₦airaland Forum

This thread is for all who are interested in the course Clinical Pharmacology. This include: Medical Doctors, Pharmacists, Nurses and medical students, pharmaceutical students, etc.

I've searched the whole of nairaland to see where Clinical Pharmacology topics are being discussed but couldn't find any. Thus I felt its necessary that this thread be created so that we can improve on our understanding of the course.

This is my plan:

* Each week, a new topic is scheduled for discussion

* A nairalander will give a brief presentation of the new topic on a Monday

* After each presentation, there will be questions, answers, comments, observations and suggestions from fellow nairalanders

* Only nairalanders who have been inducted into this Discussion Thread can be called on to give presentations however anyone can ask questions, comments, observations or suggestions

* Nairalanders are inducted into this Discussion Thread by simply indicating interest and by stating his profession. For example: "I am interested. I'm a pharmacist" OR "I'm interested. I'm a medical student"

* A space will be reserved for the list of inducted nairalanders

* A space will also be reserved for the list of topics to be discussed upon for the month/year

* The thread shall have a coordinator and an assistant coordinator. Also a moderator's blessing would be needed

* This plan may be modified upon by inducted members if 2/3 of the house agrees with the modification.

CLINICAL PHARMACOLOGY DISCUSSION THREAD MEMBERS

Obinoscopy - Pharmacist/Epidemiologist
Charliejose - Pharmacology Student
Aysuccess99 - Medical Student Aspirant
Brini - Medical Student
Zenti99 - Medical Student Aspirant
Damitism - Pharmacy Student
Teecube - Pharmacy Student
Eloghosa78 - Medical Student Aspirant
Passion007 - Medical Doctor
Samgreguc - Pharmacy Student
Eyideejay - Medical Student
ULQUIORRA - MSc Pharmacology Student
Tolugar - Physiologist/Pharmacologist
Fostermd - Medical Doctor (Psychiatrist/Neuropsychopharmacologist)
Ajpharm - Pharmacy Student
Thefarr - Veterinary Doctor
Captainnigeria - Pharmacy Student Aspirant
Gbosaa - Herbalist
Adaminedens - Medical Doctor
YMCgyna - Pharmacy Student
DrClay - Medical Doctor
Breezy90 - Pharmacy Student
Edyza - Anatomist/MSc Clinical Pharmacology Student
Lebienconnu - Medical Student
Kunlexic - Pharmacy Student Aspirant
Arsenate - Pharmacist/MSc Pharmacology Student Aspirant
Razzydoo - MSc Pharmacology (in view)
Usen9c - Chemist
Sakaguchi - Medical Student
Itzpretzy - Pharmacy Student
Hustla242 - Clinical Pharmacologist
Dungdusugyang - Medical Biochemist
GogetterMD - Medical Doctor
Quatermaine - Medical Student
Cnwamo - Nurse/Medical Student
Imperiouxx - Biochemist
Hensben - Pharmacologist
Frankyskyboi - Pharmacist
Ochek - Nurse
DonJ2 - Medical Lab Scientist
Aieromon - Pharmacist
JoannaSedley - Nurse/Anaesthetician/Doctor of Nursing (In View)
Swashi007 - Pharmacy Student
Debuscket - Radiographer
Johnsonpac - Biochemist
Tekel - Human Anatomist
JellyBean190 - Medical Doctor
Nnewi1stSon - Pharmacist
DebhariJones - Interim Pharmacist
ADUBA1 - Health and Environment
Babymillenium - Nurse
Philtrum - Medical Student
Liverpoolfc - Human physiologist
Xkid2000 - Pharmacist student
Drfash - Medical Student
Tebill - Biochemist/Medical doctor
Deltaboy10 - Medical Student
Tydd - Interim Pharmacist
Godwinigweh - Nursing Student
Yahbas83 - Medical Student
Waloma - Nurse
Mbatagr82 - Medical lab Science Student
Xoctic - Medical Student
Winzor78 - Medical Student
Igwedexy - Physiology
Lexo22 - Biochemist
Leward - Medical Student
FutureDon - Neuroscientist
Shollyps - Biochemistry Student
Firstolalekan - MSc Clinical Pharmacology Aspirant
Rxfemi - Pharmacist
Godfreykingsley - Anatomist
Greenslicks - Counselling Psychologist
Adeoladrg - Pharmacy Student
Kennymighty - Clinical Biochemist
Anselm791 - Medical Student
Johncuppa - Chemist/Pharmacy Student Aspirant
Mzdharmey - Pharmacology Student
Kinxlink - Pharmacology Aspirant
Mesther96 - Pharmacology Student
Winbyforce - Physician/Pharmacologist
Crispinkc - Dental Student
Armani03 - Medical biochemist Student
Man100 - Microbiologist
Tygood - Physiology Student
Bioduneberry - Chemist
CircleOfWilis - Medical doctor
Ekpekus - Medical doctor/Msc. Pharmacology
AGgal - Nurse/Midwife
Baebyfaze91 - Pharmacist student
Linguist - Nurse (accident& emergency)
Tfun - Nursing Student
DrAmanda - Medical Student
Somtea - Pharmacist
Abdulsalax - Pharmacist Aspirant
ProfEinstein - Physiotherapist
Mashad - Anatomist
Amaham - Anaesthesiologist
Kenshin17 - Biochemistry
Kristana - Pharmacist Student
1k001 - General Physician
Biolaolowo - Medical Student
Delpharm - Pharmacist Student
Desy24444 - Nurse
Tycoon4 - Intern. Pharmacist
Dynasty92 - Pharmacist Student
Tushqueen - Radiographer
Cmanforall - Clinical Pharmacologist Aspirant
Sisiafrika - Pharmacy Student
Akkylod - Medical Student
Tieeeboy - Human Anatomy Student
Tosodus - Medical Lab Tech/Biochemist/Medical Student Aspirant
Boluzie - Medical Student
Guldberg - Dental Surgery Student
Dadinho - MSc Pharmacology Aspirant
Shazily012 - Physiologist
Cxp - Medical Student
shollish - Pharmacy Student
Blessgod30 - Pharmacist
Jerryvyne - Pharmacy Student
Vicmed1 - Medical Student
Thewhizzkid1 - Medical Student
MTAIYEM - Clinical Student
Exynos - Medical Aspirant
Horpeyemmi66 - Physiologist/Dental Surgery Aspirant
AUNafada - Medical Student
Motunemotun - Pharmacologist

Obinoscopy: The two main areas of pharmacology are pharmacodynamics and pharmacokinetics. The former studies the effects of the drug on biological systems, and the latter the effects of biological systems on the drug.

Project400: @Obinoscopy

Pharmacology isn't the study of drugs per se, BUT the study of drug actions.

dexterinc2003: cvs drugs trivia

CAPTOPRIL; A very potent anti hypertensive,an angiotensin converting enzyme inhibitor(ACEI),side effects can be tagged with the mnemonic C-A-P-T-O-P-R-R-I-L

C; Cough
A; Angioneurotic edema
P; pottasium excess
T; Taste(metallic)
O; orthostatic hypotension
P; proteinuria
R; renal failure
I; indomethacin potentiating effect
L; Liver problems.

Arsenate: @dexterinc2003

captopril is an angiotensin ii converting enzyme (ACE) inhibitor not a calcium channel blocker.

debuscket: for easy remembrance;pharmacokinetics = PK, pharmacodynamics = PD

dexterinc2003: My bad abt captopril,was falling asleep,corrected asap........

CVS drugs tivia........

HYDROCHLOROTHIAZIDE; A thiazide diuretic,also used an an anti hypertensive,side effects can be tagged with this mnemonic

hyperCLUG (an increase in the following)...

C; hyperCALCAEMIA
L; hyperLIPIDAEMIA
U; hyperURICAEMIA
G; hyperGLYCAEMIA

hustla242: I think it's important to differentiate basic and clinical pharmacology. Basic pharmacologist study the effects of chemical agents (drugs) on biological systems; so it includes running in-vitro assays where we can look at effect of drugs on isolated cells performed in a "test tube" (for instance looking at the effect of Captopril on heart muscle or renal cells etc.), it also includes in-vivo experiments where we look at the effects of the chemical agents on these cells but within the context of a living being, so we inject a rodent with Captopril and look at how it reduces their blood volume, blood pressure etc.


Clinical Pharmacology strictly speaking looks at the effects of chemical agents in human beings, which is why most CP's are medically qualified. CP's work on First-in-Man studies, where we look at the effect of new agents on healthy people to establish it's safety before moving it into the different phases of research on patients to establish efficacy.

dexterinc2003: more on cvs pharmacology trivia...

HEART FAILURE; heart failure is the inability of the heart to pump enough blood to meet the body's metabolic requirements.

heart failure drugs can be classified using the following mnemonic...ABCD

A; Angiotensin converting enzyme inhibitors and angiotensin receptor blockers eg captopril/losartan
B; beta blockers eg labetalol
C; Calcium channel blockers eg nifedipine
D;Diuretics eg frusemide,hydrochlorothiazide

Obinoscopy: DRUGS IN PREGNANCY


A drug may be defined as any substance that brings about a change in biologic function through its chemical actions. A drug is taken for its therapeutic effect. But despite its therapeutic effect, it is a poison and should be taken with care especially during pregnancy. This is because the fetus is still in its developing stage and is very susceptible to the toxic effects of drugs.

Because of the limited data on the toxicity of drugs during pregnancy, it is safe to assume all drugs are potentially harmful until sufficient data exist to indicate otherwise. Drugs like Thalidomide have been established to be toxic because it has been used by pregnancy women in the past to treat early morning sickness. It was later withdrawn when it was discovered that it caused the birth of limbless babies (phocomelia). Social drugs like alcohol and cigarette are definitely dangerous and their use must be discouraged during pregnancy. But besides the few drugs whose toxicity to the fetus has been ascertained, none is known about the myriad of other drugs in circulation. This is because of the ethical limitations in the use of pregnant women in clinical trials.

The toxic effect of drugs could be instant (only one dose of thalidomide in the 5th-7th week of gestation results in phocomelia) or insidious (the drug diethylstilbesterol causes womanly cancer which is not manifest in the baby until she grows into an adult).

In the placenta, the maternal blood circulation is separated from that of the fetus by a cellular membrane. Such membrane allows for drug molecules less than 1000 to pass through by diffusion. Thus if the mother is taking drugs that has a small molecular weight, be rest assured that such drug is also within the blood system of fetus. However if the drug has affinity for the binding proteins (albumin etc) or if the drug has a high ionization affinity then its ability to cross the placenta will be heavily impeded. Drug molecules larger than 1000 can cross the placenta membrane via active transport.

Since the stage of gestation influences the effect on drugs on the fetus, it is convenient to divide pregnancy into four stages namely:

Fertilization and Implantation Stage
Organogenesis/Embryonic Stage
Fetogenic Stage
Delivery Stage

FERTILIZATION AND IMPLANTATION STAGE
Animal studies suggest that interference with the fetus before 17 days gestation causes abortion. Thus one should be careful of the drug she takes during this stage. Unfortunately most women don’t know that they are pregnant until the 3rd or 4th week. Thus it is highly recommended that all sexually active married women should be careful of the drugs she takes.

ORGANOGENESIS/EMBRYONIC STAGE
At this stage, the fetus is differentiating to form major organs, and this is the critical period for teratogenesis. Teratogens cause deviations or abnormalities in the development of the embryo that are compatible with prenatal life and are observable postnatally. Drugs that interfere with this process can cause gross structural defects (e.g. thalidomide phocomelia).

FETOGENIC STAGE
In this stage, the fetus undergoes further development and maturation. Even after organogenesis is almost complete, drugs can still have significant adverse effects on fetal growth and development.

• ACE inhibitors and angiotensin receptor blockers cause fetal and neonatal renal dysfunction.
• Drugs used to treat maternal hyperthyroidism can cause fetal and neonatal hypothyroidism.
• Tetracycline antibiotics inhibit growth of fetal bones and stain teeth.
• Aminoglycosides cause fetal VIIIth nerve damage.
• Opioids and cocaine taken regularly during pregnancy can lead to fetal drug dependency.
• Warfarin can cause fetal intracerebral bleeding.
• Indometacin, a potent inhibitor of prostaglandin synthesis, is used under specialist supervision to assist closure of patent ductus arteriosus in premature infants.
• Some hormones can cause inappropriate virilization or feminization.

DELIVERY STAGE
Some drugs given late in pregnancy or during delivery may cause particular problems. Pethidine, administered as an analgesic can cause fetal apnoea (this can however be reversed with naloxone). Anaesthetic agents given during Caesarean section may transiently depress neurological, respiratory and muscular functions. Warfarin given in late pregnancy causes a haemostasis defect in the baby (Heparin is preferable).


PRESCRIBING IN PREGNANCY
Inasmuch as it is not safe for a pregnant woman to take drugs, there are situations where she has to take her drugs. The prescription of drugs to a pregnant woman is a balance between possible adverse drug effects on the fetus and the risk to mother and fetus of leaving maternal disease inadequately treated. An epileptic pregnant woman needs to take her medications despite the fact that anti-epileptics are toxic to the fetus. This is because both the life of the woman and her unborn baby is at risk if she doesn’t take her medication. If a drug is to be prescribed for a pregnant woman, the following should be ensured:
• That drugs for which there is experience of safety over many years in preference to new or untried drugs. For instance, when prescribing antibiotics, penicillins and cephalosporins should be chosen over newer or untried antibiotics
• The smallest effective dose should be used
• More caution should be exercised during the first trimester as the fetus is most sensitive to adverse
drug effects during the first trimester

The following drugs are prescribed more often due to their safety profile:

Antimicrobials: Penicillins, Cephalosporins, Erythromycin, Metronidazole (teratogen in animal but no evidence in humans and its benefit outweighs any risk), Quinine

Analgesic: Paracetamol, Ibuprofen

Anti-Emetic: Promethazine, Cyclizine, Prochlorperazine,

Dispepsia and Constipation: Metoclopramide

Peptic Ulceration: Cimetidine, Ranitidine

Anti-Coagulation: Low Molecular Weight Heparin

Anti-depressants: Fluoxetine

Cardiovascular Drugs: Methl-dopa, Labetalol, Hydralazine, Nifedipine (Modified release)


The following are drugs with significant teratogenic or other adverse effects on the fetus. The trimester when the toxicity occurs is listed in bracket (culled from Katzung):

ACE inhibitors Renal damage (All, especially second and third)

Aminopterin Multiple gross anomalies (First)

Amphetamines Suspected abnormal developmental patterns, decreased school performance (All)

Androgens Masculinization of female fetus (Second, third)

Antidepressants, tricyclic Neonatal withdrawal symptoms have been reported in a few cases with clomipramine, desipramine, and imipramine (Third)

Barbiturates Chronic use can lead to neonatal dependence (All)

Busulfan Various congenital malformations; low birth weight (All)

Carbamazepine Neural tube defects (First)

Chlorpropamide Prolonged symptomatic neonatal hypoglycemia (All)

Clomipramine Neonatal lethargy, hypotonia, cyanosis, hypothermia (Third)

Cocaine Increased risk of spontaneous abortion, abruptio placentae, and premature labor; neonatal cerebral infarction, abnormal development, and decreased school performance (All)

Cyclophosphamide Various congenital malformations (First)

Cytarabine Various congenital malformations (First, second)

Diazepam Chronic use may lead to neonatal dependence (All)

Diethylstilbestrol womanly adenosis, clear cell womanly adenocarcinoma (All)

Ethanol Risk of fetal alcohol syndrome and alcohol-related neurodevelopmental defects (All)

Etretinate High risk of multiple congenital malformations (All)

Heroin Chronic use leads to neonatal dependence (All)

Iodide Congenital goiter, hypothyroidism (All)

Isotretinoin Extremely high risk of CNS, face, ear, and other malformations (All)

Lithium Ebstein’s anomaly, neonatal toxicity after third trimester (First, third)

Methadone Chronic use may lead to neonatal abstinence (All)

Methotrexate Multiple congenital malformations (First)

Methylthiouracil Hypothyroidism (All)

Metronidazole May be mutagenic (from animal studies; there is no evidence for mutagenic or teratogenic effects in humans) (First)

Misoprostol Mobius sequence (First)

Mycophenolate mofetil Major malformations of the face, limbs, and other organs (First)

Organic solvents Multiple malformations (First)

Penicillamine Cutis laxa, other congenital malformations (First)

Phencyclidine Abnormal neurologic examination, poor suck reflex and feeding (All)

Phenytoin Fetal hydantoin syndrome (All)

Propylthiouracil Congenital goiter (All)

Smoking Intrauterine growth retardation; prematurity; sudden infant death syndrome; perinatal complications (All)

SSRIs Neonatal abstinence syndrome, persistent pulmonary hypertension of the newborn (Third)

Tamoxifen Increased risk of spontaneous abortion or fetal damage (All)

Tetracycline Discoloration and defects of teeth and altered bone growth (All)

Thalidomide Phocomelia (shortened or absent long bones of the limbs) and many internal malformations (First)

Trimethadione Multiple congenital anomalies (All)

Valproic acid Neural tube defects, cardiac and limb malformations (All)

Warfarin Hypoplastic nasal bridge, chondrodysplasia (First)
CNS malformations (Second)
Risk of bleeding. Discontinue use 1 month before delivery (Third)


In conclusion, all drugs are considered poisons thus should be given with caution to pregnant women. Sometimes the benefits of giving a drug to a pregnant woman outweigh the risk. Also there are instances where a drug is given to treat the fetus invitro (the use of indomethacin to close the ductus arteriosus of the fetus and the use of Phenobarbitone to induce the glucuronidation of the bilirubin thereby preventing jaundice in newborns). However a prescriber must ensure that he gives the woman the minimum number of drugs and dose required to achieve the desired therapeutic effect, drugs with established safety profile should be prescribed and extra caution should be exercised for women in their first trimester.

Reference
Anon. Antiepileptics, pregnancy and the child. Drugs and Therapeutics Bulletin 2005; 43 no 2.
Koren G. Medication, safety in pregnancy and breastfeeding: the evidencebased
A–Z clinicians pocket guide. Maidenhead: McGraw-Hill, 2006.
Rubin PC. Prescribing in pregnancy, 3rd edn. London: Blackwell, BMJ Books, 2000.
McElhatton PR. General principles of drug use in pregnancy.
Pharmaceutical Journal 2003; 270: 305–7.
Katzung BG, et al. Basic and Clinical Pharmacology, 12 edn. McGraw-Hill, 2012.

Liverpoolfc: @dexterinc2003

can you pls explain how it causes hyperglycemia?

winbyforce: Nice presentation Obonoscopy! Just to add that thalidomide has been re-introduced in Brazil to treat leprosy- the country has a big leprosy problem and thalidomide is quite effective for treating it.So the drug is actually beneficial outside of the pregnant state.

passion007: @ Obinoscopy:

Your presentation was fluid, and to the point. Nice one, and many thanks.
However, I had expected coverage of the commoner diseases in pregnant and lactating women in Nigeria ie malaria, enteric fever. In other words, which antimalarials are safe for pregnant women?
Thanks once again, you've raised the bar on this thread.

Edit: I see you've addressed some of the issues in your latter posts.

Circle-Of-Wilis:
FDA Pregnancy Categories
The FDA has established five categories to
indicate the potential of a drug to cause birth
defects if used during pregnancy. The
categories are determined by the reliability of
documentation and the risk to benefit ratio.
They do not take into account any risks from
pharmaceutical agents or their metabolites in
bosom milk. The categories are:

Category A
Adequate and well-controlled studies have
failed to demonstrate a risk to the fetus in
the first trimester of pregnancy (and there is
no evidence of risk in later trimesters).

Category B
Animal reproduction studies have failed to
demonstrate a risk to the fetus and there are
no adequate and well-controlled studies in
pregnant women.

Category C
Animal reproduction studies have shown an
adverse effect on the fetus and there are no
adequate and well-controlled studies in
humans, but potential benefits may warrant
use of the drug in pregnant women despite
potential risks.

Category D
There is positive evidence of human fetal risk
based on adverse reaction data from
investigational or marketing experience or
studies in humans, but potential benefits may
warrant use of the drug in pregnant women
despite potential risks.

Category X
Studies in animals or humans have
demonstrated fetal abnormalities and/or
there is positive evidence of human fetal risk
based on adverse reaction data from
investigational or marketing experience, and
the risks involved in use of the drug in
pregnant women clearly outweigh potential
benefits.

Category N
FDA has not classified the drug.

http://www.drugs.com/pregnancy-categories.html

Obinoscopy: Very true winbyforce. Thanks for this wonderful information of yours. Thalidomide is actually used in the treatment of certain complications of leprosy (skin symptoms of erythema nodosum leprosum) and certain cancers (multiple myeloma). However we need not be told that the drug is a no no for pregnant women

Obinoscopy: @Circle-Of-Wilis

Thank you very much for this piece of information. During my school days, I was thought this and I even had to cram the class each drug belonged to cheesy. However, I've been made to understand that this method of classification is no longer acceptable. Katzung et al, in his recent textbook (Basic and Clinical Pharmacology) explained it in detail (page 1042). Find the excerpt below:

The widely cited Food and Drug Administration (FDA) system for teratogenic potential is an attempt to quantify teratogenic risk from A (safe) to X (definite human teratogenic risk). This system has been criticized as inaccurate and impractical. For example, several drugs have been labeled “X” despite extensive opposite human safety data (eg, oral contraceptives). Diazepam and other benzodiazepines are labeled as “D” despite lack of positive evidence of human fetal risk. Presently the FDA is changing its system from the A, B, C grading system to narrative statements that will summarize evidence-based knowledge about each drug in terms of fetal risk and safety.

aieromon: @Liverpoolfc

Several hypotheses have been put out ,with the reduction in serum potassium being the strongest. This will help to explain further:-

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904515/?tool=pubmed

Mrs Awesome: Misoprostol causes uterine contraction.....right?. It controls uterine atony during third stage among others.

Obinoscopy: @Mrs Awesome

Right. Besides inducing Uterine Contraction, Misoprostol is an abortifacient as it could lead to spontaneous abortion if taken by a pregnant woman. However it used during delivery to prevent PPH (postpartum hemorrhage). It is worthy of note that the first drug of choice in PPH or Uterine Atony is oxytocin.

Circle-Of-Wilis:
@Obiniscopy
Thanks

in my lttle experience as a clinician i have noticed that my patients (pregnt) don't do well on quinine, i have had majority of them coming back with various complaints after some doses of quinine, some have even presented back with bleeding pv....can the presenter pls shed more light on the safety of quinine in pregnancy

i want to knw if other medical wrkers have noticed a similar trend

Obinoscopy: @Circle-Of-Wilis

Quinine is very safe in pregnancy. Its the only drug that I know to have an established safety profile during the first trimester. However its cinchonic side-effects on the mother is the main reason why most patients don't like taking it. Most prefer the Artemisinin Combination Therapy Regimen (its still okay to take this in the first trimester if its benefit outweighs its risk) or even Chloroquine (also safe during 1st trimester). I've never gotten a complaint regarding the incidence of womanly Bleeding during pregnancy due to Quinine usage from either the doctors, nurses or patients in the hospital I worked in. However, I think its left for other clinicians to give us their own experience in this matter.

Regards.

Mrs Awesome: @Obinoscopy

It is the only anti malaria that is safe in first trimester when given as supposed at most 1 bd....these ensures that the body is not overloaded with the drug and also that the bioavailabilty is just enough for the purpose intended. It is also an effective abortificaent esp before 8weeks use mainly by students but it doesn't work often. kiss Titrating the dosage according to the body weight and the BMI will help to reduce the incidence of the bleeding.

aieromon: @Obinoscopy

In addition, The National Malaria Control programme recommends the use of quinine for acute treatment of cases in the first trimester, and artemsinin-based combination therapy (ACT) for acute cases in the second and third trimesters.The ACT recommended in pregnancy is the Arthemeter/lumefantrine or Artemisinin/amodiaquine combinations. Anti-malaria drugs such as primaquine, halofantine, mefloquine, etc., are contraindicated in pregnancies and thus not recommended.

The Federal Ministry of Health has banned the use of chloroquine for prophylaxis or treatment of malaria in pregnancy since 2008 due to well documented evidence of resistance in West Africa. The use of pyrimethamine(Sunday Sunday medicine) and proguanil are also not recommended for the chemoprophylaxis of malaria in pregnancy for these same reasons.

The National Malaria Control programme recommends the use of intermittent preventive treatment with sulphadoxine/pyrimethamine (IPT-SP) for chemoprophylaxis against malaria in pregnancy.

Mrs Awesome: @Obinoscopy

My problem with Oxytocin is it's ability to cause water retention.....when used in PIH, preclamptic patients ..it tends to exacerbate the hypertension though it works fast. It's very potent.

edalaropin: @Circle-Of-Wilis

First trimester abortion is quite common with Quinine. I do agree with u.

Obinoscopy:

DJMONACO:
the dose of primaquine necessary for treatment of chloroquine resistant falciparum malaria is A 2.5mg B 15mg C 45mg D 75mg

15mg daily for 14 days

Renylee: @dexterinc2003

Are diuretics first line drugs for hypertension or just adjuncts?

ULQUIORRA: There is a presence of efflux transporters such as P-glycoprotein(P-gp) in the placental membrane that prevents the entry of xenobiotics (harmful substances) into the placenta. However some drugs inhibit (P-gp) and they include Rifampicin and Phenobarbitone. They should therefore be avoided during pregnancy.

Renylee: @Obinoscopy

According to our lecturer, misoprostol does not induce abortion in all women buh when administered with methotrexate, abortion is certain..

Obinoscopy:

Renylee:
According to our lecturer, misoprostol does not induce abortion in all women

I agree with you on the bolded. Nothing is 100%. Each woman has a unique genetic make-up that could influence the pharmacokinetics and pharmacodynamics of every drug, Misoprostol inclusive. That's why the field Pharmacogenomics is an interesting aspect of Pharmacology that needs more studying.

buh when administered with methotrexate, abortion is certain..

Really? Whats the mechanism of action. I really want to know.

aieromon:

edaolaropin:
Is arthemeter/Lumefantrine combination safe in pregnancy and lactating mothers?

A/L combination is safe and effective in the second and third trimester of pregnancy. Administration during breastfeeding is strictly based on medical advice.