PST04211 Basic Pharmacology

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

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

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

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

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

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