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TROPICAL DISEASES
BLOCK 22
FACTORS DRUG USE PROBLEMS
IN TROPICAL ENVIRONMENT
Cost of medicine
MICRO-
ORGANISM / INVASIVE HOST
PARASIT
PHARMACOTHERAPY
PHARMACOTHERAPY
should be :
DRUG DOSAGE,
ABSORPTION,
DISTRIBUTION,
METABOLISM,
EXCRETION TROPIC- COUNTRIES
SITUATION
PHARMACOKINETIC BODYWEIGHT
NUTRIONAL STATUS &
DIETARY HABITS
TROPICAL ENVIRONMENT:
PHARMACOTHERAPY
PHARMACOTHERAPY climatic factors
infections and infestations
environment pollutants (chemicals,
PHARMACODYNAMIC mycotoxins, alcoholism,
smoking, etc)
EFFECTS,
RESPONSES,
INTERACTIONS,
ADVERSE EFFECTS,
Etc., etc.
DRUGS NUTRIONAL STATUS/ EFFECT ON DRUG % CHANGE
CONDITION CLEARENCE
Respone
PHARMACODYNAMIC
Drug receptor
interaction
PARASITIC INFECTIONS
1. Malaria
2. Filariasis EFFICACY
3. Onchocerciasis
SAFETY
4. Schistosomiasis
5. Leishmaniasis
6. African Trypanosomiasis
(Sleeping Sickness)
ECONOMIC
AVAILABILLITY
R
7. American Trypanosomiasis
(Chagas Disease) AFFORDABILLITY
BACTERIAL INFECTIONS
8. Leprosy
9. Tuberculosis
VIRAL INFECTION.
10. Dengue
11. HIV
1. MALARIA
- The most important tropical disease, affecting over 2200 million, more than
2 million deaths/year.
- Cause : PLASMODIUM : - P. VIVAX
- P. OVALE
- P. MALARIAE
- P. FALCIPARUM severity deaths
-COMPLICATION : 1. cerebral malaria
2. hyperpyrexia
3. hemolytic anemia
4. noncardiogenic pulmonary edema
5. acute tubular necrosis & renal failure
6. acute hepatopathy
7. hypoglycaemia
8. cardiac dysrhytmias
9. gastrointestinal syndromes
10. lactic acidosis
11. water and electrolyt imbalance
MALARIA
ADVERSE EFFECTS:
pruritis, GI upset, headache, fatigue, visual disturbances, dyskinesia,
neurovascular disease
LIMITATIONS : RESISTANCE.
MEFLOQUINE
MECHANISM OF ACTION : same as chloroquine, sensitive to : Plasmodium
falciparum and P. vivax. Class : blood schizontocide;
onset : 6 hours.
ADVERSE EFFECTS:
dizziness, GI upset, headache, pruritis, skin rashes, CNS toxicity.
LIMITATIONS.
expensive, resistance (now some area was established).
PRIMAQUINE
1. Amodiaquine
2. Quinine
3. Sulfadoxine pyrimethamine (Fansidar)
4. Atovaquone proquanil (Malarone)
5. Halofantrine
6. The Artemisinin drugs :
artesunate
artemether
artemisinin
7. Artemether lumefantrine (Co-artem)
CHEMOPROPHYLAXIS
CHLOROQUINE PRIMAQUINE
300 mg (base) / 45 mg(base)/week
week. for 8 weeks
PYRIMETHAMINE MEFLOQUINE
25 mg/week in 250 mg/week
combination with for 4 weeks, then
sulfadoxine 125 mg/week
SULFADOXINE
500 mg/week in
combination with
pyrimetamine
WHATS
THE MAIN PROBLEM
PHARMACOTHERAPY MANAGEMENT
in MALARIA ???
2. FILARIASIS
PREVENTION :
- reduce/eradicate population of mosquito
- protect from mosquito bites
3. ONCHOCERCIASIS
Syndromes :
- Visceral leishmaniasis (kala azar): L.donavani; L. infantum;
L. chagasi
- Cutaneus leishmaniasis : Old world : L. tropica; L. major;
L. aethiopica.
New world : L. mexicana.
- Mucocutaneus leishmaniasis (espundia) : Leishmania (viannia)
braziliensis; rare L(v) panamensis.
- Diffuse cutaneus leihmaniasis : L. mexicana; L. aethiopica