Pharmaceutical Sciences Notes

NTA Level 6 • Semester 1 • PST06106 Introduction to Pharmacotherapy Basic Pharmacotherapy • 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. PST 06106 BASIC PHARMACOTHERAPY Session 1: Introduction to Pharmacotherapy Learning objectives By the end of this session students are expected to be able to: Define terminologies used in Pharmacotherapy Describe principles and concepts applied in Pharmacotherapy Explain importance of Pharmacotherapy in the management of common diseases Definition of Common Terminologies used in Pharmacotherapy Pharmacotherapy is application of knowledge in making therapeutic decisions that are most likely to have maximum positive benefit for a specific patient. Pharmacotherapy specialist: is an individual who is specialized in administering and prescribing medication, and requires extensive academic knowledge in pharmacotherapy. Pharmaceutical personel are experts in pharmacotherapy and are responsible for ensuring the safe, appropriate, and economical use of pharmaceutical drugs. Definition of Common Terminologies used in Pharmacotherapy Cont.….. Pathophysiology is the physiology of abnormal states; specifically: the functional changes that accompany a particular syndrome or disease. Also is the study of changes in the way the body works that result from disease or injury Pharmaceutical care involves the process through which a pharmacist/ other pharmaceutical personnel cooperates with a patient and other professionals in designing, implementing, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient Principles and Concepts applied in pharmacotherapy There are three steps that are involved in the Pharmacotherapy process which are ; Patient assessment Development of the pharmacotherapy care plan Evaluation of the impact or results of the care plan Principles and Concepts applied in pharmacotherapy Cont ….. Fig 1.1 Patient Care Process in the Pharmacotherapy Patient Assessment The focus is on drug therapy problems in which case it is important to assess if the patient’s problem(s) is/are be caused by drug therapy and can be managed by a change in drug therapy The following is the list of drug therapy problems that should be identified; Inappropriate drug selection, Need for additional drug therapy Unnecessary drug therapy Incorrect drug regimen Therapeutic duplication Drug allergy/adverse drug event Drug Interactions Medication adherence issues Patient Assessment Cont ….. Once a drug therapy problem is identified and categorized, it is then necessary to identify the cause of the problem, thereby leading to potential solutions. The process of drug therapy problem identification is to assessing the patient’s drug therapy needs and ensuring appropriateness, effectiveness and safety of medications, and the patient’s adherence Pharmacotherapy Care Plan The pharmacotherapy care plan is important in order to achieve improved pharmacotherapy outcomes. It is the action plan developed from assessment of patient described above. Each item in the patient’s problem list must be addressed in the care plan, and the care plan should be prioritized in the same way as the problem list. The pharmacotherapy care plan has several key components for each problem: Current drug regimen Drug therapy problems Therapy goals, desired endpoints Pharmacotherapy Care Plan Cont … The goals of therapy must be achievable and realistic for the patien Drug therapy may aim to cure a disease; reduce or eliminate signs and/or symptoms slow or halt the progression of a disease prevent a disease normalize laboratory values and/or assist in the diagnostic process Therapeutic recommendations Rationale Therapeutic alternatives Monitoring Pharmacotherapy Care Plan C ont … Monitoring helps in determining whether treatment goals and endpoints (achieving positive goals and avoiding negative endpoints) are being reached. An effective monitoring plan must be realistic for the patient setting and include specific monitoring parameters (clinical and laboratory/diagnostic test) frequency of monitoring, and When the patient needs to be seen again for follow-up. Patient education Evaluation The patient care process involves continuous follow-up. As the pharmacotherapy care plan is implemented, the patient’s response to therapy is monitored, and changes in therapy may be necessary. Changes in previous problems or the development of new signs and symptoms will require the assessment process and changes in the pharmacotherapy care plan During the Pharmacotherapy process, it is important to consider/review the following factors for optimal therapeutic outcome ; Evaluation Cont ……. Patient Dermographics —name, age, etc. Chief Complaint—why the patient is seeking help, in the patient’s own words History of Present Illness (HPI)—the patient’s story about why they are seeking help Past Medical History (PMH)—including all significant illnesses, surgical procedures, injuries Family History—age and health of immediate family (parents, siblings, children); for deceased relatives, the age and cause of death are included; any hereditary diseases should be noted E valuation Cont ……. Social History—may include where the patient is from or lives, ethnicity/race, marital status, number of children, educational background, occupation, diet Tobacco/Alcohol/Substance Use Allergy/Intolerances/Adverse Drug Events (ADEs)—a common area where information from the patient is missing or incomplete Medication History—should include current (or medications prior to admission if hospitalized) and previous medications; the list should include what the patient actually is taking, not just what is prescribed, and must include OTC drugs and dietary supplements (including herbal and complementary/alternative products ). Evaluation Cont ……. Signs and symptoms Laboratory and Other Diagnostic Tests Diagnosis . Treatment (Drug) plan Follow-up plan Activity: Small Group Discussion What is the importance of Pharmacotherapy? Importance of pharmacotherapy Helps in optimization of drug treatment in complex pharmacotherapy patients such as; Patients with multiple medications Patients with multiple disease states or conditions Patients on narrow therapeutic index medications Patients on medications requiring laboratory monitoring Helps in optimization of drug therapy in patients with high risk for loss of continuity of care such as; Patients with multiple prescribers Patients with recent transitions of care (e.g., hospital discharge, rehabilitation, skilled nursing facility discharge) Importance of pharmacotherapy cont… Helps in reduction of medication nonadherence especially in patients with; Irregular refill history History of failure to pick up new prescriptions Stockpiling or incorrect pill counts Financial burden (e.g., uninsured or underinsured) Low health literacy Patient’s beliefs indicate resistance to treatment High-cost regimens Noticeable decline in the health

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 /

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 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 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 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 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