This document summarizes information on several anti-malarial, anti-amoebic, and anti-helminthic drugs including their classification, mechanism of action, pharmacokinetics, uses, and adverse effects. It discusses quinoline and artemisinin anti-malarials such as chloroquine, mefloquine, artemisinin, and their mechanisms of interfering with heme polymerization in plasmodial parasites. It also covers the anti-amoebic drugs metronidazole, tinidazole, dehydroemetine, and paromomycin and the anti-helminthics albendazole, mebendazole, and praziqu
Introduction.
Types of Diabetics Mellitus
Insulin and Insulin Preparations
Oral Hypoglycaemic Agents
Classification .
Drugs used in Anti-Diabetic agents
Mechanism of action .
Structure
Synthesis and SAR
Adverse Drug Reactions .
Uses.
Reference
Introduction.
Types of Diabetics Mellitus
Insulin and Insulin Preparations
Oral Hypoglycaemic Agents
Classification .
Drugs used in Anti-Diabetic agents
Mechanism of action .
Structure
Synthesis and SAR
Adverse Drug Reactions .
Uses.
Reference
3rd unit drugs used in congestive heart faliureNikithaGopalpet
Introduction.
Signs and Symptoms.
Types of CHF.
Classification .
Drugs used in CHF.
Mechanism of action.
Structure.
Adverse Drug Reactions and
Uses.
Reference
3rd unit drugs used in congestive heart faliureNikithaGopalpet
Introduction.
Signs and Symptoms.
Types of CHF.
Classification .
Drugs used in CHF.
Mechanism of action.
Structure.
Adverse Drug Reactions and
Uses.
Reference
Peptic Ulcer Disease Affects All Age Groups. Can occur in children, although rare. Duodenal ulcers tends to occur first at around the age 25 and continue until the age of 75. Gastric ulcers peak in people between the ages of 55 and 65. Men Have Twice The Risk as Women Do
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According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
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Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
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1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
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Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
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This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
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Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
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Educating families about their child's condition and treatment options.
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Objective: Contribute to improving the quality of care for children by participating in research initiatives.
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Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
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Pharmacology-Anti-parasitic drugs
1. M.A.A.Al-Maqrashi
Drug Name & Chemical
Classification
Target
Stage
MOA
Pharmacokinetics &
Characteristics
A.EAnti-malarialDrug
[Quinolines]
[4-aminoquinoline]
Chloroquine
Liver &
Erythrocytic
Schizont
- Traversing the hepatic/erythrocytic and
plasmodial membranes
- Protonated in the acidic food vacuole [it is
weak base]→ion trapping inside the
vacuole
- specifically binds to heme, preventing its
polymerization to hemozoin.
- increased pH and the accumulation of
heme → oxidative damage to the
phospholipid membranes → leading to
lysis of both the parasite and the host
cell.
- Well-absorbed orally
- Very large Vd
- Concentrates in RBC,
liver, spleen, kidney,
lung, retina, and WBC.
- Crosses BBB & placenta
- Long t0.5(3-10 ds.)
- Hepatic metabolism
- Drug & its metabolites
appear in urine
Esp. At high doses:
- GI upset.
- Skin:
[rash, pruritus, discolored nail
beds & mm, exacerbates
psoriasis.]
- Eye:
[Blurred vision, opacities,
retinopathy.]
- CVS:
[Prolonged QT interval.]
- CNS: [Neuropsychiatric.]
[4-
methanolquinoline]
Mefloquine
Erythrocytic
Schizont
- Well-absorbed orally.
- Well-distributed & concentrated in tissues.
- Long t0.5(20 ds.).
- Hepatic metabolism & Bile excretion
- Arrhythmia:
[esp. + quinine or quinidine]
- Neuropsychiatric
[4-
methanolquinoline]
quinine
quinidine
Erythrocytic
Schizont
- interferes with heme polymerization,
resulting in death of the erythrocytic form
of the plasmodial parasite.
- Well-absorbed orally.
- Slow IV
- must dilute if IM.
- Well-distributed.
- Hepatic metabolism
- renal excretion.
- Cinchonism:
[syndrome causing nausea,
vomiting, tinnitus, and vertigo →
reversible]
- Aplastic & G6PD deficiency
hemolytic anemia
[must suspend the treatment]
- Quinine: Blackwater fever:
[hemolysis & hemoglobinuria.]
- Quinidine: prolonged QT
interval, ↓ BP,
thrombophlebitis.
[Following IV administration]
- Mild oxytocic:
[but used for severe P.
falciparum during pregnancy.]
- Visual & auditory problems.
- Hypoglycemia.
- Hypersensitivity.
2. M.A.A.Al-Maqrashi
Anti-malarialDrug
[Quinolines]
[8-aminoquinoline]
Primaquine
-Hypnoxoite
- Liver
Schizont
-
Gametocyte
- metabolites of primaquine are believed to
act as oxidants that are responsible for the
schizonticidal action
- Well-absorbed orally
- Hepatic metabolism
- minimal renal excretion
- Avoided in pregnancy
- GI upset
- headache.
- Hemolytic Anemia &
methemoglbinemia:
[Strong oxidizing agent in G6PD
deficiency pts]
Rare, serious:
- aplastic anemia
- Arrhythmias.
[Artemisinins]
Artemisinin
Dihydro-artemisinin
Artesunate
artemether
-
Erythrocytic
Schizont
-
Gametocyte
- production of free radicals resulting
- Covalently bind to and damage specific
malarial proteins & mitochondria
- Artemisinin: insoluble & orally
- Derivatives are more soluble with better efficacy:
- Dihydroartemisinin [active metabolite]: water-soluble; oral.
- Artesunate: water-soluble; oral, rectal, IM, IV.
- Artemether: lipid-soluble; oral, rectal, IM.
- Short t0.5 (< hr.).
- Hepatic metabolism
- Bile excretion.
- Artemisinin-based Combination Therapy [ACT]:
↑ Spectrum, Tolerability & Efficacy
↓ Relapse & Resistance.
- Some ACT Preparations:
- Artemether + lumefantrine [Coartem]
- Lumefantrine an antimalarial drug.
- Used in combination with artemether "co-artemether".
- Has a much longer t1/2.
- Artesunate + [Coartem OR Mefloquine OR Atovaquone-
proguanil OR Doxycycline]
[THFA synthesis
inhibitors]
Sulfadoxine
Pyrimethamine
proguanil
Erythrocytic
Schizont
- Sulfadoxine: inhibit dihydropteroate
synthetase
- Pyrimethamine & proguanil: inhibit
dihydrofolater reductase
- Well-absorbed orally.
- Sulfadoxine: long t0.5 [6-7 ds.]
- Pyrimethamine: long t0.5 [3-5 ds.].
- Proguanil: a prodrug: short t0.5 [5 hrs.]
- Sulfadoxine-pyrimethamine:
- fixed-dose combination [Fansidar]
- Synergism → sequential blockade.
- Atovaquone-proguanil:
- [Malarone] → synergism:
- ↑ Duration of action compared to proguanil alone.
- ↑ Efficacy & ↓ resistance compared to atovaquone
alone.
3. M.A.A.Al-Maqrashi
Cont.
[Atovaquone]
- Orally
- Better with food.
- High PPB.
- Long t0.5 (2-3 ds.).
- Eliminated unchanged in bile.
Well-tolerated
Drug Name MOA
Pharmacokinetics &
Characteristics
Uses Adverse Effects
Anti-AmoebicsDrugs[Amoebicides]
Metronidazole
- Disrupts DNA
replication, TXN &
repair
- Well-absorbed orally
- distributes well
throughout body tissues
and fluids
[CSF, milk, saliva,
semen]
- Hepatic metabolism &
renal excretion.
- NOT recommended in
pregnancy & lactation.
- Mixed amebicide: Kill luminal &
tissue trophozoites
- Drug of choice for:
- tissue amoebiasis
- amoebic liver abscess
- pseudomembranous
- colitis
- giardiasis
- Oral moniliasis.
- Common:
- GI upset
[alleviated by taking it with
meals.]
- Unpleasant metallic taste
- dark urine
- Rare:
- Neurotoxicity
- Pancreatitis
Tinidazole
- Tinidazole is as effective as metronidazole, with a:
- shorter course of treatment
- more expensive.
- Alcohol consumption should be avoided during
therapy.
- Mixed amebicide: Kill luminal &
tissue trophozoites
Less toxic than Metronidazole
Dehydroemetine
- inhibits protein
synthesis by blocking
chain elongation.
- SC [better] or IM
- irritant when taken
orally
- Systemic amebicide: Kill tissue
trophozoites [intestinal wall, liver,
lung]
- Used in metronidazole
contraindication or refractoriness.
- Replaced by metronidazole ← better
safety
- NOT IV
- NOT used for > 5 days.
- Pain at the site of injection
- Cardiotoxicity
4. M.A.A.Al-Maqrashi
- NOT in young kids or pregnancy.
Cont.Amoebicides
Paromomycin
- Aminoglycoside
- not absorbed from GIT
- Luminal amebicide: Kill trophozoites
& cysts in GIT
- Alternative to metronidazole in
giardiasis.
- Occasionally:
GIT distress and diarrhea
Iodoquinol - not absorbed from GIT
- Luminal amebicide: Kill trophozoites
& cysts in GIT
- Avoid long-term use.
- GI upset [esp. diarrhea]:
[alleviated by taking it with
meals.]
- Iodine toxicity:
[dermatitis, urticaria, pruritus,
fever]
- Dose-related peripheral
neuropathy & optic neuritis.
Anti-HelminthicDrugs
Mebendazole
- inhibiting assembly of microtubules in the parasite
- irreversible blocking of glucose uptake.
- Drug of choice for nematodes.
- NOT in pregnancy.
- abdominal pain
- diarrhea
Albendazole
- inhibiting assembly of
microtubules in the
parasite
- irreversible blocking of
glucose uptake.
- Absorption is enhanced
by a high-fat meal.
- distributes widely,
including the CSF.
- extensive first-pass
metabolism → active
metabolite
- Albendazole and its
metabolites are
primarily excreted in the
bile
- Short-course (1-3 ds.) for nematodes → mild headache & nausea.
- Long-course (3ms.) for cestodes → hepatotoxicity & pancytopenia.
Praziquantel
- ↑ Ca2+
influx →
contracture and paralysis
of the parasite
- well-absorbed orally
- taken with food and not
chewed due to a bitter
taste.
- Well-distributed; CSF.
- Extensively-metabolized.
- Renal excretion.
- Drug of choice for schistosomiasis &
some cestodes.
- GI upsets
- headache
- dizziness
- malaise.