PST Level 4 Semester 2

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 Sera and Immunoglobulin Basic Pharmacology • Source Session/Topic 45 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 45: Description of Sera and Immunoglobulin 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 Sera and Immunoglobulin • List Contraindication of Sera and Immunoglobulin • Describe dose, dosage and course of Sera and Immunoglobulin • List side effects and adverse effects of Sera and Immunoglobulin • Describe interaction and precaution of Sera and Immunoglobulin Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer and projector • Handout 32.1: Management of rabies for exposed individuals SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation/ 2 20 minutes Indications of Sera and Immunoglobulin Buzzing Presentation/ 3 10 minutes Contraindication of Sera and Immunoglobulin brainstorming Dose, Dosage and Course of Sera and 4 40 minutes Presentation Immunoglobulin Presentation/ Side Effects and Adverse Effects of Sera and 5 20 minutes brainstorming Immunoglobulin Interaction and Precaution of Sera and 6 05minutes Presentation Immunoglobulin 7 10 minutes Presentation Key Points 8 10 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 288 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 Sera and Immunoglobulin (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following questions for 2 minutes • What are Sera and Immunoglobulins? • What are the indication of sera and immunoglobulins? 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 Definition • Antisera o Refers to purified and concentrated preparations of serum of horses actively immunized against a specific antigen o Example are Tetanus antitoxin (ATS), Gas gangrene antitoxin (AGS), Diphtheria antitoxin (ADS), Antirabies serum (ARS) and Antisnake venom polyvalent • Immunoglobulins (lGs) o Refers to a separated human gamma globulins which carry the antibodies o They are more efficacious than the corresponding antisera o Example are normal human gamma globulin, Anti-D immunoglobulin, Tetanus immunoglobulin, Rabies immuneglobulin and Hepatitis-B immunoglobulin Indications • Gamma – Globulins Injection o Indications for its use are viral hepatitis A and B (prophylaxis), measles, mumps, poliomyelitis and chickenpox (prophylaxis and modification of course of illness), and has some beneficial action in burns  It is especially valuable in agammaglobulinemia, premature infants and in patients of leukemia or those undergoing immunosuppression PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 289 • Anti-D(Rho) Immunoglobulin Injection o Prevention of Rho(D) sensitisation to rhesus negative woman • Anti-rabies Immunoglobulin Injection o Post-exposure prophylaxis against rabies infection • Activated Prothrombin o Treatment of bleeding episodes • Factor VII o Treatment of bleeding episodes • Snake venom polyvalent Antiserum injection o Snake bite/Poisoning • Tetanus Immunoglobulin o Post-exposure prophylaxis and treatment of tetanus infection  Indicated for prophylaxis in non-immunized persons receiving a contaminated wound who are at high risk of developing tetanus STEP 3: Contraindications of Sera and Immunoglobulin (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of sera and immunoglobulin? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • The immunoglobulins o Patients with a history of allergic reactions after administration of human immunoglobulin preparations o Individuals with isolated immunoglobulin A (IgA) deficiency (individuals could have an anaphylactic reaction to subsequent administration of blood products that contain IgA) • The antisera o Patients with hypersensitivity to horse serum or any other component of the serum PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 290 STEP 4: Dose, Dosage and Course of Sera and Immunoglobulin (40 minutes) • Gamma – Globulins Injection o Available as Gamma – Globulins Injection I.V 500mg, 2.5g and 5g o Hereditary haemolytic anaemia  Immunoglobulin IgG 400mg/kg (IV) daily for 5 days o Idiopathic thrombocytopenic Purpura (ITP) for the emergence of acute bleeding caused by severe thrombocytopenia  IV immunoglobulin may be given as a single dose infusion of 0.4-1.0g/kg followed immediately platelets transfusion Splenectomy • Anti-D(Rho) Immunoglobulin Injection o Available as Anti-D(Rho) Immunoglobulin Injection 0.25 mg/ml in set of 5ml o Dose by deep intramuscular injection, to rhesus-negative woman for prevention of Rho(D) sensitisation;  Following birth of rhesus-positive infant: 500 units immediately or within 72 hours  For transplacental bleed of over 4mL fetal red cells: Extra 100–125units per mL fetal red cells  Following any potentially sensitising episode (e.g. stillbirth, abortion, amniocentesis) up to 20 weeks‘ gestation . 250 units per episode (after 20 weeks, 500units) immediately or within 72 hours  Antenatal prophylaxis 500 units given at weeks 28 and 34 of pregnancy; if infant rhesus-positive, a further dose is still needed immediately or within 72 hours of delivery  Following Rho(D) incompatible blood transfusion 100–125 units per mL transfused rhesus-positive red cells • Anti-rabies Immunoglobulin Injection o Available as Anti-rabies Immunoglobulin Injection 1000 IU/5ml ampoule o Passive immunization of rabies  Anti-rabies human immunoglobulin 20 IU/kg half the dose given parenterally and the other half injected into and around the wound o Active immunization of rabies  Rabies immunoglobulin with the first dose (day 0) Tetanus toxoid vaccine Refer students to Handout 31.1: Management of rabies for exposed individuals for further reading • Activated Prothrombin o Treatment of bleeding episodes o Activated Prothrombin Complex Concentrate (APCC) 50-100IU/kg every12-24hrs • Factor VII PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

NTA Level 4 • Semester 2 • PST04211 Description of Vitamins and Minerals Basic Pharmacology • Source Session/Topic 44 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 44: Description of Vitamins and Minerals 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 vitamins and minerals • List Contraindications of vitamins and minerals • Describe dose, dosage and course of vitamins and minerals • List side effects and adverse effects of vitamins and minerals • Describe interactions and precautions of vitamins and minerals 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 Tasks Presentation/ 2 20 minutes Indications of Vitamins and Minerals Buzzing Presentation/ 3 20 minutes Contraindications of Vitamins and Minerals brainstorming Dose, Dosage and Course of Vitamins and 4 30 minutes Presentation Minerals Presentation/ Side Effects and Adverse Effects of Vitamins 5 20 minutes brainstorming and Minerals Interactions and Precautions of Vitamins and 6 15 minutes Presentation Minerals 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 282 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 Vitamins and Minerals (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the vitamins and minerals listed in national essential medicine list • What are the indications of Vitamins and Minerals? 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 • Vitamins are organic compounds and a vital nutrients that organisms require in limited amounts • Vitamins and minerals listed in national essential medicine list include: vitamin A, vitamin B complex, vitamin C, vitamin D, vitamin E, vitamin K, calcium and selenium • Indications of Vitamins and Minerals: o Vitamin A, is used for prevention and treatment of ocular defects known as xerophthalmia it is also used as a supplement where diet is known to be inadequate. o Vitamin B complex, is composed of nicotinamide, thiamine and riboflavin. It is used in management of vitamin B complex deficiencies, isoniazid induced neuropathy and penicillin induced neuropathy o Vitamin C is used in prevention and treatment of scurvy o Vitamin D, the term Vitamin D is used for a range of compounds which possess the property of preventing or treating rickets o Vitamin E is indicated for some neuromuscular abnormalities o Vitamin K is used for prevention and treatment of vitamin K deficiency bleeding o Calcium gluconate used in the management of hyperphosphataemia o Selenium is used in management of selenium deficiency PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 283 STEP 3: Contraindications of Vitamins and Minerals (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the Contraindications of Vitamins and Minerals? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Contraindication of vitamin and mineral o Vitamin A, is not contra indicated to any specific group of individual o Vitamin B complex, is not contra indicated to any specific group of individual but should be given with caution because it may cause anaphylactic shock when given by injection o Vitamin C is not contra indicated to any specific group of individual o Vitamin D is contraindicated to people with hypercalcaemia, metastatic calcification o Vitamin E is not contra indicated to any specific group of individual neonate weighing less than 1.5 kg o Vitamin K neonates, infants and women in their late pregnancy. o Calcium is contraindicated to people with all conditions associated with hypercalcaemia and hypercalciuria o Selenium is not contra indicated to any specific group of individual STEP 4: Dose, Dosage and Course of Vitamins and Minerals (30minutes) • Vitamin A, in prevention of vitamin deficiency, child 1 month–5 years, 5 drops daily (5 drops contain vitamin A approx. 700 units, vitamin D approx. 300 units, ascorbic acid approx. 20 mg) until the condition subside • Vitamin B complex, is usually formulated as a tablet contains combination of nicotinamide 15 mg, riboflavin 1 mg, thiamine hydrochloride 1 mg. The dose is usually 1–2 tablets daily • Vitamin C is given prophylactically at the dose 25–75 mg daily; therapeutic, not less than 250 mg daily in divided doses • Vitamin D, is given as oral supplement of only 10 micrograms (400 units) of Ergocalciferol, calciferol, vitamin D2 or colecalciferol daily • Vitamin E it is given as a supplement at the dose of 3 to 5mg daily until the condition subsides • Vitamin K 10–40 mg daily, adjusted as necessary; child 1–12 years, 5–10 mg daily, adjusted as necessary, 12–18 years, 10–20 mg daily, adjusted as necessary PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 284 • Calcium is presented as given orange flavored tablet of calcium carbonate at the dose of 2.5 g daily until the condition is corrected • Selenium is given by mouth or by intramuscular injection or by intravenous injection, 100–500 micrograms daily until the condition is corrected STEP 5: Side Effects and Adverse Effects of Vitamins and Minerals (20 Minute) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects and adverse effects of Vitamins and Minerals ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE

NTA Level 4 • Semester 2 • PST04211 Description of Oxytocics, Tocolytics and Related Medicines Basic Pharmacology • Source Session/Topic 43 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 43: Description of Oxytocics, Tocolytics and Related Medicines 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 essential oxytocics, tocolytics and related preparations • List contraindication of essential oxytocics, tocolytics and related preparations • Describe dose, dosage and course of essential oxytocics, tocolytics and related preparations • List common side effects and adverse effects of essential oxytocics, tocolytics and related preparations • Describe interactions and precautions of essential oxytocics, tocolytics and related preparations 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 tasks Presentation/ Clinical Indications of Oxytocics, Tocolytics 2 20 minutes Buzzing and Related Preparation Presentation/ Contraindications of Oxytocics, Tocolytics 3 20 minutes brainstorming and Related Preparation Dose, Dosage and Course of Oxytocics, 4 30 minutes Presentation Tocolytics and Related Preparation Presentation/ Common Side Effects and Adverse Effects of 5 20 minutes brainstorming Oxytocics, Tocolytics and Related Preparation Interaction and Precaution of Oxytocics, 6 15 minutes Presentation Tocolytics and Related Preparation 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 274 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: Clinical Indications of Essential Oxytocics, Tocolytics and Related Preparations (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the clinical indications of essential oxytocics, tocolytics and related 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 • According to Tanzania Standard treatment guideline, essential oxytocics, tocolytics and related preparations include salbutamol, ergometrine, oxytocin, misoprostol and magnesium sulphate Salbutamol • Salbutamol is used for myometrial relaxation • It is used in selected cases in attempt to inhibit premature labor once it has begun. Ergometrine • Its main action is the production of intense contractions • It is used in the active management of the third stage of labor, and to prevent or treat postpartum or postabortal haemorrhage caused by uterine atony • Ergometrine maleate or methylergometrine maleate have been used in a provocation test for the diagnosis of Prinzmetal's angina Oxytocin • Synthetic oxytocin is the most widely used drug for stimulating uterine contractions following the rapture of membranes during labor • It is also used to augment abnormal labor that is protracted or displays arrest disorder. • Oxytocics used in the immediate postpartum period, including the control of uterine hemorrhage after vaginal or cesarean delivery (Postpartum Haemorrhage – PPH) PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 275 Misoprostol • It is commonly used for labor induction • It causes uterine contractions and the ripening (effacement or thinning) of the cervix • It is also used to prevent and treat stomach ulcers, and treat postpartum bleeding due to insufficient contraction of the uterus Magnesium Sulphate • Used as a tocolytics to stop preterm labor and for severe pre-eclampsia STEP 3: Contraindication of Essential Oxytocics, Tocolytics and Related Preparation (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of essential oxytocics, tocolytics and related preparation? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below Salbutamol • Salbutamol is contraindicated in the suppression of labor in women with heart disease, eclampsia or severe pre- eclampsia, antepartum haemorrhage or placenta previa • It should be used with caution in women with diabetes, hypertension or hyperthyroidism Oxytocin • Oxytocin is contraindicated in women, for whom vaginal delivery is contraindicated because of conditions such as unfavorable foetal position (e.g. transverse lie) or placenta previa – a condition in which the placenta grows over the cervix, blocking the baby‘s exit Ergometrine • Ergometrine maleate is contra-indicated for the induction of labor or for use during the first stage of labor • Ergometrine maleate has been associated with acute attacks of porphyria and is considered unsafe in porphyric patients Misoprostol • Misoprostol is contraindicated in Pregnancy when used to reduce risk of NSAID-induced ulcers and to individuals with hypersensitivity to misoprostol, prostaglandins, or prostaglandin analogues PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 276 Magnesium sulphate • Magnesium sulphate is contraindicated in the patients with the following conditions:- o Hypersensitivity, myocardial damage, diabetic coma, heart block, hypermagnesemia, hypercalcemia • Administration during 2 hours preceding delivery for mothers with toxemia of pregnancy STEP 4: Dose, Dosage and Course of Essentail Oxytocics, Tocolytics and Related Preparation (30 minutes) Salbutamol • 10 micrograms per minute of Salbutamol is given and gradually increasing to 45 micrograms per minute until contraction has ceased and then reduce gradually • Alternatively, give by IM injection 100 -250 micrograms and repeat according to the patient response and subsequently, give orally 4mg every 6 to 8 hours as maintenance dose • Salbutamol is administered by IV infusion using dextrose 5% until 12 to 48 hour after contractions have ceased, followed by oral maintenance therapy Oxytocin • For induction of labor use: Oxytocin IV the dose will depend on parity o Primigravida:  Oxytocin IV 5 IU in 500mls of fluid titrate at 15, 30, 60 drops per minute until desired uterine contractions are attained o Multiparous:  Oxytocin IV Starts

NTA Level 4 • Semester 2 • PST04211 Description of Eye, Ear and Nose Preparations Basic Pharmacology • Source Session/Topic 42 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 42: Description of Eye, Ear and Nose Preparations Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List preparations of the eye, ear and nose and their indications • List Contraindication of eye, ear and nose preparations • Describe dose, dosage and course of eye, ear and nose preparations • List side effects and adverse effects of eye, ear and nose preparations • Describe interactions and precautions of eye, ear and nose 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 A List of the Eye, Ear And Nose Preparations 2 40 minutes small Group and their indications Discussion Dose, Dosage and Course of the Eye, Ear and 3 20 minutes Presentation Nose Preparations Presentation Side Effects and Adverse Effects of the Eye, 4 20 minutes Buzzing Ear and Nose Preparations Presentation Contraindications of the Eye, Ear and Nose 5 10 minutes Brainstorming Preparations Presentation Interactions and Precautions of 6 15 minutes Brainstorming the Eye, Ear and Nose Preparations 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 267 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: List of the Eye, Ear and Nose Preparations and their indications (40 minutes) Activity: Small Group Discussion ( 30 minutes) DIVIDE students into small manageable groups ASK students to discuss on the following question • What are the eye,ear and nose preparations that are used in clinical settings? • What are the indications of the eye, ear and nose 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 List of preparations • Nasal preparations o Beclomethasone spray o Ephedrine nasal drops • Ear preparations o Chroramphenicol ear drops o Neomycin + Dexamethasone ear drops o Ciprofloxacin ear drops o Aluminium diacetate ear drops • Eye preparations o Anti-effective agents  Acyclovir ointment  Chloramphenicol drops  Chloramphenicol ointment  Gentamycin drops  Povidone iodine  Oxytetracycline ointment  Ciprofloxacin  Dexamethasone + Chloramphenicol PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 268  Dexamethasone + Gentamycin  Natamycin  Econazole o Steroidal anti-inflammatory agents  Dexamethasone  Prednisolone  Methylprednisolone  Triamcinolone cream and injection o Ant infective and ant inflammatory agents  Cyclopentolate  Atropine  Timolol  Hydroxypropylmethylcellulose  Iodoxamine tromethazine  Sodium cromogylate  Pilocarpine  Zinc sulphate  Latanoprost  Acetazolamide Indications • The eye preparations can be indicated in either of the following: o Bacteria, fungal and viral infections o Inflammations like conjunctivitis o Mydriasis and cycloplegia o Anaesthesia induction o Glaucoma o Lubrication o Diagnosis • The ear preparations are usually indicated in microbial infections, inflammations like otitis media and lubrication in removal of ear wax • The nose preparations are indicated in microbial infections of the nose, diagnosis of nose disorders, inflammations of the nose and shrinking of the nasal polyps by corticosteroids STEP 3: Dose, Dosage and Course of Eye, Ear and Nose Preparations (20 minutes) • The dose of respective antimicrobial agent should be given to an individual depending on the diagnosis, weight and vital body organs functions • The dosage of respective antimicrobial agent depends on the severity of diagnosis, half life of an agent and vital organ functions • One to two drops of eye formulations are given 2-4 times a day depending on their half lives PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 269 • 2-3 drops of ear formulations is given 3-4 times a day and reducing the frequency as the day dose • The course of antibacterial treatment can be up to 14 days, antifungal up to three months and antiviral up to six weeks • Lubricants can be used until there is a promising outcome • The duration of treatment with steroidal ant inflammatory agents should be short especially in corticosteroids because are immunosuppressants STEP 4: Side effects of Eye, Ear and Nose Preparations (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question • What are the side effects of the eye, ear and nose preparations listed above? 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 • Aplastic anaemia and transient stinging caused by preparations containing chloramphenicol • Local burning and itching; lid margin crusting; hyperaemia; taste disturbances; corneal staining, keratitis, lid oedema, lacrimation, photophobia, corneal infiltrates; nausea and visual disturbances reported in preparations containing ciprofloxacin and other quinolones • Local irritation and inflammation, superficial and punctate keratopathy in products containing acyclovir • Aggravation of red eye, steroid cataract and glaucoma and thinning of cornea and sclera for eye corticosteroids • Local sensitivity reactions may occur in ear preparations • Dryness, irritation of nose and throat, and epistaxis in nose corticoid preparations. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 270 STEP 5: Contraindications of Eye, Ear and Nose Preparations (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of the eye, ear and nose preparations? ALLOW few students to respond WRITE their responses

NTA Level 4 • Semester 2 • PST04211 Description of Muscle Relaxants and Cholinesterase Inhibitors Basic Pharmacology • Source Session/Topic 41 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 41: Description of Muscle Relaxants and Cholinesterase Inhibitors Total Session Time: 120 minutes Prerequisite module • None Learning Tasks By the end of this session students are expected to be able to: • List indications of muscle relaxants and cholinesterase inhibitors • List Contraindication of muscle relaxants and cholinesterase inhibitors • Describe dose, dosage and course of muscle relaxants and cholinesterase inhibitors • List side effects and adverse effects of muscle relaxants and cholinesterase inhibitors • Describe interaction and precaution of muscle relaxants and cholinesterase inhibitors 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/ Listing Indications of Muscle Relaxants and 2 20 minutes Buzzing Cholinesterase Inhibitors Presentation/ Listing Contraindication of Muscle Relaxants 3 20 minutes brainstorming and Cholinesterase Inhibitors Description of Dose, Dosage and Course of 4 30 minutes Presentation Muscle Relaxants and Cholinesterase Inhibitors Listing Side Effects and Adverse Effects of Presentation/ 5 20 minutes Muscle Relaxants and Cholinesterase brainstorming Inhibitors Description of Interaction and Precaution of 6 15 minutes Presentation Muscle Relaxants and Cholinesterase Inhibitors 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 260 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 Muscle Relaxants and Cholinesterase Inhibitors (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are muscle relaxants and cholinesterase inhibitors? • What are the indications of muscle relaxants and cholinesterase inhibitors? 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 • Muscle relaxants are also known as neuromuscular blocking drugs. They include: Gallamine, Suxamethonium Chloride, Vecuronium Bromide, and Pancuronium Bromide. Anti-cholinesterase includes Edrophonium and Neostigmine • They are used in anaesthesia o They enable light anaesthesia to be used with adequate relaxation of the muscle o Gallamine is used to produce relaxation of skeletal muscle during surgery o Suxamethonium Chloride is used for short to intermediate duration neuromuscular blockade for surgery or during intensive care o Vecuronium Bromide is used for intermediate duration neuromuscular blockade for surgery or during intensive care o Pancuronium Bromide is used for long duration neuromuscular blockade for surgery or during intensive care • Anticholinesterases reverse the effects of the non-depolarising (competitive) neuromuscular blocking drugs such as pancuronium but they prolong the action of depolarizing neuromuscular blocking drugs o Edrophonium has a transient action and may be used in the diagnosis of suspected dual block due to suxamethonium o Neostigmine has a longer duration of action than edrophonium and is used specifically for reversal of nondepolarising (competitive) blockade PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 261 STEP 3: Contraindication of Muscle Relaxants and Cholinesterase Inhibitors (20 Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the Contraindication of muscle relaxants and cholinesterase inhibitors? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Most muscle relaxants are not contraindicated to any specific individuals except Suxamethonium and galamine chloride which is contraindicated to those with: o Family history of malignant o Hyperthermia o Hyperkalaemia o Major trauma o Severe burns o Neurological disease involving acute wasting of major muscle o Prolonged immobilisation o Hyperkalaemia o Low plasma-cholinesterase activity (including severe liver disease) • Cholineaterase inhibitors are contraindicated in o Intestinal obstruction o Urinary obstruction STEP 4: Dose, Dosage and Course of Muscle Relaxants and Cholinesterase Inhibitors (30 minutes) • Dose dosage and course of muscle relaxants o Atracurium Besilate:  Surgery or intubation, adult and child over 1 month, by intravenous injection, initially 300–600 micrograms/kg, then 100–200 micrograms/kg as required  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 PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 262 o Suxamethonium Chloride  By intravenous injection, initially 1 mg/kg; maintenance, usually 0.5–1 mg/kg at 5–10 minute intervals; max. 500 mg/hour; CHILD under 1 year, 2 mg/kg; CHILD over 1 year, 1 mg/kg  By intravenous infusion of a solution containing 1–2 mg/mL (0.10.2%), 2.5–4 mg/minute; max. 500 mg/hour; CHILD reduce infusion rate according to body- weight  By intramuscular injection, CHILD under 1 year, up to 4–5 mg/kg; CHILD over 1 year, up to 4 mg/kg; max o Gallanium  Adults: 1-1.5 mg/kg i.v. initially, then 0.5-1 mg/kg as required at about 40-minute intervals  Children: 1.5 mg/kg initially, then 0.5 mg/kg as required  Infants of less than 1 month: 250-750 micrograms/kg initially, then 100-500 micrograms/kg o Mivacurium  Intravenous injection, 70–250 micrograms/kg; maintenance 100 micrograms/kg every 15 minutes  CHILD 2–6 months initially 150 micrograms/kg, 7 months–12 years initially 200 micrograms/kg o Vecuronium Bromide  By intravenous injection, intubation, adult and child, initially 80–100 micrograms/kg; maintenance 20–30 micrograms/kg adjusted according to response; neonate  By intravenous infusion, 0.8–1.4 micrograms/kg/minute (after initial intravenous injection of 40–100 micrograms/kg) o Pancuronium Bromide  Intubation, by intravenous injection, initially 50–100 micrograms/kg then 10–20 micrograms/kg as required: Intensive care, by intravenous injection, 60 micrograms/kg every 60–90 minutes • Dose dosage and course of cholinesterase inhibitors o Edrophonium Is given by intravenous injection over several minutes, 500–700 micrograms/kg (after or with atropine) o Neostigmine Is given

NTA Level 4 • Semester 2 • PST04211 Description of General and Local Anaesthetics Basic Pharmacology • Source Session/Topic 40 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 40: Description of General and Local Anaesthetics 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 general and local anaesthetics • List Contraindication of general and local anaesthetics • Describe dose, dosage and course of general and local anaesthetics • List side effects and adverse effects of general and local anaesthetics • Describe interaction and precaution of general and local anaesthetics 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 General and Local Anaesthetics Buzzing Presentation/ Contraindication of General and Local 3 20 minutes brainstorming Anaesthetics Dose, Dosage and Course of General and 4 30 minutes Presentation Local Anaesthetics Presentation/ Side Effects and Adverse Effects of General 5 20 minutes brainstorming and Local Anaesthetics Interaction and Precaution of General and 6 15minutes Presentation Local Anaesthetics 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 253 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 General and Local Anaesthetics (20 Minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the general and local anaesthetics? • What are the indications of general and local anaesthesia? 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 • General anaesthetics include; halothane, ketamine, isoflurane and thiopental while local anaesthetic include lignocaine and bupivavaine • Indication of General anaesthetics include: o Halothane is occasionally used for inhalation induction of anaesthesia with careful monitoring for cardiorespiratory depression and arrhythmias o Ketamine is useful in induction and maintenance of anaesthesia it is used during surgery and intubation o Isoflurane is a volatile liquid anaesthetic, it is used in induction and maintenance of anaesthesia, it is useful during surgery and intubation o Thiopental is used in induction of general anaesthesia, anaesthesia of short duration reduction during surgery and intubation • Indication of Local anaesthetics include: o Bupivacaine labour, surgery and local infiltration o Lignocaine is used as infiltration anaesthesia, intravenous regional and nerve block, surface anaesthesia and nerve block PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 254 STEP 3: Contraindications of General and Local Anaesthetics (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the Contraindications of general and local anaesthetics? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Contra indication of General anaesthetics;. o Halothane is contraindicated if the anaesthetist is not confident of being able to maintain the airway (e.g. in the presence of a tumour in the pharynx or larynx) Extreme care is required in surgery of the mouth, pharynx, or larynx and in patients with acute circulatory failure o Ketamine is contraindicated if the anaesthetist is not confident of being able to maintain the airway (e.g. in the presence of a tumor in the pharynx or larynx). Extreme care is required in surgery of the mouth, pharynx, or larynx and in patients with acute circulatory failure. Also in hypertension, pre-eclampsia or eclampsia, severe cardiac disease, raised intracranial pressure, head trauma, acute and porphyria. o Isoflurane is contraindicated to women who are breast feeding o Thiopental is contraindicated if the anaesthetist is not confident of being able to maintain the airway (e.g. in the presence of a tumor in the pharynx or larynx). Extreme care is required in surgery of the mouth, pharynx, or larynx and in patients with acute circulatory failure. Also in acute porphyria, myotonic dystrophy and breast-feeding • Contra indication of Local anaesthetics; o Bupivacaine is contraindicated in hypovolemia, complete heart blockade should not be used in solutions containing adrenaline for anaesthesia in appendages o Lignocaine like bupivacaine, it is contraindicated in hypovolaemia, complete heart blockade should not be used in solutions containing adrenaline for anaesthesia in appendages PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 255 STEP 4: Dose, Dosage and Course of General and Local Anaesthetics (30minutes) • Dose, dosage, and course of General Anaesthetics are as follows. o Halothane:  Induction of anaesthesia: adult and child over 1 month are initially given 0.5% then increased gradually according to response to 2–4%  Using specifically calibrated vaporiser, in oxygen or nitrous oxide- oxygen  Maintenance of anaesthesia: adult and child over 1 month, 0.5–2% using specifically calibrated vaporiser, in oxygen or nitrous oxide–oxygen o Ketamine:  By intramuscular injection; For short procedures, initially 6.5–13 mg/kg, adjusted according to response  By intravenous injection; For short procedures, initially 1–4.5 mg/kg, adjusted according to response  By intravenous infusion; A solution containing 1 mg/Ml is used in longer procedures for induction, a total dose of 0.5–2 mg/kg may be given. The maintenance dose of 10–45 micrograms/ kg/minute is required and the rate may be adjusted according to response o Isoflurane:  Induction of anaesthesia, the does is increased gradually from 0.5% to 3% using specifically calibrated vaporiser, in oxygen or nitrous oxide–oxygen  Maintenance of anaesthesia; is given at 1–2.5% in nitrous oxide–oxygen using specifically calibrated vaporizer. Additional 0.5–1% may be required when given with oxygen alone o Thiopental:  The

NTA Level 4 • Semester 2 • PST04211 Description of Antipsychotic Drugs Basic Pharmacology • Source Session/Topic 39 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 39: Description of Antipsychotic 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 antipsychotic drugs • List contraindication of antipsychotic drugs • Describe dose, dosage and course of antipsychotic drugs • List side effects and adverse effects of antipsychotic drugs • Describe interactions and precautions of antipsychotic drugs 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 Tasks Presentation 2 20 minutes Indications of antipsychotic drugs Brainstorming 3 20 minutes Presentation Contraindication of antipsychotic drugs Dose, dosage and course of antipsychotic 4 30 minutes Presentation drugs Presentation Side effects and adverse effects of 5 20 minutes Buzzing antipsychotic drugs Interaction and precaution of antipsychotic 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 248 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 Antipsychotic Drugs (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • Mention anti antipsychotic drugs • What are the indications of antipsychotic 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 • They are divided into two groups: o First-generation antipsychotics, also known as typical antipsychotics o Examples are:  Chlorpromazine  Haloperidol  Thioridazine  Fluphenazine o Second-generation drugs, known as atypical antipsychotics o Examples are:  Clozapine  Olanzapine  Risperidone • Antipsychotics (also known as neuroleptics or major tranquilizers) are drugs that are used to treat psychotic disorders STEP 3: Contraindications of Antipsychotic Drugs (20 minutes) • They are contraindicated in clients with o Hypersensitivity o Liver damage o Coronary artery disease o Cerebrovascular disease o Parkinsonism o Bone marrow depression PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 249 o Severe hypotension or hypertension o Coma o Severely depressed states STEP 4: Dose, Dosage and Course of Antipsychotic Drugs (30 minutes) • Treatment of acute attacks (schizophrenia): o Haloperidol 5 mg every 30 minutes for 2 hours • For maintenance: o Chlorpromazine 100 – 600 mg (O) daily in divided doses OR o Haloperidol 3-4.5 mg (O) 12hourly OR o Olanzapine 5-10mg 12 hourly. Maximum dose 25mg/day OR o Risperidone 1mg bid then increase by 1mg every 2-3 days to 2 – 3mg twelve hourly. Maximum dose 16mg/day • For patients who have poor compliance o Fluphenazine decanoate 12.5–50 mg IM every 4 weeks. STEP 5: Side Effects and Adverse Effects of Antipsychotic Drugs (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are common adverse effects of Antipsychotics? 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 Common side effects of antipsychotics include: o Sedation (particularly common in patients on clozapine, olanzapine, quetiapine and chlorpromazine o Headaches o Dizziness o Diarrhea o Anxiety • Extrapyramidal side effects (particularly common in patients on first-generation antipsychotics), which includes: o Akathisia — an often distressing sense of inner restlessness. o Dystonia o Parkinsonism o Tremor PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 250 • Hyperprolactinaemia (rare for those on clozapine, quetiapine and aripiprazole) which can cause: o Galactorrhoea unusual secretion of breast milk. o Gynaecomastia o Sexual dysfunction (in both sexes) o Osteoporosis • Orthostatic hypotension • Weight gain (particularly prominent in patients on clozapine, olanzapine and quetiapine) • Anticholinergic side-effects (common for olanzapine, clozapine) such as: o Blurred vision o Constipation o Dry mouth (although hypersalivation may also occur) o Reduced perspiration • Tardive dyskinesia appears to be more with haloperidol and is characterised by; o Slow (hence the tardive) repetitive, involuntary and purposeless movements, most often of the face, lips, legs, or torso STEP 6: Interactions and precautions of antipsychotic drugs (15 minutes) Antipsychotics should be used cautiously in people with: • Seizure disorders • Diabetes mellitus • Glaucoma • Prostatic hypertrophy • Peptic ulcer disease • Chronic respiratory disorders STEP 7: Key Points (5 minutes) • Antipsychotics are drugs that are used to treat psychotic disorders • Antipsychotics are contraindicated in various medical conditions including patients who are hypersensitive to these drugs • Different doses of antipsychotics are used during acute and maintenance treatment of schizophrenia STEP 8: Evaluation (5 minutes) • What is the indication of antipsychotics? • What are the contraindications of antipsychotics? • What are the dose and dosage of antipsychotics? • What are the precautions of antipsychotics? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 251 References MoHSW (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 (6thed) New York, Lippincott Williams and Wilkins. School of Pharmaceutical Sciences (2011).Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam: ARDHI University Press. Talbert, R. L. Yee, G. C. Matzke, G. R. Wells, B. G. & Michael, L. (2014) Pharmacotherapy: a pathophysiologic approach (9th ed.). New York: McGraw-Hill Education. The Royal Pharmaceutical Society of Great Britain (2007). Martindale, the Extra Pharmacopoeia (5th ed). London: Pharmaceutical Press. The Royal Pharmaceutical Society

NTA Level 4 • Semester 2 • PST04211 Description of Anti-epileptics and Anticonvulsant Drugs Basic Pharmacology • Source Session/Topic 38 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 38: Description of Anti-epileptics and Anticonvulsant 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 anti-epileptics and anticonvulsant Drugs • List contraindications of anti-epileptics and anticonvulsant Drugs • Describe dose, dosage and course of anti-epileptics and anticonvulsant Drugs • List side effects and adverse effects of anti-epileptics and anticonvulsant Drugs • Describe interactions and precautions of anti-epileptics and anticonvulsant Drugs Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Computer and LCD Projector SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation Indications of Anti-Epileptics and 2 10 minutes Brainstorming Anticonvulsant Drugs Presentation Contraindications of Anti-epileptics and 3 20 minutes Buzzing Anticonvulsant Drugs Dose, Dosage and Course of Anti-epileptics 4 30 minutes Presentation and Anticonvulsant Drugs Presentation Side effects and Adverse Effects of Anti- 5 25 minutes Brainstorming epileptics and Anticonvulsant Drugs Interactions and Precautions of Anti-epileptics 6 20 minutes Presentation and Anticonvulsant Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 241 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-epileptics and Anticonvulsant Drugs (10 minutes) Activity: Brainstorming (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • Mention Anti-epileptics and Anticonvulsant Drugs • What are the indications of Anti-epileptics and Anticonvulsant 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 • Anti-epileptics include Phenobarbitone, Phenytoin, Carbamazepine and Sodium Valproate • Anti-epileptic drugs are used in management of Epilepsy • Anticonvulsants include Diazepam and Clonazepam • Anti convulsant drugs are used in management of Status epilepticus STEP 3: Contraindications of Anti-epileptics and Anticonvulsant Drugs (20 minutes) Activity: Buzzing (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of Anti-epileptics and Anticonvulsant 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 242 • Anti-epileptics Following are contraindications of phenobarbitone o Acute intermittent porphyria o Pulmonary diseases with decreased respiratory reserve (due to respiratory depressant effect) o Pregnant and nursing mothers o Hypersensitivity Following are contraindications of carbamazepine o Previous bone marrow depression o Atrioventricular conduction abnormalities o Should not be given to patients taking MAO inhibitors or within 14 days of stopping such treatment o Pregnant and nursing mothers Following are contraindications of phenytoin o Pregnancy- it is teratogenic drug causing ―foetal hydantoin syndrome‖ craniofacial anomalies, mental retardation and limb defect o Hypersensitivity to the drug o Heart blocks, sinus bradycardia • Anticonvulsants In treatment of status epilepticus, drug of 1st choice is Diazepam or Clonazepam; 2nd choice treatment is Phenobarbitone; 3rd choice is Phenytoin. • Diazepam/ Clonazepam o It is contraindicated to people with allergy to benzodiazepines o Contraindicated to people with the following conditions:  Alcohol Intoxication, Depression, Myasthenia Gravis, Wide-Angle Glaucoma, Closed Angle Glaucoma, CYP2C19 Poor Metabolizer, Severe Chronic Obstructed Lung Disease, Significant Decrease in Lung Function, Lung Disease, Liver Problems, Severe Liver Disease, Serious Kidney Problems, Temporarily Stops Breathing While Sleeping, Pregnancy, A Mother who is Producing Milk and Breastfeeding, Low Amount of Albumin Proteins in the Blood STEP 4: Dose, dosage and course of Anti-epileptics and Anticonvulsant Drugs (30minutes) • Epilepsy o Phenobarbitone (O) once daily at night  Children: 3mg/kg/24 hours  Adult: 60 to 90 mg o Phenytoin (O) once daily at night or twice daily when required  Children: 5mg/kg/24 hours  Adult: 200 mg o Carbamazepine (O) as two divided doses  Children: 10mg/kg/24 hours PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 243  Adult: 300 mg 12 hourly o Sodium valproate (O)  Children: 20mg/kg in divided doses  Adult: 600 mg in divided doses • Status epilepticus First choice: o Diazepam (IV) 10 – 20 mg at a rate of 5mg per minute. Repeat in 30 -60 minutes if necessary to a maximum of 200 mg in 24 hours; monitor respiration OR o Clonazepam (O) 0.5mg to 2mg. Once the status epilepticus has been controlled the patient should be maintained on other anti-epileptics Second choice: o Phenobarbitone 200mg (IV) slowly. Repeat after 10 minutes, thereafter it may be repeated every 30 minutes to a maximum of 15mg/kg/24 hours Third choice: o Phenytoin (IV) 150-250 mg at a rate not exceeding 50 mg/minute. Continue with 100 mg every 6 hours, but do not exceed 15mg/kg/24 hours STEP 5: Side Effects and Adverse Effects of Anti-Epileptics and Anticonvulsant Drugs (25 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side and adverse effects of Anti-epileptics and Anticonvulsant 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 Anti-epileptic Drugs are o Phenobarbitone: Hepatitis, hypotension, respiratory depression, behavioural disturbances, irritability, drowsiness, depression, hallucinations, impaired memory and cognition, hyperactivity particularly in the elderly and in children, megaloblastic anaemia (may be treated with folic acid), suicidal ideation o Phenytoin: Nausea, vomiting, constipation, drowsiness, insomnia, transient nervousness, tremor, dizziness, headache, anorexia, rash, acne, blood disorders (including megaloblastic anaemia, leucopenia, thrombocytopenia, and aplastic anaemia) PST 04211 Basic Pharmacology NTA Level 4 Semester

NTA Level 4 • Semester 2 • PST04211 Anti-asthmatic Drugs Basic Pharmacology • Source Session/Topic 37 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 37: Anti-asthmatic 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 anti-asthmatic drugs • Describe dose, dosage and course of anti-asthmatic drugs • List common side effects and adverse effects of anti-asthmatic drugs • List contraindications of anti-asthmatic drugs • Describe interactions, warnings and precautions of anti-asthmatic drugs 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 Introduction to Essential Anti-asthmatic 2 10 minutes Brainstorming Drugs Presentation/ 3 15 minutes Indications of Essential Anti-asthmatic Drugs Buzzing Dose, Dosage and Course of Treatment of 4 30 minutes Presentation Essential Anti-asthmatic Drugs Presentation/ Side Effects and Adverse Effects of Essential 5 20 minutes Buzzing Anti-asthmatic Drugs Presentation/ Contraindications of Essential Anti-asthmatic 6 10 minutes Brainstorming Drugs Interactions, Warning and Precautions of 7 20 minutes Presentation Essential Anti-asthmatic Drugs 8 05 minutes Presentation Key Points 9 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 232 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: Introduction to Essential Anti-asthmatic Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What is asthma? • What are the essential anti-asthmatic drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below Asthma • Asthma is an inflammatory condition in which there is recurrent reversible airway obstruction in response to irritant stimuli that are too weak to affect non-asthmatic subjects, characterized by attacks of wheezing, shortness of breath and often nocturnal cough. • Severe attacks are life-threatening • Essential features o Airway inflammation, which causes bronchial hyper-responsiveness, which in turn results in recurrent reversible airway obstruction Essential Anti-Asthmatic Drugs • Anti-asthmatic drugs are mainly categorized into two major groups o Bronchodilators o Anti-inflammatory agents • Most drugs acting on respiratory tract are adrenoceptor agonists, or sympathomimetic agents (bronchodilators) and corticosteroids (used as ‗controllers‘ or anti-inflammatory) • The two categories (above) are not mutually exclusive, that is some drugs classified as bronchodilators also have some anti-inflammatory effect • According to Tanzania standard guideline, essential anti-asthmatic drugs include aminophylline, beclomethasone inhalation, cromoglycate nasal spray, salbutamol, ipratropium aerosol and adrenaline PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 233 STEP 3: Indications of Essential Anti-asthmatic Drugs (15 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the clinical indications of essential anti-asthmatic 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 • Aminophylline o Is used for treating active symptoms and blockage of airway due to asthma or other lung diseases such as emphysema or bronchitis. o It improves contraction of the diaphragm (the major breathing muscle). o It is used in combination with other medicines. • Beclomethasone Inhalation o It can be used to treat asthma and other allergic conditions • Sodium Cromoglycate nasal spray o It is used to treat asthma and other allergic conditions o It is considered a breakthrough drug in management of asthma, as the patients can be freed from steroids in many cases; however, it is mainly effective as a prophylaxis for allergic and exercise induced asthma, not as a treatment for acute attacks • Salbutamol o Salbutamol is typically used to treat bronchospasm (due to any cause, allergen asthma or exercise-induced), as well as chronic obstructive pulmonary disease. o It is used to relieve bronchospasm in bronchial asthma, chronic bronchitis, emphysema and other airway resistance diseases • Ipratropium Inhalation aerosol o Is indicated as a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. • Adrenaline o Adrenaline is the drug of choice for allergic emergencies o In general this drug is used to treat life-threatening emergencies such as severe allergic reactions (anaphylaxis) such as acute asthmatic attack, cardiac arrest and cardiopulmonary resuscitation (when the heart stops beating and/or the patient stops breathing). PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 234 STEP 4: Dose, Dosage and Course of Treatment of Essential Anti- Asthmatic Drugs (30 minutes) Aminophylline • Acute severe asthma adults orally 100-300mg 3- 4 times daily after food or by slow intravenous injection over at least 20 minutes (with close monitoring), 250–500 mg (5 mg/kg), child 5 mg/kg Beclomethasone Inhalation • Adult Dose for Asthma – Maintenance o 40 mcg/inh and 80 mcg/inh inhalation aerosols:  2 inhalations (40 mcg each) twice a day  Alternatively, 2 inhalations (80 mcg each) twice daily has been effective in some patients who previously received inhaled steroids  Do not exceed 640 mcg a day • Pediatric Dose for Asthma – Maintenance o Children over 12 years of age: o 40 mcg/inh and 80 mcg/inh inhalation aerosols:  1 or 2 inhalations (40 mcg each) twice a day. Or 1 inhalation (80 mcg) twice a day  Alternatively, 2 inhalations (80 mcg each) twice daily has been effective in some patients who previously received inhaled steroids Cromoglycate Nasal spray • The usual dose is to apply one spray into each nostril, four to six times each day Salbutamol • Sabutamol may be given as following dosage: o For chronic asthma 4mg tablet 3-4 times a