Pharmaceutical Sciences Notes

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 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 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 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 Trypanosomiasis Basic Pharmacotherapy • Source Session/Topic 12 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 12: Pharmacotherapy of Trypanosomiasis Learning objectives By the end of this session students are expected to be able to: Define trypanosomiasis Explain the clinical presentation of trypanosomiasis Outline diagnosis of trypanosomiasis Describe pharmacological treatment of trypanosomiasis Describe monitoring of trypanosomiasis therapy Activity: Buzzing What is Trypanosomiasis? Definition of Trypanosomiasis Two distinct forms of the genus Trypanosoma occur in humans. One is associated with African trypanosomiasis (sleeping sickness) and the other with American trypanosomiasis (Chagas disease) Human African trypanosomiasis, also known as sleeping sickness, is a vector-borne parasitic disease. The parasites concerned are protozoa belonging to the Trypanosoma genus. They are transmitted to humans by tsetse fly ( Glossina genus) bites which have acquired their infection from human beings or from animals harbouring the human pathogenic parasites Definition of Trypanosomiasis Cont … Two forms of the disease exist. The slow-progressing form, caused by Trypanosoma brucei gambiense , is found in Western and Central Africa. The faster progressing form, caused by T. b. rhodesiense , is found in Eastern and Southern Africa Mother-to-child infection: the trypanosome can cross the placenta and infect the fetus . Mechanical transmission through other blood sucking insects is possible. Accidental infections have occurred in laboratories due to pricks from contaminated needles. Clinical presentation of Trypanosomiasis In the first stage, the trypanosomes multiply in subcutaneous tissues, blood and lymph. This is known as a haemolymphatic phase, which entails bouts of fever, headaches, joint pains and itching. After their inoculation, parasites proliferate at the site of infection, leading to an inflammatory nodule or ulcer. This trypanosomal chancre arises in about 50% of all rhodesiense—but rarely in gambiense—infections. After 3–4 weeks, the chancre usually heals with overlying desquamation, sometimes with altered pigmentation. Parasites spread to the draining lymph node and reach the bloodstream, initiating the haemolymphatic stage of the disease. This stage is characterised by general malaise, headache, and fever of an undulating type. In rhodesiense infection, with its more acute course, pancarditis with congestive heart failure, pericardial effusion, and pulmonary oedema can cause fatalities at this early stage, whereas gambiense infection shows a more insidious development that is frequently unrecognised or misdiagnosed. A typical sign of gambiense human African trypanosomiasis is generalised lymphadenopathy that develops after several weeks, frequently in the posterior triangle of the neck Clinical presentation of Trypanosomiasis cont. … In the second stage the parasites cross the blood-brain barrier to infect the central nervous system. This is known as the neurological phase. In general this is when more obvious signs and symptoms of the disease appear: changes of behaviour, confusion, sensory disturbances and poor coordination. Disturbance of the sleep cycle, which gives the disease its name, is an important feature of the second stage of the disease. Diagnosis of Trypanosomiasis The diagnosis of African Trypanosomiasis is made through laboratory methods, because the clinical features of infection are not sufficiently specific. The diagnosis rests on finding the parasite in body fluid or tissue by microscopy. The parasite load in T. b. rhodesiense infection is substantially higher than the level in T. b. gambiense infection. T. b. rhodesiense parasites can easily be found in blood. Diagnosis of Trypanosomiasis Cont … They can also be found in lymph node fluid or in fluid or biopsy of a chancre. The classic method for diagnosing T. b. gambiense infection is by microscopic examination of lymph node aspirate, usually from a posterior cervical node. It is often difficult to detect T. b. gambiense in blood. Concentration techniques and serial examinations are frequently needed. Serologic testing is available outside the U.S. for T. b. gambiense ; however, it normally is used for screening purposes only and the definitive diagnosis rests on microscopic Diagnosis of Trypanosomiasis Cont … All patients diagnosed with African trypanosomiasis must have their cerebrospinal fluid examined to determine whether there is involvement of the central nervous system, since the choice of treatment drug(s) will depend on the disease stage. The World Health Organization criteria for central nervous system involvement include increased protein in cerebrospinal fluid and a white cell count of more than 5. Trypanosomes can often be observed in cerebrospinal fluid in persons with second stage infection . Activity : Small Group Discussion What is the treatment of Trypanosomiasis? Pharmacological treatment of Trypanosomiasis The type of treatment depends on the stage of the disease. The drugs used in the first stage of the disease are of lower toxicity and easier to administer. The earlier the disease is identified, the better the prospect of a cure. Treatment success in the second stage depends on a drug that can cross the blood-brain barrier to reach the parasite. Such drugs are toxic and complicated to administer. Monitoring of Trypanosomiasis Therapy Monitor clinically and by using laboratory test In both early- and late-stage trypanosomiasis, symptoms usually resolve after treatment, and the parasitemia clears on repeat blood smears. Patients who have recovered from late-stage East African trypanosomiasis should undergo lumbar punctures every 3 months for the first year. Patients who have recovered from West African trypanosomiasis should undergo lumbar punctures every 6 months for 2 years . Monitoring of Trypanosomiasis Therapy Cont …. If symptoms return, the CSF WBC count is higher than 20/µL, CSF pleocytosis occurs((presence of an abnormally large number lymphocytes in cerebrospinal fluid), or trypanosomes are still present in blood or CSF, a relapse is suggested. However, a persistently elevated CSF WBC count may also be observed in recovering patients; thus, the change (increase or decrease) in the WBC count is more diagnostically helpful than the count by itself. If a relapse is noted, repeat treatment with melarsoprol or eflornithine may be considered Key Points Human African trypanosomiasis, also known as sleeping sickness, is a vector-borne parasitic disease. It is caused

NTA Level 6 • Semester 1 • PST06106 Pharmacotherapy of Schistosomiasis Basic Pharmacotherapy • Source Session/Topic 13 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 13: Pharmacotherapy of Schistosomiasis Learning tasks By the end of this session students are expected to be able to: Define schistosomiasis Explain pathophysiology of schistosomiasis Explain the clinical presentation of schistosomiasis Outline diagnosis of schistosomiasis Describe pharmacological treatment of schistosomiasis Describe monitoring of schistosomiasis therapy Activity: Buzzing What is Schistosomiasis ? Definition of Schistosomiasis Schistosomiasis Schistosomiasis is an acute and chronic parasitic disease caused by blood flukes (trematode worms) of the genus Schistosoma . Definition of Schistosomiasis Cont … There are 2 major forms of schistosomiasis which are intestinal and urogenital caused by 5 main species of blood fluke as follows ; Definition of Schistosomiasis Cont …. Infection happens when larval forms of the parasite released by freshwater snails penetrate the skin during contact with infested water. Transmission occurs when infected individual from schistosomiasis contaminate freshwater sources with their excreta containing parasite eggs, which hatch in water. In the body, the larvae develop into adult schistosomes . Adult worms live in the blood vessels where the females release eggs. Some of the eggs are passed out of the body in the faeces or urine to continue the parasite’s lifecycle. Others become trapped in body tissues, causing immune reactions and progressive damage to organs . Pathophysiology and Symptoms of Schistosomiasis In schistosomiasis, adult worms reside in the mesenteric and pelvic venules in various sites where they lay eggs These sites tend to be specific for each species (e.g. S. japonicum prefers the superior mesenteric veins draining to the small intestine, while S. mansoni prefers the superior mesenteric veins of the large intestine) Many eggs are carried upstream where they get lodged in various organs, especially in the liver, bowel, and genitourinary tract Acute disease may trigger a cell-driven inflammatory response (involving tumour necrosis factor, interleukin-1, and interleukin-6 cytokines) and cause febrile illness Pathophysiology and Symptoms of Schistosomiasis Cont.. As mature female worms lay eggs, products of worm and egg metabolism induce formation of immune complexes resulting to a serum like-sickness called Katayama syndrome In chronic disease, eggs are the cause of pathology; they evoke a Thelper type 2 (Th2) cell-driven granulomatous reaction (involving interleukin-4, interleukin-5, and interleukin-13 cytokines) resulting in tissue fibrosis and chronic morbidity Gastrointestinal schistosomiasis due to S. mansoni , S. japonicum and S. mekongi can cause bowel lesions such as ulceration, pseudopolyps (masses of scar tissue during healing), and microabcesses . These manifest clinically as abdominal pain, altered bowel habits, and blood in stools Pathophysiology and Symptoms of Schistosomiasis Cont … The classic sign of urogenital schistosomiasis is haematuria and is specifically noted with S. haematobium Bladder, ureter fibrosis and kidney damage are sometimes seen in advanced cases The urogenital form may present with genital lesions (e.g. vulvar nodules), vaginal bleeding, dyspareunia(painful intercourse) , and fallopian tube damage (in the late stages) in females Genital infection in males may result in damage to seminal vesicles, prostate and other related organs; this may lead to irreversible infertility Clinical Presentation of Schistosomiasis Symptoms of schistosomiasis are caused by the body’s reaction to the worms' eggs. Intestinal schistosomiasis can result in abdominal pain, diarrhoea , and blood in the stool. Liver enlargement is common in advanced cases, and is frequently associated with an accumulation of fluid in the peritoneal cavity and hypertension of the abdominal blood vessels. In such cases there may also be enlargement of the spleen. The classic sign of urogenital schistosomiasis is haematuria (blood in urine). Clinical Presentation of Schistosomiasis Cont … Fibrosis of the bladder and ureter, and kidney damage are sometimes diagnosed in advanced cases. Bladder cancer is another possible complication in the later stages. In women, urogenital schistosomiasis may present with genital lesions, vaginal bleeding, pain during sexual intercourse, and nodules in the vulva. In men, urogenital schistosomiasis can induce pathology of the seminal vesicles, prostate, and other organs. This disease may also have other long-term irreversible consequences, including infertility. Diagnosis of Schistosomiasis Schistosomiasis is diagnosed through the detection of parasite eggs in stool or urine specimens Antibodies and/or antigens detected in blood or urine samples are also indications of infection For urogenital schistosomiasis, a filtration technique using nylon, paper or polycarbonate filters is the standard diagnostic technique Children with S. haematobium almost always have microscopic blood in their urine which can be detected by chemical reagent strips Diagnosis of Schistosomiasis Cont … The eggs of intestinal schistosomiasis can be detected in faecal specimens through a technique using methylene blue-stained cellophane soaked in glycerine or glass slides, known as the Kato-Katz technique For people living in non-endemic or low-transmission areas, serological and immunological tests may be useful in showing exposure to infection and the need for thorough examination, treatment and follow-up Activity : Small Group Discussion • What is the treatment of Schistosomiasis? Pharmacological Treatment of Schistosomiasis Praziquantel (PO) 40mg/kg as a single dose or in 2 divided doses The control of schistosomiasis is based on large-scale treatment of at-risk population groups, access to safe water, improved sanitation, hygiene education, and snail control. The WHO strategy for schistosomiasis control focuses on reducing disease through periodic, targeted treatment with praziquantel through the large-scale treatment (preventive chemotherapy) of affected populations. It involves regular treatment of all at-risk groups. Groups targeted for treatment are: School-aged children in endemic areas. Pharmacological Treatment of Schistosomiasis Cont … Adults considered to be at risk in endemic areas, and people with occupations involving contact with infested water, such as fishermen, farmers, irrigation workers, and women whose domestic tasks bring them in contact with infested water. Entire communities living in highly endemic areas. In high-transmission areas, treatment may have to be repeated every year for a number of years. Monitoring is essential to determine the impact of control interventions . Monitoring Of Schistosomiasis

NTA Level 6 • Semester 1 • PST06106 Pharmacotherapy of Gonorrhoea Basic Pharmacotherapy • Source Session/Topic 14 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 14: Pharmacotherapy of Gonorrhea Learning Objective By the end of this session students are expected to be able to: Define gonorrhoea Explain pathophysiology of gonorrhoea Explain the clinical presentation of gonorrhoea Outline diagnosis of gonorrhoea Describe pharmacological treatment of gonorrhoea Describe monitoring of gonorrhoea therapy Activity: Buzzing •What is Gonorrhoea ? Definition of Gonorrhea Gonorrhea is a sexually transmitted disease ( STD) caused by infection with the bacterium Neisseria gonorrhoeae . It tends to infect warm, moist areas of the body, including the: U rethra (the tube that drains urine from the urinary bladder) E yes T hroat V agina A nus F emale reproductive tract (the fallopian tubes, cervix, and uterus) Definition of Gonorrhea Gonorrhea is transmitted from person to person through unprotected oral, anal, or vaginal sex. People with numerous sexual partners or those who don’t use a condom are at greatest risk of infection . Pathophysiology of Gonorrhea On contact with a mucosal surface lined by columnar, cuboidal, or noncornified squamous epithelial cells, the gonococci attach to cell membranes by means of surface pili and are then pinocytosed . The virulence of the organism is mediated primarily by the presence of pili and other outer membrane proteins. After mucosal damage is established, polymorphonuclear (PMN) leukocytes invade the tissue, submucosal abscesses form, and purulent exudates are secreted . Clinical Presentation of Gonorrhea Individuals infected with gonorrhea can be; symptomatic or asymptomatic, have complicated or uncomplicated infections, and Have infections involving several anatomic sites. Complications associated with untreated gonorrhea appear more pronounced in women, because most of them are asymptomatic As a result, most of these patients develop serious complications, such as; pelvic inflammatory disease (PID), Infertility and ectopic pregnancies. In other patients the gonococci invade the bloodstream and produce disseminated disease Diagnosis of Gonorrhea Diagnosis of gonococcal infections can be made by ; gram-stained smears, culture, or Methods based on the detection of cellular components of the gonococcus such as Enzyme immunoassay, DNA probe techniques, and nucleic acid amplification techniques (NAATs) are also used in clinical specimens. Various stains have been used to identify gonococci microscopically, with the Gram stain the most widely used in clinical practice. Gram-stained smears are positive for gonococci when gram-negative diplococci of typical kidney bean morphology are identified within PMN leukocytes. Activity : Small Group Discussion What is the treatment of Gonorrhoea? Pharmacological treatment of gonorrhea Uncomplicated gonococcal infection Recommended Regimen Ceftriaxone 250mg IM in a single dose PLUS Azithromycin 1g orally in a single dose Alternative regimen If ceftriaxone is not available. Cefixime 400mg orally in a single dose plus Azithromycin 1g orally in a single dose Treatment of various forms of Gonorrhea Infection Monitoring Of Gonorrhea Therapy It is recommended to obtain follow-up cultures at least 3 days after treatment However the combination gonorrhea and chlamydial therapy rarely results in treatment failures, and routine follow-up of patients treated with a regimen is not necessary. Persistence of symptoms following any treatment requires culture of the site(s) of gonorrheal infection, as well as susceptibility testing if gonococci are isolated. Monitoring Of Gonorrhea Therapy Cont.. In most cases, the presence of gonococci indicates reinfection rather than treatment failure and reflects the need for improved patient education and sex partner referral. Persistence of symptoms also can be caused by other infectious causes, such as C. trachomatis Key Points Gonorrhea is a sexually transmitted disease (STD). It’s caused by infection with the bacterium Neisseria gonorrhoeae Gonorrhea passes from person to person through unprotected oral, anal, or vaginal sex. First line drug treatment with Cetriaxone and Azithromycin is recommended Evaluation What is Gonorrhoea? What is the pathophysiology of Gonorrhoea? What are the signs and symptoms of Gonorrhoea? How is the treatment of Gonorrhoea? 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 Syphilis Basic Pharmacotherapy • Source Session/Topic 15 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 15: Pharmacotherapy of Syphilis Learning Task By the end of this session students are expected to be able to: Define syphilis Explain the clinical presentation of syphilis Outline diagnosis of syphilis Describe pharmacological treatment of syphilis Describe the monitoring of syphilis therapy . Activity: Buzzing • What is syphilis?? Definition of Syphilis Syphilis Syphilis is an infectious venereal disease caused by the spirochete Treponema pallidum . Syphilis is transmissible by sexual contact with infectious lesions, from mother to fetus in utero, via blood product transfusion, and occasionally through breaks in the skin that come into contact with infectious lesions. If untreated, it progresses through 4 stages: primary, secondary, latent, and tertiary Clinical Presentation Primary Syphilis The primary stage, characterized by the appearance of a chancre on cutaneous or mucocutaneous tissue exposed to the organism, is highly infectious. Even without treatment, chancres persist only for 1 to 8 weeks before healing spontaneously. Because syphilitic chancres can be confused with other infectious etiologies, appropriate diagnostic testing is important . Clinical Presentation Cont … Secondary Syphilis The secondary stage of syphilis is characterized by a variety of mucocutaneous eruptions resulting from widespread hematogenous and lymphatic spread of T. pallidum . Skin lesions can be either generalized or localized to a small portion of the body and, with the exception of follicular lesions, are nonpruritic . Generalized lymphadenopathy also is seen in the majority of patients, as are nonspecific symptoms such as mild and transitory malaise, fever, pharyngitis, headache, anorexia, and arthralgia. If untreated, secondary syphilis disappears in 4 to 10 weeks; however, lesions can recur at any time within 4 years. Clinical Presentation Cont … Latent Syphilis These are persons with a positive serologic test for syphilis but with no other evidence of disease. Latent syphilis is further divided into early and late latency. During early latency, the patient is considered potentially infectious. Early latency is defined as 1 year from the onset of infection, up to 2 to 4 years. Late latency is considered noninfectious, although the patient remains a host. Most untreated patients with late latent syphilis have no further sequelae; however, approximately 25% to 30% progress either to neurosyphilis or to late syphilis with clinical manifestations other than neurosyphilis. Treatment of all patients with latent syphilis is essential because there is no way to predict which patients will have progression of their disease Clinical Presentation Cont … Tertiary Syphilis and Neurosyphilis If left untreated, syphilis can slowly produce an inflammatory reaction in virtually any organ in the body. Manifestations of this disease progression are referred to as tertiary syphilis. These clinical manifestations are differentiated into two subgroups based on the presence or absence of central nervous system (CNS) involvement which are neurosyphilis or tertiary syphilis (i.e., gumma and cardiovascular syphilis). The gumma, a nonspecific granulomatous lesion, is the classic lesion of late syphilis and develops in 50% of patients with disease progression. These chronic, destructive lesions characteristically infiltrate the skin, bone, soft tissue, and liver but can be found in any organ or tissue. Gummas of critical organs, such as the heart or brain, can be fatal Clinical Presentation Of Syphilis Diagnosis Of Syphilis Syphilis diagnosis is based on the; patient’s history, physical examination, laboratory testing and Radiology Diagnosis of Sphilis Cont … The available laboratory tests for diagnosis of syphilis include D irect detection methods (i.e. dark field microscopy, direct fluorescent antibody test and nucleic acid amplification test), S erology tests such as; Treponemal tests which include the Treponema pallidum haem- agglutination assay (TPHA), the Treponema pallidum particle agglutination assay (TPPA) and the fluorescent treponemal antibody absorbed (FTA-ABS) tests Non-treponemal tests (the microscopic Venereal Diseases Research Laboratory -VDRL and the macroscopic rapid plasma reagin –RPR tests), Examination of cerebrospinal fluids Rapid diagnostic tests (RDTs) for treponemal antibodies in syphilis infection Activity : Small Group Discussion • What is the treatment of Syphilis ? Pharmacological Treatment Parenteral penicillin G is the treatment of choice for all stages of syphilis. Because T. pallidum multiplies slowly, single doses of short- or intermediate-acting penicillins do not provide the prolonged, low-level exposure to penicillin required for eradication of the treponeme . A result, benzathine penicillin G is the only penicillin effective for single-dose therapy. The recommended treatment for syphilis of less than 1 year’s duration is benzathine penicillin G 2.4 million units as a single dose. Units can be administered once a week for 2 consecutive weeks. In patients with syphilis of longer than 1 year’s duration and normal CSF examination, benzathine penicillin G is administered weekly for three successive doses Monitoring Of Syphilis Therapy Non treponemal tests should be performed at 6 and 12 months in all patients treated for primary and secondary syphilis and at 6, 12, and 24 months for early and late latent disease. More frequent monitoring of HIV-infected individuals (i.e., 3, 6, 9, 12, and 24 months after therapy) should be done In general, the time to reach seronegativity is proportional to the duration of the disease. Despite adequate therapy, some patients can remain seropositive based on non- treponemal test results. In these cases, stabilization of low antibody titers is indicative of adequate therapy. For women treated during pregnancy, monthly quantitative non-treponemal tests are recommended in those at high risk of reinfection. Key Points Syphilis is a systemic disease from the outset and is caused by the spirochaete , Treponema pallidum (T. pallidum) The infection can be classified as congenital (transmitted from mother to child in utero) or acquired (through sex or blood transfusion) Acquired syphilis is divided into early and late syphilis Early syphilis comprises the primary, secondary and early latent stages while late syphilis refers to late latent syphilis, gummatous , neurological and cardiovascular syphilis Long-acting benzathine

NTA Level 6 • Semester 1 • PST06106 Pharmacotherapy of Chlamydial Genital Tract Infections Basic Pharmacotherapy • Source Session/Topic 16 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 16: Pharmacotherapy of Chlamydial Genital Tract Infections Learning Tasks By the end of this session students are expected to be able to : Define chlamydial genital tract infections Explain pathophysiology of chlamydial genital tract infections Explain the clinical presentation of chlamydial genital tract infections Outline diagnosis of chlamydial genital tract infections Describe pharmacological treatment of chlamydial genital tract infections Describe the monitoring of chlamydial genital tract infections therapy Activity: Buzzing What is Chlamydial Genital Tract Infections? Definition of Chlamydial Genital Tract Infections Chlamydial Genital Tract Infections Chlamydial Genital Tract Infections is a sexually transmissible infection caused by bacterium Chlamydia t rachomatis Persons infected with the bacterium may not have symptoms of infection but can still transmit the bacterium. Chlamydia can affect the urethra (the urine passage), cervix (the neck of the womb), rectum and anus, throat, and eyes . Pathophysiology of Chlamydial Genital Tract Infections C. trachomatis is an obligate intracellular parasite that shares properties of both viruses and bacteria. Like viruses, chlamydiae require cellular material from host cells for replication; however, unlike viruses, chlamydiae maintain their cellular identity throughout development. Although C. trachomatis lacks a cell-wall peptidoglycan, its major outer membrane is similar to gram-negative bacteria. At least 18 serovars (subspecies) of C. trachomatis exist, of which only the lymphogranuloma venereum strains produce potentially invasive infections. The remaining serovars are involved primarily with superficial infection of epithelial cells . Pathophysiology of Chlamydial Genital Tract Infections Cont .. Chlamydia have the ability to establish long-term associations with host cells. When an infected host cell is starved for various nutrients such as amino acids (for example, tryptophan), iron, or vitamins, this has a negative consequence for Chlamydiae since the organism is dependent on the host cell for these nutrients. The starved Chlamydiae enter a persistent growth state wherein they stop cell division and become morphologically aberrant by increasing in size. Persistent organisms remain viable as they are capable of returning to a normal growth state once conditions in the host cell improve and causing chronic Clinical Presentation of Chlamydial Genital Tract Infections In comparison with gonorrhea, chlamydial genital tract infections are more frequently asymptomatic, and when present, symptoms tend to be less noticeable. Urethral discharge usually is less profuse and more mucoid or watery than the urethral discharge associated with gonorrhea. Diagnosis of Chlamydia Genital tract infection A sample of urine can be collected and analyzed in the laboratory to investigate the presence of this infection. A swab of the discharge can be collected for culture or antigen testing for chlamydia. Nucleic Acid Amplification Tests (NAAT), such as Polymerase Chain Reaction (PCR ), Transcription Mediated Amplification ( TMA), and the DNA Strand Displacement Amplification (SDA) now are the mainstays. NAAT for chlamydia may be performed on swab specimens sampled from the cervix (women) or urethra (men), on self-collected vaginal swabs, or on voided urine Activity : Small Group Discussion What is the treatment of Chlamydial Genital Tract Infections? Pharmacological treatment of Chlamydial Genital Tract infection Monitoring of chlamydial Genital Tract Infections Therapy Treatment of chlamydial infections with the recommended regimens is highly effective; therefore, post-treatment laboratory testing is not recommended routinely unless symptoms persist or there are other specific concerns (e.g., pregnancy). Post-treatment tests should not be performed for at least 3 weeks following completion of therapy. When post-treatment tests are positive, they usually represent noncompliance, failure to treat sexual partners, or laboratory error rather than inadequate therapy or resistance to therapy. Infants with pneumonitis should receive follow-up testing because erythromycin is only 80% effective, and a second course of therapy can be necessary Key Points Chlamydia is a sexually transmissible infection caused by bacterium Chlamydia t rachomatis Persons infected with the bacterium may not have symptoms of infection but can still transmit the bacterium. Azithromycin is drug of choice for the treatment of chlamydia infection Evaluation What is Chlamydia infection? What is the pathophysiology of Chlamydial infection? What are the signs and symptoms of Chlamydia infection? How is the treatment of Chlamydia Infection? 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 Genital Herpes Basic Pharmacotherapy • Source Session/Topic 17 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 17: Pharmacotherapy of Genital Herpes Learning Tasks By the end of this session students are expected to be able to: Define genital herpes Explain pathophysiology of genital herpes Explain the clinical presentation of genital herpes Outline diagnosis of genital herpes Describe pharmacological treatment of genital herpes Describe the monitoring of genital herpes therapy Activity: Buzzing • What is Genital Herpes? Definition of Genital Herpes Genital Herpes Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus (HSV). Sexual contact is the primary way that the virus spreads. There are two types of Herpes Simplex viruses; herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). HSV-1 is associated most commonly with oropharyngeal disease, and HSV-2 is associated most closely with genital disease; However, each virus is capable of causing clinically indistinguishable infections in both anatomic areas. Definition of Genital Herpes Cont.…. Humans are the sole known reservoir for HSV. Infection is transmitted via inoculation of virus from infected secretions onto mucosal surfaces (e.g., urethra, oropharynx, cervix, and conjunctivae) or through abraded skin. The cycle of HSV infection occurs in five stages: primary muco-cutaneous infection, infection of the ganglia, establishment of latency, reactivation, and recurrent infection Pathophysiology Of Genital Herpes After viral inoculation, HSV infection is associated with cytoplasmic granulation(condensed areas of cellular material that may be bounded by a membrane), ballooning degeneration of cells (cells undergoing this form of death increase in size(balloon), and production of mononucleated giant cells ( cells formed by fusion of monocytes/macrophage) Initially, the cellular response is predominantly polymorph nuclear, followed by a lymphocytic response. Replication occurs with viral spread to contiguous cells and peripheral sensory nerves. Latency then is established in sensory or autonomic nerve root ganglia. Latency appears to be lifelong, interrupted only by reactivation of the viral infection. It is unclear what factors are important in maintaining latency, but immune responses and emotional and physical stresses appear important in reactivating latent virus. Clinical Presentation Of Genital Herpes The signs and symptoms of genital herpes infection are influenced by many factors, including previous exposure to HSV, viral type, and host factors such as age and site of infection. High percentage of initial and recurrent infections are asymptomatic, Viral shedding can occur in the absence of apparent lesions or symptoms A summary of the clinical presentation of genital herpes is provided in Table Diagnosis Of Genital Herpes A presumptive diagnosis of genital herpes commonly is made based on the presence of dark-field negative , vesicular, or ulcerative genital lesions. A prior history of similar lesions or recent sexual contact with an individual with similar lesions also is useful in making the diagnosis Viral culture. This test involves taking a tissue sample or scraping of the sores for examination in the laboratory . Diagnosis Of Genital Herpes Cont …. Polymerase chain reaction (PCR) test. PCR is used to copy patient DNA from a blood sample, tissue from a sore or spinal fluid. The DNA can then be tested to establish the presence of HSV and determine which type of HSV you have. Blood test. This test analyzes a sample of blood for the presence of HSV antibodies to detect a past herpes infection. Several serologic tests capable of distinguishing HSV-1 and HSV-2 antibodies are available. These tests detect antibodies to type-specific HSV-1 and HSV-2 proteins gG-1 and gG-2, respectively Activity : Small Group Discussion What is the treatment of Genital Herpes? Pharmacological Treatment of Genital Herpes The most achievable goals in the management of genital herpes are to relieve symptoms and to shorten the clinical course, to prevent complications and recurrences, and to decrease disease transmission. Although research has focused primarily on the treatment of active infection and suppression of recurrences, increasing emphasis is being placed on various approaches, including immunotherapy that might provide protection from disease transmission or possibly eliminate established latency. . Pharmacological Treatment of Genital Herpes Oral formulations of acyclovir, famciclovir , and valacyclovir have demonstrated efficacy in reducing viral shedding, duration of symptoms, and time to healing of first-episode genital herpes infections, with maximal benefits seen when therapy is initiated at the earliest stages of infection Pharmacological Treatment of Genital Herpes Monitoring of Genital Herpes Therapy Available antiviral compounds are of greatest benefit in patients experiencing first-episode primary infections, immunocompromised patients, and patients with frequent or severe recurrent infections. Antivirals, however, are palliative and not curative, and patients receiving these agents should be monitored closely for adverse drug effects. Discontinuation of suppressive therapy after 1 year should be considered to assess for possible changes in the patient’s intrinsic pattern of recurrence. In many patients, decreases in recurrence rates and the severity of symptoms occur over time. However, it is also preferred to continue suppressive therapy indefinitely because it significantly reduces asymptomatic viral shedding, a potential benefit in reducing the risk of disease transmission to uninfected sexual partners Key Points Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus (HSV). Infection is transmitted via inoculation of virus from infected secretions onto mucosal surfaces (e.g., urethra, oropharynx, cervix, and conjunctivae) or through abraded skin The signs and symptoms of genital herpes infection are influencedby many factors, including previous exposure to HSV, viral type, and host factors such as age and site of infection Oral formulations of acyclovir, famciclovir , and valacyclovir have demonstrated efficacy in the treatment of genital herpes Evaluation What is genital herpes? What is the pathophysiology of genital herpes? What are the signs and symptoms of genital herpes? How is the treatment of genital herpes? References Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6 th Ed). New York, NY: McGraw-Hill. DiPiro JT, Talbert RL, Yee GC,