Clinical pharmacy and pharmacy practice

Question 1

What is malaria?

Answer 1

It is a parasitic infection caused by plasmodium species

Question 2

Which specie causes malaria in tropical Africa

Answer 2

Plasmodium falciparum others include p.ovale,p.vivax and p.malariae

Question 3

Transmission of malaria?

Answer 3

It starts through the bite of infected female anopheles mosquitoes

Question 4

What are the signs and symptoms of malaria

Answer 4

Fever
Headache
Chills
Sweating
Anorexia
Nausea
Vomiting
Abdominal discomfort

Question 5

Classification of malaria

Answer 5

Acute uncomplicated

Severe malaria

Question 6

Acute complicated

Answer 6

Objective is to cure the infection

Question 7

Severe malaria

Answer 7

Primary objective is to prevent death
prevent the emergence and spread of resistance to anti malarial drugs ,tolerability

Question 8

Diagnosis

Answer 8

Primary diagnosis is the presence of fever in the last 24hrs

Question 9

Parasitological diagnosis include

Answer 9

Light microscopy and Rapid diagnostic test

Question 10

treatment of uncomplicated p falciparum malaria

Answer 10

Artemether + lumefantrine

Artesunate + Amodiaquine

Artesunate +Mefloquine
Artesunate + Sulfadoxine pyrimethamine sp
Dihydroartemisine +piperaquine

Question 11

Treatment of severe falciparum malaria

Answer 11

Artesunate iv,im or rectal for children
Artemether im
Quinine iv infusion or im injection
Doxycycline
Clindamycin

Question 12

Malaria in pregnancy

Answer 12

Avoid Artemisinin based combination in1st trimester
Recommended treatment is quinine+clindamycin for 7days

2nd and 3rd trimesters-ACTS or Artesunate +clindamycin for 7days or quinine +clindamycin

Question 13

Misuse of drug?

Answer 13

Is the irrational or irresponsible use of drug.

Question 14

what causes Typhoid fever

Answer 14

Gram negative salmonella typhi
it is an infection of the reticulo-endothelial system, intestinal lymphoid tissue and the gall bladder.

Question 15

Transmission of typhoid fever

Answer 15

transmitted through the feco-oral route as a result of poor personal and food hygiene.

Question 16

Pathogenesis of Typhoid include

Answer 16

-ingestion of contaminated food or water
-salmonella bacteria invades the small intestine and enters the blood stream
-it is then carried by white blood cells into the liver, spleen and bone marrow
-it multiplies and re enters the blood stream
-Bacteria then invades the gall bladder,billiary system and lymphatic tissue of the bowel and multiply in high numbers
-it then passes through the intestinal tract and can be detected for diagnosis in labs.

Question 17

symptoms of Typhoid fever

Answer 17

-Lethargy
poor appetite
fever(39-40 degrees)
Diarrhoea
constipation
chest congestion
abdominal pain and discomfort are common
headaches
slow heart beat
vomiting

Question 18

Diagnosis of Typhoid

Answer 18

prolonged fever,rashes,bradycardia and leucopenia
PCR on peripheral mononuclear cells
stoola nd urine cultures are positive in the 2nd week
blood cultures are positive in the 1st week
the confirmation is from bone marrow aspirate cultures

Question 19

Differential diagnosis of Typhoid

Answer 19

Malaria
viral hepatitis
tuberculosis

Question 20

Types of Typhoid Vaccines

Answer 20

Injectable-TYPHIM-VI and TYPHIVAX: administered by subcutaneous or intramuscular injection for pt over 2yrs of age.

The live oral vaccine-TYPHORAL-given orally as one capsule a day,taken an hour before food with a glass of water or milk on the 1st,3rd and 5th day. Do not take natibiotics during this course. Immunity lasts for 3yrs, booster dose is required after 3yrs

Question 21

Treatment of Typhoid

Answer 21

treatment is essential to prevent ut from progressing to Pneumonia, intestinal bleeding and perforation

Question 22

Drug treatment of Typhoid

Answer 22

includes antibacterial therapy :
Amoxicillin
Fluroquinolones
Azithromycin
Ceftriaxone

Question 23

what is TETANUS and what is it caused by

Answer 23

Tetanus is an infection of the wound caused by the bacteria clostridium tetani.
it usually occurs when in contact with the environment such as in the soil,dusst and animal waste
-the bacteria enters th body through puncture wounds caused by rusty nails, splinters,insect bites,burns and breaks in the skin.
Tetanus is more common in developing coutries as they have soil rich in organic matter

Question 24

What is incubation period

Answer 24

it is the time from injury to the first symptom. Severe tetanus has an incubation period of less than 48hrs

Question 25

Treatment of tetanus

Answer 25

-neutralization of unbound toxin with -human tetanus immunoglobin
-prevention of further toxin production(wound debridement and antibiotics-metronidazole
-control of spasms-anticonvulsants, protecting the airways, avoid unnecessary stimuli
-supportive care-nutrition,hydration,treatment of secondary infection,prevention of bed sores

Question 26

Prevention of tetanus

Answer 26

-active tetanus immunization
-Immunization provides protection for 10yrs, give booster after every 10yrs
-cleaning wounds thoroughly and cover to pevent infection.

Question 27

what is meningitis

Answer 27

the infection of fluid in the spinal cord and fluid that surrounds the brain

Question 28

Types of Meningitis

Answer 28

Viral Meningitis-self limiting,clears up within a week or 2
Bacterial Meningitis-results in bacteria invasion of mebrane that surrounds the brain and spinal cord, charcaterised by inflammed meninges

Question 29

Bacteria meningitis is caused by

Answer 29

Haemophilus influenza type b
Neisseria meningitides(Meningoccal meningitis)
Streptococcus Pneumonia

Question 30

Signs and symptoms of Meningitis

Answer 30

Headache
high fever
sensitivity to light
seizures
sleepiness
confusion
nausea and vomiting
stiff neck
petechiae that spreads rapidly

Question 31

Diagnosis of meningitis

Answer 31

Lumbar puncture(spinal tap) and testing for bacteria growth in the spinal fluid

Question 32

Severe complications of Meningitis could include

Answer 32

Brain damage
coma
death
long term hearing loss
mental retardment
paralysis
seizures

Question 33

Drug treatment of meningitis

Answer 33

Antibiotic-only given if bacteria found,eg penicillinc, vancomycin,cephalosporins

Steroids-Dexamethasone

Question 34

Pathophysiology of sickle cell disease

Answer 34

-characterised by a crescent sickle shape red blood cell
-it in an inherited disroder in which there is an abnormality in the haemoglobin molecule. there is substitution of glutamic acid by valine at the 6th position, - charged amino acid is replaced by neutral
-this leads to abnormal functioning of the red blood cells and cause small blood clots(lead to recurrent painful episodes

Question 35

Sickle cell disease is caused by

Answer 35

Haemoglobin S- this reduces the amount of oxygen inside the cells distoting their shape
-the fragile sickle cell deliver less oxygen to the body’s tissues and can breakninto pieces that disrupt blood flow.

Question 36

What is haemoglobin?

Answer 36

it is a protein inside red blood cells that carries oxygen

Question 37

signs and symptoms of Sickle cell disease.

Answer 37

chest pain
bone pain
fatigue
breathlessness
jaundice
rapid heart rate
poor eyesight/blindness
attacks on abdominal pain
fever

Question 38

diagnosis

Answer 38

haemoglobin electrophoresis
sickle cell test
reduced serum haemoglobin
elevated bilirubin
high white blood cell count
elevated serum potassium
CT scan
MRI

Question 39

Treatment of sickle cell disease

Answer 39

main goal of treatment is to manage and control symptoms and reduce the frequency of crises
-supplementation of folic acid to help produce cells
adequate hydration
Bone marrow transplant

Question 40

prevention of sickle cell disease or complications

Answer 40

Genetic counselling to all carriers of sickle cell trait
prompt treatment of infections , adequate oxygenation and preventing dehydration

Question 42

what is misuse of drugs?

Answer 42

misuse of drugs is irrational drug use or irresponsible drug use

Question 43

Impact of misuse of medications include

Answer 43

-reduced quality of therapy which may lead to morbidity and mortality
-waste of resources which leads to reduced availability and increased cost.
-risk of unwanted effect leading to adverse reaction and bacterial resistance
-pyschosocial impact;patients rely on unnecessary drugs.

Question 44

what is Antimicrobial resistance?

Answer 44

it is the ability of a microorganism to stop an antimicrobial from having any effect on it.

Question 45

what is Drug abuse?

Answer 45

it is the use of prescription drugs in nayway other than as prescribed by the doctor or prescriber

Question 46

examples of pyschoactive drugs

Answer 46

codeine
morphine
pentazocine
Tramadol