Medicine

METHODOLOGICAL INSTRUCTIONS TO LESSONS № 3 FOR STUDENTS

METHODICAL INSTRUCTIONS TO LESSON 2 FOR STUDENTS

 

THEME: Clinical Pharmacology of Drugs for Asthma and Other Bronchoconstrictive Disorders. Clinical Pharmacology of Steroidal and Nonsteroidal Antiinflammatory Agents.

 

Aim: To study clinical pharmacology of agents influencing on the function of respiratory track: respiratory stimulators, cough remedies, expectorans, broncholitics, of steroid and non-steroid anti-inflammatory drugs and immunomodulators,  their clinical usage and complications.

 

 

Professional Motivation:

A large proportion of all days lost from work and school is caused by respiratory tract illnesses. This disorders which range from common cold to bronchitis, asthma and other severe condition, are very important in health care and have rational management. A cough is protective respiratory reflex. It is usually helpful. However, in many conditions cough increases in frequency and severity and becomes troublesome rather than helpful, particularly at night when it can prevent sleep. Antitusssives, expectorants and mucolyties are widely used to treatment of acute respiratory infections.

          Spasm of the bronchial smooth muscle is the distinguishing characteristic of the group of diseases affecting the lower respiratory tract, e.g. asthma. Mucosal edema and hypersecretion by the bronchial glands frequently accompany bronchospasm. The most widely used bronchodilatators are b-adrenergic stimulants methilxanthine drugs, antimuscarinic agents, an inhibitor of mast cell degranulation and corticosteroids. Some of them are used as asthma prophylactic drugs, and other for treatment of acute attacks of asthma.

Inflammation is an important mechanism for protection of body from attack of invading organisms. However, inflammation is also a cause of the disability that accompanies a variety of disorders. Adrenal corticosteroids and non-steroidal anti- inflammatory agents have anti-inflammatory activity. For treatment of disorders affecting immune system immunomodulators are used.

Basic Level: For learning this theme students have to review pathogenesis of inflammation, mechanisms of allergic reactions and hypersensivity, the immune response (department of pathologic physiology), students have to review anatomy and physiology of respiratory tract (department of normal anatomy and normal physiology), main pathologic features of respiratory disorders (pathologic physiology department).

 

Students`, Independent Study Program

I.                   Objectives for Students’ Studies

You should prepare for the practical class using exist textbooks and lectures. Special attention should be paid to the following:

1.     Clinical pharmacology of non-steroid anti-inflammatory drugs.

2.     Clinical pharmacology of steroid anti-inflammatory drugs.

3.     Clinical pharmacology of immunomodulators.

4.     Pharmacokinetic and pharmacodynamic effects, uses and contraindications of  respiratory stimulators.

5.     Clinical pharmacology of cough remedies.

6.     Clinical pharmacology of expectorans.

7.     Clinical pharmacology of bronchodilators.

Key words: inflammation, immune response, immunomodulators, arthritis. respiratory tract, antitussive drugs, cough, expectorant, mucolytic, bronchospasm, asthma.

 

II.                Tests and Assignments for Self-assessment.

 

1.     Write out the prescriptions for the following drugs in different medicinal forms: hydrocortisonum, prednisolonum, methylprednisolonum, triamcinolonum, dexamethasonum, cromolynum, levamizolum, timalinum, tactioin, salicylic acid (aspirin), indomethacin, ortofen (vilaren), bromhexinum, acetylcystinum, glanvelitum, Codeini phosphas, Libexinum, infusion of herbae Thermonsidis. Kalii iodium, trypsinum crystalisatum, Salbutamolum, Manitum, urea pura, Berotec, Euphyllinum, Spiritus aethilicus, Strophantinum, Mucaltinum, Desoxyribonucleasa, Pertussinum, Cordiaminum, Camphora, Bemegridum, Aethimisolum, Coffeini natrii benzoas, Solutio Ammonii caustici, Carbogenum, Decoctum of radicis althaeae, Ammonii chloridum, Chimotrypsinum,Infusion of follii farfarae, isadrinum, ephedrini hydrochloridum, Athropini sulfas,furosimidim, corgliconum, Hydronium, pentaminum.

 

2.      Choose the correct answer / statement:

A.   True statement concerning the pharmacologic effects of salicylates include:

A.    salicylates are thought to exert their activity at least partially by inhibiting prostaglandin synthetase

B.     high-dose salicylate therapy (more than 5 g /day) lowers the serum uric acid concentration

C.     the effect of salicylates upon platelet aggregation is irreversible unlike that of other non-steroidal anti-inflammatory drugs

D.    salicylate overdose is potentionally fatal, however, promt administration of acetylcystein will avert this danger

1.     A, B, C

2.     A, B

3.     B,D

4.     D only

5.     All above

B.   Aspirin may be fatal in taken in sufficient quantity. The syndrome of fatal salicyate overdose in children is characterized by

1.     marked hypotermia secondary to an antipyretic effect

2.     fever

3.     peripheral oedema

4.     disturbance in acid - base  and electrolyte balance

5.     tinnitus

C.   Common adverse reactions of corticosteroidal therapy are:

1.     bradycardia, mental dullness

2.     anorexia, polyuria

3.     tachycardia, insomnia

4.     “moon face”, obese trunk

 

D.   The most specific agent for prevention of asthma is:

1.     Salbutamolum

2.     Libexinum

3.     Adrenalini hydrochloridum

4.     Pertussinum

5.      Mucollinum

 

3.                                  Real life – situation to be solved:

A. The patient with severe allergic bronchial asthma has been treated by oral drug during 7 months. Hypertension, “moon face”, obese trunk, oedema, insomnia occur. What drugs does he used?

 

B. Patient 65 years old suffers from bronchial asthma. Adrenergic receptor activator is used for treatment, After two weeks of management a pain near heart, palpitation. What might be the cause of these side effects? How can they be prevent?

 

III.             Answer to the self-assessment

1.     A - 1; B - 2,4,5; C – 4. D– 1.

3. A.  Patient used one of orally used glucocorticoids, e.g. prednisolonum.

3. B. patient used ab- adrenergic receptor activator, which can stimulate heart activity due to b1-adrenergic stimulation. It is necessary to prescribe selective    b2-adrenergic receptor stimulator, for example salbutamolum.

 

Visual Aids and Material Tools: Medical documents, tables, slides.

 

Students’ Practical Activities

Students must know: pharmacokinetic, pharmacodynamic effects, uses and contraindications of steroidal and non-steroid anti-inflammatory drugs, immunomodulators, pharmacokinetic and pharmacodynamic effects, uses and contraindications for respiratory stimulators, cough remedies, expectorans, broncholitical preparations.

 

 

Students should be able to: make a choice of different above mentioned drugs in real-life situations, write out the prescriptions for these agents in different medicinal forms.

 

 

References:

1.     Barnes PJ: Drugs for asthma. Br J Pharmacol 2006;147(Suppl 1):S297.

2.     Tattersfield AE et al: Asthma. Lancet 2002;360:1313.

3.     Bryan SA et al: Novel therapy for asthma. Exp Opin Invest Drugs 2000;9:25.

4.     Hellman DB, Stone JH: Arthritis and musculoskeletal disorders. In: McPhee ST, Papadakis MA (editors). Current Medical Diagnosis & Treatment 2007. McGraw-Hill, 2007.

5.     Immer FF et al: Pain treatment with a COX-2 inhibitor after coronary artery bypass operation: A randomized trial. Ann Thorac Surg 2003;75:490.

http://intranet.tdmu.edu.ua/data/kafedra/internal/index.php?&path=distance/lectures_stud/English/1%20course/Clinical%20Pharmacology%20with%20Prescription/

http://intranet.tdmu.edu.ua/data/kafedra/internal/index.php?&path=distance/presentations/English/1%20course/Clinical%20Pharmacology%20with%20Prescription/

http://intranet.tdmu.edu.ua/data/kafedra/internal/index.php?&path=distance/classes_stud/English/1course/Clinical%20Pharmacology/

 

 

Prepared by ass. prof. Meretskyy V.M.

Methodical instruction was discussed 

and adopted at the Department sitting

 4.01.2013,

Minute № 7

Methodical instruction was adopted

 and reviewed at the Department sitting

27.08.2013 Minute № 1