PST NTA Level 4

NTA Level 4 • Semester 2 • PST04211 Description of Keratoplastic and Keratolytic Basic Pharmacology • 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. Session 17: Description of Keratoplastic and Keratolytic Agents Total Session Time: 60 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Outline indications of keratoplastic and keratolytic agents • List contraindications of keratoplastic and keratolytic agents • Describe dose, dosage and course of keratoplastic and keratolytic agents • List side effects and adverse effects of keratoplastic and keratolytic agents • Describe interactions and precautions of keratoplastic and keratolytic agents Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Overhead projector and computer SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Objectives Presentation/ Indications of Keratoplastic and Keratolytic 2 20 minutes Buzzing Agents Presentation/ Contraindications of Keratoplastic and 3 05 minutes Brainstorming Keratolytic Agents Dose, Dosage and Course of Keratoplastic and 4 05 minutes Presentation Keratolytic Agents Presentation/ Side effects and adverse effects of 5 05 minutes Brainstorming Keratoplastic and Keratolytic Agents Interactions and precautions Keratoplastic 6 10 minutes Presentation and Keratolytic Agents 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 101 SESSION CONTENTS STEP 1: Presentation of Session Title and Learning tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Indications of Keratoplastic and Keratolytic Agents (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the keratoplastic and keratolytic agents that are used in clinical practice? What are indications of keratoplastic and keratolytic agents? ALLOW few pairs to respond and let other pairs to add on points not mentioned WRITE their response on the flip chart/board CLARIFY and SUMMARIZE by using the content below • A keratolytics are agents that induces sloughing of cornified epithelium (horny or hard layer of the skin) • Keratolytic drugs act to damage the cornifled layer of skin that is then sloughed off to whatever depth the agent has acted • A keratoplastic (mild keratolytic) effect is seen when the drug does not produce a rapid destruction and sloughing, thereby softening the keratin and loosening the cornified epithelium • Keratolytic agents are used to remove warts and corns. They are also used in the treatment of severe acne • Keratoplastic agents are used in the treatment of acne, eczema, psoriasis, and seborrheic dermatitis • Coal Tar (chemical name). This agent is used as a keratoplastic in the treatment of eczema, psoriasis, and seborrheic dermatitis • Salicylic Acid (chemical name). It is used as a keratolytic when present in concentrations of from 5% to 20%. It is used as a kerato- plastic when present in concentrations of from 1% to 2% • Sulfur (chemical name). Sulfur is used as a keratoplastic in the treatment of acne and seborrheic dermatitis, it is used for the treatment of skin fungal infection • Tretinoin (topical) (Retin A®). This agent is used in the treatment of severe acne. The application of this agent to the skin will produce a horny layer of skin that is more easily removed PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 102 • Salicylic Acid 2% and Sulfur 2% (Fostex®). This preparation is available in cream or soap. It is used to treat acne • Salicylic Acid 2% and Sulfur 2% shampoo (Sebulex® or Sebra®). This shampoo is used to treat dandruff • Salicylic Acid 2%, Coal Tar 0.5%, and Sulfur 2% Shampoo (Sebutone® or Sebra T®). This product is used to treat dandruff STEP 3: Contraindications of Keratoplastic and Keratolytic Agents (5 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are contraindications of keratoplastic and keratolytic agents? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below Contraindicated in: • Children • Diabetic patients • Patients with hypersensitivity to be to the drugs • removal of birth marks, facial warts, warts on mucous membrane • Infected skin • Avoid on broken skin • Not suitable for internal genital what should be avoided in uncircumcised males STEP 4: Dose, Dosage and Course of Keratoplastic and Keratolytic Agents (5 minutes) • Podophyllotoxin Apply twice daily for three consecutive days • Silver nitrate Apply moisture caustic pencil tip 1-2 minutes repeat after 24 hours up to maximum 3 application for warts and six application for verrucas, for umbilical granuloma apply 1-2 minutes while protecting skin with soft paraffin • Retinoic acid topically 0.025-0.05% at night if unresponsive refer to specialist for oral retinoids (isotretinoin 0.5 -1mg/kg) • Crude Coal tar 5% in Vaseline in the morning (Acne) PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 103 • Salicylic acid 5% in Vaseline to descale (Psoriasis) STEP 5: Side Effects and Adverse Effects of Keratoplastic and Keratolytic Agents (5 Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are side effects and adverse effects of keratoplastic and keratolytic agents? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Topical use may be associated with: o Local irritation, o Acute inflammation o Ulceration • Chemical burns on surrounding skin • Stain skin and fabric STEP 6: Interactions and Precautions of Keratoplastic and Keratolytic Agents (10minutes) • Precautions • Particular care must be exercised when using the drug on the extremities of diabetics or patients with peripheral vascular disease. • Silver nitrate is not suitable for application to face, ano-genital region, or large area

NTA Level 4 • Semester 2 • PST04211 Description of Analgesics Basic Pharmacology • Source Session/Topic 18 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 18: Description of Analgesics Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of analgesics • List contraindication of analgesics • Describe dose, dosage and course of analgesics • List side effects and adverse effects of analgesics • Describe interaction and precaution of analgesics Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer and overhead projector SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Objectives Presentation/ 2 20 minutes Indications of Analgesics Buzzing Presentation/ 3 20 minutes Contraindication of Analgesics brainstorming 4 30 minutes Presentation Dose, Dosage and Course of Analgesics Presentation/ Side Effects and Adverse Effects of 5 20 minutes brainstorming Analgesics Description of Interaction and Precaution of 6 15 minutes Presentation Analgesics 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 107 SESSION CONTENTS STEP 1: Presentation of Session Title and Learning tasks (5 minutes) READ or ASK students to read the learning objectives and clarify ASK students if they have any questions before continuing. STEP 2: Indications of analgesics (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the indications of analgesics? ALLOW few pairs to respond and let other pairs add on points not mentioned WRITE their response on the flip chart/board CLARIFY and SUMMARIZE by using the content below • Most drugs which have analgesic properties are also anti inflammatory and antipyretics; they include; Paracetamol, Aspirin and Others are Diclofenac, Ibuprofen, indomethacin, Piroxicam, Mefenamic acid and Naproxen • Narcotic analgesics like tramadol are used in the management of pain only, have no antiiflammatory or antppyretic effects • They are used in management of pain, fever and inflammation o Paracetamol and aspirin are used in management of pain and fever o Diclofenac, ibuprofen, indomethacin. Piroxicam, Mefenamic acid, and Naproxen are used in management of pain, fever and inflamation STEP 3: Contraindication of Analgesics (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the Contraindications of analgesics? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 108 • Most individual drug which can be used as analgesic has different properties which make them to be contraindicated to patient with some conditions o Aspirin in children under 16 years and in breast-feeding due to Reye‘s syndrome, previous or active peptic ulceration and haemophilia o Diclofenac, ibuprofen, indomethacin, piroxicam, mefenamic acid, and naproxen are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID o Diclofenac, ibuprofen, indomethacin, piroxicam, mefenamic acid, and naproxen are contraindicated in severe heart failure and ischemic heart disease STEP 4: Dose, Dosage and Course of Analgesics (30 minutes) • Dose dosage and course of analgesics o Aspirin  By mouth, 300–900 mg every 4–6 hours when necessary, maximum dose 4 g daily  By rectum, 450–900 mg every 4 hours maximum dose 3.6 g daily)  Intensive care, ADULT and CHILD over 1 month, by intravenous injection, initially 300–600 micrograms/kg then by intravenous infusion 4.5–29.5 micrograms/kg/minute  Duration of the course should not exceed 5 days in case of pain and inflammation o Paracetamol  By mouth, ADULT 0.5–1 g every 4–6 hours to a maximum dose. of 4 g daily  CHILDREN 2 months 60 mg for post-immunisation pyrexia, repeated once after 6 hours if necessary  CHILDREN 3 months–1 year 60–120 mg, 1–5 years 120–250 mg,  6–12 years 250–500 mg; these doses may be repeated every 4–6 hours when necessary (max. of 4 doses in 24 hours)  By rectum, ADULT and CHILD over 12 years 0.5–1 g every 4–6 hours to a max. of 4 g daily; CHILD under 3 months  Duration of the course should not exceed 3 days o Diclofenac  By mouth, 75–150 mg daily in 2–3 divided doses  By rectum in suppositories, 75–150 mg daily in 2-3 divided doses.  Duration of the course should not exceed 5 days o Ibuprofen  ADULT and CHILD over 12 years, initially 300–400 mg 3–4 times daily; increased if necessary to max. 2.4 g daily; maintenance dose of 0.6–1.2 g daily may be adequate  Duration of the course should not exceed 5 days PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 109 o Indomethacin  By mouth, rheumatic disease, 50–200 mg daily in divided doses  Acute gout, 150–200 mg daily in divided doses  Dysmenorrhoea, up to 75 mg daily  By rectum in suppositories, 100 mg at night and in dose 150–200 mg o Mefenamic acid  CHILDREN 12–18 years, acute pain including dysmenorrhoea,  ADULT over 18 years, 500 mg 3 times daily  In menorrhagia, 500 mg 3 times daily  Duration of the course should not exceed 5 days o Naproxen  Acute musculoskeletal disorders and dysmenorrhoea, 500 mg initially, then 250 mg every 6–8 hours as required; maximum dose after first day 1.25 g daily.  Duration of the course should not exceed 5 days o Piroxicam  By mouth, rheumatic disease, initially 20 mg daily, increased if necessary to 30 mg daily in single or divided doses  CHILD (6–18 years), juvenile idiopathic arthritis, under 15 kg, 5 mg daily; 16–25 kg, 10 mg; 26–45 kg, 15 mg; over 46 kg, 20 mg  Duration of the course should not exceed 14 days o Indomethacin  By

NTA Level 4 • Semester 2 • PST04211 Description of Anti-allergies Basic Pharmacology • Source Session/Topic 19 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 19: Description of Anti-allergies Total Session Time: 120 minutes Prerequisites • PST04211_S3_ General Classification of Medicines Learning Tasks By the end of this session students are expected to be able to: • List indications of anti-allergies • List Contraindication of anti-allergies • Describe dose, dosage and course of anti-allergies • List side effects and adverse effects of anti-allergies • Describe interaction and precaution of anti-allergies Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer and overhead projector SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation/ 2 20 minutes Indications of Anti-allergies Buzzing Presentation/ 3 20 minutes Contraindication of Anti-allergies Brainstorming 4 30 minutes Presentation Dose, Dosage and Course of Anti-allergies Presentation/ Side Effects and Adverse Effects of Anti- 5 20 minutes brainstorming allergies 6 15 minutes Presentation Interaction and precaution of Anti-allergies 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 114 SESSION CONTENTS STEP 1: Presentation of Session Title and Learning tasks (5 minutes) READ or ASK students to read the learning objectives and clarify ASK students if they have any questions before continuing. STEP 2: Indications of Anti Allergies (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • Which anti allergies are listed in essential medicine list? • What are the indications of anti-allergies? ALLOW few pairs to respond and let other pairs add on points not mentioned WRITE their response on the flip chart/board CLARIFY and SUMMARIZE by using the content below • Anti-allergies listed in essential medicine list include; Chlorpheniramine maleate, Cetirizine Hydrochloride, Loratadine, Promethazine hydrochloride, Adrenalin, Hydrocortisone, Dexamethasone and Calamine lotion • Indications of drugs with anti-alergies properties are; o Chlorpheniramine maleate is used in symptomatic relief of allergy such as hay fever, urticaria; emergency treatment of anaphylactic reactions o Cetirizine Hydrochloride, Loratadine are used in symptomatic relief of allergy such as hay fever and chronic idiopahtic urticaria o Promethazine hydrochloride is used in symptomatic relief of allergy such as hay fever and urticaria; emergency treatment of anaphylactic reactions; sedation nausea and vomiting o Adrenalin is used in emergency treatment of acute anaphylaxis, angioedema and cardiopulmonary resuscitation o Hydrocortisone is used in adrenocortical insufficiency, hypersensitivity reactions e.g. anaphylactic shock and angioedema asthma, severe inflammatory bowel disease, haemorrhoids and rheumatic disease o Dexamethasone is used in suppression of inflammatory and allergic disorders, diagnosis of Cushing‘s disease, congenital adrenal hyperplasia, cerebral oedema associated with malignancy, nausea and vomiting with chemotherapy o Calamine lotion is indicated for pruritus PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 115 STEP 3: Contraindication of Anti-allergies (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the Contraindications of anti-allergies? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Most individual drug which can be used as anti-allergies has different properties which make them to be contraindicated to patient with some specific conditions. o Chlorpheniramine maleate like many antihistamines it should be avoided in acute porphyria o Cetirizine Hydrochloride and Loratadine like many antihistamines they should be avoided in acute porphyria they should also be avoided in pregnancy and breast- feeding o Promethazine hydrochloride like many antihistamines it should be avoided in acute porphyria o Hydrocortisone and dexamethasone are contraindicated to patients with systemic infection (unless specific therapy given):  Live virus vaccines should also be avoided due to possible suppression of immunity because serum antibody response diminished) STEP 4: Dose, Dosage and Course of Anti-allergies (30 minutes) o Chlorpheniramine maleate  By mouth, 4 mg every 4–6 hours, max. 24 mg daily Children, 1–2 years 1 mg twice daily; 2–6 years 1 mg every 4–6 hours, maximum 6 mg daily; 6–12 years 2 mg every 4–6 hours, max. 12 mg daily  By intramuscular injection or by intravenous injection over 1 minute, 10 mg, repeated if required up to 4 times in 24 hours; CHILD under 6 months 250 micrograms/kg (max. 2.5 mg), repeated if required up to 4 times in 24 hours; 6 months–6 years 2.5 mg, repeated if required up to 4 times in 24 hours; 6–12 years 5 mg, repeated if required up to 4 o Cetirizine Hydrochloride and Loratadine  ADULT and CHILD over 6 years 10 mg once daily; CHILD 2–6 years 5 mg once daily PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 116 o Promethazine hydrochloride  By mouth, 10–20 mg 2–3 times daily; CHILDREN under 2 years not recommended, 2–5 years 5–15 mg daily in 1–2 divided doses, 5–10 years 10–25 mg daily in 1–2 divided doses  By deep intramuscular injection, 25–5mg; max.100 mg; CHILD 5–10 years 6.25– 12.5 mg  By slow intravenous injection in emergencies, 25–50 mg as a solution containing 2.5 mg/mL in water for injections; max. 100 mg  The drug should be administered twice daily for not more than five days o Adrenalin  Acute anaphylaxis, by intramuscular injection of 1 in 1000 (1 mg/mL) solution.  Acute anaphylaxis when there is doubt as to the adequacy of the circulation, by slow intravenous injection of 1 in 10 000 (100 micrograms/mL) solution o Hydrocortisone  By mouth, replacement therapy, 20–30 mg daily in divided doses, CHILDREN 10–30 mg  By intramuscular injection or slow intravenous injection or infusion, 100–500 mg, 3–4 times in 24 hours or as required; CHILDREN by slow intravenous injection up to 1 year 25 mg, 1–5 years 50 mg, 6–12 years 100 mg o Dexamethasone  By mouth, usual range

NTA Level 4 • Semester 2 • PST04211 Description of Antiacids and Antiulcer Drugs Basic Pharmacology • Source Session/Topic 20 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 20: Description of Antiacids and Antiulcer Drugs Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Outline indications of antacids and antiulcer drugs • List contraindication of antacids and antiulcer drugs • Describe dose, dosage and course of antacids and antiulcer drugs • List side effects and adverse effects of antacids and antiulcer drugs • Describe interaction and precaution of antacids and antiulcer drugs Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Overhead projector and computer SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Objectives Presentation/ 2 20 minutes Indications of Antacids and Antiulcer Drugs Buzzing Presentation/ Contraindications of Antacids and Antiulcer 3 15 minutes Brainstorming Drugs Dose, Dosage and Course of Antacids and 4 30 minutes Presentation Antiulcer Drugs Presentation/ Side Effects and Adverse Effects of Antacids 5 20 minutes Brainstorming and Antiulcer Drugs Interactions and Precautions of Antacids and 6 20 minutes Presentation Antiulcer Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 121 SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Objectives (5 minutes) READ or ASK students to read the learning objectives and clarify ASK students if they have any questions before continuing. STEP 2: Indications of Antacids and Antiulcer Drugs (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the indications of antacids? • What are the indications of antiulcer drugs? ALLOW few pairs to respond and let other pairs to add on points not mentioned WRITE their response on the flip chart/board CLARIFY and SUMMARIZE by using the content below • Antacids o Antacids are weak bases that react with gastric hydrochloric acid to form a salt and water o Antacids have been used for centuries in the treatment of acid-peptic disorders o Antacids (usually containing aluminium or magnesium Compounds) can often relieve symptoms in ulcer dyspepsia and in non-erosive gastro-oesophageal reflux o Antacids are also sometimes used in functional (non-ulcer) dyspepsia o Aluminium hydroxide is used in management of dyspepsia and hyperphosphatemia o Magnesium trisilicate is used in management of dyspepsia • Anti-Ulcer Drugs o Histamin (H2-receptor) antagonists (e.g. cimetidine, famotidine and ranitidine)  These drugs are indicated for gastroesophageal reflux disease (GERD), peptic ulcer disease, non-ulcer dyspepsia, acute gastritis, Zollinger-Ellison Syndrome and prevention of bleeding from stress-related gastritis o Proton Pump Inhibitors (PPI) (e.g. Omeprazole and Lansoprazole)  These drugs are indicated for gastroesophageal reflux disease (GERD), H pylori- associated ulcers, NSAID-associated ulcers, Prevention of re-bleeding from peptic ulcers, nonulcer dyspepsia, acute gastritis, prevention of stress-related mucosal bleeding, gastrinoma and other hypersecretory conditions o Drugs for Treatment of Helicobacter Pylori PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 122  Omeprazole + Amoxycillin + plus Metronidazole  Lansoprazole + Clarithromycin + plus Tinidazole  Then Lansoprazole for one month STEP 3: Contraindications of Antacids and Antiulcer Drugs (15 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the Contraindication of antacids and antiulcer drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Antacids o Magnesium Carbonate is contraindicated in hypophosphatemia o Magnesium trisilicate is contraindicated in hypophosphatemia o Aluminium hydroxide is contraindicated in hypophosphatemia, neonates o and infants o Both magnesium and aluminum are absorbed and excreted by the kidneys. Hence, patients with renal insufficiency should not take these agents long-term STEP 4: Dose, Dosage and Course of Antacids and Antiulcer Drugs (30 minutes) • Antacids o Magnesium trisilicate 250 mg 1–2 tablets chewed when required o Magnesium Trisilicate Mixture/ Suspension 5% each of magnesium trisilicate,10–20 mL in water 3 times daily or as required o Dried aluminium hydroxide 220 mg/5 Ml: 10–20 mL 3 times daily, 20–60 minutes after meals, and at bedtime or when required PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 123 • Antiulcer Drugs H-2 Antagonists o Cimetidine 400 mg twice daily (with breakfast and at night) or 800 mg at night (benign gastric and duodenal ulceration) for at least 4 weeks (6 weeks in gastric ulceration, 8 weeks in NSAID-associated ulceration). When necessary the dose may be increased to 400 mg four times daily o Cimetidine is used in Prophylaxis of stress ulceration, 200–400 mg every 4–6 hours o Ranitidine is administered as 150 mg twice daily or 300 mg at night for 4–8 weeks in benign gastric and duodenal ulceration, up to 6 weeks in chronic episodic dyspepsia, and up to 8 weeks in NSAID-associated ulceration o In duodenal ulcer 300 mg Ranitidine can be given twice daily for 4 weeks to achieve a higher healing rate • Proton Pump Inhibitors o Lansoprazole in Benign gastric ulcer, 30 mg daily in the morning for 8 weeks o Lansoprazole in Duodenal ulcer, 30 mg daily in the morning for 4 weeks; maintenance 15 mg daily o Lansoprazole NSAID-associated duodenal or gastric ulcer, 30 mg once daily for 4 weeks o Lansoprazole when used in eradication of Helicobacter pylori associated with duodenal ulcer see eradication regimens below o Omeprazole when used benign gastric and duodenal ulcers,20 mg once daily for 4 weeks in duodenal ulceration or 8 weeks in gastric ulceration; in severe or recurrent cases increase to 40 mg daily; maintenance for recurrent duodenal ulcer, 20 mg once daily o Omeprazole when used for NSAID-associated duodenal or gastric ulcer and gastro duodenal erosions, 20 mg once daily for 4 weeks, continued

NTA Level 4 • Semester 2 • PST04211 Description of Antiemetic Drugs Basic Pharmacology • Source Session/Topic 21 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 21: Description of Antiemetic Drugs Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of antiemetic drugs • List contraindications of antiemetic drugs • Describe dose, dosage and course of antiemetic drugs • List side effects and adverse effects of antiemetic drugs • Describe interactions and precautions of antiemetic drugs Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Overhead projector and computer SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation/ 2 20 minutes Indications of Antiemetic Drugs Buzzing Presentation/ 3 20 minutes Contraindications of Antiemetic Drugs Brainstorming Dose, Dosage and Course of Antiemetic 4 30 minutes Presentation Drugs Presentation/ Side Effects and Adverse Effects of 5 20 minutes Brainstorming Antiemetic Drugs Interactions and Precautions Antiemetic 6 15 minutes Presentation Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 129 STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Listing Indications of Antiemetic Drugs (20minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • Mention antiemetic drugs used in clinical practice. • What are indications of antiemetic drugs? ALLOW few pairs to respond and let other pairs to add on points not mentioned WRITE their response on the flip chart/board CLARIFY and SUMMARIZE by using the content below • Antiemetic drugs used in clinical practice include: o Chlorpromazine o Metoclopramide o Promethazine hydrochloride o Droperidone o Donperidone • Are indicated for treatment of nausea and vomiting due to: o Adverse effects from medications o Systemic disorders: pregnancy, vestibular dysfunction, increased pressure, hepatobiliary disorders, radiation or chemotherapy, and gastrointestinal obstruction, dysmotility o Infections: central nervous system infection, peritonitis • Used in intractable hiccoughs and vertigo • Are indicated in post operative PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 130 STEP 3: Contraindications of Antiemetic Drugs (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are contraindications of antiemetic drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Antiemetic drugs are contraindicated in patients with known hypersensitivity to these drugs • Prochlorperazine is contraindicated in patients with: o Narrow angle glaucoma o Severe liver disease o Cardiovascular disease STEP 4: Dose, Dosage and Course of Antiemetic Drugs (30 minutes) • Chlorpromazine 10-25 mg PO q4-6 h prn • Metoclopramide 1-2mg/kg iv 15-30 min • Promethazine hydrochloride 20-25mg at bed time • Droperidol 0.625-1.25mg 30 min before end of the surgery • Donperidone 10-20mg 3-4 times daily PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 131 STEP 5: Side Effects and Adverse Effects of Antiemetic Drugs (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are side effects and adverse effects of antiemetic drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Side effects of antiemetic drugs are: o Headache o Dizziness o Constipation o Drowsiness o Sedation o Dry mouth o Hypertension o Hypotension o Nasal congestion o Diarrhea STEP 6: Interactions and Precautions of Antiemetic Drugs (15minutes) • Precaution should be taken in: o Severe nausea and vomiting o Obstructive diseases of gastro intestinal or genitourinary system • To be used with caution to patients with: o Hypertension o Sleep apnea o Epilepsy • Antiemetics interact with: o Central nervous system depressants such as:  Sedatives  Antidepressants  Opiates  Hypnotics  Antianxiety drugs PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 132 o Also exaggerate the anticholinergic effects of antihistamine, antidepressants, phenothiazines and disopyramide o Antiacids decrease absorption of antiemetic Step 7: Key Points (5 minutes) • Antiemetic drugs are indicated in patients with nausea and vomiting due to infections, systemic disorders and effects of other medications • Antiemetic drugs are contraindicated in patients with known hypersensitivity and severe liver and cardiovascular diseases • The side effects of Antiemetic drugs are headache, dizziness, constipation diarrhea and sedation • Caution should be taken to patient with severe nausea and vomiting and genitourinary and gastrointestinal obstructive condition • Antiemetic drugs react with different drugs central nervous depressant and increases effects of anticholinergic drugs STEP 8: Evaluation (5 minutes) • What are antiemetic drugs? • What are indications of antiemetic drugs? • What are the contraindications of antiemetic drugs? • What are the dose, dosage and course of antiemetic drugs • What are side effects and adverse effects of antiemetic drugs? • Describe interaction and precaution of antiemetic drugs? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 133 References Ministry Of Health and Social Welfare. (2013). Standard Treatment Guidelines & National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania government printers. Robert, L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael. (2014). Pharmacotherapy: A Pathophysiologic Approach (9th ed.). New York, McGraw-Hill Education. Sally, S.R, Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed) New York, Lippincott Williams and Wilkins School of Pharmaceutical sciences. (2011).Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam, ARDHI University press. The Royal Pharmaceutical Society of Great Britain. (2007). Martindale, The Extra Pharmacopoeia (5TH ed). London, pharmaceutical press. The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary (59th ed). London, BMJ

NTA Level 4 • Semester 2 • PST04211 Description of Drugs Used in Diarrhoea Basic Pharmacology • Source Session/Topic 22 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 22: Description of Drugs Used in Diarrhoea Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of drugs used in diarrhoea • List contraindications of drugs used in diarrhoea • Describe dose, dosage and course of drugs used in diarrhoea • List side effects and adverse effects of drugs used in diarrhoea • Describe interactions and precautions of drugs used in diarrhoea Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Overhead projector and computer SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning tasks Presentation/ 2 20 minutes Indications of Drugs Used in Diarrhoea Buzzing Presentation/ 3 20 minutes Contraindications of Drugs Used in Diarrhoea Brainstorming Dose, Dosage and Course of Drugs Used in 4 30 minutes Presentation Diarrhoea Presentation/ Side Effects and Adverse Effects of Drugs 5 20 minutes Brainstorming Used in Diarrhoea Interactions and Precautions of Drugs Used 6 15minutes Presentation In Diarrhoea 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 135 SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Indications of Drugs Used in Diarrhoea (20minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are drugs are indicated in patient with diarrhea? ALLOW few pairs to respond and let other pairs to add on points not mentioned WRITE their response on the flip chart/board CLARIFY and SUMMARIZE by using the content below • Indications o Loperamide is useful in symptomatic treatment of acute diarrhoea adjunct to rehydration in adults and children over 4 years. It is also used for chronic diarrhoea in adults only o Zinc is used for treatment of acute diarrhoea and prevention of zinc deficiency and its consequences, including stunted growth in children, and slow wound healing o Oral rehydration salt is useful in replacement of fluid and electrolyte loss in diarrhoea STEP 3: Contraindications of Drugs Used in Diarrhoea (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of drugs used in diarrhea? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 136 • Loperamide is contraindicated in conditions where inhibition of peristalsis should be avoided, where abdominal distension develops and in conditions such as active ulcerative colitis or antibiotic-associated colitis • Zinc is not contraindicated to any specific group of individual Oral rehydration is not contraindicated to any specific group of individual STEP 4: Dose, Dosage and Course of Drugs Used in Diarrhoea (30 minutes) • Loperamide o Acute diarrhea, 4 mg initially followed by 2 mg after each loose stool for up to 5 days. Usual dose 6–8 mg daily, maximum 16 mg daily, children 4–8 years, 1 mg 3–4 times daily for up to 3 days only, 8–12 years, 2 mg 4 times daily for up to 5 days o Chronic diarrhea, in adults initially 4–8 mg daily in divided doses, subsequently adjusted according to response and given in 2 divided doses for maintenance, maximum 16 mg daily o Fecal incontinence initially 500 micrograms daily, adjusted according to response, maximum 16 mg daily in divided doses • Zinc o For diarrhea in malnourished or zinc-deficient children: 10-40 mg elemental zinc daily o For preventing and treating pneumonia in undernourished children in developing countries, 10-70 mg/day o For hypogeusia, (sense of taste is abnormal), 25-100 mg zinc o For the eating disorder anorexia nervosa: 100 mg of zinc gluconate daily o For treating stomach ulcers, zinc sulfate 200 mg three times daily o For muscle cramps in zinc deficient people with liver disease zinc sulfate 220 mg twice daily o For osteoporosis, 15 mg zinc combined with 5 mg manganese, 1000 mg calcium, and 2.5 mg copper has been used o For sickle cell disease, zinc sulfate 220 mg three times daily o To increase growth and weight gain in children with sickle cell disease who have not reached puberty, 10 mg elemental zinc per day • Oral rehydration salt is given to fluid loss, usually 200–400 mL solution after every loose motion; infant 1–1½ times usual feed volume; child 200 mL after every loose motion PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 137 STEP 5: Side Effects and Adverse Effects of Drugs Used in Diarrhea (15 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects and adverse drug reactions of drugs used in diarrhoea? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Loperamide, abdominal cramps, dizziness, drowsiness, and skin reactions including urticaria; paralytic ileus and abdominal bloating also reported • Zinc, zinc cause nausea, vomiting, diarrhea, metallic taste, kidney and stomach damage, and other side effects. On broken skin zinc may cause burning, stinging, itching and tingling sensation • ORS when given in excess may cause oedema and hyperchloraemic acidosis STEP 6: Interactions and Precautions of Drugs Used in Diarrhoea (15minutes) • Loperamide increases plasma concentration of oral desmopressin • Zinc decrease absorption of antibiotic in the GIT there by decreasing their effectiveness For example: o Zinc can attach to tetracyclines in the stomach. This decreases the amount

NTA Level 4 • Semester 2 • PST04211 Description of Solutions for Correcting Basic Pharmacology • Source Session/Topic 23 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 23: Description of Solutions for Correcting Electrolyte Imbalance Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of solutions for correcting electrolyte imbalance • List contraindications of solutions for correcting electrolyte imbalance • Describe dose, dosage and course of solutions for correcting electrolyte imbalance • List side effects and adverse effects of solutions for correcting electrolyte imbalance • Describe interactions and precautions of solutions for correcting electrolyte imbalance Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer and projector SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Objectives Presentation/ Indications of Solutions for Correcting 2 20 minutes Buzzing Electrolyte Imbalance Presentation/ Contraindications of Solutions for Correcting 3 20 minutes brainstorming Electrolyte Imbalance Dose, Dosage and Course of Solutions for 4 30 minutes Presentation Correcting Electrolyte Imbalance Presentation/ Side Effects and Adverse Effects of Solutions 5 15 minutes brainstorming for Correcting Electrolyte Imbalance Interactions and Precautions of Solutions for 6 20 minutes Presentation Correcting Electrolyte Imbalance 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 141 SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Objectives (5 minutes) READ or ASK students to read the learning objectives and clarify ASK students if they have any questions before continuing. STEP 2: Indications of Solutions for Correcting Electrolyte Imbalance (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following questions for 2 minutes • What are the solutions used for correcting electrolyte imbalance? • What are the indications of solutions for correcting electrolyte imbalance? ALLOW few pairs to respond and let other pairs to add on points not mentioned WRITE their response on the flip chart/board CLARIFY and SUMMARIZE by using the content below • Solution for correcting electrolyte imbalance include dextrose solution, sodium lactate solution, sodium chloride solution, potassium chloride solution and potassium citrate oral solution • General indications/uses: o Administration of concentrated drugs which require dilution o To minimize/control side effects of some drugs (e.g. Quinine in Dextrose to avoid hypoglycemic effect) o Correction of electrolyte and acid-base disorders/imbalances for example in conditions like severe diarrhea, severe vomiting o To correct hypotension by restoring blood volume in conditions like anaphylactic shock, poisoning o Correction of shock and establish proper tissue perfusion o When a quick effect of a drug is required through I.V administration • Sodium Chloride (Normal Saline): o Principal fluid used for intravascular resuscitation and replacement of salt loss e.g. diarrhoea and vomiting o Hypovolemic shock o Stroke o Used as a sterile irrigation medium PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 142 • Sodium Lactate compound (Ringers Lactate): o Hypovolemic shock o Burns o Diarrhoea o Intraoperative o Intravenous fluid and electrolyte replacement o As a source of bicarbonate in treatment of mild to metabolic acidosis associated with potassium deficiency • Dextrose 5%: o Primarily used to maintain water balance in patients who are not able to take anything by mouth i.e. starvation deficit o Commonly used post-operatively in conjunction with salt retaining fluids i.e. saline • Dextrose 10%: o As Intravenous solution for fluid replenishment o caloric supply in single dose container for intravenous administration o As parenteral nutrient • Dextrose 50%: o Hypoglycemia o Status epilepticus o Coma o Altered mental status • Sodium chloride+ Dextrose (Dextrose saline): o Similar indications to 5% dextrose o Provides Na+ 30mmol/l and Cl- 30mmol/l i.e. a sprinkling of salt and sugar o Does not commonly cause water or salt overload • Potassium chloride Solution: o Hypokalemia STEP 3: Contraindications of Solutions for Correcting Electrolyte Imbalance (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of solutions for correcting electrolyte imbalance? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 143 • Sodium Chloride (Normal Saline): o Severe Hypertension o Pulmonary edema o Congestive cardiac failure o Oedema o Severe renal impairment o Liver cirrhosis • Dextrose 5%: o Hyperglycemia • Dextrose 50%: o Cerebral vascular accident in presence of normal blood sugar. o Hyperglycemia o Increased Intracranial pressure(ICP) o Intracranial hemorrhage • Sodium Lactate Compound (Ringers Lactate): o Known hypersensitivity to sodium lactate o Congestive heart failure o Severe renal impairment o Lactic acidosis STEP 4: Dose, Dosage and Course of Solutions for Correcting Electrolyte Imbalance (30 minutes) • Dextrose 5%; 500ml, 1000ml. Provides some calories [approximately 10% of daily requirements]. Regarded as ‗electrolyte free‘ – contains NO Sodium, Potassium, Chloride or Calcium • Dextrose 10%;500ml • Dextrose 25%, 50%; 50ml, 100ml • Sodium lactate compound (Ringer‘s solution) 500ml, 1000ml. Each liter provides approximately Na+ 131 mmol, K 5mmol, Ca++ 2mmol, C1-111mmol and HCO3- (lactate) 29mmol • Sodium chloride+ Dextrose(Dextrose saline), 0.9%+5%; 500ml, 1000ml • Potassium chloride Solution 7.4% 10ml Vial • Potassium citrate oral solution containing potassium citrate PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 144 STEP 5: Side Effects and Adverse Effects of Solutions for Correcting Electrolyte Imbalance (15 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are side effects and adverse effects of solutions for correcting electrolyte imbalance? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Sodium Chloride (Normal Saline): o Common cause of iatrogenic hyponatremia in surgical patients. o Reactions which may occur because of

NTA Level 4 • Semester 2 • PST04211 Description of Cathartic Drugs Basic Pharmacology • Source Session/Topic 24 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 24: Description of Cathartic Drugs Total Session Time: 60 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of cathartics drugs • List contraindications of cathartics drugs • Describe dose, dosage and course of cathartics drugs • List side effects and adverse effects of cathartics drugs • Describe interaction and precaution of cathartics drugs Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Overhead projector and computer SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation/ 2 10 minutes Indications of Cathartic Drugs Buzzing Presentation/ 3 10 minutes Contraindications of Cathartic Drugs Brainstorming 4 10 minutes Presentation Dose, Dosage and Course of Cathartic Drugs Presentation/ Side Effects and Adverse Effects of 5 10 minutes Brainstorming Cathartics Drugs Interactions and Precautions of Cathartic 6 05minutes Presentation Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 149 SESSION CONTENTS STEP 1: Presentation of Session Title and Learning tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Indications of Cathartic Drugs (10 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • Mention cathartic drugs. • What are indications of cathartic drugs? ALLOW few pairs to respond and let other pairs to add on points not mentioned WRITE their response on the flip chart/board CLARIFY and SUMMARIZE by using the content below • Also called stimulus laxatives and include lactulose and bisacodyl • Cathartic drugs are indicated in : o Constipation o Preparation for radiological procedure o Preparation for surgery o Lactulose is indicated in hepatic encephalopathy (portal systemic encephalopathy) • Commonly cathartics are bisacodyl and lactulose STEP 3: Contraindications of Cathartic Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of cathartic drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Lactulose are contraindicated in patients with : o Intestinal obstruction o Galactosaemia • Bisacodyl are contraindicated in: o Acute surgical condition PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 150 o Acute inflammatory bowel diseases o Severe dehydration STEP 4: Dose, Dosage and Course of Cathartic Drugs (10 minutes) • Bisacodyl o For treatment of constipation:  5-10mg orally at night  Or suppositories 10mg in the morning o Preparation for surgery and radiological procedures:  10-20 mg orally the night before procedure  Suppositories 10mg 1-2 hours before procedure • Lactulose o For treatment of constipation  15ml twice daily adjust according to response o Hepatic encephalopathy  30-50ml three times daily STEP 5: Side Effects and Adverse Effects of Cathartic Drugs (10 Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are side effects and adverse effects of cathartic drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • The side effects and adverse effects of Lactulose are: o Nausea o Vomiting o Flatulence o Cramps o Abdominal discomfort • The side effects and adverse effects of bisacodyl are: o Nausea o Vomiting o Colitis o Local irritation on suppository application PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 151 STEP 6: Interactions and Precautions of Cathartic Drugs (5 minutes) • Interactions o Lactulose enhances the anticoagulant effect of coumarins • Precautions o Avoid lactulose in lactose intolence o Avoid excessive use in hypokalaemia Step 7: Key Points (5minutes) • Cathartic drugs are indicated to patients with constipation and in preparation for surgical and radiological procedures • Cathartic drugs are contraindicated in patients with intestinal obstruction and severe dehydration • Cathartic drugs can be given orally or as suppositories • Nausea and vomiting are common side effects of Cathartic drugs • Caution should be taken to patient with lactose intolerance STEP 8: Evaluation (5minutes) • What are the indications of Cathartic drugs? • What are the Contraindication of Cathartic drugs? • What are side effects and adverse effects of Cathartic drugs? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 152 References Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael (2014). Pharmacotherapy: a pathophysiologic approach (9th ed.). New York, McGraw-Hill Education. Ministry Of Health and Social Welfare. 2013. Standard Treatment Guidelines & National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania government printers. Sally S.R, Jeanne C.S. 2000. Introductory Clinical Pharmacology (6th ed) New York, Lippincott Williams and Wilkins School of Pharmaceutical sciences. 2011. Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam, ARDHI University press. The Royal Pharmaceutical Society of Great Britain. 2007. Martindale, the Extra Pharmacopoeia (5TH ed). London, pharmaceutical press. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 153 ← Previous TopicNext Topic →View all Basic Pharmacology topicsOpen Complete Full Notes PDF / OFFLINE NOTES Unataka kutumiwa notes hizi kupitia WhatsApp?Kwa notes zilizopangiliwa vizuri kwa kusoma offline au PDF, bonyeza kitufe hapa chini. Ujumbe wenye Level, Semester, Module na Topic utaandaliwa moja kwa moja.TUMIWA NOTES WHATSAPP WhatsApp: 255620339260

NTA Level 4 • Semester 2 • PST04211 Description of Anti Hemorrhoid Drugs Basic Pharmacology • Source Session/Topic 25 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 25: Description of Anti Hemorrhoid Drugs Total Session Time: 60 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of anti hemorrhoid drugs • List contraindication of anti hemorrhoid drugs • Describe dose, dosage and course of anti hemorrhoid drugs • List side effects and adverse effects of anti hemorrhoid drugs • Describe interactions and precautions of anti hemorrhoid drugs Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Overhead projector and computer SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation/ 2 10 minutes Indications of Anti hemorrhoid Drugs Buzzing 3 05 minutes Presentation Contraindications of Anti hemorrhoid Drugs Dose, Dosage and Course of Anti hemorrhoid 4 10 minutes Presentation Drugs Presentation/ Side effects and Adverse Effects of Anti 5 15 minutes Brainstorming hemorrhoids Drugs Interactions and Precautions of Anti 6 05 minutes Presentation hemorrhoid Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 154 SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Indications of Anti hemorrhoid Drugs (10 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the indications of anti hemorrhoid drugs? ALLOW few pairs to respond and let other pairs to add on points not mentioned WRITE their response on the flip chart/board CLARIFY and SUMMARIZE by using the content below • Anusol suppository/or ointment which contains: Benzyl benzoate 33 mg, bismuth oxide 24 mg, bismuth subgallate 59 mg, hydrocortisone acetate 10 mg, Peru balsam 49 mg and zinc oxide 296 mg is used in management of hemorrhoids in adults o Ingredients contained in anusol suppository such as bismuth subgallate, zinc oxide are mild astringents which give symptomatic relief in hemorrhoids • Bismuth subgallate: With 1% hydrocortisone ointment is used in management of hemorrhoids. Hydrocortisone helps to relieve rectal pain, itching, bloody diarrhoea, and bleeding by reducing swelling (inflammation) directly in the rectum and anus • Paracetamol is used to relieve pain and inflammation in hemorrhoids • Proctosedyl suppository or ointment is used as a second choice in hemorrhoids • Many proprietary preparations also contain lubricants, mild antiseptics or vasoconstrictors that reduce swelling and relieve itching and discomfort by tightening blood vessels • Phenylephrine is an example of a vasoconstrictor (contained in Preparation) used in hemorrhoids STEP 3: Contraindications of Anti hemorrhoids Drugs (5 minutes) • Anti hemorrhoid drugs containing local anaesthetics should be avoided in infants and children • Allergic reactions/hypersensitivity to any of the ingredients of anti hemorrhoid preparation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 155 STEP 4: Dose, Dosage and Course of Anti hemorrhoid Drugs (10 minutes) • One Anusol suppository is inserted night only OR and morning after bowel movement for a maximum of seven days • A second choice Proctosedyl suppository or ointment is used once or twice a day, that is 12 hourly • Bismuth subgallate with 1% hydrocortisone ointment is used once or twice a day, that is 24 hourly or 12 hourly STEP 5: Side Effects and Adverse Effects of Anti hemorrhoids Drugs (15 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are side effects and adverse effects of anti hemorrhoid drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Side effects of anti hemorrhoid drugs are rare: Burning, itching, dryness, skin/hair follicle irritation, and changes in skin colour around the rectal area may occur • Rarely, it is possible corticosteroids and other ingredients of anusol will be absorbed into the bloodstream leading to toxicity. Refer Lecture on corticosteroids for side effects STEP 6: Interactions and Precautions Anti hemorrhoids Drugs (5 minutes) • Anusol suppository and most anti hemorrhoid drugs are not recommended in children • Precaution should be taken when using anti hemorrhoid preparations containing vasoconstrictors such phenylephrine if a patients has hypertension, heart problems, thyroid problems or diabetes • Interactions of anti hemorrhoid drugs are rare, may occur when corticosteroids and other ingredients are absorbed into blood stream PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 156 STEP 7: Key Points (5 minutes) • Only few drugs are available for management of hemorrhoids • Early stages of the disease could be effectively managed lifestyle changes, fiber supplement, use of food softeners, and drugs mainly topical ointments and suppositories • The more advanced hemorrhoid stages need some type of surgery • Astringents (drying agents) help shrink hemorrhoids by pulling water out of the swollen tissue. This, in turn, helps relieve itching, burning, and irritation STEP 8: Evaluation (5 minutes) • What drugs are indicated for Hemorrhoids? • What are contraindications of anti hemorrhoids? • What are the dose, dosage and course of anti hemorrhoid drugs? • What are side effects of anti hemorrhoids? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 157 References Ministry Of Health and Social Welfare. (2013). Standard Treatment Guidelines & National Essential Medicines List Tanzania Mainland (4th ed.). Dar- es- salaam, Tanzania government printers. The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary (59th ed). London, BMJ Group and RPS Publishing. Sally, S.R., & Jeanne, C.S. (2000). Introductory Clinical Pharmacology (6th ed). New York, Lippincott Williams and Wilkins. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 158

NTA Level 4 • Semester 2 • PST04211 Description of Antispasmodic Drugs Basic Pharmacology • Source Session/Topic 26 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 26: Description of Antispasmodic Drugs Total Session Time: 60 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of antispasmodic drugs • List Contraindication of antispasmodic drugs • Describe dose, dosage and course of antispasmodic drugs • List side effects and adverse effects of antispasmodic drugs • Describe interaction and precaution of antispasmodic drugs Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer and LCD SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation 2 10 minutes Indications of antispasmodic drugs Brainstorming Presentation 3 05 minutes Contraindications of antispasmodic drugs Buzzing Dose, dosage and course of antispasmodic 4 10 minutes Presentation drugs Presentation Side effects and adverse effects of 5 10 minutes Brainstorming antispasmodic drugs Interactions and precautions of antispasmodic 6 10 minutes Presentation drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 159 SESSION CONTENTS STEP 1: Presentation of Session Title and Learning tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Indications of Antispasmodic Drugs (10 minutes) Activity: Brainstorming (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the indications of antispasmodic drugs? ALLOW few pairs to respond and let other pairs to add on points not mentioned WRITE their response on the flip chart/board CLARIFY and SUMMARIZE by using the content below • Antispasmodic drugs are relaxants of intestinal smooth muscles. o They include drugs such as Atropine sulfate, Dicycloverine hydrochloride, Belladonna and Hyoscine butyl-bromide • Indications The smooth muscle relaxant properties of anti-muscarinic and other antispasmodic drugs may be useful in providing symptomatic relief gastro-intestinal disorders characterized by smooth muscle spasms, especially in: o Dysmenorrhea ( Hyoscine butyl-bromide) o Irritable bowel syndrome o Diverticular disease ( a condition associated with lower abdominal pain, anorexia, fevers and disturbed bowel habit) STEP 3: Contraindication of antispasmodic drugs (5 minutes) Activity: Buzzing (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of antispasmodic drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 160 CLARIFY and SUMMARISE by using the content below • Anti-muscarinic drugs are contraindicated in myasthenia gravis • Dicyclomine hydrochloride is contraindicated to infants under 6 months STEP 4: Dose, Dosage and Course of Antispasmodic Drugs (10 minutes) • Atropine sulfate o 0.6-1.2 mg at night • Dicycloverine hydrochloride o 10–20mg 3 times daily; INFANT 6–24 months 5–10mg 3–4 times daily, 15 minutes before feeds; CHILD 2–12 years 10mg 3 times daily • Belladonna o 12.5mg every 8 hours • Hyoscine butyl-bromide o By mouth: smooth muscle spasm, 20mg 4 times daily; CHILD 6– 12 years, 10mg 3 times daily. Irritable bowel syndrome, 10mg 3 times daily, increased if required up to 20mg 4 times daily o By intramuscular or slow intravenous injection, acute spasm and spasm in diagnostic procedures, 20mg repeated after 30 minutes if necessary (may be repeated more frequently in endoscopy), max. 100mg daily STEP 5: Side effects and adverse effects of antispasmodic drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects and adverse effects of Antispasmodic drugs ALLOW few students to respond? WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below Side and adverse effects of Antispasmodics drugs: • Anti-muscarinic drugs have side effects which include o Constipation o Transient bradycardia (followed by tachycardia, palpitation and arrhythmias) o Reduced bronchial secretions o Urinary urgency and retention PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 161 o Dilatation of the pupils with loss of accommodation o Photophobia o Dry mouth o Flushing o Dryness of the skin • Side-effects that occur occasionally include: o Confusion (particularly in the elderly) o Nausea o Vomiting o Giddiness o Angle-closure glaucoma may occur. STEP 6: Interaction and Precaution of Antispasmodic Drugs (10 minutes) • Antimuscarinics should be used with caution in Down‘s syndrome, in children and in the elderly • They should also be used with caution in gastro-oesophageal reflux disease • Diarrhoea • Ulcerative colitis • Hypertension STEP 7: Key points (5 minutes) • These are relaxants of intestinal smooth muscles • They are useful in providing symptomatic relief 0f gastro-intestinal disorders characterized by smooth muscle spasms, especially in irritable bowel syndrome • They are contraindicated in myasthenia gravis • Their common side effects include: Constipation, urinary retention, dry mouth and dryness of the skin • They should be used with caution in Down‘s syndrome, in children and in the elderly STEP 7: Evaluation (5 minutes) • What are the indications of antispasmodic drugs? • What are the contraindications of antispasmodic drugs? • What are the side effects and adverse effects of antspasmodic drugs? • What are the interactions and precautions of antispasmodic drugs? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 162 References Ministry of Health and Social Welfare. (2013). Standard Treatment Guidelines & National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania government printers. Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells &, L. Michael. (2014). Pharmacotherapy: a pathophysiologic approach (9th ed.). New York, McGraw-Hill Education. Sally S.R & Jeanne C.S. 2000. Introductory Clinical Pharmacology (6th ed) New York, Lippincott Williams and Wilkins School of Pharmaceutical sciences. (2011).Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam,