By F. Reto. Wells College. 2018.
While use of artesunate in patients with renal or hepatic impairment has not been studied extensively generic ibuprofen 400 mg without a prescription, the limited data available (and the known metabolism and excretion of drug) do not suggest that artesunate would be toxic to renally or hepatically impaired individuals discount ibuprofen 600 mg amex. Dosage optimization For the treatment of uncomplicated malaria, the target dose of artesunate remains 4 mg/kg bw daily, with a daily dose range of 2–10 mg/kg bw. Children weighing < 25 kg with severe malaria had lower exposure to intravenous or intramuscular artesunate and its active metabolite dihydroartemisinin than older children and adults given the same dose of 2. This may increase the risk for treatment failure, which can be fatal in severe malaria. These models confrmed that young children (< 25 kg/5 years) should receive a slightly higher dose of 3 mg/kg (see section 7. A pharmacokinetic and pharmacodynamic study of intravenous vs oral artesunate in uncomplicated falciparum malaria. Pharmacokinetics/ pharmacodynamics fndings after repeated administration of artesunate thermostable suppositories (Rectocaps) in Vietnamese patients with uncomplicated malaria. Oral bioavailability of dihydroartemisinin in Vietnamese volunteers and in patients with falciparum malaria. Byakika-Kibwika P, Lamorde M, Mayito J, Nabukeera L, Mayanja-Kizza H, Katabira E, et al. Pharmacokinetics and pharmacodynamics of intravenous artesunate during severe malaria treatment in Ugandan adults. Pharmacokinetics and pharmacodynamics of intravenous artesunate in severe falciparum malaria. Plasma levels of artesunate and dihydroartemisinin in children with Plasmodium falciparum malaria in Gabon after administration of 50-milligram artesunate suppositories. Population pharmacokinetics of intramuscular artesunate in African children with severe malaria: implications for a practical dosing regimen. Comparative 5 pharmacokinetics of intramuscular artesunate and artemether in patients with severe falciparum malaria. The pharmacokinetic properties of intramuscular artesunate and rectal dihydroartemisinin in uncomplicated falciparum malaria. Effects of alpha-thalassemia on pharmacokinetics of the antimalarial agent artesunate. Disposition of artesunate and dihydroartemisinin after administration of artesunate suppositories in children from Papua New Guinea with uncomplicated malaria. Bioavailability and preliminary clinical effcacy of intrarectal artesunate in Ghanaian children with moderate malaria. Pharmacokinetic profles of artesunate following multiple intravenous doses of 2, 4, and 8 mg/kg in healthy volunteers: phase 1b study. Intramuscular bioavailability and clinical effcacy of artesunate in Gabonese children with severe malaria. The pharmacokinetics of intravenous artesunate in adults with severe falciparum malaria. Pengsaa K, Sirivichayakul C, Na-Bangchang K, Thaiarporn I, Chaivisuth A, Wongsuwan A, et al. Population pharmacokinetics of artesunate and dihydroartemisinin following intra-rectal dosing of artesunate in malaria patients. Sirivichayakul C, Sabchareon A, Pengsaa K, Thaiarporn I, Chaivisuth A, Na-Bangchang K, et al. Comparative study of the effectiveness and pharmacokinetics of two rectal artesunate/oral mefoquine combination regimens for the treatment of uncomplicated childhood falciparum malaria. Chanthap L, Tsuyuoka R, Na-Bangchang K, Nivanna N, Suksom D, Sovannarith T, et al. Investigation of bioavailability, pharmacokinetics and safety of new pediatric formulations of artesunate and mefoquine. Assessment of the effect of mefoquine on artesunate pharmacokinetics in healthy male volunteers. Krudsood S, Looareesuwan S, Tangpukdee N, Wilairatana P, Phumratanaprapin W, Leowattana W, et al. Pharmacokinetics of two paediatric artesunate mefoquine drug formulations in the treatment of uncomplicated falciparum malaria in Gabon. Population parmacokinetic and pharmacodynamic modelling of artemisinin and mefoquine enantiomers in patients with falciparum malaria. Pharmacokinetics of artemether–lumefantrine and artesunate– amodiaquine in children in Kampala, Uganda. Population pharmacokinetics of artesunate and dihydroartemisinin in pregnant and non-pregnant women with malaria. Krudsood S, Wilairatana P, Vannaphan S, Treeprasertsuk S, Silachamroon U, A Phomrattanaprapin W, et al. Clinical experience with intravenous quinine, 5 intramuscular artemether and intravenous artesunate for the treatment of severe malaria in Thailand. Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Effcacy of rectal artesunate compared with parenteral quinine in initial treatment of moderately severe malaria in African children and adults: a randomised study.
Decisions about drug therapy must be based upon the independent judgment of the clinician trusted ibuprofen 600 mg, changing drug information generic 600mg ibuprofen with mastercard, and evolving healthcare practices. Analgesics Mild / Moderate Pain Acetaminophen Both acute and chronic doses of acetaminophen are associated with hepatotoxicity. For this reason, this drug has been reformulated so the products are limited to 325 mg per dosage unit. Forms: Liquid, tablet, oral disintegrating tablet, caplet, rectal suppository, injectable Usual oral dosage:1,2 Children <12 years: 10-15 mg/kg/dose every 4-6 hours as needed (maximum90 mg/kg/24 hours,3 but not to exceed 2. Other children may be poor metabolizers of codeine with lower conversion to morphine and, consequently, under-respond to the narcotic. Forms: Liquids: 120 mg acetaminophen and 12 mg codeine/5 mL (Note: Te elixir and solution, but not suspension, contain alcohol. For acute pain, naproxen sodium may be preferred because of increased solubility leading to faster onset, higher peak concentration, and decreased adverse drug events. Forms: Suspension, tablet Usual dosage:2 Children >2 years up to 12 years: 5-7 mg/kg every 8-12 hours as needed Children >12 years: 200 mg every 8-12 hours as needed; may take 400 mg for initial dose (maximum 600 mg/24 hours) Adults: Initial dose of 500 mg, then 250 mg every 6-8 hours as needed (maximum 1250 mg/24 hours) Moderate/Severe Pain Acetaminophen with hydrocodone For pediatric patients, the practitioner should consider prescribing in accordance to body weight (mg/kg) and in 5 mL dosage increments. Forms: Liquids: 300 mg acetaminophen and 10 mg hydrocodone/15 mL 325 mg acetaminophen and 7. May titrate up to 5 mg/dose oxycodone every 4-6 hours (acetaminophen maximum90 mg/kg/24 hours,3 but not to exceed 2. Forms: Suspension, chewable tablet, tablet Usual oral dosage:1,2 (based on amoxicillin component): Children >3 months of age up to 40 kg: 25-45 mg/kg/day in doses divided every 12 hours (prescribe suspension or chewable tablet due to clavulanic acid component) Children >40 kg and adults: 500-875 mg every 12 hours (prescribe tablet) Azithromycin This drug is one of two options for patients with Type I allergy to penicillin and/or cephalosporin antibiotics. Caution: This drug can cause cardiac arrhythmias in patients with pre-existing cardiac conduction defects. Forms: Tablet, capsule, suspension, injectable Usual oral dosage:1,2 (Note: Doses may vary for extended release suspension depending on the reason for prescribing the antibiotic. Forms: Suspension, tablet, capsule Usual oral dosage:1,2 Children >1 year: 25-100 mg/kg/day in divided doses every 6-8 hours (maximum 4g/day) Adults: 250-1000 mg every 6 hours (maximum 4g/day) Endocarditis prophylaxis:2,9 50 mg/kg (maximum 2 g) 30-60 minutes before procedure Clindamycin Note: This is one of two options for patients with Type I allergic reactions to penicillin and/or cephalosporin antibiotics. This antibiotic is effective for infections (eg, abscesses) with gram-positive aerobic bacteria and gram-positive or gram-negative anaerobic bacteria. Due to these and other side efects, women who are pregnant and children <8 years old should not use this drug. Forms: Suspension, tablet, delayed release tablet, capsule, injectable Usual oral dosage for necrotizing ulcerative gingivitis:1,8 Children >8 years who weigh <45 kg: 2. Patients should avoid ingestion of alcohol as a beverage or ingredient in medications while taking metronidazole. Forms: Tablet, tablet extended release, capsule, injectable Usual oral dosage: For anaerobic skin and bone infection:1,3 Children: 30/mg/kg/day in divided doses every 6 hours (maximum 4 g/24 hours) Adolescents and adults: 7. Anaphylactic reactions have been demonstrated in patients receiving penicillin, most notably those with a history of beta-lactam hypersensitivity, sensitivity to multiple allergens, or prior IgE-mediated reactions (eg, angioedema, urticaria, anaphylaxis). Form: Suspension 10 mg/mL, 40 mg/mL; tablet: 50 mg, 100 mg, 150 mg, 200 mg; injectable 200 mg, 400 mg Usual dosage:1,2 Neonates >14 days: Single dose of 6 mg/kg on day 1; then decrease to 3 mg/kg once/day for 7 to 14 days Adolescents and adults: Single dose of 200 mg on day 1; then decrease to 100 mg once/day for 14 days Ketoconazole Form: Tablet, 200 mg Usual oral dosage:1,8 Children >2 years: 3. Miconazole nitrate Forms: Ointment 2%; cream 2% Usual dosage:1 Children >2 years and adults: Apply a thin layer to the corners of the mouth 4 times/day for 14 days or until complete healing. Nystatin Forms: Ointment, cream (100,000 units/g) Usual dosage:1 For all ages: Apply a thin layer to angles of mouth 4 times/day for 14 days or until complete healing. Nystatin, triamcinolone acetonide Forms: Ointment, cream (100,000 units nystatin/g and 0. Topical or transmucosal agents for oral candidiasis Clotrimazole Form: Lozenge 10 mg Usual dosage:1,2 (Note: Not for use in patients < 3 years of age. Miconazole (Oravig ) ® Form: Buccal tablet 50 mg Usual dosage:1,3 Adolescents >16 years and adults: One tablet/day for 14 days; apply to the gum region, just above the upper lateral incisor. Acyclovir Form: Cream 5% Usual dosage:1,3 Children >12 years and adults: Apply a thin layer on the lesion 5 times/day for 4 days. Acyclovir with hydrocortisone (Xerese®) Form: Cream (5% acyclovir with 1% hydrocortisone) Usual dosage:1,3 Children >12 years and adults: Apply a thin layer on the lesion 5 times/day for 5 days. Penciclovir Form: Cream 1% Usual dosage:1,3 Children >12 years and adults: Apply a thin layer on the lesion every 2 hours while awake for 4 days. Tere is a potential for lidocaine toxicity if oral suspension is overused, and there is an increased risk for aspiration if used in children who cannot expectorate. Form: Suspension [needs to be compounded by pharmacist; 50/50 mixture of liquid diphenhydramine hydrochloride (12. Note: Maximum dose of diphenhydramine hydrochloride in case the suspension is swallowed: Children 2 to <6 years: 37. Mupirocin Forms: Ointment 2%; cream 2% Usual dosage for localized impetigo or skin infection:1,3 (Note: For external use only; not for use in patients <2 months of age) Apply a small amount of ointment to the afected area 3 times/day. Pharmacogenetics of neonatal opioid toxicity following maternal use of codeine during breast-feeding: A case-control study. Prevention of infective endocarditis: Guidelines from the American Heart Association. The North Shore-Long Island Jewish Health System is not affliated with the owner of any of the brands referenced in this Guide.
Sometimes students are only expected to copy the prescribing behaviour of their clinical teachers ibuprofen 400 mg online, or existing standard treatment guidelines generic ibuprofen 400 mg on line, without explanation as to why certain treatments are chosen. Pharmacology reference works and formularies are drug-centred, and although clinical textbooks and treatment guidelines are disease-centred and provide treatment recommendations, they rarely discuss why these therapies are chosen. The result of this approach to pharmacology teaching is that although pharmacological knowledge is acquired, practical prescribing skills remain weak. In one study, medical graduates chose an inappropriate or doubtful drug in about half of the cases, wrote one-third of prescriptions incorrectly, and in two- thirds of cases failed to give the patient important information. Some students may think that they will improve their prescribing skills after finishing medical school, but research shows that despite gains in general experience, prescribing skills do not improve much after graduation. Bad prescribing habits lead to ineffective and unsafe treatment, exacerbation or prolongation of illness, distress and harm to the patient, and higher costs. They also make the prescriber vulnerable to influences which can cause irrational prescribing, such as patient pressure, bad example of colleagues and high- powered salesmanship. It provides step by step guidance to the process of rational prescribing, together with many illustrative examples. Postgraduate students and practising doctors may also find it a source of new ideas and perhaps an incentive for change. Its contents are based on ten years of experience with pharmacotherapy courses for medical students in the Medical Faculty of the University of Groningen (Netherlands). Box 1: Field test of the Guide to Good Prescribing in seven universities The impact of a short interactive training course in pharmacotherapy, using the Guide to Good Prescribing, was measured in a controlled study with 219 undergraduate medical students in Groningen, Kathmandu, Lagos, Newcastle (Australia), New Delhi, San Francisco and Yogyakarta. The impact of the training course was measured by three tests, each containing open and structured questions on the drug treatment of pain, using patient examples. After the course, students from the study group performed significantly better than controls in all patient problems presented (p<0. This applied to all old and new patient problems in the tests, and to all six steps of the problem solving routine. The students not only remembered how to solve a previously discussed patient problem (retention effect), but they could also apply this knowledge to other patient problems (transfer effect). At all seven universities both retention and transfer effects were maintained for at least six months after the training session. It gives you the tools to think for yourself and not blindly follow what other people think and do. It also enables you to understand why certain national or departmental standard treatment guidelines have been chosen, and teaches you how to make the best use of such guidelines. The manual can be used for self-study, following the systematic approach outlined below, or as part of a formal training course. Part 1: The process of rational treatment This overview takes you step by step from problem to solution. After reading this chapter you will know that prescribing a drug is part of a process that includes many other components, such as specifying your therapeutic objective, and informing the patient. It teaches you how to choose the drugs that you are going to prescribe regularly and with which you will become familiar, called P(ersonal)-drugs. In this selection process you will have to consult your pharmacology textbook, national formulary, and available national and international treatment guidelines. After you have worked your way through this section you will know how to select a drug for a particular disease or complaint. Part 3: Treating your patients This part of the book shows you how to treat a patient. Part 4: Keeping up-to-date To become a good doctor, and remain one, you also need to know how to acquire and deal with new information about drugs. This section describes the advantages and disadvantages of different sources of information. Annexes The annexes contain a brief refresher course on the basic principles of pharmacology in daily practice, a list of essential references, a set of patient information sheets and a checklist for giving injections. A word of warning Even if you do not always agree with the treatment choices in some of the examples it is important to remember that prescribing should be part of a logical deductive process, based on comprehensive and objective information. Please write to: The Director, Action Programme on Essential Drugs, World Health Organization, 1211 Geneva 27, Switzerland. The process of choosing a first-choice treatment is discussed first, followed by a step by step overview of the process of rational treatment. The chapter focuses on the principles of a stepwise approach to choosing a drug, and is not intended as a guideline for the treatment of dry cough. A good scientific experiment follows a rather rigid methodology with a definition of the problem, a hypothesis, an experiment, an outcome and a process of verification. This process, and especially the verification step, ensures that the outcome is reliable.
The bleeding may be due to defective blood vessels cheap ibuprofen 400mg fast delivery, platelet disorders or clotting factor deficiency generic ibuprofen 400mg otc. The pattern of bleeding is a helpful guide to its cause: in platelet and vessel wall defects, bleeding is usually into skin and mucosal surfaces like the gums, nose, gastrointestinal tract; in coagulation factor deficiency (e. In newborns with Vitamin K deficiency (which leads to multiple coagulation factor deficiency) spontaneous bleeding occurs from various sites such as the umbilical cord, gastrointestinal tract, scalp, brain. Patients may be severely anaemic and in haemorrhagic shock if there is a large bleed. Note For information on appropriate blood products for various bleeding disorders see “National Guidelines for the Clinical Use of Blood and Blood Products in Ghana” for more details. The possession of one normal haemoglobin (haemoglobin A) together with one abnormal haemoglobin (e. Sickle cell disease patients may present either in the steady state, in crises or with complications. The crises are commonly vaso-occlusive (precipitated by cold weather, dehydration, infection, ischaemia or physical exertion), which often cause pain in the bones. In sequestration crises, the spleen and liver enlarge rapidly due to trapping of red blood cells. Patients with sickle cell disease should be encouraged to have periodic check-ups at a Sickle Cell Clinic. Transfusion will be necessary if haemoglobin level < 5 g/dl In the Steady State • Folic acid, oral, Adults 5 mg daily Children > 1 year; 5 mg daily < 1 year; 2. The abnormal plasma cells in the bone marrow result in a reduction in normal blood cell production and erosion of bone with release of calcium. The abnormal immunoglobulin in blood results in hyperviscosity, renal failure and impaired ability to fight infections. Follow-up can be done by a physician specialist with guidance from the haematologist. There are two main types of leukaemia depending on the type of white cell affected. Each can further be divided into acute (where the patient falls suddenly ill) and chronic (where the patient may have been harbouring the disease for months and occasionally years without knowing). Follow-up can continue at a regional centre by a physician under the distant guidance of a haematologist in the case of chronic leukaemias. From the tertiary centre, patients with a good chance of cure by bone marrow transplant and who have a stem cell donor should be referred to the appropriate centre. There are three clinical variants - the endemic, sporadic and immunodeficiency associated forms. The endemic form is found in tropical and malaria endemic regions like Ghana and commonly presents as a jaw swelling with loosening of the associated teeth. Follow-up can continue at a regional centre by a physician under the distant guidance of a haematologist. The vaccine protects all children against Diptheria, Pertussis, Tetanus, Hepatitis B and Haemophilus influenzae Type B. The pentavalent vaccine should not be given to children above 2 years because of the increase in side effects due to the Pertussis component. Measles -No child should be denied measles vaccine because of a past episode of presumed measles 2. It is very infectious from up to 7 days before to 5 days after appearance of the rash. Measles is often complicated by croup, vitamin A deficiency leading to xerophthalmia and blindness, otitis media and deafness from otitis media. Other complications include bronchopneumonia, diarrhoea, malnutrition and activation of latent tuberculosis. Any non-immunised child of age 9 months and above who comes into contact with a measles sufferer should be immunized. It may be complicated by protein-calorie malnutrition, bronchiectasis and cerebral hypoxia flowing apnoeic episodes leading to convulsions and coma. Secondary bacterial infections like otitis media, pneumonia or activation of latent tuberculosis may also occur. Pertussis can be prevented by the “Five in One” immunization recommended for all children (see immunization schedule at the beginning of this chapter). In the event of a child developing pertussis before immunuization, the “Five in One” vaccine should still be given to protect against the four other diseases. During epidemics, or when there is a clear history of contact in a child with catarrh, antibiotics may help reduce the period of infectivity and reduce transmission.
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