Module: Pharmacy Professional Skills
Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Undergraduate, B.Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This Presentation is for Educational Purpose. It has no commercial value associated with it.
THIS POWERPOINT PRESENTATION IS AN EASIEST BRIEF GLANCE ON THE DRUGS THAT ARECOMMONLY USING IN DE ADDICTION. THIS PRESENTATION WILL BE HELPFUL FOR THOSE WHO ARE STUDYING PHARMACOLOGY PARTICULARLY NURSING AS WELL AS ALLIED HEALTH STUDENTS.
THIS POWERPOINT PRESENTATION IS AN EASIEST BRIEF GLANCE ON THE DRUGS THAT ARECOMMONLY USING IN DE ADDICTION. THIS PRESENTATION WILL BE HELPFUL FOR THOSE WHO ARE STUDYING PHARMACOLOGY PARTICULARLY NURSING AS WELL AS ALLIED HEALTH STUDENTS.
Approach to case of type 2 DM
lifestyle modificatios
indications to start drug therapy
classification of antidiabetic drugs , mechanism of action , adeverse drug effects , doses , drug interactions , how to add differents class of drugs to give combination therapy . over view insulin therapy
All diabetics irrespective of other treatment require some control of their eating and exercise patterns
Dibetics must watch their
- total caloric intake
-types of nutrients and eating schedule
50% of patients may require only diet Another 25% would need to augment their natural insulin with drugs
while the remainder will need insulin
Diet recommendations include
- discouraging fats
encouraging complex carbohydrate and fibre
The recommended diabetic diet except in a few respects is now similar to the normal healthy diet that everyone should eat. i.e regular meals, low in fats, low simple sugars, low in sodium and high in complex carbohydrate (starch) and fibre
Diet recommendations include
- discouraging fats
encouraging complex carbohydrate and fibre
The recommended diabetic diet except in a few respects is now similar to the normal healthy diet that everyone should eat. i.e regular meals, low in fats, low simple sugars, low in sodium and high in complex carbohydrate (starch) and fibre
Diet recommendations include
- discouraging fats
encouraging complex carbohydrate and fibre
The recommended diabetic diet except in a few respects is now similar to the normal healthy diet that everyone should eat. i.e regular meals, low in fats, low simple sugars, low in sodium and high in complex carbohydrate (starch) and fibre Diet recommendations include
- discouraging fats
encouraging complex carbohydrate and fibre
The recommended diabetic diet except in a few respects is now similar to the normal healthy diet that everyone should eat. i.e regular meals, low in fats, low simple sugars, low in sodium and high in complex carbohydrate (starch) and fibre
Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Glucose is an important source of energy for the cells that make up the muscles and tissues.
(ضبط أدوية السكر على النظام الغذائي منخفض الكربوهيدرات (نظام اللوكاربArwa M. Amin
ويبنار التغذية العلاجية بنظام اللوكارب لمرضى السكري النوع الثاني و ضبط أدوية السكري على النظام
لمشاهدة المحاضرة كاملة
https://youtu.be/-6ri8WvlpNY
هذه المحاضرة تهدف إلى تقديم الوعي و التثقيف الصحي و لا تقدم أي استشارة طبية
و على المريض استشارة طبيبه المعالج لتعديل الخطة الدوائية قبل اتباع النظام
Pharmacotherapy of Ischemic Heart Disease (IHD)Arwa M. Amin
This Presentation is for educational purposes and it has no profit associated with it.
References for this Presentation:
Pharmacotherapy: A Pathophysiologic Approach, 11e
This Presentation is for educational purposes and it has no profit associated with it.
References for this Presentation:
Pharmacotherapy: A Pathophysiologic Approach, 11e
Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. 2020;75(6):1334-57. doi:doi:10.1161/HYPERTENSIONAHA.120.15026.
Foo LF, Tay J, Wilkinson I. Treatment Options for Hypertension in Pregnancy. In: Lees C, Gyselaers W, editors. Maternal Hemodynamics. Cambridge: Cambridge University Press; 2018. p. 141-60.
F. Sacchet-Cardozo, MD et al, 2016 Revisiting Clevidipine Experience in the Pediatric Population: a Perioperative Perspective
التغذية العلاجية بنظام غذائي منخفض الكربوهيدرات لمرض السكر من النوع الثانيArwa M. Amin
عرض التغذية العلاجية بنظام غذائي منخفض الكربوهيدرات لمرض السكر من النوع الثاني في ويبنار حياة صحية خالية من المضاعفات لمرض السكري
لمشاهدة المحاضرة على يوتيوب:
https://www.youtube.com/watch?v=cSBvUnKA6b4&t=5s
لتحميل جداول معالق السكر بعدة لغات
https://phcuk.org/sugar/
لورقة علمية تشرح الجزء المتعلق بالحلقة المفرغة لمقاومة الانسولين و ارتفاع الانسولين
https://onlinelibrary.wiley.com/doi/f...
LCHF Diet as an Effective Therapy for T2DMArwa M. Amin
This presentation was presented by Dr Arwa at the Guest Lecturer, UTA45 Jakarta University Webinar.
Low carbohydrate healthy fat (LCHF) Diet as an Effective Therapy for T2DM
Lecture on YouTube:
https://www.youtube.com/watch?v=Fzpg4hT1NkE&t=3s
To download Dr Unwin sugar infographics in different languages:
https://phcuk.org/sugar/
Review paper on Cardiometabolic diseases and their linked metabolic pathways
https://onlinelibrary.wiley.com/doi/full/10.1002/lim2.25
This Presentation is for educational purposes and it has no profit associated with it.
Reference for this Presentation:
Pharmacotherapy: A Pathophysiologic Approach, 11e
Joseph T. DiPiro, Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael Posey
This Presentation is for educational purposes and it has no profit associated with it.
Reference for this Presentation:
Pharmacotherapy: A Pathophysiologic Approach, 10e
Joseph T. DiPiro, Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael Posey
This mind Map was created By Jana Shaker and it was revised and edited By Dr Arwa M Amin. The information of the mind-map are from:
Chapter 96: Menstruation-Related Disorders, Pharmacotherapy: A Pathophysiologic Approach, 11e
Premenstrual Syndrome and Premenstrual Dysphoric Disorder Mind-MapsArwa M. Amin
This Mind Map was created By Shahd Al Johny and it was revised and edited By Dr Arwa M Amin. The information of the mind-map are from:
Chapter 96: Menstruation-Related Disorders, Pharmacotherapy: A Pathophysiologic Approach, 11e
This Mind Map was created By Areej Al Mohamadi and it was revised and edited By Dr Arwa M Amin. The information of the mind-map are from:
Chapter 96: Menstruation-Related Disorders, Pharmacotherapy: A Pathophysiologic Approach, 11e
This Mind Map was created By Lina Al Harbi and it was revised and edited By Dr Arwa M Amin. The information of the mind-map are from:
Chapter 96: Menstruation-Related Disorders, Pharmacotherapy: A Pathophysiologic Approach, 11e
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
1. Proper use of Diabetes Mellitus
Management Devices
Arwa M. Amin Mostafa
PhD & M.Pharm Clinical Pharm, DipMgt, B.Pharm.
2. Outlines
•Types of Insulins
•Insulin Regimens
•Insulin Devices
•Proper injection of insulin using insulin Devices
•Glucagon Injection
•Proper use of GLP-1 Agonist Injection (Dulaglutide)
(Trulicity®)
•Measurement of Blood Glucose Level using
Glucometer
3. Insulin Devices
• Insulin is used to control blood glucose (BG) level in T1DM
patients and T2DM patients with BG that can’t be controlled by
oral hypoglycemic Drugs, diet and exercise.
• Insulin Devices are devices which are used to deliver insulin to
patient’s body.
4. Physiological Insulin secretion
Insulin is secreted by the Pancreas in a
glucose-dependent Manner continuously
throughout the day and in response to
oral carbohydrates dose
Figure source: American Family physician: Insulin Management of Type 2 Diabetes Mellitus (https://www.aafp.org/afp/2011/0715/p183.html) as adapted from Diabetes Education Online.
University of California, San Francisco. http://www.deo.ucsf.edu. Accessed December 10, 2010.
5. Source: Medinterest Group http://www.medinterestgroup.com/portfolio-items/diabetes-insulin-types/
NPH: Isophane Insulin
Types of Insulin
6. Activity of DifferentTypes of Insulins
Figure source: TMedWeb; http://tmedweb.tulane.edu/pharmwiki/lib/exe/detail.php/insulins.png?id=insulin_regimens
7. Insulin Regimens
• Basal-Bolus Regimen:
• Separate doses of short or rapid acting insulin 20–30 min
before main meals and intermediate or long-acting insulin
once or twice daily.
• Long acting insulin stabilizes blood glucose (BG) during
fasting (background insulin) and short acting insulin prevent
rises of BG after meals.
• Premixed-Insulin Regimen:
• 2- 3 injections-times daily of Insulin Mixture of specified
portions of short acting and intermediate acting insulins.
• Should be administered before Breakfast and evening meal.
• Examples: Humulin 70/30, Novolin 70/30, Novolog 70/30,
Humulin 50/50.
8. Insulin Regimens
Basal-Bolus Regimen
Premixed Regular/NPH
70/30 Regimen
Which Regimen is similar to physiological insulin secretion?
Figure source: American Diabetes Association: Practical Insulin
10. Basal-bolus OR Pre-mixed Insulin Regimens
Pre-mixed InsulinBasal-Bolus Insulin
• Simple Regimen
• Lower number of
injections
• Both basal and
short acting insulins
are in the same
mixture
• Flexibility in adjusting bolus dose based
on the content of every meal (mainly
carbohydrates and a percentage of the protein)
• Doesn’t require consistent lifestyle
pattern (meals and exercise is flexible)
• Similar to Physiological insulin
secretion.
• Low chances of developing
Hypoglycemia
• Low weight gain
• Better efficacy in glycemic control:
• Short term efficacy: FG, PPG
• Long term efficacy: HbA1C
Advantages
FG: Fasting glucose, PPG: Post-prandial glucose
11. Pre-mixed InsulinBasal-Bolus Insulin
• Requires consistent meals
content, meals timing and
exercise pattern
• Treatment doesn’t offer flexible
lifestyle
• High chances of developing
Hypoglycemia.
• Weight gain
• If basal insulin didn’t last long,
there will be high chances of high
FG
• Difficult to achieve glycemic
targets
• Requires carbohydrates
counting and insulin
dose calculation for
every meal
• Requires Patients
Education for insulin
dose calculation (Insulin-
to-Carb ratio)
• Requires more times of
injections
Disadvantages
Basal-bolus OR Premixed Insulin Regimens
13. Layers of the Skin and Insulin Injection
• For Insulin to be absorbed properly, it should be injected in the
Subcutaneous fat.
• For slow and sustained rate of absorption
15. Insulin Syringe
•Not Commonly used Nowadays
•If patient is slim, use 45 ◦ angle to give the injection
•If the needle is long, pinch up skin folding is
required to increase the chance of SC injection
17. Insulin Syringe
How to Inject Insulin Using a Syringe | Nucleus Health
https://www.youtube.com/watch?v=bBZXkNbpOGQ
18. Storage of InsulinVials
•Refrigerate Insulin vials Not in use BUT DO NOT FREEZE
•Opened Insulin vial is stable at RoomTemp from 28 - 42 days
• Avoid extreme temp
• Discard after the specified stability days
19. Insulin Pen
Insulin Pen: a pen like injecting device to deliver insulin
Advantages of Insulin Pen:
• Easy to use
• Precise dose adjustment
• More Convenient
• Patient can carry with him every where
Disadvantages:
• Expensive compared to syringes
20. Main Parts of Insulin Pen
Main Parts of Insulin Needle
Main Parts of Insulin Pen
22. How to use Insulin Pen
How to do an Insulin Injection
https://www.youtube.com/watch?v=Pl28IILPDTU
How to use your Insulin Pen (UPDATED )
https://www.youtube.com/watch?v=hue_HkIpxKU&list=WL&in
dex=16
25. Advantages of Insulin Pump:
• Fewer Injections (Cannula has to be changed every 7 days)
• Lifestyle flexibility
• Lower frequency of Hypoglycemia (Particularly in Pediatrics)
• Can store history of previous doses (Bolus and Basal)
Disadvantages of Insulin Pump:
• Expensive
• Superficial Infection
• Pump failure which may cause hyperglycemia
• Inconvenience of wearing External Pump
Advantages and Disadvantages of Insulin Pump
26. Insulin Pump
How the insulin Pump work?
How Does An Insulin PumpWork?
https://www.youtube.com/watch?v=t7ajHnpaLpk
27. Insulin Inhaler
• Afrezza is an Inhaled Human Insulin Powder
• Fast absorption through the lung
• Super-rapid inhalable meal-time insulin (Peak action in 15 minutes)
and action will finish within 90 minutes.
• Pulmonary function has to be assessed before initiation and every 6
months
28. Advantages of Afrezza:
• No Injections
• Small size
• Lifestyle flexibility
• Fast action in lowering Blood glucose
Disadvantages of Afrezza:
• Contraindicated in chronic lung diseases (Asthma and COPD)
• Can cause Bronchospasm
• May reduce lung function over-time
• Some patients reported having cough after using Afrezza
• Severe Allergic Reaction
Advantages and Disadvantages of Afrezza
33. Medications for Hypoglycaemia
• Chewable GlucoseTablets
• Only for conscious and cooperative patients
• 25 g to 100 g
• Glucagon Injection
• For Unconscious patients
• 0.5 – 1 mg IM and SC injection
• Dextrose IV bolus - slowly
• 25 g/dose
IM: Intramuscular, SC: Subcutaneous
34. Glucagon Injection
• Glucagon Injection is used to treat:
• Severe Hypoglycemia due to high insulin Dose.
• Insulin Coma or insulin reaction resulting from severe low blood glucose.
• Glucagon Injection can be life saving for patients suffering from hypoglycemic
Coma.
• Care givers should be trained how to administer it to the patient
• Contraindicated in patients suffering from Pheochromocytoma OR
Glucagon Allergy
35. Glucagon Injection
Storing Glucagon Injection:
• Before dissolving: Store the kit at room temperature between 20° to 25°C .
• After dissolving: Use immediately.
• Discard any unused portion.
36.
37. Glucagon Injection
Important Notes:
• Make sure that the patient is NOT in Hyperglycemic Coma
before use.
• Do Not prepareGlucagon Injection until you are ready to use it.
• The contents of the syringe are inactive and must be mixed with
the Glucagon in the bottle immediately before giving injection.
• After preparation, solution should be clear and of a water-like
consistency at the time of use.
38. Glucagon Injection
Important Notes.. Cont.:
•If the patient is unconscious, turn him on his/her side to
prevent choking.
• Feed the patient as soon as he/she awakens and is able to
swallow.
• If the patient does not awaken within 15 minutes, give another
dose of glucagon and INFORM EMERGENCY SERVICES
IMMEDIATELY.
39. Glucagon Injection
Glucagon Dose:
•The usual adult dose is 1 mg (1 unit).
•For children weighing less than 20 kg, give 1/2 adult dose (0.5
mg).
• Withdraw 1/2 of the solution from the bottle (0.5 mg mark on
syringe).
40. Glucagon Injection
How to use Glucagon Injection?
How to do a glucagen injection
https://www.youtube.com/watch?v=CfrBjojzlqQ
41. Dulaglutide Injection (Trulicity®)
• Dulaglutide is Glucagon-Like peptide-1 receptor agonist
• To be used Once weekly as adjuvant to diet and exercise
forT2DM.
• Should NOT be used by:
• T 1 DM
• Diabetic ketoacidosis (DKA)
• People with a history of severe GI disease.
• Children < 18 years old.
• Patients or if their family members had medullary thyroid
carcinoma (MTC).
44. Dulaglutide Injection (Trulicity®)
Side Effects:
• Serious side effects:
• Acute pancreatitis
• Hypoglycemia
• Renal impairment.
• Common side effects:
• Dyspepsia
• Nausea
• Vomiting
• Diarrhea
• Decreased appetite
45. Proper use of Dulaglutide Injection (Trulicity®)
•How to useTrulicity?
https://www.trulicity.com/how-to-use/non-insulin-pen/
•Trulicity Pen demo
https://www.youtube.com/watch?v=bn50cC3kuto
46. Blood Glucose Measurement Device (Glucometer)
• Glucometer is a device which measure glucose in the blood .
• I t helps patients with DM to monitor their blood glucose level
and keep a record of it to get the best clinical advice based on
the measured glucose record.
47. Blood Glucose Measurement Device (Glucometer)
How glucometer works?
• The test strips contain glucose oxidase (GLO) and an
electrical terminal
• GLO will react with glucose in the blood producing gluconic
acid
• The strip contains electrical terminal that can measure the
amount of gluconic acid based on the current changes
between the 2 terminals of the strip.
49. Blood Glucose Measurement Device (Glucometer)
Proper StoringTest strips
• Test strips should be stored in their original vial away from
humidity, heat and refrigerating.
• Vial should be closed tightly after taking out the test strip.
• Strips should not be used after the expiration date.
Medical Information : How Does a Glucose Monitor MeterWork?
https://www.youtube.com/watch?v=Tzc5QYHxfdU
Diabetes Education: How are diabetes blood glucose meter test
strips made?
https://www.youtube.com/watch?v=72IgXDMOE60https://www.you
tube.com/watch?v=72IgXDMOE60
50. Blood Glucose Measurement Device (Glucometer)
• How to measure Blood Glucose using a
Glucometer?
Blood glucose measurement - OSCE Guide
https://www.youtube.com/watch?v=AyDH
P9puCag
CheckingYour Blood Glucose | Diabetes
Discharge | Nucleus Health
https://www.youtube.com/watch?v=28oR
B1LWWEw