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NTA Level 4 • Semester 2 • PST04211 Description of Cardiac Glycosides Basic Pharmacology • Source Session/Topic 30 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 30: Description of Cardiac Glycosides 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 cardiac glycosides • List Contraindication of cardiac glycosides • Describe dose, dosage and course of cardiac glycosides • List side effects and adverse effects of cardiac glycosides • Describe interaction and precaution of cardiac glycosides 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 Cardiac Glycosides Buzzing Presentation/ 3 10 minutes Contraindications of Cardiac Glycosides Brainstorming Dose, Dosage and Course of Cardiac 4 10 minutes Presentation Glycosides Presentation/ Side Effects and Adverse Effects of Cardiac 5 10 minutes Brainstorming Glycosides Interactions and Precautions of Cardiac 6 10 minutes Presentation Glycosides 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 187 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 Cardiac Glycosides (5minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • list glycosides that are used in clinical practice • What are indications of cardiac glycoside 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 • The common cardiac glycosides drugs are digoxin and digitoxin • Cardiac glycosides are also called cardiotonics or digitalis glycosides • Cardiac glycosides are indicated in patients with: o Heart failure o Atrial fibrillation o Dilated heart cardiomyopathies • Digoxin is the commonly used cardiac glycosides • Digoxin is used for acute and chronic conditions while digitoxin is used for maintenance PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 188 STEP 3: Contraindications of Cardiac Glycosides (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are contraindications of cardiac glycosides? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Cardiac glycosides are contraindicated in patients with : o Known hypersensitivity o Ventricular failure o Ventricular tachycardia o Digitalis toxicity STEP 4: Dose, Dosage and Course of Cardiac Glycosides (15 minutes) • When symptoms are mild, slow loading (digitalization) with 0.125-0.25 mg per day is safer than and just as effective as the rapid method 0.5-0.75 mg every 8 hours for 3 doses, followed by 0.125-0.25 mg per day • It is usually given only if diuretics and ACE inhibitors have failed to control symptoms • Digoxin is rapidly absorbed after oral administration • Cardiac glycosides are widely distributed to tissues, including the CNS STEP 5: Side Effects and Adverse Effects of Cardiac Glycosides (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are the side effects and adverse effects of cardiac glycosides? 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 189 • The major signs of digitalis toxicity are arrhythmias, nausea, vomiting, and diarrhea • This toxicity may be partially caused by direct effects on the gastrointestinal tract but is also the result of central nervous system actions • Central nervous system effects include disorientation and hallucinations especially in the elderly and visual disturbances are noted • Gynecomastia is a rare effect reported in men taking digitalis STEP 6: Interactions and Precautions of Cardiac Glycosides Drug (15 minutes) Precaution • Caution should be taken when giving cardiac glycosides to patient with: o Electrolyte imbalance(especially hypokalaemia and hypomagnesemia) o Severe carditis o Heart block o Acute glomerulonephritis o Pregnancy Interaction • Cardiac glycosides react with different drugs • Drugs that increases the plasma level of digitalis are: o Benzodiazepines o Nifedipine o Captopril o Verapamil • Drugs that Decreases the Plasma Level of Cardiac Glycosides o Antihistamine o Barbiturates o Thyroid hormones PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 190 Step 7: Key Points (5minutes) • Cardiac glycosides are indicated in patients with: o Heart failure o Atrial fibrillation o Dilated heart cardiomyopathies • Cardiac glycosides are contraindicated in patients with : o Known hypersensitivity o Ventricular failure o Ventricular tachycardia o Digitalis toxicity • Loading (digitalization) with 0.125-0.25 mg per day is safer than and just as effective as the rapid method 0.5-0.75 mg every 8 hours for 3 doses, followed by 0.125-0.25 mg per day • The major signs of digitalis toxicity are arrhythmias, nausea, vomiting, and diarrhea • Caution should be taken to patient with electrolyte imbalance STEP 8: Evaluation (5minutes) • What glycosides are used in clinical practice? • What are indications of cardiac glycosides drugs? • What are the contraindications of cardiac glycosides drugs? • What are the dose, dosage and course of cardiac glycosides drugs? • What are the side effects and adverse effects of cardiac glycosides drugs? • What are the interaction and precaution of cardiac glycosides drug? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 191 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:

NTA Level 4 • Semester 2 • PST04211 Description of Anti-angina and Anti Basic Pharmacology • Source Session/Topic 29 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 29: Description of Anti-angina and Anti- Arrhythmic Drugs Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Outline classes of anti-angina and anti-arrhythmic drugs • List indications of anti-angina and anti-arrhythmic drugs • List Contraindication of anti-angina and anti-arrhythmic drugs • Describe dose, dosage and course of anti-angina and anti-arrhythmic drugs • List side effects and adverse effects of anti-angina and anti-arrhythmic drugs • Describe interaction and precaution of anti-angina and anti-arrhythmic 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 Objectives Classes of Anti-angina and Anti-arrhythmic 2 10 minutes Presentation Drugs Presentation/ Indications of Anti-angina and Anti- 3 15 minutes Buzzing arrhythmic Drugs Presentation/ Contraindications of Anti-Angina and Anti- 4 10 minutes brainstorming arrhythmic Drugs Dose, Dosage and Course of Anti-angina and 5 30 minutes Presentation Anti-Arrhythmic Drugs Presentation/ Side Effects and Adverse Effects of Anti- 6 20 minutes brainstorming angina and Anti-arrhythmic Drugs Interactions and Precautions of Anti-Angina 7 15 minutes Presentation and Anti-Arrhythmic Drugs 8 05 minutes Presentation Key Points 9 10 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 178 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 question(s) before continuing. STEP 2: Classes of Anti-angina and Anti-arrhythmic Drugs (10 minutes) • Antianginal drugs are drugs that are used to manage angina by either improving perfusion of the myocardium, reducing the metabolic demand of the heart, or both • There are three classes of antianginal drugs; organic nitrates, Beta-adrenoreceptor antagonists and calcium channel blockers • Organic Nitrares and adrenoceptor antagonists are vasodilators and improve myocardial perfusion, and reduced metabolic demand of the myocardium • Beta-adrenoreceptor antagonists slow the heart rate therefore reduces metabolic demand of the heart • Antiarrhythmic drugs are a group of pharmaceuticals that are used to suppress abnormal rhythms of the heart (cardiac arrhythmias), such as atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation • They are classified according to their general effect; o Class I: Fast sodium (Na) channel blockers o Class II: Beta blockers o Class III: Potassium (K) channel blockers o Class IV: Slow calcium (Ca) channel blockers STEP 3: Indications of Anti-angina and Anti-arrhythmic Drugs (15 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the indications of anti-angina and anti-arrythmic 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 PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 179 • Anti-angina drugs o Nitrates (Nitroglycerin – glyceryl trinitrate, isosorbide dinitrate and isosorbide-5- mononitrate) are indicated for;  Unstable angina  Immediate treatment of angina (s.l.)  Severe, recurrent rest angina (i.v.)  Maintenance therapy of angina (slow release forms)  Prinzmetal‘s angina  Control myocardial ischemia,  Reduce infarction size  Treatment of acute angina episodes  Prophylaxis of chronic angina  Treatment of moderate to severe congestive heart failure and myocardial infarction  Control of blood pressure in cardiac surgical procedure o Calcium channel blockers (Nifedipine, Verapamil) are indicated for:  Stable angina  Unstable angina  Variant angina o Beta-adrenoreceptor (Atenolol, Metoprolol, Nadolol, Propranolol) are indicated for;  Stable angina  Unstable angina  Acute myocardial infarction • Anti-arrhythmic drugs o Class I: Fast sodium (Na) channel blockers (Lidocaine) are indicated for the treatment of ventricular arrhythmias o Class II: Beta blockers (Atenolol, propanolol) are indicated for  Treatment of hypertension,  Reduce infarct size in the periinfarction period, as adjuncts for rate control in atrial fibrillation or flutter o Class III: Potassium (K) channel blockers(Amiodarone) are effective for both supraventricular and ventricular arrhythmias o Class IV: Slow calcium (Ca) channel blockers (Amlodipine, verapamil) are not effective antiarrhythmic drugs because they have little effect on cardiac Ca2+ channels PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 180 STEP 3: Contraindications of Anti-angina and Anti-arrhythmic Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of anti-angina and anti-arrhythmic drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below Table 16.1: Contraindications of anti-angina and anti-arrhythmic drugs Drug class Contraindications Nitrates • Hypersensitivity • Head trauma • Cerebral hemorrhage • Severe anemia • Pericardial tamponade • Constrictive pericarditis Calcium channel blockers • Severe hypotension • Severe aortic stenosis • Extreme bradycardia • Moderate to severe heart failure • Cardiogenic shock • Sick sinus syndrome Beta-adrenoreceptor • Contraindicated in variant angina • Bradyarrhythmias • Atrioventricular block • Peripheral vascular disease Anti-arrhythic drugs • Hypersensitivity to the antiarrhythmic drugs • During pregnancy and lactation. • Second- or third-degree atrioventricular block (if the patient has no artificial pacemaker) • Severe congestive heart failure (CHF) • Aortic stenosis • Hypotension • Cardiogenic shock PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 181 STEP 5: Dose, Dosage and Course of anti-angina and anti-arrhythmic Drugs (30 minutes) • Nitroglycerin o PO Immediate-release tablets, 2.5–9 mg 2 or 3 times per day PO o Sustained-release tablets or capsules, 2.5 mg 3 or 4 times per day o SL 0.15–0.6 mg PRN for chest pain o Translingual spray, one or two metered doses (0.4 mg/dose) sprayed onto oral mucosa at onset of

NTA Level 4 • Semester 2 • PST04211 Description of Antihypertensive Drugs Basic Pharmacology • Source Session/Topic 28 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 28: Description of Antihypertensive Drugs Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Outline classes of antihypertensive drugs • List indications of antihypertensive drugs • List contraindications of antihypertensive drugs • Describe dose, dosage and course of antihypertensive drugs • List side effects and adverse effects of antihypertensive drugs • Describe interactions and precautions of antihypertensive 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 Objectives 2 10 minutes Presentation Classes of Antihypertensives Presentation/ 3 15 minutes Indications of Antihypertensive Drugs Buzzing Presentation/ Contraindications of Antihypertensive Drugs 4 10 minutes brainstorming Dose, Dosage and Course of Antihypertensive 5 30 minutes Presentation Drugs Presentation/ Side Effects and Adverse Effects of 6 20 minutes brainstorming Antihypertensive Drugs Interactions and Precautions of 7 15 minutes Presentation Antihypertensive Drugs 8 05 minutes Presentation Key Points 9 10 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 170 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 question(s) before continuing. STEP 2: Classes of Antihypertensives (10minutes) • Antihypertensive are a class of drugs that are used to treat hypertension (high blood pressure). Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction • Hypertention is categorized as follows: o Mild hypertension: Diastolic Blood Pressure range of 90 – 99 mm Hg and Systolic Blood Pressure range of 140-159mm Hg o Moderate hypertension: Diastolic Blood Pressure range of 100 – 109 mm Hg and Systolic Blood Pressure range of 100-180mmHg o Severe hypertension: Diastolic Blood Pressure range of 110 mm Hg or above and Systolic Blood Pressure range of 180mm Hg and above o Malignant hypertension: Severe hypertension associated with retinal exudates, haemorrhages or papilledema • There are many classes of antihypertensives, which lower blood pressure by different means. Among the most important and most widely used classes are: o Thiazide Diuretics o Loop Diuretics o Potassium Sparing Diuretics o Central Adrenergic Inhibotor o Beta Blockers o Alpha& Beta blockers o Angiotensin Converting Enzyme Inhibitors (ACEI) o Angiotensin II Receptor Agonist (ARB's) o Calcium Channel Blockers (CCB) o Direct vasodilators PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 171 STEP 3: Indications of Antihypertensive Drugs (15 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the indications of antihypertensive 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 Table 17.1: Indications of various classes of Antihypertensives Compelling indications Drug class Angina • ß-blocker or Long acting calcium channel blocker Prior or Post-myocardial infarct • ß-blocker and ACE inhibitor •If s-blocker contraindicated: Long acting calcium channel blocker eg verapamil Heart failure • ACE inhibitor and Carvedilol For volume overload: • Diuretics – Spironolactone Furosemide Left ventricular hypertrophy (confirmed by ACE inhibitor or ARB ECG) Stroke: secondary prevention Hydrochlorothiazide or Indapimide and ACE inhibitor Diabetes Mellitus ACE inhibitor or ARB, usually in combination with diuretic Chronic kidney disease ACE inhibitor, usually in combination with diuretic Isolated systolic hypertension Hydrochlorothiazide or Long acting calcium channel blocker Pregnancy Methyldopa or Hydralazine (Avoid ACEI/ARB tetratogenic) Prostatism alpha-blocker Elderly CCB PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 172 STEP 3: Contraindications of Antihypertensive Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of antihypertensive drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Patient with known hypersensitivity reaction to the individual drug. • Methyldopa is contraindicated in patient with active hepatic disease. • Alpha and B- blocker and calcium channel blockers are contraindicated in patient with: o Heart block o Cardiogenic shock o Heart failure • The use of ACE inhibitors is contraindicated during the second and third trimesters of pregnancy • Captopril, is contraindicated particularly when given in high doses to patients with renal insufficiency PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 173 STEP 5: Dose, Dosage and Course of Antihypertensive Drugs (30 minutes) Table 17.2: Antihypetensives and their corresponding doses Sn Class Drug Dosage 1 Thiazide Diuretics Bendroflumethiazide 5mg once daily Hydrochlothiazide 12.5mg once daily 2 Loop Diuretics Furosemide 40mg- 80mg daily Torasemide 2.5mg-5mg daily 3 Potassium Sparing Spirinolactone 25mg once daily Diuretics Eplerenone 25mg once daily 4 Central Methylodopa 250mg 12hrly Adrenergic Inhibotor 5 Beta Blockers Non selective Propranolol 80mg 12 hrly Selective Atenolol 50 – 100mg once daily Metoprolol 100mg 12hrly Alpha& Beta blockers Carvedilol 12.5 -25mg daily 6 ACE Inihibitors Captopril 12.5mg- 25mg 12hrly Enalapril 5- 20mg daily Angiotensin II Losartan 50mg-100mg daily Receptor Agonist (ARB's) 7 Calcium channel Nifedipine SR 10- 20mg 12hrly blochers (CCB) Amlodipine 5 – 10mg once daily 8 Direct vasodilators Hydralazine 25mg 12hrrly STEP 6: Side Effects and Adverse Effects of Antihypertensive Drugs (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are side effects and adverse effects of antihypertensive 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 174 Table 17.3: Classes of Antihypertensives and their Side Effects

NTA Level 4 • Semester 2 • PST04211 Description of Drugs affecting Blood Basic Pharmacology • Source Session/Topic 27 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 27: Description of Drugs affecting Blood 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 drugs affecting blood • List contraindications of drugs affecting blood • Describe dose, dosage and course of drugs affecting blood • List side effects and adverse effects of drugs affecting blood • Describe interactions and precautions of drugs affecting blood Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Objectives Presentation/ 2 10 minutes Indications of Drugs Affecting Blood Buzzing Presentation/ 3 10 minutes Contraindications of Drugs Affecting Blood Brainstorming Description of Dose, Dosage and Course of 4 10 minutes Presentation Drugs Affecting Blood Presentation/ Side Effects and Adverse Effects of Drugs 5 10 minutes Brainstorming Affecting Blood Interactions and Precautions of Drugs 6 05 minutes Presentation Affecting Blood 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 164 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 drugs affecting blood (10 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • Mention drugs affecting blood • What are the indications of drugs affecting blood? 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 • Ferrous sulphate: used in management of iron deficiency anaemia • Folic acid: used in management of anaemia and neuro tube defect • Hydroxocobalamin: is also known as vitamin B12, it is used in management of megaloblastic anaemia • Iron dextran Injection: used in management of iron deficiency anaemia STEP 3: Contraindications of Drugs Affecting Blood (10 Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of drugs affecting blood? 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 165 • Ferrous sulphate is not contra-indicated to specific group of individual but should be given with care to those people with peptic ulcers • Folic acid is not contra-indicated to specific group of individual but should never be given alone for pernicious anaemia and other vitamin B12 deficiency states since it may precipitate subacute combined degeneration of the spinal cord • Hydroxocobalamin is not contra-indicated to specific group of individual but should not be given before diagnosis fully established • Iron dextran Injection is contra-indicated to those with history of allergic disorders including asthma and eczema, infection, active rheumatoid arthritis, severe hepatic impairment and acute renal failure STEP 4: Dose, Dosage and Course of Drugs Affecting Blood (10 minutes) • Ferrous sulphate o Dose prophylactic, 1 tablet (200mg) daily; therapeutic, 1 tablet 2–3 times daily until signs and symptoms disappear • Folic acid o Folate-deficient megaloblastic anaemia, by mouth, adult and child over 1 year, 5 mg daily for 4 months (until term in pregnant women); up to 15 mg daily may be required in malabsorption state o Children under 1 year, 500 micrograms/kg daily (max. 5 mg) for up to 4 months; up to 10 mg daily may be required in malabsorption states • Hydroxocobalamin o By mouth, vitamin B12 deficiency of dietary origin, 50–150 micrograms daily taken between meals children 50–105 micrograms daily in 1–3 divided doses. o By intramuscular injection, initially 1 mg repeated 10 times at intervals of 2–3 days, maintenance 1 mg every month • Iron dextran Injection o By deep intramuscular injection into the gluteal muscle or by slow intravenous injection or by intravenous infusion, 50 mg/mL, 2ml ample or calculated according to bodyweight and iron deficit o The product is not recommended to children under 14 years PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 166 STEP 5: Side Effects and Adverse Effects of Drugs Affecting Blood (10 Minute) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects and adverse effects of drugs affecting blood? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Ferrous sulphate: Main side effects include; o Gastro-intestinal irritation can occur with iron salts example ferrous sulphate. o Nausea and epigastric pain are dose-related and occur with high dose o Oral iron, particularly modified-release preparations, can exacerbate diarrhea • Folic acid: Not common, rarely gastro-intestinal disturbances • Hydroxocobalamin: Main side effects include; o Nausea, headache, dizziness and fever o Hypersensitivity reactions (including rash and pruritus) may occur. o Injection-site reactions o Hypokalaemia o Thrombocytosis o Chromaturia • Iron dextran Injection: Not common, they may include; o Nausea, vomiting and abdominal pain o Flushing, dyspnoea and anaphylactic reactions o Numbness, cramps and blurred Vision o Pruritus, and rash; STEP 6: Interactions and Precautions of Drugs Affecting Blood (5 minutes) • Ferrous sulphate o Absorption of Ferrous sulphate is reduced by oral magnesium salts, calcium salts and zinc o Ferrous sulphate reduces absorption of ciprofloxacin and other fluoroquinolones, levodopa, mycophenolates, Penicillamine, bisphosphonates and levothyroxines • Folic acid; usually does not interact with any specific group of drugs or any individual drug • Hydroxocobalamin; usually does not interact with any specific group of drugs or any individual drug PST

NTA Level 4 • Semester 2 • PST04211 Description of Antispasmodic Drugs Basic Pharmacology • Source Session/Topic 26 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 26: Description of Antispasmodic 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 antispasmodic drugs • List Contraindication of antispasmodic drugs • Describe dose, dosage and course of antispasmodic drugs • List side effects and adverse effects of antispasmodic drugs • Describe interaction and precaution of antispasmodic drugs Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer and LCD SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation 2 10 minutes Indications of antispasmodic drugs Brainstorming Presentation 3 05 minutes Contraindications of antispasmodic drugs Buzzing Dose, dosage and course of antispasmodic 4 10 minutes Presentation drugs Presentation Side effects and adverse effects of 5 10 minutes Brainstorming antispasmodic drugs Interactions and precautions of antispasmodic 6 10 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 159 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 Antispasmodic Drugs (10 minutes) Activity: Brainstorming (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the indications of antispasmodic 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 • Antispasmodic drugs are relaxants of intestinal smooth muscles. o They include drugs such as Atropine sulfate, Dicycloverine hydrochloride, Belladonna and Hyoscine butyl-bromide • Indications The smooth muscle relaxant properties of anti-muscarinic and other antispasmodic drugs may be useful in providing symptomatic relief gastro-intestinal disorders characterized by smooth muscle spasms, especially in: o Dysmenorrhea ( Hyoscine butyl-bromide) o Irritable bowel syndrome o Diverticular disease ( a condition associated with lower abdominal pain, anorexia, fevers and disturbed bowel habit) STEP 3: Contraindication of antispasmodic drugs (5 minutes) Activity: Buzzing (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of antispasmodic drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 160 CLARIFY and SUMMARISE by using the content below • Anti-muscarinic drugs are contraindicated in myasthenia gravis • Dicyclomine hydrochloride is contraindicated to infants under 6 months STEP 4: Dose, Dosage and Course of Antispasmodic Drugs (10 minutes) • Atropine sulfate o 0.6-1.2 mg at night • Dicycloverine hydrochloride o 10–20mg 3 times daily; INFANT 6–24 months 5–10mg 3–4 times daily, 15 minutes before feeds; CHILD 2–12 years 10mg 3 times daily • Belladonna o 12.5mg every 8 hours • Hyoscine butyl-bromide o By mouth: smooth muscle spasm, 20mg 4 times daily; CHILD 6– 12 years, 10mg 3 times daily. Irritable bowel syndrome, 10mg 3 times daily, increased if required up to 20mg 4 times daily o By intramuscular or slow intravenous injection, acute spasm and spasm in diagnostic procedures, 20mg repeated after 30 minutes if necessary (may be repeated more frequently in endoscopy), max. 100mg daily STEP 5: Side effects and adverse effects of antispasmodic drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects and adverse effects of Antispasmodic 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 Antispasmodics drugs: • Anti-muscarinic drugs have side effects which include o Constipation o Transient bradycardia (followed by tachycardia, palpitation and arrhythmias) o Reduced bronchial secretions o Urinary urgency and retention PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 161 o Dilatation of the pupils with loss of accommodation o Photophobia o Dry mouth o Flushing o Dryness of the skin • Side-effects that occur occasionally include: o Confusion (particularly in the elderly) o Nausea o Vomiting o Giddiness o Angle-closure glaucoma may occur. STEP 6: Interaction and Precaution of Antispasmodic Drugs (10 minutes) • Antimuscarinics should be used with caution in Down‘s syndrome, in children and in the elderly • They should also be used with caution in gastro-oesophageal reflux disease • Diarrhoea • Ulcerative colitis • Hypertension STEP 7: Key points (5 minutes) • These are relaxants of intestinal smooth muscles • They are useful in providing symptomatic relief 0f gastro-intestinal disorders characterized by smooth muscle spasms, especially in irritable bowel syndrome • They are contraindicated in myasthenia gravis • Their common side effects include: Constipation, urinary retention, dry mouth and dryness of the skin • They should be used with caution in Down‘s syndrome, in children and in the elderly STEP 7: Evaluation (5 minutes) • What are the indications of antispasmodic drugs? • What are the contraindications of antispasmodic drugs? • What are the side effects and adverse effects of antspasmodic drugs? • What are the interactions and precautions of antispasmodic drugs? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 162 References Ministry of Health and Social Welfare. (2013). Standard Treatment Guidelines & National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania government printers. Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells &, L. Michael. (2014). Pharmacotherapy: a pathophysiologic approach (9th ed.). New York, McGraw-Hill Education. Sally S.R & Jeanne C.S. 2000. Introductory Clinical Pharmacology (6th ed) New York, Lippincott Williams and Wilkins School of Pharmaceutical sciences. (2011).Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam,

NTA Level 4 • Semester 2 • PST04211 Description of Anti Hemorrhoid Drugs Basic Pharmacology • Source Session/Topic 25 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 25: Description of Anti Hemorrhoid 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 anti hemorrhoid drugs • List contraindication of anti hemorrhoid drugs • Describe dose, dosage and course of anti hemorrhoid drugs • List side effects and adverse effects of anti hemorrhoid drugs • Describe interactions and precautions of anti hemorrhoid 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 Anti hemorrhoid Drugs Buzzing 3 05 minutes Presentation Contraindications of Anti hemorrhoid Drugs Dose, Dosage and Course of Anti hemorrhoid 4 10 minutes Presentation Drugs Presentation/ Side effects and Adverse Effects of Anti 5 15 minutes Brainstorming hemorrhoids Drugs Interactions and Precautions of Anti 6 05 minutes Presentation hemorrhoid Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 154 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 hemorrhoid Drugs (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 anti hemorrhoid 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 • Anusol suppository/or ointment which contains: Benzyl benzoate 33 mg, bismuth oxide 24 mg, bismuth subgallate 59 mg, hydrocortisone acetate 10 mg, Peru balsam 49 mg and zinc oxide 296 mg is used in management of hemorrhoids in adults o Ingredients contained in anusol suppository such as bismuth subgallate, zinc oxide are mild astringents which give symptomatic relief in hemorrhoids • Bismuth subgallate: With 1% hydrocortisone ointment is used in management of hemorrhoids. Hydrocortisone helps to relieve rectal pain, itching, bloody diarrhoea, and bleeding by reducing swelling (inflammation) directly in the rectum and anus • Paracetamol is used to relieve pain and inflammation in hemorrhoids • Proctosedyl suppository or ointment is used as a second choice in hemorrhoids • Many proprietary preparations also contain lubricants, mild antiseptics or vasoconstrictors that reduce swelling and relieve itching and discomfort by tightening blood vessels • Phenylephrine is an example of a vasoconstrictor (contained in Preparation) used in hemorrhoids STEP 3: Contraindications of Anti hemorrhoids Drugs (5 minutes) • Anti hemorrhoid drugs containing local anaesthetics should be avoided in infants and children • Allergic reactions/hypersensitivity to any of the ingredients of anti hemorrhoid preparation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 155 STEP 4: Dose, Dosage and Course of Anti hemorrhoid Drugs (10 minutes) • One Anusol suppository is inserted night only OR and morning after bowel movement for a maximum of seven days • A second choice Proctosedyl suppository or ointment is used once or twice a day, that is 12 hourly • Bismuth subgallate with 1% hydrocortisone ointment is used once or twice a day, that is 24 hourly or 12 hourly STEP 5: Side Effects and Adverse Effects of Anti hemorrhoids Drugs (15 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are side effects and adverse effects of anti hemorrhoid 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 anti hemorrhoid drugs are rare: Burning, itching, dryness, skin/hair follicle irritation, and changes in skin colour around the rectal area may occur • Rarely, it is possible corticosteroids and other ingredients of anusol will be absorbed into the bloodstream leading to toxicity. Refer Lecture on corticosteroids for side effects STEP 6: Interactions and Precautions Anti hemorrhoids Drugs (5 minutes) • Anusol suppository and most anti hemorrhoid drugs are not recommended in children • Precaution should be taken when using anti hemorrhoid preparations containing vasoconstrictors such phenylephrine if a patients has hypertension, heart problems, thyroid problems or diabetes • Interactions of anti hemorrhoid drugs are rare, may occur when corticosteroids and other ingredients are absorbed into blood stream PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 156 STEP 7: Key Points (5 minutes) • Only few drugs are available for management of hemorrhoids • Early stages of the disease could be effectively managed lifestyle changes, fiber supplement, use of food softeners, and drugs mainly topical ointments and suppositories • The more advanced hemorrhoid stages need some type of surgery • Astringents (drying agents) help shrink hemorrhoids by pulling water out of the swollen tissue. This, in turn, helps relieve itching, burning, and irritation STEP 8: Evaluation (5 minutes) • What drugs are indicated for Hemorrhoids? • What are contraindications of anti hemorrhoids? • What are the dose, dosage and course of anti hemorrhoid drugs? • What are side effects of anti hemorrhoids? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 157 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. The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary (59th ed). London, BMJ Group and RPS Publishing. Sally, S.R., & Jeanne, C.S. (2000). Introductory Clinical Pharmacology (6th ed). New York, Lippincott Williams and Wilkins. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 158

NTA Level 4 • Semester 2 • PST04211 Description of Cathartic Drugs Basic Pharmacology • Source Session/Topic 24 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 24: Description of Cathartic 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 cathartics drugs • List contraindications of cathartics drugs • Describe dose, dosage and course of cathartics drugs • List side effects and adverse effects of cathartics drugs • Describe interaction and precaution of cathartics 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 Cathartic Drugs Buzzing Presentation/ 3 10 minutes Contraindications of Cathartic Drugs Brainstorming 4 10 minutes Presentation Dose, Dosage and Course of Cathartic Drugs Presentation/ Side Effects and Adverse Effects of 5 10 minutes Brainstorming Cathartics Drugs Interactions and Precautions of Cathartic 6 05minutes Presentation Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 149 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 Cathartic Drugs (10 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • Mention cathartic drugs. • What are indications of cathartic 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 • Also called stimulus laxatives and include lactulose and bisacodyl • Cathartic drugs are indicated in : o Constipation o Preparation for radiological procedure o Preparation for surgery o Lactulose is indicated in hepatic encephalopathy (portal systemic encephalopathy) • Commonly cathartics are bisacodyl and lactulose STEP 3: Contraindications of Cathartic Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of cathartic drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Lactulose are contraindicated in patients with : o Intestinal obstruction o Galactosaemia • Bisacodyl are contraindicated in: o Acute surgical condition PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 150 o Acute inflammatory bowel diseases o Severe dehydration STEP 4: Dose, Dosage and Course of Cathartic Drugs (10 minutes) • Bisacodyl o For treatment of constipation:  5-10mg orally at night  Or suppositories 10mg in the morning o Preparation for surgery and radiological procedures:  10-20 mg orally the night before procedure  Suppositories 10mg 1-2 hours before procedure • Lactulose o For treatment of constipation  15ml twice daily adjust according to response o Hepatic encephalopathy  30-50ml three times daily STEP 5: Side Effects and Adverse Effects of Cathartic Drugs (10 Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are side effects and adverse effects of cathartic drugs? 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 Lactulose are: o Nausea o Vomiting o Flatulence o Cramps o Abdominal discomfort • The side effects and adverse effects of bisacodyl are: o Nausea o Vomiting o Colitis o Local irritation on suppository application PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 151 STEP 6: Interactions and Precautions of Cathartic Drugs (5 minutes) • Interactions o Lactulose enhances the anticoagulant effect of coumarins • Precautions o Avoid lactulose in lactose intolence o Avoid excessive use in hypokalaemia Step 7: Key Points (5minutes) • Cathartic drugs are indicated to patients with constipation and in preparation for surgical and radiological procedures • Cathartic drugs are contraindicated in patients with intestinal obstruction and severe dehydration • Cathartic drugs can be given orally or as suppositories • Nausea and vomiting are common side effects of Cathartic drugs • Caution should be taken to patient with lactose intolerance STEP 8: Evaluation (5minutes) • What are the indications of Cathartic drugs? • What are the Contraindication of Cathartic drugs? • What are side effects and adverse effects of Cathartic drugs? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 152 References Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael (2014). Pharmacotherapy: a pathophysiologic approach (9th ed.). New York, McGraw-Hill Education. Ministry Of Health and Social Welfare. 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 (6th ed) New York, Lippincott Williams and Wilkins School of Pharmaceutical sciences. 2011. Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam, ARDHI University press. The Royal Pharmaceutical Society of Great Britain. 2007. Martindale, the Extra Pharmacopoeia (5TH ed). London, pharmaceutical press. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 153 ← Previous TopicNext Topic →View all Basic Pharmacology 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

NTA Level 4 • Semester 2 • PST04211 Description of Solutions for Correcting Basic Pharmacology • Source Session/Topic 23 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 23: Description of Solutions for Correcting Electrolyte Imbalance 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 solutions for correcting electrolyte imbalance • List contraindications of solutions for correcting electrolyte imbalance • Describe dose, dosage and course of solutions for correcting electrolyte imbalance • List side effects and adverse effects of solutions for correcting electrolyte imbalance • Describe interactions and precautions of solutions for correcting electrolyte imbalance 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/ Indications of Solutions for Correcting 2 20 minutes Buzzing Electrolyte Imbalance Presentation/ Contraindications of Solutions for Correcting 3 20 minutes brainstorming Electrolyte Imbalance Dose, Dosage and Course of Solutions for 4 30 minutes Presentation Correcting Electrolyte Imbalance Presentation/ Side Effects and Adverse Effects of Solutions 5 15 minutes brainstorming for Correcting Electrolyte Imbalance Interactions and Precautions of Solutions for 6 20 minutes Presentation Correcting Electrolyte Imbalance 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 141 SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Objectives (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 Solutions for Correcting Electrolyte Imbalance (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following questions for 2 minutes • What are the solutions used for correcting electrolyte imbalance? • What are the indications of solutions for correcting electrolyte imbalance? 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 • Solution for correcting electrolyte imbalance include dextrose solution, sodium lactate solution, sodium chloride solution, potassium chloride solution and potassium citrate oral solution • General indications/uses: o Administration of concentrated drugs which require dilution o To minimize/control side effects of some drugs (e.g. Quinine in Dextrose to avoid hypoglycemic effect) o Correction of electrolyte and acid-base disorders/imbalances for example in conditions like severe diarrhea, severe vomiting o To correct hypotension by restoring blood volume in conditions like anaphylactic shock, poisoning o Correction of shock and establish proper tissue perfusion o When a quick effect of a drug is required through I.V administration • Sodium Chloride (Normal Saline): o Principal fluid used for intravascular resuscitation and replacement of salt loss e.g. diarrhoea and vomiting o Hypovolemic shock o Stroke o Used as a sterile irrigation medium PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 142 • Sodium Lactate compound (Ringers Lactate): o Hypovolemic shock o Burns o Diarrhoea o Intraoperative o Intravenous fluid and electrolyte replacement o As a source of bicarbonate in treatment of mild to metabolic acidosis associated with potassium deficiency • Dextrose 5%: o Primarily used to maintain water balance in patients who are not able to take anything by mouth i.e. starvation deficit o Commonly used post-operatively in conjunction with salt retaining fluids i.e. saline • Dextrose 10%: o As Intravenous solution for fluid replenishment o caloric supply in single dose container for intravenous administration o As parenteral nutrient • Dextrose 50%: o Hypoglycemia o Status epilepticus o Coma o Altered mental status • Sodium chloride+ Dextrose (Dextrose saline): o Similar indications to 5% dextrose o Provides Na+ 30mmol/l and Cl- 30mmol/l i.e. a sprinkling of salt and sugar o Does not commonly cause water or salt overload • Potassium chloride Solution: o Hypokalemia STEP 3: Contraindications of Solutions for Correcting Electrolyte Imbalance (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of solutions for correcting electrolyte imbalance? 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 143 • Sodium Chloride (Normal Saline): o Severe Hypertension o Pulmonary edema o Congestive cardiac failure o Oedema o Severe renal impairment o Liver cirrhosis • Dextrose 5%: o Hyperglycemia • Dextrose 50%: o Cerebral vascular accident in presence of normal blood sugar. o Hyperglycemia o Increased Intracranial pressure(ICP) o Intracranial hemorrhage • Sodium Lactate Compound (Ringers Lactate): o Known hypersensitivity to sodium lactate o Congestive heart failure o Severe renal impairment o Lactic acidosis STEP 4: Dose, Dosage and Course of Solutions for Correcting Electrolyte Imbalance (30 minutes) • Dextrose 5%; 500ml, 1000ml. Provides some calories [approximately 10% of daily requirements]. Regarded as ‗electrolyte free‘ – contains NO Sodium, Potassium, Chloride or Calcium • Dextrose 10%;500ml • Dextrose 25%, 50%; 50ml, 100ml • Sodium lactate compound (Ringer‘s solution) 500ml, 1000ml. Each liter provides approximately Na+ 131 mmol, K 5mmol, Ca++ 2mmol, C1-111mmol and HCO3- (lactate) 29mmol • Sodium chloride+ Dextrose(Dextrose saline), 0.9%+5%; 500ml, 1000ml • Potassium chloride Solution 7.4% 10ml Vial • Potassium citrate oral solution containing potassium citrate PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 144 STEP 5: Side Effects and Adverse Effects of Solutions for Correcting Electrolyte Imbalance (15 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are side effects and adverse effects of solutions for correcting electrolyte imbalance? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Sodium Chloride (Normal Saline): o Common cause of iatrogenic hyponatremia in surgical patients. o Reactions which may occur because of

NTA Level 4 • Semester 2 • PST04211 Description of Drugs Used in Diarrhoea Basic Pharmacology • Source Session/Topic 22 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 22: Description of Drugs Used in Diarrhoea 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 drugs used in diarrhoea • List contraindications of drugs used in diarrhoea • Describe dose, dosage and course of drugs used in diarrhoea • List side effects and adverse effects of drugs used in diarrhoea • Describe interactions and precautions of drugs used in diarrhoea 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 20 minutes Indications of Drugs Used in Diarrhoea Buzzing Presentation/ 3 20 minutes Contraindications of Drugs Used in Diarrhoea Brainstorming Dose, Dosage and Course of Drugs Used in 4 30 minutes Presentation Diarrhoea Presentation/ Side Effects and Adverse Effects of Drugs 5 20 minutes Brainstorming Used in Diarrhoea Interactions and Precautions of Drugs Used 6 15minutes Presentation In Diarrhoea 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 135 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 Drugs Used in Diarrhoea (20minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are drugs are indicated in patient with diarrhea? 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 • Indications o Loperamide is useful in symptomatic treatment of acute diarrhoea adjunct to rehydration in adults and children over 4 years. It is also used for chronic diarrhoea in adults only o Zinc is used for treatment of acute diarrhoea and prevention of zinc deficiency and its consequences, including stunted growth in children, and slow wound healing o Oral rehydration salt is useful in replacement of fluid and electrolyte loss in diarrhoea STEP 3: Contraindications of Drugs Used in Diarrhoea (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of drugs used in diarrhea? 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 136 • Loperamide is contraindicated in conditions where inhibition of peristalsis should be avoided, where abdominal distension develops and in conditions such as active ulcerative colitis or antibiotic-associated colitis • Zinc is not contraindicated to any specific group of individual Oral rehydration is not contraindicated to any specific group of individual STEP 4: Dose, Dosage and Course of Drugs Used in Diarrhoea (30 minutes) • Loperamide o Acute diarrhea, 4 mg initially followed by 2 mg after each loose stool for up to 5 days. Usual dose 6–8 mg daily, maximum 16 mg daily, children 4–8 years, 1 mg 3–4 times daily for up to 3 days only, 8–12 years, 2 mg 4 times daily for up to 5 days o Chronic diarrhea, in adults initially 4–8 mg daily in divided doses, subsequently adjusted according to response and given in 2 divided doses for maintenance, maximum 16 mg daily o Fecal incontinence initially 500 micrograms daily, adjusted according to response, maximum 16 mg daily in divided doses • Zinc o For diarrhea in malnourished or zinc-deficient children: 10-40 mg elemental zinc daily o For preventing and treating pneumonia in undernourished children in developing countries, 10-70 mg/day o For hypogeusia, (sense of taste is abnormal), 25-100 mg zinc o For the eating disorder anorexia nervosa: 100 mg of zinc gluconate daily o For treating stomach ulcers, zinc sulfate 200 mg three times daily o For muscle cramps in zinc deficient people with liver disease zinc sulfate 220 mg twice daily o For osteoporosis, 15 mg zinc combined with 5 mg manganese, 1000 mg calcium, and 2.5 mg copper has been used o For sickle cell disease, zinc sulfate 220 mg three times daily o To increase growth and weight gain in children with sickle cell disease who have not reached puberty, 10 mg elemental zinc per day • Oral rehydration salt is given to fluid loss, usually 200–400 mL solution after every loose motion; infant 1–1½ times usual feed volume; child 200 mL after every loose motion PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 137 STEP 5: Side Effects and Adverse Effects of Drugs Used in Diarrhea (15 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects and adverse drug reactions of drugs used in diarrhoea? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Loperamide, abdominal cramps, dizziness, drowsiness, and skin reactions including urticaria; paralytic ileus and abdominal bloating also reported • Zinc, zinc cause nausea, vomiting, diarrhea, metallic taste, kidney and stomach damage, and other side effects. On broken skin zinc may cause burning, stinging, itching and tingling sensation • ORS when given in excess may cause oedema and hyperchloraemic acidosis STEP 6: Interactions and Precautions of Drugs Used in Diarrhoea (15minutes) • Loperamide increases plasma concentration of oral desmopressin • Zinc decrease absorption of antibiotic in the GIT there by decreasing their effectiveness For example: o Zinc can attach to tetracyclines in the stomach. This decreases the amount

NTA Level 4 • Semester 2 • PST04211 Description of Antiemetic Drugs Basic Pharmacology • Source Session/Topic 21 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 21: Description of Antiemetic 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 antiemetic drugs • List contraindications of antiemetic drugs • Describe dose, dosage and course of antiemetic drugs • List side effects and adverse effects of antiemetic drugs • Describe interactions and precautions of antiemetic 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 20 minutes Indications of Antiemetic Drugs Buzzing Presentation/ 3 20 minutes Contraindications of Antiemetic Drugs Brainstorming Dose, Dosage and Course of Antiemetic 4 30 minutes Presentation Drugs Presentation/ Side Effects and Adverse Effects of 5 20 minutes Brainstorming Antiemetic Drugs Interactions and Precautions Antiemetic 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 129 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: Listing Indications of Antiemetic Drugs (20minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • Mention antiemetic drugs used in clinical practice. • What are indications of antiemetic 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 • Antiemetic drugs used in clinical practice include: o Chlorpromazine o Metoclopramide o Promethazine hydrochloride o Droperidone o Donperidone • Are indicated for treatment of nausea and vomiting due to: o Adverse effects from medications o Systemic disorders: pregnancy, vestibular dysfunction, increased pressure, hepatobiliary disorders, radiation or chemotherapy, and gastrointestinal obstruction, dysmotility o Infections: central nervous system infection, peritonitis • Used in intractable hiccoughs and vertigo • Are indicated in post operative PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 130 STEP 3: Contraindications of Antiemetic Drugs (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are contraindications of antiemetic drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Antiemetic drugs are contraindicated in patients with known hypersensitivity to these drugs • Prochlorperazine is contraindicated in patients with: o Narrow angle glaucoma o Severe liver disease o Cardiovascular disease STEP 4: Dose, Dosage and Course of Antiemetic Drugs (30 minutes) • Chlorpromazine 10-25 mg PO q4-6 h prn • Metoclopramide 1-2mg/kg iv 15-30 min • Promethazine hydrochloride 20-25mg at bed time • Droperidol 0.625-1.25mg 30 min before end of the surgery • Donperidone 10-20mg 3-4 times daily PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 131 STEP 5: Side Effects and Adverse Effects of Antiemetic Drugs (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are side effects and adverse effects of antiemetic 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 antiemetic drugs are: o Headache o Dizziness o Constipation o Drowsiness o Sedation o Dry mouth o Hypertension o Hypotension o Nasal congestion o Diarrhea STEP 6: Interactions and Precautions of Antiemetic Drugs (15minutes) • Precaution should be taken in: o Severe nausea and vomiting o Obstructive diseases of gastro intestinal or genitourinary system • To be used with caution to patients with: o Hypertension o Sleep apnea o Epilepsy • Antiemetics interact with: o Central nervous system depressants such as:  Sedatives  Antidepressants  Opiates  Hypnotics  Antianxiety drugs PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 132 o Also exaggerate the anticholinergic effects of antihistamine, antidepressants, phenothiazines and disopyramide o Antiacids decrease absorption of antiemetic Step 7: Key Points (5 minutes) • Antiemetic drugs are indicated in patients with nausea and vomiting due to infections, systemic disorders and effects of other medications • Antiemetic drugs are contraindicated in patients with known hypersensitivity and severe liver and cardiovascular diseases • The side effects of Antiemetic drugs are headache, dizziness, constipation diarrhea and sedation • Caution should be taken to patient with severe nausea and vomiting and genitourinary and gastrointestinal obstructive condition • Antiemetic drugs react with different drugs central nervous depressant and increases effects of anticholinergic drugs STEP 8: Evaluation (5 minutes) • What are antiemetic drugs? • What are indications of antiemetic drugs? • What are the contraindications of antiemetic drugs? • What are the dose, dosage and course of antiemetic drugs • What are side effects and adverse effects of antiemetic drugs? • Describe interaction and precaution of antiemetic drugs? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 133 References Ministry Of Health and Social Welfare. (2013). Standard Treatment Guidelines & National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania government printers. Robert, L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael. (2014). Pharmacotherapy: A Pathophysiologic Approach (9th ed.). New York, McGraw-Hill Education. Sally, S.R, Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed) New York, Lippincott Williams and Wilkins School of Pharmaceutical sciences. (2011).Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam, ARDHI University press. The Royal Pharmaceutical Society of Great Britain. (2007). Martindale, The Extra Pharmacopoeia (5TH ed). London, pharmaceutical press. The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary (59th ed). London, BMJ