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NTA Level 4 • Semester 2 • PST04211 Description of Antimalarial Drugs Basic Pharmacology • Source Session/Topic 10 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 10: Description of Antimalarial Drugs Total Session Time: 120 minutes + 2 hours Assignment Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of antimalarial drugs • List contraindications of antimalarial drugs • Describe dose, dosage and course of antimalarial drugs • List side effects and adverse effects of antimalarial drugs • Describe interactions and precautions of antimalarial 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 Antimalarial Drugs Buzzing Presentation/ 3 20 minutes Contraindications of Antimalarial Drugs Brainstorming Dose, Dosage and Course of Antimalarial 4 20 minutes Presentation Drugs Presentation/ Side Effects and Adverse Effects of 5 20 minutes Brainstorming Antimalarial drugs Interactions and Precautions of Antimalarial 6 15 minutes Presentation Drugs 7 05 minutes presentation Key points 8 05 minutes presentation evaluation 9 10 minutes Presentation Assignment PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 55 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 Antimalarial Drugs (20minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are indications of antimalarial 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 indications of antimalarial drugs depends on the stage of disease and are classified as follows: o Drugs that eliminate developing or dormant liver forms of malaria parasite are called tissue schizonticides o Those that act on erythrocytes stage of malarial parasites are blood schizonticides o Those that kill sexual stages of malaria parasites and prevent transmission to mosquitoes are gametocides o No one available agent can reliably affect a radical cure, that is, eliminate both hepatic and erythrocytic stages of malaria parasite o Few available agents are causal prophylactic drugs, that is, capable of preventing erythrocytic malaria infection o However, all effective malaria chemoprophylactic agents kill erythrocytic parasites before they increase sufficiently in number to cause clinical disease • The indications of different antimalaria drugs: o Chloroquine  Is a highly effective blood schizonticide  It is also moderately effective against gametocytes of P. vivax, P. ovale, and P. malariae but not against those of p falciparum  Chloroquine is not active against liver stage parasites  But its utility against p falciparum has been seriously compromised by drug resistance PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 56 o Amodiaquine  Amodiaquine is closely related to chloroquine, and it probably shares mechanisms of action and resistance with that drug o Quinine & Quinidine  Quinine is a rapidly acting, highly effective blood schizonticide against the four species of human malaria parasites  The drug is gametocidal against P. vivax and P. ovale but not P. falciparum  It is not active against liver stage parasites.  The mechanism of action of quinine is unknown o Artemisinin and its derivatives  Are very rapidly acting blood schizonticides against all human malaria parasites  Artemisinins have no effect on hepatic stages of malaria parasites  Artemisininsin particular artesunate and artemether are playing an increasingly important role in the treatment of multidrug-resistant p falciparum malaria  They are the only drugs reliably effective against quinine resistant strains The most important of these analogs are:  Artesunate (water-soluble; useful for oral, intravenous, intramuscular, and rectal administration)  Artemether (lipid-soluble; useful for oral, intramuscular, and rectal administration) o Lumefantrine  Is an aryl alcohol related to halofantrine, is available as a fixed-dose combination with artemether as Coartem in some countries  Coartem is highly effective in the treatment of falciparum malaria STEP 3: Contraindications of Antimalarial Drugs (20 Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are contraindications of antimalarial drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Chloroquine is contraindicated in patients with o Psoriasis or porphyria, in whom it may precipitate acute attacks of these diseases o It should generally not be used in those with retinal or visual field abnormalities or myopathy. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 57 • Quinine (or quinidine) o Should be discontinued if signs of severe cinchonism, hemolysis, or hypersensitivity occur o It should be avoided if possible in patients with underlying visual or auditory problems • Artemisinins o It is contraindicated the first trimester of pregnancy if possible because teratogenicity has been seen in animal studies, but limited inadvertent use in pregnancy has apparently not led to fatal problems o Is avoided in breast feeding mother whose infant is below 5kg body weight STEP 4: Dose, Dosage and Course of Antimalarial Drugs (30 minutes) • Artemether & Lumefantrine o Dosage of Artemether 20mg & Lumefantrine 120mg tablets according to weight and age WT(Kg) AGE Day 1 Day1 Day2 Day2 Day 3 Day3 O hr 8hrs 24 hrs 36 hrs 48hrs 60hrs 5-14 3mon-3yrs 1 1 1 1 1 1 15-24 3yrs-8yrs 2 2 2 2 2 2 25-34 8yrs-12yrs 3 3 3 3 3 3 35 12yrs 4 4 4 4 4 4 above above o The first dose should be given as Direct Observed Therapy(DOT) o The second dose should strictly be given after 8hours

NTA Level 4 • Semester 2 • PST04211 Description of Amoebicides Basic Pharmacology • Source Session/Topic 9 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 9: Description of Amoebicides 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 Amoebicides • List Contraindication of Amoebicides • Describe dose, dosage and course of Amoebicides • List side effects and adverse effects of Amoebicides • Describe interaction and precaution of Amoebicides 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 10 minutes Indications of Amoebicides Buzzing Presentation/ 3 10 minutes Contraindication of Amoebicides brainstorming 4 10 minutes Presentation Dose, Dosage and Course of Amoebicides Presentation/ 5 10 minutes Effects and Adverse Effects of Amoebicides Brainstorming 6 05 minutes Presentation Interaction and Precaution of Amoebicides 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 50 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 Amoebicides (10 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the examples of Amoebicides? • What are the indications of Amoebicides? 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 • Amoebicides listed on essential medicine list include metronidazole and tinidazole. • Indications of Amoebicides o Metrinidazole is the drug of choice in the treatment of all tissue infections with E histolytica. They are not reliably effective against luminal parasites and so must be used with a luminal amebicide to ensure eradication of the infection o Tinidazole like metronidazole, it is also the drug of choice in the treatment of all tissue infections with E histolytica. They are not reliably effective against luminal parasites and so must be used with a luminal amebicide to ensure eradication of the infection STEP 3: Contraindication of Amoebicides (10Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the Contraindications of Amoebicides? 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 51 Metrinidazole and Tinidazole are contraindicated to people who have taken alcohol STEP 4: Dose, Dosage and Course of Amoebicides (10minutes) • Metronidazole o By mouth, invasive intestinal amoebiasis, extraintestinal amoebiasis (including liver abscess), 800 mg every 8 hours for 5 days in intestinal infection (for 5–10 days in extra-intestinal infection) o Children 1–3 years 200 mg every 8 hours; 3–7 years 200 mg every 6 hours; 7–10 years 400 mg every 8hours • Tinidazole o Intestinal amoebiasis, 2 g daily for 2–3 days; o Children 50–60 mg/kg daily for 3 days o Amoebic involvement of liver, 1.5–2 g daily for 3–6days o Children 50–60 mg/kg daily for 5 days STEP 5: Side Effects and Adverse Effects of Amoebicides (10 Minute) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects and adverse effects of Amoebicides? 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 amoebicides o Metrinidazole and Tinidazole o Gastro-intestinal disturbances (including nausea and vomiting), o Taste disturbances, furred tongue, oral mucositis, anorexia o Very rarely hepatitis, jaundice, pancreatitis o Drowsiness, dizziness, headache, ataxia, psychotic disorders o Darkening of urine o Thrombocytopenia, pancytopenia o Myalgia, arthralgia o Visual disturbances o Rash, pruritus, and erythema multiform o On prolonged or intensive therapy peripheral neuropathy, transient epileptiform seizures PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 52 STEP 6: Interaction and Precaution of Amoebicides (minutes) • Metrinidazole and Tinidazole o Disulfiram-like reaction with alcohol, there for it should never be given with alcohol or where there is a suspected use of alcohol o Hepatic impairment and hepatic encephalopathy o Pregnancy o Breast-feeding o Avoid in acute porphyria o Clinical and laboratory monitoring advised if treatment exceeds 10 days STEP 7: Key Points (5 minutes) • Metrinidazole and Tinidazole are common medicines in amoebiasis • Metrinidazole and Tinidazole should not given to patient who have taken alcohol • Long term use of Metrinidazole and Tinidazole need clinical and laboratory monitoring • Long course and higher dose is required in liver abscess STEP 7: Evaluation (5 minutes) • What are the indication of Metrinidazole and Tinidazole? • What is the dose of Metrinidazole and Tinidazole? • What is the common adverse effect of Metrinidazole and Tinidazole? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 53 References Ministry of Health and Social Welfare. (2013). Standard Treatment Guidelines & National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania government printers. Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael. (2014). Pharmacotherapy: A Pathophysiologic Approach (9th ed.). New York, McGraw-Hill Education. Sally S.R, Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed) New York, Lippincott Williams and Wilkins. School of Pharmaceutical sciences. (2011).Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam, ARDHI University press. The Royal Pharmaceutical Society of Great Britain. (2007). Martindale, the Extra Pharmacopoeia (5TH ed). London, pharmaceutical press. The Royal Pharmaceutical Society of Great Britain. 2009. British National Formulary (59th ed). London, BMJ Group and RPS Publishing. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator

NTA Level 4 • Semester 2 • PST04211 Description of Antituberculosis Basic Pharmacology • Source Session/Topic 8 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 8: Description of Antituberculosis 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 antituberculosis • List contraindications of antituberculosis • Describe dose, dosage and course of antituberculosis • List side effects and adverse effects of antituberculosis • Describe interactions and precautions of antituberculosis 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 Antituberculosis Buzzing Presentation/ 3 20 minutes Contraindications of Antituberculosis Brainstorming 4 30 minutes Presentation Dose, Dosage and Course of Antituberculosis Presentation/ Side Effects and Adverse Effects of 5 20 minutes Brainstorming Antituberculosis Interactions and Precautions of 6 15 minutes Presentation Antituberculosis 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 44 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 Antituberculosis Drugs (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • Which drugs are used in treatment of tuberculosis? 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 • Tuberculosis is managed by the following drugs usually in combination to prevent mycobacterium resistance and toxicity o Rifampicin symbolized by R o Isoniazid symbolized by H o Pyrazinamide symbolized by Z o Ethambutol symbolized by E o Streptomycin symbolized by S • Tuberculosis is usually managed in two phases, initial phases and continuous phase o The initial phase; during this phase combination drugs are continued for 2 months o Drugs used in initial phase are rifampicin, isoniazid, pyrazinamide and ethambutol o These drugs should be continued until full susceptibility is confirmed, even if this is for longer than 2 months o Continuation phase; after the initial phase, treatment is continued for a further 4 months with isoniazid and rifampicin (preferably given as a combination preparation). Longer treatment is necessary for meningitis, direct spinal cord involvement, and for resistant organisms which may also require modification of the regimen • Other drugs indicated for management of tuberculosis as second line include cycloserine, ethionamide and streptomycin PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 45 STEP 3: Contraindications of Antituberculosis Drugs (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of antituberculosis drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Rifampicin is contraindicated to patient with jaundice • Isoniazid is contraindicated to patient with drug induced liver disease • Pyrazinamide is contraindicated to patient with Hepatic disorders o Patients or their careers should be told how to recognize signs of liver disorder, and advised to discontinue treatment and seek immediate medical attention if symptoms such as persistent nausea, vomiting, malaise or jaundice develop • Ethambutol is contraindicated in optic neuritis and poor vision • Streptomycin is contraindicated to patient with mythenia gravis • Cycloserine is contraindicated to patient with epilepsy, depression, severe anxiety, psychotic states, alcohol dependence and acute porphyria STEP 4: Dose, Dosage and Course of Antituberculosis Drugs (30minutes) • Rifampicin o Is usually given 600 mg/daily (10 mg/kg/d) orally, must be administered with isoniazid or other antituberculosis drugs to patients with active tuberculosis to prevent emergence of drug-resistant mycobacteria o Rifampin 600 mg daily or twice weekly for 6 months also is effective in combination with other agents in some atypical mycobacterial infections and in leprosy • Isoniazid o Usual dosage is 5 mg/kg/d; a typical adult dose is 300 mg given once daily. Up to 10 mg/kg/d may be used for serious infections or if malabsorption is a problem o A 15 mg/kg dose, or 900 mg, may be used in a twice-weekly dosing regimen in combination with a second antituberculosis agent (e.g., rifampin 600 mg) o Pyridoxine, 25-50 mg/d, is recommended for those with conditions predisposing to neuropathy, an adverse effect of isoniazid o Isoniazid is usually given by mouth but can be given parenterally in the same dosage PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 46 • Pyrazinamide o Should be used at a dose of 40-50 mg/kg is used for thrice-weekly or twice-weekly treatment regimens. o Pyrazinamide is an important front-line drug used in conjunction with isoniazid and rifampin in short-course (ie, 6-month) regimens as a "sterilizing" agent active against residual intracellular organisms that may cause relapse • Ethambutol o As hydrochloride salt is given at 15-25 mg/kg, is usually given as a single daily dose in combination with isoniazid or rifampin. o The higher dose is recommended for treatment of tuberculous meningitis. o The dose of ethambutol is 50 mg/kg when a twice-weekly dosing schedule is used. • Streptomycin o The usual dosage is 15 mg/kg/d intramuscularly or intravenously daily for adults (20- 40 mg/kg/d, not to exceed 1-1.5 g for children) for several weeks, followed by 1-1.5 g two or three times weekly for several months STEP 5: Side Effects and Adverse Effects of Antituberculosis (20 minute) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are the side effects and adverse effects of antituberculosis? ALLOW few students to respond? WRITE their responses on the flip chart/ board CLARIFY

NTA Level 4 • Semester 2 • PST04211 Description of Fluoroquinolone Drugs Basic Pharmacology • Source Session/Topic 7 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 7: Description of Fluoroquinolone 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 Fluoroquinolone Drugs • List Contraindication of Fluoroquinolone Drugs • Describe dose, dosage and course of Fluoroquinolone Drugs • List side effects and adverse effects of Fluoroquinolone Drugs • Describe interaction and precaution of Fluoroquinolone 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/ Indications of Fluoroquinolone 2 20 minutes Buzzing Drugs Presentation/ Contraindication of Fluoroquinolone 3 20 minutes brainstorming Drugs 4 30 minutes Presentation Dose, Dosage and Course of Fluoroquinolone Drugs Presentation/ Side Effects and Adverse Effects of 5 20 minutes brainstorming Fluoroquinolone Drugs Interaction and Precaution of Fluoroquinolone 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 38 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 Fluoroquinolone Drugs (20minutes) Activity: Buzzing (5 minutes) Ask students to pair up and buzz on the following questions: • What are the Fluoroquinolone drugs? • What are the indications of Fluoroquinolone drugs? ALLOW few pairs to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Fluoroquinolones include Nalidixic acid, norfloxacin, ciprofloxacin, oxfloxacin and levofloxacin • The remarkably powerful and specific activity of antimicrobial drugs is due to their selectivity for targets that are either unique to microorganisms or much more important in them than in humans • Fluoroquinolones are active against a variety of gram-positive and gram-negative bacteria • Nalidixic acid and norfloxacin are effective in uncomplicated urinary-tract infections. • Ciprofloxacin is active against both Gram-positive and Gram-negative bacteria. It is particularly active against Gram-negative bacteria, including salmonella, shigella,campylobacter, neisseria, and pseudomonas • Ciprofloxacin has only moderate activity against Gram-positivebacteria such as Streptococcus pneumoniae and Enterococcusfaecalis; it should not be used for pneumococcal pneumonia.It is active against chlamydia and some Mycobacteria • Ofloxacin is used for urinary-tract infections, lowerrespiratory-tract infections, gonorrhoea, and non-gonococcalurethritis and cervicitis • Levofloxacin is active against Gram-positive and Gramnegativeorganisms. o It has greater activity against pneumococci than ciprofloxacin. o Levofloxacin is licensed for community-acquired pneumonia but it is considered to be second-line treatment for this indication PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 39 STEP 3: Contraindication of Fluoroquinolones Drugs (20 minutes) Activity: brainstorming (5 minutes) ASK learners to brainstorm on the following question • What is contraindication of Fluoroquinolone drugs? ALLOW few students to respond WRITE their responses on the flipchart CLARIFY and SUMMARISE by using the content below Fluoroquinolones are contraindicated in: • Pregnancy • Patients with a history of tendon disorders related to quinolone use • Severe hepatic impairment • Bradycardia • History of symptomatic arrhythmias • Heart failure • Electrolyte disturbances STEP 4: Dose, Dosage and Course of Fluoroquinolone drugs (30 minutes) • Ciprofloxacilin o By mouth, respiratory-tract infections, 500–750 mg twice daily (750 mg twice daily( in pseudomonal lower respiratory-tract infection in cystic fibrosis) o Urinary-tract infections, 250–750 mg twice daily (250 mg twice daily for 3 days usually adequate for acute uncomplicated cystitis in women) o Acute or chronic prostatitis, 500 mg twice daily for 28 days o Gonorrhoea, 500 mg as a single dose o Most other infections, 500 mg twice daily (increased to 750 mg twice daily in severe or deep-seated infection o Surgical prophylaxis [unlicensed], 750 mg 60 minute before procedure o Prophylaxis of meningococcal meningitis by intravenous infusion over 60 minutes, 400 mg o Anthrax (treatment and post-exposure prophylaxis, every 8–12 hours o by mouth, 500 mg twice daily o By intravenous infusion over 60 minutes, 400 mg every 12 hours • Levofloxacilin o By mouth, acute sinusitis, 500 mg daily for 10–14 days o Exacerbation of chronic bronchitis, 250–500 mg daily for 7–10 days o Community-acquired pneumonia, 500 mg once or twice daily for 7–14 days o Urinary-tract infections, 250 mg daily for 7–10 days(for 3 days in uncomplicated infection) PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 40 o Chronic prostatitis, 500 mg once daily for 28 days o Skin and soft tissue infections, 250 mg daily STEP 4: Side Effects and Adverse Effects of Fluoroquinolone Drugs (20minutes) ACTIVITY: brainstorming (5 minutes) ASK students to brainstorm on the following question • What are the side effects and adverse effects of Fluoroquinolone drugs? ALLOW few students to respond WRITE their responses on the flipchart CLARIFY and SUMMARISE by using the content below Adverse effects and side effects of Fluoroquinolones • Fluoroquinolones are extremely well tolerated • The most common effects are nausea, vomiting, and diarrhea • Occasionally, headache, dizziness, insomnia, skin rash, or abnormal liver function tests develop • Photosensitivity has been reported with lomefloxacin and pefloxacin may damage growing cartilage and cause an arthropathy • Tendinitis, a rare complication that has been reported in adults STEP 5: Interactions and Precautions of Essential Fluoroquinolone Drugs (15 minutes) • Interaction of Fluoroquinolones o Also should avoided in those receiving quinidin procainamide sotalol, ibutilide, amiodarone) o Patients receiving other agent like erythromycin, tricyclic antidepressants should be given fluoroquinolones with caution • Precaution Quinolones should be used with caution in: o Patients with a history of epilepsy or conditions that o Renal impairment o Pregnancy o During breast-feeding o Quinolones may induce convulsions in patients with without a history of convulsions o

NTA Level 4 • Semester 2 • PST04211 Description of Aminoglycoside Drugs Basic Pharmacology • Source Session/Topic 6 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 6: Description of Aminoglycoside Drugs Total Session Time: 120 minutes Prerequisites • Session 3: General Classification of Essential Medicine Learning Tasks By the end of this session students are expected to be able to: • List indications of aminoglycosides • List contraindications of aminoglycosides • Describe dose, dosage and course of aminoglycosides • List side effects and adverse effects of aminoglycosides • Describe interactions and precautions of aminoglycosides 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 tasks Presentation/ 2 20 minutes Indications of Aminoglycosides Buzzing Presentation/ 3 20 minutes Contraindications of Aminoglycosides Brainstorming 4 30 minutes Presentation Dose, Dosage and Course of Aminoglycosides Presentation/ Side Effects and Adverse Effects of 5 20 minutes Brainstorming Aminoglycosides Interactions and Precautions of 6 15 minutes Presentation Aminoglycosides 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 32 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 Aminoglycosides (20minutes) Activity: Buzzing (5minutes) ASK students to pair up and buzz on the following questions for 2 minutes • What are the types of aminoglycosides? • What are the indications of aminoglycosides? 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 • The aminoglycosides include streptomycin, neomycin, kanamycin, amikacin, gentamicin, tobramycin • All aminoglycosides are bactericidal and active against some Gram-positive and many Gram-negative organisms • Amikacin, gentamicin, and tobramycin are also active against Pseudomonas aeruginosa • Streptomycin is active against Mycobacterium tuberculosis and is now almost entirely reserved for tuberculosis STEP 3: Contraindications of Aminoglycosides (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of aminoglycosides? 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 33 • The aminoglycosides are contraindicated in: o Myasthenia gravis o In patients with renal failure o Hearing impairment o Pregnancy STEP 4: Dose, Dosage and Course of Aminoglycoside (30 minutes) The following are the commonly dose, dosage and courses of common aminoglycosides o Gentamycin Multiple daily dose regimen, by intramuscular or by slow intravenous injection over at least 3 minutes or by intravenous infusion, 3–5 mg/kg daily (in divided doses every 8 hours) o Neomycin Given by mouth, pre-operative bowel sterilisation, 1 g every hour for 4 hours, then 1 g every 4 hours for 2–3 days, for Hepatic coma, up to 4 g daily in divided doses usually for 5–7 days o Amikacin Given by intramuscular or by slow intravenous injection or by infusion, 15 mg/kg daily in 2 divided doses, can be increased to 22.5 mg/kg daily in 3 divided doses in severe infections; max. 1.5 g daily for up to 10 days (max. cumulative dose 15 g) STEP 4: Side Effects and Adverse Effects of Aminoglycosides (20minutes) Activity: Brainstorming (5 minutes) ASK students to brainstorm on the following question: • What are the common side effects/ adverse effects of aminoglycosides?‖ ALLOW few learners to respond WRITE their responses on the flipchart SUMMARIZE the discussion by the following information All aminoglycosides are ototoxic and nephrotoxic • This is more likely to be encountered when therapy is continued for more than 5 days, at higher doses, in the elderly, and in the setting of renal insufficiency) • Neomycin, kanamycin, and amikacin are the most ototoxic agents • Streptomycin and gentamicin are the most vestibulotoxic • Neomycin, tobramycin, and gentamicin are the most nephrotoxic PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 34 STEP 5: Interactions and Precautions of Aminoglycosides (15minutes) Interaction and precaution of the aminoglycosides • Concurrent use with: loop diuretics eg, furosemide, ethacrynic acid • Other nephrotoxic antimicrobial agents eg, vancomycin or amphotericin) potentiates nephrotoxicity • The above drugs should be avoided if possible when using aminoglycosides Step 6: Key Points (5minutes) • Commonly used Aminoglycosides are: streptomycin, neomycin, kanamycin, amikacin, gentamicin, tobramycin • Aminoglycosides are active against gram-negative enteric bacteria • Aminoglycosides are contraindicated in myasthenia gravis, renal and hearing problems • Aminoglycosides are mainly given by injection STEP 7: Evaluation (5minutes) • What are the indications of aminoglycoside drugs? • What are the contraindications of aminoglycoside drugs? • What are the common side effects of aminoglycoside drugs? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 35 References Ministry Of Health and Social Welfare. (2013). Standard Treatment Guidelines & National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania government printers. Robert, L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael. (2014). Pharmacotherapy: A Pathophysiologic Approach (9th ed.). New York, McGraw-Hill Education. Sally, S.R, Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed) New York, Lippincott Williams and Wilkins. School of Pharmaceutical sciences. (2011). Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam, ARDHI University press. The Royal Pharmaceutical Society of Great Britain. (2007). Martindale, the Extra Pharmacopoeia (5TH ed). London, pharmaceutical press. The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary (59th ed). London, BMJ Group and RPS Publishing. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 36 PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 37 ← Previous TopicNext Topic →View all Basic Pharmacology topicsOpen Complete Full Notes PDF / OFFLINE NOTES Unataka kutumiwa

NTA Level 4 • Semester 2 • PST04211 Description of Macrolide Drugs Basic Pharmacology • Source Session/Topic 5 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 5: Description of Macrolide 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 Macrolide Drugs • List Contraindications of Macrolide Drugs • Describe dose, dosage and course of Macrolidede Drugs • List side effects and adverse effects of Macrolide Drugs • Describe interactions and precautions of Macrolide Drugs 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 Tasks Presentation/ 2 10 minutes Indications of Macrolide Drugs Buzzing Presentation/ 3 10 minutes Contraindications of MacrolideDrugs brainstorming The dose, Dosage and Course of Macrolide 4 10minutes Presentation Macrolide Drugs Presentation/ The Side Effects and Adverse Effects of 5 10 minutes brainstorming Macrolide Drugs Interactions and Precautions of Macrolide 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 26 SESSION CONTENTS STEP1: 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 Macrolide Drugs (10minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are macrolide antibiotics? • What are the indications of Macrolide 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 SUMMARIZEby using the content below • Macrolide antibiotics includes: o Erythromycin o Clarithromycin o Azithromycin • The indication of the macrolides: o Are effective against gram-positive organisms, especially pneumococci, streptococci, staphylococci, and corynebacteria o Also effective to Mycoplasma, legionella, Chlamydia trachomatis, Chlamydia psittaci, Chlamydia pneumoniae, helicobacter, listeria, and certain mycobacteria (Mycobacterium kansasii, M scrofulaceum) o Gram-negative organisms such as Neisseria sp, Bordetella pertussis, Bartonella henselae, and B quintana (etiologic agents of cat-scratch disease and bacillary angiomatosis) some rickettsia sp, Treponema pallidum, and campylobacter sp are susceptible. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 27 STEP 3: Contraindication of Macrolide Drugs (10minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of Macrolide drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Erythromycin is contraindicated in: o In patient with hepatic impairment o In patient with Renal impairment • Clarithromycin is contraindicated in: o Pregnancy o Hepatic dysfunction o Renal impairment • Azithromycin are contraindicated in: o Breastfeeding o Pregnancy o Hepatic dysfunction o Renal impairment STEP 4: Dose, Dosage and Course of Macrolide drugs (10minutes) • Erythromycin o The oral dosage of erythromycin base is250-500mg every 6 hours (for children, 40 mg/kg/d) o Over 8 years 250-500mg every six hoursOr 4000mg daily in divided doses in severe infection o The dosage of erythromycin ethylsuccinate is 400-600mg every 6 hours o Oral erythromycin base (1 g) is sometimes combined with oral neomycin or kanamycin for preoperative preparation of the colon o The intravenous dosage of erythromycin gluceptate or lactobionate is 500-1000 mg every 6 hours for adults and 20-40 mg/kg/d for children PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 28 • Azithromycin o 500mg once daily for 3three days o 500mg on the firstday then250mg once daily for 4 days o Child over 6 month 10mg/kg once daily for 3 days • Clarithromycin o 250mg every 12 hours for seven days o In severe infections 500mg 12hourly for 14 days o Intravenously infusion 500mg twice daily STEP 5:Side Effects and Adverse Effects of Macrolide Drugs(10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects and adverse effects of macrolide drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below The following are the side effects/adverse effects of macrolides drugs: • Anorexia, nausea, vomiting, and Diarrhoea occasionally accompany oral administration • Gastrointestinal intolerance, which is due to a direct stimulation of gut motility, • Can produce acute cholestatic hepatitis (fever, jaundice, impaired liver function) • Other allergic reactions include fever, eosinophilia, and rashes STEP 6: Interaction and Precaution of Essential Macrolide drugs(5min) • Interaction and precaution: o Erythromycin metabolites can inhibit cytochrome P450 enzymes thus increase the serum concentrations of theophylline, oral anticoagulants, cyclosporine, and methylprednisolone o Erythromycin increases serum concentrations of oral digoxin by increasing its bioavailability PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 29 Step 7: Key Points (5 minutes) • Macrolide drugs includes erythromycin,Clarithromycin and azithromycin • Macrolides are effective against gram-positive organisms, especially pneumococci, streptococci, staphylococci, and corynebacteria • Macrolides are contraindicated in: Pregnancy, Hepatic dysfunction Renal impairment • Macrolides can be given orally or by injection • Common side effects of Macrolides are Anorexia, nausea, vomiting, and Diarrhoeadiarrhoea • Macrolides increases effects of many drugs like digoxin and theophylline STEP 8: Evaluation (5 minutes) • What are the indications of Macrolide drug? • What are the Contraindications of Macrolide drugs? • What are the dose, dosage and course of Macrolide drugs? • What are side effects and adverse effects of Macrolide drugs? • What are the interactions and precautions of Macrolide drugs? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 30 References Robert, L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells& L. Michael. (2014). Pharmacotherapy: a pathophysiologic approach (9thed.). New York, McGraw-Hill Education. Ministry Of Health and Social Welfare. ( 2013). Standard

NTA Level 4 • Semester 2 • PST04211 Description of Penicillin and Cephalosporins Basic Pharmacology • Source Session/Topic 4 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 4: Description of Penicillin and Cephalosporins 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 penicillins and cephalosporins • List contraindications of penicillin and cephalosporins • Describe dose, dosage and course of penicillins and cephalosporins • List side effects and adverse effects of penicillins and cephalosporins • Describe interactions and precautions of penicillins and cephalosporins 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 Penicillins and Cephalosporins Buzzing Presentation/ Contraindications of Penicillins and 3 20 minutes Brainstorming Cephalosporins Dose, Dosage and Course of Penicillins and 4 30 minutes Presentation Cephalosporins Presentation/ Listing side effects and adverse effects of 5 20 minutes Brainstorming Penicillins and Cephalosporins Drugs Description of interactions and precautions of 6 15 minutes Presentation Penicillins and Cephalosporin Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 20 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 Penicillins and Cephalosporins (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following questions for 2 minutes • Mention commonly used penicillins and cephalosporins • What are indications for cephalosporins and penicillins? 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 remarkably powerful and specific activity of antimicrobial drugs is due to their selectivity for targets that are either unique to microorganisms or much more important in them than in humans • Penicillins: o Have greatest activity against gram-positive organisms, gram-negative cocci, and non-lactamase-producing anaerobes. o However, they have little activity against gram-negative rods, o They are active against staphylococci and streptococci but not against enterococci, anaerobic bacteria, and gram-negative cocci and rods. o Extended-spectrum penicillins (ampicillin and the antipseudomonal penicillins) retain the antibacterial spectrum of penicillin and have improved activity against gram-negative organisms o Commonly used Penicillins include:  Amoxicillin  Flucloxacillin  Benzyl penicillin  Procaine penicillin  Ampicillin PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 21 • Cephalosporins: o similar to penicillins o But more stable to many bacterial lactamases o Therefore have a broader spectrum of activity o However, strains of E coli and Klebsiella species expressing extended-spectrum lactamases that can hydrolyze most cephalosporins are becoming a problem o Cephalosporins are not active against enterococci and L monocytogenes o Commonly used Cephalosporins include:  Cefuroxime  Cefotaxime  Ceftriaxone  Cefalexin  Cefradoxil STEP 3: Contraindications of Penicillins and Cephalosporins (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are contraindications of penicillins and cephalosporins? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Penicillins are contraindicated: o In patients with renal failure o In patients with penicillin hypersensitivity • Cephalosporins are contraindicated: o In patients with cephalosporin hypersensitivity o In patients with a history of anaphylaxis to penicillins STEP 4: Dose, Dosage and Course of Penicillins and Cephalosporins (30 minutes) • Penicillins o Amoxicillin 250-500mg every 6hourly for 5-7 days o Ampicillin 250-500mg every 6hourly for 5-7 days o Penicillin G up to 2.4mU/dose I.M • Cephalosporins o Orally PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 22  Cephalexin is given orally in dosages of 0.25-0.5 g four times daily (15-30 mg/kg/d)  Cefadroxil in dosages of 0.5-1 g twice daily. o Parenterally  The usual intravenous dosage for adults is 0.5-2 g intravenously every 8 hours.  can also be administered intramuscularly STEP 4: Side Effects and Adverse Effects of Penicillins and Cephalosporins (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are side effects and adverse effects of penicillins and cephalosporins? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Penicillin o Adverse effects and side effects:  The penicillins are remarkably nontoxic  Most of the serious adverse effects are due to hypersensitivity.  All penicillins are cross-sensitizing and cross-reacting  Allergic reactions include anaphylactic shock (serum sickness-type reactions, urticaria, fever, joint swelling, angioneurotic edema, intense pruritus, and respiratory embarrassment variety of skin rashes  Oral lesions, fever, interstitial nephritis vasculitis may also occur  Most patients allergic to penicillins can be treated with alternative drugs • Cephalosporins o Adverse effects and side effects:  Cephalosporins are sensitizing and may elicit a variety of hypersensitivity reactions that are identical to those of penicillins  These include anaphylaxis, fever, skin rashes, nephritis, granulocytopenia, and hemolytic anemia  Local irritation can produce severe pain after intramuscular injection and thrombophlebitis after intravenous injection  Renal toxicity, including interstitial nephritis and even tubular necrosis. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 23 STEP 5: Interactions and Precautions of Penicillins and Cephalosporins (15 minutes) • Penicillins o Interactions  Reduce excretion of cytotoxic like methotrexate  Allopurinol increases risk of rash when used with amoxicillin or ampicillin  Effects of anticoagulants are altered by penicillin o Precautions  History of allergy  Most patients allergic to penicillins can be treated with alternative drugs. • Cephalosporins o Interaction and precaution 

NTA Level 4 • Semester 2 • PST04211 Description of Anti-infective Medicines Basic Pharmacology • Source Session/Topic 3 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 3: Description of Anti-infective Medicines Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Define anti-infective medicine • Describe pharmacological classes of anti-infective medicine Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer and overhead projector where necessary SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation/ 2 40 minutes Definition of Anti Infective Medicine Buzzing Presentation/ Description of Pharmacological Classes of 3 65 minutes small group Anti Infective Medicine discussion 4 05 minutes Presentation Key Points 5 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 15 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: Definitions of Pharmacological Classes of Essential Medicine (40 Minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What is anti-infective medicine? 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 • Ant –infective medicines are those medicines used to fight against organisms that cause infections • Drug, anti-infective: Something capable of acting against infection, by inhibiting the spread of an infectious agent or by killing the infectious agent outright • . Anti-infective is a general term that encompasses antibacterials, antibiotics, antifungals, antiprotozoans and antivirals. STEP 3: Description of Pharmacological Classes of Anti Infective Medicine (65 Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • List the pharmacological classes of anti-infective medicines? 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 16 • There are several pharmacological classes of anti-infective medicine which are listed in the National essential drug lists. The classes include: o Antibacterial : used in treatment of various bacterial infection groups of antbacterials include aminoglycosides, antitubaculosis and leprosy, fluoroquinolones, peniciliins and cephalosporins, macrolides, chloramphenical, tetracyclines, o Antiprotozoans: used to treat protozoans infections such as mamoebiasis, filariasis, leishmaniasis, malaria, and schistosomiasis and trypanosomiasis o Ant helminthes: used in treatment of various worm infestation o Fungicides (Systemic and Mucosal): used in management of systemic and mucosal fungal infection o Antiviral: used to treat viral infection STEP 7: Key Points (5 Minutes) • In pharmacological classification, anti-infective drugs are grouped according to similarity indication • The definition of anti-infective drugs are based on their pharmacological action STEP 7: Evaluation (5 Minutes) • What is ant-infective medicine? • What are the main groups of ant-infective medicines? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 17 References Ministry of Health and Social Welfare. (2013). Standard Treatment Guidelines & National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania government printers. Robert, L., Talbert, Gary C. Yee, Gary R., Matzke, Barbara, G., Wells, L. Michael. (2014). Pharmacotherapy: A Pathophysiologic Approach (9th ed.). New York, McGraw-Hill Education. Sally S.R, Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed) New York, Lippincott Williams and Wilkins. School of Pharmaceutical sciences. (2011).Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam, ARDHI University press. The Royal Pharmaceutical Society of Great Britain. (2007). Martindale, the Extra Pharmacopoeia (5TH ed). London, pharmaceutical press. The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary (59th ed). London, BMJ Group and RPS Publishing. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 18 PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 19 ← 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 General Classification of Medicines Basic Pharmacology • Source Session/Topic 2 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 2: General Classification of Medicines Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Define pharmacological classes of essential medicines • Describe pharmacological classes of essential medicines Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer and overhead projector where necessary SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Learning Tasks Definition of Pharmacological Classes of 2 40 minutes Presentation/buzzing Essential Medicines Presentation/small Description Pharmacological Classes of 3 65 minutes group discussion Essential Medicines 4 05 minutes Presentation Key Points 5 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 8 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: Definitions of pharmacological classes of essential medicine (40 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question • What are the pharmacological classes of medicines? 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 • There are several pharmacological classes of medicines which are listed in the National essential drug lists. The classes include: o Anaethetics which are used in surgery and intubation o Muscle relaxants which are used in surgery o Analgesics which are used in management of pain and fever o Anti allergies which are used in management of allergic reactions o Antidotes which are used in counteracting the effects of a particular poison o Anti epileptic which are used in management of epilepsy o Anti infective which are used in management of various types of infections o Anti-neoplastic/immunosuppressive drugs which are used in immunosuppression especially during organ transplant and management of some cancers o Ant parkinsonism which are used in management of Parkinson‘s disease o Blood boaster which are used in management of anemia o Anti coagulants which are used as blood thinner and management of thrombosis o Cardiovascular medicines which are used in management of heart and problems associated with blood vessels o Dermatological medicines which are used in management of skin diseases o Gastro intestinal medicines which are used in management of problems in gastrointestinal tracts o Hormone and antidiabetic medicines which are used in management of diabetes and other hormonal diseases o Vaccines which are used in prevention of diseases PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 9 o Ophthalmological preparations which are used in management of eye diseases o Medicine used in ear and nose which are used in management of ear and nose problems o Oxytocics which are used in management of delayed labour o Psychotherapeutics which are used in management of psychiatric conditions o Medicines acting on the respiratory tracts which are used in management of diseases associated with respiratory system o Solution correcting water and electrolyte which are used in management of fluid and electrolyte imbalances o Vitamins and minerals which are used in management of vitamin and mineral deficiency STEP 3: Description Of Pharmacological Classes of Essential Medicines (65 Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • How do we describe pharmacological classes of essential medicines? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Pharmacological classes of medicines include drugs which have similar functions. Examples of drugs with similar functions are: o Anaethetics include general anaesthetic (halothane, ketamine, isoflurane and thiopental) and local anaesthetics ( lignocaine and bupivacaine) o Muscle relaxants include gallamine, neostigmine, pancuronium, suxamethonium o Analgesics is for pain relief and include aspirin, paracetamol, diclofenac, ibuprofen, indomethazine, piroxicam, mefenamic acid, naproxen, they also have antpyretic and antinflammatory effects, narcotics such as tromadol are pain relief and they act in the central nervous system o Anti allergies such as chlorpheniramine, loratadine, cetirizine, adrenaline, dopamine hydrocortisone, promethazine, dexamethasone are used in management of allergic reactions o Antidotes such as ipecacuanha, activated charcoal, magnesium salt and antivenom used in counteracting the effects of poisons o Anti epileptics (carbamazepine, diazepam, Phenobarbital, phenytoin and magnesium sulphate) are used in management of epilepsy PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 10 o Anti-neoplastic/immunosuppressive ( cyclophosphamide, rituximub and prednisolone) are used in immunosuppression especially during organ transplant and management of some cancers o Antiparkinsonism such as benzhexol, biperidine, bromocriptine and carbidopa are used in management of Parkinson‘s disease o Blood boaster such as ferrous sulphate, folic acid and vitamin B12 are used in management of anemia o Anti coagulants such as aspirin, activated prothrombin, enoxaparin sodium, heparin, vitamin K, protamin sulphate, streptokinase, alteplase, frozen plasma, factor viii and factor ix are used as blood thinner and management of thrombosis o Cardiovascular medicine; drugs used in management of heart disease and problems associated with blood vessels, they include:  Anti anginal drugs ( glyceryl trinitrate, isosorbide mono/dinitrate, nifedipine, clopidegral and propranolol), used in management of angina  Anti arrythimic drugs, (amiodarone, verapamil, adenosine and lidocaine) are used in management of cardiac arrhythmias  Anti-hypertensivesuch as methyldopa, captopril, nifedipine, atenolol, propranolol, labetalol, bumetanide, peridopril, carvediol, metoprolol, amlodipine, hydralazine and bisoprolol are used in management of hypertension  Cardiac Glycosides such as digoxine is used in management of congestive heart failure  Diurects such as frusemide, bendrofluazide, spironolactone, mannitol and glycerol syrup are used in management of hypertension and extracellular edema  Lipid Lowering such as simvastatin and atovastatin are used in lowering cholesterol level in

NTA Level 4 • Semester 2 • PST04211 Introduction to Pharmacology Basic Pharmacology • Source Session/Topic 1 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 1: Introduction to Pharmacology Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Define the terms pharmacology, drug and pro-drug and medicine • List sources of drugs • Define the term pharmacokinetics and list pharmacokinetics Parameters • Explain bioavailability and half life of drugs • Define pharmacodynamic, receptor, agonist, antagonist and synergy • Explain terms toxic, therapeutic dose and therapeutic index • Define the terms tolerance, habituation, dependence and addiction 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 Definition of Pharmacology, Drug and 2 10 minutes Presentation/Buzzing Pro-drug and medicine 3 10 minutes Presentation/Brainstorming Sources of Drugs Definition of Pharmacokinetics and 4 20 minutes Presentation Pharmacokinetics Parameters 5 15 minutes Presentation Bioavailability and Half-life of Drugs Pharmacodynamics, Receptor, Agonist, 6 15 minutes Presentation Antagonist and Synergy Toxic Dose, Therapeutic Dose and 7 15 minutes Presentation Therapeutic Index Tolerance, Habituation, Dependence and 8 20 minutes Presentation Addiction 9 05 minutes Presentation Key Points 10 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 1 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: Definition of Pharmacology, Drug and Pro-drug (10 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following questions for 5 minutes • What is Pharmacology? • What is a drug? • What is a Pro-drug? • What is a medicine? 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 and define other terminologies not defined by students • Pharmacology is a study of the effects of chemical substances on the function of living systems • A drug may is a substance that brings about a change in biologic functions through its chemical actions • A pro-drug is a chemical that is converted to active drug/form by biologic processes inside the body • A medicine is a chemical preparation, which usually but not necessarily contains one or more drugs, administered with the intention of producing a therapeutic effect • Medicines usually contain other substances (i.e. excipients, stabilisers, solvents, etc.) besides the active drug, to make them more convenient to use • In everyday parlance, the word drug is often associated with addictive, narcotic or mind- altering substances-an unfortunate negative connotation that tends to bias opinion against any form of chemical therapy PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 2 STEP 3: Sources of Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are sources of drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Drugs obtain from various sources such as: synthetic chemicals, chemicals obtained from plants, fungal sources, animal sources, marine organisms or products of genetic engineering • Plant-derived drugs include: quinine, digitalis, atropine, ephedrine, strychnine, vinca alkaloids and others which result from purification of active compounds from these plants. For example, morphine which is purified from opium • Fungal-derived sources include penicillin, streptomycin and many other antibiotics. • Animal-derived sources include Insulin, fats containing nutrients/vitamins derived from fish and others • Natural products, derived mainly from fungal and plant sources, have proved to be a fruitful source of new therapeutic agents, particularly in the field of anti-infective, anticancer and immunosuppressant drugs • Semi-synthetic drugs are derived from chemical modification of natural products for example Beta-Lactam antibiotics such as cephalosporins • Nowadays drugs are derived from chemical modifications/reactions in laboratories STEP 4: Definition of Pharmacokinetics and Pharmacokinetics parameters (20 minutes) • Pharmacodynamics is define as actions of the drug on the body • Pharmacokinetics is define as the actions of the body on the drug • When a drug is administered it must be absorbed into blood from its site of administration, distributed to its site of action, metabolized (mainly by the liver and other processes) and finally eliminated from the body by excretion and other processes • In short pharmacokinetics (PK) = Absorption (A), Distribution (D), Metabolism (M) and Elimination (E). Therefore, PK=ADME • The common terms used in description of pharmacokinetics are: Bioavailability (F) for absorption, Volume of distribution (Vd) for distribution, extraction ratio (ER) for metabolism and Clearance (CL) for elimination PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 3 STEP 5: Bioavailability and Half-life of Drugs (15 minutes) • Bioavailability is the fraction of administered drug that reaches systemic circulation. For example, if 100mg of a drug is administered orally and 80mg of the drug is absorbed, the bioavailability is 80% or 0.8 • The capital letter F is used to represent bioavailability • When a drug is administered through intravenously, all of the amount reaches systemic circulation, and thus bioavailability is 100% or 1 • Half-life (t1/2) is the time required for the concentration of drugs in the body (blood) to remain to half of the original concentration • Half-life is useful in designing drug dosage regimens, predicting elimination (clearance) and distribution of a drug (volume of distribution) STEP 6: Pharmacodynamics, Receptor, Agonist, Antagonist and Synergy (15 minutes) • Pharmacodynamics refers to the relationship between drug concentration at the site of action and the resulting effect, including the time course and intensity of therapeutic and adverse effects • A