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Note: During the second and third trimesters of pregnancy Artemether-Lumefantrine is the drug of choice for treatment of uncomplicated malaria First trimester: During the first trimester of pregnancy, treat with quinine plus clindamycin for seven days or quinine alone if clindamycin is not available or unaffordable. Uterine contractions and foetal distress with the use of quinine may be attributable to fever and effects of malaria disease. At present, artemisinin derivatives cannot be recommended in the first trimester of pregnancy. However, they should not be withheld if treatment is considered life saving for the mother, and other suitable antimalarials are not available. The management of severe malaria in pregnant women does not differ from the management of severe malaria in other adult patients, except pregnant women in the first trimester. The risk of quinine induced hypoglycaemia is greater in pregnant than non-pregnant women. It is given intradermally on the right upper arm, above the insertion of the deltoid muscle. Sputum cannot often be obtained from children and in any case it is often negative even on culture. Women using contraceptive should be adviced to use pills with higher dose of oestrogen 50mcg or change to another method P a g e 2.

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Modafinil is an oral drug that is prescribed to counteract sleepiness in people especially those that work long hours into the night. The drug is also used to alleviate fatigue and general lethargy. Modafinil stimulates the brain and gives it more energy making people that take it to be more alert and focus more. The drug is often used for people that have excessive sleepiness to improve wakefulness. Modafinil is very effective in treating excessive sleepiness mainly associated with shift work disorder, obstructive sleep apnea, and narcolepsy. Modafinil should not be self-medicated; use it as recommended by your doctor.

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Treatment of osteoarthritis is with NSAIDs for their analgesic and anti-inflammatory effects. Corticosteroids are not recommended and disease-modifying drugs are not effective in osteoarthritis. Pagets disease is a disorder of bone turnover of unknown aetiology producing characteristic bone deformities. The disease is rarely seen before the age of approximately that is often without symptoms and progresses slowly over many years, being discovered during other investigations in approximately one-fifth of those diagnosed. In Pagets disease, osteoclasts, the cells that digest bone during the normal bone remodelling process, become hyperactive and osteoblasts, the cells that form new bone are unable to replace bone at the same rate. Instead affected bones develop fibrous tissue and become enlarged, which may cause pressure on nerves and result in bone pain and neurological complications.

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