Amitdswnza4jbdssxjnxsrivcseibzstins .pptx

Pharmacology

1. ANTI-LEPROTIC AGENTS Amit Singh B.Pharm 3rd year

2. LEPROSY Leprosy caused by Mycobacterium leprae , has been considered incurable since ages and bears a social stigma. Due to availability of effect anti- leprotic drugs it is entirely curable now. ACID FAST BACILLI. Primarily affect superficial tissues,especially the skin,eyes,lining of the nose and peripheral nerves. Also known as Hansen’s disease, after the scientist who dicovered M.leprae in 1873. A Leprosy patient who someone has skin patch or patches with a definite loss of sensation.

3. CAUSES AND TRANSMISSION Although human-to-human transmission is the primary source of infection ,three other species can carry and (rarely) transfer Mycobacterium leprae to humans : chimpanzees,manngabey monkeys,and nine banded armadillos. The spread of leprosy is beleived to be via nasal discharge (Droplets infection). 1ml of nasal secretion = 1-2 millions lepra bacilli. Other modes of transmission : Contact through the skin (rare). Transmission from milk of leprosy patient to infant. Tattooing needles. Insect vectors : e.g. Mosquitos,bedbugs .

4. SYMPTOMS OF LEPROSY A spot (skin lesions) is red,darker or lighter than normal skin colour . Numbness of affected areas of the skin. Muscles weakness or paralysis (especially in the hands and feet). Growth (nodules) on skin . Vision loss. Swelling or lumps in the face or earlobes . Losing hair on eyebrows or lid. A stuffy nose or bleeding. Painless ulcers on the soles of feet.

5. Treatment of Leprosy (Multi-drug therapy) Multi drug therapy (MDT) is the standard treatment for leprosy . It involves a combination of antibiotics such as dapsone , Rifampicin,and clofazimine . MDT is introduced by WHO (World health Organization), in 1981. ADVANTAGES OF MDT : Effective in dapsone resistance case. Prevent dapsone resistance Quick symptoms releif,stop rogression,prevent further complications. Reduce total duration of therapy and chances of relap . #PAUCIBACILLARY LEPROSY : Dapsone + Rifampin (For 06 months). #MULTIBACILLARY LEPROSY : Dapsone + Rifampin+clofazimin (2 years or till disease inactivity .skin smear should be negative.

6. CLASSIFICATION OF ANTILEPROTIC AGENTS 1.SULFONE : e.g.,DAPSONE (DDS) 2.PHENAZIINE DERIVATIVE : e.g.,CLOFAZIMINE 3.ANTITUBERCULAR DRUGS : e.g.,RIFAMPIN,ETHIONAMIDE 4.OTHER ANTIBIOTiCS : e.g.,OFLOXACIN,MOXIFLOXACIN,MINOCYCLINE , CLARIITHROMYCIN

7. DAPSONE (DDS) Diamino diphenyl sulfone (DDS) ,the simplest , oldest,cheapest,most active.(DOSE=100MG/DAY) ACTIVITY AND MECHANISM : Dapsone is chemically related to sulphonamides,and has the same mechanism of action i.e.,which inhibit the PABA incorporation into folic acid by folate synthase. LEPROSTATIC – At very low concentration . PHARMACOKINETICS Completely absorbed after oral administration. Concentrated (distribute) : Skin (infected), liver,muscles and kidneys. Metabolite in liver, and elimination via urine .

8. ADVERSE DRUG REACTION (ADR) Well tolerated at 100mg/day or lesser dose . OTHER DOSE : Anoroxia Nausea Fever Rashes Dermititis Haemolytic Anaemia Phototoxicity Hypermelanosis NOTE : Iron preparation should be given to prevent anaemia.

9. CLOFAZIMINE Clofazimine ( Listantene ) may be effective in patients who shows resistance to the sulfones. Mechanism of action Its mechanism of action is unknown.But may involve DNA binding.It Is thought that it is involved with binding with guanine of DNA and inhibits the template function of DNA,thus no replication occurs .

10. EPIDEMIOLOGY The highest rate of Leprosy are in tropical countries, especially in Asia and Africa. Over 200,000 new cases of leprosy have been reported annually in recent years. The primary source is lapromatous patients who are not being treated. The highest no of cases in the world still found in india,with brazil ranking second .

11. PREVENTION Earlier detection and treatment of cases. Public Education and awareness. There is no vaccine against Leprosy but the vaccine against tuberculosis Vaccination : BCG vaccine (at birth,intramuscular 0.05ml)may offer some protection.This is because both the disease are closely related. Use of mask and gloves while handling the patient. Avoid close physical contact with untreated patients.

12. RECENT ADVANCEMENTS The diagnosis of leprosy at earlier stages is important for its effective treatment. Recent studies on vitamin D and its receptors make leprosy diagnosis easier at earlier stages . The studies of micro RNAs (miRNAs) made it easy to differentiate leprosy from other diseases especially from tuberculosis. Besides Mycobacterium leprae , recently a new bacterium Mycobacterium lepromatosis was also identified as a cause of leprosy. Conclusion: Leprosy can be distinguished from sarcoidosis by quantitative study of reticulin fibers present in skin. The treatment used until now for leprosy is multi-drug treatment.

13. References: Essentials of medical pharmacology book(8 th edition), kd Tripathi , published by Jaypee brothers Medical publishers (P) Ltd,new delhi,110002,INDIA. https://pubmed.ncbi.nlm.nih.gov/30360715/#:~:text=The%20studies%20of%20micro%20RNAs,leprosy%20is%20multi%2Ddrug%20treatment.

14. THANK YOU!