systemic assessment in pharmacology
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SYSTEMIC ASSESSMENT SYSTEMIC ASSESSMENT IN PHARMACOLOGYIN PHARMACOLOGY
By By Dr. Sahar KamalDr. Sahar KamalFaculty of MedicineFaculty of Medicine
Workshop on Systemic AssessmentWorkshop on Systemic Assessment
DSASPDSASP Cairo, Egypt, November 2011Cairo, Egypt, November 2011--
I-Systemic Multiple Choice QuestionsI-Systemic Multiple Choice Questions
[SMCQ, s][SMCQ, s]
--
--
( )( )
EnalaprilEnalapril Replace by candesartanReplace by candesartan
If no hypersensitivity to ACEIs, If no hypersensitivity to ACEIs, use from the start acc. To AHAuse from the start acc. To AHA
If angioedemaIf angioedema
If edema and fluid retentionIf edema and fluid retention
If HF +AFIf HF +AF
a)a)
+ digoxin+ digoxin + furosemide+ furosemide
( )( )
digoxindigoxin ThiazideThiazide
-if asso. With VF-if asso. With VF
If volume overloadIf volume overload
If hyperkalemiaIf hyperkalemia
If angioedemaIf angioedema
b)b)
+ + EnalaprilEnalapril
+ + spironolactonspironolacton
ee
ExampleExample : : [pharma.]:[pharma.]: Put (Put () in front of the correct systemic diagram ) in front of the correct systemic diagram in TTT of congestive heart failurein TTT of congestive heart failure::
II] Systemic matching questions [SMQs]
4
Example- (Pharmacology): Choose Drugs used in control of congestive heart failure
from column (A) & therapeutic action From column (C) to build the correct systemic relations in column (B):
.
,
Column [A]Column [A]Column [B]Column [B]Column [C]Column [C]
ACEIsACEIsReduction of pre- Reduction of pre- and after-loadsand after-loads
ARBsARBsIf cough and If cough and angioedema with angioedema with
ACEIsACEIs
DiureticsDiureticsIf fluid retention, If fluid retention, edemaedema
DigoxinDigoxinIf heart failure + If heart failure + supraventricular supraventricular
tachyarrhythmiastachyarrhythmias
5
III] Systemic Sequencing questions
[SSQs]
6
( )( )-Digoxin-Digoxin
-ACEIs-ACEIs
ARBsARBs
diureticsdiuretics
( )( )
To control CHF To control CHF symptomssymptoms
Decrease in pre-and after loadDecrease in pre-and after load
-+ digoxin if HF+AF-+ digoxin if HF+AF
ACEIsACEIs
ARBsARBs
+ diuretics5+ diuretics5
Reduce edema and Reduce edema and fluid retnetionfluid retnetion
Used if intolerant to Used if intolerant to ACEIsACEIs
Example :Example : [Pharmacology.]: [Pharmacology.]: Put the following drugs in the correct sequence in the following systemic diagram to Put the following drugs in the correct sequence in the following systemic diagram to
control a case of congestive heart failure: ACEIs, ARBs, Diuretics, Digoxincontrol a case of congestive heart failure: ACEIs, ARBs, Diuretics, Digoxin
IV-Synthesize Systemic relations between concepts, facts, issues,
[SSyQ,S]
,
ACEIsACEIs Reduce congestionReduce congestion
To ensure reduction of mortalityTo ensure reduction of mortality
[ [ + diuretics + diuretics]]
+ Digoxin+ Digoxin
+ spironolactone+ spironolactone
A-I)A-I)
Prevents Prevents remodellingremodelling
Control HF+ Control HF+ AFAF
ARBsARBs Reduce congestionReduce congestion
To ensure reduction of mortalityTo ensure reduction of mortality÷÷
+ diuretics+ diuretics
+ spironolactone+ spironolactone
+ Digoxin+ Digoxin
A-II)A-II)
Control HF+AFControl HF+AF Reduce mortalityReduce mortality
Example:Example: [Pharma.]: [Pharma.]: Build a correct systemic shows the relations between the following drugs: ACEIs, Build a correct systemic shows the relations between the following drugs: ACEIs,
ARBs, Diuretics, Digoxin in the control of a case of congestive heart failureARBs, Diuretics, Digoxin in the control of a case of congestive heart failure
V-Analyze Systemic to its
Components [ SAQ,s]
PenecillinPenecillin
To Increase antimicrobial effect and uptakeTo Increase antimicrobial effect and uptake
-if desensitization to penicillin is done-if desensitization to penicillin is done If hypersensitivity If hypersensitivity of of
penicillinpenicillin
If associated with anerobic infectionsIf associated with anerobic infectionsReplace by Replace by
vancomycin or vancomycin or linezolidlinezolid
Example-Example- : [Pharma.]: : [Pharma.]: Analyze the following combination of antibiotics in treatment of infective Analyze the following combination of antibiotics in treatment of infective
endocarditis into relations:endocarditis into relations:
+ gentamycin+ gentamycin
+ clindamycin+ clindamycin
VI-Complete Systemics
( )( )
Topical Topical nystatinnystatin
If sever eoral mucosal candidiasisIf sever eoral mucosal candidiasis we can combine systemic drugs withwe can combine systemic drugs with
No improvementNo improvement
If drug interactionIf drug interaction
If immunocompromized patientIf immunocompromized patient
a)a)
Example :Example : [Pharma.]: [Pharma.]: Complete the following systemic diagram by using the Following antifungal Complete the following systemic diagram by using the Following antifungal drugs to give correct systemic drug prescription in TTT of oral candidiasis:, drugs to give correct systemic drug prescription in TTT of oral candidiasis:,
( )( )
Topical Topical nystatinnystatin
Systemic ketoconazoleSystemic ketoconazole
Combined topical and systemic drugsCombined topical and systemic drugs
No improvementNo improvement
If drug interaction If drug interaction With serious drugs with e.g. With serious drugs with e.g.
Terfenadine or oralTerfenadine or oralanticoagulant asanticoagulant as
it decreases their metabolismit decreases their metabolism
If immunocompromized patientIf immunocompromized patient
b)b)
IV amphoterecin-BIV amphoterecin-B Systemic Systemic fluconazolefluconazole
14
THANK THANK YOUYOU
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