PST04211 Basic Pharmacology

NTA Level 4 • Semester 2 • PST04211 Description of Antituberculosis Basic Pharmacology • Source Session/Topic 8 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 8: Description of Antituberculosis 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 antituberculosis • List contraindications of antituberculosis • Describe dose, dosage and course of antituberculosis • List side effects and adverse effects of antituberculosis • Describe interactions and precautions of antituberculosis 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 Antituberculosis Buzzing Presentation/ 3 20 minutes Contraindications of Antituberculosis Brainstorming 4 30 minutes Presentation Dose, Dosage and Course of Antituberculosis Presentation/ Side Effects and Adverse Effects of 5 20 minutes Brainstorming Antituberculosis Interactions and Precautions of 6 15 minutes Presentation Antituberculosis 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 44 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 Antituberculosis Drugs (20 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • Which drugs are used in treatment of tuberculosis? 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 • Tuberculosis is managed by the following drugs usually in combination to prevent mycobacterium resistance and toxicity o Rifampicin symbolized by R o Isoniazid symbolized by H o Pyrazinamide symbolized by Z o Ethambutol symbolized by E o Streptomycin symbolized by S • Tuberculosis is usually managed in two phases, initial phases and continuous phase o The initial phase; during this phase combination drugs are continued for 2 months o Drugs used in initial phase are rifampicin, isoniazid, pyrazinamide and ethambutol o These drugs should be continued until full susceptibility is confirmed, even if this is for longer than 2 months o Continuation phase; after the initial phase, treatment is continued for a further 4 months with isoniazid and rifampicin (preferably given as a combination preparation). Longer treatment is necessary for meningitis, direct spinal cord involvement, and for resistant organisms which may also require modification of the regimen • Other drugs indicated for management of tuberculosis as second line include cycloserine, ethionamide and streptomycin PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 45 STEP 3: Contraindications of Antituberculosis Drugs (20 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications of antituberculosis drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Rifampicin is contraindicated to patient with jaundice • Isoniazid is contraindicated to patient with drug induced liver disease • Pyrazinamide is contraindicated to patient with Hepatic disorders o Patients or their careers should be told how to recognize signs of liver disorder, and advised to discontinue treatment and seek immediate medical attention if symptoms such as persistent nausea, vomiting, malaise or jaundice develop • Ethambutol is contraindicated in optic neuritis and poor vision • Streptomycin is contraindicated to patient with mythenia gravis • Cycloserine is contraindicated to patient with epilepsy, depression, severe anxiety, psychotic states, alcohol dependence and acute porphyria STEP 4: Dose, Dosage and Course of Antituberculosis Drugs (30minutes) • Rifampicin o Is usually given 600 mg/daily (10 mg/kg/d) orally, must be administered with isoniazid or other antituberculosis drugs to patients with active tuberculosis to prevent emergence of drug-resistant mycobacteria o Rifampin 600 mg daily or twice weekly for 6 months also is effective in combination with other agents in some atypical mycobacterial infections and in leprosy • Isoniazid o Usual dosage is 5 mg/kg/d; a typical adult dose is 300 mg given once daily. Up to 10 mg/kg/d may be used for serious infections or if malabsorption is a problem o A 15 mg/kg dose, or 900 mg, may be used in a twice-weekly dosing regimen in combination with a second antituberculosis agent (e.g., rifampin 600 mg) o Pyridoxine, 25-50 mg/d, is recommended for those with conditions predisposing to neuropathy, an adverse effect of isoniazid o Isoniazid is usually given by mouth but can be given parenterally in the same dosage PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 46 • Pyrazinamide o Should be used at a dose of 40-50 mg/kg is used for thrice-weekly or twice-weekly treatment regimens. o Pyrazinamide is an important front-line drug used in conjunction with isoniazid and rifampin in short-course (ie, 6-month) regimens as a "sterilizing" agent active against residual intracellular organisms that may cause relapse • Ethambutol o As hydrochloride salt is given at 15-25 mg/kg, is usually given as a single daily dose in combination with isoniazid or rifampin. o The higher dose is recommended for treatment of tuberculous meningitis. o The dose of ethambutol is 50 mg/kg when a twice-weekly dosing schedule is used. • Streptomycin o The usual dosage is 15 mg/kg/d intramuscularly or intravenously daily for adults (20- 40 mg/kg/d, not to exceed 1-1.5 g for children) for several weeks, followed by 1-1.5 g two or three times weekly for several months STEP 5: Side Effects and Adverse Effects of Antituberculosis (20 minute) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are the side effects and adverse effects of antituberculosis? ALLOW few students to respond? WRITE their responses on the flip chart/ board CLARIFY

NTA Level 4 • Semester 2 • PST04211 Description of Amoebicides Basic Pharmacology • Source Session/Topic 9 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 9: Description of Amoebicides 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 Amoebicides • List Contraindication of Amoebicides • Describe dose, dosage and course of Amoebicides • List side effects and adverse effects of Amoebicides • Describe interaction and precaution of Amoebicides 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 10 minutes Indications of Amoebicides Buzzing Presentation/ 3 10 minutes Contraindication of Amoebicides brainstorming 4 10 minutes Presentation Dose, Dosage and Course of Amoebicides Presentation/ 5 10 minutes Effects and Adverse Effects of Amoebicides Brainstorming 6 05 minutes Presentation Interaction and Precaution of Amoebicides 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 50 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 Amoebicides (10 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are the examples of Amoebicides? • What are the indications of Amoebicides? 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 • Amoebicides listed on essential medicine list include metronidazole and tinidazole. • Indications of Amoebicides o Metrinidazole is the drug of choice in the treatment of all tissue infections with E histolytica. They are not reliably effective against luminal parasites and so must be used with a luminal amebicide to ensure eradication of the infection o Tinidazole like metronidazole, it is also the drug of choice in the treatment of all tissue infections with E histolytica. They are not reliably effective against luminal parasites and so must be used with a luminal amebicide to ensure eradication of the infection STEP 3: Contraindication of Amoebicides (10Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the Contraindications of Amoebicides? 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 51 Metrinidazole and Tinidazole are contraindicated to people who have taken alcohol STEP 4: Dose, Dosage and Course of Amoebicides (10minutes) • Metronidazole o By mouth, invasive intestinal amoebiasis, extraintestinal amoebiasis (including liver abscess), 800 mg every 8 hours for 5 days in intestinal infection (for 5–10 days in extra-intestinal infection) o Children 1–3 years 200 mg every 8 hours; 3–7 years 200 mg every 6 hours; 7–10 years 400 mg every 8hours • Tinidazole o Intestinal amoebiasis, 2 g daily for 2–3 days; o Children 50–60 mg/kg daily for 3 days o Amoebic involvement of liver, 1.5–2 g daily for 3–6days o Children 50–60 mg/kg daily for 5 days STEP 5: Side Effects and Adverse Effects of Amoebicides (10 Minute) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the side effects and adverse effects of Amoebicides? 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 amoebicides o Metrinidazole and Tinidazole o Gastro-intestinal disturbances (including nausea and vomiting), o Taste disturbances, furred tongue, oral mucositis, anorexia o Very rarely hepatitis, jaundice, pancreatitis o Drowsiness, dizziness, headache, ataxia, psychotic disorders o Darkening of urine o Thrombocytopenia, pancytopenia o Myalgia, arthralgia o Visual disturbances o Rash, pruritus, and erythema multiform o On prolonged or intensive therapy peripheral neuropathy, transient epileptiform seizures PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 52 STEP 6: Interaction and Precaution of Amoebicides (minutes) • Metrinidazole and Tinidazole o Disulfiram-like reaction with alcohol, there for it should never be given with alcohol or where there is a suspected use of alcohol o Hepatic impairment and hepatic encephalopathy o Pregnancy o Breast-feeding o Avoid in acute porphyria o Clinical and laboratory monitoring advised if treatment exceeds 10 days STEP 7: Key Points (5 minutes) • Metrinidazole and Tinidazole are common medicines in amoebiasis • Metrinidazole and Tinidazole should not given to patient who have taken alcohol • Long term use of Metrinidazole and Tinidazole need clinical and laboratory monitoring • Long course and higher dose is required in liver abscess STEP 7: Evaluation (5 minutes) • What are the indication of Metrinidazole and Tinidazole? • What is the dose of Metrinidazole and Tinidazole? • What is the common adverse effect of Metrinidazole and Tinidazole? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 53 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 Group and RPS Publishing. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator

NTA Level 4 • Semester 2 • PST04211 Description of Antimalarial Drugs Basic Pharmacology • Source Session/Topic 10 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 10: Description of Antimalarial Drugs Total Session Time: 120 minutes + 2 hours Assignment Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of antimalarial drugs • List contraindications of antimalarial drugs • Describe dose, dosage and course of antimalarial drugs • List side effects and adverse effects of antimalarial drugs • Describe interactions and precautions of antimalarial 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 Antimalarial Drugs Buzzing Presentation/ 3 20 minutes Contraindications of Antimalarial Drugs Brainstorming Dose, Dosage and Course of Antimalarial 4 20 minutes Presentation Drugs Presentation/ Side Effects and Adverse Effects of 5 20 minutes Brainstorming Antimalarial drugs Interactions and Precautions of Antimalarial 6 15 minutes Presentation Drugs 7 05 minutes presentation Key points 8 05 minutes presentation evaluation 9 10 minutes Presentation Assignment PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 55 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 Antimalarial Drugs (20minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following question for 2 minutes • What are indications of antimalarial drugs? ALLOW few pairs to respond and let other pairs to add on points not mentioned WRITE their response on the flip chart/board CLARIFY and SUMMARIZE by using the content below • The indications of antimalarial drugs depends on the stage of disease and are classified as follows: o Drugs that eliminate developing or dormant liver forms of malaria parasite are called tissue schizonticides o Those that act on erythrocytes stage of malarial parasites are blood schizonticides o Those that kill sexual stages of malaria parasites and prevent transmission to mosquitoes are gametocides o No one available agent can reliably affect a radical cure, that is, eliminate both hepatic and erythrocytic stages of malaria parasite o Few available agents are causal prophylactic drugs, that is, capable of preventing erythrocytic malaria infection o However, all effective malaria chemoprophylactic agents kill erythrocytic parasites before they increase sufficiently in number to cause clinical disease • The indications of different antimalaria drugs: o Chloroquine  Is a highly effective blood schizonticide  It is also moderately effective against gametocytes of P. vivax, P. ovale, and P. malariae but not against those of p falciparum  Chloroquine is not active against liver stage parasites  But its utility against p falciparum has been seriously compromised by drug resistance PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 56 o Amodiaquine  Amodiaquine is closely related to chloroquine, and it probably shares mechanisms of action and resistance with that drug o Quinine & Quinidine  Quinine is a rapidly acting, highly effective blood schizonticide against the four species of human malaria parasites  The drug is gametocidal against P. vivax and P. ovale but not P. falciparum  It is not active against liver stage parasites.  The mechanism of action of quinine is unknown o Artemisinin and its derivatives  Are very rapidly acting blood schizonticides against all human malaria parasites  Artemisinins have no effect on hepatic stages of malaria parasites  Artemisininsin particular artesunate and artemether are playing an increasingly important role in the treatment of multidrug-resistant p falciparum malaria  They are the only drugs reliably effective against quinine resistant strains The most important of these analogs are:  Artesunate (water-soluble; useful for oral, intravenous, intramuscular, and rectal administration)  Artemether (lipid-soluble; useful for oral, intramuscular, and rectal administration) o Lumefantrine  Is an aryl alcohol related to halofantrine, is available as a fixed-dose combination with artemether as Coartem in some countries  Coartem is highly effective in the treatment of falciparum malaria STEP 3: Contraindications of Antimalarial Drugs (20 Minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: What are contraindications of antimalarial drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Chloroquine is contraindicated in patients with o Psoriasis or porphyria, in whom it may precipitate acute attacks of these diseases o It should generally not be used in those with retinal or visual field abnormalities or myopathy. PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 57 • Quinine (or quinidine) o Should be discontinued if signs of severe cinchonism, hemolysis, or hypersensitivity occur o It should be avoided if possible in patients with underlying visual or auditory problems • Artemisinins o It is contraindicated the first trimester of pregnancy if possible because teratogenicity has been seen in animal studies, but limited inadvertent use in pregnancy has apparently not led to fatal problems o Is avoided in breast feeding mother whose infant is below 5kg body weight STEP 4: Dose, Dosage and Course of Antimalarial Drugs (30 minutes) • Artemether & Lumefantrine o Dosage of Artemether 20mg & Lumefantrine 120mg tablets according to weight and age WT(Kg) AGE Day 1 Day1 Day2 Day2 Day 3 Day3 O hr 8hrs 24 hrs 36 hrs 48hrs 60hrs 5-14 3mon-3yrs 1 1 1 1 1 1 15-24 3yrs-8yrs 2 2 2 2 2 2 25-34 8yrs-12yrs 3 3 3 3 3 3 35 12yrs 4 4 4 4 4 4 above above o The first dose should be given as Direct Observed Therapy(DOT) o The second dose should strictly be given after 8hours

NTA Level 4 • Semester 2 • PST04211 Description of Anti-schistosomals Basic Pharmacology • Source Session/Topic 11 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 11: Description of Anti-schistosomals Total Session Time: 60 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List indications of anti-schistosomals • List contraindications of anti-schistosomals • Describe dose, dosage and course of anti-schistosomals • List side effects and adverse effects of anti-schistosomals • Describe interactions and precautions of anti-schistosomals • Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks Presentation/ 2 10 minutes Indications of anti-schistosomals Buzzing Presentation/ 3 10 minutes Contraindications of anti-schistosomals Brainstorming Dose, Dosage and Course of anti- 4 10 minutes Presentation schistosomals Presentation/ Side Effects and Adverse Effects of anti- 5 10 minutes Brainstorming schistosomals Interactions and Precautions of anti- 6 5minutes Presentation schistosomals 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 63 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-schistosomals (10 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following questions for 5 min What are indications for anti-schistosomals 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 • Schistosomiasis is caused by the fluke schistosome • Praziquantel is the only drug used in treatment of schistosomiasis in Tanzania • Praziquantel is used in treatment of the common species found in Tanzania which are S. haematobium and S. mansoni STEP 3: Contraindications of Anti-schistosomals (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are the contraindications for antischistomiasis drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Praziquantel is contraindicated in ocular cysticercosis, as parasite destruction in the eye may cause irreparable damage PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 64 STEP 4: Dose, Dosage and Course of Antischistosomiasis Drugs (10 minutes) • Praziquantel o 40mg – 60mg/kg body weight as a single dose Or o Three doses of 20mg/kg body weight at an interval of 4 to 6 hours for one day STEP 5: Side Effects and Adverse Effects of Antischistosomiasis Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are side effects and adverse effects of anti-schistosomals? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below Mild and transient adverse effects are common; they begin within several hours after ingestion and may persist for hours to one day • Most frequent are headache, dizziness, drowsiness, and lassitude; others include nausea, vomiting, abdominal pain, loose stools, pruritus, urticaria, arthralgia, myalgia, and low- grade fever • Mild and transient elevations of liver enzymes have been reported • Several days after starting Praziquantel, low-grade fever, pruritus and skin rashes (macular and urticarial) STEP 6: Interactions and Precautions of Antischistosomals (5 minutes) • Because the drug induces dizziness and drowsiness, patients should not drive during therapy and should be warned regarding activities requiring particular physical coordination or alertness • Some workers also caution against use of the drug in spinal neurocysticercosis PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 65 Step 7: Key Points (5minutes) • Schistosomiasis is caused by the fluke schistosome • Drug of choice is called Praziquantel • Praziquantel is contraindicated in ocular cysticercosis STEP 8: Evaluation (5minutes) • What are the indications of anti-schistosomals? • What are the contraindications of anti-schistosomals? • What are the dose, dosage and course of anti-schistosomals? • What are side effects and adverse effects of anti-schistosomals? PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 66 References Robert, L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael. 2014. Pharmacotherapy: a pathophysiologic approach (9th ed.). New York, McGraw-Hill Education. Ministry Of Health and Social Welfare. 2013. Standard Treatment Guidelines & National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania government printers. Sally, S.R, Jeanne C.S. 2000. Introductory Clinical Pharmacology (6th ed) New York, Lippincott Williams and Wilkins School of Pharmaceutical sciences. 2011. Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam, ARDHI University press. The Royal Pharmaceutical Society of Great Britain. 2007. Martindale, the Extra Pharmacopoeia (5TH ed). London, pharmaceutical press. 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 67 ← Previous TopicNext Topic →View all Basic Pharmacology topicsOpen Complete Full Notes PDF / OFFLINE NOTES Unataka kutumiwa notes hizi kupitia WhatsApp?Kwa notes zilizopangiliwa vizuri kwa kusoma offline au PDF, bonyeza kitufe hapa chini. Ujumbe wenye Level, Semester, Module na Topic utaandaliwa moja kwa moja.TUMIWA NOTES WHATSAPP WhatsApp: 255620339260

NTA Level 4 • Semester 2 • PST04211 Description of Antihelminthes Basic Pharmacology • Source Session/Topic 12 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 12: Description of Antihelminthes 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 antihelminthes • List Contraindication of a antihelminthes • Describe dose, dosage and course of antihelminthes • List side effects and adverse effects of antihelminthes • Describe interaction and precaution of antihelminthes 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 Antihelminthes Buzzing Presentation/ 3 20 minutes Contraindication of Antihelminthes Brainstorming 4 30 minutes Presentation Dose, Dosage and Course of Antihelminthes Presentation/ Side Effects and Adverse Effects of 5 20 minutes brainstorming Antihelminthes 6 15 minutes Interaction and Precaution of Antihelminthes Presentation 7 05 minutes Presentation Key Points 8 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 68 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 Antihelminthes Drugs (20 minutes) Activity: Buzzing (5minutes) ASK students to pair up and buzz on the following question for 2 minutes • What is anti helminthes? • What are the indications of antihelminthes? 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 • Antihelminthes drugs include; Mebendazole, Albendazole, Ivermectin, Niclosamides amd Thiabendazoles. Others include Piperazine and Praziquental • The indications of different essential antihelminthes are : o Mebendazole is effective in treatment of the following parasitic infestations:  Roundworm  Thread worms  Whipworm  Hook worms o Albendazole are effective treatment of following parasites:  Hookworms  Roundworms  Tapeworms  Strongyloides  Cutaneous lava migrains o Ivermectin are effective for treatment of:  Filariasis  Cutaneous larva migrans o Niclosamides are effective for treatment of tapeworms o Thiabendazoles are used in treatment stronyloides • Indications of other antihelminthes not in the National Essential Medicine List(NEMLIT) are: o Piperazine is effective for threadworms and round worms o Praziquental is used in treatment of schistosomiasis PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 69 STEP 3: Contraindication of Antihelminthes (20 minutes) Activity: Brainstorming (5 minutes) ASK learners • What are the contraindications of antihelminthes? ALLOW few learners to respond WRITE their responses on the flipchart SUMMARIZE the discussion by the following information • The contraindication of the essential antihelminthes drugs are: o Pregnancy during first trimester (Mebendazole, albendazole, thiabendazoles) o Known hypersensitivity to antihelminthes drugs STEP 4: Dose, Dosage and Course of Antihelminthes (30 minutes) • Mebendazole o Adult and Children above 2 years 100mg 12 hourly for 3 days Or o 500mg as a single dose • Albendazole o 400mg as a single dose • Levamisole o Adult 120-150 mg as a single dose o Children below 2 years 3 mg/kg body weight as single dose Or o 2.5 mg/kg body weight as single dose, repeated after 7 days • Niclosamide o Adult: 2g as a single dose. Chew tablets on an empty stomach o Children: 30mg/kg body weight starts on an empty stomach o For Taenia solium, Taenia saginata and Diphyllobothrium latum  Adults and children over 6 years: 2g as a single dose after a light breakfast, followed by a purgative after 2 hours  Children 2-6 years: 1g as a single dose after a light meal, followed bya purgative after 2 hours  Children under 2 years 500mg as a single dose after a light meal, followedby a purgative after 2 hours o For Hymenolepsis nana  Adult and children over 6 years 2g as a single dose on the first day, then 1g daily for 6 days PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 70  Children under 2 years 500mg on the first day as a single dose then 250mg daily for 6 days  Children 2-6 years 1g on the first day as a single dose then 500mg once daily • Ivermectin o 150mcg/kg (0.15mg/kg) body weight as a single dose  Treat again at intervals of 6 to 12 months, depending on symptoms or until the adult worms die out • Diethylcarbamazine (DEC) o 1mg/kg body weight  Increase the dose gradually by 1mg/kgbody at an interval of 3 days to maximum of 6mg/kg body weight  Duration of treatment is 21 days • Thiabendazole o Adults: 25mg/kg body weight (max.1.5g) 12 hourly for 3 days  Tablets must be chewed o Children Same as for adults STEP 5: Side Effects and Adverse Effects of Antihelminthes (20 minutes Activity: Brainstorming (5 minutes) ASK learners • What side effects and adverse effects of antihelminthes? ALLOW few learners to respond WRITE their responses on the flipchart SUMMARIZE the discussion by the following information • Mebendazole o Side effects and adverse effects:  Very rarely abdominal pain, diarrhoea, convulsions (in infants)  Rash (including Stevens-Johnson syndrome and toxic epidermal necrolysis)  Short-term mebendazole therapy for intestinal nematodes is nearly free of adverse effects  Mild nausea, vomiting, diarrhoea, and abdominal pain have been reported infrequently  Rare side effects, usually with high-dose therapy, are hypersensitivity reactions (rash, urticaria), agranulocytosis, alopecia, and elevation of liver enzymes • Niclosamide o side-effects and adverse effects:  Occasional gastro-intestinal upset  Lightheadedness  Pruritis PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 71  Infrequent, mild, and transitory adverse events include nausea, vomiting, diarrhea, and abdominal discomfort • Ivermectin o

NTA Level 4 • Semester 2 • PST04211 Introduction to Pharmacology Basic Pharmacology • Source Session/Topic 1 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 1: Introduction to Pharmacology Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Define the terms pharmacology, drug and pro-drug and medicine • List sources of drugs • Define the term pharmacokinetics and list pharmacokinetics Parameters • Explain bioavailability and half life of drugs • Define pharmacodynamic, receptor, agonist, antagonist and synergy • Explain terms toxic, therapeutic dose and therapeutic index • Define the terms tolerance, habituation, dependence and addiction 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 Definition of Pharmacology, Drug and 2 10 minutes Presentation/Buzzing Pro-drug and medicine 3 10 minutes Presentation/Brainstorming Sources of Drugs Definition of Pharmacokinetics and 4 20 minutes Presentation Pharmacokinetics Parameters 5 15 minutes Presentation Bioavailability and Half-life of Drugs Pharmacodynamics, Receptor, Agonist, 6 15 minutes Presentation Antagonist and Synergy Toxic Dose, Therapeutic Dose and 7 15 minutes Presentation Therapeutic Index Tolerance, Habituation, Dependence and 8 20 minutes Presentation Addiction 9 05 minutes Presentation Key Points 10 05 minutes Presentation Evaluation PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 1 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: Definition of Pharmacology, Drug and Pro-drug (10 minutes) Activity: Buzzing (5 minutes) ASK students to pair up and buzz on the following questions for 5 minutes • What is Pharmacology? • What is a drug? • What is a Pro-drug? • What is a medicine? 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 and define other terminologies not defined by students • Pharmacology is a study of the effects of chemical substances on the function of living systems • A drug may is a substance that brings about a change in biologic functions through its chemical actions • A pro-drug is a chemical that is converted to active drug/form by biologic processes inside the body • A medicine is a chemical preparation, which usually but not necessarily contains one or more drugs, administered with the intention of producing a therapeutic effect • Medicines usually contain other substances (i.e. excipients, stabilisers, solvents, etc.) besides the active drug, to make them more convenient to use • In everyday parlance, the word drug is often associated with addictive, narcotic or mind- altering substances-an unfortunate negative connotation that tends to bias opinion against any form of chemical therapy PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 2 STEP 3: Sources of Drugs (10 minutes) Activity: Brainstorming (5 minutes) Ask students to brainstorm on the following question: • What are sources of drugs? ALLOW few students to respond WRITE their responses on the flip chart/ board CLARIFY and SUMMARISE by using the content below • Drugs obtain from various sources such as: synthetic chemicals, chemicals obtained from plants, fungal sources, animal sources, marine organisms or products of genetic engineering • Plant-derived drugs include: quinine, digitalis, atropine, ephedrine, strychnine, vinca alkaloids and others which result from purification of active compounds from these plants. For example, morphine which is purified from opium • Fungal-derived sources include penicillin, streptomycin and many other antibiotics. • Animal-derived sources include Insulin, fats containing nutrients/vitamins derived from fish and others • Natural products, derived mainly from fungal and plant sources, have proved to be a fruitful source of new therapeutic agents, particularly in the field of anti-infective, anticancer and immunosuppressant drugs • Semi-synthetic drugs are derived from chemical modification of natural products for example Beta-Lactam antibiotics such as cephalosporins • Nowadays drugs are derived from chemical modifications/reactions in laboratories STEP 4: Definition of Pharmacokinetics and Pharmacokinetics parameters (20 minutes) • Pharmacodynamics is define as actions of the drug on the body • Pharmacokinetics is define as the actions of the body on the drug • When a drug is administered it must be absorbed into blood from its site of administration, distributed to its site of action, metabolized (mainly by the liver and other processes) and finally eliminated from the body by excretion and other processes • In short pharmacokinetics (PK) = Absorption (A), Distribution (D), Metabolism (M) and Elimination (E). Therefore, PK=ADME • The common terms used in description of pharmacokinetics are: Bioavailability (F) for absorption, Volume of distribution (Vd) for distribution, extraction ratio (ER) for metabolism and Clearance (CL) for elimination PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide 3 STEP 5: Bioavailability and Half-life of Drugs (15 minutes) • Bioavailability is the fraction of administered drug that reaches systemic circulation. For example, if 100mg of a drug is administered orally and 80mg of the drug is absorbed, the bioavailability is 80% or 0.8 • The capital letter F is used to represent bioavailability • When a drug is administered through intravenously, all of the amount reaches systemic circulation, and thus bioavailability is 100% or 1 • Half-life (t1/2) is the time required for the concentration of drugs in the body (blood) to remain to half of the original concentration • Half-life is useful in designing drug dosage regimens, predicting elimination (clearance) and distribution of a drug (volume of distribution) STEP 6: Pharmacodynamics, Receptor, Agonist, Antagonist and Synergy (15 minutes) • Pharmacodynamics refers to the relationship between drug concentration at the site of action and the resulting effect, including the time course and intensity of therapeutic and adverse effects • A

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 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 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 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