Description of Anti-allergies – PST04211 Basic Pharmacology

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NTA Level 4 • Semester 2 • PST04211

Description of Anti-allergies

Basic Pharmacology • Source Session/Topic 19
Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability.

Session 19: Description of Anti-allergies

Total Session Time: 120 minutes

Prerequisites

• PST04211_S3_ General Classification of Medicines

Learning Tasks

By the end of this session students are expected to be able to:

• List indications of anti-allergies
• List Contraindication of anti-allergies
• Describe dose, dosage and course of anti-allergies
• List side effects and adverse effects of anti-allergies
• Describe interaction and precaution of anti-allergies

Resources Needed:

• Flip charts, marker pens, and masking tape
• Black/white board and chalk/whiteboard markers
• Computer and overhead projector

SESSION OVERVIEW

Activity/

Step Time Content

Method

1 05 minutes Presentation Introduction, Learning Tasks

Presentation/

2 20 minutes Indications of Anti-allergies

Buzzing

Presentation/

3 20 minutes Contraindication of Anti-allergies

Brainstorming

4 30 minutes Presentation Dose, Dosage and Course of Anti-allergies

Presentation/ Side Effects and Adverse Effects of Anti-

5 20 minutes

brainstorming allergies

6 15 minutes Presentation Interaction and precaution of Anti-allergies

7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

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SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning tasks (5 minutes)

READ or ASK students to read the learning objectives and clarify

ASK students if they have any questions before continuing.

STEP 2: Indications of Anti Allergies (20 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• Which anti allergies are listed in essential medicine list?
• What are the indications of anti-allergies?

ALLOW few pairs to respond and let other pairs add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

• Anti-allergies listed in essential medicine list include; Chlorpheniramine maleate,

Cetirizine Hydrochloride, Loratadine, Promethazine hydrochloride, Adrenalin,

Hydrocortisone, Dexamethasone and Calamine lotion

• Indications of drugs with anti-alergies properties are;

o Chlorpheniramine maleate is used in symptomatic relief of allergy such as hay

fever, urticaria; emergency treatment of anaphylactic reactions

o Cetirizine Hydrochloride, Loratadine are used in symptomatic relief of allergy such

as hay fever and chronic idiopahtic urticaria

o Promethazine hydrochloride is used in symptomatic relief of allergy such as hay

fever and urticaria; emergency treatment of anaphylactic reactions; sedation nausea

and vomiting

o Adrenalin is used in emergency treatment of acute anaphylaxis, angioedema and

cardiopulmonary resuscitation

o Hydrocortisone is used in adrenocortical insufficiency, hypersensitivity reactions e.g.

anaphylactic shock and angioedema asthma, severe inflammatory bowel disease,

haemorrhoids and rheumatic disease

o Dexamethasone is used in suppression of inflammatory and allergic disorders,

diagnosis of Cushing‘s disease, congenital adrenal hyperplasia, cerebral oedema

associated with malignancy, nausea and vomiting with chemotherapy

o Calamine lotion is indicated for pruritus

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STEP 3: Contraindication of Anti-allergies (20 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

• What are the Contraindications of anti-allergies?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

• Most individual drug which can be used as anti-allergies has different properties which

make them to be contraindicated to patient with some specific conditions.

o Chlorpheniramine maleate like many antihistamines it should be avoided in acute

porphyria

o Cetirizine Hydrochloride and Loratadine like many antihistamines they should be

avoided in acute porphyria they should also be avoided in pregnancy and breast-

feeding

o Promethazine hydrochloride like many antihistamines it should be avoided in acute

porphyria

o Hydrocortisone and dexamethasone are contraindicated to patients with systemic

infection (unless specific therapy given):

 Live virus vaccines should also be avoided due to possible suppression of

immunity because serum antibody response diminished)

STEP 4: Dose, Dosage and Course of Anti-allergies (30 minutes)

o Chlorpheniramine maleate

 By mouth, 4 mg every 4–6 hours, max. 24 mg daily Children, 1–2 years 1 mg
twice daily; 2–6 years 1 mg every 4–6 hours, maximum 6 mg daily; 6–12 years 2
mg every 4–6 hours, max. 12 mg daily
 By intramuscular injection or by intravenous injection over 1 minute, 10 mg,

repeated if required up to 4 times in 24 hours; CHILD under 6 months 250

micrograms/kg (max. 2.5 mg), repeated if required up to 4 times in 24 hours; 6
months–6 years 2.5 mg, repeated if required up to 4 times in 24 hours; 6–12 years
5 mg, repeated if required up to 4

o Cetirizine Hydrochloride and Loratadine

 ADULT and CHILD over 6 years 10 mg once daily; CHILD 2–6 years 5 mg once

daily

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o Promethazine hydrochloride

 By mouth, 10–20 mg 2–3 times daily; CHILDREN under 2 years not
recommended, 2–5 years 5–15 mg daily in 1–2 divided doses, 5–10 years 10–25
mg daily in 1–2 divided doses
 By deep intramuscular injection, 25–5mg; max.100 mg; CHILD 5–10 years 6.25–
12.5 mg
 By slow intravenous injection in emergencies, 25–50 mg as a solution containing
2.5 mg/mL in water for injections; max. 100 mg

 The drug should be administered twice daily for not more than five days

o Adrenalin

 Acute anaphylaxis, by intramuscular injection of 1 in 1000 (1 mg/mL) solution.

 Acute anaphylaxis when there is doubt as to the adequacy of the circulation, by

slow intravenous injection of 1 in 10 000 (100 micrograms/mL) solution

o Hydrocortisone

 By mouth, replacement therapy, 20–30 mg daily in divided doses, CHILDREN
10–30 mg
 By intramuscular injection or slow intravenous injection or infusion, 100–500 mg,

3–4 times in 24 hours or as required; CHILDREN by slow intravenous injection

up to 1 year 25 mg, 1–5 years 50 mg, 6–12 years 100 mg

o Dexamethasone

 By mouth, usual range 0.5–10 mg daily; CHILDREN 10–100 micrograms/kg

daily

 By intramuscular injection or slow intravenous injection or infusion (as

dexamethasone phosphate), initially 0.5–24 mg
 CHILDREN 200–400 micrograms/kg daily Cerebral oedema associated with
malignancy (as dexamethasone phosphate), by intravenous injection, 10 mg
initially, then 4 mg by intramuscular injection every 6 hours as required for 2–4

days then gradually reduced and stopped over 5–7 days

o Calamine lotion should be applied occlusive to the affected part

STEP 5: Effects and Adverse Effects of Anti-Allergies (20 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

• What are the side effects and adverse effects of anti-allergies?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

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CLARIFY and SUMMARISE by using the content below

• Side and adverse effects of ant allergies

o Chlorpheniramine maleate and Promethazine Hydrochloride

 Drowsiness

 Headache

 Psychomotor impairment

 Antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and

gastro-intestinal disturbances

 Other rare side-effects of antihistamines include hypotension, palpitation,

arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep

disturbances, tremor, convulsions, hypersensitivity reactions (including

bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity

reactions)

 Dermatitis and tinnitus reported

o Cetirizine Hydrochloride and Loratadine

 Psychomotor impairment

 antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and

gastro-intestinal disturbances

 Other rare side-effects of antihistamines include hypotension, palpitation,

arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep

disturbances, tremor, convulsions, hypersensitivity reactions (including

bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity

reactions)

o Adrenalin

 Nausea, vomiting, tachycardia, arrhythmias, palpitation, cold extremities,

hypertension (risk of cerebral haemorrhage); dyspnoea, pulmonary oedema (on

excessive dosage or extreme sensitivity); anxiety, tremor, restlessness, headache,

weakness, dizziness; hyperglycaemia; urinary retention; sweating

 Tissue necrosis at injection site

o Hydrocortisone and Dexamethasone

 Mineralocorticoid side-effects include hypertension, sodium and water retention,

and potassium and calcium loss

 Glucocorticoid side-effects include diabetes and osteoporosis which is a danger,

particularly in the elderly, as it can result in osteoporotic fractures for example of

the hip or vertebrae

 Other side-effects include: gastro-intestinal effects: dyspepsia, abdominal

distension, acute pancreatitis, oesophageal ulceration and candidiasis

 Musculoskeletal effects: muscle weakness, vertebral and long bone fractures,

tendon rupture

 Endocrine effects: menstrual irregularities and amenorrhoea, hirsutism, weight

gain

o Calamine lotion

 No reported side effect so far

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STEP 6: Interaction and Precaution of Anti-allergies (20 minutes)

• Drug interactions:

o Chlorpheniramine maleate, Cetirizine Hydrochloride, Loratadine and Promethazine

hydrochloride being antihistamine when given with MAOI example phenelzine their

sedative and antimuscarinic effects is increased

o Adrenalin no serious interaction

o Hydrocortisone and Dexamethasone like other corticosteroids increases hematological

effect of methotraxate

o Calamine lotion no serious interaction

• Precautions and cautions:

o Chlorpheniramine maleate, Cetirizine Hydrochloride, Loratadine and Promethazine

hydrochloride should therefore be used with caution in prostatic hypertrophy, urinary

retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction

and in hepatic disease

o Adrenalin should be given with coution heart disease, hypertension, arrhythmias,

cerebrovascular disease, phaeochromocytoma; diabetes mellitus, hyperthyroidism;

susceptibility to angle-closure glaucoma; elderly

o Hydrocortisone and Dexamethasone Abrupt withdrawal after a prolonged period can

lead to acute adrenal insufficiency, hypotension or death

 Withdrawal can also be associated with fever, myalgia, arthralgia, rhinitis,

conjunctivitis, painful itchy skin nodules and weight loss

STEP 7: Key points (5 minutes)

• Antihistamine are common medicines in most allergic condition
• Adrenaline is useful in emergence allergic condition like anaphylactic shock
• Corticosteroid therapy should not be stopped abruptly
• Patient taking antihistamine should not drive or operate the machines

STEP 7: Evaluation (5 minutes)

• What are the indications of antihistamine?
• What is the use of corticosteroids?
• Which adult dose of promethazine hydrochloride
• What is the common adverse effect of hydrocortisone?
• Which group of drug which has interaction with antihistamine?

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

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References

Ministry of Health and Social Welfare. (2013). Standard Treatment Guidelines & National

Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania

government printers.

Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael. (2014).

Pharmacotherapy: A Pathophysiologic Approach (9th ed.). New York, McGraw-Hill

Education.

Sally S.R, Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed) New York,

Lippincott Williams and Wilkins.

School of Pharmaceutical sciences. (2011).Tanzania Pharmaceutical Handbook (2nd ed.).

Dar es Salaam, ARDHI University press.

The Royal Pharmaceutical Society of Great Britain. (2007). Martindale, The Extra

Pharmacopoeia (5TH ed). London, pharmaceutical press.

The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary

(59th ed). London, BMJ Group and RPS Publishing.

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

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