CRITERIA

A Drug Study on Arthemeter Lumefrantrine

Format 5
Neatness 5
____________________ 
Picture 5
Content 70
A Drug Study Presented to References 5
Promptness 10

The Faculty of the Nursing Department

Mrs. Bevan Balbuena, RN, MN

____________________

In Partial Fulfillment of

The Requirements in NCM 209 - RLE

IMCI ROTATION

By: 

Hinlog, Aila Kye B.

BSN – 2B, Group 3

April 17, 2020

Generic Name: Artemether + Lumefantrine

Brand Name: Coartem

Drug Classification: Antimalarials

Pregnancy Category: C

Mechanism of Action

Artemether and lumefantrine exert their

antimalarial action in the food vacuole of the parasite. They interfere with the conversion

of hem (a toxic intermediate produced during hemoglobin breakdown) to the nontoxic

hemozoin, malarial pigment. Both inhibit nucleic acid and protein synthesis.

Artemether and its active metabolite dihydroartemisinin (DHA) are rapid

schizontocides. Its anti-malarial activity is attributed to their endoperoxide moiety.

Lumefantrine is a dichlorobenzylidine derivative. The exact mechanism of action

of is still unknown, but it is thought to inhibit the formation of β-hematin by complexing

with hemin.

Route/Dosage

PO (Adults 35 kg): 4 tablets per dose for a total of 6 doses; given as two doses 8

hours apart on the first day, then twice daily for the next two days.

PO (Children 25 – 35 kg): 3 tablets per dose for a total of 6 doses; given as two

doses 8 hours apart on the first day, then twice daily for the next two days.

PO (Children 15 – 25 kg): 2 tablets per dose for a total of 6 doses; given as two

doses 8 hours apart on the first day, then twice daily for the next two days.

PO (Children 5 – 15 kg): 1 tablet per dose for a total of 6 doses; given as two
 doses 8 hours apart on the first day, then twice daily for the next two days.

Indication

Treatment of acute, uncomplicated malaria in patients 5 kg. Not approved for

severe/complicated P. falciparum malaria or prevention.

Contraindications

Hypersensitivity, history of sudden death or congenital prolongation of QT

interval, history of cardiac arrhythmias, bradycardia, CHF with reduced left ventricle

ejection fraction, electrolyte disturbances (e.g. hypokalaemia, hypomagnesemia).

Concomitant use with strong CYP3A4 inducers, and with drugs known to prolong QT

interval.

Side Effects/Adverse Effects

CNS: dizziness, fatigue, headache, sleep disorder, weakness, insomnia, malaise

EENT: vertigo

RESP: cough

CV: palpitations

GI: abdominal pain, anorexia, nausea, vomiting, diarrhea, hepatomegaly,

splenomegaly

DERM: pruritus

HEMAT: anemia

MS: arthralgia, myalgia

MISC: hypersensitivity reactions including urticaria and angioedema, chills, fever

Drug Interactions

May reduce effectiveness of hormonal contraceptives.

Potentially Fatal: Decreased plasma concentration with strong CYP3A4 inducers

(e.g. phenytoin, carbamazepine, rifampicin). Additive QT prolongation effect with

antiarrhythmics Class I and II (e.g. quinidine, amiodarone), antipsychotics (e.g.

pimozide, ziprasidone), neuroleptics, antidepressants, antibiotics (e.g. macrolide,

fluoroquinolone), triazole antifungals, non-sedating antihistamines (e.g.

terfenadine, astemizole), cisapride, flecainide, halofrantine.

Nursing Interventions

1. Assess patient for improvement in signs and symptoms of malaria (fever,

chills, muscle pains, headache) periodically during therapy.

2. Administer with food.

3. For patients with difficulty swallowing, crush tablet and mixed with 1– 2 tsp

water immediately before administration. Rinse container with more water and

have patient swallow contents.

4. Follow with food or drink (milk, formula, pudding, broth, porridge) if possible.

5. If vomiting occurs within 1– 2 hours of administration, repeat dose. If repeat

dose is vomited, use an alternative antimalarial.

6. Review methods of minimizing exposure to mosquitoes with patient.

7. Advise patient to use a non-hormonal form of birth control during therapy.

8. Monitor patient’s flu-like symptoms (chills, fever, muscle pains, headache).

9. Encourage Increased in Clear Oral Fluid Intake.

 10. Ensure adequate food intake to decrease risk for malaria relapse.

Health Teachings

1. Lack of adequate food increases risk for malaria relapse.

2. Instruct patient to take medication as directed

3. Advise patient to resume eating as soon as food can be tolerated.

4. Advise patient to notify health care professional of flu-like symptoms (chills,

fever, muscle pains, headache) occur again after finishing medication.

5. Advise patient to avoid drinking grapefruit juice during therapy; may cause

increased concentrations and risk of arrhythmias

6. May cause dizziness. Caution patient to avoid driving and other activities

requiring alertness until response to medication is known.

7. Advise patient to notify health care professional if symptoms of prolongation

of the QT interval (prolonged heart palpitations, loss of consciousness) occur.

8. Instruct patient to notify health care professional immediately if signs of

hypersensitivity (skin rash, hives, other skin reactions, rapid heartbeat,

difficulty breathing or swallowing, swelling of the lips, tongue, face, tightness

or throat, hoarseness) occur.

9. Medication may cause loss of pregnancy and decreased effectiveness of

hormonal contraceptives.

10. Review methods of minimizing exposure to mosquitoes with patient such as

getting rid of clear stagnant water in their home.

References

MIMS Philippines. (2020). Artemether + Lumefantrine. Retrieved on April 14, 2020.

Retrieved from https://www.mims.com/philippines/drug/info/artemether%20%2B

%20lumefantrine/#PatientCounsellingInformation

US National Library of Medicine. (2016). Artemether and Lumefantrine. Retrieved on

April 14, 2020. Retrieved from

https://medlineplus.gov/druginfo/meds/a609024.html

Davis’ Guide Book. (2015). Artemether-lumefantrine. Retrieved on April 14, 2020.

Retrieved from

https://davisplus.fadavis.com/3976/meddeck/pdf/artemetherlumefantrine.pdf
 CRITERIA
A Drug Study on Pyrazinamide
Format 5
Neatness 5
____________________ 
Picture 5
Content 70
A Drug Study Presented to References 5
Promptness 10

The Faculty of the Nursing Department

Mrs. Bevan Balbuena, RN, MN

____________________

In Partial Fulfillment of

The Requirements in NCM 209 - RLE

IMCI ROTATION

By: 

Hinlog, Aila Kye B.

BSN – 2B, Group 3

April 17, 2020

Generic Name: Pyrazinamide

Brand Name: Pyramin, Zinaplex, Zcure,

CombiPack, Pharex Pyrazinamide, RiteMED

Pyrazinamide, Zynaphar, PZA-Ciba, Midazen

Drug Classification: Anti-TB Agents

Pregnancy Category: C

Mechanism of Action

Pyrazinamide may be bacteriostatic or bactericidal in action, depending on the

concentration of the drug attained at the site of the infection and the susceptibility of the

infecting organism. Its activity appears to partly depend on conversion of the drug to

pyrazinoic acid (POA), which lowers the pH of the environment below that which is

necessary for growth of Mycobacterium tuberculosis. Susceptible strains of M.

tuberculosis produce pyrazinamidase, an enzyme that deaminates pyrazinamide to

POA, and the in vitro susceptibility of a given strain of the organism appears to

correspond to its pyrazinamidase activity.

Route/Dosage

PO (Adults and Children): 15 – 30 mg/kg/day as a single dose. Up to 60

mg/kg/day has been used in isoniazid-resistant tuberculosis (not to exceed 2 g/day as a

single dose or 3 g/day in divided doses).

May also be given as 50– 70 mg/kg 2– 3 times weekly (not to exceed 2 g/dose

on daily regimen, 3 g/dose for 3-times-weekly regimen, or 4 g/dose for twice-weekly

regimen). Patients with HIV—20– 40 mg/kg/day for first 2 mo of therapy (maximum: 2

g/day); further dosing depends on regimen employed.

Indications

Used in combination with other agents in the treatment of active tuberculosis.

Contraindications

Hypersensitivity; Cross-sensitivity with ethionamide, isoniazid, niacin, or nicotinic

acid may exist; Severe liver impairment.

Side Effects/ Adverse Effects

GI: HEPATOTOXICITY, anorexia, diarrhea, nausea, vomiting.

GU: dysuria.

DERM: acne, itching, photosensitivity, skin rash.

HEMAT: anemia, thrombocytopenia.

METAB: hyperuricemia.

MS: arthralgia, gouty arthritis.

Drug Interactions

Antagonises the effect of uricosuric agents (e.g. probenecid, sulfinpyrazone).

May reduce the contraceptive effect of estrogens. May inactivate oral typhoid

vaccine. May increase the serum concentration of ciclosporin. May enhance the

hepatotoxic effect of rifampicin.

Nursing Interventions

1. Perform mycobacterial studies and susceptibility tests before and periodically

during therapy to detect possible resistance.

2. Evaluate hepatic function before and every 2 – 4 weeks during therapy.

Increased AST and ALT may not be predictive of clinical hepatitis and may

return to normal levels during treatment.

3. Patients with impaired liver function should receive pyrazinamide therapy only

if crucial to treatment.

4. Monitor serum uric acid concentrations during therapy. Increased Uric acid

may result in precipitation of acute gout.

5. Administer with food.

6. Encourage Increased in Clear Oral Fluid Intake.

7. Demonstrate to patient the effective coughing which is to inhale, hold breath

and cough.

8. Administer the drug on time.

9. Monitor the progress of treatment by checking on the characteristic of

sputum.

10. Reassess the patient for the Tuberculosis Clinical Manifestations such as

Weight Loss, Anorexia, Hemoptysis and Low-grade fever.

Health Teachings

1. Advise patient to take medication as directed and not to skip doses or double

up on missed doses.

2. Take missed doses as soon as remembered unless almost time for next

dose.

3. Emphasize the importance of continuing therapy even after symptoms have

subsided.

4. Inform patient that length of therapy depends on regimen being used and

underlying disease states.

5. Inform diabetic patients that pyrazinamide may interfere with urine ketone

measurements.

6. Advise patients to notify health care professional if no improvement is noticed

after 2– 3 weeks of therapy or if fever, anorexia, malaise, nausea, vomiting,

darkened urine, yellowish discoloration of the skin and eyes, pain, or swelling

of the joints occurs.

7. Advise patients to use sunscreen and protective clothing to prevent

photosensitivity reactions.

8. Emphasize the importance of regular follow-up exams to monitor progress

and check for side effects.

9. Cover mouth when coughing.

10. Have a treatment partner (A family member that is 18 years old or above).
References

MIMS Philippines. (2020). Pyrazinamide. Retrieved on April 14, 2020. Retrieved from

https://www.mims.com/philippines/drug/info/pyrazinamide?

mtype=generic#Actions

Davis’ Guide Book. (2015). Pyrazinamide. Retrieved on April 14, 2020. Retrieved from

https://davisplus.fadavis.com/3976/meddeck/pdf/pyrazinamide.pdf