PST06106 Basic Pharmacotherapy

NTA Level 6 • Semester 1 • PST06106 Pharmacotherapy of Gonorrhoea Basic Pharmacotherapy • 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. PST 06106 Basic Pharmacotherapy Session 14: Pharmacotherapy of Gonorrhea Learning Objective By the end of this session students are expected to be able to: Define gonorrhoea Explain pathophysiology of gonorrhoea Explain the clinical presentation of gonorrhoea Outline diagnosis of gonorrhoea Describe pharmacological treatment of gonorrhoea Describe monitoring of gonorrhoea therapy Activity: Buzzing •What is Gonorrhoea ? Definition of Gonorrhea Gonorrhea is a sexually transmitted disease ( STD) caused by infection with the bacterium Neisseria gonorrhoeae . It tends to infect warm, moist areas of the body, including the: U rethra (the tube that drains urine from the urinary bladder) E yes T hroat V agina A nus F emale reproductive tract (the fallopian tubes, cervix, and uterus) Definition of Gonorrhea Gonorrhea is transmitted from person to person through unprotected oral, anal, or vaginal sex. People with numerous sexual partners or those who don’t use a condom are at greatest risk of infection . Pathophysiology of Gonorrhea On contact with a mucosal surface lined by columnar, cuboidal, or noncornified squamous epithelial cells, the gonococci attach to cell membranes by means of surface pili and are then pinocytosed . The virulence of the organism is mediated primarily by the presence of pili and other outer membrane proteins. After mucosal damage is established, polymorphonuclear (PMN) leukocytes invade the tissue, submucosal abscesses form, and purulent exudates are secreted . Clinical Presentation of Gonorrhea Individuals infected with gonorrhea can be; symptomatic or asymptomatic, have complicated or uncomplicated infections, and Have infections involving several anatomic sites. Complications associated with untreated gonorrhea appear more pronounced in women, because most of them are asymptomatic As a result, most of these patients develop serious complications, such as; pelvic inflammatory disease (PID), Infertility and ectopic pregnancies. In other patients the gonococci invade the bloodstream and produce disseminated disease Diagnosis of Gonorrhea Diagnosis of gonococcal infections can be made by ; gram-stained smears, culture, or Methods based on the detection of cellular components of the gonococcus such as Enzyme immunoassay, DNA probe techniques, and nucleic acid amplification techniques (NAATs) are also used in clinical specimens. Various stains have been used to identify gonococci microscopically, with the Gram stain the most widely used in clinical practice. Gram-stained smears are positive for gonococci when gram-negative diplococci of typical kidney bean morphology are identified within PMN leukocytes. Activity : Small Group Discussion What is the treatment of Gonorrhoea? Pharmacological treatment of gonorrhea Uncomplicated gonococcal infection Recommended Regimen Ceftriaxone 250mg IM in a single dose PLUS Azithromycin 1g orally in a single dose Alternative regimen If ceftriaxone is not available. Cefixime 400mg orally in a single dose plus Azithromycin 1g orally in a single dose Treatment of various forms of Gonorrhea Infection Monitoring Of Gonorrhea Therapy It is recommended to obtain follow-up cultures at least 3 days after treatment However the combination gonorrhea and chlamydial therapy rarely results in treatment failures, and routine follow-up of patients treated with a regimen is not necessary. Persistence of symptoms following any treatment requires culture of the site(s) of gonorrheal infection, as well as susceptibility testing if gonococci are isolated. Monitoring Of Gonorrhea Therapy Cont.. In most cases, the presence of gonococci indicates reinfection rather than treatment failure and reflects the need for improved patient education and sex partner referral. Persistence of symptoms also can be caused by other infectious causes, such as C. trachomatis Key Points Gonorrhea is a sexually transmitted disease (STD). It’s caused by infection with the bacterium Neisseria gonorrhoeae Gonorrhea passes from person to person through unprotected oral, anal, or vaginal sex. First line drug treatment with Cetriaxone and Azithromycin is recommended Evaluation What is Gonorrhoea? What is the pathophysiology of Gonorrhoea? What are the signs and symptoms of Gonorrhoea? How is the treatment of Gonorrhoea? References Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6 th Ed). New York, NY: McGraw-Hill. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008): Pharmacotherapy: A Pathophysiologic Approach (7 th ed ): New York, NY: McGraw-Hill. Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011) Principles & Practice Study Guide: A Case-Based Care Plan Approach : New York, NY: McGraw-Hill. Schwinghammer TL, Koehler JM (2009) Pharmacotherapy Casebook: A Patient-Focused Approach (7 th ed ): New York, NY: McGraw-Hill. ← Previous TopicNext Topic →View all Basic Pharmacotherapy 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 6 • Semester 1 • PST06106 Pharmacotherapy of Syphilis Basic Pharmacotherapy • 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. PST 06106 Basic Pharmacotherapy Session 15: Pharmacotherapy of Syphilis Learning Task By the end of this session students are expected to be able to: Define syphilis Explain the clinical presentation of syphilis Outline diagnosis of syphilis Describe pharmacological treatment of syphilis Describe the monitoring of syphilis therapy . Activity: Buzzing • What is syphilis?? Definition of Syphilis Syphilis Syphilis is an infectious venereal disease caused by the spirochete Treponema pallidum . Syphilis is transmissible by sexual contact with infectious lesions, from mother to fetus in utero, via blood product transfusion, and occasionally through breaks in the skin that come into contact with infectious lesions. If untreated, it progresses through 4 stages: primary, secondary, latent, and tertiary Clinical Presentation Primary Syphilis The primary stage, characterized by the appearance of a chancre on cutaneous or mucocutaneous tissue exposed to the organism, is highly infectious. Even without treatment, chancres persist only for 1 to 8 weeks before healing spontaneously. Because syphilitic chancres can be confused with other infectious etiologies, appropriate diagnostic testing is important . Clinical Presentation Cont … Secondary Syphilis The secondary stage of syphilis is characterized by a variety of mucocutaneous eruptions resulting from widespread hematogenous and lymphatic spread of T. pallidum . Skin lesions can be either generalized or localized to a small portion of the body and, with the exception of follicular lesions, are nonpruritic . Generalized lymphadenopathy also is seen in the majority of patients, as are nonspecific symptoms such as mild and transitory malaise, fever, pharyngitis, headache, anorexia, and arthralgia. If untreated, secondary syphilis disappears in 4 to 10 weeks; however, lesions can recur at any time within 4 years. Clinical Presentation Cont … Latent Syphilis These are persons with a positive serologic test for syphilis but with no other evidence of disease. Latent syphilis is further divided into early and late latency. During early latency, the patient is considered potentially infectious. Early latency is defined as 1 year from the onset of infection, up to 2 to 4 years. Late latency is considered noninfectious, although the patient remains a host. Most untreated patients with late latent syphilis have no further sequelae; however, approximately 25% to 30% progress either to neurosyphilis or to late syphilis with clinical manifestations other than neurosyphilis. Treatment of all patients with latent syphilis is essential because there is no way to predict which patients will have progression of their disease Clinical Presentation Cont … Tertiary Syphilis and Neurosyphilis If left untreated, syphilis can slowly produce an inflammatory reaction in virtually any organ in the body. Manifestations of this disease progression are referred to as tertiary syphilis. These clinical manifestations are differentiated into two subgroups based on the presence or absence of central nervous system (CNS) involvement which are neurosyphilis or tertiary syphilis (i.e., gumma and cardiovascular syphilis). The gumma, a nonspecific granulomatous lesion, is the classic lesion of late syphilis and develops in 50% of patients with disease progression. These chronic, destructive lesions characteristically infiltrate the skin, bone, soft tissue, and liver but can be found in any organ or tissue. Gummas of critical organs, such as the heart or brain, can be fatal Clinical Presentation Of Syphilis Diagnosis Of Syphilis Syphilis diagnosis is based on the; patient’s history, physical examination, laboratory testing and Radiology Diagnosis of Sphilis Cont … The available laboratory tests for diagnosis of syphilis include D irect detection methods (i.e. dark field microscopy, direct fluorescent antibody test and nucleic acid amplification test), S erology tests such as; Treponemal tests which include the Treponema pallidum haem- agglutination assay (TPHA), the Treponema pallidum particle agglutination assay (TPPA) and the fluorescent treponemal antibody absorbed (FTA-ABS) tests Non-treponemal tests (the microscopic Venereal Diseases Research Laboratory -VDRL and the macroscopic rapid plasma reagin –RPR tests), Examination of cerebrospinal fluids Rapid diagnostic tests (RDTs) for treponemal antibodies in syphilis infection Activity : Small Group Discussion • What is the treatment of Syphilis ? Pharmacological Treatment Parenteral penicillin G is the treatment of choice for all stages of syphilis. Because T. pallidum multiplies slowly, single doses of short- or intermediate-acting penicillins do not provide the prolonged, low-level exposure to penicillin required for eradication of the treponeme . A result, benzathine penicillin G is the only penicillin effective for single-dose therapy. The recommended treatment for syphilis of less than 1 year’s duration is benzathine penicillin G 2.4 million units as a single dose. Units can be administered once a week for 2 consecutive weeks. In patients with syphilis of longer than 1 year’s duration and normal CSF examination, benzathine penicillin G is administered weekly for three successive doses Monitoring Of Syphilis Therapy Non treponemal tests should be performed at 6 and 12 months in all patients treated for primary and secondary syphilis and at 6, 12, and 24 months for early and late latent disease. More frequent monitoring of HIV-infected individuals (i.e., 3, 6, 9, 12, and 24 months after therapy) should be done In general, the time to reach seronegativity is proportional to the duration of the disease. Despite adequate therapy, some patients can remain seropositive based on non- treponemal test results. In these cases, stabilization of low antibody titers is indicative of adequate therapy. For women treated during pregnancy, monthly quantitative non-treponemal tests are recommended in those at high risk of reinfection. Key Points Syphilis is a systemic disease from the outset and is caused by the spirochaete , Treponema pallidum (T. pallidum) The infection can be classified as congenital (transmitted from mother to child in utero) or acquired (through sex or blood transfusion) Acquired syphilis is divided into early and late syphilis Early syphilis comprises the primary, secondary and early latent stages while late syphilis refers to late latent syphilis, gummatous , neurological and cardiovascular syphilis Long-acting benzathine

NTA Level 6 • Semester 1 • PST06106 Pharmacotherapy of Chlamydial Genital Tract Infections Basic Pharmacotherapy • 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. PST 06106 Basic Pharmacotherapy Session 16: Pharmacotherapy of Chlamydial Genital Tract Infections Learning Tasks By the end of this session students are expected to be able to : Define chlamydial genital tract infections Explain pathophysiology of chlamydial genital tract infections Explain the clinical presentation of chlamydial genital tract infections Outline diagnosis of chlamydial genital tract infections Describe pharmacological treatment of chlamydial genital tract infections Describe the monitoring of chlamydial genital tract infections therapy Activity: Buzzing What is Chlamydial Genital Tract Infections? Definition of Chlamydial Genital Tract Infections Chlamydial Genital Tract Infections Chlamydial Genital Tract Infections is a sexually transmissible infection caused by bacterium Chlamydia t rachomatis Persons infected with the bacterium may not have symptoms of infection but can still transmit the bacterium. Chlamydia can affect the urethra (the urine passage), cervix (the neck of the womb), rectum and anus, throat, and eyes . Pathophysiology of Chlamydial Genital Tract Infections C. trachomatis is an obligate intracellular parasite that shares properties of both viruses and bacteria. Like viruses, chlamydiae require cellular material from host cells for replication; however, unlike viruses, chlamydiae maintain their cellular identity throughout development. Although C. trachomatis lacks a cell-wall peptidoglycan, its major outer membrane is similar to gram-negative bacteria. At least 18 serovars (subspecies) of C. trachomatis exist, of which only the lymphogranuloma venereum strains produce potentially invasive infections. The remaining serovars are involved primarily with superficial infection of epithelial cells . Pathophysiology of Chlamydial Genital Tract Infections Cont .. Chlamydia have the ability to establish long-term associations with host cells. When an infected host cell is starved for various nutrients such as amino acids (for example, tryptophan), iron, or vitamins, this has a negative consequence for Chlamydiae since the organism is dependent on the host cell for these nutrients. The starved Chlamydiae enter a persistent growth state wherein they stop cell division and become morphologically aberrant by increasing in size. Persistent organisms remain viable as they are capable of returning to a normal growth state once conditions in the host cell improve and causing chronic Clinical Presentation of Chlamydial Genital Tract Infections In comparison with gonorrhea, chlamydial genital tract infections are more frequently asymptomatic, and when present, symptoms tend to be less noticeable. Urethral discharge usually is less profuse and more mucoid or watery than the urethral discharge associated with gonorrhea. Diagnosis of Chlamydia Genital tract infection A sample of urine can be collected and analyzed in the laboratory to investigate the presence of this infection. A swab of the discharge can be collected for culture or antigen testing for chlamydia. Nucleic Acid Amplification Tests (NAAT), such as Polymerase Chain Reaction (PCR ), Transcription Mediated Amplification ( TMA), and the DNA Strand Displacement Amplification (SDA) now are the mainstays. NAAT for chlamydia may be performed on swab specimens sampled from the cervix (women) or urethra (men), on self-collected vaginal swabs, or on voided urine Activity : Small Group Discussion What is the treatment of Chlamydial Genital Tract Infections? Pharmacological treatment of Chlamydial Genital Tract infection Monitoring of chlamydial Genital Tract Infections Therapy Treatment of chlamydial infections with the recommended regimens is highly effective; therefore, post-treatment laboratory testing is not recommended routinely unless symptoms persist or there are other specific concerns (e.g., pregnancy). Post-treatment tests should not be performed for at least 3 weeks following completion of therapy. When post-treatment tests are positive, they usually represent noncompliance, failure to treat sexual partners, or laboratory error rather than inadequate therapy or resistance to therapy. Infants with pneumonitis should receive follow-up testing because erythromycin is only 80% effective, and a second course of therapy can be necessary Key Points Chlamydia is a sexually transmissible infection caused by bacterium Chlamydia t rachomatis Persons infected with the bacterium may not have symptoms of infection but can still transmit the bacterium. Azithromycin is drug of choice for the treatment of chlamydia infection Evaluation What is Chlamydia infection? What is the pathophysiology of Chlamydial infection? What are the signs and symptoms of Chlamydia infection? How is the treatment of Chlamydia Infection? References Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6 th Ed). New York, NY: McGraw-Hill. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008): Pharmacotherapy: A Pathophysiologic Approach (7 th ed ): New York, NY: McGraw-Hill. Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011) Principles & Practice Study Guide: A Case-Based Care Plan Approach : New York, NY: McGraw-Hill. Schwinghammer TL, Koehler JM (2009) Pharmacotherapy Casebook: A Patient-Focused Approach (7 th ed ): New York, NY: McGraw-Hill. ← Previous TopicNext Topic →View all Basic Pharmacotherapy 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 6 • Semester 1 • PST06106 Pharmacotherapy of Genital Herpes Basic Pharmacotherapy • 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. PST 06106 Basic Pharmacotherapy Session 17: Pharmacotherapy of Genital Herpes Learning Tasks By the end of this session students are expected to be able to: Define genital herpes Explain pathophysiology of genital herpes Explain the clinical presentation of genital herpes Outline diagnosis of genital herpes Describe pharmacological treatment of genital herpes Describe the monitoring of genital herpes therapy Activity: Buzzing • What is Genital Herpes? Definition of Genital Herpes Genital Herpes Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus (HSV). Sexual contact is the primary way that the virus spreads. There are two types of Herpes Simplex viruses; herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). HSV-1 is associated most commonly with oropharyngeal disease, and HSV-2 is associated most closely with genital disease; However, each virus is capable of causing clinically indistinguishable infections in both anatomic areas. Definition of Genital Herpes Cont.…. Humans are the sole known reservoir for HSV. Infection is transmitted via inoculation of virus from infected secretions onto mucosal surfaces (e.g., urethra, oropharynx, cervix, and conjunctivae) or through abraded skin. The cycle of HSV infection occurs in five stages: primary muco-cutaneous infection, infection of the ganglia, establishment of latency, reactivation, and recurrent infection Pathophysiology Of Genital Herpes After viral inoculation, HSV infection is associated with cytoplasmic granulation(condensed areas of cellular material that may be bounded by a membrane), ballooning degeneration of cells (cells undergoing this form of death increase in size(balloon), and production of mononucleated giant cells ( cells formed by fusion of monocytes/macrophage) Initially, the cellular response is predominantly polymorph nuclear, followed by a lymphocytic response. Replication occurs with viral spread to contiguous cells and peripheral sensory nerves. Latency then is established in sensory or autonomic nerve root ganglia. Latency appears to be lifelong, interrupted only by reactivation of the viral infection. It is unclear what factors are important in maintaining latency, but immune responses and emotional and physical stresses appear important in reactivating latent virus. Clinical Presentation Of Genital Herpes The signs and symptoms of genital herpes infection are influenced by many factors, including previous exposure to HSV, viral type, and host factors such as age and site of infection. High percentage of initial and recurrent infections are asymptomatic, Viral shedding can occur in the absence of apparent lesions or symptoms A summary of the clinical presentation of genital herpes is provided in Table Diagnosis Of Genital Herpes A presumptive diagnosis of genital herpes commonly is made based on the presence of dark-field negative , vesicular, or ulcerative genital lesions. A prior history of similar lesions or recent sexual contact with an individual with similar lesions also is useful in making the diagnosis Viral culture. This test involves taking a tissue sample or scraping of the sores for examination in the laboratory . Diagnosis Of Genital Herpes Cont …. Polymerase chain reaction (PCR) test. PCR is used to copy patient DNA from a blood sample, tissue from a sore or spinal fluid. The DNA can then be tested to establish the presence of HSV and determine which type of HSV you have. Blood test. This test analyzes a sample of blood for the presence of HSV antibodies to detect a past herpes infection. Several serologic tests capable of distinguishing HSV-1 and HSV-2 antibodies are available. These tests detect antibodies to type-specific HSV-1 and HSV-2 proteins gG-1 and gG-2, respectively Activity : Small Group Discussion What is the treatment of Genital Herpes? Pharmacological Treatment of Genital Herpes The most achievable goals in the management of genital herpes are to relieve symptoms and to shorten the clinical course, to prevent complications and recurrences, and to decrease disease transmission. Although research has focused primarily on the treatment of active infection and suppression of recurrences, increasing emphasis is being placed on various approaches, including immunotherapy that might provide protection from disease transmission or possibly eliminate established latency. . Pharmacological Treatment of Genital Herpes Oral formulations of acyclovir, famciclovir , and valacyclovir have demonstrated efficacy in reducing viral shedding, duration of symptoms, and time to healing of first-episode genital herpes infections, with maximal benefits seen when therapy is initiated at the earliest stages of infection Pharmacological Treatment of Genital Herpes Monitoring of Genital Herpes Therapy Available antiviral compounds are of greatest benefit in patients experiencing first-episode primary infections, immunocompromised patients, and patients with frequent or severe recurrent infections. Antivirals, however, are palliative and not curative, and patients receiving these agents should be monitored closely for adverse drug effects. Discontinuation of suppressive therapy after 1 year should be considered to assess for possible changes in the patient’s intrinsic pattern of recurrence. In many patients, decreases in recurrence rates and the severity of symptoms occur over time. However, it is also preferred to continue suppressive therapy indefinitely because it significantly reduces asymptomatic viral shedding, a potential benefit in reducing the risk of disease transmission to uninfected sexual partners Key Points Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus (HSV). Infection is transmitted via inoculation of virus from infected secretions onto mucosal surfaces (e.g., urethra, oropharynx, cervix, and conjunctivae) or through abraded skin The signs and symptoms of genital herpes infection are influencedby many factors, including previous exposure to HSV, viral type, and host factors such as age and site of infection Oral formulations of acyclovir, famciclovir , and valacyclovir have demonstrated efficacy in the treatment of genital herpes Evaluation What is genital herpes? What is the pathophysiology of genital herpes? What are the signs and symptoms of genital herpes? How is the treatment of genital herpes? References Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6 th Ed). New York, NY: McGraw-Hill. DiPiro JT, Talbert RL, Yee GC,