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NTA Level 4 • Semester 2 • PST04211 Description of General and Local Anaesthetics Basic Pharmacology • 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: Description of General and Local Anaesthetics Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of general and local anaesthetics • List Contraindication of general and local anaesthetics • Describe dose, dosage and course of general and local anaesthetics • List side effects and adverse effects of general and local anaesthetics • Describe interaction and precaution of general and local anaesthetics 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 General and Local Anaesthetics Buzzing Presentation/ Contraindication of General and Local 3 20 minutes brainstorming Anaesthetics Dose, Dosage and Course of General and 4 30 minutes Presentation Local Anaesthetics Presentation/ Side Effects and Adverse Effects of General 5 20 minutes brainstorming and Local Anaesthetics Interaction and Precaution of General and 6 15minutes Presentation Local Anaesthetics 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 253 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 General and Local Anaesthetics (20 Minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the general and local anaesthetics? • What are the indications of general and local anaesthesia? 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 include; halothane, ketamine, isoflurane and thiopental while local anaesthetic include lignocaine and bupivavaine • Indication of General anaesthetics include: o Halothane is occasionally used for inhalation induction of anaesthesia with careful monitoring for cardiorespiratory depression and arrhythmias o Ketamine is useful in induction and maintenance of anaesthesia it is used during surgery and intubation o Isoflurane is a volatile liquid anaesthetic, it is used in induction and maintenance of anaesthesia, it is useful during surgery and intubation o Thiopental is used in induction of general anaesthesia, anaesthesia of short duration reduction during surgery and intubation • Indication of Local anaesthetics include: o Bupivacaine labour, surgery and local infiltration o Lignocaine is used as infiltration anaesthesia, intravenous regional and nerve block, surface anaesthesia and nerve block PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 254 STEP 3: Contraindications of General and Local Anaesthetics (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the Contraindications of general and local anaesthetics? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Contra indication of General anaesthetics;. o Halothane is contraindicated if the anaesthetist is not confident of being able to maintain the airway (e.g. in the presence of a tumour in the pharynx or larynx) Extreme care is required in surgery of the mouth, pharynx, or larynx and in patients with acute circulatory failure o Ketamine is contraindicated if the anaesthetist is not confident of being able to maintain the airway (e.g. in the presence of a tumor in the pharynx or larynx). Extreme care is required in surgery of the mouth, pharynx, or larynx and in patients with acute circulatory failure. Also in hypertension, pre-eclampsia or eclampsia, severe cardiac disease, raised intracranial pressure, head trauma, acute and porphyria. o Isoflurane is contraindicated to women who are breast feeding o Thiopental is contraindicated if the anaesthetist is not confident of being able to maintain the airway (e.g. in the presence of a tumor in the pharynx or larynx). Extreme care is required in surgery of the mouth, pharynx, or larynx and in patients with acute circulatory failure. Also in acute porphyria, myotonic dystrophy and breast-feeding • Contra indication of Local anaesthetics; o Bupivacaine is contraindicated in hypovolemia, complete heart blockade should not be used in solutions containing adrenaline for anaesthesia in appendages o Lignocaine like bupivacaine, it is contraindicated in hypovolaemia, complete heart blockade should not be used in solutions containing adrenaline for anaesthesia in appendages PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 255 STEP 4: Dose, Dosage and Course of General and Local Anaesthetics (30minutes) • Dose, dosage, and course of General Anaesthetics are as follows. o Halothane:  Induction of anaesthesia: adult and child over 1 month are initially given 0.5% then increased gradually according to response to 2–4%  Using specifically calibrated vaporiser, in oxygen or nitrous oxide- oxygen  Maintenance of anaesthesia: adult and child over 1 month, 0.5–2% using specifically calibrated vaporiser, in oxygen or nitrous oxide–oxygen o Ketamine:  By intramuscular injection; For short procedures, initially 6.5–13 mg/kg, adjusted according to response  By intravenous injection; For short procedures, initially 1–4.5 mg/kg, adjusted according to response  By intravenous infusion; A solution containing 1 mg/Ml is used in longer procedures for induction, a total dose of 0.5–2 mg/kg may be given. The maintenance dose of 10–45 micrograms/ kg/minute is required and the rate may be adjusted according to response o Isoflurane:  Induction of anaesthesia, the does is increased gradually from 0.5% to 3% using specifically calibrated vaporiser, in oxygen or nitrous oxide–oxygen  Maintenance of anaesthesia; is given at 1–2.5% in nitrous oxide–oxygen using specifically calibrated vaporizer. Additional 0.5–1% may be required when given with oxygen alone o Thiopental:  The

NTA Level 4 • Semester 2 • PST04211 Description of Antipsychotic Drugs Basic Pharmacology • 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: Description of Antipsychotic Drugs Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of antipsychotic drugs • List contraindication of antipsychotic drugs • Describe dose, dosage and course of antipsychotic drugs • List side effects and adverse effects of antipsychotic drugs • Describe interactions and precautions of antipsychotic drugs Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer and projector SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation 2 20 minutes Indications of antipsychotic drugs Brainstorming 3 20 minutes Presentation Contraindication of antipsychotic drugs Dose, dosage and course of antipsychotic 4 30 minutes Presentation drugs Presentation Side effects and adverse effects of 5 20 minutes Buzzing antipsychotic drugs Interaction and precaution of antipsychotic 6 15 minutes Presentation drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 248 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 Antipsychotic Drugs (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • Mention anti antipsychotic drugs • What are the indications of antipsychotic drugs? 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 • They are divided into two groups: o First-generation antipsychotics, also known as typical antipsychotics o Examples are:  Chlorpromazine  Haloperidol  Thioridazine  Fluphenazine o Second-generation drugs, known as atypical antipsychotics o Examples are:  Clozapine  Olanzapine  Risperidone • Antipsychotics (also known as neuroleptics or major tranquilizers) are drugs that are used to treat psychotic disorders STEP 3: Contraindications of Antipsychotic Drugs (20 minutes) • They are contraindicated in clients with o Hypersensitivity o Liver damage o Coronary artery disease o Cerebrovascular disease o Parkinsonism o Bone marrow depression PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 249 o Severe hypotension or hypertension o Coma o Severely depressed states STEP 4: Dose, Dosage and Course of Antipsychotic Drugs (30 minutes) • Treatment of acute attacks (schizophrenia): o Haloperidol 5 mg every 30 minutes for 2 hours • For maintenance: o Chlorpromazine 100 – 600 mg (O) daily in divided doses OR o Haloperidol 3-4.5 mg (O) 12hourly OR o Olanzapine 5-10mg 12 hourly. Maximum dose 25mg/day OR o Risperidone 1mg bid then increase by 1mg every 2-3 days to 2 – 3mg twelve hourly. Maximum dose 16mg/day • For patients who have poor compliance o Fluphenazine decanoate 12.5–50 mg IM every 4 weeks. STEP 5: Side Effects and Adverse Effects of Antipsychotic Drugs (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are common adverse effects of Antipsychotics? 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 Common side effects of antipsychotics include: o Sedation (particularly common in patients on clozapine, olanzapine, quetiapine and chlorpromazine o Headaches o Dizziness o Diarrhea o Anxiety • Extrapyramidal side effects (particularly common in patients on first-generation antipsychotics), which includes: o Akathisia — an often distressing sense of inner restlessness. o Dystonia o Parkinsonism o Tremor PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 250 • Hyperprolactinaemia (rare for those on clozapine, quetiapine and aripiprazole) which can cause: o Galactorrhoea unusual secretion of breast milk. o Gynaecomastia o Sexual dysfunction (in both sexes) o Osteoporosis • Orthostatic hypotension • Weight gain (particularly prominent in patients on clozapine, olanzapine and quetiapine) • Anticholinergic side-effects (common for olanzapine, clozapine) such as: o Blurred vision o Constipation o Dry mouth (although hypersalivation may also occur) o Reduced perspiration • Tardive dyskinesia appears to be more with haloperidol and is characterised by; o Slow (hence the tardive) repetitive, involuntary and purposeless movements, most often of the face, lips, legs, or torso STEP 6: Interactions and precautions of antipsychotic drugs (15 minutes) Antipsychotics should be used cautiously in people with: • Seizure disorders • Diabetes mellitus • Glaucoma • Prostatic hypertrophy • Peptic ulcer disease • Chronic respiratory disorders STEP 7: Key Points (5 minutes) • Antipsychotics are drugs that are used to treat psychotic disorders • Antipsychotics are contraindicated in various medical conditions including patients who are hypersensitive to these drugs • Different doses of antipsychotics are used during acute and maintenance treatment of schizophrenia STEP 8: Evaluation (5 minutes) • What is the indication of antipsychotics? • What are the contraindications of antipsychotics? • What are the dose and dosage of antipsychotics? • What are the precautions of antipsychotics? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 251 References MoHSW (2013). Standard Treatment Guidelines & National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam: Tanzania Government Printers. Sally, S.R. Jeanne, C.S. (2000). Introductory Clinical Pharmacology (6thed) New York, Lippincott Williams and Wilkins. School of Pharmaceutical Sciences (2011).Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam: ARDHI University Press. Talbert, R. L. Yee, G. C. Matzke, G. R. Wells, B. G. & Michael, L. (2014) Pharmacotherapy: a pathophysiologic approach (9th ed.). New York: McGraw-Hill Education. The Royal Pharmaceutical Society of Great Britain (2007). Martindale, the Extra Pharmacopoeia (5th ed). London: Pharmaceutical Press. The Royal Pharmaceutical Society

NTA Level 4 • Semester 2 • PST04211 Description of Anti-epileptics and Anticonvulsant Drugs Basic Pharmacology • 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: Description of Anti-epileptics and Anticonvulsant Drugs Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of anti-epileptics and anticonvulsant Drugs • List contraindications of anti-epileptics and anticonvulsant Drugs • Describe dose, dosage and course of anti-epileptics and anticonvulsant Drugs • List side effects and adverse effects of anti-epileptics and anticonvulsant Drugs • Describe interactions and precautions of anti-epileptics and anticonvulsant Drugs Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer and LCD Projector SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation Indications of Anti-Epileptics and 2 10 minutes Brainstorming Anticonvulsant Drugs Presentation Contraindications of Anti-epileptics and 3 20 minutes Buzzing Anticonvulsant Drugs Dose, Dosage and Course of Anti-epileptics 4 30 minutes Presentation and Anticonvulsant Drugs Presentation Side effects and Adverse Effects of Anti- 5 25 minutes Brainstorming epileptics and Anticonvulsant Drugs Interactions and Precautions of Anti-epileptics 6 20 minutes Presentation and Anticonvulsant Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 241 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: Indications of Anti-epileptics and Anticonvulsant Drugs (10 minutes) Activity: Brainstorming (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • Mention Anti-epileptics and Anticonvulsant Drugs • What are the indications of Anti-epileptics and Anticonvulsant Drugs? 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 • Anti-epileptics include Phenobarbitone, Phenytoin, Carbamazepine and Sodium Valproate • Anti-epileptic drugs are used in management of Epilepsy • Anticonvulsants include Diazepam and Clonazepam • Anti convulsant drugs are used in management of Status epilepticus STEP 3: Contraindications of Anti-epileptics and Anticonvulsant Drugs (20 minutes) Activity: Buzzing (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of Anti-epileptics and Anticonvulsant Drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 242 • Anti-epileptics Following are contraindications of phenobarbitone o Acute intermittent porphyria o Pulmonary diseases with decreased respiratory reserve (due to respiratory depressant effect) o Pregnant and nursing mothers o Hypersensitivity Following are contraindications of carbamazepine o Previous bone marrow depression o Atrioventricular conduction abnormalities o Should not be given to patients taking MAO inhibitors or within 14 days of stopping such treatment o Pregnant and nursing mothers Following are contraindications of phenytoin o Pregnancy- it is teratogenic drug causing ―foetal hydantoin syndrome‖ craniofacial anomalies, mental retardation and limb defect o Hypersensitivity to the drug o Heart blocks, sinus bradycardia • Anticonvulsants In treatment of status epilepticus, drug of 1st choice is Diazepam or Clonazepam; 2nd choice treatment is Phenobarbitone; 3rd choice is Phenytoin. • Diazepam/ Clonazepam o It is contraindicated to people with allergy to benzodiazepines o Contraindicated to people with the following conditions:  Alcohol Intoxication, Depression, Myasthenia Gravis, Wide-Angle Glaucoma, Closed Angle Glaucoma, CYP2C19 Poor Metabolizer, Severe Chronic Obstructed Lung Disease, Significant Decrease in Lung Function, Lung Disease, Liver Problems, Severe Liver Disease, Serious Kidney Problems, Temporarily Stops Breathing While Sleeping, Pregnancy, A Mother who is Producing Milk and Breastfeeding, Low Amount of Albumin Proteins in the Blood STEP 4: Dose, dosage and course of Anti-epileptics and Anticonvulsant Drugs (30minutes) • Epilepsy o Phenobarbitone (O) once daily at night  Children: 3mg/kg/24 hours  Adult: 60 to 90 mg o Phenytoin (O) once daily at night or twice daily when required  Children: 5mg/kg/24 hours  Adult: 200 mg o Carbamazepine (O) as two divided doses  Children: 10mg/kg/24 hours PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 243  Adult: 300 mg 12 hourly o Sodium valproate (O)  Children: 20mg/kg in divided doses  Adult: 600 mg in divided doses • Status epilepticus First choice: o Diazepam (IV) 10 – 20 mg at a rate of 5mg per minute. Repeat in 30 -60 minutes if necessary to a maximum of 200 mg in 24 hours; monitor respiration OR o Clonazepam (O) 0.5mg to 2mg. Once the status epilepticus has been controlled the patient should be maintained on other anti-epileptics Second choice: o Phenobarbitone 200mg (IV) slowly. Repeat after 10 minutes, thereafter it may be repeated every 30 minutes to a maximum of 15mg/kg/24 hours Third choice: o Phenytoin (IV) 150-250 mg at a rate not exceeding 50 mg/minute. Continue with 100 mg every 6 hours, but do not exceed 15mg/kg/24 hours STEP 5: Side Effects and Adverse Effects of Anti-Epileptics and Anticonvulsant Drugs (25 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side and adverse effects of Anti-epileptics and Anticonvulsant Drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Side and adverse effects of Anti-epileptic Drugs are o Phenobarbitone: Hepatitis, hypotension, respiratory depression, behavioural disturbances, irritability, drowsiness, depression, hallucinations, impaired memory and cognition, hyperactivity particularly in the elderly and in children, megaloblastic anaemia (may be treated with folic acid), suicidal ideation o Phenytoin: Nausea, vomiting, constipation, drowsiness, insomnia, transient nervousness, tremor, dizziness, headache, anorexia, rash, acne, blood disorders (including megaloblastic anaemia, leucopenia, thrombocytopenia, and aplastic anaemia) PST 04211 Basic Pharmacology NTA Level 4 Semester

NTA Level 4 • Semester 2 • PST04211 Anti-asthmatic Drugs Basic Pharmacology • 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: Anti-asthmatic Drugs Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of anti-asthmatic drugs • Describe dose, dosage and course of anti-asthmatic drugs • List common side effects and adverse effects of anti-asthmatic drugs • List contraindications of anti-asthmatic drugs • Describe interactions, warnings and precautions of anti-asthmatic drugs Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer and projector SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Objectives Presentation Introduction to Essential Anti-asthmatic 2 10 minutes Brainstorming Drugs Presentation/ 3 15 minutes Indications of Essential Anti-asthmatic Drugs Buzzing Dose, Dosage and Course of Treatment of 4 30 minutes Presentation Essential Anti-asthmatic Drugs Presentation/ Side Effects and Adverse Effects of Essential 5 20 minutes Buzzing Anti-asthmatic Drugs Presentation/ Contraindications of Essential Anti-asthmatic 6 10 minutes Brainstorming Drugs Interactions, Warning and Precautions of 7 20 minutes Presentation Essential Anti-asthmatic Drugs 8 05 minutes Presentation Key Points 9 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 232 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: Introduction to Essential Anti-asthmatic Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What is asthma? • What are the essential anti-asthmatic drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below Asthma • Asthma is an inflammatory condition in which there is recurrent reversible airway obstruction in response to irritant stimuli that are too weak to affect non-asthmatic subjects, characterized by attacks of wheezing, shortness of breath and often nocturnal cough. • Severe attacks are life-threatening • Essential features o Airway inflammation, which causes bronchial hyper-responsiveness, which in turn results in recurrent reversible airway obstruction Essential Anti-Asthmatic Drugs • Anti-asthmatic drugs are mainly categorized into two major groups o Bronchodilators o Anti-inflammatory agents • Most drugs acting on respiratory tract are adrenoceptor agonists, or sympathomimetic agents (bronchodilators) and corticosteroids (used as ‗controllers‘ or anti-inflammatory) • The two categories (above) are not mutually exclusive, that is some drugs classified as bronchodilators also have some anti-inflammatory effect • According to Tanzania standard guideline, essential anti-asthmatic drugs include aminophylline, beclomethasone inhalation, cromoglycate nasal spray, salbutamol, ipratropium aerosol and adrenaline PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 233 STEP 3: Indications of Essential Anti-asthmatic Drugs (15 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the clinical indications of essential anti-asthmatic drugs? 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 • Aminophylline o Is used for treating active symptoms and blockage of airway due to asthma or other lung diseases such as emphysema or bronchitis. o It improves contraction of the diaphragm (the major breathing muscle). o It is used in combination with other medicines. • Beclomethasone Inhalation o It can be used to treat asthma and other allergic conditions • Sodium Cromoglycate nasal spray o It is used to treat asthma and other allergic conditions o It is considered a breakthrough drug in management of asthma, as the patients can be freed from steroids in many cases; however, it is mainly effective as a prophylaxis for allergic and exercise induced asthma, not as a treatment for acute attacks • Salbutamol o Salbutamol is typically used to treat bronchospasm (due to any cause, allergen asthma or exercise-induced), as well as chronic obstructive pulmonary disease. o It is used to relieve bronchospasm in bronchial asthma, chronic bronchitis, emphysema and other airway resistance diseases • Ipratropium Inhalation aerosol o Is indicated as a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. • Adrenaline o Adrenaline is the drug of choice for allergic emergencies o In general this drug is used to treat life-threatening emergencies such as severe allergic reactions (anaphylaxis) such as acute asthmatic attack, cardiac arrest and cardiopulmonary resuscitation (when the heart stops beating and/or the patient stops breathing). PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 234 STEP 4: Dose, Dosage and Course of Treatment of Essential Anti- Asthmatic Drugs (30 minutes) Aminophylline • Acute severe asthma adults orally 100-300mg 3- 4 times daily after food or by slow intravenous injection over at least 20 minutes (with close monitoring), 250–500 mg (5 mg/kg), child 5 mg/kg Beclomethasone Inhalation • Adult Dose for Asthma – Maintenance o 40 mcg/inh and 80 mcg/inh inhalation aerosols:  2 inhalations (40 mcg each) twice a day  Alternatively, 2 inhalations (80 mcg each) twice daily has been effective in some patients who previously received inhaled steroids  Do not exceed 640 mcg a day • Pediatric Dose for Asthma – Maintenance o Children over 12 years of age: o 40 mcg/inh and 80 mcg/inh inhalation aerosols:  1 or 2 inhalations (40 mcg each) twice a day. Or 1 inhalation (80 mcg) twice a day  Alternatively, 2 inhalations (80 mcg each) twice daily has been effective in some patients who previously received inhaled steroids Cromoglycate Nasal spray • The usual dose is to apply one spray into each nostril, four to six times each day Salbutamol • Sabutamol may be given as following dosage: o For chronic asthma 4mg tablet 3-4 times a

NTA Level 4 • Semester 2 • PST04211 Description of Cough and Cold Preparations Basic Pharmacology • 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: Description of Cough and Cold Preparations Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Define and list the symptoms of common cold and cough • List indications of Cough and Cold Preparations • Describe dose, dosage and course of Cough and Cold Preparations • List Contraindications, side effects, adverse effects, interactions and precautions of Cough and Cold Preparations Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Overhead projector (OHP) and computer. SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Objectives Presentation Definition and Symptoms of Common Cold 2 10 minutes Brainstorming and Cough Presentation 3 20 minutes Indications of Cough and Cold Preparations Buzzing Dose, Dosage and Course of Cough and Cold 4 20 minutes Presentation Preparations Presentation Side Effects, Adverse Effects, 5 55 minutes Small Group Contraindications, Interactions and Discussion Precautions of Cough and Cold Preparations. 6 05 minutes Presentation Key Points 7 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 226 SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Objectives (05 minutes) READ or ASK students to read the learning objectives and clarify ASK students if they have any questions before continuing. STEP 2: Definition and Symptoms of Common Cold and Cough (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following questions: • What causes common cold? • What are the symptoms of common cold? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Common cold, also known simply as a cold, is a viral infectious disease of the upper respiratory tract that primarily affects the nose • The common cold is a self-limiting condition and must be distinguished from respiratory infections • The episodes of the common cold are mostly due to viruses • The symptoms attribute to the common cold include: o Cough o Runny nose o Blocked nose o Sore throat o Fever o Malaise o Headache and o Loss of appetite • Cough is the expulsion of air from the lungs with a sudden sharp sound. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 227 STEP 3: Indications of Cough and Cold Preparations (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the indications for cough and cold preparations? 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 Cough and cold preparations are indicated for: Preparations which contains Codeine, dextromethorphan (and some other opioids), antihistamines and soothing remedies like cough syrups are used for cough relief • Expectorants like guaphensin and mucolytic agents like carbocisteine are used to clean the thick sputum by reducing the viscosity • Sympathomimetic preparations like pseudoephedrine, antihistamines like brompheniramine, saline nose drops and hot fluids are used for nose congestion • Soothing remedies like syrups and lozenges and topical anaesthetic agents like benzocaine are used for sore throat relieves STEP 4: Dose, Dosage and Course of Cough and Cold Preparations (20 minutes) • The dose of cough and cold preparations depends on the type of the agent used in a preparation • It is important for a health worker to give right information to patients about the dose, dosage and course of the preparations • Read the leaflet inserted in a preparation in order to identify the ingredients used, their doses and dosages • Most of ingredients in cough and cold preparations are used in 8 hourly, 6 hourly or 4 hourly bases • Example 60mg of pseudoephedrine is used 3-4 times daily for adults and 30mg 3-4 daily for children above five years • The preparations should be used up to two weeks and if there is no improvement see your doctor for further check-up PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 228 STEP 5: Side Effects, Contraindications, Interactions and Precautions of Cough and Cold Preparations (55 minutes) Activity: Small Group Discussion ( 30 minutes) DIVIDE students into small manageable groups ASK students to discuss on the following question • What are Side/adverse effects, contraindications, interactions and precautions of cough and cold preparations? ALLOW students to discuss for 15 minutes ALLOW few groups to present and the rest to add points not mentioned CLARIFY and SUMMARIZE by using the contents below • Side effects and adverse effects o Codeine and dextromethorphan cause nausea, vomiting, constipation, dizziness and dependence o Antihistamines cause gastrointestinal disturbances plus central nervous system disturbances like nausea o High concentration of alcohol in cough syrups causes sedation by supressing the cough reflex. Also high concentration of sugar may cause osmotic diarrhoea o Expectorants cause gastric mucosa irritation, nausea and vomiting o Mucolytic agents cause bronchospasm, fever and gastrointestinal disturbances o Ephedrine and pseudoephedrine cause constriction of nasal blood vessels hence reducing mucosal swelling o Infants may choke due to aspiration if large volume of normal saline nasal drop is used o Lozenges cause aspiration in children • Contraindications o Most of mucolytic agents are contraindicated to peptic ulceration, and some in pregnancy and breast feeding o Codeine and dextromethorphan should be avoided in patients with acute respiratory depression o In intracranial pressure and head injury • Interactions and Precautions o Most drug combinations in cough and cold preparations have no rational basis as may contain ineffective or effective opposing ingredients such as expectorants with cough suppressants. Such

NTA Level 4 • Semester 2 • PST04211 Description of Hormonal Contraceptives Basic Pharmacology • Source Session/Topic 35 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 35: Description of Hormonal Contraceptives Methods Total Session Time: 60 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of hormonal contraceptives • List contraindication of hormonal contraceptives • Describe dose, dosage and course of hormonal contraceptives • List side effects and adverse effects of hormonal contraceptives • Describe interaction and precaution of hormonal contraceptives Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Overhead projector and computer SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation/ 2 05 minutes Indications of Hormonal Contraceptives Buzzing Presentation/ Contraindications of Hormonal 3 10 minutes Brainstorming Contraceptives Dose, Dosage and Course of Hormonal 4 20 minutes Presentation Contraceptives Presentation/ Side Effects and Adverse Effects of Hormonal 5 05 minutes Brainstorming Contraceptives Interactions and Precaution of Hormonal 6 05minutes Presentation Contraceptives 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 219 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: Indications of Hormonal Contraceptives (5 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What hormonal contraceptives are used in clinical practice? • What are indications for hormonal contraceptives? • 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 • Hormonal contraceptives are either given orally or by injection • Oral contraceptive fall into two major categories: o Combined oral contraceptives) COCs) o Progestogen Only Pills (POPs) • Hormonal contraceptives are indicated in: o Alleviating menopausal symptoms o In women with early natural or surgical menopause o Primarily for prevention of conception o Treatment of dysfunctional uterine bleeding, o Treatment of dysmenorrheal o Treatment of endometriosis. o In management of Menorrhagia o Treatment of premenstrual symptoms o Post Coital Contraception (―morning-after pill‖) PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 220 STEP 3: Contraindications of Hormonal Contraceptives (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of hormonal contraceptives? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Hormonal contraceptives are contraindicated in patients with: o Thrombophlebitis o Thromboembolic phenomena o Cardiovascular and o Cerebrovascular disorders or a past history of these conditions o Treat vaginal bleeding when the cause is unknown • They should be avoided in patients with known or suspected tumors of the breast or estrogen-dependent neoplasm • They are contraindicated in patient with the following conditions: o Liver disease o Pregnancy o Severe headaches especially associated with visual disturbances o Numbness or paresis of extremities o Unexplained chest pain or shortness of breath o Severe leg pains STEP 4: Dose, Dosage and Course of Hormonal Contraceptives (30 minutes) • Hormonal contraceptives can be administered orally, intramuscular or through intradermal o Combined Oral Contraceptive (COP)  The use of COP in contraception  In pack of 28 pills, first 21 have hormone and the last 7 have no hormone  Take one pill each day until the pack is empty o Menopausal symptoms with uterus  Give one tablet of combined oral contraceptive daily o Menopausal symptom and osteoporosis prophylaxis (with progesterone for 12-14 days per cycle in women with intact uterus)  10-50 micrograms daily for 21 days repeated after 7 days tablet free period. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 221 o Female hypogonadism  10-50micrograms daily o Post Coital Contraception (―morning-after pill‖)  The method is applicable mostly after rape and unprotected sexual intercourse where pregnancy is not desired  Within 3 days (72 hours) of unprotected sexual intercourse, give  Combined oral Contraceptive 100 microgram ethinylestradiol and 500 micrograms levonorgestrel (2 high dose COC tablets) Or  When this preparation is not available, use 3 tablets each containing 30-35 micrograms ethinyloetradiol and 150-250 microgram levonorgestrel (3 low dose COC tablets) • Management of the dysfunctional uterine bleeding o Norethisterone (Primolut N) 5mg 12hourly for 10 -14 days COC (E+P) Combined oral contraception 2-3 cycles • Progesterone only pills (POP) o This type is suitable for lactating mothers or women with mild or moderate hypertension. Start 6 week after birth o Use of POP in contraception o Take one tablet every daily at the same time o Use of POP in management of dysmenorrhea. Give POP 5mg three times daily by mouth from day 5 to 24 for 3-4 cycles o Use of POP in management premenstrual syndrome. Give POP 5mg 2-3 times • Progesterone injection o This type is suitable for lactating mothers or women with mild or moderate hypertension • Use of progesterone in contraception o Depo Provera 150m intramuscular after every three month • Use of progesterone injection in management of dysfunctional uterine bleeding o Deep intramuscular into buttock of 5-10mg daily for 5-10 days until 2days before onset of menstruation • Injectable Contraceptive: o Medroxy progesterone acetate IM 150 mg every three months • Implant Contraceptive: o Levonorgestrel in six plastic capsules is implanted in the left upper arm made under local anesthesia o Levonorgestrel is effective for five years and is recommended for women who have completed their family or not ready for sterilization or those not able to take estrogen containing contraceptives PST 04211 Basic Pharmacology NTA Level 4

NTA Level 4 • Semester 2 • PST04211 Description of Insulin and Anti Diabetic Basic Pharmacology • Source Session/Topic 34 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 34: Description of Insulin and Anti Diabetic Agents Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Outline indications of Insulin and Anti diabetics agents • List Contraindication of Insulin and Anti diabetics agents • Describe dose, dosage and course of Insulin and Anti diabetics agents • List side effects and adverse effects of Insulin and Anti diabetics agents • Describe interaction and precaution of Insulin and Anti diabetics agents Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer • LCD SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning tasks Presentation/ Indications of Insulin and Anti Diabetics 2 20 minutes Buzzing Agents Presentation/ Contraindication of Insulin and Anti Diabetics 3 20 minutes brainstorming Agents Dose, Dosage of Insulin and Anti Diabetics 4 30 minutes Presentation Agents Presentation/ Side Effects and Adverse Effects of Insulin 5 20 minutes brainstorming and Anti Diabetics Agents Interaction and Precaution of Insulin and Anti 6 15minutes Presentation Diabetics Agents 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 211 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: Indications of Insulin and Anti Diabetics Agents (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the types of insulin and anti diabetic agents? • What are the indications of Insulin and Anti diabetics‘ agents? 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 • There are various types of insulin which are given to patients depending on the conditions of a patient. They include Short-acting insulins, Rapid-acting insulin and Intermediate action Insulin • Anti diabetic agents include, Chlorpropamide, Glibenclalmide, Gliclazide and metformin • Indications of Insulin o Treatment with insulin injection is indicated in Type I Diabetes Mellitus or in uncontrolled Type II Diabetes Mellitus, Hyperglycemic emergencies, Pancreatitis, Pregnancy and trauma or Surgery o Insulin preparations are divided into 3 types:  Short-acting insulins those of short duration which have a relatively rapid onset of action, namely soluble insulin. Soluble insulin is the most appropriate form of insulin for use in diabetic emergencies e.g. diabetic ketoacidosis and at the time of surgery  Rapid-acting insulin analogues, insulin as part, insulin glulisine, and insulin lispro  Intermediate action Insulin, e.g. isophane insulin • Anti-diabetics Agents o Chlorpropamide: Is used in the treatment of type 2 diabetes mellitus in patients who cannot control blood sugar levels by diet and exercise alone. It is used along with diet and exercise. It may be used alone or with other ant diabetic medicines PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 212 o Glibenclalmide: Is used in the treatment of type 2 diabetes mellitus o Gliclazide: It is indicated in Non-insulin dependent diabetes mellitus, maturity onset diabetes and in insulin resistant diabetes o Tolbutamide : It is indicated in type 2 diabetes mellitus o Metformin: Is used in the treatment of diabetes mellitus.  Metformin is used for the symptomatic management of polycystic ovary syndrome [unlicensed indication];  It improves insulin sensitivity, may aid weight reduction, helps to normalize menstrual cycle (increasing the rate of spontaneous ovulation), and may improve hirsutism STEP 3: Contraindication of Insulin and Anti Diabetics Agents (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the Contraindication of Insulin and Anti Diabetics agents? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Contraindication of Insulin and Anti diabetics agents: o Insulin: Is contraindicated in persons who have Hypersensitivity to any ingredient of the product and during episodes of hypoglycemia o Chlorpropamide : Is contraindicated in pregnancy, heart disease, liver problems, recent operation, body temperature more than 101 0F, severe nausea and vomiting that has lasted a long time, weakened patient, injury, low blood sugar, pituitary hormone deficiency, Addison's disease, hepatic porphyria, G6PD Anemia, Hemolytic Anemia o Glibenclalmide: Is contraindicated in diabetic emergencies (ketoacidosis, hyperosmolar coma), advanced hepatic or renal insufficiencies, pregnancy and nursing period o Gliclazide: Is contraindicated in following conditions, pregnancy, lactation, hypersensitivity, renal impairment, juvenile onset diabetes, unstable or brittle diabetes, diabetic ketoacidosis PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 213 o Tolbutamide: Is contraindicated in patients with known hypersensitivity or allergy to the drug, diabetic ketoacidosis, with or without coma, Metformin Is contraindicated in patients with any condition that could increase the risk of lactic acidosis, including kidney disorders , lung disease and liver disease STEP 4: Dose, Dosage of Insulin and Anti Diabetics Agents (30minutes) • The following are the dose and Dosage of Insulin and Anti diabetics agents o Insulin -Children and Adults – Subcutaneous 0.5 to 1 units/kg/day. Adjust doses to achieve pre-meal and bedtime blood glucose levels of 80 to 140 mg/dL (children younger than 5 yr of age, 100 to 200 mg/dL). Severe Ketoacidosis or Diabetic Coma Subcutaneous 0.8 to 1.2 units/kg/day. Regular insulin is given IV or IM. o Chlorpropamide Initially 250 mg daily with breakfast (elderly 100– 125 mg), adjusted according to response; max. 500 mg daily o Gliclazide for Noninsulin dependent diabetes, oral dose: The drug is increased in stepwise fashion. It is started as 40-80

NTA Level 4 • Semester 2 • PST04211 Description of Thyroid, Parathyroid Basic Pharmacology • Source Session/Topic 33 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 33: Description of Thyroid, Parathyroid Hormones and Their Antagonists Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of thyroid and parathyroid hormones and antagonists • List contraindication of thyroid and parathyroid hormones and antagonists • Describe dose, dosage and course of thyroid and parathyroid hormones and antagonists • List side effects and adverse effects of thyroid and parathyroid hormones and antagonists • Describe interactions and precautions of thyroid and parathyroid hormones and antagonists Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Overhead projector and computer SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation/ Indications of Thyroid and Parathyroid 2 10 minutes Buzzing Hormones and Antagonists Presentation/ Contraindications of Thyroid and Parathyroid 3 10 minutes Brainstorming Hormones and Antagonists Dose, Dosage and Course of Thyroid and 4 20 minutes Presentation Parathyroid Hormones and Antagonists Presentation/ Side Effects and Adverse Effects of Thyroid 5 20 minutes Brainstorming and Parathyroid Hormones and Antagonists Interactions and Precautions of Thyroid and 6 35 minutes Presentation Parathyroid Hormones and Antagonists 7 10 minutes Presentation Key Points 8 10 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 204 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: Thyroid, Parathyroid Hormones and their Antagonists (10 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the indications of thyroid hormones and Antithyroid drugs? 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 • Carbimazole o Hyperthyroidism • Iodine (Lugol's solution) Solution and Iodized oil Capsules o Hyperthyroidism (thyrotoxicosis) • Levothyroxine o Hypothyroidism (decreased production or secretion of thyroid hormone) STEP 3: Contraindications of Thyroid, Parathyroid Hormones and their Antagonists (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of thyroid hormones and antithyroid drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 205 • Levothyroxine o Thyrotoxicosis • Carbimazole o Severe blood disorders • Iodine (Lugol's solution) Solution and Iodized oil Capsules o Potassium iodide is contraindicated in patients with hypersensitivity to iodine o Potassium iodide should be avoided in patients with hyperthyroidism Hyperkalaemia, and acute bronchitis also during pregnancy (category D) and lactation STEP 4: Dose, Dosage and Course of Thyroid and Parathyroid Hormones and Antagonists (20 minutes) • Levothyroxine o Available as Levothyroxine Tablets (sodium salt) 0.05g o To maintain normal TSH levels  Levothyroxine 1.5µg/kg. Maximum dose 100 -150µg daily o Hypothyroidism after treatment of grave disease  Levothyroxine 75µg to 125µg/day • Carbimazole o Available as carbimazole tablets 5mg  Carbimazole 40mg (O) once daily for 3 weeks then 20mg daily for 3 weeks  Maintenance dose 5mg for up to one year • Iodine (Lugol's solution) Solution o Available as Iodine (Lugol's solution) Solution containing 5 percent iodine and 10 percent potassium iodide o Three (3) drops (21mg) once each month for up to one year STEP 5: Side Effects and Adverse Effects of Thyroid, Parathyroid Hormones and their Antagonists (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects of thyroid hormones and antithyroid drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 206 • Carbimazole o Side-effects  Nausea, mild gastro-intestinal disturbances, taste disturbance, headache, fever, malaise, rash, pruritus, arthralgia; rarely myopathy, alopecia, bone marrow suppression (including pancytopenia and agranulocytosis • Levothyroxine sodium (Thyroxine sodium) o Side-effects usually at excessive dosage  Diarrhoea, vomiting, anginal pain, arrhythmias, palpitation, tachycardia, tremor, restlessness, excitability, insomnia; headache, flushing, sweating, fever, heat intolerance, weight-loss, muscle cramp, and muscular weakness and transient hair loss in children o Hypersensitivity reactions  Rash, pruritus and oedema • Iodine (Lugol's solution) and Iodized oil Capsules o Side-effects  Headache, lacrimation, conjunctivitis, pain in salivary glands, laryngitis, bronchitis, rashes; on prolonged treatment depression, insomnia, impotence; goitre in infants of mothers taking iodides STEP 6: Interactions and Precautions of Thyroid, Parathyroid Hormones and their Antagonists (35 minutes) • Iodine (Lugol's solution) and Iodized oil Capsules o Precaution  Potassium iodide should be used cautiously in patients with renal impairment, cardiac disease, pulmonary tuberculosis, and Addison‘s disease  Iodine and iodide should be used with cautions in children  Can cause neonatal goitre and hypothyroidism in pregnancy  Iodine and iodide appears to be concentrated in milk thus stop breast-feeding due to danger of neonatal hypothyroidism or goitre o Drug Interactions  Lugol‘s solution can increase the risk of hypothyroidism if taken concurrently with lithium  Potassium-sparing diuretics, potassium supplements, and ACE inhibitors increase the risk of hyperkalemia • Levothyroxine o Precaution  Caution in Panhypopituitarism or predisposition to adrenal insufficiency (corticosteroid therapy should be initiated before starting levothyroxine)  Care in elderly, cardiovascular disorders (including hypertension, myocardial insufficiency or myocardial infarction), Long-standing hypothyroidism and diabetes insipidus PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 207  In patients with diabetes mellitus the dose of antidiabetic drugs including insulin may need to be increased 

NTA Level 4 • Semester 2 • PST04211 Description of Adrenal Hormones and Synthetic Substitutes Basic Pharmacology • Source Session/Topic 32 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 32: Description of Adrenal Hormones and Synthetic Substitutes Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of adrenal hormones and synthetic substitutes • List contraindications of adrenal hormones and synthetic substitutes • Describe dose, dosage and course of adrenal hormones and synthetic substitutes • List side effects and adverse effects of adrenal hormones and synthetic substitutes • Describe interactions and precautions of adrenal hormones and synthetic substitutes Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Overhead projector and computer SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation/ Indications of Adrenal Hormones and 2 25 minutes Buzzing Synthetic Substitutes Presentation/ Contraindications of Adrenal Hormones and 3 10 minutes Brainstorming Synthetic Substitutes Dose, Dosage and Course of Adrenal 4 30 minutes Presentation Hormones and Synthetic Substitutes Presentation/ Side Effects and Adverse Effects of Adrenal 5 20 minutes Brainstorming Hormones and Synthetic Substitutes Interactions and Precautions of Adrenal 6 20 minutes Presentation Hormones and Synthetic Substitutes 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 198 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: Indications of Adrenal Hormones and Synthetics Substitutes (25minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the common hormones and synthetic substitutes used in clinical practice? • What are indications for adrenal hormones and synthetic substitutes used in clinical practice? 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 • The commonly used are dexamethasones, prednisolone and hydrocortisone • Dexamethasones drugs are indicated in the: o Suppression of inflammatory condition o Suppression of allergic condition o Patients with raised intracranial pressure o Patients with cerebral edema o Stimulation of lung maturation in the fetus o Rheumatoid disease • Prednisolone are indicated in the: o In treating asthma o In suppression of inflammatory condition o Suppression of allergic disorder o Inflammatory bowel disease o Rheumatoid disease • Hydrocortisone are indicated in the: o In treating asthma o Suppression of inflammatory condition o In treating hemorrhoids o In management of shock eg anaphylactic shock o Rheumatoid disease PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 199 o Used in inflammatory and pruritus skin conditions STEP 3: Contraindications of Adrenal Hormones and Synthetic Substitutes (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of adrenal hormone and synthetic substitutes? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Adrenal Hormone and Synthetic Substitute are contraindicated in : o Patient with peptic ulcer o Heart disease o Systemic infections o Hypertension with heart failure o In infection such varicella, psychosis, diabetes, osteoporosis or glaucoma STEP 4: Dose, Dosage and Course of Adrenal Hormones and Synthetic Substitutes (30 minutes) • Dexamethasone can be given orally or parenterally: o 0.5-10 mg orally daily in adults o 10-100micrigrams/kg daily in children o Intravenous or intramuscular 0.5-24mg in adults or 200-400micrograms/kg daily in children • Hydrocortisone can be given orally or parenterally: o 20-30 mg per orally daily in divided dose in adults o 10-100micrigrams/kg daily in children o Intravenous or intramuscular 100-500mg,3-4 times in 24 hours in adults o or in children, up to 1 year 25mg,1-5 years 50mg,6-12 years 100mg • Prednisolone can be given orally or parenterally o 10-20 mg daily (severe disease up to 60 mg daily) o 2.5-25 mg as maintenance dose o Intramuscular injection prednisolone acetate 25-100mg once or twice weekly PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 200 STEP 5: Side Effects and Adverse Effects of Adrenal Hormones and Synthetic Substitutes (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects and adverse drug reactions of adrenal hormone and synthetic substitutes? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • The side effects and adverse effects of the adrenal hormones and synthetic substitute includes: o Hypertension o Sodium and water retention o Potassium and calcium loss o Osteoporosis o Diabetes o Muscle wasting o Peptic ulceration or perforation o Gastrointestinal effects : dyspepsia o Abdominal distension, acute pancreatitis, esophageal ulceration o Musculoskeletal effects: muscle weakness, vertebral and long bone fracture, tendon rupture o Endocrine effects: menstrual irregularities, hirsutism, weight gain, increased appetite o Neuropsychiatric: insomnia, aggregation of epilepsy o Skin : urticaria, skin atrophy, bruising STEP 6: Interactions and Precautions of Adrenal Hormones and Synthetic Substitutes (20 minutes) • Interaction o Interactions do not generally apply to corticosteroids used for topical action (including inhalation) o Corticosteroids antagonize hypertensive effects of:  ACE inhibitors  Adrenergic neuron blockers  Alpha blockers o Corticosteroids increases risk of gastro-intestinal bleeding when given with NSAIDs PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 201 o Corticosteroids may enhance or reduce anticoagulant effects of coumarins o Metabolism of corticosteroids is accelerated by carbamazepine, phenytoin, primidone, barbiturates o Corticosteroids antagonizes effects of:  Diuretics  Calcium channel blockers • Precaution o Adrenal hormones and synthetics substitute oral or parenteral preparation should be taken

NTA Level 4 • Semester 2 • PST04211 Description of Lipid Lowering Drugs Basic Pharmacology • Source Session/Topic 31 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 31: Description of Lipid Lowering Drugs Total Session Time: 60 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of lipid lowering drugs • List contraindications of lipid lowering drugs • Describe dose, dosage and course of lipid lowering drugs • List side effects and adverse effects of lipid lowering drugs • Describe interactions and precautions of lipid lowering drugs Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Overhead projector and computer SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning tasks Presentation/ 2 10 minutes Indications of Lipid Lowering Drugs Buzzing Presentation/ 3 10 minutes Contraindications of Lipid Lowering Drugs Brainstorming Dose, Dosage and Course of Lipid Lowering 4 10 minutes Presentation Drugs Presentation/ Side Effects and Adverse Effects of Lipid 5 10 minutes Brainstorming Lowering Drugs Interactions and Precautions of Lipid 6 05 minutes Presentation Lowering Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 193 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: Indications of Lipid Lowering Drugs (10minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What lipid lowering drugs are used in clinical practice? • What are the indications of lipid lowering drugs? 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 • Lipid Lowering drugs include simvastatin and atovastatin which are in a group of statins used in lowering cholesterol level in blood • Statins are group of lipid lowering drugs • Lipid lowering drugs are indicated in patients with: o Primary hypercholesterolemia o Homozygous familial hypercholesterolemia o Combined (mixed) hyperlipidemia in patients who have not responded adequately to diet and other appropriate measures o Prevention of cardiovascular events in patients with atherosclerotic cardiovascular disease or diabetes mellitus STEP 3: Contraindications of Lipid Lowering Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are contraindications of lipid lowering drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 194 • Lipid lowering drugs are contraindicated in patients with : o Active liver disease o Persistently abnormal liver function tests o In pregnancy (adequate contraception required during treatment and for 1 month afterwards) o Who are breast-feeding STEP 4: Dose, Dosage and Course of Lipid Lowering Drugs (10 minutes) Dose of Simvastatin • Primary hypercholesterolemia, combined hyperlipidemia, 10–20 mg daily at night, adjusted at intervals of at least 4 weeks; usual range 10–80 mg once daily at night • Homozygous familial hypercholesterolemia, 40 mg daily at night or 80 mg daily in 3 divided doses (with largest dose at night) • Prevention of cardiovascular events, initially 20–40 mg once daily at night adjusted at intervals of at least 4 weeks; max 80 mg once daily at night STEP 5: Side Effects and Adverse Effects of Lipid Lowering Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are the side effects and adverse effects of lipid lowering drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Side effects of simvastatin are: o Constipation is common, o Diarrhoea o Nausea, vomiting o Gastro-intestinal discomfort o Hypertriglyceridaemia may be aggravated o An increased bleeding tendency has been reported due to hypoprothrombinemia associated with vitamin K deficiency PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 195 STEP 6: Interactions and Precautions of Lipid Lowering Drugs (5minutes) • Precautions: o Bile acid sequestrates interfere with the absorption of fat-soluble vitamins; supplements of vitamins A, D, and K may be required when treatment is prolonged Step 7: Key Points (5minutes) • Lipid lowering are indicated in hypercholesterolemia, hyperlipidemia and in prevention of cardiac events in patients with cardiac diseases and in diabetic patients • Lipid lowering are contraindicated in liver failure, pregnancy and during breast feeding • The side effects of lipid lowering drugs are nausea, vomiting ,constipation and abnormal bleeding • Dose of simvastatin ranges from 10-80mg once a day • When using lipid lowering drugs caution as it interfere with absorption of fat soluble vitamins STEP 8: Evaluation (5minutes) • What are the indications of lipid lowering drugs? • What are the contraindications of lipid lowering drugs? • What are the dose, dosage and course of lipid lowering drugs? • What are side effects and adverse effects of lipid lowering drugs? • What are the interactions and precautions of lipid lowering drug? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 196 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. T., Gary, C.Y., Gary, R.M, Barbara, G.W., Michael, L. (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