INTRODUCTION

Pharmacist of the week is the special programme designed by TAPSA-SJUT to equip pharmacy students with various knowledge about pharmacy practice and especially the general role of the pharmacist in both clinical and community pharmacy

This is aimed at increasing confidence and competence to these young upcoming pharmacists

Therefore TAPSA expects that by attending and participating fully in this programme, the pharmacists from St. John’s University of Tanzania will not only be competent and confident, but also courageous enough to defend their right views whenever needed

WHAT WILL BE DONE AND HOW??

Presentation from one among students Prompt or on spot questions from the presented matters Teacher (professional) contribution and experience sharing As it will be judged by the mass, more elaborations from superiors or seniors and most probably in the next period.

The today’s pharmaceutical product In discussion/presentation is METRONIDAZOLE

METRONIDAZOLE

Metronidazole (flagyl) is a synthetic antiprotozoal and antibacterial agent,( l-β-hydroxyethyl)-2-methyl-5-nitroimidazole, which has the following structural formula:

It belongs to the group of nitro imidazoles Other members related to metronidazole are tinidazole and others Flagyl tablets contain 250 mg or 500 mg of metronidazole. Inactive ingredients include cellulose, hydroxypropyl cellulose, polyethylene glycol, stearic acid, and titanium dioxide.

STRUCTURE OF METRONIDAZOLE

MECHANISM OF ACTION

Metronidazole acts by inhibiting nucleic acid synthesis by disrupting the DNA of microbial cells. This function only occurs when metronidazole is partially reduced, and because this reduction usually happens only in anaerobic cells, it has relatively little effect upon human cells or aerobic cells

SUMMARY

INDICATIONS

Anaerobe infections C. difficileH. pyloriBacterial vaginosisTrichomonas vaginitisAmebiasisGiardiasis

SIDE EFFECTS OF METRONIDAZOLEepigastric distressSeisuresMetallic tasteDarkening of urinePeripheral neuropathyPancreatitisHepatitisFeverReversible neutropenia

DRUG INTERACTIONS

DRUG INTERACTION

ALCOHOL Mild disulfiram like reaction (Nausea, headache, vomiting, abdominal cramps)

ANTICOAGULANTS (WARFARIN) Prolonged PT(Prothrombin time)

CIMETIDINE Prolong half life & decrease clearance of Metronidazole

PHENYTOIN & PHENOBARBITONE Decrease serum concentration and increase metabolism of Metronidazole

WHAT HAPPENS IF ONE MISSES THE DOSE The decision of drug dose is a practical issue after many complicated trials both in-vitro and in-vivo Missing a dose in any cause of treatment will disturb the optimal therapeutic concentration which in turn may compromise treatment, and hence impair healing.

WHAT IF ACCIDENTALY THE FIRST TRIMESTER PREGNANT MOTHER HAS TAKEN METRONIDAZOLE The ideal practice is to prevent any incidence of taking Metronidazole by a lactating and the pregnant women, especially during the first trimester, however it might happen accidentaly. The following measures should be taken: Advice the patient to stop taking the next dose and immediately meet her doctor Based on the assumption that the doctor/prescriber doesn’t remember what should be done: Advice the doctor since there is no specific antidote for metronidazole, the patient should be treated

symptomatically accompanied by supportive treatment

IMPORTANT THINGS TO REMEMBER BEFORE DISPENSING METRONIDAZOLE Any woman in child bearing age should be asked

if she is pregnant

Any old man should be asked about history of chronic illness, especially hepatic and renal diseases.

Social history must inquire alcohol consumption of the patient

Patient should be asked about other medications he/she is taking as well as other important questions like allergies and intolerances