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NTA Level 6 • Semester 1 • PST06106 Pharmacotherapy of Amoebiasis Basic Pharmacotherapy • Source Session/Topic 11 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. PST 06106 Basic Pharmacotherapy Session 11: Pharmacotherapy of Amoebiasis Learning Objectives By the end of this session students are expected to be able to: Define of amebiasis and ameobic liver abscess Explain pathophysiology of amebiasis and ameobic liver abscess Explain the clinical presentation of amebiasis and ameobic liver abscess Outline diagnosis of amebiasis and ameobic liver abscess Describe pharmacological treatment of amebiasis and ameobic liver abscess Describe the monitoring of amebiasis and ameobic liver abscess therapy Activity: Buzzing • What is Amoebiasis? Definition of Amebiasis Amebiasis Amoebiasis is an infection caused by the protozoa organism Entamoeba histolytica, which can cause colitis and other extra-intestinal manifestations. The infection is primarily acquired through ingestion of contaminated food and water and occasionally can be acquired through oral-anal sexual practices. Amoebic Liver Abscess It is the most frequent extra-intestinal manifestation of Entamoeba histolytica infection which results from the invasion of the portal venous system from the colon leading to inflammation and subsequently abscess formation particularly involving the right lobe of the liver. Pathophysiology Of Amoebiasis E histolytica invades mucosal cells of colonic epithelium, producing the classic flask-shaped ulcer in the submucosa. The trophozoite has a cytolethal effect on cells through a toxin. If the trophozoite gets into the portal circulation, it will be carried to the liver, where it produces abscess and periportal fibrosis. Amebic ulcerations can affect the colon, perineum, and genitalia, and abscesses may occur in the lung and brain. Clinical Presentation Of Amoebiasis Intestinal disease Vague abdominal discomfort, malaise to severe abdominal cramps, flatulence, bloody diarrhea ( heme -positive in 100% of cases) with mucus Eosinophilia is usually absent, although moderate leukocytosis is not unusual Evidence of motile trophozoites or cysts on saline wet mount from a stool specimen Clinical Presentation Of Amoebiasis Cont.… Amebic liver abscess High fever, rigors(sudden feeling of cold and shivering) and profuse sweating, significant leukocytosis with left shift, elevated alkaline phosphatase, and liver tenderness on palpation Right-upper-quadrant pain, hepatomegaly, and liver tenderness, with referred painto the left or right shoulder Erosion of liver abscesses may also present as peritonitis(inflammation of the membrane lining the abnominal wall and covering the abnominal organs). Positive imaging evidence of liver abscess and Serological evidence of E. histolytica antibodies or antigens. Activity : Small Group Discussion • What is the treatments of amebiasis? Pharmacological treatment and diagnosis of Amoebiasis Monitoring Of Amoebiasis Therapy Follow up in patients with amebiasis should include; repeat stool examination, serology, colonoscopy (for colitis), or Computed tomography (CT) (for liver abscess) between days 5 and 7, at the end of the course of therapy, and a month after the end of therapy. Most patients with either intestinal amebiasis or colitis will respond in 3 to 5 days with amelioration of symptoms. Monitoring Of Amoebiasis Therapy Cont.… Patients with liver abscesses may take from 7 to 10 days to respond; Patients not responding during this period may require aspiration of abscesses or exploratory laparotomy. Serial liver scans have demonstrated healing of liver abscesses over 4 to 8 months after adequate therapy. Key Points Amebiasis is a parasitic infection of the intestines caused by the protozoan Entamoeba histolytica, or E. histolytica. Infection by Entamoeba histolytica occurs by ingestion of mature cysts infecally contaminated food, water, or hands The symptoms of amebiasis include loose stool, abdominal cramping, and stomach pain Treatment for uncomplicated cases of amebiasis generally consists of a course of metronidazole or tinidazole Evaluation What is Amebiasis? What is the pathophysiology of amebiasis? What are the signs and symptoms of Amebiasis? How is the treatment of Amebiasis? References Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6 th Ed). New York, NY: McGraw-Hill. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008): Pharmacotherapy: A Pathophysiologic Approach (7 th ed ): New York, NY: McGraw-Hill. Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011) Principles & Practice Study Guide: A Case-Based Care Plan Approach : New York, NY: McGraw-Hill. Schwinghammer TL, Koehler JM (2009) Pharmacotherapy Casebook: A Patient-Focused Approach (7 th ed ): New York, NY: McGraw- ← Previous TopicNext Topic →View all Basic Pharmacotherapy 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 6 • Semester 1 • PST06106 Pharmacotherapy of Typhoid Fever Basic Pharmacotherapy • 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. PST 06106 Basic Pharmacotherapy Session 10: Pharmacotherapy of Typhoid Fever Learning Objectives By the end of this session students are expected to be able to: Define typhoid fever Explain pathophysiology of typhoid fever Explain the clinical presentation of typhoid fever Outline diagnosis of typhoid fever Describe pharmacological treatment of typhoid fever Describe monitoring of typhoid fever therapy Activity: Buzzing • What is typhoid fever? Definition of Typhoid Fever Typhoid Fever Typhoid fever, also called enteric fever, is caused by a bacterial infection with Salmonella enterica subspecies enterica serotype Typhi or serotypes Paratyphi A, B or C . Infection is acquired through ingestion of contaminated food and water. Humans are the only known hosts of Salmonella Typhi . Bacteria are shed in the faeces of an infected person and transmitted from person to person via ingestion of food or water contaminated by these faeces (faecaloral route). Definition of Typhoid Fever Cont.…. Large outbreaks of typhoid fever are often associated with contamination of a drinking water. The organism can survive for several days in fresh water (e.g. ground water, pond-water) and seawater. Furthermore, the organism can survive for prolonged periods (up to several months) in contaminated foods Pathophysiology Of Typhoid Fever Once ingested and successfully beyond host defense mechanisms such as low gastric pH and bile salts, organisms can attach and invade the distal ileum and proximal colon. Gastroenteritis often is characterized by massive neutrophil infiltration followed by lymphocytes and macrophages. The serotypes that are responsible for human illness cause intestinal epithelial cellsto secrete interleukin 8, a potent neutrophil chemo-tactic factor. Degranulation and release of toxic substances by neutrophils may contribute to inflammation and result in tissue damage, fluid secretion, or leakage across the intestinal mucosa Clinical Presentation Of Typhoid Fever Few clinical features reliably distinguish typhoid fever from other causes of febrile illnesses(temporary increase in average body temperature). Infection in the absence of treatment manifests after an average incubation period of 10-14 days (range 5-21 days) as a multistage febrile illness . Acute typhoid fever: Systemic illness characterised by: Fever: remittent during the first week, rising in a stepwise fashion and becomes sustained (lasting > 48 hours) after the first week. Headache Clinical Presentation Of Typhoid Fever Cont …. Gastrointestinal symptoms including: Abdominal pain/cramps Nausea and vomiting (usually not severe), and/or Constipation or diarrhoea (diarrhoea is more frequent in children and HIV infected adults). Clinical presentation cont. … Relative bradycardia (slower heart rate) Hepatosplenomegaly (23-65 %).——liver and spleen swell beyond normal size Leukopenia (16-46 %).—— Low white blood count Nonspecific symptoms, such as chills, diaphoresis, anorexia, cough, weakness, sore throat, Dizziness, and muscle pains, are frequent before the onset of fever. Severe illness and extra-intestinal complications may include; gastrointestinal bleeding , intestinal perforation, Septic shock or acidosis. Blood culture is the diagnostic test of choice Activity : Small Group Discussion • What is the first line treatment of Typhoid Fever?? Pharmacological Treatment Of Typhoid Fever Monitoring of Typhoid fever Therapy After therapy has been instituted, appropriate clinical parameters such as signs and symptoms and other laboratory markers should be monitored to ensure the efficacy and safety of the therapeutic regimen Key Points It is an acute systemic disease resulting from infection by Salmonella typhi and S.paratyphi , serovar group A and B respectively. Infection is acquired through ingestion of contaminated food and water. Patients may complain of nausea and vomiting followed by abdominal cramps, headache, fever, and diarrhea Ciprofloxacin (PO) 500mg 12 hourly for 10 days OR Azithromycin (PO) Adult 500mg for 7 days can be used for treatment Evaluation What is typhoid fever? What is the pathophysiology of typhoid fever? What are the signs and symptoms of acute typhoid fever? How is the treatment of typhoid fever? References Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6 th Ed). New York, NY: McGraw-Hill. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008): Pharmacotherapy: A Pathophysiologic Approach (7 th ed ): New York, NY: McGraw-Hill. Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011) Principles & Practice Study Guide: A Case-Based Care Plan Approach : New York, NY: McGraw-Hill. Schwinghammer TL, Koehler JM (2009) Pharmacotherapy Casebook: A Patient-Focused Approach (7 th ed ): New York, NY: McGraw-Hill. ← Previous TopicNext Topic →View all Basic Pharmacotherapy 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 6 • Semester 1 • PST06106 Pharmacotherapy of Bronchitis Basic Pharmacotherapy • 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. PST 06106 Basic Pharmacotherapy Session 9: Pharmacotherapy of Bronchitis 12/3/2020 Pharmacotherapy of Leprosy Learning objectives By the end of this session, you are expected to be able to: Define bronchitis Explain pathophysiology of bronchitis Explain the clinical presentation of bronchitis Outline diagnosis of bronchitis Describe pharmacological treatment of bronchitis Describe the monitoring of bronchitis therapy Activity: Buzzing •What is Chronic Bronchitis?? Definition of Bronchitis Bronchitis is an infection resulting from the inflammation of the lining of the lungs/bronchioles It is subdivided into two types Acute Bronchitis Chronic Bronchitis Acute bronchitis is one of the most common conditions associated with antibiotic misuse. Respiratory viruses are by far the most common infectious agents associated with acute bronchitis Chronic bronchitis It defined by a chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough have been excluded. Chronic Bronchitis It defined by a chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough have been excluded. Patients may get secondary bacterial infection with development of fever and production of thick smelly sputum. The disease is a result of several contributing factors; the most prominent include; cigarette smoking, exposure to occupational dusts, fumes, and environmental pollution; and Host factors [e.g., genetic factors and bacterial (and possibly viral) infections ]. Pathophysiology of Chronic Bronchitis Microorganisms gain access to the lower respiratory tract by three routes. Through inhalation as aerosolized particles, or via the bloodstream from an extra pulmonary site of infection; Aspiration of oropharyngeal contents which is a common occurrence in both healthy and ill persons during sleep is the major mechanism by which pulmonary pathogens gain access to the normally sterile lower airways and alveoli. When pulmonary defense mechanisms are functioning optimally, aspirated microorganisms are cleared from the region before infection can become established; However, aspiration of potential pathogens from the oropharynx can result in pneumonia if lung defenses are impaired Pathophysiology of Chronic Bronchitis Cont.. Factors that promote aspiration, such as altered sensorium and neuromuscular disease, may result in an increase in the size of the inoculum delivered to the lower respiratory tract, thereby overwhelming local defense mechanisms. Lung infections with viruses suppress the antibacterial activity of the lung by impairing alveolar macrophage function and mucociliary clearance, thus setting the stage for secondary bacterial pneumonia. Mucociliary transport is also depressed by ethanol and narcotics and by obstruction of a bronchus by mucus, tumor, or extrinsic compression. All these factors can severely impair pulmonary clearance of aspirated bacteria hence causing infection in the lung Clinical Presentation And Diagnosis Of Chronic Bronchitis Signs and symptoms Excessive sputum expectoration Cyanosis (advanced disease) Obesity Clinical Presentation And Diagnosis Of Chronic Bronchitis Cont …. Physical examination Chest auscultation usually reveals inspiratory and expiratory rates, Rhonchi(Sound generated by the movement of air through the respiratory system), and mild wheezing with an expiratory phase that is frequently prolonged; H yper resonance on percussion(Too much air present within the lung) with obliteration of the area of cardiac dullness(dense tissue) Normal vesicular breathing sounds are diminished Clubbing of digits (advanced disease)—- enlargement of the tip of the lung and change in angle, present in bronchitis but not in asthma and pneumonia Clinical Presentation And Diagnosis Of Chronic Bronchitis Cont …. Chest radiograph Increase in anteroposterior diameter of the thoracic cage (observed as a barrel chest )—rib cage broadened as in the middle of deep breath, person find hard to breath Depressed diaphragm with limited mobility Laboratory tests Erythrocytosis (advanced disease )—-Too many red blood cells to carry oxygen to your organ and tissue. Pulmonary function tests Decreased vital capacity Prolonged expiratory flow (person’s maximum speed of expiration as measured with a peak flow meter) Activity: Small Group Discussion • What is the first line treatment of Pneumonia? Treatment of chronic Bronchitis The goals of therapy for chronic bronchitis are: T o reduce the severity of chronic symptoms and T o ameliorate acute exacerbations and achieve prolonged infection-free intervals Treatment of chronic Bronchitis Cont … Non-Pharmacological Treatment Stop smoking and/or remove from hazardous environment Prompt treatment of infective exacerbations Antibiotics as above in case of secondary bacterial infection Controlled oxygen therapy Physiotherapy Treatment of chronic Bronchitis Cont …… Pharmacological Treatment Inhaler Salbutamol (PO) 100 μg two puff 6 hourly OR Salbutamol (PO) 4mg 8 hourly OR Ipratropium bromide aerosol 20–80mg, 6–8 hourly Trial of steroids if there is possibility of reversible airways obstructions Prednisolone (PO) 20mg once daily for 5 days Treatment of chronic Bronchitis Cont …… Pharmacological Treatment.. Antibiotics are probably helpful only in acute exacerbations of chronic bronchitis Common current clinical practice is to promptly use antibiotics empirically in patients who demonstrate a fever or a change in sputum character. Such therapy should be directed against streptococcal species, Haemophilus species and Moraxella catarrhalis . Treatment of chronic Bronchitis Cont …… Monitoring of Chronic Bronchitis Therapy After therapy has been instituted, appropriate clinical parameters such as signs and symptoms and other laboratory markers such as lung function tests should be monitored to ensure the efficacy and safety of the therapeutic regimen. Key Points Pneumonia is an infection of the lung tissue whereby the air sacs in the lungs become infected with microorganisms, fluid and inflammatory cells and hence they lungs fail to work properly. Diagnosis of pneumonia is based on symptoms and signs of an acute lower respiratory tract infection, and can be confirmed by a chest X-ray showing new shadowing that is not due to any other cause Penicillins as well as other antibiotics can be used for treatment of Pneumonia as indicated Evaluation What is Chronic Bronchitis? What are the signs and symptoms of Chronic Bronchitis? How is Chronic Bronchitis diagnosed?

NTA Level 6 • Semester 1 • PST06106 Pharmacotherapy of Pneumonia Basic Pharmacotherapy • 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. PST 06106 Basic Pharmacotherapy Session 8: Pharmacotherapy of Pneumonia Learning objectives By the end of this session students are expected to be able to: Define pneumonia Explain pathophysiology of pneumonia Explain the clinical presentation of bronchitis and pneumonia Outline diagnosis of bronchitis and pneumonia Describe pharmacological treatment of bronchitis and pneumonia Describe monitoring of bronchitis and pneumonia therapy Activity: Buzzing • What is Pneumonia? Definition of Pneumonia Pneumonia Pneumonia is the inflammation of the lung tissue. Pneumonia can either be primary (to the causing organism) or secondary to pathological damage in the respiratory system It occurs in persons of all ages, although the clinical manifestations are most severe in the very young, the elderly, and the chronically ill . The most prominent pathogen causing community-acquired pneumonia (CAP) in otherwise healthy adults is S. pneumonia and accounts for up to 75% of all acute cases. Other common pathogens include M. pneumoniae , Legionella species, C. pneumoniae , H. influenzae , and a variety of viruses including influenza. Pathophysiology of Pneumonia Microorganisms gain access to the lower respiratory tract by three routes. Through inhalation as aerosolized particles, or via the bloodstream from an extra pulmonary site of infection; Aspiration of oropharyngeal contents which is a common occurrence in both healthy and ill persons during sleep is the major mechanism by which pulmonary pathogens gain access to the normally sterile lower airways and alveoli. Pathophysiology of Pneumonia CONT….. When pulmonary defense mechanisms are functioning optimally, aspirated microorganisms are cleared from the region before infection can become established; However, aspiration of potential pathogens from the oropharynx can result in pneumonia if lung defenses are impaired Factors that promote aspiration, such as altered sensorium and neuromuscular disease, may result in an increase in the size of the inoculum delivered to the lower respiratory tract, thereby overwhelming local defense mechanisms. Pathophysiology of Pneumonia CONT….. Lung infections with viruses suppress the antibacterial activity of the lung by impairing alveolar macrophage function and mucociliary clearance, thus setting the stage for secondary bacterial pneumonia. Mucociliary transport is also depressed by ethanol and narcotics and by obstruction of a bronchus by mucus, tumor, or extrinsic compression. All these factors can severely impair pulmonary clearance of aspirated bacteria hence causing infection in the lung. Clinical Presentation And Diagnosis Of Pneumonia Signs and symptoms Abrupt onset of fever, chills, dyspnea, and productive cough Rust-colored sputum or hemoptysis Pleuritic chest pain Clinical Presentation And Diagnosis Of Pneumonia CONT… Physical examination Tachypnea and tachycardia Dullness to percussion Increased tactile fremitus, whisper pectoriloquy , and egophony Chest wall retractions and grunting respirations Diminished breath sounds over affected area Inspiratory crackles during lung expansion Clinical Presentation And Diagnosis Of Pneumonia CONT… Chest radiograph Dense lobar or segmental infiltrate Laboratory tests Leukocytosis with predominance of polymorphonuclear cells Low oxygen saturation on arterial blood gas or pulse oximetry Sign and symptoms of pneumonia Activity: Small Group Discussion What is the first line treatment of Pneumonia? Pharmacological Treatment Of Pneumonia Treatment goals of pneumonia includes: Eradication of the offending organism through selection of the appropriate antibiotic and complete clinical cure Therapy should minimize associated morbidity, including reversible or irreversible disease and drug-induced organ toxicity (e.g., renal, lung, or hepatic dysfunction). Most cases of viral pneumonia are self-limiting, although therapy of influenza pneumonia with specific antiviral agents (oseltamivir and zanamivir ) may hasten recovery . Treatment of Pneumonia in Adults First- line Treatment of Atypical Community Acquired Pneumonias Pharmacological Treatment Of Pneumonia In Children Non-severe pneumonia A: Amoxicillin 25 mg/kg 8 hourly for 5 days Plus A: Paracetamol suppositories 10–15mg/kg (if there is fever) OR B: Ibuprofen 15mg/kg 12 hourly for 5 days Give the first dose at the clinic and teach the mother how to give the other doses at home. And Encourage breasting and feeding. Pharmacological Treatment Of Pneumonia In Children Severe Pneumonia A: Benzyl Penicillin 50000 units/kg IV or IM every 6 hours for at least 3 days THEN A: Amoxicillin 40 mg/kg 8 hourly for 7 days. OR A: Ampicillin 50 mg/kg IV/IM every 6 hourly AND A: Gentamicin (7.5 mg/kg IV/IM once a day) for 5 days; then, If child responds well, complete treatment at home or in hospital with A: Amoxicillin 30 mg/kg 8 hourly for 7 days. Pharmacological Treatment Of Pneumonia In Children Cont ….. Very severe Pneumonia: A: Ampicillin 50 mg/kg IV/IM every 6 hours AND A : Gentamicin (7.5 mg/kg IV/IM once a day) for 5 days; then, If child responds well, complete treatment at home or in hospital with A : Amoxicillin (40 mg/kg12 hourly 10 days Alternatively, A: Ceftriaxone 80 mg/kg IV or IM once daily for 10 days. Monitoring Of Pneumonia Therapy After therapy has been instituted, appropriate clinical parameters such as signs and symptoms and other laboratory markers should be monitored to ensure the efficacy and safety of the therapeutic regimen. For patients with CAP or pneumonia from any source of mild to moderate clinical severity, the time to resolution of cough, decreasing sputum production, and fever, as well as other constitutional symptoms of malaise, nausea, vomiting, and lethargy, should be noted. Monitoring Of Pneumonia Therapy Cont.…. Initial resolution should be observed within the first 2 days and progression to complete resolution within 5 to 7 days but usually no more than 10 days. For patients with HAP, substantial underlying diseases, or both, additional parameters can be followed, including the magnitude and character of the peripheral blood WBC count, chest radiograph, and blood gas determinations. Monitoring Of Pneumonia Therapy cont. … . Similar to patients with less severe disease, some resolution of symptoms should be observed within 2 days of instituting antibiotic therapy. If no resolution of symptoms is observed within 2 days of starting seemingly appropriate antibiotic therapy or if the

NTA Level 6 • Semester 1 • PST06106 Pharmacotherapy of Pharyngitis, Sinusitis and Otitis Media Basic Pharmacotherapy • 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. PST 06106 Basic Pharmacotherapy Session 7: Pharmacotherapy of Pharyngitis, Sinusitis, and Otitis Media Learning objectives By the end of this session students are expected to be able to: Define pharyngitis, sinusitis, and otitis media Explain pathophysiology of pharyngitis, sinusitis, and otitis media Explain the clinical presentation of pharyngitis, sinusitis, and otitis media Outline diagnosis of pharyngitis, sinusitis, and otitis media Describe pharmacological treatment of pharyngitis, sinusitis, and otitis media Describe monitoring of pharyngitis, sinusitis, and otitis media therapy Activity: Buzzing • What is pharyngitis?? Definition of Pharyngitis, Sinusitis, and Otitis Media Pharyngitis is an acute infection of the oropharynx or nasopharynx. It is caused by virus and bacteria Viruses cause the majority of acute pharyngitis cases Specific etiologies include rhinovirus, coronavirus, adenovirus, herpes simplex virus, influenza virus, parainfluenza virus, and Epstein-Barr virus Group A β –hemolytic streptococci (GAS; also known as S. pyogenes ), is the primary bacterial cause. Other, less-common causes of acute pharyngitis are groups C and G Streptococcus, Corynebacterium diphtheriae , Neisseria gonorrhoeae, Mycoplasma pneumoniae, Arcanobacterium haemolyticum , Yersinia enterocolitica , and Chlamydia pneumonia Pathophysiology Of Pharyngitis The mechanism by which Group A beta haemolytic streptococci (GAS) causes pharyngitis is not well defined Asymptomatic pharyngeal carriers of the organism may have an alteration in host immunity (e.g., a breach in the pharyngeal mucosa) and the bacteria of the oropharynx, allowing colonization to become an infection Pathogenic factors associated with the organism itself may also play a role These include pyrogenic toxins, hemolysins , streptokinase, and proteinase. Clinical presentation and Diagnosis of Pharyngitis General A sore throat of sudden onset that is mostly self-limited Fever and constitutional symptoms resolving in about 3 to 5 days Clinical signs and symptoms are similar for viral causes and nonstreptococcal bacterial causes Clinical presentation and Diagnosis of Pharyngitis Cont … Signs and Symptoms Sore throat ( pain or irritation in the throat that occurs with/without swallowing) Pain on swallowing Fever Headache, nausea, vomiting, and abdominal pain (especially children) Erythema/inflammation of the tonsils and pharynx with or without patchy exudates Enlarged, tender lymph nodes Red swollen uvula, petechiae on the soft palate, and a scarlatiniform rash Several symptoms that are not suggestive of group A streptococci are cough, conjunctivitis, coryza , and diarrhea Clinical presentation and Diagnosis of Pharyngitis Cont … Signs Suggestive of Viral Origin for Pharyngitis Conjunctivitis Coryza (irritation and swelling of the mucous membrane in the nose) Cough Diarrhea Laboratory Tests Throat swab and culture Rapid antigen detection testing (RADT) Activity: Small Group Discussion What is the first line treatment of Pharyngitis ? Pharmacological treatment of Pharyngitis The goals of treatment for pharyngitis are to; Improve clinical signs and symptoms, M inimize adverse drug reactions, Prevent transmission to close contacts, and P revent acute rheumatic fever and suppurative complications, such as peritonsillar abscess, cervical lymphadenitis, and mastoiditis Pharmacological treatment of Pharyngitis For recurrent pharyngitis Monitoring of Pharyngitis Therapy Most pharyngitis cases are self-limited; however, antibiotics hasten resolution when given early for proven cases of Group A beta hemolytic streptococci (GAS) pharyngitis . Generally, fever and other symptoms resolve within 3 or 4 days of onset without antibiotics; however, symptoms will improve 16 hours to 2 days earlier with antibiotic therapy. Follow-up testing is generally not necessary for index cases or in asymptomatic contacts of the index patient. However, for patients who remain symptomatic or when symptoms recur despite completion of treatment, posttreatment throat cultures 2 to 7 days after completion of antibiotics should be done . Key Points Acute pharyngitis is characterized by the rapid onset of sore throat and pharyngeal inflammation (with or without exudate). . It can be caused by a variety of viral and bacterial pathogens, including group A Streptococcus (GAS), Diagnosis can be done clinically especially and by using lab test Most of the time the condition is self limiting, but antibiotics may be needed Evaluation What is pharyngitis? What are the signs and symptoms of pharyngitis? How is pharyngitis diagnosed? How is the treatment of pharyngitis REFER Students to Handout 7.1: Pharmacotherapy of Sinusitis REFER Students to Handout 7.2: Pharmacotherapy of Otitis Media References Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6 th Ed). New York, NY: McGraw-Hill. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008): Pharmacotherapy: A Pathophysiologic Approach (7 th ed ): New York, NY: McGraw-Hill. Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011) Principles & Practice Study Guide: A Case-Based Care Plan Approach : New York, NY: McGraw-Hill. Schwinghammer TL, Koehler JM (2009) Pharmacotherapy Casebook: A Patient-Focused Approach (7 th ed ): New York, NY: McGraw-Hill. ← Previous TopicNext Topic →View all Basic Pharmacotherapy 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 6 • Semester 1 • PST06106 Pharmacotherapy of Leprosy Basic Pharmacotherapy • 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. PST 06106 Basic Pharmacotherapy Session 6: Pharmacotherapy of Leprosy 11/11/2020 Pharmacotherapy of Leprosy Learning Task By the end of this session students are expected to be able to: Define leprosy Explain pathophysiology of leprosy Explain the clinical presentation of leprosy Outline diagnosis of leprosy Describe pharmacological treatment of leprosy Describe monitoring of leprosy therapy 11/11/2020 Pharmacotherapy of Leprosy Activity: Small Group Discussion • What is the first line treatment of Pneumonia? Definition of Leprosy Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae ). It mainly affects the skin, peripheral nerves, and mucous membranes. It is a disease mainly of human beings, which affects people of all races, all ages, and both sexes. Similar to TB, leprosy bacilli are mainly transmitted through infectious droplets that are spread by an infectious individual through coughing and sneezing. 11/11/2020 Pharmacotherapy of Leprosy Definition of Leprosy Cont.… Patients carrying many leprosy bacilli are called multibacillary (MB) patients. They are the main source of infection. People may carry the bacilli but not develop the disease. These people, called healthy carriers, are also probably able to transmit the bacilli to others. Individuals with few bacilli in their body are called paucibacillary (PB). Like healthy carriers, they are not a significant source of infection 11/11/2020 Pharmacotherapy of Leprosy Pathophysiology of Leprosy Onset of leprosy is insidious. The disease affects nerves, skin and eyes. It may also affect mucosa (mouth, nose, pharynx), testes, kidney, voluntary/smooth muscles, reticulo -endothelial system, and vascular endothelium. Bacilli enter the body usually through respiratory system. It has low pathogenicity, only a small proportion of infected people develop signs of the disease. Though infected, majority of the population do not develop the disease. 11/11/2020 Pharmacotherapy of Leprosy Pathophysiology of Leprosy Cont.….. After entering the body, bacilli migrate towards the neural tissue and enter the Schwann cells. Bacteria can also be found in, macrophages, muscle cells and endothelial cells of blood vessels. After entering the Schwann cells /macrophage; fate of the bacterium depends on the resistance of the infected individual towards the infecting organism. Bacilli start multiplying slowly (about 12-14 days for one bacterium to divide into two) within the cells, get liberated from the destroyed cells and enter other unaffected cells. Till this stage person remains free from signs and symptoms of leprosy . 11/11/2020 Pharmacotherapy of Leprosy Pathophysiology of Leprosy Cont .….. As the bacilli multiply, bacterial load increases in the body and infection is recognized by the immunological system. Lymphocytes and histiocytes (macrophages) invade the infected tissue. At this stage clinical manifestation may appear as involvement of nerves with impairment of sensation &/ or skin patch. If it is not diagnosed and treated in the early stages, further progress of the diseases is determined by the strength of the patient’s immune response 11/11/2020 Pharmacotherapy of Leprosy Pathophysiology of Leprosy Cont.….. Specific and effective cell mediated immunity (CMI) provides protection to a person against leprosy. When specific CMI is effective in eliminating/ controlling the infection in the body, lesions heal spontaneously or it produces pauci -bacillary (PB) type of leprosy. If CMI is deficient; the disease spreads uncontrolled and produces multi bacillary (MB) leprosy with multiple system involvement. Some times, the immune response is abruptly altered, either following multiple drug treatment (MDT) or due to improvement of immunological status, which results in – 12 – the inflammation of skin or / and nerves and even others tissue, called as leprosy reaction 11/11/2020 Pharmacotherapy of Leprosy Clinical presentation and Diagnosis of Leprosy The diagnosis of leprosy The diagnosis of leprosy relies on both passive and active case-finding. Clinical diagnosis. This is achieved through observation of signs or symptoms of leprosy which includes; One or more pale or reddish, hypo-pigmented patch( es ) on the skin with diminished or loss of sensation. Painless swelling or lumps in the face and/or earlobes. Enlarged and/or tender nerves. 11/11/2020 Pharmacotherapy of Leprosy Clinical presentation Cont.…. Burning sensation of the skin. Numbness or tingling of hands and/or feet. Weakness of eyelids, hands, and/or feet. Painless wounds or burns on the hands and/or feet. 11/11/2020 Pharmacotherapy of Leprosy Clinical presentation and Diagnosis of Leprosy Cont.… Examination of other organs : Leprosy can affect a few organs other than skin and peripheral nerves. Depending on the duration of the disease and the spread of leprosy through the body, various other organs may show signs typical for leprosy 11/11/2020 Pharmacotherapy of Leprosy Activity: Small Group Discussion • What is the first line treatment of Leprosy?? Pharmacological Treatment Of Leprosy Treatment regimens The drugs and dosages for PB and MB for both adults and children are shown below : Adults (MB) Monthly treatment: Day 1 Rifampicin 600 mg (2 x 300 mg) Clofazimine 300 mg (3 x 100 mg) Dapsone 100 mg 11/11/2020 Pharmacotherapy of Leprosy Pharmacological Treatment Of Leprosy Cont.…. Daily treatment: Days 2–28 Clofazimine 50 mg Dapsone 100 mg Duration of treatment 12 blister packs to be taken within a period of 12-18 months 11/11/2020 Pharmacotherapy of Leprosy Pharmacological Treatment Of Leprosy Cont … Children 10-14 years (MB) Monthly treatment: Day 1 Rifampicin 450 mg (3 x 150 mg) Clofazimine 150 mg (3 x 50 mg) Dapsone 50 mg Daily treatment: Days 2–28 Clofazimine 50 mg every other day Dapsone 50 mg daily Duration of treatment 12 blister packs to be taken within a period of 12-18 months 11/11/2020 Pharmacotherapy of Leprosy Pharmacological Treatment Of Leprosy Cont … Adults (PB) Monthly treatment: Day 1 Rifampicin 600 mg (2 x 300 mg) Dapsone 100 mg Daily treatment: Days 2–28 Dapsone 100 mg Duration of treatment Six blister packs to be taken within a period of 6–9 months. 11/11/2020 Pharmacotherapy of Leprosy Pharmacological Treatment Of Leprosy Cont … Children 10-14 years (PB) Monthly treatment: Day

NTA Level 6 • Semester 1 • PST06106 Pharmacotherapy of Tuberculosis Basic Pharmacotherapy • 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. BASIC PHARMACOTHERAPY Pharmacotherapy of Tuberculosis Complete learning session 1 / 20 Basic Pharmacotherapy Learning outcomes • Define Pharmacotherapy of Tuberculosis. • Explain its main principles and classifications. • Apply the concept safely in pharmaceutical practice. • Recognise common errors and appropriate corrective action. 2 / 20 Basic Pharmacotherapy Why this topic matters • Tuberculosis is caused by organisms in the Mycobacterium tuberculosis complex. • Combination therapy reduces treatment failure and selection of resistance. • Correct understanding supports safe, effective and accountable practice. 3 / 20 Basic Pharmacotherapy Core definition • Pharmacotherapy of Tuberculosis is studied as a structured concept within Basic Pharmacotherapy. • Tuberculosis is caused by organisms in the Mycobacterium tuberculosis complex. • Use precise terms before attempting application or calculation. 4 / 20 Basic Pharmacotherapy Foundational principles • Combination therapy reduces treatment failure and selection of resistance. • Adherence support is essential because treatment continues for months. • Each principle should be linked to a practical decision. 5 / 20 Basic Pharmacotherapy Key components • Tuberculosis is caused by organisms in the Mycobacterium tuberculosis complex. • Adherence support is essential because treatment continues for months. • Drug interactions and adverse effects require active monitoring. 6 / 20 Basic Pharmacotherapy Classification and organisation • Group the subject by function, structure, source, risk or stage as appropriate. • Use one classification system consistently. • State the feature that separates one category from another. 7 / 20 Basic Pharmacotherapy How the process works • Combination therapy reduces treatment failure and selection of resistance. • Adherence support is essential because treatment continues for months. • Follow the sequence from input or cause to outcome. 8 / 20 Basic Pharmacotherapy Professional terminology • Distinguish related terms that are often confused. • Use names, units and abbreviations consistently. • Define technical words before using them in explanations. 9 / 20 Basic Pharmacotherapy Practical application • Drug interactions and adverse effects require active monitoring. • Prepare the required materials, information or records before starting. • Complete each step in order and document important observations. 10 / 20 Basic Pharmacotherapy Quality requirements • Persistent severe symptoms or treatment complications require clinical review. • Check identity, accuracy, completeness and fitness for purpose. • Record deviations and take corrective action promptly. 11 / 20 Basic Pharmacotherapy Safety and risk control • Identify hazards before beginning the task. • Use appropriate protective, ethical and legal safeguards. • Stop and refer when the situation exceeds competence or available resources. 12 / 20 Basic Pharmacotherapy Common errors • Using an incorrect definition, unit, category or sequence. • Skipping verification, documentation or a final reasonableness check. • Applying a general rule without considering the patient, material or research context. 13 / 20 Basic Pharmacotherapy Preventing avoidable mistakes • Use a written procedure or checklist. • Independently verify high-risk calculations and decisions. • Communicate unclear or abnormal findings before proceeding. 14 / 20 Basic Pharmacotherapy Worked application • Start with a clearly stated problem related to Pharmacotherapy of Tuberculosis. • Select the correct principle from the earlier slides. • Show the decision or calculation step by step. • Confirm that the final answer is reasonable and professionally usable. 15 / 20 Basic Pharmacotherapy Practice scenario • A routine situation requires the learner to apply Pharmacotherapy of Tuberculosis. • Identify the information that must be collected first. • Explain the safest action and the record that should be completed. 16 / 20 Basic Pharmacotherapy Decision points • What finding confirms that the chosen approach is suitable? • What warning sign requires correction, referral or further investigation? • What evidence must be documented to support the decision? 17 / 20 Basic Pharmacotherapy Connection to patient care • Accurate practice reduces preventable harm. • Clear communication helps patients and colleagues use information correctly. • Monitoring outcomes shows whether the intended benefit was achieved. 18 / 20 Basic Pharmacotherapy Session summary • Tuberculosis is caused by organisms in the Mycobacterium tuberculosis complex. • Combination therapy reduces treatment failure and selection of resistance. • Adherence support is essential because treatment continues for months. • Drug interactions and adverse effects require active monitoring. • Persistent severe symptoms or treatment complications require clinical review. 19 / 20 Basic Pharmacotherapy Self-check questions • Define Pharmacotherapy of Tuberculosis in your own words. • List three important principles or components. • Describe one practical application and one common error. • Explain one quality or safety control. 20 / 20 ← Previous TopicNext Topic →View all Basic Pharmacotherapy 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. 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NTA Level 6 • Semester 1 • PST06106 Pharmacotherapy of HIV/AIDS Basic Pharmacotherapy • 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. PST 06106 Basic Pharmacotherapy Session 4: Pharmacotherapy of HIV/AIDS Learning Objective By the end of this session students are expected to be able to: Define HIV/AIDS Explain pathophysiology of HIV/AIDS Explain the clinical presentation of HIV/AIDS Outline diagnosis of HIV/AIDS Describe pharmacological treatment of HIV/AIDS Describe the monitoring of HIV/AIDS Therapy Activity: Buzzing What is HIV/AIDS? INTRODUCTION AIDs is a set of symptoms (or syndrome) caused by Human Immunodeficiency Virus (HIV). The clinical features may be due to HIV per se or as a result of immune system destruction. It has the following features: Fever, diarrhoea, weight loss, skin rashes, sores, generalized pruritis , altered mental status, persistent severe headache, oral thrush or Kaposi’s sarcoma may be found in patients with advanced disease Most patients, however, present with symptoms due to opportunistic infections such as tuberculosis, candidiasis and pyogenic infections Human immunodeficiency virus Pathophysiology of HIV/AIDS The virus through its envelope proteins attaches to the CD4 receptor and co-receptors found on the surface of T lymphocytes and macrophage to gain entry to the host cells. Following entry of the HIV into a susceptible host cell using the enzyme reverse transcriptase, the viral genome copies itself from RNA to DNA genetic material. The viral DNA copy enters the nucleus of the host cell and becomes intimately incorporated into the host cell’s own DNA using the enzyme integrase. Pathophysiology of HIV/AIDS CONT… The virus thus becomes a permanent part of an infected person’s nuclear proteins. There follows a latent period during which the provirus in the infected nucleus waits for an external stimulus to start reproducing. CD4+ T lymphocytes, when stimulated by new HIV, other infections and infestations which would normally result in the CD4+ T lymphocyte reproducing itself, now responds to these stimuli by manufacturing HIV. As more and more viruses are produced and leave the host cell, the cell membrane weakens leading eventually to the death of the infected CD4+ T lymphocytes 37 Pathophysiology of HIV/AIDS CONT … The multiple steps in replication of HIV provide multiple opportunities for intervention. Therapeutic regimens may be directed at one or several of the following stages essential for viral replication: Attachment of HIV to the host cell; Reverse transcription of viral RNA to DNA; Integration of the pro-viral DNA into the host cells’ DNA; or Expression of the viral gene after it has been integrated into host cell DNA, including the transcription of more viral RNA and the translation of viral proteins . Clinical Presentation Of HIV/AIDS In the absence of ART, disease progression goes through the following clinical stages Primary Infection or becoming HIV Infected Most primary infection, i.e. new infection with HIV, usually is not immediately noticed. It presents with short illnesses and flu-like symptoms such as fever, malaise, enlarged lymph nodes, sore throat, skin rash, and/or joint pain soon after being infected. It may last for a few weeks. This acute febrile illness is accompanied by widespread dissemination of the virus to different tissues, especially the lymphoid system. This is called sero -conversion illness. Clinical Presentation Of HIV/AIDS Cont …. Clinically Asymptomatic Stage This stage is free of symptoms, except for the possibility of swollen glands: persistent generalized lymphadenopathy – Persistent Generalized Lymphadenopathy (PGL). However, this is the stage where there is ongoing extensive immunologic fighting/changes and rapid viral replication begins. This may last for an average of eight to ten years. However, disease progression in children and elderly is faster due to high set point. This is WHO Stage1 Clinical Presentation Of HIV/AIDS Cont … Symptomatic HIV Over time, the immune system loses the struggle to contain HIV, resulting in extensive destruction of CD4 cells This is characterised by the occurrence of opportunistic infections (OIs), which is when) symptoms develop The most common symptoms include fever, respiratory infections, cough, TB tuberculosis, weight loss, skin diseases, viral infections, oral thrush, pain, and lymphadenopathy This is WHO Stage 2 or 3, depending on the particular OI seen Clinical Presentation Of HIV/AIDS Cont … Acquired Immune Deficiency Syndrome (AIDS) AIDS is defined as a point when a person with HIV develops severe immunosuppression, OIs, or malignancies/cancers. Such conditions are: severe weight loss, Kaposi’s sarcoma, Cryptococcus meningitis, PCP, toxoplasmosis, CMV (Cytomegalovirus) retinitis, etc. This is WHO Stage 4 Diagnosis of HIV/AIDS ELISA Test — ELISA, which stands for enzyme-linked immunosorbent assay, is used to detect HIV infection (detects antibodies against HIV-1)and is both highly sensitive and specific If an ELISA test is positive, the Western blot test is usually administered to confirm the diagnosis. If an ELISA test is negative, but you think you may have HIV, you should be tested again in one to three months ELISA is quite sensitive in chronic HIV infection, but because antibodies aren't produced immediately upon infection, you may test negative during a window of a few weeks to a few months after being infected. Viral Load Test — This test measures the amount of HIV in your blood. It quantifies viremia by measuring the amount of viral RNA. Generally, it's used to monitor treatment progress or detect early HIV infection. Three technologies measure HIV viral load in the blood: reverse transcription polymerase chain reaction (RT-PCR), branched DNA ( bDNA ) and nucleic acid sequence-based amplification assay (NASBA). The basic principles of these tests are similar. HIV is detected using DNA sequences that bind specifically to those in the virus Western Blot — This is a very sensitive blood test used to confirm a positive ELISA test result Activity: Small Group Discussion •What explanations can you give on monitoring therapy for HIV/AIDS? Pharmacological treatment of HIV/AIDS Early initiation of combination treatment (ART) is associated with health benefits in terms of reduced morbidity and mor­tality in all age groups. In addition, ART is

NTA Level 6 • Semester 1 • PST06106 Pharmacotherapy of Malaria Basic Pharmacotherapy • 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. PST 06106 Basic Pharmacotherapy Session 3: Pharmacotherapy of Malaria Learning Objectives By the end of this session students are expected to be able to: Define malaria Explain pathophysiology of malaria Explain the clinical presentation of malaria Outline diagnosis of malaria Describe pharmacological treatment of malaria Describe monitoring malaria therapy Activity: Buzzing What is the disease status of a patient with malaria? Definition of Malaria Uncomplicated malaria : defined as symptomatic malaria without signs of severity or evidence (clinical or laboratory) of vital organ dysfunction. It has the following features; fever, headache, joint pains, malaise, vomiting, diarrhoea, body ache, body weakness, poor appetite, pallor, enlarged spleen Severe malaria: In a patient with P. falciparum asexual parasitemia and no other obvious cause of symptoms the presence of one or more of features listed below classify the patient as suffering from severe malaria It has the following features; prostration/extreme weakness, impaired consciousness, change of behaviour, convulsions, respiratory distress (due to lactic acidosis and/or pulmonary oedema), bleeding tendency, jaundice, circulatory collapse, vomiting everything, inability to drink or breast feed Pathophysiology of Malaria The Plasmodium species that infect humans are P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi (rarely). The basic elements of the life cycle are the same for all Plasmodium sp Transmission begins when a female Anopheles mosquito feeds on a person with malaria and ingests blood containing gametocytes. During the following 1 to 2 wk , gametocytes inside the mosquito reproduce sexually and produce infective sporozoites . When the mosquito feeds on another human, sporozoites are inoculated and quickly reach the liver and infect hepatocytes. Pathophysiology of Malaria cont …. The parasites mature into tissue schizonts within hepatocytes. Each schizont produces 10,000 to 30,000 merozoites , which are released into the bloodstream 1 to 3 wk later when the hepatocyte ruptures. Each merozoite can invade an RBC and there transform into a trophozoite Trophozoites grow, and most develop into erythrocyte schizonts ; schizonts produce further merozoites , which 48 to 72 h later rupture the RBC and are released in plasma. Pathophysiology of Malaria cont.…. These merozoites then rapidly invade new RBCs, repeating the cycle Some trophozoites develop into gametocytes, which are ingested by an Anopheles mosquito They undergo sexual union in the gut of the mosquito, develop into oocysts, and release infective sporozoites , which migrate to the salivary glands Plasmodium Life Cycle Clinical Presentation Of Malaria Signs and symptoms of uncomplicated Malaria Fever Headache Malaise Joint pains Vomiting /diarrhoea Body ache Poor appetite Body weakness Pallor Enlarged spleen Signs and symptoms of Severe Malaria Extreme weakness Impaired consciousness Change of behaviour ( hallucinations, delusions, agitation, and acute state of confusion) Respiratory distress Bleeding tendency Jaundice Circulatory collapse/ shock Vomiting everything Inability to drink or breastfeed Diagnosis of Malaria Parasite-based diagnosis is recommended for all patients presenting with signs and symptoms of malaria. The recommended investigations are: malaria microscopy and malaria rapid diagnostic tests ( mRDTs ) In severe malaria, blood slide (BS) is a recommended malaria test as it quantifies parasitemia. Activity: Small Group Discussion What is pharmacological treatment of malaria ? Pharmacological Treatment of Malaria Management OF Uncomplicated M alaria Drug of choice for treatment of uncomplicated malaria is Artemether-Lumefantrine (AL), which is a fixed formulation of artemether 20mg and lumefantrine 120mg or dispersible tablets for paediatric use. Dosage regimen of ALU Pharmacological Treatment of Malaria Cont.….. Use of Artemether-lumefantrine ( ALu ) in Pregnancy Presently, Artemisinin compounds cannot be recommended for treatment of malaria in the first trimester of pregnancy. In the first trimester of pregnancy quinine should be used as first line treatment. After the first trimester ALu tablets is first line medicine. Use of Artemether-lumefantrine ( ALu ) in Lactation Due to the long elimination half-life of Lumefantrine (up to 10 days), it is not recommended in mothers breast-feeding children below 5kgs. In this case quinine should be used . Pharmacological Treatment of Malaria Cont.….. Management of Severe Malaria Parenteral artesunate Dosage: 2.4 mg/kg in body weight. IV or IM given on admission (time = 0 hour), then at 12 hours and 24 hours for a minimum of 3 injections in 24 hours regardless of patient’s recovery Alternatively; Injectable Artemether should be administered in a dose of 3.2mg/kg body weight loading dose IM stat then 1.6mg/kg bwt (time= 0 hrs, then 24hrs then 48 hrs) Major Anti Malarial Drugs Monitoring Of Malaria Therapy It is important to monitor Malaria therapy in order to evaluate if it is effective Patients can be monitored clinically and/or by using laboratory test to confirm for absence/presence of malaria parasite in their blood A follow-up period after the completion of the Malaria therapy varies according to the drugs used. Follow-up periods longer than 14 days are appropriate for amodiaquine , chloroquine and SP which is 28 days For lumefantrine+artemether is 42 days, For mefloquine is 63 days Monitoring Of Malaria Therapy Cont … This allows drug levels in the blood to fall below the minimum therapeutic threshold. Any recrudescence of parasites before this threshold is reached would be due to drug resistance Recrudescence after this threshold is reached is not necessarily related to resistance (even sensitive parasites could recrudesce if blood drug levels are subtherapeutic ). Shorter follow-up (i.e. <14 days) will underestimate overall treatment failure rates It is also important for patient to report any adverse reaction of the drugs that may occurs during Malaria therapy. Key Points P . falciparum causes microvascular obstruction and tissue ischemia, particularly in the brain, kidneys, lungs, and GI tract of nonimmune infants and adults; patients may die within days of their initial symptoms. P. vivax , P. ovale , and P. malariae typically do not compromise vital organs; mortality is rare. Clinical maanifestations include recurrent

NTA Level 6 • Semester 1 • PST06106 Therapeutic Drug Monitoring (TDM) Basic Pharmacotherapy • 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. PST 06106 Basic Pharmacotherapy Session 2: Therapeutic Drug Monitoring (TDM) Learning Tasks By the end of this session students are expected to be able to: Define therapeutic drug monitoring List principles and outline concepts of therapeutic drug monitoring Outline criteria for therapeutic drug monitoring List drugs that qualify for therapeutic drug monotoring Explain clinical significance of therapeutic drug monitoring List limitations of therapeutic drug monitoring Principles and Concepts of Therapeutic Drug Monitoring Therapeutic drug monitoring (TDM) is defined as the use of drug concentration measurements in plasma as an aid to the management of drug therapy for the cure, alleviation or prevention of disease. TDM enables the assessment of the efficacy and safety of a particular medication in a variety of clinical settings . TDM aims at improving patient care by adjusting the dose of drugs for which clinical experience or clinical trial have shown it improved outcome in the general or special populations Principles and Concepts of Therapeutic Drug Monitoring Cont ….. Therapeutic Drug Monitoring aims to individualize therapeutic regimens for optimal patient benefit and avoid both sub therapeutic and toxic plasma drug concentrations. Specifically, TDM is a practice applied to a small group of drugs in which there is a direct relation between plasma drug concentration and pharmacological response Therefore, close relationship between the plasma level of the drug and its clinical effect is essential. If such a relationship does not exit TDM is of little value. The measurement of plasma level is justified only when the information provided is of potential therapeutic benefit. Principles and Concepts of Therapeutic Drug Monitoring Cont.….. In summary, TDM process involves the following; Administration of a predetermined dose of drug Collection of blood samples Determination/measurements of blood samples using analytical procedures Evaluation of Clinical effect of drug Development/Adjustment of dosage regimen Activity: Buzzing What are the criteria for therapeutic drug monitoring? Criteria for therapeutic drug monitoring The drug in question has a narrow therapeutic range, eg : Lithium, phenytoin, and digoxin A direct relationship exists between the drug or drug metabolite levels in plasma and the pharmacological or toxic effects, The therapeutic effect can not be readily assessed by the clinical observation, Large individual variability in steady state plasma concentration exits at any given dose Appropriate analytic techniques are available to determine the drug and metabolite levels Criteria for therapeutic drug monitoring Cont … Drugs for which relationship between dose and plasma concentration is unpredictable, e.g Phenytoin Non compliance Therapeutic failure Major organ failure Prevention of adverse drug effects Drugs that qualify for therapeutic drug monitoring Cardio active drugs amiodarone, digoxin, digitoxin disopyramide , lignocaine, procainamide, propranolol and quinidine Drugs that qualify for therapeutic drug monitoring Cont.…. Aminoglycoside gentamycin, A mikacin and tobramycin Anti Cancer methotrexate Antidepressants : lithium tricyclic antidepressants Drugs that qualify for therapeutic drug monitoring Cont.…. Antiepileptic drugs Phenytoin, phenobarbitone benzodiazepines, carbamazepine, Valproic acid and ethosuximide Bronchodilators : theophylline Therapeutic drug monitoring process Fig 2.1: Summary of TDM Process Clinical significance of Therapeutic drug monitoring … Drug levels from TDM are used in conjunction with other clinical data to assist practitioners in determining how a patient is responding. Drug levels provide a basis for individualizin g patient dosage regimens. Drug levels assist in determining if a change in patient-specific pharmacokinetics has occurred during a course of treatment, whether as a result of a change in physiological state, a change in diet, or addition of other drugs. Clinical significance of Therapeutic drug monitoring Cont. … Maximizes drug efficacy Helps in avoidance of drug toxicity Identifies therapeutic failure due to subtherapeutic level May help to identifies patients who are non compliant Limitation of Therapeutic D rug M onitoring(TDM) There may be some factors that may lead to incorrect interpretation of plasma drug levels such as; Non-compliance of patient leading to low plasma drug levels Low dose administered which leads to subtharapapeutic concentrations Patient suffer from mal-absorption Drug with low bioavailability may also lead to subtherapeutic concentrations Concomitant drugs that could affect the plasma levels of the drug in question Limitation of Therapeutic Drug Monitoring(TDM ) Cont.…. Hepatic or renal dysfunction Diseases related to genetic factors affecting drug metabolism .Time of administration of the drug is not accurate. Dose administration error. Inaccurate time of sampling, or timing was before steady-state is reached Wrong site of sampling. Lab assay error. Limitation of Therapeutic Drug Monitoring(TDM) Cont.…. Effect of age There is a great variability in response to drugs at extremes of age. As an example, elderly patients are more sensitive to the CNS depressant effect of drugs but are less sensitive to cardiovascular effects of Propranolol. It is well known that children are more sensitive to morphine. Pregnancy Many drugs can be affected by pregnancy state. As an example, drug levels of phenytoin and phenobarbitone are lower during pregnancy Key Points TDM is a very important and widely used technique throughout the treatment process. TDM is used when there is a sufficient relationship between the plasma level of the drug and its clinical effect Evaluation What is therapeutic drug monitoring? What are steps involved during therapeutic drug monitoring? What are criteria for therapeutic drug monitoring What the clinical significance of therapeutic drug monitoring References Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6th Ed). New York, NY: McGraw-Hill. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008): Pharmacotherapy: A Pathophysiologic Approach (7th ed ): New York, NY: McGraw-Hill. Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011) Principles & Practice Study Guide: A Case-Based Care Plan Approach: New York, NY: McGraw-Hill. Schwinghammer TL, Koehler JM (2009) Pharmacotherapy Casebook: A Patient-Focused Approach (7th ed ): New York, NY: McGraw-Hill. ← Previous TopicNext Topic →View all Basic Pharmacotherapy topicsOpen Complete Full Notes PDF /