Chemotherapy:Pharmacology

Pharmacy#MBBS#B.Sc#Pharmacology

1. PHARMACOLOGY -III
TOPIC :
Chemotherapy
l. Urinary tract infections and sexually transmitted diseases.
II. Chemotherapy of malignancy
By Ishika Choudhary

2. I. A Urinary Tract Infection
(UTI)
A urinary tract infection(UTI)is an
infection in any part of your urinary
system – your kidney , uteres , bladder
, and urethra . Most infections involve
the lower urinary tract .
A urinary tract infection (UTI) occurs
when bacteria (germs) get into the
urinary tract and multiply .
The upper urinary tract is composed of
the kidneys and ureters. Infection in
the upper urinary tract generally
affects the kidneys (pyelonephritis),
which can cause fever , chills , nausea ,
vomiting , and other severe symptons.
The lower urinary racts consists of the
bladder and the urethra. Infection in
the lower urinary tract can affect the
urethra (urethritis)or the bladder
(cystitis).

3. Risk Factors For UTI

Most common infection diseases.
Affects all ages.
Males predominate in the new born period , beyond this age , female predominate.
Most numerous specimens are received in the laboratory.
Appropriate clinical information gives many clues for better diagnostics evaluation.
Specimen collection is the primary objective in getting an ideal sample.
More common in adults than in children .
Physical contact with infected partner.
Waiting too long to urinate.
Pregnancy.
Diabetic.
Immunosuppressed individual.
Calculi.
Men with an enlarged prostate.
Any medical condition which cause incomplete bladders emptying ( spinal cord
injury)or bladder decompensation after menopause.
The most common cause of UTI are bacteria from the bowel that live on the skin
near the rectum or in the vagina , which can spread enter the urinary tract through
urethra.

4. Common symptoms

Frequent urination , but very little
may come out.
Painful burning sensation before ,
during , and after urinating.
Urinating blood.
Urgent need to urinate , and in
serious cases, unable to control
bladders and leaks urine.
Cloudy or foul smelling urine.
Fever.
Malaise or the general feeling of
unwell.
Severe pain in the lower abdominal
region.

5. Etiological agents of urinary
tract infections
Bacteria-
Gram-negative bacilli – E-coli, Proteus species, Klebsiella .
enterobacter , Pseudomonas.
Gram-positive cocci- Staphylococcus aureus,
Staphylococcus epidermidies, Staphylococcus
saprophyticus Enterococcus species.

Others – Mycobacterium tuberculosis. Salmonella species
, Gardnella Vaginallis.
Viruses – Adenovirus.
Fungi – Candida albicans.
Parasites – Tricomonas vaginalis , Schistosomia
hematobium , Enterobius vermicularis.

7. Classification of Drugs for UTI

8. Nitrofurantoin:
It is primarily bactcriostatic, but may be cidal at higher
concentrations and in acidic urine, because its activity is
enhanced at lower pH. Many gram-negative bacteria except
Ps. aeruginosa and Proteus were susceptible, but due to
development of resistance over time, activity is now
restricted largely to E. coli.
Pharmacokinetics: Nitrofuramoin is well absorbed orally;
rapidly metabolized in liver and other tissues: less than half is
excreted unchanged in urine; plasma t½ is 30--60 min.
Antibacterial concentrations arc not attained in blood or
tissues.
Adverse effects: Commonest is gastrointestinal intolerance
nausea, epigastric pain and diarrhoea. An acute reaction with
chills, fever and leucopenia occurs occasionally. Peripheral
neuritis and other neurological effects arc reported with long-
term use. Haemolytic anaemia is rare, except in G-6-PD
deficiency. Liver damage and a pulmonary reaction with
fibrosis on chronic use arc infrequent events. Urine of patients
taking nitrofurantoin turns dark brown on exposure to air.

9. Methenamine (Hexamine):
It is hexamethylene- tetramine, which is inactive as such; but
decomposes slowly in acidic urine to release formaldehyde
which inhibits all bacteria . This drug exerts no antimicrobial
activity in blood and tissues, including kidney parenchyma.
Adverse effects: Gastritis can occur due to release of
formaldehyde in stomach patient compliance is poor due to
this. Chemical cystitis and hematuria may develop with high
doses given for long periods. CNS symptoms are produced
occasionally.

URINARY ANALGESIC
Phenazopyridine
It is an orange dye which exerts analgesic action in the urinary
tract and affords symptomatic relief of burning sensation,
dysuria and urgency due to cystitis. It does not have
antibacterial property. Side effects arc nausea and epigastric
pain.

10. Empirical antimicrobial regimens for acute UTI
(all given orally for 3-5 days)*

1. Ciprofloxacin 250-500 mg 12 hourly
2. Ofloxacin 20G-400 mg 12 hourly
3. Cotrimoxazole 960 mg 12 hourly
4. Cephalexin 250-500 mg 6 hourly
5. Cefpodoxime proxetil 200 mg 12 hourly
6. Amoxicillin + clavulanic acid (500 + 125 mg) 8
hourly
7. Nitrofurantoin 50 mg 8 hourly or 100 mg 12
hourly x 5- 7 days

11. Urinary infection in patients
with renal impairment
•This is relatively difficult to treat because most AMAs
attain lower urinary concentration. in the presence of
renal impairment. Methenamine mandelate,
tetracyclines (except doxycycline) and certain
cephalosporin are contraindicated.
•Nitrofurantoin, nalidixic acid and aminoglycosides are
better avoided. Every effort must be made to cure
the infection, because if it persists, kidneys may be
further damaged. Bacteriological testing and follow
up cultures are a must to select the appropriate d rug
and to ensure eradication of the pathogen.
Potassium salts and acidifying agents are
contraindicated.

12. Prophylaxis for urinary tract infection
Prophylaxis may be given when:
(a) Women of child bearing age have recurrent
cystitis.
(b) Catheterization or instrumentation inflicting
trauma to the lining o f the urinary tract is
performed: bacteremia frequently occurs and
injured lining is especially susceptible.
(c) Indwelling catheters are placed.
(d) Uncorrectable abnormalities of the urinary
tract are present.
(e) Inoperable prostate enlargement or other
chronic obstruction causes urinary stasis.

13. Sexually
Transmitted
Diseases (STDs)

14. Sexually Transmitted Diseases
Very Common
•79 million Americans have HPV
Easily transmitted
•Mucous membrane contact
•Some can be shared through bed linen, towels, etc.
May be asymptomatic.

15. Common STDs

17. Prevention
No sexual contact
•Asymptomatic
•Symptomatic
Use of barrier devices

18. How will these come to your attention ?
Penile discharge
Vaginal discharge
Painful urination
Painful bumps, ulcers, or sores on the genitals
Pharyngitis
Abdominal pain

19. Unlikely you will identify specific agent
Physical exam (chaperoned)
•External genitalia ONLY
•No findings
•Rashes
•Foul odours
•Discharge
Labs
Urine pregnancy test
Urine dip

20. Treatment:
Talk to medical control
•IM/PO meds
Public health investigation
•You need to identify and treat shipboard contacts

Red flags for evacuation
Diffuse abdominal pain
Fever
Vital sign abnormalities

21. II. Chemotherapy of
malignancy