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7.2. Assessment of competence - legal competence.

7.2.1. Activities in the field of sanitary and epidemiological  RK (Chapter 24, Code of the Republic of Kazakhstan "Nation health and system Health ", 2009).

 7.2.2. The legislative framework for the protection of the environment (Environmental Code Republic of Kazakhstan, 2007)

Lesson 19

  1. Theme: Fundamentals of Pharmacogenetics

  1. Object: Form students’ knowledge of the individual character of medicines action depending on peculiarities or patient’s genetic constitution (genotype)

  1. Educational Tasks:

  • familiarize the students with the concepts of pharmacological genetics, genetic control of medicine’s metabolism;

  • explain the essence of pharmacogenetics as the science studying the role of genes (genotypes) in formation of response of the patient’s organism to introduction of a medicine and efficiency of its action;

  • explain the mechanisms of genetic control of different stages of medicine’s metabolism in the patient’s organisms (by example of treatment of patients with tuberculosis with Isoniazid;

  • demonstrate the role of genetic factors and formation of organism’s response to intake of medicinal preparations by example of some blood system hereditary diseases (methemoglobinemia, hemolytic anemia), liver (porphyria), etc.;

  • teach students to use the knowledge received in their practical activity, namely, prescribe medicaments with taking into account of the patient’s genotype;

  • familiarize students with the legal requirements to safety of medicinal preparations.

  1. Principal Questions of the Theme:

    1. Significance of pharmacogenetics in modern medicine and pharmacy

    2. Genetic control of metabolism of medicinal preparations

    3. Hereditary diseases and states provoked by intake of medicinal preparations

    4. New possibilities of personalization of use of medicines in practice

  1. Methods of Teaching: combined method of education (conversation, solution of situation problems)

  1. Literature:

Basic:

    1. Bochkov N.P. Clinical Genetics. M., 2006, pp. 309-322.

    2. Bochkov N.P. Pharmacogenetics in Paediatrics. Paediatrics. No 3, 2004, pp. 4-7.

    3. Ginter Y.K. Medical Genetics, M., 2003, pp. 340-348.

    4. Chshipkov V.P., Krivosheina G.N. General and Medical Genetics. M., 2003, pp. 211-216.

Additional:

6.1. Gavrilova S.I. Pharmacogenetic Approaches to Therapy of Alzheimer’s disease. Bulletin of the RAMS, № 9-10. 2006, pp. 30-33.

6.2. Lilin Y.T. et al. Genetics for Physicians. M., 1999, pp. 176-193.

6.3. Lyakhovich V.V. et al. Pharmacogenetics and Modern Medicine.Bulletin of the RAMS, № 10.2004, pp. 40-45.

6.4. Fogel F., Motulski A. Human Genetics.V 2, M.,1990, pp. 108-115.

Molecular Biology of the Cell.V.1. M., 1994, pp.3-15.

  1. Control:

    1. Evaluation of competence – knowledge

      1. Interrogation on questions of the theme

      1. Test control – 2 variants, 10 questions each

      2. Filling in the table Individual Sensitivity of the Human Organism to Action of Medicines in Case of Genetic Impairments.

Pos.

Character of pharmacologic action of medicines in case of genetic impairments

Impairment of ferment systems

Type of inheritance

1

Ditilin (for muscle relaxation) - respiratory arrest for 1 hour and more

2

Solution of oxygen peroxide for wound treatment is not efficient

3

Primaquine – hemolysis of erythrocytes

4

Absence of the bitter taste of phenylthiocarbamide

5

Isoniazid

      1. Filling in the table Response of the Organism for Medicinal Preparations

Response of the organisms for medicinal preparations

Medicinal preparation

Ferment insufficiency

Description

Increased sensitivity

Tolerance

Paradoxality

      1. Solution of situation problems:

Match ferment impairments related to the following clinic situations:

  1. Occurrence of hemolytic anemia after intake of Primaquine;

  2. Long-term respiration arrest after intake of Ditilin;

  3. A patient with lung tuberculosis has toxic reactions from use of Isoniazid

  4. About 40% of Europeans do not fill bitter taste of phenylthiocarbamide

1 – anomalousacetyltransferase

2 – catalase deficit

3 – deficit of glucose-6-phasphatedehydrogenase

4 – anomalous pseudo cholinesterase

5 –tyrosinase deficit

      1. Acatalasemia was discovered by otolaryngologist Takagara by accident during treatment with hydrogen peroxide of mucous membranes of the nasopharynx and mouth of a Japanese girl. During irrigation of the mucous membraneswith hydrogen peroxide, the blood turned brown. Later it was established that in case of acatalasemia ferment catalase is absent in blood of patients. Explain, why treatment of the wound with hydrogen peroxide is not efficient, i.e. action of the preparation is not seen, and what genotype the girl has.

      2. In surgery for muscle relaxation, preparation Ditilin is used. Normally it arrests respiration (apnoea) for 2-3 minutes. In some patients after injection of Ditilin apnoea lasts for 1 hour and more. Such patients can be saved only with artificial lung ventilation for this time. Explain, deficit of what ferment and what type of inheritance of sensitivity to Ditilin cause such atypical reaction.