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]

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( )( )

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

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III] Systemic Sequencing questions

[SSQs]

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( )( )-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

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