МЕТHODOLOGICAL INSTRUCTION
FOR THE V-th YEAR STUDENTS
foreign students faculty
LESSON № 2 (6 hours)
Theme 2: Main princips of prescription of the immune medicine. Immunorheabilitation, immunoprophilaxis. Vaccination. Immune inflammation and infectious disease: immune-diagnostic, prognosis of the disease. The role of the immune system in recurrent infectious process and manifestation of opportunistic infections.
Aim: to form the detail picture of the clinical pharmacology of immunomodulative drugs and vaccines, indications and contraindications for its clinical application.
Professional motivation: immunomodulative drugs are one of the most frequently used medicines. So, understanding of the clinical pharmacology of immunomodulative drugs and vaccines, indications and contraindications for its clinical application is necessary for all practitioners.
Methodology of Practical Class
Introduction by the teacher, control the initial level of knowledge – 09.00-09.30
Individual students’ work with patients – 09.30-12.00
Break – 12.00-12.30
Seminar (discussion of theoretical questions, practical work with patients) – 12.30-14.00
Break – 14.00-14.15
Individual work 1415-1500 (students who didn`t pass the tests in Moodle system, complete the individual work).
Algorithm of students’ communication with patients with pathology in subject (communication skills):
During examination of the patient students have to use such communicative algorithm:
Complaints and anamnesis taking in patients
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Take complaints and anamnesis in a patient.
5. Explain to the patient results of his/her lab tests correctly and accessibly.
6. Explain to the patient your actions concerning him/her (the necessity of hospitalization, certain examinations and manipulations), which are planned in future.
7. Conversation accomplishment.
Objective examination:
Physical methods of examination of patients with internal diseases
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Explain to a patient, what examinations will be carried out and get his/her informed consent.
5. Find a contact with the patient and make an attempt to gain his/her trust.
6. Inform about the possibility of appearing of unpleasant feelings during the examination.
7. Prepare for the examination (clean warm hands, cut nails, warm phonendoscope, etc.).
8. Examination (demonstration of clinical skill).
9. Explain to the patient results of his/her lab tests correctly and accessibly.
10. Conversation accomplishment.
Estimation of laboratory and instrumental investigations
Informing about the results of examination of patients with internal diseases
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Explain to a patient results of his/her lab tests correctly and clearly.
5. Involve the patient into the conversation (compare present examination results with previous ones, clarify whether your explanations are clearly understood).
Planning and prognosis the results of the conservative treatment
Friendly facial expression and smile.
1. Gentle tone of speech.
2. Greeting and introducing.
3. Correct and clear explanation of necessary treatment directions.
4. Discuss with a patient the peculiarities of taking medicines, duration of their usage, possible side effects; find out whether your explanations are clear for him/her or not.
5. Conversation accomplishment.
WORK 1: Curation of the thematic patient. Indications and contraindications to the immunomodulative medicines.
WORK 2: Curation of the patient recurrent infectious process and manifestation of opportunistic infections.
WORK 3: To learn calendar of vaccination.
Individual Students Program
1. Terms of immunopharmacology.
2. Clinical pharmacology of vaccines, indications, contraindications.
3. Clinical pharmacology of immune globulins, indications, contraindications.
4. Clinical pharmacology of immunostimulators, indications, contraindications.
5. Clinical pharmacology of immunosuppressors, indications, contraindications.
6. Immunomodulation and immunoprophylaxis in immunocompromised host.
7. Immunomodulation in case of therapeutical pathology.
8. Immunomodulation in case of surgical pathology.
9. Immunomodulation and immunoprophylaxis in obstetrics.
10. Pulse-therapy.
11. Vaccination
Seminar discussion of theoretical issues:
1. Imunomodulative medicines.
2. Classification, mechanism of action, side effects action.
3. The principles of clinical application imunotropnyh preparations, indications and contraindications for the purpose,
4. Selection doses immunological monitoring therapeutic effectiveness.
5. Basic principles imunoprofilaxis bacterial and viral infections.
6. The main types of immunorehabilitation.Immune inflammation and infectious disease: immune-diagnostic, prognosis of the disease.
7. The role of the immune system in recurrent infectious process and manifestation of opportunistic infections.
8. Mechanisms of defense against bacterial and viral infections.
9. The role of the immune system in antifungal immunity and protection against helminths.
10. The value of the immune system in the development and opportunistic protozoan infections
11. . Immunological methods in the diagnosis of infectious diseases.
12. Immune response in acute inflammatory process.
13. Types and characteristics of specific immunoprophylaxis of infectious diseases.
14. Immunodependent reactions and complications of vaccination.
Test evaluation and situational tasks:
A. corticosteroids
B. corticosteroids and an alkylating agent
C. monthly intravenous immunoglobulin
D. splenectomy
E. bone marrow transplantation
2. Each of the following would be an acceptable initial therapeutic regimen for an HIV-infected patient EXCEPT
A. zidovudine/didanosine
B. zidovudine monotherapy
C. didanosine monotherapy
D. zidovudine/zalcitabine
E. zidovudine/lamivudine
3. All the medicines could be useful in case of SLE except:
A. prednisone
B. betametasone
C. indometacin
D. heparin
E. epinephrine
4. The medical therapy for Crohn’s disease can be described by all the following statements EXCEPT
A. Metronidazole is useful if the perineal area is involved
B. Azathioprine may reduce steroid requirements
C. The frequency of recurrence is not altered by prophylactic therapy with steroids
D. The frequency of recurrence is not altered by prophylactic therapy with sulfasalazine
E. Sulfasalazine is contraindicated in the treatment of pregnant women who have Crohn’s disease
5. An 18-year-old man is evaluated because of severe diarrhea and cramping abdominal pain of 3 months’ duration. Colonoscopy shows ulcerative colitis with moderate inflammatory changes from the rectum to the mid-transverse colon. Biopsy specimens show moderate chronic inflammation. Which of the following will provide the optimal therapeutic regimen for this patient?
A. Oral prednisone followed by maintenance with oral sulfasalazine
B. Oral prednisone followed by maintenance with oral low-dose prednisone every other day
C. Oral prednisone followed by maintenance with oral budesonide
D. Intravenous cyclosporine followed by maintenance with oral 6-mercaptopurine
E. Intravenous cyclosporine followed by maintenance with oral sulfasalazine.
6. Which of the following is/are recommended before initiating anti-TNF-α treatment?
A. PPD skin test
B. Pregnancy test
C. Evaluation of signs of infection
D. Evaluation for history of canser
E. All of above
tonsillitis 2 weeks ago. He is in a bad state. The skin is pale. Heart borders are widened, the tones are weakened. Above all heart area you can hear pericardium friction sound. Electrocardiogramm: the descent of voltage QRS, the inversion T. The liver is 3 sm enlarged. ESR – 4mm/h, ASL – 0 – 1260, C-reaction protein +++.Your diagnosis:
A. Rheumatic pancarditis
B. Rheumatic pericarditis
C. Rheumatic myocarditis
D. Rheumatic endocarditis
E. Septic endocarditis
A. Nonsteroidal anti-inflammatory drugs
B. Cephalosporines
C. Tetracyclines
D. Sulfonamides
E. Fluorchinolones
corticosteroid therapy is evaluated in a routine office follow-up visit. She smokes a pack of cigarettes daily. Her blood pressure is 140/90 mm Hg. There are no abnormalities on cardiac or pulmonary auscultation, no carotid bruits or friction rubs, and no chest wall tenderness. Previous laboratory tests have not shown antiphospholipid antibodies. Her total serum cholesterol concentration is 250 mg/dL (hypercholesterolemia). Which of the following is the best next step in the management of this patient?
A. Measurement of serum thyroid-stimulating hormone
B. Measurement of serum creatinine
C. Measurement of fasting plasma glucose and serum lipids
D. Esophageal manometry
E. High-resolution CT scan of the chest
She is currently taking 17.5 mg/week, along with enteric-coated aspirin, 3 g/d. This regimen has
alleviated her joint pain; her morning stiffness is limited to 35 minutes, as opposed to the previous
duration of 2 hours. On examination the nodules are not warm, and her joints appear much improved. No other physical abnormalities are found. Which of the following is the most appropriate next step in this patient’s management?
A. Biopsy a newly developed nodule.
B. Reassure the patient that these nodules occur occasionally with methotrexate therapy.
C. Initiate antituberculosis therapy.
D. Measure fasting serum lipids, including triglycerides.
E. Measure serum uric acid
Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions (the instructor has tests & situational tasks)
Students should know:
1. Target cells and molecules for immunomodulative drugs
2. Pharmacology of immunosuppressive and immunostimulative drugs
3. Immunomodulation and immunoprophylaxis in pediatrics, surgical pathology, therapeutical pathology.
4. Immunomodulation and immunoprophylaxis in immunocompromised host.
5. Calendar of vaccination.
Students should be able to:
1. To assess main immunopathologic syndrome.
2. To find out indications, contraindications to immunomodulative medicines.
3. To prescribe correct immunomodulative medicines.
4. To deal with calendar of vaccination and patient.
Correct answers of test evaluations and situational tasks:
References.
А – Basic:
1. Stephen Holgate. Martin Church. David Broide Fernando
2. Mark Peakman. Diego Vergani. Basic and Clinical Immunology with STUDENT. – Imprint: Churchill Livingstone Published: – April 2009.
3. Roderick Nairn, Matthew Helbert. Immunology for medical students / Hardboun – 2012 –326 p.
4. Web -sites:
a) http://intranet.tdmu.edu.ua : Main princips of prescription of the immune medicine
b) http://emedicine.medscape.com/
B – Additional:
1. Linda Cox. Allergen Immunotherapy, An Issue of Immunology and Allergy Clinics.- / Published: May 2011.- Hardbound, – 312 p.
2. Dédée Murrell. Autoimmune Diseases of the Skin, An Issue of Immunology and Allergy Clinics. – Imprint: Saunders.- Published: May 2012.
Methodical instruction has been worked out by assoc. prof. Volodymyr Horodetskyy
Methodical instruction was discussed and adopted at the Department sitting: “