Clinical pharmacy and pharmacy practice Flashcards
What is malaria?
It is a parasitic infection caused by plasmodium species
Which specie causes malaria in tropical Africa
Plasmodium falciparum others include p.ovale,p.vivax and p.malariae
Transmission of malaria?
It starts through the bite of infected female anopheles mosquitoes
What are the signs and symptoms of malaria
Fever
Headache
Chills
Sweating
Anorexia
Nausea
Vomiting
Abdominal discomfort
Classification of malaria
Acute uncomplicated
Severe malaria
Acute complicated
Objective is to cure the infection
Severe malaria
Primary objective is to prevent death
prevent the emergence and spread of resistance to anti malarial drugs ,tolerability
Diagnosis
Primary diagnosis is the presence of fever in the last 24hrs
Parasitological diagnosis include
Light microscopy and Rapid diagnostic test
treatment of uncomplicated p falciparum malaria
Artemether + lumefantrine
Artesunate + Amodiaquine
Artesunate +Mefloquine
Artesunate + Sulfadoxine pyrimethamine sp
Dihydroartemisine +piperaquine
Treatment of severe falciparum malaria
Artesunate iv,im or rectal for children
Artemether im
Quinine iv infusion or im injection
Doxycycline
Clindamycin
Malaria in pregnancy
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
Misuse of drug?
Is the irrational or irresponsible use of drug.
what causes Typhoid fever
Gram negative salmonella typhi
it is an infection of the reticulo-endothelial system, intestinal lymphoid tissue and the gall bladder.
Transmission of typhoid fever
transmitted through the feco-oral route as a result of poor personal and food hygiene.
Pathogenesis of Typhoid include
-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.
symptoms of Typhoid fever
-Lethargy
poor appetite
fever(39-40 degrees)
Diarrhoea
constipation
chest congestion
abdominal pain and discomfort are common
headaches
slow heart beat
vomiting
Diagnosis of Typhoid
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
Differential diagnosis of Typhoid
Malaria
viral hepatitis
tuberculosis
Types of Typhoid Vaccines
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
Treatment of Typhoid
treatment is essential to prevent ut from progressing to Pneumonia, intestinal bleeding and perforation
Drug treatment of Typhoid
includes antibacterial therapy :
Amoxicillin
Fluroquinolones
Azithromycin
Ceftriaxone
what is TETANUS and what is it caused by
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
What is incubation period
it is the time from injury to the first symptom. Severe tetanus has an incubation period of less than 48hrs
Treatment of tetanus
-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
Prevention of tetanus
-active tetanus immunization
-Immunization provides protection for 10yrs, give booster after every 10yrs
-cleaning wounds thoroughly and cover to pevent infection.
what is meningitis
the infection of fluid in the spinal cord and fluid that surrounds the brain
Types of Meningitis
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
Bacteria meningitis is caused by
Haemophilus influenza type b
Neisseria meningitides(Meningoccal meningitis)
Streptococcus Pneumonia
Signs and symptoms of Meningitis
Headache
high fever
sensitivity to light
seizures
sleepiness
confusion
nausea and vomiting
stiff neck
petechiae that spreads rapidly
Diagnosis of meningitis
Lumbar puncture(spinal tap) and testing for bacteria growth in the spinal fluid
Severe complications of Meningitis could include
Brain damage
coma
death
long term hearing loss
mental retardment
paralysis
seizures
Drug treatment of meningitis
Antibiotic-only given if bacteria found,eg penicillinc, vancomycin,cephalosporins
Steroids-Dexamethasone
Pathophysiology of sickle cell disease
-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
Sickle cell disease is caused by
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.
What is haemoglobin?
it is a protein inside red blood cells that carries oxygen
signs and symptoms of Sickle cell disease.
chest pain
bone pain
fatigue
breathlessness
jaundice
rapid heart rate
poor eyesight/blindness
attacks on abdominal pain
fever
diagnosis
haemoglobin electrophoresis
sickle cell test
reduced serum haemoglobin
elevated bilirubin
high white blood cell count
elevated serum potassium
CT scan
MRI
Treatment of sickle cell disease
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
prevention of sickle cell disease or complications
Genetic counselling to all carriers of sickle cell trait
prompt treatment of infections , adequate oxygenation and preventing dehydration
what is misuse of drugs?
misuse of drugs is irrational drug use or irresponsible drug use
Impact of misuse of medications include
-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.
what is Antimicrobial resistance?
it is the ability of a microorganism to stop an antimicrobial from having any effect on it.
what is Drug abuse?
it is the use of prescription drugs in nayway other than as prescribed by the doctor or prescriber
examples of pyschoactive drugs
codeine
morphine
pentazocine
Tramadol
