs. Your study of pharmacology will continue in second year courses.
Just as the immune system is the body's main internal host defense system, the body has in place mechanisms to limit the toxic effects of drugs and foreign chemicals to which we are exposed, i.e. the development of specific drug metabolizing enzymes constitute a parallel host defense system to the immune system, for protecting the body against foreign chemicals. In teaching you the fundamental principles of pharmacology upon which all drug prescribing is based we aim to provide you with a framework that you can apply in making prescribing decisions. As a physician you will need to know not only which drugs to use but also how to distinguish between many drugs available with similar effects and to evaluate new marketing claims. Every drug can become a toxic agent depending on dose. The statement of Paracelsus (1493-1541) remains true today: “All substances are poisons; there is none which is not a poison. The right dose differentiates a poison and a remedy”.
The Pharmacology portion of the Host Defenses course includes 13 lectures and 2 large group conferences. Eight lectures specifically address pharmacologic principles: Dose-response and selective toxicity; drug absorption, distribution and excretion; drug biotransformation, induction and inhibition; drug interactions in patients; pharmacokinetics; tolerance and dependence; principles of anti-neoplastic treatment; maternal-fetal interactions. One large group conference will reinforce your learning about pharmacokinetics. The other will be a review of the main pharmacologic principles we want you to master. In each “principles” lecture we will use drugs to illustrate principles, but we do not expect you to learn the pharmacology of those illustrative drugs or the drug classes from which they come, from those lectures.
Three of the Pharmacology lectures: Antibiotics, Antiviral drugs and Antifungal drugs can be considered hybrid lectures. While addressing principles applying to each of those drug classes, they will also present some specific pharmacology for selected drugs or drug classes within those topics. Pharmacology of Antibiotic, Antiviral and Antifungal agents will be covered again in the Infectious Disease Module of Basis of Disease next year.
There are also two new pharmacology lectures in Host Defenses for 2008. One on “Responsible prescribing; What you need to know about drugs and where to find it” is intended to help you identify useful and reliable sources of drug information from the many available. We hope this will be useful to you in learning about specific drugs in medical school and when you become a physician. The second new lecture will tell you about the pre-marketing drug approval process and post-marketing surveillance, to make you better informed about these procedures and their limitations.
You will also learn some specific pharmacology in relation to your PBL exercises. In an exercise called “Pharmacologic Spotlights”, two drugs will be assigned in association with each PBL. You will be expected to learn the pharmacology for each, based on information provided in your textbook, Katzung. A checklist “Key Categories of Pharmacologic Information” is provided below as a guide listing the categories of information you should consider in learning the pharmacology of specific drugs. The required reading list for pharmacology is followed below by a list of the drugs and the chapters in Katzung in which you can find the necessary information for the “Pharmacologic Spotlights”. You should expect to be quizzed on the pharmacology of those drugs based on material found in the text. We hope this exercise will help you to learn how to look up drugs and learn about them in a concise and rational way, and should be useful in studying for National Boards as well as in future practice.
Key Categories of Pharmacologic Information
- Generic name of drug and brand name
- Chemical type and pharmacologic class
- Uses
- Mechanism of action (if known)
- Side effects
- Contraindications
- Clinically significant drug interactions
- Pharmacokinetic considerations relevant to patient dosing.
Quizzes will be given each week on Monday (except for Memorial Day). The quizzes will cover the material covered during the previous week including lectures, labs, small group conferences and the “Pharmacologic Spotlights” described above. The quizzes are meant to serve as a means for both the students and faculty to assess competence.
Student Evaluation
Your overall evaluation in this course will be derived as follows:
- Knowledge Base - Quizzes 55%
- Professional Performance 35%
- PBL & Lab Reports
- Triple Jump Exam 10%
