Download Topic 9. Clinical-pharmacological characteristics of anti

Topic 9. Clinical-pharmacological characteristics of anti-allergic drugs.
1.
Numbers of hours: 2
2.
The rationale behind the topic. Today, Allergy is called a disease of civilization. According to data from the
World Health Organization (WHO), the rate of Allergy takes the 3rd place among other diseases. According to statistics,
now in the world on one or another form of allergic diseases affecting 20-40% of population, that's mean at least every
5th inhabitants for the planet is allergy sufferer. Today >40% of the world population has allergies history. Every 10
years the number of patients with allergic diseases doubled. According to forecasts, in the coming decade, everyone on
Earth suffers from allergic disease. According to official data, in Ukraine, the Allergy is diagnosed in about 1,5% of the
population. However, the real figures are much higher – up to 25% ( around 10 million people). In their daily practice,
dentists are increasingly faced with cases of allergic reaction in patients. The most dangerous is the development of
allergic reactions of immediate type, named anaphylactic shock. Anti-allergic drugs inhibit the action of histamine and
other biologically active substances that are released as a result of sensitization reactions (antigen-antibody). Therefore,
the study of the pharmacological action of drugs which block H1 receptors, provides the possibility to help patients with
allergic disease and as emergency treatment of anaphylaxis.
3.
The aim of the lesson
•
General: the future dentists need to pay attention of the possibility of development in patients manifestations
of allergic reactions of different types, to teach the rational use of antihistamine drugs in case of dosing regimen,
possibility of side effects of the drug and rules of excerpt of formulation;
•
Specific:
•
facts: clinical and pharmacological characteristics of drugs; principles of selection and appointment of drugs,
considering clinical symptoms and data to support research;
•
be able to: conduct a general inspection of patients; rationally choose an anti allergic drug to each patient; to
appoint dose and the scheme of the drug; to analyze the drug sheet assignment based on diagnosis data and clinical and
laboratory parameters, also substitution of one drug to another; to provide adequate medical care to patients with
clinical symptoms of anaphylactic shock, allergic reaction of immediate and delayed type; to write the prescription.
4.
Graf logical structure of topic.
Antiallergic drugs
1.
Classification
2.
Pharmacological effects:
3.
Application
I generation
in
dentist’s
practice:
II generation
III generation

pruritic

decongestant

anti spastic

antiserotoninic

sedative

local anesthetic
•
in the treatment of allergic and inflammatory diseases of the oral cavity
•
Kvinka’s swelling, anaphylactic shock
•
for sedation before a dental intervention
•
to relieve gag reflex
•
for conducting of local anesthesia in patients with allergy to al local
anesthetics
•
4.
Side effect:
•
gastrointestinal: decrease of salivation, dry mouth, numbness of mucous
membranes of the mouth, anorexia, nausea, vomiting, diarrhea,
constipation
•
from the side of nervous system: from sedatives to sleeping pills,
nervousness, euphoria, insomnia, headache, dizziness, in coordination,
hyperthermia, convulsions, paraesthesia, tinnitus
•
from the side of cardio-vascular system: hypotension, tachycardia,
arrhythmia, thrombocytopenia, agranulocytosis, hemolytic anemia
•
from the side of the urinary system: frequent and difficult urination, a delay
of urination, early menstruation
5.
Contraindications:
6.
Caution; Gently apply at:
5.
•
other: violation of accommodation,sweating, photosensibilisation
•
hypersensitivity
•
pregnancy, breastfeeding
•
glaucoma
•
stenosis of the bladder neck
•
prostate adenoma, impaired urination
•
the aggravation of erosive-ulcerative diseases of the gastrointestinal track
•
severe cardiovascular and endocrine diseases, renal and liver failure
•
old patients
•
the drivers of vehicles
•
people, whose profession requires quick and motor responses
Facilities and support topics: manuals, textbooks, methodological materials, tests, situational tasks, list of
appointment, medical history.
6.
Materials for practical lessons (lesson content):

the content of Allergy

types of allergic reactions

drugs which are used in allergic reaction of various types

classification of anti allergic drugs

clinical-pharmacological characteristics of the antihistamine drugs

peculiarities of action of antihistamines I, II, III generations

indications of using antiallergic drugs

tolerability and side effects of Allergy medicines

pharmacotherapy of allergic reactions of immediate type

contraindications to use the antiallergic drugs

the principles of the application of antihistamine drugs

methods of evaluating the effectiveness and safety of using antihistamine
7.
Practical skills of topic:

to conduct a general inspection of patients to diagnose conditions of allergy

to estimate laboratories records to assign antiallergic drug

to know indications for prescribing antiallergic drug

evaluate contraindications for appointment of selecting antiallergic drug

choose antiallergic drug for special patient

assign the dose and the scheme of the drug

to analyze a piece of medical appointments

to change one drug to other

to provide adequate medical care for patients with clinical symptoms of anaphylactic shock, allergic reaction of
immediate and delayed type

to write correctly the prescription
8.
Terminology
Classification of antihistamines drugs for different generations
I generation
II generation
III generation
Diphenhydraminum
Loratadinum
Desloratadium
Clemastinum
Oxatomide
Levocetirizinum
Mebhydrolinum
Cetirizinum
Fexofenadinum
Promethazinum
Chloropyraminum
9.
Questions for knowledges control
9.1. Checklist
•
which are the groups of medicines that have an antiallergic properties
•
name the mechanism of action of blocker of H1-receptors
•
indications of antihistamine drugs
•
name the difference in major pharmacodynamic effects of antihistamine drugs for different generations
•
indicate side effects and contradictions to the appointment of antihistamine drugs
•
Where are H1 receptors localized, and which pharmacodynamic effects are occur in their stimulation
•
Classification of allergic reactions
•
Name the main schemes
9.2.
Test tasks:
Problem #1. The patient with atopic dermatitis was prescribed loratadine (claritin). Which group of antiallergic drugs is
it?
•
Histamine receptor of 2nd type
•
Glucocorticoids
•
Membrane stabilizing drugs
•
Receptors of antagonists leukotriene
•
Blockers of histamine receptors of 1st ty
Problem #2. The mechanism of H1-blockers is in all presented
•
Inhibiting the actions of histamine
•
Inhibiting of biologically active substances
•
Have hanolin effect
•
Have a sedative effect
•
Have a serotonin activity
statement, except:
Problem #3. Which of the following drugs has not got a sedative effect?
•
Diphenhydramine
•
Promethazine
•
Suprastinum
•
Tavegil
•
Pipolfen
Problem #4. Which of the following drugs belongs to antiallergicdrug of 3 rd generation?
•
Ketotifenum
•
Tavegil
•
Loratadine
•
Terfenadine
•
Cetirizine
Problem #5. Woman with seasonal vasomotor rhinitis, who works as a dispatcher on the railway, asked for advice,
which antihistamine drug in use has not got depressing effect on central nervous system?
•
Promethazine (pipolfen)
•
Diphenhydramine
•
Claritin (loratadine)
•
Clemastine (tavegil)
•
Chloropyramine (suprastin)
9.3.
Situational tasks:
Task 1. After taking an aspirin, dipyrone, patient M., 45 years old, has swelling of mucous membranes, face, upper and
lower extremities of white papules, which eventually passed into roseola, with severe itching and swelling. What is the
reason of developing of this condition? Which are the ways of treating it?
Task 2. Patient D., 62 years old, began to complain about general weakness, nausea, dizziness, after 10 min. the dentist
injected him a anesthesia. Also he had pale skin, dizziness, shortness of breath, cold sweat, hypotension phenomena that
had peroli in the collapse with thready pulse. What is your diagnose? Your treatment tactics.
10.
Literature
1.
2.
3.
4.
5.
Клінічна фармакологія: підручник / Яблучанський М.І. - Харків, Харківський національний
університет імені В. Н. Каразіна, 2011. – 407 с.
Клінічна фармакологія: підручник (ВЗН І р.а.) / за ред.. О.Я. Бабака, О.М. Біловала, І.С. Чекмана. – 2-ге
вид., переробл. І допов. – Київ, Медицина, 2010. – 776 с.
Клиническая фармакология : учебник / О. Я. Бабак, А. Н. Беловол, Н. П. Безуглая [и др.] ; под ред. :
О. Я. Бабака, А. Н. Беловола, И. С. Чекмана. – К. : Медицина, 2012. – 726 с. : табл., ил.
Фармакологія: підручник для мед.ВНЗ. 5-е вид./Нековаль І.В., Казанюк Т.В.. – Київ, Медицина, 2013. –
520 с.Фармакологія: підручник для студентів медичних факультетів/ Чекман І.С., Горчакова Н.О.,
Казак Л.І., Бєленічев І.Ф., Бобирьов В.М., Висоцький І.Ю. та ін..; за ред. І.С Чекмана. _ Видання 2-ге. –
Віниця: Нова книга, 2011. – 784 с.
Basic and Clinical Pharmacology, edited by Bertram G. Katzung, ISBN 0-8385-1453
Lesson manual was written by Prof. Safonova O.V., translated by asst. prof. Kozlovska H. Y.
Lesson manual was revised and approved at the faculty meeting of Endocrinology Department of Danylo Halytsky Lviv
National Medical University from 14.06.2016 (protocol № 20).
Сurriculum director of the Endocrinology Department,
Prof. Safonova O.V., MD PhD