Clinical Pharmacology Of Malaria

Effective chemotherapy of malaria relies on an accurate diagnosis and an appropriate affordable choice of drugs bearing in mind likely adverse effects, patterns of drug resistance, and the degree of host immunity. Choice of Antimalarial Drug: Treatment of multidrug-resistant Plasmodium falciparum malaria prevalent in our environment relies increasingly on combination chemotherapy using blood schizonticides. Chloroquine and Sulfodoxine/Pyremethamine have been cheap and safe options. However widespread resistance to these drugs (and the problem of chloroquine-related pruritus) means that these agents are often ineffective. Quinine has been relied on for multidrug-resistant malaria. However its marked toxicity potential (e.g. cinchonism and ventricular tachyarrhythmias) means that other drugs such as mefloquine, doxycycline, chlorproguanil-dapsone and proguanil-atovaquone are preferred. Halofantrine is not recommended because of its cardiotoxic potential. Increasing problems with drug resistance have led to current recommendations for the use of artemisinin-based combination therapy such as co-artemether (artemether plus lumefantrine). Plasmodium vivax, P. ovale and P. malariae remain sensitive to chloroquine, and likewise the emergent parasite P. knowlesi. Primaquine is used to eradicate hypnozoites of P. vivax and P. ovale. Treatment of malaria: Prompt treatment is of vital importance, especially in patients who lack innate or acquired immunity. Delaying effective treatment increases morbidity and mortality. Circumstances such as pregnancy and infancy should be taken into account, for example to avoid possible teratogenic effects of mefloquine, artemisinins or halofantrine during the first trimester, and to avoid primaquine and halofantrine while breastfeeding. Supportive treatment is important in severe malaria. Fever is part of the host defence against infection and so should not be entirely suppressed. Careful attention should be paid to fluid balance, to postural hypotension and hypoglycemia (which are exacerbated by quinoline antimalarials), to accompanying bacterial infections, renal impairment and the need for anticonvulsants or blood transfusion. Therapeutic failure may be due to a wrong diagnosis, or an additional cause for the febrile illness apart from malaria. Parasite resistance to antimalarials, poor patient compliance, and the use of fake or substandard drugs are alternative explanations. Key Words: Malaria, Drug treatment of Malaria, Clinical Pharmacology Orient Journal of Medicine Vol.16(2) 2004: 59-6

Prescription pattern and adverse effects profile of drugs used for breast, cervical & prostate cancers in Enugu, Nigeria

SummaryBackground: Breast, cervical and prostate malignancies are the most common cancers in Enugu, Nigeria. Supportive therapies are given with anticancer drug treatments to mitigate adverse effects. The objectives of this study were to characterize the prescription pattern of anticancer drugs, their adverse effects, and the supportive therapies used to manage these malignancies in Enugu, Nigeria. Materials and methods: A descriptive cross-sectional and retrospective questionnaire-based study. Data relating to breast, cervical and prostate cancer patients in the University of Nigeria Teaching hospital (UNTH), Parklane State Teaching hospital and Annunciation Specialist hospital, Emene, Enugu were collected for 7 months. Data were analysed using SPSS versions 22 and 23. Results: Anti-cancer agents commonly used in managing these cancers include anti-metabolites, mitotic inhibitors, anti-androgens, alkylating agents and anti-tumor anti-biotics. Conclusion: Anti-androgens, anti-metabolites and alkylating agents were the most prescribed anticancer drugs. Vitamin supplements, anti-emetics and analgesics were used to manage some side effects from prescribed anticancer drugs. Failure to document common side effects associated with use of some anticancer drugs in this study suggest a low index of suspicion on the part of the clinicians. AbstraitContexte: Les tumeurs malignes du sein, du col utérin et de la prostate sont les cancers les plus courants à Enugu, au Nigéria. Des traitements de soutien sont administrés avec des médicaments anticancéreux afin d'atténuer les effets indésirables. Les objectifs de cette étude étaient de caractériser le schéma de prescription des médicaments anticancéreux, leurs effets indésirables et les thérapies de soutien utilisées pour gérer ces tumeurs malignes à Enugu, au Nigéria. Matériels et méthodes: Une étude descriptive transversale et rétrospective par questionnaire. Les données relatives aux patients atteints de cancer du sein, du col de l'utérus et de la prostate à l'hôpital universitaire de l'Université du Nigéria (UNTH), à l'hôpital universitaire Parklane State et à l'hôpital spécialisé dans l'annonciation, à Emene (Enugu), ont été recueillies pendant 7 mois. Les données ont été analysées à l'aide des versions 22 et 23 de SPSS. Résultats: Les agents anticancéreux couramment utilisés dans la prise en charge de ces cancers incluent: les anti-métabolites, les inhibiteurs de la mitose, les anti-androgènes, les agents alkylants et les anti-biotiques. Conclusion: les anti-androgènes, les anti-métabolites et les agents alkylants étaient les médicaments anticancéreux les plus prescrits. Des suppléments de vitamines, des anti-émétiques et des analgésiques ont été utilisés pour gérer certains effets secondaires des médicaments anticancéreux prescrits. Aucune documentation sur des effets secondaires courants associés à l'utilisation de certains médicaments anticancéreux dans cette étude suggère un faible indice de suspicion de la part des cliniciens. West Afr. J. Pharmacol. Drug Res. Vol. 32 January – December 2017; 46-6

Toxicity study of DHFCOP-A, chemical derived from empty oil palm bunch ash in mice

Background: Deseeded Fruit Head Chemical of the Oil Palm – Fractionate A (DFHCOP-A) an anhydrous chemical, has a remarkable high pH 12-14 hence an alkali. DFHCOP-A is commonly used to prepare food delicacies native to the South-East part of Nigeria. Reports has shown cancer thrives in low pH. Cancer aggressiveness has been linked to the acidic extracellular microenvironment of tumour. The high pH of DFHCOP-A may have potentials to inhibit cancer growth. Objective: In this study we investigated the LD50 of DFHCOP-A in mice which will suggest doses for subsequent studies on its effect on tumour microenvironment. Methods: Two methods were used, Lorke's method and the up and down procedure (UDP). The tests were carried out in male and female mice which involved subcutaneous and oral administration. In the Lorke's method, female and male mice were divided in groups of three (n=3) for subcutaneous and oral administration. Varying doses 10mg/kg, 100mg/kg and 1000mg/kg were given. In the second phase, two groups (n=3), were administered 2000mg/kg and 5000mg/kg subcutaneously and Orally. For UDP, 5000mg/kg was administered subcutaneously (sc) to each male and female mouse in the limit test. In the main test, 7 and 12 male mice; 7 and 8 female mice were respectively treated subcutaneously and orally with up and down doses of 550mg/kg, 1750mg/kg, 2000mg/ and 5000mg/kg. Results: By Lorke's method, LD50 of 3,162mg/kg was obtained for both female and male mice by both routes. UDP estimated LD50 is 2000mg/kg for female and LD50 is greater than 2000mg/kg for male mice administered subcutaneously. LD50 for the orally administered female and male mice gave 5000mg/kg. Conclusion: UDP appears better than Lorkes methods because it highlighted the differential sensitivities of the male and female mice to DFHCOP-A, where female mice are more sensitive which reflected in LD50sc