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Pharmaceutical Sciences Notes, PST Level 5 Semester 1, PST NTA Level 5, PST05105 Rational Use of Medicines

Control Measures for Irrational Medicines Use – PST05105 Rational Use of Medicines

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NTA Level 5 • Semester 1 • PST05105 Control Measures for Irrational Medicines Use Rational Use of Medicines • Source Session/Topic 5 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 5: Control Measures for Irrational Medicines Use Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Give overview of control measures for irrational medicines use • Identify control measures for irrational medicines use • Explain control measures for irrational medicines use Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |5 minutes |Presentation |Introduction, Learning Tasks | |2 |15 minutes |Presentation |Introduction to Control measures for| | | | |irrational medicines use | |3 |30 minutes |Presentation |Types of Control Measures for | | | |Brainstorming |Irrational Medicines Use | |4 |60 minutes |Presentation |Control Measures for Irrational | | | | |Medicines Use | |5 |05 minutes |Presentation |Key Points | | 6 |05 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (05 Minutes) READ or ASK students to read the learning objectives and clarify ASK students if they have any questions before continuing. STEP 2: Introduction to Control Measures for Irrational Medicines Use (15 Minutes) • The first step to correcting irrational use of medicines is to measure it. • Prescribing, dispensing and patient use should be regularly monitored in terms of: o Types of irrational use of medicines, so that strategies can be targeted towards changing specific problems o Amount of irrational use, so that the size of the problem is known and the impact of the strategies can be monitored o Reasons why medicines are used irrationally, so that appropriate, effective and feasible strategies can be chosen. • People often have very rational reasons for using medicines irrationally • Medicines cannot be used rationally unless everyone involved in the pharmaceutical supply chain has access to objective information about the drug they buy and use. • Knowledge and ideas about drugs are constantly changing, pharmaceutical personnel and physician are expected to know about the new development in drug therapy. STEP 3: Types of Control Measures for Irrational Medicines Use (30 Minutes) |Activity: Brainstorming (15 Minutes) | |Ask students to brainstorm on the following question: | |What are the control measures for irrational medicines use? | |ALLOW few students to respond | |WRITE their responses on the flip chart/ board | |CLARIFY and SUMMARISE by using the content below | World Health Organization (WHO) advises countries to implement national programmes to combat irrational use of medicines through policies, structures, information and education. These include: • Educational Strategies • Printed Materials • Approaches Based on Face-to-Face Contact • Managerial Strategies • Prescribing and Dispensing Approaches • Financing • Regulatory Strategies STEP 4: Control Measures For Irrational Medicines Use (60 Minutes) The following are the control measures for irrational medicines use Educational strategies • There should be training of prescribers and dispensers through: o Formal education (pre-service) o Continuing education (in-service) o Supervisory visits o Group lectures, seminars, and workshops Printed materials • The following materials should be available in the health institutions and health training institutions. o Clinical literature and newsletters o Treatment guidelines and drug formularies o Illustrated materials (flyers, leaflets) Approaches based on face-to-face contact o Educational outreach o Patient education o Influencing opinion leaders Managerial strategies There should be special attention in Selection, Procurement, and Distribution of medicines and medical supplies such as o Limited procurement lists o Drug utilization review and feedback o Hospital and regional drug committees o Cost information Prescribing and dispensing approaches • They should have the following documents o Structured drug order forms o Standard diagnostic and treatment guidelines o Course-of-therapy packaging Financing • Health institution should have o Price setting o Capitation-based budgeting Regulatory strategies • The responsible drug authorities should pay more attention in: o Drug registration o Limited drug lists o Prescribing restrictions o Dispensing restrictions STEP 5: Key Points (05 Minutes) • The most effective approach to improve medicines use is a combination of education and supervision of health personnel, consumer education, and ensuring an adequate supply of appropriate medicines. • There should be special attention in selection, procurement, and distribution of medicines and medical supplies such as: limited procurement lists, drug utilization review and feedback, hospital and regional drug committees. • Approaches based on face-to-face Contact should be applied such as: educational outreach, patient education and influencing opinion leaders STEP 6: Evaluation (05 Minutes) • What are the control measures for irrational medicines use? • List responsibilities of drug authorities in promoting rational use of medicines. References: Rees, J. A., Smith, I., & Watson, (2012) J. Pharmaceutical practice (5th ed.). London, United Kingdom: Churchill Livingstone Dean, B., Schachter, M., Vincent, C, Barber, N (2002).Lancet: Causes of prescribing errors in hospital inpatients: a prospective study. 359:1373–8 . Knudsen, P., Herborg, H., Mortensen, A,R., Knudsen, M., Hellebek, A .(2007). QualSafealthCare:Preventing medication errors in community pharmacy: root-cause analysis of transcription errors.16:285–290. Lesar, T.S., Briceland, L., Stein, D, S. (1997). JAMA:Factors related to errors in medication prescribing..277:312–317. ← Previous TopicNext Topic →View all Rational Use of Medicines topicsOpen Complete Full Notes PDF / OFFLINE NOTES Unataka kutumiwa notes hizi kupitia WhatsApp?Kwa notes zilizopangiliwa vizuri kwa kusoma offline au PDF, bonyeza kitufe hapa chini. Ujumbe wenye Level, Semester, Module na Topic utaandaliwa moja kwa moja.TUMIWA NOTES WHATSAPP WhatsApp: 255620339260

Pharmaceutical Sciences Notes, PST Level 5 Semester 1, PST NTA Level 5, PST05105 Rational Use of Medicines

Problems Associated with Irrational Medicine Usage – PST05105 Rational Use of Medicines

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NTA Level 5 • Semester 1 • PST05105 Problems Associated with Irrational Medicine Usage Rational Use of Medicines • Source Session/Topic 4 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 4: Problems Associated with Irrational Medicine Usage Total Session Time: 120 minutes Prerequisites • None Students Learning Tasks By the end of this session students are expected to be able to: • Give overview of problems associated with Irrational Medicine Usage • List Problems Associated with Irrational Medicine Usage • Explain Problems associated with irrational medicine usage Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Figure 4.3 complications related to irrational use of medicines SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |5 minutes |Presentation |Introduction, Learning Tasks | |2 |30 minutes |Presentation |Introduction of Problems Associated | | | | |with Irrational Medicine Usage | |3 |30 minutes |Buzzing |List Types ofProblems Associated | | | |Presentation |with Irrational Medicine Usage | |4 |45 minutes |Presentation |Problems Associated with irrational | | | | |Medicine Usage | |5 |05 minutes |Presentation |Key Points | | 6 |05 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks(05 Minutes) READ or ASK students to read the learning objectives and clarify ASK students if they have any questions before continuing. STEP 2: Introduction of Problems Associated with Irrational Medicine Usage (30 Minutes) • Medicines play an important role in healthcare delivery, and when used properly, can help cure diseases, relieve symptoms, and alleviate patient suffering. • Irrational use of medicines remains a major issue facing most health systems across the world. • Worldwide more than 50% of all medicines are prescribed, dispensed, or sold inappropriately, while 50% of patients fail to take them correctly and about one-third of the world's population lacks access to essential medicines. • The problem of irrational medicine use is known to be worse in developing countries with weak health systems, where mechanisms for routine monitoring of medicine use are often not well developed or are at times non-existent. STEP 3: Types of Problems Associated with Irrational Medicine Usage (30 Minutes) |Activity: Buzzing (10 minutes) | |ASK students to pair up and buzz on the following question for 2 | |minutes | |What are the problems associated with irrational medicine usage? | | | |ALLOW few pairs to respond and let other pairs to add on points not | |mentioned | |WRITE their response on the flip chart/board | |CLARIFY and SUMMARIZE by using the content below | Incorrect use of medicines occurs in all countries, causing harm to people and wasting resources, consequences include: • Antimicrobial resistance. • Adverse drug reactions and medication errors. • Lost resources. • Eroded patient confidence • Treatment failure leading to unnecessary financial burden • Increase of toxicity risk • Non-compliance to drug regimen. STEP 4: Problems Associated with Irrational Medicine Usage (45 Minutes) The following are the explanation of the problems associated with irrational medicine usage Antimicrobial resistance • Overuse of antibiotics increases antimicrobial resistance and the number of medicines that are no longer effective against infectious disease. • Many surgical procedures and cancer therapies are not possible without antibiotics to fight infection. • Resistance prolongs illnesses and hospital stays, and can even cause disability and death. Adverse drug reactions and medication errors • Harmful reactions to medicines caused by wrong use, or allergic reactions to medicines can lead to increased illness, suffering and death. • Adverse drug reactions have been estimated to increase treatment cost each year. Lost resources • Out-of-pocket purchases of medicines can cause severe financial hardship to individuals and their families. • If medicines are not prescribed and used properly, the income of public and personal funds are wasted. Eroded patient confidence • Exacerbated by the overuse of limited medicines, drugs may be often out of stock or at unaffordable prices and as result erode patient confidence. • Poor or negative health outcomes due to inappropriate use of medicines may also reduce confidence. Treatment failure leading to unnecessary financial burden • Misuse, underuse and over-use of medicines waste resources – often out- of-pocket payments by patients and result in significant patient harm in terms of poor patient outcomes/treatment and adverse drug reactions. Increase of toxicity risk • Drug toxicity can occur as a result of over-ingestion of a medication—having too much of a drug (irrational use) in a person's system at once. • Drug toxicity occurs when a person has accumulated too much of a drug in his bloodstream, leading to adverse effects on the body. • Drug toxicity may occur when the dose given is too high or the liver or kidneys are unable to remove the drug from the bloodstream, allowing it to accumulate in the body • In this case, irrational use of medicines can cause morbidity or mortality in the society Non-compliance to drug regimen • Treatment regimens are only effective if the patient is willing to follow the plan. • Compliance is the extent to which a patient adheres to a treatment regimen, primarily involves following the medication instructions, but it also can include lifestyle modifications, as well as keeping follow- up medical appointments • Noncompliance may lead to relapse, aggravation of the disease state, hospitalization, escalating health care costs, and even death. • Pharmaceutical personnel have a major impact on compliance rates through fighting against irrational use of medicines. Figure 4:3Complications related to irrational use of medicines [pic] STEP 5: Key Points (05 Minutes) • Promoting the rational use of medicines requires effective policies as well as efficient collaboration between health professionals, patients, and entire communities. • Adequate understanding regarding the relevant aspects of medicine use on the part of all stakeholders is essential to drive collaborative efforts towards addressing the problem of irrational medicine use. • Tackling the issue

Pharmaceutical Sciences Notes, PST Level 5 Semester 1, PST NTA Level 5, PST05105 Rational Use of Medicines

Factors Contributing to Irrational Use of Medicines – PST05105 Rational Use of Medicines

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NTA Level 5 • Semester 1 • PST05105 Factors Contributing to Irrational Use of Medicines Rational Use of Medicines • Source Session/Topic 3 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 3: Factors Contributing to Irrational Use of Medicines Total Session Time: 120 minutes Prerequisites • None Students Learning Tasks By the end of this session students are expected to be able to: • Give Overview of Factors Contributing to Irrational Use of Medicines • Identify Factors Contributing to Irrational Use of Medicines • Explain Factors Contributing to Irrational Use of Medicines Resources Needed: • flip charts, marker pens, and masking tape • black/white board and chalk/whiteboard markers • Figure 3.2:Factors influence use of medicines SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |5 minutes |Presentation |Introduction, Learning Tasks | |2 |30 minutes |Presentation |Introduction to Factors Contributing| | | | |to Irrational Use of Medicines | |3 |30minutes |Presentation |Factors Contributing to Irrational | | | |Buzzing |Use of Medicines | |4 |45 minutes |Presentation |Factors Contributing to Irrational | | | | |Use of Medicines | |6 |05 minutes |Presentation |Key Points | | 7 |05 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (05 Minutes) READ or ASK students to read the learning objectives and clarify ASK students if they have any questions before continuing. STEP 2: Factors Contributing to Irrational Use of Medicines (30 Minutes) • There are many factors that contribute to the irrational prescribing or use of medicines. • These factors can be traced to various stages of the medicine use cycle, and can be broadly categorized into those emanating from patients, prescribers, workplace (health system), supply system (including industry influences), regulation, drug information or misinformation, or a combination of these factors. • Uninformed patients who may have the perception that there exists a pill for every ailment can exert undue pressure on health providers to prescribe medicines, even when this is not needed. STEP 3: Factors Contributing to Irrational Use of Medicines (30 Minutes) |Activity: Brainstorming (15 Minutes) | |Ask students to brainstorm on the following question: | |What are the factors contributing to irrational use of medicines? | |ALLOW few students to respond? | |WRITE their responses on the flip chart/ board | |CLARIFY and SUMMARISE by using the content below | The following are the factors contributing to irrational use of medicines • Lack of skills and knowledge. • Inappropriate unethical promotion of drugs • Overworked of health workers. • Lack of coordinated national pharmaceutical policy. • Poor communication skills. • Inadequate supervision • Misleading beliefs. • Irrational self-medication • Inability to communicate problems STEP 4: Factors Contributing to Irrational Use of Medicines (45 Minutes) The following are the explanations of Factors Contributing to Irrational Use of Medicines: Lack of skills and knowledge • Diagnostic uncertainty, lack of prescriber knowledge of optimal diagnostic approaches, lack of independent information such as clinical guidelines, lack of opportunity for patient follow-up, or fear of possible litigation, lead to improper prescription and dispensing of medicines Inappropriate unethical promotion of drugs • Most prescribers get medicine information from pharmaceutical companies rather than independent sources such as clinical guidelines. • Some countries allow direct-to-consumer advertising of prescription medicines, which may lead to patients pressuring doctors for unnecessary medicines, these can lead to inappropriate usage of medicines. Profit from selling medicines • In many countries, drug retailers prescribe and sell medicines over-the- counter. • The more they sell the more income they generate, leading to overuse of medicines, particularly the more expensive medicines Overworked and patient load to health workers • Many prescribers have too little time with each patient, which can result in poor diagnosis and treatment. • In such circumstances prescribers rely on prescribing habit as they do not have the time to update their knowledge on medicines. • A prescriber may be forced to prescribe without proper diagnosis and thus prescribe inappropriate medication. • Too many patients also for dispensers may lead to medication errors and irrational dispensing. Lack of coordinated national pharmaceutical policy • Less than half of all countries implement the basic policies recommended by WHO to ensure the appropriate use of medicines. • These include appropriate measures and infrastructure for monitoring and regulation of medicines use, and training and supervision for prescribing health workers. Poor communication skills • Rudeness of the dispenser or language barrier between the dispenser and the patient leading to misunderstanding of the use of medicines by the patient. • Medical practitioners & other health professional giving less time to the patient & not explaining some basic information about the use of drugs. Inadequate supervision • Poor or inadequate supervision may lead to irrational dispensing, such as not following good dispensing practice (e.g. adequate labelling, adequate instructions, adequate dose, etc.) Misleading beliefs • People tend to think for example that injectables are better than tablets, or imported medicines or expensive medicines are better than locally manufactured or cheap medicines respectively. Irrational self-medication • Taking medicines without prescription or consultation Demand from the patient • To satisfy the patient expectations and demand of quick relief, clinician prescribe drug for every single complaint. Also, there is a belief that “every ill has a pill” All these increase the tendency of polypharmacy. Inability to communicate problems; • Communication barriers, which lead to wrong diagnosis and therefore wrong prescription, consequently wrong dispensing. • Communication barriers may include language, or/and stigma. Figure 1.2 Factors Influence Use of Medicines STEP 5: Key Points (05 Minutes) • Many interrelated factors influence medicine use. • The health system, prescriber, dispenser, patient, and community are all involved in the therapeutic process, and all can contribute to irrational use in a variety ways. • Less than half of all countries implement the basic policies recommended by WHO to ensure the appropriate use of medicines. • These

Pharmaceutical Sciences Notes, PST Level 5 Semester 1, PST NTA Level 5, PST05105 Rational Use of Medicines

Introduction to Irrational Use of Medicines – PST05105 Rational Use of Medicines

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NTA Level 5 • Semester 1 • PST05105 Introduction to Irrational Use of Medicines Rational Use of Medicines • Source Session/Topic 2 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 2: Introduction to Irrational Use of Medicines Total Session Time: 120 Minutes Prerequisites • None Students Learning Tasks By the end of this session students are expected to be able to: • Give over view of irrational medicines use • Identify types of irrational Medicines use • Describe dispenser’s influence on irrational use of medicines • Describe prescriber’s influence on irrational use of medicines • Give reasons for irrational use of medicines to continue Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Handout 2.1:Factors underlying irrational Use of Medicines SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 Minutes |Presentation |Introduction, Learning Tasks | |2 |20 Minutes |Presentation |Introduction to Irrational Use Of | | | | |Medicines | |3 |30 Minutes |Presentation |Types Of Irrational Medicines Use | | | |Buzzing |Based on Prescribing Practice | |4 |20 Minutes |Presentation |Dispenser’s Influence on Irrational | | | | |Use of Medicines | |5 |20 Minutes |Presentation |Prescriber’s Influence on Irrational| | | | |Use of Medicines | |6 |15Minutes |Presentation |Reasons For Irrational Use of | | | |Brainstorming |Medicine to Continue | |7 |05 Minutes |Presentation |Key Points | |8 |05 Minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (05Minutes) READ or ASK students to read the learning objectives and clarify ASK students if they have any questions before continuing. STEP 2: Introduction to Irrational Use of Medicines (20Minutes) Irrational use of medicines: • Is the use of medicines in a way that is not compliant with rational use, this incorrect use may take the form of overuse, underuse and misuse of prescription or non-prescription medicines Irrational use of medicines is a serious public health problem worldwide and can be seen as: • Use of too many medicines per patient • Inappropriate use of antimicrobials, often in inadequate dosage and insufficient duration; • Overuse of injections when oral medication would be more appropriate; • Failure to prescribe in accordance with clinical guidelines including standard treatment guidelines and prescribing policy; and • Inappropriate self-medication, often of prescription-only medicines. STEP 3: Types of Irrational Medicines Use Based on Prescribing Practice (30 Minutes) |Activity: Small Group Discussion ( 05 minutes) | |DIVIDE students into small manageable groups | |ASK students to discuss on the following question | |Give types of irrational medicine use base on prescribing practice | |ALLOW students to discuss for 10 minutes | |ALLOW few groups to present and the rest to add points not mentioned | |CLARIFY and SUMMARIZE by using the contents below | The following are some types of irrational use of medicines based on prescribing practices that observed in health institutions: • Under-prescribing; • Over-prescribing • Incorrect prescribing or dispensing • Extravagant prescribing • Multiple prescribing • Poly-pharmacy • Under-prescribing: o Occurs when needed medications are not prescribed and the dosage prescribed is inadequate • Over-prescribing: o Occurs when the prescribed drug is not needed by the patient and the quantity of drug dispensed is too much for current course of treatment • Incorrect prescribing or dispensing: o Occurs when prescribing the wrong drug, dispensing the wrong drug due to the prescription being prepared improperly and adjustments are not made for existing medical, genetic, environmental or other conditions • Extravagant prescribing: o Occurs when prescribing a more expensive branded drug when there is a less expensive generic drug of good quality available and treating the patient symptomatically instead of treating the serious illness, hence making the patient use a lot of his funds. • Polypharmacy o The use of too many medicines per patient when more than one medicine is used unnecessarily to treat same condition. STEP 4: Dispenser’s Influence on Irrational Use of Medicines (20 Minutes) The dispenser plays a crucial role in the therapeutic process, on the other hand: • Dispensing quality may be affected by training and supervision the dispenser has received and the medicine information available to the dispenser. • A shortage of dispensing materials and short dispensing time caused by heavy patient load may also have an adverse impact on dispensing. • As with prescribers, dispensers, especially private drug sellers, may have a financial incentive to dispense irrationally. • Drug sellers in retail outlets are rarely trained and there is little knowmonitoring or supervision. • Low status of dispensers affects the quality of dispensing. Dispensing characteristics that lead to Irrational Medicine Use are: • Incorrect interpretation of the prescription • Retrieval of wrong medicines/ingredients • Inaccurate counting, compounding, or pouring • Inadequate labelling • Unsanitary procedures packaging: o Poor-quality packaging materials o Odd package size, which may require repackaging o Unappealing package Pharmaceutical personnel promoting irrational use of medicines by: – • Recommending prescription medicines even though the law does not permit it. • When recommending Over-The-Counter (OTC) medicines, he may recommend/provide: o Irrational medicines and combinations. o Inappropriate dosage. o Improper medicine for a particular condition. o Insufficient or inappropriate information about the medicines, dosages, timing set leading to improper dosing by the patient. • By being tempted to stock and push/recommend medicines that are costly, or those which offer better schemes/profit margins, but compromise on genuine need and rationality. • By following/copying prescribing patterns similar to those of physicians. • By passing on misleading information from pharmaceutical companies/medical representatives to clients. [pic] STEP 5: Prescriber’s Influence on Irrational Use of Medicines (20 Minutes) Prescriber can be affected by internal and external factors such as: • He or she may have received inadequate training either pre-service or in- service, or his or her prescribing practices may have become outdated because of a lack of continuing education

Pharmaceutical Sciences Notes, PST Level 5 Semester 1, PST NTA Level 5, PST05105 Rational Use of Medicines

Introduction to Rational use of Medicines – PST05105 Rational Use of Medicines

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NTA Level 5 • Semester 1 • PST05105 Introduction to Rational use of Medicines Rational Use of Medicines • Source Session/Topic 1 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 1: Introduction to Rational use of Medicines Total Session Time: 120minutes Prerequisites None Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Figure 1.1: The cycle of rational medicine use Learning Tasks By the end of this session students are expected to be able to: • Give introduction of rational use of medicines • Define common terms in rational use of medicines. • Identify characteristics of medical prescription • Outline six steps of rational prescribing. • Describe avoidable mistakes in prescribing. • Describe how to promote rational use of medicines. • Explain criteria for assessing rational drug use SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 Minutes |Presentation |Introduction, Learning Tasks | |2 |15 Minutes |Presentation |Introduction to Rational Use of | | | | |Medicines | |3 |20 Minutes |Presentation |Definitions of Common Terms in | | | | |Rational Use of Medicines. | |4 |15 Minutes |Presentation |Characteristics of Medical | | | |Buzzing |Prescription | |5 |10 Minutes |Presentation |Avoidable Mistakes in Prescribing. | |6 |15 Minutes |Brainstorming |Steps to Improve Rational Drug | | | |Presentation |Prescribing | |7 |20 Minutes |Presentation | Promoting Rational Use of | | | | |Medicines. | |8 |10 Minutes |Presentation |Criteria for Assessing Rational Drug| | | | |Use | |9 |05 Minutes |Presentation |Key Points | | 10|05 Minutes |Presentation |Evaluation | SESSION CONTENTS STEP1: Presentation of Session Title and Learning Tasks (05 Minutes) READ or ASK students to read the learning objectives and clarify ASK students if they have any questions before continuing. STEP 2: Introduction to Rational Use of Medicines(15 Minutes) • The rational use of drugs requires that Patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community. • It focuses on four important aspects of the rational use of medicines: correct medication, correct dose, correct duration of treatment and correct cost, irrational use occurs when one or more of these conditions are not met. • Rational use of medicine has three components and they are o Availability of essential medicines o Access and affordability of medicines o Rationality of prescription • In public health service system, free access of low cost medicine to all patient is an important element in ensuring implementation of rational drug use guidelines • Rational Use of Medicines has several importance such as: o Reducing the incidences of drug resistance o Improving patience adherence to medicines o Reducing unnecessary cost of drug acquisition o Reducing incidences of treatment failure o Reducing the incidences of drug adverse reaction STEP 3: Definitions of common terms in Rational Use of Medicines.(20 Minutes) • Irrational use of medicines • Rational prescribing • Irrational prescribing • Rational dispensing • Irrational dispensing • Brand or trade name • Generic name • Adherence to treatment (compliance) • Expirations date • Shelf life • International nonproprietary name (INN) • Labeling • Prescription • Irrational or non-rational use of medicines: o This is s the use of medicines in a way that is not compliant with rational use of medicines. • Rational Prescribing: o The process in which the prescriber make accurate diagnosis of the condition, selects the most suitable medication from those available, prescribes the medicine in the right dosage for a sufficient length of time according to the standard treatment guidelines. • Irrational Prescribing: o Prescribing that does not conform to good standards of treatment –for example, extravagant prescribing, overprescribing, incorrect prescribing, and multiple prescribing or under prescribing. • Rational dispense: o To prepare and distribute/supply to a patient a course of therapy with appropriate instructions, on the basis of prescription. • Irrational dispensing; o The preparation and distribution of a course of therapy to a patient, without appropriate instructions, based on a prescription. • Brand or Trade Name; o This is a name given to a drug product by its manufacturer. • Generic Name; o A generic name is the unique INN given to the active ingredients of a drug and is recognized worldwide. • Adherence to treatment (Compliance); o The degree to which patients adhere/comply to medical advice and take medicines as directed. • Expiration Date; o The date after which the manufacturer can no longer guarantee the stability, safety and potency of a drug. • Shelf Life; o The length of time a drug may be stored without affecting its stability, safety, purity or potency. • International Nonproprietary Name (INN); o Internationally recognized name for a chemical entity. • Labeling; o Placing written or symbolic instructions on the immediate container in which drugs are dispensed. • Prescription; o A set of instructions written by a qualified or authorized prescriber to a dispenser for supply of drugs and provision of information to the patient. STEP4 : Characteristics of Medical Prescription (15 Minutes) |Activity: Buzzing (05 Minutes) | |ASK students to pair up and buzz on the following question for 2 | |minutes | |What are the characteristics of medical prescription? | | | |ALLOW few pairs to respond and let other pairs to add on points not | |mentioned | |WRITE their response on the flip chart/board | |CLARIFY and SUMMARIZE by using the content below | Characteristics of medical prescriptions: • Prescriptions should promote the rational use of drugs. • Prescription should be written after a diagnosis or a health problem has been identified. • The prescription will present the necessary drugs and measures sufficient to heal or improve the state of the patient. • The prescription must contain all necessary information clearly written. STEP 5: Avoidable

Pharmaceutical Sciences Notes, PST Level 5 Semester 1, PST NTA Level 5, PST05104 Pharmacology and Therapeutics

Pharmacodynamics of Antiarrythmic Drugs 315 – PST05104 Pharmacology and Therapeutics

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NTA Level 5 • Semester 1 • PST05104 Pharmacodynamics of Antiarrythmic Drugs 315 Pharmacology and Therapeutics • Source Session/Topic 40 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 40: Pharmacodynamics of Antiarrythmic Drugs 315 PST 05104 Pharmacology & Therapeutics iv NTA Level 5 Semester 1 Facilitator Guide Background There is currently an ever-increasing demand for pharmaceutical personnel in Tanzania. This is due to expanding investment in public and private pharmaceutical sector. Shortage of trained pharmaceutical human resource contributes to poor quality of pharmaceutical services and low access to medicines in the country (GIZ, 2012). Through Public-Private-Partnership (PPP) the Pharmacy Council (PC) together with Development Partners (DPs) in Germany and Pharmaceutical Training Institutions (PTIs) worked together to address the shortage of human resource for pharmacy by designing a project named “Supporting Training Institutions for Improved Pharmaceutical Services in Tanzania‖ in order to improve quality and capacity of PTIs in training. CSSC prepared a Multi-actor Partnership (MAP) project proposal on how to sustain and strengthen health care in Tanzania through improvement of pharmaceutical training and an inter-institutional coordination of actors. This will harmonize and improve access to quality pharmaceutical service in Tanzania. The project has a various key stakeholders like; CSSC, NACTE, PC, TCU, CEDHA and Pharmaceutical Training Institutions (PTIs). Through this project, few PTIs will receive infrastructural improvements to increase the quantitative and qualitative capacities (CUHAS, RUCU and KSP). Furthermore this project will train Pharmaceutical tutors from different PTIs on teaching and assessment methods in Tanzania and thus improved health delivery through increased qualified human resource. It was also observed that in the previous stakeholder‘s meetings there was a need for the development of training manuals and assessment plans for NTA Level 5 & 6, in order to support the establishment and implementation of the curriculum in PTIs. During MAP kick-off workshop done in February 2018, Stakeholders agreed that there was a need for development of the said manuals and it was among the highest priority in Pharmacy education in Tanzania. Therefore this project aims at developing facilitator‘s guide and assessment plans for NTA Level 5 & 6. Pharmacy Council, CSSC and action medeor developed the Terms of Reference and selected a qualified service provider with experience in material development to develop the mentioned training manuals and assessment plan. Centre for Educational Development in Health Arusha (CEDHA) was selected and offered a contract to develop Facilitators guide for NTA level 5 & 6 and assessment plan. Centre for Educational Development in Health Arusha (CEDHA) was offered a leading role with the instructions to include experts who have developed teaching materials for NTA Level 4. These experts are primarily experienced pharmaceutical and non-pharmaceutical tutors. The mode of operation used by CEDHA to develop facilitators guide and assessment plan was participatory approach which included a number of activities through various workshops such as planning, and orientation of material development. After these preliminary PST 05104 Pharmacology & Therapeutics v NTA Level 5 Semester 1 Facilitator Guide workshops, experts developed materials individually and in-groups. Thereafter, developed draft materials were reviewed, edited and formatted and draft one was finalized and shared to stakeholders for inputs. Finally, CEDHA submitted the finalized Facilitator‘s guides and assessment plans for NTA level 5 and 6 to CSSC for endorsement, printing, dissemination and sharing with relevant authorities. There are 11 modules for NTA level 5 making 11 facilitator guides including one practicum guide. PST 05104 Pharmacology & Therapeutics vi NTA Level 5 Semester 1 Facilitator Guide PST 05104 Pharmacology & Therapeutics vii NTA Level 5 Semester 1 Facilitator Guide Acknowledgment The development of standardized training materials of a competence-based curriculum for pharmaceutical sciences has been accomplished through involvement of different stakeholders. Special thanks go to the Pharmacy Council for spearheading the harmonization of training materials in the pharmacy after noticing that training institutions in Tanzania were using different curricula and train their students differently. I would also like to extend my gratitude to Christian Social Service Commission (CSSC) for their tireless efforts to mobilize funds from development partners (German Ministry of Industry and action medeor). It is through the implementation of the Multi-Actors Partnership (MAP) project, CSSC has been able to provide the financial and technical support needed during the development of this training material. Many thanks go to the Centre for Educational Development in Health Arusha (CEDHA) experts on health material development and training who coordinated the development of these module sessions particularly Ms. Diana H. Gamuya for her commitment in coordinating and facilitating the planning and development to its completion. Particular acknowledgements are sent to Mr. Dickson Mtalitinya and Members from the secretariat of National Council for Technical Education (NACTE) for facilitating and providing their expertise to the success of this work. It will be unfair if I will not recognize the efforts and contributions of all CEDHA supportive staff that made this process a success; accountant, secretary, drivers and printers Finally, I very much appreciate the contributions of the tutors and content experts representing PTIs, hospitals, and other health training institutions. Their participation in meetings and workshops, and their input in the development of this training manual/facilitators guide have been invaluable. These participants are listed with our gratitude below: Ms. Elizabeth Shekalaghe Registrar, Pharmacy Council of Tanzania Registrar, Pharmacy Council of Tanzania Assistant Director Allied Health,MoHCDGEC Assistant Director Allied Health,MoHCDGEC MoHCDGEC MoHCDGEC Acting Principal, CEDHA Acting Principal, CEDHA Project Manager – MAP, CSSC Project Manager – MAP, CSSC CEDHA Ms. Diana H. Gamuya CEDHA SIBS Ms. Grace Mallange PC KSP CSSC Ms. Emily Mwakibolwa Pharmacy Council Pharmacy Council Pharmacy Council Pharmacy Council PST 05104 Pharmacology & Therapeutics viii NTA Level 5 Semester 1 Facilitator Guide Ms. Tumaini H. Lyombe Ms. Dilisi J. Makawia NACTE NACTE CEDHA CEDHA HKMU CUHAS CUHAS CUHAS CUHAS MUHAS MUHAS MUHAS TCHRT KSP KSP KSP RAS-KLM RuCU RuCU SIBS SIBS SIBS Director of Human Resources Development Ministry of Health, Community Development, Gender, Elderly

Pharmaceutical Sciences Notes, PST Level 5 Semester 1, PST NTA Level 5, PST05104 Pharmacology and Therapeutics

Pharmacodynamics of Antituberculosis Drugs – PST05104 Pharmacology and Therapeutics

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NTA Level 5 • Semester 1 • PST05104 Pharmacodynamics of Antituberculosis Drugs Pharmacology and Therapeutics • Source Session/Topic 39 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 39: Pharmacodynamics of Antituberculosis Drugs Total Session Time: 120 minutes Prerequisites None Learning Tasks By the end of this session students are expected to be able to: Describe mechanism of action of Antituberculosis Drugs Describe drug interactions associated with Antituberculosis Drugs Describe side effects of Antituberculosis Drugs Describe contraindications of Antituberculosis Drugs Flip charts, marker pens, and masking tape Black/white board and chalk/whiteboard markers Computer and projector SESSION OVERVIEW Step Time Activity/ Content Step Time Activity/ Content Step Time Method Content Method Method 1 1 05 minutes 05 minutes Presentation Introduction, Learning Tasks Introduction, Learning Tasks Introduction, Learning Tasks 2 2 45 minutes 45 minutes Presentation Mechanism of Action of Antituberculosis Mechanism of Action of Antituberculosis Mechanism of Action of Antituberculosis 2 2 45 minutes 45 minutes Presentation Drugs Drugs 3 3 20 minutes 20 minutes Presentation/ Drug Interactions Associated With Drug Interactions Associated With Drug Interactions Associated With 3 3 20 minutes 20 minutes brainstorming Antituberculosis Drugs Antituberculosis Drugs Antituberculosis Drugs brainstorming Antituberculosis Drugs Antituberculosis Drugs Antituberculosis Drugs 4 4 20 minutes 20 minutes Presentation Side Effects of Antituberculosis Drugs Side Effects of Antituberculosis Drugs Side Effects of Antituberculosis Drugs 5 5 20 minutes 20 minutes Presentation/ Contraindications of Antituberculosis Drugs Contraindications of Antituberculosis Drugs Contraindications of Antituberculosis Drugs 5 5 20 minutes 20 minutes Brainstorming Contraindications of Antituberculosis Drugs Contraindications of Antituberculosis Drugs Contraindications of Antituberculosis Drugs Brainstorming 6 6 05 minutes 05 minutes Presentation Key Points Key Points Key Points PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics 308 308 308 NTA Level 5 Semester 1 Facilitator Guide NTA Level 5 Semester 1 Facilitator Guide 7 05 minutes Presentation Evaluation PST 05104 Pharmacology & Therapeutics 309 NTA Level 5 Semester 1 Facilitator Guide SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Mechanism of Action of Antituberculosis Drugs (45 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes How do Antituberculosis Drugs produce their pharmacological effects? 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 Isoniazid Isoniazid inhibits synthesis of mycolic acids, which are essential components of mycobacterial cell walls. Isoniazid is a prodrug that is activated by KatG, the mycobacterial catalase-peroxidase. The activated form of isoniazid forms a covalent complex with an acyl carrier protein (AcpM) and KasA, a beta-ketoacyl carrier protein synthetase, which blocks mycolic acid synthesis and kills the cell. Rifampin Rifampin binds to the β subunit of bacterial DNA-dependent RNA polymerase and thereby inhibits RNA synthesis Human RNA polymerase does not bind rifampin and is not inhibited by it. Rifampin is bactericidal for mycobacteria. It can kill organisms that are poorly accessible to many other drugs, such as intracellular organisms and those sequestered in abscesses and lung cavities Ethambutol Ethambutol inhibits mycobacterial arabinosyl transferases, which are encoded by the embCAB operon. Arabinosyl transferases are involved in the polymerization reaction of arabinoglycan, an essential component of the mycobacterial cell wall. PST 05104 Pharmacology & Therapeutics 310 NTA Level 5 Semester 1 Facilitator Guide Pyrazinamide Pyrazinamide is converted to pyrazinoic acid—the active form of the drug—by mycobacterial pyrazinamidase, which is encoded by pncA . The specific drug target is unknown, but pyrazinoic acid disrupts mycobacterial cell membrane metabolism and transport functions. STEP 3: Drug Interactions Associated with Antituberculosis Drugs (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are drug interactions associated with antituberculosis drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below There is no serious interaction between ant tuberculosis drugs and other drugs except that rifampicin reduces plasma concentration of digoxin Absorption of isoniazid is reduced by antacids, Hepatotoxic of isoniazid is potentiated by general anaesthesia and its CNS toxicity is increased by cycloserine Pyrazinamide antagonizes effect of probenecid STEP 4: Side Effects of Antituberculosis Drugs (20 minutes) Side effects and adverse effects of antituberculosis drugs include: Rifampicin o Occasional adverse effects include rashes, thrombocytopenia, and nephritis. It may cause cholestatic jaundice and occasionally hepatitis o Rifampin commonly causes light-chain proteinuria Isoniazid side effects are dose related o They occur in high dose and may include nausea, vomiting, constipation, dry mouth; peripheral neuritis with high doses (pyridoxine prophylaxis, see notes above), optic neuritis, convulsions, psychotic episodes and vertigo Pyrazinamide o Major adverse effects of pyrazinamide include hepatotoxicity, nausea, vomiting, drug fever, and hyperuricemia o Hyperuricemia may provoke acute gouty arthritis PST 05104 Pharmacology & Therapeutics 311 NTA Level 5 Semester 1 Facilitator Guide Ethambutol; the most common serious adverse event is retro bulbar neuritis, resulting in loss of visual acuity and red-green color blindness Streptomycin is ototoxic and nephrotoxic o Vertigo and hearing loss are the most common side effects and may be permanent. o Toxicity is dose-related, and the risk is increased in the elderly o Toxicity can be reduced by limiting therapy to no more than 6 months whenever possible STEP 5: Contraindications of Antituberculosis Drugs (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are the contraindications of Antituberculosis Drugs? ALLOW few students to respond? WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below Rifampicin is contraindicated to patient with jaundice Isoniazid

Pharmaceutical Sciences Notes, PST Level 5 Semester 1, PST NTA Level 5, PST05104 Pharmacology and Therapeutics

Pharmacodynamics of General Anaesthetics – PST05104 Pharmacology and Therapeutics

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NTA Level 5 • Semester 1 • PST05104 Pharmacodynamics of General Anaesthetics Pharmacology and Therapeutics • Source Session/Topic 38 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 38: Pharmacodynamics of General Anaesthetics Total Session Time: 120 minutes Prerequisites None Learning Tasks By the end of this session students are expected to be able to: Describe mechanism of action of General Anaesthetics Describe drug interactions associated with General Anaesthetics Describe side effects of General Anaesthetics Describe contraindications of General Anaesthetics Resources Needed: Flip charts, marker pens, and masking tape Black/white board and chalk/whiteboard markers Computer and LCD projector Handout 38.1. Side Effects of Inhalation Anaesthetics SESSION OVERVIEW Step Time Activity/ Content Step Time Activity/ Content Step Time Method Content Method Method 1 1 05 minutes 05 minutes Presentation Introduction, Learning Tasks Introduction, Learning Tasks 2 2 40 minutes 40 minutes Presentation Mechanism of Action of General Mechanism of Action of General 2 2 40 minutes 40 minutes Presentation Anaesthetics Anaesthetics Anaesthetics Anaesthetics 3 3 15 minutes 15 minutes Presentation/ Drug Interactions Associated With General Drug Interactions Associated With General 3 3 15 minutes 15 minutes brainstorming Anaesthetics Anaesthetics brainstorming Anaesthetics Anaesthetics 4 4 15minutes 15minutes Presentation Side Effects of General Anaesthetics Side Effects of General Anaesthetics 5 5 15minutes 15minutes Presentation/ Contraindications of General Anaesthetics Contraindications of General Anaesthetics 5 5 15minutes 15minutes Brainstorming Contraindications of General Anaesthetics Contraindications of General Anaesthetics Brainstorming 6 6 05 minutes 05 minutes Presentation Key Points Key Points 7 7 05 minutes 05 minutes Presentation Evaluation Evaluation 8 8 10 minutes 10 minutes Presentation Assignment Assignment PST 05104 Pharmacology & Therapeutics 300 NTA Level 5 Semester 1 Facilitator Guide SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Mechanism of Action of General Anaesthetics (40minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes How do general anaesthetics produce their pharmacological effects? 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 General Anaesthetics are the drugs which produce reversible loss of all sensation and consciousness, or simply, a drug that brings about a reversible loss of consciousness General Anaesthetics are generally administered by an anesthesiologist in order to induce or maintain general anesthesia to facilitate surgery General anaesthetics are mainly inhalation or intravenous as shown in the table below; Inhalation: Inhalation: Inhalation: Intravenous: Intravenous: Gas: Gas: Inducing agents: Inducing agents: e.g Nitrous Oxide e.g Nitrous Oxide e.g Nitrous Oxide • Thiopentone, • Methohexitone sodium, • propofol • etomidate Volatile liquids: Volatile liquids: Volatile liquids: Benzodiazepines (slower acting): Benzodiazepines (slower acting): • Ether Ether • Diazepam • Halothane Halothane • Lorazepam • Enflurane Enflurane • Midazolam • Isoflurane Isoflurane • Desflurane Desflurane • Sevoflurane Sevoflurane Dissociative anaesthesia: Dissociative anaesthesia: e.g Ketamine e.g Ketamine Neurolept analgesia: Neurolept analgesia: e.g. Fentanyl e.g. Fentanyl PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics 301 301 NTA Level 5 Semester 1 Facilitator Guide Major targets of General Anaesthetics is ligand gated ion channels GABA-A, Cl¯ channel receptors which are found throughout the CNS Normally, GABA-A receptor mediates the effects of gamma-amino butyric acid (GABA), the major inhibitory neurotransmitter in the brain When a general anaesthetic binds to this receptor, it causes conformational changes leading to opening of central pore and passing down of Cl- along concentration gradient The result is inhibitory effect which reduces the activity of neurones Therefore, General Anaesthetics bind with these channels and cause opening and potentiation of these inhibitory channels leading to inhibition and anaesthesia Fig 38. 2 Structure of GABAA receptor STEP 3: Drug Interactions Associated with General Anaesthetics (15minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are drug interactions associated with general anaesthetics drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below PST 05104 Pharmacology & Therapeutics 302 NTA Level 5 Semester 1 Facilitator Guide Adrenergic Neurone Blockers: enhanced hypotensive effect when general anaesthetics given with Adrenergic Neurone Blockers Alpha-blockers: enhanced hypotensive effect when general anaesthetics given with Alpha-Blockers Aminophylline: increased risk of convulsions when Ketamine given with Aminophylline Analgesics: metabolism of etomidate inhibited by Fentanyl (consider reducing dose of etomidate); effects of thiopental possibly enhanced by Aspirin; effects of intravenous general anaesthetics and volatile liquid general anaesthetics possibly enhanced by Opioid Analgesics Angiotensin-II Receptor Antagonists: enhanced hypotensive effect when general anaesthetics given with Angiotensin-II Receptor Antagonists STEP 4: Side Effects of Local Anaesthetics (15minutes) The side effects of General Anaesthetics are as indicated in the tables below; Table 28.1; Intravenous Anaesthetic Agents Drug Speed of induction and Main unwanted effect(s) Main unwanted effect(s) Notes Notes recovery Propofol Fast onset, very fast Cardiovascular and Cardiovascular and • Rapidly metabolized recovery respiratory depression respiratory depression • Possible to use as • Possible to use as • Possible to use as • Possible to use as continuous infusion • Causes pain at injection site Thiopental Fast (accumulation Cardiovascular and Cardiovascular and • Largely replaced by occurs, giving slow respiratory depression respiratory depression propofol recovery) propofol recovery) • Causes pain at 'Hangover' • Causes pain at 'Hangover' injection site injection site • Risk of precipitating porphyria in susceptible patients Etomidate Fast onset, fairly fast Excitatory effects during Excitatory effects during • Less cardiovascular recovery induction and recovery induction and recovery and respiratory Adrenocortical Adrenocortical and respiratory Adrenocortical Adrenocortical depression than with suppression suppression depression than with suppression suppression thiopental • Causes pain at injection site Ketamine Slow onset, after effects • Psychotomimetic Produces good analgesia Produces good analgesia common during recovery effects following and amnesia and

Pharmaceutical Sciences Notes, PST Level 5 Semester 1, PST NTA Level 5, PST05104 Pharmacology and Therapeutics

Pharmacodynamics of Local Anaesthetics – PST05104 Pharmacology and Therapeutics

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NTA Level 5 • Semester 1 • PST05104 Pharmacodynamics of Local Anaesthetics Pharmacology and Therapeutics • Source Session/Topic 37 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 37: Pharmacodynamics of Local Anaesthetics Total Session Time: 120 minutes Prerequisites None Learning Tasks By the end of this session students are expected to be able to: Describe mechanism of action of Local Anaesthetics Describe drug interactions associated with Local Anaesthetics Describe side effects of Local Anaesthetics Describe contraindications of Local Anaesthetics Resources Needed: Flip charts, marker pens, and masking tape Black/white board and chalk/whiteboard markers Computer and LCD projector SESSION OVERVIEW Step Time Activity/ Content Step Time Activity/ Content Step Time Method Content Method Method 1 1 05 minutes 05 minutes Presentation Introduction, Learning Tasks Introduction, Learning Tasks Introduction, Learning Tasks 2 2 45 minutes 45 minutes Presentation Mechanism of Action of Local Anaesthetics Mechanism of Action of Local Anaesthetics Mechanism of Action of Local Anaesthetics 3 3 20 minutes 20 minutes Presentation/ Drug Interactions Associated With Local Drug Interactions Associated With Local Drug Interactions Associated With Local PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics 293 293 NTA Level 5 Semester 1 Facilitator Guide NTA Level 5 Semester 1 Facilitator Guide brainstorming Anaesthetics 4 20 minutes Presentation Side Effects of Local Anaesthetics 5 20 minutes Presentation/ Contraindications of Local Anaesthetics 5 20 minutes Brainstorming Contraindications of Local Anaesthetics Brainstorming 6 05 minutes Presentation Key Points 7 05 minutes Presentation Evaluation PST 05104 Pharmacology & Therapeutics 294 NTA Level 5 Semester 1 Facilitator Guide SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Mechanism of Action of Local Anaesthetics (45 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes How do local anaesthetics produce their pharmacological effects? 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 Local anaesthetics are drugs which upon topical application or local injection cause reversible loss of sensory perception, especially of pain in a localized area of the body. They block generation and conduction of nerve impulses at a localized site of contact without structural damage to neurons. Clinically they are used to block pain sensation from or sympathetic vasoconstrictor impulses to specific areas of the body Local Anaesthetics are classified as follows; o Injectable anaesthetic: Low potency, short duration – Procaine and Chlorprocaine Intermediate potency – Lidocaine (Lignocaine) and Prilocaine High potency and long duration – Tetracaine, Bupivacaine, Ropivacaine, Surface anaesthetic: Soluble – Cocaine, Lidocaine, Tetracaine and Benoxinate Insoluble – Benzocaine, Butylaminobenzoate and Oxethazine o Miscellaneous drugs: Clove oil, phenol, chlorpromazine and diphenhydramine etc. The mechanism of action of Local Anaesthetics is as follows; All local anesthetics are membrane stabilizing drugs They slows down speed of Action Potential (AP) ultimately stoping AP generation PST 05104 Pharmacology & Therapeutics 295 NTA Level 5 Semester 1 Facilitator Guide They reversibly decrease the rate of depolarization and repolarization of excitable membranes They inhibiting sodium influx through sodium-specific ion channels in the neuronal cell – voltage-gated sodium channels When the influx of sodium is interrupted – action potential cannot rise and signal conduction is inhibited Local anesthetic s bind (located at inner surface) more readily to sodium channels in activated state – and slows its reversion to the resting state – refractory period is increased – ―state dependent blockade‖ – no action on resting nerve. STEP 3: Drug Interactions Associated with Local Anaesthetics (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are drug interactions associated with local anaesthetics drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below Anti-arrhythmics: increased myocardial depression when anti-arrhythmics given with Bupivacaine, Levobupivacaine, Prilocaine or Ropivacaine Beta-Blockers: Increased risk of bupivacaine toxicity when given with Propranolol STEP 4: Side Effects of Local Anaesthetics (20 minutes) CNS Stimulation: It is dose-related spectrum of effects and All effects are due to depression of neurons First an apparent CNS stimulation (convulsions most serious) followed by CNS depression (death due to respiratory depression) Premonitory signs include: ringing in ears, metallic taste, and numbness around lips Cocaine causes euphoria (unique in its ability to stimulate CNS) Lidocaine causes sedation even at non-toxic doses. Cardiocascular system Arrhythmias: o The adverse cardiovascular effects of local anaesthetics are due mainly to myocardial depression, conduction block and vasodilatation. PST 05104 Pharmacology & Therapeutics 296 NTA Level 5 Semester 1 Facilitator Guide Reduction of myocardial contractility probably results indirectly from an inhibition of the Na+ current in cardiac muscle The resulting decrease of [Na+]i in turn reduces intracellular Ca2+ stores and this reduces the force of contraction. Interference with atrioventricular conduction can result in partial or complete heart block, as well as other types of dysrhythmia Hypotension Vasodilatation, mainly affecting arterioles, is due partly to a direct effect on vascular smooth muscle, and partly to inhibition of the sympathetic nervous system. This leads to a fall in blood pressure, which may be sudden and life-threatening. Cocaine is an exception in respect of its cardiovascular effects, because of its ability to inhibit noradrenaline reuptake STEP 5: Contraindications of Local Anaesthetics (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are the contraindications of Local Anaesthetics? ALLOW few students to respond? WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below Local anaesthetics should not be injected into

Pharmaceutical Sciences Notes, PST Level 5 Semester 1, PST NTA Level 5, PST05104 Pharmacology and Therapeutics

Pharmacodynamics of Antiplatelet Drugs – PST05104 Pharmacology and Therapeutics

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NTA Level 5 • Semester 1 • PST05104 Pharmacodynamics of Antiplatelet Drugs Pharmacology and Therapeutics • Source Session/Topic 36 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 36: Pharmacodynamics of Antiplatelet Drugs Total Session Time: 120 minutes Prerequisites None Learning Tasks By the end of this session students are expected to be able to: Describe mechanism of action of Antiplatelet Drugs Describe drug interactions associated with Antiplatelet Drugs Describe side effects of Antiplatelet Drugs Describe contraindications of Antiplatelet Drugs Resources Needed: Flip charts, marker pens, and masking tape Black/white board and chalk/whiteboard markers Computer and LCD projector SESSION OVERVIEW Step Time Activity/ Content Step Time Activity/ Content Step Time Method Content Method Method 1 1 05 minutes 05 minutes Presentation Introduction, Learning tasks Introduction, Learning tasks Introduction, Learning tasks 2 2 45 minutes 45 minutes Presentation/ Mechanism of Action of Antiplatelet Drugs Mechanism of Action of Antiplatelet Drugs Mechanism of Action of Antiplatelet Drugs 2 2 45 minutes 45 minutes Buzzing Mechanism of Action of Antiplatelet Drugs Mechanism of Action of Antiplatelet Drugs Mechanism of Action of Antiplatelet Drugs Buzzing 3 3 20 minutes 20 minutes Presentation/ Drug Interactions Associated with Antiplatelet Drug Interactions Associated with Antiplatelet Drug Interactions Associated with Antiplatelet 3 3 20 minutes 20 minutes brainstorming Drugs brainstorming Drugs 4 4 20 minutes 20 minutes Presentation Side Effects of Antiplatelet Drugs Side Effects of Antiplatelet Drugs Side Effects of Antiplatelet Drugs 5 5 20 minutes 20 minutes Presentation/ Contraindications of Antiplatelet Drugs Contraindications of Antiplatelet Drugs Contraindications of Antiplatelet Drugs 5 5 20 minutes 20 minutes Brainstorming Contraindications of Antiplatelet Drugs Contraindications of Antiplatelet Drugs Contraindications of Antiplatelet Drugs Brainstorming 6 6 05 minutes 05 minutes Presentation Key Points Key Points Key Points PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics PST 05104 Pharmacology & Therapeutics 286 286 286 NTA Level 5 Semester 1 Facilitator Guide NTA Level 5 Semester 1 Facilitator Guide 7 05 minutes Presentation Evaluation PST 05104 Pharmacology & Therapeutics 287 NTA Level 5 Semester 1 Facilitator Guide SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Mechanism of Action of Antiplatelet Drugs (45 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes How do Antiplatelet Drugs produce their pharmacological effects? 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 Salicylates: acetylsalicylic acid (ASA) o ASA works by irreversibly inhibiting COX-1, an enzyme that catalyses the formation of cyclic endoperoxide, which in turn is then converted to Thromboxane A2 (TXA2) in platelets. TXA2 is a potent inducer of platelet aggregation and release. o Inhibition of TXA2 leads to the antiplatelet effects of ASA. Adenosine Diphosphate (ADP) Blockers o Platelets are activated by adhering to damaged endothelium by linking of glycoprotein Ia (GPIa) receptors with collagen and GPIb receptors with von Willebrand factor (vWF). The activation of platelets leads to aggregation and clot formation. o Platelet activation leads to synthesis and release of mediators involved in platelet aggregation: TXA2, Serotonin (5-HT) and ADP. o Mediators such as ADP promote platelet aggregation by increasing GP receptor expression and promoting binding of fibrinogen to GPIIIa/IIb receptors. o Ticlopidine, prasugrel, and clopidogrel inhibit the ADP-dependent pathway of platelet activation and subsequent aggregation. Antiplatelet IIb/IIIa Inhibitors o IIb/IIIa receptors are located on the outside of platelets, in very high numbers (50,000 to 80,000 per cell); in the resting platelet they are inactive. o Fibrinogen and vWF bind to IIb/IIIa receptors; once bound, they bind to foreign surfaces and also bridge other platelets to induce platelet aggregation. PST 05104 Pharmacology & Therapeutics 288 NTA Level 5 Semester 1 Facilitator Guide These drugs bind to the IIb/IIIa receptor complex on the platelet and prevent binding of endogenous ligands including fibrinogen and vWF, thus inhibiting aggregation of the platelet Dipyridamole Dipyridamole was introduced as a vasodilator, but provokes rather than prevents angina (via a steal mechanism). It is used acutely as in stress tests for ischaemic heart disease (e.g. combined with nuclear medicine myocardial perfusion scanning). It is also used chronically, combined with aspirin, for its antiplatelet effect in patients with cerebrovascular disease. Dipyridamole inhibits phosphodiesterase which leads to reduced breakdown of cAMP, and inhibits adenosine uptake with consequent enhancement of the actions of this mediator on platelets and vascular smooth muscle.. STEP 3: Drug Interactions Associated with Antiplatelet Drugs (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are drug interactions associated with antiplatelet drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below Salicylates: acetylsalicylic acid (ASA) o Aspirin not only influences haemostasis when co-administered with warfarin by its effect on platelet function, but also increases the likelihood of peptic ulceration, displaces warfarin from plasma albumin, and in high doses decreases prothrombin synthesis. When low doses of aspirin are taken regularly with warfarin may be more than offset by clinical benefits to patients at high risk of thromboembolism following cardiac valve replacement. o For details refer session on Pharmacodynamics of Antinflammatory drugs Dipyridamole Dipyridamole increases the potency and duration of action of adenosine. This may be clinically important in patients receiving dipyridamole in whom adenosine is considered for treatment of dysrhythmia. PST 05104 Pharmacology & Therapeutics 289 NTA Level 5 Semester 1 Facilitator Guide STEP 4: Adverse Effects of Antiplatelet Drugs (20 minutes) Antiplatelet Drugs Salicylates: acetylsalicylic acid (ASA) o GI: GI effects are caused by reduced levels

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