PST Level 4 Semester 2

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

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

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

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

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

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

NTA Level 4 • Semester 2 • PST04211 Description of Antinflamatory and Antipruritic Drugs Basic Pharmacology • Source Session/Topic 16 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 16: Description of Antinflamatory and Antipruritic 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 Antinflamatory and Antipruritic Drugs • List Contraindication of Antinflamatory and Antipruritic Drugs • Describe dose, dosage and course of Antinflamatory and Antipruritic Drugs • List side effects and adverse effects of Antinflamatory and Antipruritic Drugs • Describe interaction and precaution of Antinflamatory and Antipruritic 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/ Indications of Antinflamatory and Antipruritic 2 10 minutes Buzzing Drugs Presentation/ Contraindication of Antinflamatory and 3 10minutes brainstorming Antipruritic Drugs Dose, Dosage and Course of Antinflamatory 4 10 minutes Presentation and Antipruritic Drugs Presentation/ Side Effects and Adverse Effects of 5 10 minutes brainstorming Antinflamatory and Antipruritic Drugs Interaction and Precaution Antinflamatory and 6 05minutes Presentation Antipruritic Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 95 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 Topical Anti inflammatory and Antipruritic Drugs (10minutes) Activity: Buzzing (5minutes) ASK students to pair up and buzz on the following questions for 5minutes • What essential topical anti inflammatory and anti pruritic drugs are used in clinical practice? • What are the indications of topical anti inflammatory and antipruritic drugs? ALLOW few learners to respond WRITE their responses on the flipchart CLARIFY and SUMMARIZE by using the content below • Topical anti-inflammatory preparations include betamethazone, hydrocortisone, clobetasol proprionate. • They are used in management of: o Inflammatory conditions of the skin o Contact dermatitis o Insects sting o Eczema o Psoriasis • Topical antipruritic agents include calamine, dithranol, tretionin acid, para amino benzoic acid and calciprotrial. They are used in the management of Pruritus associated with: o Mild eczematous dermatoses o Pruritus associated with atopic dermatitis o Lichen simplex chronicus PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 96 STEP 3: Contraindication of Topical Anti inflammatory and Antipruritic Drugs (10 minutes) Activity: brainstorming (5 minutes) students to brainstorm on the following question: • What are the contraindications of topical anti inflammatory and antipruritic drug? ALLOW few learners to respond WRITE their responses on the flipchart CLARIFY and SUMMARIZE by using the content below • Topical anti-inflammatory preparations are contraindicated to: o Those who demonstrate hypersensitivity to them o In untreated infections o Wide spread plaque psoriasis • Topical antipruritic are contraindicated to: o Acute exudative dermatoses STEP 4: Dose, Dosage and Course of Topical Anti inflammatory and Antipruritic Drug (10minutes) • Topical anti-inflammatory preparations: o Topical preparations should be applied once daily • Topical antipruritic o Topical application of the cream should be performed four times daily for up to 8 days of therapy STEP 5: Side Effects and Adverse Effects of Topical Anti inflammatory and Antipruritic Drug (10 Minutes) Activity: brainstorming (5 minutes) students to brainstorm on the following question: • What are the side effects and adverse reaction of topical anti inflammatory and antipruritic drug? ALLOW few learners to respond WRITE their responses on the flipchart CLARIFY and SUMMARIZE by using the content below PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 97 • Topical anti-inflammatory preparations: (corticosteroids) o Skin atrophy o Purpura o Ecchymosis o Steroid rosacea, o Erythema o Perioral dermatitis o Steroid acne o Hypopigmentation o Hypertrichosis o Allergic contact dermatitis • Topical antipruritic o Transient burning o Stinging o Drowsiness o Rash o Irritation STEP 6: Interaction and Precaution of Topical Anti inflammatory and Antipruritic Drug (5 minutes) • Topical anti-inflammatory preparations: o avoid prolonged use on the face and in the children • Topical antipruritic o Interact tricyclic antidepressants o Avoid near eyes o Avoid in broken skin Step 7: Key Points (5minutes) • Topical anti inflammatory are used for the inflammatory condition of the skin • Topical antipruritic are used for pruritus condition • The topical anti-inflammatory is contraindicated untreated infection and hypersensitivity • The topical antipruritic are contraindicated in acute exudative dermatoses PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 98 STEP 8: Evaluation (5minutes) • What are indications of anti inflammatory and antipruritic drugs? • What are the contraindications of anti inflammatory and antipruritic drugs? • What are the dose, dosage and course of anti inflammatory and antipruritic drugs? • What are side effects and adverse effects of anti inflammatory and antipruritic drugs? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 99 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 ed). London, pharmaceutical press. The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary (59th ed). London, BMJ Group and RPS Publishing. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 100 ← Previous TopicNext Topic →View all Basic Pharmacology topicsOpen Complete Full Notes PDF /

NTA Level 4 • Semester 2 • PST04211 Description of Antiviral Drugs Basic Pharmacology • Source Session/Topic 15 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 15: Description of Antiviral Drugs Total Session Time: 120 minutes Prerequisites None Students Learning Tasks By the end of this session students are expected to be able to: • List indications of antiviral drugs • List contraindication of antiviral drugs • Describe dose, dosage and course of antiviral drugs • List side effects and adverse effects of antiviral drugs • Describe interaction and precaution of antiviral 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 Objectives 15 minutes Indications, dosage, side effects, Presentation 2 contraindications, interactions and precaution Brainstorming of acyclovir 15 minutes Indications, dosage, side effects, 3 Presentation contraindications, interactions and precaution of gancyclovir 30 minutes Indications, dosage, side effects, Presentation 4 contraindications, interactions and precaution Buzzing of nucleoside reverse transcriptase inhibitors 30 minutes Presentation Indications, dosage, side effects, contraindications, interactions and precaution 5 of non-nucleoside reverse transcriptase inhibitors 15 minutes Presentation Indications, dosage, side effects, 6 Brainstorming contraindications, interactions and precaution of protease inhibitors 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 87 SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Objectives (5 minutes) READ or ASK students to read the learning objectives and clarify ASK students if they have any questions before continuing. STEP 2: Indications, Dosage, Side Effects, Contraindications, Interactions Precaution of Acyclovir (15 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are indications of acyclovir? ALLOW few students to respond? WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below Antiviral drugs are a class of medication used for treating viral infections Indications Acyclovir is indicated to treat; • Herpes simplex virus (hsv) infections • Varicella-zoster virus (vzv) infections Dose and Dosage • Herpes Simplex o Acyclovir (O) 400mg 8 hourly for 7 – 10 days • Herpes Zoster (Shingles) o Acyclovir cream 5% applied until vesicles desapear. Plus o Acyclovir (O) 800 mg 5 times a day until no new lesions appear Side effects • Nausea and vomiting, • Abdominal Pain, • Diarrhoea, • Headache, • Fatigue, • Rash, urticaria and pruritus, • Photosensitivity PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 88 Contraindications Hypersensitivity to acyclovir or other related drugs Interactions Interactions do not apply to topical aciclovir preparations • Ciclosporin: increased risk of nephrotoxicity when aci- clovir given with ciclosporin • Probenecid: excretion of aciclovir reduced by pro- benecid (increased plasma concentration) Precautions • Maintain adequate hydration • In renal impairment • In elderly STEP 3: Indications, Dosage, Side Effects, Contraindications, Interactions Precaution of Ganciclovir (15 minutes) Indications Ganciclovir is used to treat cytomegalovirus (cmv) infections Dose and Dosage By intravenous infusion, Initially (induction) 5mg/kg every 12 hours for 14–21 days for treatment Side effects • Diarrhoea, • Nausea, Vomiting, • Dyspepsia, • Abdominal Pain, • Constipation, • Flatulence, • Dysphagia, • Taste Disturbance, • Leucopenia, Thrombocytopenia, Contraindications • Hypersensitivity to ganciclovir, aciclovir, • Abnormally low haemoglobin, neutrophil, or platelet counts Interactions • Probenecid: excretion of ganciclovir reduced by probenecid • Hence increased plasma concentration and risk of toxicity Precautions • Close monitoring of full blood count • Ensure adequate hydration during intravenous administration PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 89 STEP 4: Indications, Dosage, Side Effects, Contraindications, Interactions Precaution of Nucleoside Reverse Transcriptase Inhibitors (30 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are commonly used nucleoside reverse transcriptase inhibitors? 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 Nucleoside Reverse Transcriptase Inhibitors (NRTIs) include: • Zidovudine (AZT) • Lamivudine (3TC) • Abacavir (ABC) • Emtricitabine (FTC) • Stavudine (d4T) • Tenofovir (TDF) o Tenofovir is classified as Nucleotide Reverse Transcriptase Inhibitor Indications Nucleoside Reverse Transcriptase Inhibitors (NRTIs) are antiretroviral drugs that are indicated for treatment of HIV/AIDS in combination with other antiretrovirals Dose and Dosage Zidovudine (AZT) 300 mg PLUS Lamivudine (3TC) 150 mg twice daily OR Tenofovir (TDF) 300mg PLUS Lamivudine (3TC) 150 mg twice daily Side effects • Gastrointestinal disturbances (nausea, vomiting, abdominal pain, diarrhoea) • Lactic acidosis • Lipodystrophy • Anaemia by Zidovudine • Hypersensitivity by Abacavir • Peripheral neuropathy by Stavudine • Nephrotoxicity by Tenofovir PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 90 Contraindications • Zidovudine is contraindicated to patients with Anaemia • Patients who are hypersensitive to the NRTIs • Tenofovir is contraindicated to patients with renal failure Interactions Increased risk of haematological toxicity when Zidovudine given with NSAIDs Precautions • Monitor liver function when using NRTIs • Monitor renal function when using Tenofovir • Monitor red blood cell count when using Zidovudine STEP 5: Indications, Dosage, Side Effects, Contraindications, Interactions Precaution of Non-Nucleoside Reverse Transcriptase Inhibitors (30 minutes) Non-nucleoside reverse transcriptase inhibitors (NNRTIs) include: • Nevirapine (NVP) • Efavirenz (EFV). Indications Non-nucleoside reverse transcriptase inhibitors are antiretroviral drugs used for the treatment of HIV/AIDS in combination with other antiretrovirals Dose • Efavirenz (EFV) 600 mg once daily at night. or • Nevirapine (NVP) 200mg twice a day Side effects • Rashes due hypersensitivity reaction by Nevirapine • CNS disturbances, abnormal dreams, hallucinations by Efavirenz Contraindications Efavirenz and Nevirapine are contraindicated in patients with acute porhyria Interactions Clarithromycin increase plasma levels of Efavirenz leading to increased risk of rash Precautions • Monitor liver function • Close follow up when using Efavirenz inpatinets with history of mental

NTA Level 4 • Semester 2 • PST04211 Description of Topical Antiinfective Drugs Basic Pharmacology • Source Session/Topic 14 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 14: Description of Topical Antiinfective 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 topical antiinfective drugs • List contraindications of Topical antiinfective drugs • Describe dose, dosage and course of topical antiinfective drugs • List side effects and adverse effects of topical antiinfective drugs • Describe interactions and precautions of topical antiinfective drugs Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers • Overhead projector and computer SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation/ 2 20 minutes Indications of Topical Antiinfective Drugs Buzzing Presentation/ Contraindications of Topical Antiinfective 3 05 minutes Brainstorming Drugs Dose, Dosage and Course of Topical 4 05 minutes Presentation Antiinfective Drugs Presentation/ Side Effects and Adverse Effects of Topical 5 10 minutes Brainstorming Antiinfective Drugs Interactions and Precautions Topical 6 05 minutes Presentation Antiinfective Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 81 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 Topical Anti-infective Drugs (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the anti-infective drugs? • How do we classify topical anti-infective drugs? • What are indications of topical anti-infective 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-infective Drugs: Are drugs capable of acting against infection, by inhibiting the spread of an infectious agent or by killing the infectious agent outright • Anti-infective is a general term that encompasses antibacterial, antibiotics, antifungal, antiprotozoans and antiviral • Topical antifungal preparations: o Active against dermatophytes (epidermophyton, microsporum, and trichophyton) o Active against yeasts, including Candida albicans and Pityrosporum orbiculare • Topical antibacterial: o Useful in preventing infections in clean wounds o In the early treatment of infected dermatoses and wounds o In reducing colonization of the nares by staphylococci, in axillary deodorization o Management of acne vulgaris • Topical antiviral agents: o Active against Herpesvirus family, including herpes simplex types 1 and 2 o Active against VZV Epstein-Barr virus (EBV) o Active against Cytomegalovirus (CMV) o Active against Human herpesvirus-6 (HHV-6) PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 82 STEP 3: Contraindications of Topical Anti-infective Drugs (5 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are contraindications of topical anti-infective drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Hypersensitivity to topically applied anti infectives • Griseofulvin is contraindicated in patients with porphyria or hepatic failure Topical • Metronidazole is not indicated in breast feeding mothers and during first trimester STEP 4: Dose, Dosage and Course of Topical Anti-infective Drugs (5 minutes) • Topical Antifungal drugs o Once- or twice-daily application to the affected area will generally result in clearing of superficial dermatophyte infections in 2-3 weeks • Topical antiviral drugs o Twice a day for 5-7 days • Topical antibacterial drugs o 2-3 times a day for 5-7 days STEP 5: Side Effects and Adverse Effects of Topical Antiinfective Drugs (10 Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: o What are side effects and adverse effects of topical antiinfective 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 83 • Topical antifungal preparations o Photosensitivity o Peripheral neuritis o Stinging, o Pruritus, o Erythema o Local irritation. o Allergic contact dermatitis appears to be uncommon o Gynecomastia, • Topical antibacterial o Burning sensation o Drying of the skin o Irritation of the skin o Stinging sensation o Allergic contact dermatitis occurs frequently with bacitracin • Topical antiviral agents o Pruritus o Mild pain o Transient stinging o Burning sensation STEP 6: Interactions and Precautions of Antiinfectives Drugs (5minutes) • Topical antibacterial o Caution should be exercised when applying metronidazole near the eyes to avoid excessive tearing • Topical antiviral agents o Caution in pregnancy and in breast feeding • Topical antifungal preparations o Contact with mucous membranes should be avoided when using Allyl amines Step 7: Key Points (5minutes) • The topical Antiinfectives are antibacterial, antiviral or antifungal drugs • Topical Antiinfectives are indicated for the bacteria fungi or viral infections on the skin • Common side effects of most topical Antiinfectives are: irritation, burning, pruritus, drying PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 84 STEP 8: Evaluation (10 minutes) • What are indications of Antiinfectives drugs? • What are the contraindications of Antiinfectives drugs? • What are the dose, dosage and course of Antiinfectives drugs? • What are side effects and adverse effects of Antiinfectives drugs? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 85 References 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. Ministry of Health and Social Welfare. ( 2013). Standard Treatment Guidelines & National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania government printers. Sally S.R., Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed) New

NTA Level 4 • Semester 2 • PST04211 Description of Antifungal Drugs Basic Pharmacology • Source Session/Topic 13 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 13: Description of Antifungal Drugs Total Session Time: 120 minutes Prerequisites module • None Learning Tasks By the end of this session students are expected to be able to: • List indications of systemic and mucosal antifungal drugs • List contraindications of systemic and mucosal antifungal drugs • Describe dose, dosage and course of systemic and mucosal antifungal drugs • List side effects and adverse effects of systemic and mucosal antifungal drugs • Describe interactions and precautions of systemic and mucosal antifungal 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/ Indications of Systemic and Mucosal 2 20 minutes Buzzing Antifungal Drugs Presentation/ Contraindications of Systemic and Mucosal 3 20 minutes Brainstorming Antifungal Drugs Dose, Dosage and Course of Systemic and 4 30 minutes Presentation Mucosal Antifungal Drugs Presentation/ Side Effects and Adverse Effects of Systemic 5 20 minutes Brainstorming and Mucosal Antifungal Drugs Interactions and Precautions of Systemic and 6 15 minutes Presentation Mucosal Antifungal Drugs 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 75 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 Antifungal Drugs (20 Minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the indications of antifungal 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 • Amphotericin B o Is useful agent for nearly all life-threatening mycotic infections o It is often used as the initial induction regimen for serious fungal infections and is then replaced by one of the newer fluconazole o Is s especially important for immunosuppressed patients and those with severe fungal pneumonia, cryptococcal meningitis with altered mental status, or sepsis syndrome due to fungal infections • Clotrimazole, Miconazole and Fluconazole o Are useful agents in management of candida species, Cryptococcus neoformans, the endemic mycoses (blastomycosis, coccidioidomycosis and histoplasmosis) • Griseofulvin is only use is in the systemic treatment of dermatophytosis example infections of the skin, scalp, hair and nails where topical therapy has failed or is inappropriate • Nystatin used in treatment of oral candidiasis; and skin infection PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 76 STEP 3: Contraindications of Antifungal Drugs (20 Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are contraindications of antifungal drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Amphotericin B is not contraindicated to specific group of individual • Clotrimazole, Miconazole and Fluconazole are contraindicated in acute porphyria, hepatic impairment and breast-feeding • Griseofulvin is contraindicated to people with severe liver disease; systemic lupus erythematosus acute, porphyria, pregnancy (avoid pregnancy during and for 1 month after treatment men should not father children within 6 months of treatment) and breast- feeding • Nystatin is not contraindicated to specific group of individual STEP 4: Dose, Dosage and Course of Systemic and Mucosal Antifungal Drugs (30minutes) • Amphotericin B lozenges taken 4 times daily. Allowed to dissolve slowly in the mouth for 10–15 days (continued for 48 hours after lesions have resolved); increased to 8 daily in severe infection • Clotrimazole o 2% cream for vaginal candidiasis. Applied twice a day for 7 days • Miconazole o Topical: 2% cream, is used for vaginal candidiasis, vulvovaginal candidiasis and candidal balanitis o 200 mg vaginal suppositories is used for vaginal candidiasis o The drug is applied twice daily for 5 to 7 days • Fluconazole o Vaginal candidiasis, Vulvovaginal Candidiasis, and candidal balanitis, ADULT and children over 16 years, by mouth, a single dose of 150 mg. o Mucosal candidiasis (except genital), by mouth, 50 mg daily (100 mg daily in unusually difficult infections) given for 7–14 days in oropharyngeal candidiasis PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 77 • Griseofulvin o Dermatophyte infections, 500 mg once daily or in divided doses o In severe infection dose may be doubled, the dose need to be reduced when response occurs children under 50 kg, 10 mg/kg once daily or in divided doses o Tinea capitis caused by Trichophyton tonsurans, 1g once daily or in divided doses children under 50 kg, 15– 20 mg/kg once daily or in divided doses o Treatment should continue for not less than 21 days • Nystatin o Treatment for adult and children suffering from oral pharyngeal candidiasis 100 000 units 4 times daily after food, usually for 7 days (continued for 48 hours after lesions have resolved) STEP 5: Side Effects and Adverse Effects of Antifungal Drugs (20 Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects and adverse effects of antifungal drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Amphotericin B o When given parenterally it causes anorexia, nausea and vomiting, diarrhoea, epigastric pain, febrile reactions, headache, muscle and joint pain, anaemia disturbances in renal function and renal toxicity • Clotrimazole o The most common adverse reaction is relatively minor gastrointestinal upset and, very rarely, clinical hepatitis • Miconazole o Causes nausea, vomiting; rash; with buccal tablets o