PST NTA Level 4

NTA Level 4 • Semester 2 • PST04211 Description of Drugs affecting Blood Basic Pharmacology • Source Session/Topic 27 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 27: Description of Drugs affecting Blood 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 drugs affecting blood • List contraindications of drugs affecting blood • Describe dose, dosage and course of drugs affecting blood • List side effects and adverse effects of drugs affecting blood • Describe interactions and precautions of drugs affecting blood Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Objectives Presentation/ 2 10 minutes Indications of Drugs Affecting Blood Buzzing Presentation/ 3 10 minutes Contraindications of Drugs Affecting Blood Brainstorming Description of Dose, Dosage and Course of 4 10 minutes Presentation Drugs Affecting Blood Presentation/ Side Effects and Adverse Effects of Drugs 5 10 minutes Brainstorming Affecting Blood Interactions and Precautions of Drugs 6 05 minutes Presentation Affecting Blood 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 164 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 drugs affecting blood (10 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • Mention drugs affecting blood • What are the indications of drugs affecting blood? 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 • Ferrous sulphate: used in management of iron deficiency anaemia • Folic acid: used in management of anaemia and neuro tube defect • Hydroxocobalamin: is also known as vitamin B12, it is used in management of megaloblastic anaemia • Iron dextran Injection: used in management of iron deficiency anaemia STEP 3: Contraindications of Drugs Affecting Blood (10 Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of drugs affecting blood? 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 165 • Ferrous sulphate is not contra-indicated to specific group of individual but should be given with care to those people with peptic ulcers • Folic acid is not contra-indicated to specific group of individual but should never be given alone for pernicious anaemia and other vitamin B12 deficiency states since it may precipitate subacute combined degeneration of the spinal cord • Hydroxocobalamin is not contra-indicated to specific group of individual but should not be given before diagnosis fully established • Iron dextran Injection is contra-indicated to those with history of allergic disorders including asthma and eczema, infection, active rheumatoid arthritis, severe hepatic impairment and acute renal failure STEP 4: Dose, Dosage and Course of Drugs Affecting Blood (10 minutes) • Ferrous sulphate o Dose prophylactic, 1 tablet (200mg) daily; therapeutic, 1 tablet 2–3 times daily until signs and symptoms disappear • Folic acid o Folate-deficient megaloblastic anaemia, by mouth, adult and child over 1 year, 5 mg daily for 4 months (until term in pregnant women); up to 15 mg daily may be required in malabsorption state o Children under 1 year, 500 micrograms/kg daily (max. 5 mg) for up to 4 months; up to 10 mg daily may be required in malabsorption states • Hydroxocobalamin o By mouth, vitamin B12 deficiency of dietary origin, 50–150 micrograms daily taken between meals children 50–105 micrograms daily in 1–3 divided doses. o By intramuscular injection, initially 1 mg repeated 10 times at intervals of 2–3 days, maintenance 1 mg every month • Iron dextran Injection o By deep intramuscular injection into the gluteal muscle or by slow intravenous injection or by intravenous infusion, 50 mg/mL, 2ml ample or calculated according to bodyweight and iron deficit o The product is not recommended to children under 14 years PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 166 STEP 5: Side Effects and Adverse Effects of Drugs Affecting Blood (10 Minute) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects and adverse effects of drugs affecting blood? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Ferrous sulphate: Main side effects include; o Gastro-intestinal irritation can occur with iron salts example ferrous sulphate. o Nausea and epigastric pain are dose-related and occur with high dose o Oral iron, particularly modified-release preparations, can exacerbate diarrhea • Folic acid: Not common, rarely gastro-intestinal disturbances • Hydroxocobalamin: Main side effects include; o Nausea, headache, dizziness and fever o Hypersensitivity reactions (including rash and pruritus) may occur. o Injection-site reactions o Hypokalaemia o Thrombocytosis o Chromaturia • Iron dextran Injection: Not common, they may include; o Nausea, vomiting and abdominal pain o Flushing, dyspnoea and anaphylactic reactions o Numbness, cramps and blurred Vision o Pruritus, and rash; STEP 6: Interactions and Precautions of Drugs Affecting Blood (5 minutes) • Ferrous sulphate o Absorption of Ferrous sulphate is reduced by oral magnesium salts, calcium salts and zinc o Ferrous sulphate reduces absorption of ciprofloxacin and other fluoroquinolones, levodopa, mycophenolates, Penicillamine, bisphosphonates and levothyroxines • Folic acid; usually does not interact with any specific group of drugs or any individual drug • Hydroxocobalamin; usually does not interact with any specific group of drugs or any individual drug PST

NTA Level 4 • Semester 2 • PST04211 Description of Antihypertensive Drugs Basic Pharmacology • Source Session/Topic 28 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 28: Description of Antihypertensive Drugs Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Outline classes of antihypertensive drugs • List indications of antihypertensive drugs • List contraindications of antihypertensive drugs • Describe dose, dosage and course of antihypertensive drugs • List side effects and adverse effects of antihypertensive drugs • Describe interactions and precautions of antihypertensive 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 2 10 minutes Presentation Classes of Antihypertensives Presentation/ 3 15 minutes Indications of Antihypertensive Drugs Buzzing Presentation/ Contraindications of Antihypertensive Drugs 4 10 minutes brainstorming Dose, Dosage and Course of Antihypertensive 5 30 minutes Presentation Drugs Presentation/ Side Effects and Adverse Effects of 6 20 minutes brainstorming Antihypertensive Drugs Interactions and Precautions of 7 15 minutes Presentation Antihypertensive Drugs 8 05 minutes Presentation Key Points 9 10 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 170 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 question(s) before continuing. STEP 2: Classes of Antihypertensives (10minutes) • Antihypertensive are a class of drugs that are used to treat hypertension (high blood pressure). Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction • Hypertention is categorized as follows: o Mild hypertension: Diastolic Blood Pressure range of 90 – 99 mm Hg and Systolic Blood Pressure range of 140-159mm Hg o Moderate hypertension: Diastolic Blood Pressure range of 100 – 109 mm Hg and Systolic Blood Pressure range of 100-180mmHg o Severe hypertension: Diastolic Blood Pressure range of 110 mm Hg or above and Systolic Blood Pressure range of 180mm Hg and above o Malignant hypertension: Severe hypertension associated with retinal exudates, haemorrhages or papilledema • There are many classes of antihypertensives, which lower blood pressure by different means. Among the most important and most widely used classes are: o Thiazide Diuretics o Loop Diuretics o Potassium Sparing Diuretics o Central Adrenergic Inhibotor o Beta Blockers o Alpha& Beta blockers o Angiotensin Converting Enzyme Inhibitors (ACEI) o Angiotensin II Receptor Agonist (ARB's) o Calcium Channel Blockers (CCB) o Direct vasodilators PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 171 STEP 3: Indications of Antihypertensive Drugs (15 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the indications of antihypertensive 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 Table 17.1: Indications of various classes of Antihypertensives Compelling indications Drug class Angina • ß-blocker or Long acting calcium channel blocker Prior or Post-myocardial infarct • ß-blocker and ACE inhibitor •If s-blocker contraindicated: Long acting calcium channel blocker eg verapamil Heart failure • ACE inhibitor and Carvedilol For volume overload: • Diuretics – Spironolactone Furosemide Left ventricular hypertrophy (confirmed by ACE inhibitor or ARB ECG) Stroke: secondary prevention Hydrochlorothiazide or Indapimide and ACE inhibitor Diabetes Mellitus ACE inhibitor or ARB, usually in combination with diuretic Chronic kidney disease ACE inhibitor, usually in combination with diuretic Isolated systolic hypertension Hydrochlorothiazide or Long acting calcium channel blocker Pregnancy Methyldopa or Hydralazine (Avoid ACEI/ARB tetratogenic) Prostatism alpha-blocker Elderly CCB PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 172 STEP 3: Contraindications of Antihypertensive Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of antihypertensive drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Patient with known hypersensitivity reaction to the individual drug. • Methyldopa is contraindicated in patient with active hepatic disease. • Alpha and B- blocker and calcium channel blockers are contraindicated in patient with: o Heart block o Cardiogenic shock o Heart failure • The use of ACE inhibitors is contraindicated during the second and third trimesters of pregnancy • Captopril, is contraindicated particularly when given in high doses to patients with renal insufficiency PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 173 STEP 5: Dose, Dosage and Course of Antihypertensive Drugs (30 minutes) Table 17.2: Antihypetensives and their corresponding doses Sn Class Drug Dosage 1 Thiazide Diuretics Bendroflumethiazide 5mg once daily Hydrochlothiazide 12.5mg once daily 2 Loop Diuretics Furosemide 40mg- 80mg daily Torasemide 2.5mg-5mg daily 3 Potassium Sparing Spirinolactone 25mg once daily Diuretics Eplerenone 25mg once daily 4 Central Methylodopa 250mg 12hrly Adrenergic Inhibotor 5 Beta Blockers Non selective Propranolol 80mg 12 hrly Selective Atenolol 50 – 100mg once daily Metoprolol 100mg 12hrly Alpha& Beta blockers Carvedilol 12.5 -25mg daily 6 ACE Inihibitors Captopril 12.5mg- 25mg 12hrly Enalapril 5- 20mg daily Angiotensin II Losartan 50mg-100mg daily Receptor Agonist (ARB's) 7 Calcium channel Nifedipine SR 10- 20mg 12hrly blochers (CCB) Amlodipine 5 – 10mg once daily 8 Direct vasodilators Hydralazine 25mg 12hrrly STEP 6: Side Effects and Adverse Effects of Antihypertensive Drugs (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are side effects and adverse effects of antihypertensive drugs? 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 174 Table 17.3: Classes of Antihypertensives and their Side Effects

NTA Level 4 • Semester 2 • PST04211 Description of Anti-angina and Anti Basic Pharmacology • Source Session/Topic 29 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 29: Description of Anti-angina and Anti- Arrhythmic Drugs Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Outline classes of anti-angina and anti-arrhythmic drugs • List indications of anti-angina and anti-arrhythmic drugs • List Contraindication of anti-angina and anti-arrhythmic drugs • Describe dose, dosage and course of anti-angina and anti-arrhythmic drugs • List side effects and adverse effects of anti-angina and anti-arrhythmic drugs • Describe interaction and precaution of anti-angina and anti-arrhythmic 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 Classes of Anti-angina and Anti-arrhythmic 2 10 minutes Presentation Drugs Presentation/ Indications of Anti-angina and Anti- 3 15 minutes Buzzing arrhythmic Drugs Presentation/ Contraindications of Anti-Angina and Anti- 4 10 minutes brainstorming arrhythmic Drugs Dose, Dosage and Course of Anti-angina and 5 30 minutes Presentation Anti-Arrhythmic Drugs Presentation/ Side Effects and Adverse Effects of Anti- 6 20 minutes brainstorming angina and Anti-arrhythmic Drugs Interactions and Precautions of Anti-Angina 7 15 minutes Presentation and Anti-Arrhythmic Drugs 8 05 minutes Presentation Key Points 9 10 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 178 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 question(s) before continuing. STEP 2: Classes of Anti-angina and Anti-arrhythmic Drugs (10 minutes) • Antianginal drugs are drugs that are used to manage angina by either improving perfusion of the myocardium, reducing the metabolic demand of the heart, or both • There are three classes of antianginal drugs; organic nitrates, Beta-adrenoreceptor antagonists and calcium channel blockers • Organic Nitrares and adrenoceptor antagonists are vasodilators and improve myocardial perfusion, and reduced metabolic demand of the myocardium • Beta-adrenoreceptor antagonists slow the heart rate therefore reduces metabolic demand of the heart • Antiarrhythmic drugs are a group of pharmaceuticals that are used to suppress abnormal rhythms of the heart (cardiac arrhythmias), such as atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation • They are classified according to their general effect; o Class I: Fast sodium (Na) channel blockers o Class II: Beta blockers o Class III: Potassium (K) channel blockers o Class IV: Slow calcium (Ca) channel blockers STEP 3: Indications of Anti-angina and Anti-arrhythmic Drugs (15 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-angina and anti-arrythmic 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 PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 179 • Anti-angina drugs o Nitrates (Nitroglycerin – glyceryl trinitrate, isosorbide dinitrate and isosorbide-5- mononitrate) are indicated for;  Unstable angina  Immediate treatment of angina (s.l.)  Severe, recurrent rest angina (i.v.)  Maintenance therapy of angina (slow release forms)  Prinzmetal‘s angina  Control myocardial ischemia,  Reduce infarction size  Treatment of acute angina episodes  Prophylaxis of chronic angina  Treatment of moderate to severe congestive heart failure and myocardial infarction  Control of blood pressure in cardiac surgical procedure o Calcium channel blockers (Nifedipine, Verapamil) are indicated for:  Stable angina  Unstable angina  Variant angina o Beta-adrenoreceptor (Atenolol, Metoprolol, Nadolol, Propranolol) are indicated for;  Stable angina  Unstable angina  Acute myocardial infarction • Anti-arrhythmic drugs o Class I: Fast sodium (Na) channel blockers (Lidocaine) are indicated for the treatment of ventricular arrhythmias o Class II: Beta blockers (Atenolol, propanolol) are indicated for  Treatment of hypertension,  Reduce infarct size in the periinfarction period, as adjuncts for rate control in atrial fibrillation or flutter o Class III: Potassium (K) channel blockers(Amiodarone) are effective for both supraventricular and ventricular arrhythmias o Class IV: Slow calcium (Ca) channel blockers (Amlodipine, verapamil) are not effective antiarrhythmic drugs because they have little effect on cardiac Ca2+ channels PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 180 STEP 3: Contraindications of Anti-angina and Anti-arrhythmic Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of anti-angina and anti-arrhythmic drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below Table 16.1: Contraindications of anti-angina and anti-arrhythmic drugs Drug class Contraindications Nitrates • Hypersensitivity • Head trauma • Cerebral hemorrhage • Severe anemia • Pericardial tamponade • Constrictive pericarditis Calcium channel blockers • Severe hypotension • Severe aortic stenosis • Extreme bradycardia • Moderate to severe heart failure • Cardiogenic shock • Sick sinus syndrome Beta-adrenoreceptor • Contraindicated in variant angina • Bradyarrhythmias • Atrioventricular block • Peripheral vascular disease Anti-arrhythic drugs • Hypersensitivity to the antiarrhythmic drugs • During pregnancy and lactation. • Second- or third-degree atrioventricular block (if the patient has no artificial pacemaker) • Severe congestive heart failure (CHF) • Aortic stenosis • Hypotension • Cardiogenic shock PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 181 STEP 5: Dose, Dosage and Course of anti-angina and anti-arrhythmic Drugs (30 minutes) • Nitroglycerin o PO Immediate-release tablets, 2.5–9 mg 2 or 3 times per day PO o Sustained-release tablets or capsules, 2.5 mg 3 or 4 times per day o SL 0.15–0.6 mg PRN for chest pain o Translingual spray, one or two metered doses (0.4 mg/dose) sprayed onto oral mucosa at onset of

NTA Level 4 • Semester 2 • PST04211 Description of Cardiac Glycosides Basic Pharmacology • Source Session/Topic 30 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 30: Description of Cardiac Glycosides 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 cardiac glycosides • List Contraindication of cardiac glycosides • Describe dose, dosage and course of cardiac glycosides • List side effects and adverse effects of cardiac glycosides • Describe interaction and precaution of cardiac glycosides 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 05 minutes Indications of Cardiac Glycosides Buzzing Presentation/ 3 10 minutes Contraindications of Cardiac Glycosides Brainstorming Dose, Dosage and Course of Cardiac 4 10 minutes Presentation Glycosides Presentation/ Side Effects and Adverse Effects of Cardiac 5 10 minutes Brainstorming Glycosides Interactions and Precautions of Cardiac 6 10 minutes Presentation Glycosides 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 187 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 Cardiac Glycosides (5minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • list glycosides that are used in clinical practice • What are indications of cardiac glycoside drugs? ALLOW few pairs to respond and let other pairs to add on points not mentioned WRITE their response on the flip chart/board CLARIFY and SUMMARIZE by using the content below • The common cardiac glycosides drugs are digoxin and digitoxin • Cardiac glycosides are also called cardiotonics or digitalis glycosides • Cardiac glycosides are indicated in patients with: o Heart failure o Atrial fibrillation o Dilated heart cardiomyopathies • Digoxin is the commonly used cardiac glycosides • Digoxin is used for acute and chronic conditions while digitoxin is used for maintenance PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 188 STEP 3: Contraindications of Cardiac Glycosides (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are contraindications of cardiac glycosides? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Cardiac glycosides are contraindicated in patients with : o Known hypersensitivity o Ventricular failure o Ventricular tachycardia o Digitalis toxicity STEP 4: Dose, Dosage and Course of Cardiac Glycosides (15 minutes) • When symptoms are mild, slow loading (digitalization) with 0.125-0.25 mg per day is safer than and just as effective as the rapid method 0.5-0.75 mg every 8 hours for 3 doses, followed by 0.125-0.25 mg per day • It is usually given only if diuretics and ACE inhibitors have failed to control symptoms • Digoxin is rapidly absorbed after oral administration • Cardiac glycosides are widely distributed to tissues, including the CNS STEP 5: Side Effects and Adverse Effects of Cardiac Glycosides (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are the side effects and adverse effects of cardiac glycosides? 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 189 • The major signs of digitalis toxicity are arrhythmias, nausea, vomiting, and diarrhea • This toxicity may be partially caused by direct effects on the gastrointestinal tract but is also the result of central nervous system actions • Central nervous system effects include disorientation and hallucinations especially in the elderly and visual disturbances are noted • Gynecomastia is a rare effect reported in men taking digitalis STEP 6: Interactions and Precautions of Cardiac Glycosides Drug (15 minutes) Precaution • Caution should be taken when giving cardiac glycosides to patient with: o Electrolyte imbalance(especially hypokalaemia and hypomagnesemia) o Severe carditis o Heart block o Acute glomerulonephritis o Pregnancy Interaction • Cardiac glycosides react with different drugs • Drugs that increases the plasma level of digitalis are: o Benzodiazepines o Nifedipine o Captopril o Verapamil • Drugs that Decreases the Plasma Level of Cardiac Glycosides o Antihistamine o Barbiturates o Thyroid hormones PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 190 Step 7: Key Points (5minutes) • Cardiac glycosides are indicated in patients with: o Heart failure o Atrial fibrillation o Dilated heart cardiomyopathies • Cardiac glycosides are contraindicated in patients with : o Known hypersensitivity o Ventricular failure o Ventricular tachycardia o Digitalis toxicity • Loading (digitalization) with 0.125-0.25 mg per day is safer than and just as effective as the rapid method 0.5-0.75 mg every 8 hours for 3 doses, followed by 0.125-0.25 mg per day • The major signs of digitalis toxicity are arrhythmias, nausea, vomiting, and diarrhea • Caution should be taken to patient with electrolyte imbalance STEP 8: Evaluation (5minutes) • What glycosides are used in clinical practice? • What are indications of cardiac glycosides drugs? • What are the contraindications of cardiac glycosides drugs? • What are the dose, dosage and course of cardiac glycosides drugs? • What are the side effects and adverse effects of cardiac glycosides drugs? • What are the interaction and precaution of cardiac glycosides drug? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 191 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. T., Gary, C.Y., Gary, R.M, Barbara, G.W., Michael, L. (2014). Pharmacotherapy:

NTA Level 4 • Semester 2 • PST04211 Description of Lipid Lowering Drugs Basic Pharmacology • Source Session/Topic 31 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 31: Description of Lipid Lowering 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 lipid lowering drugs • List contraindications of lipid lowering drugs • Describe dose, dosage and course of lipid lowering drugs • List side effects and adverse effects of lipid lowering drugs • Describe interactions and precautions of lipid lowering 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 Lipid Lowering Drugs Buzzing Presentation/ 3 10 minutes Contraindications of Lipid Lowering Drugs Brainstorming Dose, Dosage and Course of Lipid Lowering 4 10 minutes Presentation Drugs Presentation/ Side Effects and Adverse Effects of Lipid 5 10 minutes Brainstorming Lowering Drugs Interactions and Precautions of Lipid 6 05 minutes Presentation Lowering Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 193 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 Lipid Lowering Drugs (10minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What lipid lowering drugs are used in clinical practice? • What are the indications of lipid lowering 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 • Lipid Lowering drugs include simvastatin and atovastatin which are in a group of statins used in lowering cholesterol level in blood • Statins are group of lipid lowering drugs • Lipid lowering drugs are indicated in patients with: o Primary hypercholesterolemia o Homozygous familial hypercholesterolemia o Combined (mixed) hyperlipidemia in patients who have not responded adequately to diet and other appropriate measures o Prevention of cardiovascular events in patients with atherosclerotic cardiovascular disease or diabetes mellitus STEP 3: Contraindications of Lipid Lowering Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are contraindications of lipid lowering drugs? 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 194 • Lipid lowering drugs are contraindicated in patients with : o Active liver disease o Persistently abnormal liver function tests o In pregnancy (adequate contraception required during treatment and for 1 month afterwards) o Who are breast-feeding STEP 4: Dose, Dosage and Course of Lipid Lowering Drugs (10 minutes) Dose of Simvastatin • Primary hypercholesterolemia, combined hyperlipidemia, 10–20 mg daily at night, adjusted at intervals of at least 4 weeks; usual range 10–80 mg once daily at night • Homozygous familial hypercholesterolemia, 40 mg daily at night or 80 mg daily in 3 divided doses (with largest dose at night) • Prevention of cardiovascular events, initially 20–40 mg once daily at night adjusted at intervals of at least 4 weeks; max 80 mg once daily at night STEP 5: Side Effects and Adverse Effects of Lipid Lowering Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are the side effects and adverse effects of lipid lowering 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 simvastatin are: o Constipation is common, o Diarrhoea o Nausea, vomiting o Gastro-intestinal discomfort o Hypertriglyceridaemia may be aggravated o An increased bleeding tendency has been reported due to hypoprothrombinemia associated with vitamin K deficiency PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 195 STEP 6: Interactions and Precautions of Lipid Lowering Drugs (5minutes) • Precautions: o Bile acid sequestrates interfere with the absorption of fat-soluble vitamins; supplements of vitamins A, D, and K may be required when treatment is prolonged Step 7: Key Points (5minutes) • Lipid lowering are indicated in hypercholesterolemia, hyperlipidemia and in prevention of cardiac events in patients with cardiac diseases and in diabetic patients • Lipid lowering are contraindicated in liver failure, pregnancy and during breast feeding • The side effects of lipid lowering drugs are nausea, vomiting ,constipation and abnormal bleeding • Dose of simvastatin ranges from 10-80mg once a day • When using lipid lowering drugs caution as it interfere with absorption of fat soluble vitamins STEP 8: Evaluation (5minutes) • What are the indications of lipid lowering drugs? • What are the contraindications of lipid lowering drugs? • What are the dose, dosage and course of lipid lowering drugs? • What are side effects and adverse effects of lipid lowering drugs? • What are the interactions and precautions of lipid lowering drug? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 196 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. T., Gary, C.Y., Gary, R.M, Barbara, G.W., Michael, L. (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

NTA Level 4 • Semester 2 • PST04211 Description of Adrenal Hormones and Synthetic Substitutes Basic Pharmacology • Source Session/Topic 32 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 32: Description of Adrenal Hormones and Synthetic Substitutes 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 adrenal hormones and synthetic substitutes • List contraindications of adrenal hormones and synthetic substitutes • Describe dose, dosage and course of adrenal hormones and synthetic substitutes • List side effects and adverse effects of adrenal hormones and synthetic substitutes • Describe interactions and precautions of adrenal hormones and synthetic substitutes 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/ Indications of Adrenal Hormones and 2 25 minutes Buzzing Synthetic Substitutes Presentation/ Contraindications of Adrenal Hormones and 3 10 minutes Brainstorming Synthetic Substitutes Dose, Dosage and Course of Adrenal 4 30 minutes Presentation Hormones and Synthetic Substitutes Presentation/ Side Effects and Adverse Effects of Adrenal 5 20 minutes Brainstorming Hormones and Synthetic Substitutes Interactions and Precautions of Adrenal 6 20 minutes Presentation Hormones and Synthetic Substitutes 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 198 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 Adrenal Hormones and Synthetics Substitutes (25minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the common hormones and synthetic substitutes used in clinical practice? • What are indications for adrenal hormones and synthetic substitutes used in clinical practice? ALLOW few pairs to respond and let other pairs to add on points not mentioned WRITE their response on the flip chart/board CLARIFY and SUMMARIZE by using the content below • The commonly used are dexamethasones, prednisolone and hydrocortisone • Dexamethasones drugs are indicated in the: o Suppression of inflammatory condition o Suppression of allergic condition o Patients with raised intracranial pressure o Patients with cerebral edema o Stimulation of lung maturation in the fetus o Rheumatoid disease • Prednisolone are indicated in the: o In treating asthma o In suppression of inflammatory condition o Suppression of allergic disorder o Inflammatory bowel disease o Rheumatoid disease • Hydrocortisone are indicated in the: o In treating asthma o Suppression of inflammatory condition o In treating hemorrhoids o In management of shock eg anaphylactic shock o Rheumatoid disease PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 199 o Used in inflammatory and pruritus skin conditions STEP 3: Contraindications of Adrenal Hormones and Synthetic Substitutes (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of adrenal hormone and synthetic substitutes? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Adrenal Hormone and Synthetic Substitute are contraindicated in : o Patient with peptic ulcer o Heart disease o Systemic infections o Hypertension with heart failure o In infection such varicella, psychosis, diabetes, osteoporosis or glaucoma STEP 4: Dose, Dosage and Course of Adrenal Hormones and Synthetic Substitutes (30 minutes) • Dexamethasone can be given orally or parenterally: o 0.5-10 mg orally daily in adults o 10-100micrigrams/kg daily in children o Intravenous or intramuscular 0.5-24mg in adults or 200-400micrograms/kg daily in children • Hydrocortisone can be given orally or parenterally: o 20-30 mg per orally daily in divided dose in adults o 10-100micrigrams/kg daily in children o Intravenous or intramuscular 100-500mg,3-4 times in 24 hours in adults o or in children, up to 1 year 25mg,1-5 years 50mg,6-12 years 100mg • Prednisolone can be given orally or parenterally o 10-20 mg daily (severe disease up to 60 mg daily) o 2.5-25 mg as maintenance dose o Intramuscular injection prednisolone acetate 25-100mg once or twice weekly PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 200 STEP 5: Side Effects and Adverse Effects of Adrenal Hormones and Synthetic Substitutes (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects and adverse drug reactions of adrenal hormone and synthetic substitutes? 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 the adrenal hormones and synthetic substitute includes: o Hypertension o Sodium and water retention o Potassium and calcium loss o Osteoporosis o Diabetes o Muscle wasting o Peptic ulceration or perforation o Gastrointestinal effects : dyspepsia o Abdominal distension, acute pancreatitis, esophageal ulceration o Musculoskeletal effects: muscle weakness, vertebral and long bone fracture, tendon rupture o Endocrine effects: menstrual irregularities, hirsutism, weight gain, increased appetite o Neuropsychiatric: insomnia, aggregation of epilepsy o Skin : urticaria, skin atrophy, bruising STEP 6: Interactions and Precautions of Adrenal Hormones and Synthetic Substitutes (20 minutes) • Interaction o Interactions do not generally apply to corticosteroids used for topical action (including inhalation) o Corticosteroids antagonize hypertensive effects of:  ACE inhibitors  Adrenergic neuron blockers  Alpha blockers o Corticosteroids increases risk of gastro-intestinal bleeding when given with NSAIDs PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 201 o Corticosteroids may enhance or reduce anticoagulant effects of coumarins o Metabolism of corticosteroids is accelerated by carbamazepine, phenytoin, primidone, barbiturates o Corticosteroids antagonizes effects of:  Diuretics  Calcium channel blockers • Precaution o Adrenal hormones and synthetics substitute oral or parenteral preparation should be taken

NTA Level 4 • Semester 2 • PST04211 Description of Thyroid, Parathyroid Basic Pharmacology • Source Session/Topic 33 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 33: Description of Thyroid, Parathyroid Hormones and Their Antagonists 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 thyroid and parathyroid hormones and antagonists • List contraindication of thyroid and parathyroid hormones and antagonists • Describe dose, dosage and course of thyroid and parathyroid hormones and antagonists • List side effects and adverse effects of thyroid and parathyroid hormones and antagonists • Describe interactions and precautions of thyroid and parathyroid hormones and antagonists 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/ Indications of Thyroid and Parathyroid 2 10 minutes Buzzing Hormones and Antagonists Presentation/ Contraindications of Thyroid and Parathyroid 3 10 minutes Brainstorming Hormones and Antagonists Dose, Dosage and Course of Thyroid and 4 20 minutes Presentation Parathyroid Hormones and Antagonists Presentation/ Side Effects and Adverse Effects of Thyroid 5 20 minutes Brainstorming and Parathyroid Hormones and Antagonists Interactions and Precautions of Thyroid and 6 35 minutes Presentation Parathyroid Hormones and Antagonists 7 10 minutes Presentation Key Points 8 10 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 204 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: Thyroid, Parathyroid Hormones and their Antagonists (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 thyroid hormones and Antithyroid 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 • Carbimazole o Hyperthyroidism • Iodine (Lugol's solution) Solution and Iodized oil Capsules o Hyperthyroidism (thyrotoxicosis) • Levothyroxine o Hypothyroidism (decreased production or secretion of thyroid hormone) STEP 3: Contraindications of Thyroid, Parathyroid Hormones and their Antagonists (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of thyroid hormones and antithyroid drugs? 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 205 • Levothyroxine o Thyrotoxicosis • Carbimazole o Severe blood disorders • Iodine (Lugol's solution) Solution and Iodized oil Capsules o Potassium iodide is contraindicated in patients with hypersensitivity to iodine o Potassium iodide should be avoided in patients with hyperthyroidism Hyperkalaemia, and acute bronchitis also during pregnancy (category D) and lactation STEP 4: Dose, Dosage and Course of Thyroid and Parathyroid Hormones and Antagonists (20 minutes) • Levothyroxine o Available as Levothyroxine Tablets (sodium salt) 0.05g o To maintain normal TSH levels  Levothyroxine 1.5µg/kg. Maximum dose 100 -150µg daily o Hypothyroidism after treatment of grave disease  Levothyroxine 75µg to 125µg/day • Carbimazole o Available as carbimazole tablets 5mg  Carbimazole 40mg (O) once daily for 3 weeks then 20mg daily for 3 weeks  Maintenance dose 5mg for up to one year • Iodine (Lugol's solution) Solution o Available as Iodine (Lugol's solution) Solution containing 5 percent iodine and 10 percent potassium iodide o Three (3) drops (21mg) once each month for up to one year STEP 5: Side Effects and Adverse Effects of Thyroid, Parathyroid Hormones and their Antagonists (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects of thyroid hormones and antithyroid drugs? 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 206 • Carbimazole o Side-effects  Nausea, mild gastro-intestinal disturbances, taste disturbance, headache, fever, malaise, rash, pruritus, arthralgia; rarely myopathy, alopecia, bone marrow suppression (including pancytopenia and agranulocytosis • Levothyroxine sodium (Thyroxine sodium) o Side-effects usually at excessive dosage  Diarrhoea, vomiting, anginal pain, arrhythmias, palpitation, tachycardia, tremor, restlessness, excitability, insomnia; headache, flushing, sweating, fever, heat intolerance, weight-loss, muscle cramp, and muscular weakness and transient hair loss in children o Hypersensitivity reactions  Rash, pruritus and oedema • Iodine (Lugol's solution) and Iodized oil Capsules o Side-effects  Headache, lacrimation, conjunctivitis, pain in salivary glands, laryngitis, bronchitis, rashes; on prolonged treatment depression, insomnia, impotence; goitre in infants of mothers taking iodides STEP 6: Interactions and Precautions of Thyroid, Parathyroid Hormones and their Antagonists (35 minutes) • Iodine (Lugol's solution) and Iodized oil Capsules o Precaution  Potassium iodide should be used cautiously in patients with renal impairment, cardiac disease, pulmonary tuberculosis, and Addison‘s disease  Iodine and iodide should be used with cautions in children  Can cause neonatal goitre and hypothyroidism in pregnancy  Iodine and iodide appears to be concentrated in milk thus stop breast-feeding due to danger of neonatal hypothyroidism or goitre o Drug Interactions  Lugol‘s solution can increase the risk of hypothyroidism if taken concurrently with lithium  Potassium-sparing diuretics, potassium supplements, and ACE inhibitors increase the risk of hyperkalemia • Levothyroxine o Precaution  Caution in Panhypopituitarism or predisposition to adrenal insufficiency (corticosteroid therapy should be initiated before starting levothyroxine)  Care in elderly, cardiovascular disorders (including hypertension, myocardial insufficiency or myocardial infarction), Long-standing hypothyroidism and diabetes insipidus PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 207  In patients with diabetes mellitus the dose of antidiabetic drugs including insulin may need to be increased 

NTA Level 4 • Semester 2 • PST04211 Description of Insulin and Anti Diabetic Basic Pharmacology • Source Session/Topic 34 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 34: Description of Insulin and Anti Diabetic Agents 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 Insulin and Anti diabetics agents • List Contraindication of Insulin and Anti diabetics agents • Describe dose, dosage and course of Insulin and Anti diabetics agents • List side effects and adverse effects of Insulin and Anti diabetics agents • Describe interaction and precaution of Insulin and Anti diabetics agents Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer • LCD SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning tasks Presentation/ Indications of Insulin and Anti Diabetics 2 20 minutes Buzzing Agents Presentation/ Contraindication of Insulin and Anti Diabetics 3 20 minutes brainstorming Agents Dose, Dosage of Insulin and Anti Diabetics 4 30 minutes Presentation Agents Presentation/ Side Effects and Adverse Effects of Insulin 5 20 minutes brainstorming and Anti Diabetics Agents Interaction and Precaution of Insulin and Anti 6 15minutes Presentation Diabetics Agents 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 211 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 Insulin and Anti Diabetics Agents (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the types of insulin and anti diabetic agents? • What are the indications of Insulin and Anti diabetics‘ 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 • There are various types of insulin which are given to patients depending on the conditions of a patient. They include Short-acting insulins, Rapid-acting insulin and Intermediate action Insulin • Anti diabetic agents include, Chlorpropamide, Glibenclalmide, Gliclazide and metformin • Indications of Insulin o Treatment with insulin injection is indicated in Type I Diabetes Mellitus or in uncontrolled Type II Diabetes Mellitus, Hyperglycemic emergencies, Pancreatitis, Pregnancy and trauma or Surgery o Insulin preparations are divided into 3 types:  Short-acting insulins those of short duration which have a relatively rapid onset of action, namely soluble insulin. Soluble insulin is the most appropriate form of insulin for use in diabetic emergencies e.g. diabetic ketoacidosis and at the time of surgery  Rapid-acting insulin analogues, insulin as part, insulin glulisine, and insulin lispro  Intermediate action Insulin, e.g. isophane insulin • Anti-diabetics Agents o Chlorpropamide: Is used in the treatment of type 2 diabetes mellitus in patients who cannot control blood sugar levels by diet and exercise alone. It is used along with diet and exercise. It may be used alone or with other ant diabetic medicines PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 212 o Glibenclalmide: Is used in the treatment of type 2 diabetes mellitus o Gliclazide: It is indicated in Non-insulin dependent diabetes mellitus, maturity onset diabetes and in insulin resistant diabetes o Tolbutamide : It is indicated in type 2 diabetes mellitus o Metformin: Is used in the treatment of diabetes mellitus.  Metformin is used for the symptomatic management of polycystic ovary syndrome [unlicensed indication];  It improves insulin sensitivity, may aid weight reduction, helps to normalize menstrual cycle (increasing the rate of spontaneous ovulation), and may improve hirsutism STEP 3: Contraindication of Insulin and Anti Diabetics Agents (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the Contraindication of Insulin and Anti Diabetics agents? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Contraindication of Insulin and Anti diabetics agents: o Insulin: Is contraindicated in persons who have Hypersensitivity to any ingredient of the product and during episodes of hypoglycemia o Chlorpropamide : Is contraindicated in pregnancy, heart disease, liver problems, recent operation, body temperature more than 101 0F, severe nausea and vomiting that has lasted a long time, weakened patient, injury, low blood sugar, pituitary hormone deficiency, Addison's disease, hepatic porphyria, G6PD Anemia, Hemolytic Anemia o Glibenclalmide: Is contraindicated in diabetic emergencies (ketoacidosis, hyperosmolar coma), advanced hepatic or renal insufficiencies, pregnancy and nursing period o Gliclazide: Is contraindicated in following conditions, pregnancy, lactation, hypersensitivity, renal impairment, juvenile onset diabetes, unstable or brittle diabetes, diabetic ketoacidosis PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 213 o Tolbutamide: Is contraindicated in patients with known hypersensitivity or allergy to the drug, diabetic ketoacidosis, with or without coma, Metformin Is contraindicated in patients with any condition that could increase the risk of lactic acidosis, including kidney disorders , lung disease and liver disease STEP 4: Dose, Dosage of Insulin and Anti Diabetics Agents (30minutes) • The following are the dose and Dosage of Insulin and Anti diabetics agents o Insulin -Children and Adults – Subcutaneous 0.5 to 1 units/kg/day. Adjust doses to achieve pre-meal and bedtime blood glucose levels of 80 to 140 mg/dL (children younger than 5 yr of age, 100 to 200 mg/dL). Severe Ketoacidosis or Diabetic Coma Subcutaneous 0.8 to 1.2 units/kg/day. Regular insulin is given IV or IM. o Chlorpropamide Initially 250 mg daily with breakfast (elderly 100– 125 mg), adjusted according to response; max. 500 mg daily o Gliclazide for Noninsulin dependent diabetes, oral dose: The drug is increased in stepwise fashion. It is started as 40-80

NTA Level 4 • Semester 2 • PST04211 Description of Hormonal Contraceptives Basic Pharmacology • Source Session/Topic 35 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 35: Description of Hormonal Contraceptives Methods 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 hormonal contraceptives • List contraindication of hormonal contraceptives • Describe dose, dosage and course of hormonal contraceptives • List side effects and adverse effects of hormonal contraceptives • Describe interaction and precaution of hormonal contraceptives 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 05 minutes Indications of Hormonal Contraceptives Buzzing Presentation/ Contraindications of Hormonal 3 10 minutes Brainstorming Contraceptives Dose, Dosage and Course of Hormonal 4 20 minutes Presentation Contraceptives Presentation/ Side Effects and Adverse Effects of Hormonal 5 05 minutes Brainstorming Contraceptives Interactions and Precaution of Hormonal 6 05minutes Presentation Contraceptives 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 219 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 Hormonal Contraceptives (5 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What hormonal contraceptives are used in clinical practice? • What are indications for hormonal contraceptives? • 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 • Hormonal contraceptives are either given orally or by injection • Oral contraceptive fall into two major categories: o Combined oral contraceptives) COCs) o Progestogen Only Pills (POPs) • Hormonal contraceptives are indicated in: o Alleviating menopausal symptoms o In women with early natural or surgical menopause o Primarily for prevention of conception o Treatment of dysfunctional uterine bleeding, o Treatment of dysmenorrheal o Treatment of endometriosis. o In management of Menorrhagia o Treatment of premenstrual symptoms o Post Coital Contraception (―morning-after pill‖) PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 220 STEP 3: Contraindications of Hormonal Contraceptives (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of hormonal contraceptives? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Hormonal contraceptives are contraindicated in patients with: o Thrombophlebitis o Thromboembolic phenomena o Cardiovascular and o Cerebrovascular disorders or a past history of these conditions o Treat vaginal bleeding when the cause is unknown • They should be avoided in patients with known or suspected tumors of the breast or estrogen-dependent neoplasm • They are contraindicated in patient with the following conditions: o Liver disease o Pregnancy o Severe headaches especially associated with visual disturbances o Numbness or paresis of extremities o Unexplained chest pain or shortness of breath o Severe leg pains STEP 4: Dose, Dosage and Course of Hormonal Contraceptives (30 minutes) • Hormonal contraceptives can be administered orally, intramuscular or through intradermal o Combined Oral Contraceptive (COP)  The use of COP in contraception  In pack of 28 pills, first 21 have hormone and the last 7 have no hormone  Take one pill each day until the pack is empty o Menopausal symptoms with uterus  Give one tablet of combined oral contraceptive daily o Menopausal symptom and osteoporosis prophylaxis (with progesterone for 12-14 days per cycle in women with intact uterus)  10-50 micrograms daily for 21 days repeated after 7 days tablet free period. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 221 o Female hypogonadism  10-50micrograms daily o Post Coital Contraception (―morning-after pill‖)  The method is applicable mostly after rape and unprotected sexual intercourse where pregnancy is not desired  Within 3 days (72 hours) of unprotected sexual intercourse, give  Combined oral Contraceptive 100 microgram ethinylestradiol and 500 micrograms levonorgestrel (2 high dose COC tablets) Or  When this preparation is not available, use 3 tablets each containing 30-35 micrograms ethinyloetradiol and 150-250 microgram levonorgestrel (3 low dose COC tablets) • Management of the dysfunctional uterine bleeding o Norethisterone (Primolut N) 5mg 12hourly for 10 -14 days COC (E+P) Combined oral contraception 2-3 cycles • Progesterone only pills (POP) o This type is suitable for lactating mothers or women with mild or moderate hypertension. Start 6 week after birth o Use of POP in contraception o Take one tablet every daily at the same time o Use of POP in management of dysmenorrhea. Give POP 5mg three times daily by mouth from day 5 to 24 for 3-4 cycles o Use of POP in management premenstrual syndrome. Give POP 5mg 2-3 times • Progesterone injection o This type is suitable for lactating mothers or women with mild or moderate hypertension • Use of progesterone in contraception o Depo Provera 150m intramuscular after every three month • Use of progesterone injection in management of dysfunctional uterine bleeding o Deep intramuscular into buttock of 5-10mg daily for 5-10 days until 2days before onset of menstruation • Injectable Contraceptive: o Medroxy progesterone acetate IM 150 mg every three months • Implant Contraceptive: o Levonorgestrel in six plastic capsules is implanted in the left upper arm made under local anesthesia o Levonorgestrel is effective for five years and is recommended for women who have completed their family or not ready for sterilization or those not able to take estrogen containing contraceptives PST 04211 Basic Pharmacology NTA Level 4

NTA Level 4 • Semester 2 • PST04211 Description of Cough and Cold Preparations Basic Pharmacology • Source Session/Topic 36 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 36: Description of Cough and Cold Preparations Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Define and list the symptoms of common cold and cough • List indications of Cough and Cold Preparations • Describe dose, dosage and course of Cough and Cold Preparations • List Contraindications, side effects, adverse effects, interactions and precautions of Cough and Cold Preparations Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Overhead projector (OHP) and computer. SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Objectives Presentation Definition and Symptoms of Common Cold 2 10 minutes Brainstorming and Cough Presentation 3 20 minutes Indications of Cough and Cold Preparations Buzzing Dose, Dosage and Course of Cough and Cold 4 20 minutes Presentation Preparations Presentation Side Effects, Adverse Effects, 5 55 minutes Small Group Contraindications, Interactions and Discussion Precautions of Cough and Cold Preparations. 6 05 minutes Presentation Key Points 7 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 226 SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Objectives (05 minutes) READ or ASK students to read the learning objectives and clarify ASK students if they have any questions before continuing. STEP 2: Definition and Symptoms of Common Cold and Cough (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following questions: • What causes common cold? • What are the symptoms of common cold? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Common cold, also known simply as a cold, is a viral infectious disease of the upper respiratory tract that primarily affects the nose • The common cold is a self-limiting condition and must be distinguished from respiratory infections • The episodes of the common cold are mostly due to viruses • The symptoms attribute to the common cold include: o Cough o Runny nose o Blocked nose o Sore throat o Fever o Malaise o Headache and o Loss of appetite • Cough is the expulsion of air from the lungs with a sudden sharp sound. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 227 STEP 3: Indications of Cough and Cold Preparations (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the indications for cough and cold preparations? 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 Cough and cold preparations are indicated for: Preparations which contains Codeine, dextromethorphan (and some other opioids), antihistamines and soothing remedies like cough syrups are used for cough relief • Expectorants like guaphensin and mucolytic agents like carbocisteine are used to clean the thick sputum by reducing the viscosity • Sympathomimetic preparations like pseudoephedrine, antihistamines like brompheniramine, saline nose drops and hot fluids are used for nose congestion • Soothing remedies like syrups and lozenges and topical anaesthetic agents like benzocaine are used for sore throat relieves STEP 4: Dose, Dosage and Course of Cough and Cold Preparations (20 minutes) • The dose of cough and cold preparations depends on the type of the agent used in a preparation • It is important for a health worker to give right information to patients about the dose, dosage and course of the preparations • Read the leaflet inserted in a preparation in order to identify the ingredients used, their doses and dosages • Most of ingredients in cough and cold preparations are used in 8 hourly, 6 hourly or 4 hourly bases • Example 60mg of pseudoephedrine is used 3-4 times daily for adults and 30mg 3-4 daily for children above five years • The preparations should be used up to two weeks and if there is no improvement see your doctor for further check-up PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 228 STEP 5: Side Effects, Contraindications, Interactions and Precautions of Cough and Cold Preparations (55 minutes) Activity: Small Group Discussion ( 30 minutes) DIVIDE students into small manageable groups ASK students to discuss on the following question • What are Side/adverse effects, contraindications, interactions and precautions of cough and cold preparations? ALLOW students to discuss for 15 minutes ALLOW few groups to present and the rest to add points not mentioned CLARIFY and SUMMARIZE by using the contents below • Side effects and adverse effects o Codeine and dextromethorphan cause nausea, vomiting, constipation, dizziness and dependence o Antihistamines cause gastrointestinal disturbances plus central nervous system disturbances like nausea o High concentration of alcohol in cough syrups causes sedation by supressing the cough reflex. Also high concentration of sugar may cause osmotic diarrhoea o Expectorants cause gastric mucosa irritation, nausea and vomiting o Mucolytic agents cause bronchospasm, fever and gastrointestinal disturbances o Ephedrine and pseudoephedrine cause constriction of nasal blood vessels hence reducing mucosal swelling o Infants may choke due to aspiration if large volume of normal saline nasal drop is used o Lozenges cause aspiration in children • Contraindications o Most of mucolytic agents are contraindicated to peptic ulceration, and some in pregnancy and breast feeding o Codeine and dextromethorphan should be avoided in patients with acute respiratory depression o In intracranial pressure and head injury • Interactions and Precautions o Most drug combinations in cough and cold preparations have no rational basis as may contain ineffective or effective opposing ingredients such as expectorants with cough suppressants. Such