South Sudanese future pharmacists

Aldosterone antagonists

EXAMPLES
Spironolactone, eplerenone or take a SEAT.

MECHANISM OF ACTION

Competitive antagonist at intracellular aldosterone receptors in
renal tubules causing reduced production of aldosterone-induced proteins. This indirectly
reduces activity of Na */K* ATase in the collecting ducts, increasing excretion of Na* and
decreasing K* loss. Spironolactone, in particular, also acts on receptors in other tissues, including androgen receptors.

INDICATIONS

• Congestive cardiac failure (spironolactone)
• Oedema and ascites in liver disease (spironolactone)
• Post-MI heart failure (eplerenone)
• Nephrotic syndrome (spironolactone)
• Primary hyperaldosteronism (including Conn's syndrome) (spironolactone)

CAUTIONS AND CONTRA- INDICATIONS

• Electrolyte disturbances (including hyperkalaemia and hyponatraemia)
• Caution in renal impairment

SIDE-EFFECTS

• Hyperkalaemia (K* sparing effect)
• GI disturbance
• Anti-androgenic effects (spironolactone - menstrual irregularities in females,
gynaecomastia and hypogonadism in males)

METABOLISM AND HALF-LIFE

Metabolised to active metabolites. ty of drug is 60-90 min
but ty of active metabolites is longer (up to 11 h).

MONITORING

Monitor plasma electrolytes for adverse effects as above.

DRUG INTERACTIONS

• Enhanced hypotensive effect with other antihypertensives
• Increased risk of hyperkalaemia with ACEls/ARBs and amiloride
• Increased risk of nephrotoxicity with NSAIDs

IMPORTANT POINTS

• Eplerenone is more selective than spironolactone and therefore causes fewer s*x hormone-related adverse effects
• Spironolactone may also be used in hypertension (unlicensed indication)

Vein infrared finder.

GERD (Gastroesophageal Reflux Disease) is a condition in which the gastric acid content in the stomach flows back to the oesophagus.

This usually causes a painful burning sensation in the middle of the chest (heartburn).

The Proton Pump Inhibitors (PPIs) are the most effective drugs used for treating GERD.

Examples include Omeprazole, Lansoprazole, Rabeprazole and regularly take 30 or 60 mins before lunch or dinner.

Cimetidine Vs Ranitidine

Both drugs are used to treat peptic ulcer.
Chronic use of Cimetidine causes the abnormal enlargement of the male breasts (Gynaecomastia)

Ranitidine doesn't

Chronic use of Cimetidine decreases libido and causes impotence in male

Ranitidine doesn't.

The day mitochondria went from being "the powerhouse of the cell to the ATP synthesis by oxidative phosphorylation" was a horrible day.

What is an absolute contraindication of ACE inhibitor.

Hello hearty,love your stuff. I'm a pharmacist who has had addiction issues and I am in recovery but my job options are limited to say the least. I currently float for WURH and honestly they treat me fairly well. The problem is there aren't many stores close to me and I regularly have 3 or 4 hours a day of driving or hotel stays. I have an offer from CVS that is close with a set schedule. Your disdain for them is clear but do you honestly think that it would be much worse than what l'm doing?

Thanks for any help.

Your thoughts pharmacists.

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🇸🇸

🇸🇸 Drugs expert advice to drug’s users.

If you are a single lady, please hear me loud and clear stop taking tablets or injection to prevent pregnancy, when you are still dating, how could you involve yourself in family planning when you are still single.
Don't you know that family planning is made only for the married couples who are no longer interested in having more kids.
Some ladies always take injection that last 6 months or 1 yr, One thing you don't know about these drugs is that they are only made to kill your eggs and immobilize your hormones and it weakens your circles,
if you would believe with me that since you started taken it, you have noticed that anytime you are to see your me**es, it won't be as regular as it use to be,
sometimes these drugs will hold your menstruation for up to 3 to 4months before it will normalize again,You know exactly what am saying my dear.
I know some ladies may have been living this type of life for over 6 or 10 yrs now.
You are single and in school but you prefer going into family planning when you know you are not married, my dear sister, you are calling yourself into a seriously Barrenness to come and take over your life in the nearest future.
And by that time your chewing gum boyfriend won't be there again for you, by now he will be going home with his new wife and children while you run from pillar to post in search of a child.
Superglue yourself. Even as am writing this now, there are still millions of single ladies who are in the Universities carrying out Family planning ropes inside their womb. Just because you want to be the happening Girl in the campus.
Shame shame shame, such life does not last, am sorry to have exposed you but I have to tell you the truth.
Ladies, protect your eggs, protect your womb and protect your fetus.
Don't be angry and pls don't call me names, because am not feeling fine. but I have said my mind, in as much as I know that Truth is better.

A 55-year-old man with hypertension and no other chronic medical problems is currently treated with hydrochlorothiazide 50 mg daily, irbesartan 300 mg daily, carvedilol 25 mg twice daily, and amlodipine 10 mg daily. His BP is 144/96 mm Hg (146/94 mm Hg when repeated). He is adherent with all of these medications. Serum creatinine is 1.2 mg/dL, potassium is 4.2 mEq/L, and all other laboratory values are normal. Which of the following is the most appropriate to add to his regimen?

A. Terazosin 2 mg daily
B. Spironolactone 25 mg daily
C. Clonidine 0.1 mg twice daily
D. Chlorthalidone 12.5 mg daily

Death will be optional by the year 2045

DYING will be 'optional' within just 22 years and the ageing process will be 'reversible', according to two genetic engineers during the presentation of their new book in Barcelona.

My good friend and member of Transhuman Coin Scientific Advisory Board, José Luis Cordeiro, born in Venezuela to Spanish parents, and Cambridge (UK) mathematician David Wood, founder of the operating system 'Symbian', published The Death of Death and say immortality is a real and scientific possibility that could come much earlier than originally thought.

Humans will only die in accidents, never of natural causes or illness, by around the year 2045, say Cordeiro and Wood, who say it is 'crucial' that old age starts to be classified as an 'illness' so that publicly-funded research into its 'cure' can extend.

Nanotechnology is key, among other new genetic manipulation techniques, the engineers said during the presentation at Barcelona's Equestrian Circle.

The process will involve turning 'bad' genes into healthy ones, eliminating dead cells from the body, repairing damaged cells, treatments with stem cells and 'printing' vital organs in 3D.

Cordeiro, who studied at the Massachusetts Institute of Technology (MIT) in the USA, says he has 'chosen not to die' and that in 30 years' time, he will be 'younger than he is today'.

Ageing is the result of DNA 'tails', known as 'telomeres', in chromosomes – of which every cell except red blood and s*x cells has 23 pairs – becoming shorter, and reversing ageing involves lengthening the telomeres.

Telomeres become damaged and shortened with the passage of time, a process that speeds up in the event of toxins entering the body – smoking, alcohol and air pollution are among elements that reduce the length of telomeres, thus accelerating ageing.

Cordeiro and Wood believe that within 10 years, illnesses such as cancer will be curable, and that major international corporations such as Google will be 'entering the field of medicine' because they are 'beginning to realise that curing ageing is possible'.

Microsoft has reportedly already announced the setting up of a cryopreservation centre and a scientist is researching the possibility of cancer being completely curable within a decade.

The engineers explain that, although 'people generally do not know about it', it was discovered in 1951 how cancer cells are immortal: when Henrietta Lacks died from cervical cancer, surgeons removed the tumour and kept it – and it is still 'alive' today.

Immortality will not necessarily mean the planet becomes overcrowded, the scientists say: there is still plenty of room for more people on Earth, and these days, people do not have anywhere near as many children as they did in past decades and centuries; plus, 'it will be possible to live in space by then'.

“Japan and the Koreas, if they continue with their current trend of hardly having any children, will become extinct – within two centuries, there'll be no Japanese or Korean people on the planet,” Cordeiro says.

“But thanks to these new techniques, there will indeed be Japanese and Korean people, because they'll live forever and remain young.”

The cost of anti-ageing treatment was compared to that of the latest SmartPhones.

“At first, it'll be expensive, but with a competitive market the price will gradually fall because it'll be something that benefits everyone,” Cordeiro says.

“Technology, when it's new, is poor and extremely expensive, but it eventually becomes democratic and mainstream and becomes cheaper.”

The engineers say they have already been employing their techniques for two years – illegally, but in Colombia where there are fewer regulations covering genetic manipulation.

Elizabeth Parish, their first human patient, 'started to see symptoms of ageing and asked what could be done to prevent it'.

Her treatment is 'very risky and even illegal', Wood explains, but at the moment is going well, has not had any adverse side-effects, and the level of telomeres in her blood is '20 years younger than before'.

“I want Spain to have a place in the world of these technologies and show that we're not mad, it's just that people still don't know about them,” Wood concluded.

Their book, Death of Death will has been published in four languages at first – Spanish, English, Portuguese and Korean – and all proceeds from its sales will be ploughed back into the authors' research.

Copied.

The easiest way to memorize anti-hypertensive drugs.

🇸🇸 Beta blockers.

How should it be taken?

Usually once daily unless propranolol, metoprolol

Why is it prescribed?

Hypertension
Heart Failure
Angina

What important side effects to look out for?

May cause sleep disturbances/nightmares, erectile dysfunction, bronchospasm, cold extremities

What monitoring is required?

Blood pressure and pulse before and during treatment

Treatment Cessation

Beta blockers should not be stopped suddenly, gradual withdrawal advised.

99% percent of deaths rate in South Sudan cause by misuse of drugs,nor by war.

A love letter from the pharmacist
[ For the girl who came to the dispensary to buy antibiotics.]

The special prescription I am interpreting for you today is to express how much I love you like narcotic and psychotropic drugs and I am addicted to you.

My diazepam I can't sleep without thinking of you!!
If I tell you that you have created tolerance for me, my mouth will be closed or should I inject you with ketamine?? When I see you from a distance, I am amazed by your beauty and open my eyes like an atropine injection. But what does it matter because of your pride my nightmare life has made me doubt if you are Effavirenz.

Unless you give me your love by donation, I cannot purchase you by procurement like my poverty. And don't think there is someone who will reimburse me what I invested in you. You are my brand, why don't you afford it? I thought you were like promethazine 1st line and potent, but you are like Barbiturate toxicity without antidote!!

I don't have a narrow therapeutic index like Digoxin.
I will protect you with my wide Pencillin heart. But what I won't hide is that I am tired of thinking about you everyday QID. How long do you think you are going to Titrate me like the reaction that has no endpoint?? Reading the structure of Tubocurarine doesn’t bother me like you.

If you levitate my heart with your pride mortal and pestle sizun reduce; with your contempt and with
› spatula levigate and ointment me, you are done.

Galanthamine found from Leuiocum aestivum, so I have written this for you because I forget to take it.
Minimal Change disease (MCD) steroid sensitive, I have become sensitive to you too but with poor prognosis!!
Wait who tf are you?? People are bitter like
Erythromycin, let her come close to you! ' Why did I ask for??. Why are you doing BBB Cross and causing CNS Disturbance to me??
Or give me your heart so I can Macerate it and Extract Love.. QALY WITH YOU IS SURELY BETTER THAN WITHOUT YOU.
Think about it, since I am Chiral, I can't change the dosage form and go to others. Yes think about it I don't want to think about you like TDF+3TC+EFV.

Flexible for you because I am led by cGMP.
Don't worry if you change your love from infusion to bolus I won't get Red man syndrome. I would like to use this opportunity to tell you that your love Bioavailabilty is 100%. So my love, tell me your updated, recent and reliable goal of therapy and I will take treatment approach and show you the pharmaceutical care I have for you.

Copied.

ANTISTAPHYLOCOCCAL PENICILLINS

Agents: nafcillin, oxacillin, dicloxacillin, methicillin

It did not take long for Staphylococcus species to become resistant to penicillin. Within a few years of penicillin becoming widely available, staphylococcal strains began to produce beta- lactamases, rendering penicillin useless in these infections. The basic structure of penicillin was modified to resist these destructive enzymes, leading to the antistaphylococcal penicillins. This modification gave these drugs activity against staphylococci that produce penicillinases, but it did not add to the poor gram-negative activity of the natural penicillins.

Mechanism of Action

All beta-lactams inhibit cross-linking of peptidoglycan in the cell wall, leading to autolysis and cell death.

Spectrum

Good: MSSA, streptococci

Poor: GNRs, enterococci, anaerobes, MRSA
Adverse Effects
Similar to those of other beta-lactams, with a possibly higher incidence of AIN.

IMPORTANT FACTS

Antistaphylococcal penicillins have a short half-life and must be dosed frequently. This presents a problem because they cause phlebitis. Does your patient have phlebitis? Try a first-generation cephalosporin instead. In general, they are easier to administer, better tolerated, and a good choice for most patients.
Most antistaphylococcal penicillins are eliminated from the body in large part by the liver and do not need to be adjusted in cases of renal dysfunction.
These drugs are interchangeable therapeutically. Therefore, S aureus that is susceptible to methicillin (which is no longer used) is susceptible to oxacillin, nafcillin, and the rest. That is, MSSA = OSSA = NSSA, etc. The “standard tests” are usually done with either oxacillin or cefoxitin, not methicillin.

What They’re Good For

Infections caused by MSSA, such as endocarditis, bloodstream infections, and skin and soft- tissue infections.

Don’t Forget!

Beta-lactams kill staphylococci more quickly than vancomycin, so patients with MSSA infections who lack serious beta-lactam allergies should be switched to beta-lactams, such as antistaphylococcal penicillins or first-generation cephalosporins. This has been shown to be an important difference in serious infection.

Follow our page for more clinical updates.

🇸🇸 Empiric Therapy

Empiric therapy is given to patients who have a proven or suspected infection, but the responsible organism(s) has or have not yet been identified. It is the type of therapy most often initiated in both outpatient and inpatient settings. After the clinician assesses the likelihood of an infection based on physical exam, laboratory findings, and other signs and symptoms, he or she should generally collect samples for culture and Gram staining. For most types of cultures, the Gram stain is performed relatively quickly. In the Gram stain, details about the site of presumed infection are revealed, such as the presence of organisms and white blood cells (WBCs), morphology of the organisms present (e.g., gram-positive cocci in clusters), and the nature of the sample itself, which in some cases indicates if the sample is adequate. The process of culturing the sample begins around the time that the clinician performs the Gram stain. After a day or so, testing will reveal the identification of the organism, and eventually the organism can be tested for its susceptibility to various antibiotics.
However, this process takes several days, so empiric therapy is generally initiated before the clinician knows the exact identification and susceptibilities of the causative organism. Empiric therapy is our best guess of which antimicrobial agent or agents will be most active against the likely cause of infection. Sometimes we are right, and sometimes we are wrong. The significance of making a correct guess differs depending on the severity of the infection; a wrong choice for an uncomplicated urinary tract infection (UTI) results in an annoyed patient, whereas the wrong choice for meningitis is fatal. Keep in mind that empiric therapy should not be directed against every known organism in nature—just those that cause the infection in question. In other words, broad-spectrum antibiotics are not a substitute for rational thought!

Follow our page for more clinical pharmacy update.

We know that Paracetamol causes toxicity to the liver, and the toxicity is as follows:

🇸🇸 In children: liver poisoning occurs if the child takes Paracetamol at a dose of more than (4000 mg per day).

🇸🇸 In adults: Hepatotoxicity occurs if an adult takes Paracetamol at a dose of more than 12,000 mg per day.

🇸🇸 Symptoms (nausea and vomiting - abdominal pain - yolk -encephalopathy
- increased lactic acid in the body) appear after (24 hours ) after taking the toxic dose.

🇸🇸 Liver enzymes (AST and ALT) rise after (24 to 72 hours) after taking the toxic dose.

🇸🇸 As the percentage of risk of liver poisoning (Paracetamol) is more in adults than in children.

🇸🇸 The US Food and Drug
Administration (FDA) approves and releases a new drug to treat acute migraine pain.

The medicine is called (Zavegepant).
Its mechanism of action (MOA) works to lock (GRP receptors, which are considered migraine pathogens.
Pharmaceutical form / nasal spray.
Dosage: (10mg) one spray into one nostril only when needed.

🇸🇸 Note / It has not been confirmed that it is safe when using it more than (8 shifts per month).

Copied from Hakim.

Great News!

For the last 6 months, we were dealing with a life threatening health condition of my brother. His liver was failed 100%. People thought my brother was dead, but God did not say that! Thank God!

Another brother stepped up to save his brother’s life. Yes, Zelalem donated a portion of his liver to Tibebu. Yes, liver donation is possible. This is what brotherhood is!

It was the most challenging experience we had. Two brothers were going through a major surgery, but not knowing the results. In God we trust! We gave everything to God. The surgery was in India and it took the whole day, the donor was unconscious and stayed in the ICU for 2 days. The recipient was also unconscious and stayed in the ICU for 3 days. Guess what: no complications at all.

Zelalem went back home Ethiopia two weeks ago after a successful donation. Now Tibebu has completely recovered and going back home Ethiopia this weekend with our sister Jerry. Praise be to God!

Heroes: Zelalem Markos, Tibebu Markos, Ebrahim Ahimed (I have a lot of respect for Islam because of you, I saw true love. I can not thank you enough!)

Heroine: Jerry (Florida Florida)

Finally, I’m proud of myself and my wife Kalianah Tesfaye (a female lion), we worked together God saved a life! You may be going through some hardship, Please never give up! Just trust in God!

Andualem Markos Borko, Younger brother of the patient

God first.

🇸🇸 Minocycline causes hyperpigmentation much more than other tetracyclines
Why?

# It forms insoluble complexes with iron which causes pigmentation (other tetracyclines tend to chelate calcium)

# Increase lipophilic and increase pe*******on into different tissues

# It turns black when oxidized.

Pharmacy challenges.

🇸🇸 ACEIs and ARBs are contraindicated in the 2nd and 3rd trimesters of pregnancy. Addition
of a daily ACE-I or ARB is strongly recommended for renal protection in patients with hypertension and/or diabetes. The “ACE inhibitor cough,” a dry cough, is an adverse side effect produced by an accumulation of bradykinins that occurs in 5% to 10% of the population and resolves within days of discontinuing the drug.

🇸🇸 Alcohol is contraindicated with concomitant narcotic analgesics, benzodiazepines, SSRIs, antihistamines, TCAs, and other sedating agents due to risk of over-sedation.

🇸🇸 Alpha-1 blockers have a potential adverse side effect of sudden hypotension, especially with first dose. Alert the patient regarding this “first-dose effect” and recommend the patient sit or lie down to take the first dose. Usually start at lowest dose and titrate upward.

🇸🇸 Antidepressant monotherapy should be avoided until any presence of (hypo) mania or positive family history for bipolar spectrum disorder has been ruled out as antidepressant monotherapy can induce mania in the bipolar patient.
For patients 65 years-of-age and older, consult the May 2017 Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults, to help improve the safety of prescribing medications for older adults, presented in table format at: https://www.priorityhealth.com/provider/clinical-resources/medication-resources/~/media/ documents/pharmacy/cms-high-risk-medications.pdf

🇸🇸 Aspirin is contraindicated in children and adolescents with Varicella or other viral illness, and 3rd trimester of pregnancy.

www.priorityhealth.com