Transcript Dr S Bosnic-Anticevich

Mrs Kearns (78 y.o)
asks for an
antihistamine. She
tells you that she
used to use Teldane®
when she last had
this problem.
Tutorial Scenario.
• Mrs Kearns, a healthy 78 year old female is visiting
Sydney to attend her grandson’s wedding.
• She is 5 days in to a 14-day course of erythromycin
therapy.
• Yesterday she had an upset stomach and diarrhoea, so
she is also taking diphenoxylate (Lomotil), which
contains a sub-therapeutic amount of atropine sulfate
to discourage abuse.
• She is feeling a little tired and she also as a dry mouth
and slightly blurred vision.
Tutorial Scenario.
• She has woken up with red itchy, watery eyes and is
sneezing frequently.
• She used to suffer from hayfever when she lived in
Sydney and her doctor had treated her with Teldane
(10 years ago).
• The antihistamines you have available are Claratyne
(loratadine), Phenergan (promethazine), Telfast
(fexofenadine) and Polaramine (dexchlorpheniramine).
Tutorial Scenario.
• She also asks you for a Ventolin inhaler and presents an
asthma card
• She woke up coughing last night and needed her
Ventolin
Lectures to support this case
• Histamine and Antihistamines A/Prof J Hanrahan
• Clinical Interventions Dr T Chen
• Adrenergic Receptors (relevant to Cardiovascular and
Respiratory) Prof B Roufogalis
• Allergic Rhinitis Dr L Smith
• Asthma Therapy Dr B Saini
• Asthma Devices Dr B Saini
• Inhaler Technique Dr S Bosnic-Anticevich
References to support this case
• Second year lectures on antibiotics
• Foye's Principles of Medicinal Chemistry;
Thomas L Lemke, David A Williams, Victoria F
Roche & S. William Zito, 6th Edition, 2007.
• NAC Asthma management handbook
• NAC health professional guide Allergic rhinitis
and the patient with Asthma
• Respiratory Guidelines
• AMH
General learning objectives for
PHAR3812
By the end of this tutorial students should be able to:
 Predict the activity of a drug based on its structure and
physicochemical properties
 Demonstrate an understanding of how the physical and
chemical properties of a drug determine its
pharmacology, toxicology, bioavailability and behaviour
in formulations
 Identify typical examples of drugs which are used to
restore physiological functions in the respiratory system
 Describe the mechanism of therapeutic action of a
selected drug at the molecular, cellular, organ system
and whole body levels
General learning objectives for
PHAR3812
By the end of this tutorial students should be able to:
• Describe the common adverse effects of a selected drug
and their mechanism of production
• Demonstrate an understanding of basic metabolism in
relation to drugs and efficacy and safety in relation to
the treatment of disease and/or maintenance of health
• Apply an understanding of the basic and applied
sciences to pharmaceutical care in order to optimise
health outcomes
• Respond to direct product and symptom based requests
(in relevant therapeutic areas)
Learning outcomes specific for Case 1
By the end of this tutorial students should be able to:
• Have an understanding of the link between Asthma
and Allergic Rhinitis
• Identify the different structure of antihistamines
• Understand the structural features likely to cause
adverse effects with antihistamines
• Demonstrate an ability to develop appropriate
allergic rhinitis and asthma management plans.
Information Gathering
Prior to Tutorial 1
• WHAT ARE THE PATIENT SPECIFIC FACTS
THAT NEED TO BE IDENTIFIED AND
PRIORITISED?
• Before your tutorial you should have a list of
questions that you would like to ask Mrs.
Kearns
Information Gathering
Prior to Tutorial 1
• WHAT ARE THE POSSIBLE CAUSES OF
COUGH?
• Before your tutorial you should have a list of
possible causes of cough and differentiating
features.
Information Gathering
Prior to Tutorial 1.
• WHAT IS THE LINK BETWEEN ASTHMA AND
ALLERGIC RHINITIS?
• Before your tutorial you should have read the
NAC health professionals guide on WebCT
Information Gathering
Prior to Tutorial 1
• WHAT DO THE STRUCTURES OF THE
AVAILABLE ANTIHISTAMINES TELL YOU ABOUT
THEIR ACTIVITY AND SIDE EFFECTS
• Before your tutorial you should review the
structures, think about solubility of functional
groups, size, drug interactions and adverse
effects
Information Gathering
Prior to Tutorial 1
• HOW IS ERYTHROMYCIN METABOLISED BY THE
LIVER?
• Before your tutorial you should review the
metabolism pathways of erythromycin and her
other medicines.
Information Processing
Prior to Tutorial 1.
During tutorial 1.
• You may be asked to present interesting insights from your
placement
• The tutor will ask for answers to the pre-work questions
• A role play with the patient will occur
• Discussion and debate will occur in order to choose
appropriate management for Mrs Kearns
Information Gathering
In Tutorial 1
• WHO IS THE PATIENT?
• In your tutorial
students should roleplay with the patient
• (20mins)
Information Processing
In Tutorial 1
• WHAT ARE THE PATIENT SPECIFIC FACTS THAT
NEED TO BE IDENTIFIED AND PRIORITISED?
• Identify key issues that need to be addressed
and discuss in your table groups
Information Processing
In Tutorial 1
• WHAT COULD BE CAUSING HER COUGH?
• After questioning make a differential diagnosis
Information Processing in
Tutorial 1
• WHAT DO THE STRUCTURES OF THE
AVAILABLE ANTIHISTAMINES TELL YOU ABOUT
THEIR ACTIVITY AND SIDE EFFECTS
• Discuss the pros and cons of each medicine
and choose an appropriate agent
Information Processing in
Tutorial 1
• WHAT ISSUES MAY LOMOTIL AND
ERYTHROMYCIN POSE?
• Discuss the pros and cons of each medicine
and choose an appropriate agent
Information Processing in
Tutorial 1.
• WHAT IS THE BEST WAY TO MANAGE MRS
KEARNS’ SYMPTOMS
• During the tutorial devise an appropriate
allergy and asthma action plan
Information Processing in
Tutorial 1
• WHAT ASTHMA THERAPY WOULD YOU
RECOMMEND IF SHE WAS:
– A. BACK AT HOME
– B. PLANNING ON STAYING IN SYDNEY FOR A
WHILE?
• During the tutorial devise an appropriate
allergy and asthma action plan
• END OF TUTORIAL 1.
Information Processing before
Tutorial 2
• WHAT ARE THE PATIENT SPECIFIC FACTS THAT
NEED TO BE IDENTIFIED AND PRIORITISED TO
ACHIEVE THE DESIRED THERAPEUTIC
OUTCOME?
• Before tutorial 2. identify and prioritise the
issues on hand
Information Delivery before
Tutorial 2
• WHAT ARE THE PATIENT SPECIFIC FACTS THAT
NEED TO BE IDENTIFIED AND PRIORITISED TO
ACHIEVE THE DESIRED THERAPEUTIC
OUTCOME?
• Before tutorial 2. document your findings and
recommendations for this case. (Be ready to
discuss these with the doctor and patient)
During tutorial 2.
• You may be asked to present interesting insights from your
placement
• The tutor will ask for answers to the pre-work questions
• role play with the doctor will occur
• role play with the patient will occur
Information Delivery during
Tutorial 2
• WHAT ARE THE PATIENT SPECIFIC FACTS THAT
NEED TO BE IDENTIFIED AND PRIORITISED TO
ACHIEVE THE DESIRED THERAPEUTIC
OUTCOME?
• During tutorial 2. present your findings and
recommendations in powerpoint
Information Delivery during
Tutorial 2
• DISCUSS ANY ISSUES YOU HAVE WITH THE
DOCTOR
• During tutorial 2. articulate your clinical
intervention(s) to the patient’s doctor
Information Delivery during
Tutorial 2
• COUNSEL THE PATIENT ON THE CORRECT USE
OF THE APPROPRIATE ANTIHISTAMINE
• During tutorial 2. explain to the patient why
you have chosen the particular agent and
counsel her on its use
Information Delivery during
Tutorial 2
• COUNSEL THE PATIENT ON HER OVERALL PLAN
• During tutorial 2. tell Mrs Kearns about her
asthma and allergy management