SYSTEMIC ASSESSMENT IN PHARMACOLOGY

1. SYSTEMIC ASSESSMENT IN PHARMACOLOGY By Dr. Sahar Kamal Faculty of Medicine Workshop on Systemic Assessment DSASP Cairo, Egypt, November 2011 -

2. I-Systemic Multiple Choice Questions [SMCQ, s] - -

3. If angioedema Enalapril Replace by candesartan a) If no hypersensitivity to ACEIs, use from the start acc. To AHA If edema and fluid retention ( ) + digoxin + furosemide If HF +AF If volume overload digoxin Thiazide If hyperkalemia b) -if asso. With VF ( ) + spironolactone + Enalapril If angioedema Example : [pharma.]:Put () in front of the correct systemic diagram in TTT of congestive heart failure:

4. II] Systemic matching questions [SMQs]

5. 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): . ,

6. III] Systemic Sequencing questions [SSQs]

7. -ACEIs ( ) -Digoxin ARBs diuretics ACEIs To control CHF symptoms Decrease in pre-and after load -+ digoxin if HF+AF ( ) ARBs Reduce edema and fluid retnetion Used if intolerant to ACEIs + diuretics5 Example :[Pharmacology.]: Put the following drugs in the correct sequence in the following systemic diagram to control a case of congestive heart failure: ACEIs, ARBs, Diuretics, Digoxin

8. IV-Synthesize Systemic relations between concepts, facts, issues, [SSyQ,S] ,

9. Example:[Pharma.]: Build a correct systemic shows the relations between the following drugs: ACEIs, ARBs, Diuretics, Digoxin in the control of a case of congestive heart failure [ + diuretics] ACEIs Reduce congestion A-I) To ensure reduction of mortality + Digoxin Prevents remodelling Control HF+ AF + spironolactone + diuretics ARBs Reduce congestion A-II) To ensure reduction of mortality÷ + spironolactone Control HF+AF Reduce mortality + Digoxin

10. V-Analyze Systemic to its Components [SAQ,s]

11. Penecillin To Increase antimicrobial effect and uptake If hypersensitivity of penicillin -if desensitization to penicillin is done Replace by vancomycin or linezolid If associated with anerobic infections Example- : [Pharma.]: Analyze the following combination of antibiotics in treatment of infective endocarditis into relations: + gentamycin + clindamycin

12. VI-Complete Systemics

13. Example : [Pharma.]: Complete the following systemic diagram by using the Following antifungal drugs to give correct systemic drug prescription in TTT of oral candidiasis:, Topical nystatin No improvement No improvement Topical nystatin Systemic ketoconazole If drug interaction With serious drugs with e.g. Terfenadine or oral anticoagulant as it decreases their metabolism b) a) If sever eoral mucosal candidiasis we can combine systemic drugs with Combined topical and systemic drugs ( ) If drug interaction ( ) Systemic fluconazole IV amphoterecin-B If immunocompromized patient If immunocompromized patient

14. THANK YOU