Você está na página 1de 15

c

January 14, 2011


Pharmacology 2:
CLINICAL MANAGEMENT TARGETS
c

c
c

3 cc
 c   c c cc  c
c
c3c c 
 c
3  c c  
 c
c c    c
c ccc
c 
c
 
c
c

c
c


c  c

c
c

c
c

c
c


c  c

c
c

Malaria

Salient Feature Drug of Choice or Medical Management


Fever 


 c
c  
c
c  
cc c  cc
 c

c !
cºcc cc"  
c
c  c

cºcc #$ccºcccc
Pain
c
PGE1 Featuresc

c


cc
c c
c
Hyperthermia r/t inflammatory process
of rbc destruction by malarial parasite.

Acute pain r/t inflammatory process of


malarial infection
Etiology: Parasitecc 1st Line Agents
%c&
c  
)cc
%c'


c DOC: Chloroquine (250mg)
%c

c # 
(! 
c*+,, -.+ /c
%c
(c 2nd Line Agents
c   c., 0c1
 c., c
c 3rd Line Agents
c 2c

! c c3(!! c
c
c

c
c cºc c c  ccc
c 4c* 4/c
c  c5c 
 c&.cºc c
"

cºc3  !c'


c


c
c
Anopheles Mosquito sp.c & c611c*
0c7  ccc
  c  cºc8
 /c
Prophylaxis ºc
c  ccc Chloroquine .+, c.
 c-59c
c

c   c c c.c59 cc(  %c
Complications: c
c c

c*  !/cºc$1"3 c   c $ c
  c"
cc
:
c 
!  c
" 9c c9   c !
cºc c 
c
" 9c c !(
ccºc1 cc"$7cc 
cc
 c c&.ccc;c
c
neffective tissue perfusion r/t continual
damage of rbc by the malarial parasite.
ccc
cc
Seizure 3
4
c
Delirium # c$c" c
" 
c !c
Àisk for injury (Falls) r/t uncontrolled
patient response secondary to the
brains inflammatory process.
Secondary bacterial infections  c
  ccc7  cc
-  
cc # !c c
c   c c
cc
cc   c  
ccc   %

Leptospirosis:

Salient Feature Drug of Choice or Medical Management




cc c*/c 


 c
:c
 c*/c
Etiology: Bacteria c
eptospira spirochete Penicillin Gc%+c c c)c cc
family: (Syphilis sp) 59c c
c 
c*3 -7
 -"
 /cºc 3(!! c,, c&c$3c cc59c
( cc
c c
c
:
cc1 c
  c
3!
c  cc   !c"
c
"
c
  c 3
!  cc
3
c3 c
Tetanus

Salient Feature Drug of Choice or Medical Management


Wound Infection (site of injury) #9c3 -c"
ccc
c
c 3
c  c c c*c(! /cºc  c*

-
4c  /ccc

c
cc7&.cºc  c c
 c cñ. tetani.c !  c (c*'
c9
c
c
c (! /cc$
cc
Àisk infection r/t continual growth of c
microorganisms on the devitalized and #  cc
hypoxic tissue.
Muscular Rigidity Diazepam (Benzodiazepine)
c cc$c  
cc c $c
c*  !
c
c 
 
-
 ! cºc 7 /%ccc
 c !c 
  c c " 
 c$cºcccc
 
c*$/c '<c

c* /cºc' 
c
c  c  cºc'<cºc' 
c 
(
c
7
cºc" !c c
c
Altered breathing pattern º Hypoxia  c5  c
Risk Aspiration #c ! c
c
c c &c
" 9c c= !c c

 c! 
c !c
Airway & Respiratory Compromisec 
c
*' 
c" !cc#
ccc 3
4
cc

! 
c

5
! cºc> c
 
 !c
c  %c*#"3&"/c
Sedation Purposes 3
4
c
Tetanolysin 
c
 c  c
c 
4c(cc
Etiology: Bacteria  cc?' c> c23-c
ñlostridium tetani sp. (SO) ' 
4 c+,, c
Supportive: c
c$  cc   c  cºc7&"#&1c cc#

c c
 c
"1#c*1 ccc&c'$/c c

c 


 c c
 c  c
c

Syphilis

Salient Feature Drug of Choice or Medical Management


Etiology: Bacteria Benzathine Pen G 2.4 mil IM
©reponema palladium sp.c 3(!! c&c c
! cc c
 ! !c

Gonorrhea

Salient Feature Drug of Choice or Medical Management


7  c !
( c*@
c c !/c #  c 
c
 ! !c!c&c
Etiology: Bacteria /STD 4 !c
& (
cc
Neisseria gonorrhea sp%* /c ' 
4 c
7 
c   
c'  c cc
*'  /c 
!cc

Vaginal Candidiasis

Salient Feature Drug of Choice or Medical Management


Etiology: Fungus ! ccc
ñandida sp%c  
4 cc
 c
7 
!c

c   c

Chicken Pox

Salient Feature Drug of Choice or Medical Management


Etiologic: Virus !  c*A
(/cc
Ñaricella zoster sp.c
Herpes zoster sp. 

  c*
 (/c

cc #3#c
 c*
c$c7 (/c
 c 7

c c
7

 ! c*$
 ! c /c
! c
 c 


 c
cº  c*"! c#! cc
  /c
c

 c c c c c c

Salient Feature Drug of Choice or Medical Management


’tiologic: Ñirus Oseltamivir:c 

c cºc  c
H1N1c 
%cc
c
c
Immunomodulation Effects Bronchodilators:
c  
c  
c Salbutamolcºc$
c
 c*$./c
c 3 c

cc  ccc Ipratropium Hbrcºc' 
c  c 9 c
  c * 9 cc

c  /cc
c  c c!  c %c$ 
c
.%cc  c
Bronchoconstriction º AIRWAY Aminophylline º Beta Agonist
OBSTRUCTION
Phospholiapse A2 inhibitor
!   c
%c1(! 
ccºc c  
c
 cc

c
 
!c cºc# cc
Secondary Infections Antibiotics based on Culture and Sensitivity

%c  
ccc Test
cccc 
c Empiric Therapy:c
cccc#
%cc c< c7
  0c
!
c

Rabies

Salient Feature Drug of Choice or Medical Management


Prophylaxis "
 c
c
a. Animal Ñaccination )c"
 ccc  c*

/c
b. Persons who handles
cccccc -5 c
ccccc 

cccc
ccccc   -'3c c c
 cc
Post-Exposure Animal Bitec
Wound Site 8
c  c5
 c* 
/c
c &c  c(  c c

cc #9c3 cc
*7%c
/ 
 c c(  c* 
c
 c
c & c
 
c   /c
7 (
 c
"cc*"
 cc  /cc
Rabid Human
Confusion  
c
Delirium "  c$c  c
1 c 
c*  --  -
 /c
Laryngospasm º Upper airway &c
obstruction and pain c >#& c
! 
cc cc


c Goal:c1cc
cc5c !cc
c
&!

c*
 c 5
5 /c
c7& ' & cc
# 
cc
 c c""c

HIV

Salient Feature Drug of Choice or Medical Management


Prophylaxis Goal: Reduce the growth of the virusc*
c
  
c c ccc 
c c  c5 /c
3
 c5 9c ccBc ccc  c 9c
 cc
c  c c

 c*   -'3/c
Test for Susceptible Host Based on GOAL: To confirm HIV infection
History

Diagnostic Test:

Elisa Test
Western Blot (Confirmatory)

Post Exposure (HIV +) GOAL:


"cc
c1
c
c 
c73?c
Target: CD4 T Lymphocyte 1!! c
c
%c  c&  c c
Diagnostics: c%c  c c  !cc
ccccc*
/ºc"## 7cc
c%c  c   c*7
 /ccc
CD4 Count: (n) >1,500 c%c"c
  c
c cc
(AIDS) <350 ccccc c   %c
Viral Load: (n) 0.00
(High) 150,000 O©H’ÀS: MON’ & Support
Suspected Culture for opportunistic
Infections 1 capsule º 380 pesos x 2 a day

Biopsy for suspected Tumors NB: Walang pera walang gamut


PhilippinesÚc ccc
c c   cc
thc ctc
ccc
c
Anti-Retroviral Agents:
c c'
cc c
c "c 5cc cc
c
" c
  
cºc" c cc3 C c

cºc3 cc cºc'
-3 c
3

cºc  c

%c 
c c
wc "
 c*   /c
wc #
)
 c* 

Dc
/c
wc  
 c*
/c
wc 
 c*7 (
/c
wc  
 c* 
/c
cccccccccccccccccccc1
 cc
cc
%c   c" c
  
c c
wc AZTc*4Dc"  /c
wc 3TC *
Dc /c
wc d4Tc* 
DcA /c
wc ddIc*
 Dc(/c
wc Abacavirc*A
/c
wc ddC *4

Dc /c
c
%c    c" c
  
c
 c
wc 
 4c*# 
/c
wc 
c*
/c
wc 3
 c*"   /c
c
c
c
%c c c
c
cccccccccccccccc4c
%c
c
cccccccccccccccc7 
c 
c

Naïve Patients: ( c;c


 c5c
cc!c
 c  
/c

Nursing Responsibility:
%c' cc$
 c
a. ñonfirm that the patient HÑ +
b. Secure ñ count & Ñiral oad
ñountccc
ccccc%cc1 c4! c*#-1/c
ccccc%c
 
c*# c!
/c
ccccc%c"
cc*$> -7 
/c
ccccc%cc8$7-"$7ccc
.%c7 
c'
c
cccccc79
 cc  c* c
c.c
 /c
cccccc
c
!-
c*c
/c
cccccc3
!cc#! c
<%c 
c
 c
cccccc
c 9 c  cºc(!c
cccccc
c 9 c
:c
c c 
cc
ccccccc 9 c c
c5c c
 %cc
c  cc c  -
! cc
c  cc 
c
c#E>1c
3>7& %c
c

PTB

Salient Feature Drug of Choice or Medical Management


Pre-Exposure: c
c
Mantoux ©estcºc  c 
c c 

c$7c*1/c
 c
cc
c c( c5cc c  
cc
'%c    %c c 7

c   cc

%c( c cc!c


cc
! c   
c
c
-c!c
cc%c c 7
c   c$c !  cc
%cc9
c c
c  
c
Sputum AFB º GOLD STANDARD
c5
 c
carrier and infectious 8
c3 
cºc#c
'
9c

PTB AGENTS: 6 Months Duration


Part 1: Initial Phase ( 2 months)
Part 2: Continuous Phase (4 Months)
c
c
c
Gastric Analysis ºc6ccc
cºc h chc
ctccc

t t
cc
ttcc

ñhest PA º APñA hyperaireation

c
c
 c*
 - /c 


 c
8 c1 cºc cc 
c
 c  
c3cc
 c

c*7 c

/cc 3 9c$c3  cc
.c59cc cc  
c&
c c
9c
&
c
cc
c

UNIT X. Drugs for Communicable Diseases


 
!c    c
 
!c3  cc
# !c
 
4c* /c
"
c
!
4
c*A/c

 c
#
!c3  c
7
 !c

c




!
c c
7!   c
%?c
 cc 
c
%?%c
c
c
%?%.c7
c
c
.%c
c
cccc.%cc# 
c
c

%c cc
%c7
(c
%c  ) c
cccccccccccccccc.%.c
  c
c

%c( 7


c
%c 



c( c
ccccccccccccccccc.%<c'! 
c
c

%c'
  c
%c
! c
cccccccccccccccc.%?c
c
c

%c&  
 c
%cA

 c
cccccccccccccccc.%+c7
!
c
c

%c  ) c


cccccccccccccccc.%Bc  

) c

- 
c
c

%c c;c7  (
c
%c1 (
c
%c ! c
ccccccccccccccc.%Fc6  
c
c

%c !   c
%c7
    c
%c' c
%c1 (
c
c
 -
4

c;cc9
c
<%c'


c
cccc<%c7  )c
cccc<%.c 
)c
cccc<%<c2c
cccc<%?c# 
(cc
?%c1    c
cccccccccc?%c' c1    c
ccccccccccccccccccc
%c3(!! c
ccccccccccccccccccc%c( c
ccccccccccc?%.c'
cc# c1    ccc
ccccccccccccccccccc
%c cc
ccccccccccccccccccc%c c
+%c

 c
cccccccccc+%c3! 


4c*31/c
cccccccccc+%.c 
4 c
cccccccccc+%<c3(!! c
cccccccccc+%?c c
B%c79c(c*

/c
cccccccccB%c!  c
F%c!c c
ccccccccccF%c7  (
c
ccccccccccF%.c7 
 c
ccccccccccF%<c4 !c
ccccccccccF%?c c
cccccccccF%+c7 (
4 c
G%c
c 
 c
ccccccccccG%c1
c
ccccccccccG%.c  cc
ccccccccccG%<c   c
H%c"
 c
cccccccccH%c"
 c  c*"/c (  c !
( c
cccccccccccccc*c
 c
  -

 c
/c
,%c
 c
cccccccccc,%c cc
c
cccccccccc,%.c#0cc cc
%c#
 c
cccccccccc%c  c 
c
cccccccccc%.c1
c c
.%c7
 c
ccccccccccc.%c cc
ccccccccccc.%.c
!c
<%cc 
c
cccccccccc<%c c1cc
cccccccccccccccc
%c7 
(c
cccccccccccccccc%c3(!! c
cccccccccc<%.c  
c
cccccccccccccccc
%c74(c
cccccccccccccccc%c7
c;c c
?%c7
!
c
ccccccccccc?%c3(!! c
ccccccccccc?%.c
! c
ccccccccccc?%<c4 !c*  
/c
+%c -3#c
ccccccccccc+%c" 
  
c c
cccccccccccccccc
%cAc*A3/c
cccccccccccccccc%c3
 c
cccccccccccccccc%cA

c
cccccccccccccccc%c#
c
cccccccccccccccc%c1
c
cccccccccccccccc%c 
c
ccccccccccc+%.c 
c c
cccccccccccccccc
%c#
)
 c
cccccccccccccccc%c"
 c
cccccccccccccccc%c
 cc
ccccccccccc+%<c
c c
cccccccccccccccc
%c"

 cc
B%c#  
 c
ccccccccccB%c
4)
 c
F%c 

 c
ccccccccccF%c 
4 c
ccccccccccF%.c c
ccccccccccF%<c
4c7
c
ccccccccccF%?c!
 c

c
G%c 
 c
ccccccccccG%c'
4 c
ccccccccccG%.c!
 c

ccccc
c
ccc
c
c
c